Ch 41: Sports Medicine and Outpatient Orthopedics

Question 1

There is a high mortality rate among older adult patients following hip fracture, with death occurring in __-__% within 30 days and in approximately __-__% within 1 year.

Answer 1

8 – 9%

25–30

Question 2

Surgery for hip fracture is recommended within the _____ __ hours because studies have shown that delaying surgery 48 hours results in at least _____ the rate of major and minor medical complications, including pneumonia, pressure injuries (formerly pressure ulcers), and deep venous thrombosis.

Answer 2

first 24 hours

twice

Question 3

Cartilage loss and OA symptoms are preceded by damage to the _____-_____ _____.

Answer 3

collagen-proteoglycan matrix

Question 4

In a large cohort, running significantly reduced OA and hip replacement risk possibly since running is associated with _____ ___.

Answer 4

lower BMI

Question 5

The knee is stabilized by the collateral ligaments against varus (_____ _____ ligament) and valgus (_____ _____ ligament) stresses.

Answer 5

lateral collateral

medial collateral

Question 6

The prepatellar bursae is located…

Answer 6

…between the skin and patella.

Question 7

The pes anserine bursa is located…

Answer 7

…medial and inferior to the patella, just below the tibial plateau.

Question 8

Acute swelling of the knee within minutes to hours suggests a ______, most likely due to an ___ ______, _____, or patellar dislocation, especially if trauma is involved.

Answer 8

hemarthrosis

ACL injury, fracture

Question 9

Describe the anterior drawer test.

Answer 9

Performed with the patient lying supine and the knee flexed to 90 degrees. The clinician stabilizes the patient’s foot by sitting on it and grasps the proximal tibia with both hands around the calf and pulls anteriorly. A positive test finds anterior cruciate ligament laxity compared with the unaffected side.

Question 10

Describe the McMurray test.

Answer 10

Performed with the patient lying supine. The clinician flexes the knee until the patient reports pain. For this test to be valid, it must be flexed pain-free beyond 90 degrees. The clinician externally rotates the patient’s foot and then extends the knee while palpating the medial knee for “click” in the medial compartment of the knee or pain reproducing pain from a meniscus injury. To test the lateral meniscus, the same maneuver is repeated while rotating the foot internally (53% sensitivity and 59–97% specificity).

[Remember Mc - click - meniscus]

Question 11

Describe the pivot shift test.

Answer 11

Used to determine the amount of rotational laxity of the knee. The patient is examined while lying supine with the knee in full extension. It is then slowly flexed while applying internal rotation and a valgus stress. The clinician feels for a subluxation at 20–40 degrees of knee flexion. The patient must remain very relaxed to have a positive test.