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Musculoskeletal > Clinical Aspect (Sports Medicine) > Flashcards

Clinical Aspect (Sports Medicine) Flashcards

1
Q

What are the muscles of the anterior compartment of the thigh?

A

1) Pectineus
2) Iliopsoas
3) Sartorious
4) Recuts femoris
5) Vastus Lateralis
6) Vastus intermedius
7) Vastus medialis

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2
Q

What is the innervation for the anterior compartment of the thigh?

A

Femoral nerve (Posterior L2-4)

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3
Q

What is the innervation of the posterior compartment of the thigh?

A

Tibial nerve (L4-S2)

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4
Q

What are the muscles of the posterior compartment of the thigh?

A

1) Semimembranous
2) Semitendinosus
3) Biceps femoris

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5
Q

What is the function of the ACL?

A

1) To prevent hyperextension

2) To prevent anterior motion of the tibia on the femur

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6
Q

What is the function of the PCL

A

1) To prevent hyperflexion

2) To prevent posterior motion on the femur

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7
Q

Quick effusion after trauma; Positive Lachman’s test; Positive anterior drawer test; Imaging shows a Segon fracture

A

ACL tear

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8
Q

What is the result to damage of the common peroneal nerve?

A

1) Loss of dorsiflexion and most eversion

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9
Q

Deep, achy, or sharp pain with motion of the hip, tenderness over groin and lesser trochanter; positive thomas test,

A

Groin Strain

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10
Q

What are the risk factors for a stress fracture?

A

1) Low calcium nutrition
2) Female athlete who stops menstruation
3) Eating disorder
4) Osteoporosis

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11
Q

What are the tendons of the Pes tendons? What are their innervations?

A

SGT FOS

1) Sartorius, Gracilis, Semitendinosous
2) Femoral, Obturator, sciatic

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12
Q

Loss of dorsiflexion and most eversion of the knee. What ligament is most likely torn? What nerve is damaged?

A

1) LCL tear

2) Common peroneal nerve damage

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13
Q

Opening to varus stress at 30 degrees flexion; hit lateral and below the knee

A

LCL tear

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14
Q

Opening to valgus stress at 30 degrees flexion

A

MCL tear

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15
Q

How do you treat a patella dislocation:

A

Extend the knee and push patella over medial

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16
Q

Pt. has a hip that is severely painful and is short, adducted, and internally rotated

A

Posterior Hip Dislocation

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17
Q

Pt. has a hip that is severely painful and is flexed, abducted, and externally rotated

A

Anterior Hip Dislocation

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18
Q

What is the treatment of a hip dislocation?

A

1) Emergent reduction with sedation or anesthesia

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19
Q

What is synovitis on physical exam indicate?

A

1) Inflammatory arthritides

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20
Q

Sudden onset of joint pain in seconds or minutes

A

1) Fracture
2) Internal derangement
3) Trauma
4) Loose body

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21
Q

Onset of joint pain over several hours or days

A

1) Infection
2) Crystal deposition
3) Inflammatory arthritic conditions

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22
Q

Joint pain associated with intravenous drug use or immunosuppression; fever

A

Septic arthritis

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23
Q

Urethritis, conjunctivitis, diarrhea, and rash

A

Reiter syndrome

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24
Q

Eye inflammation and low back pain

A

Ankylosing spondylitis

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25
Q

Hilar adenopathy and erythema nodosum

A

Sarcoidosis

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26
Q

What is the sensitivity and specificity of the ANA test?

A

ANA has:

1) high sensitivity (good for ruling out)
2) Low specificity (not good for ruling things in)

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27
Q

What is a Segon Fracture?

A

1) small avulsion frx of proximal part of the tibia that is seen just proximal to fibular head
2) Pathognomonic for ACL tear

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28
Q

What is a Pellegrini Stieda Lesion?

A

1) Calcification of the medial femoral condyle

2) Pathognomonic for MCL tear

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29
Q

What is the general treatment for an MCL tear?

A

1) Hinge Knee brace with early ROM

2) PT for quad strength

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30
Q

Knee pain that can occur acutely or chronically; Positive joint line tenderness, McMurray, Apley, Thessally

A

Meniscal tear

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31
Q

Knee pain found in pt younger than 40; can’t extend knee; high riding patella

A

Patellar Tendon Rupture

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32
Q

Knee pain found in pt. older than 40; can’t extend knee; low riding patella

A

Quadriceps tendon rupture

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33
Q

Knee pain with acute hemarthrosis; valgus force and external rotation of tibia and knee flexion; most common in females

A

Patella dislocation

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34
Q

Fracture of the patella found in 8-12 year old; child equivalent of patellar tendon rupture; extensor lag

A

Patella Sleeve Fracture

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35
Q

What is the first step in tx. for a pt. with a patellar sleeve fracture?

A

1) Immediate referral to ortho

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36
Q

What is the most sensitive AND specific diagnostic imaging test in confirming an ACL tear and evaluating for concomitant injuries of the knee?

A

MRI

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37
Q

What is required before ACL reconstructive surgery?

A

1) Improve ROM of the knee

2) Quadriceps strengthening

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38
Q

What is the best test for indicating a meniscal tear?

A

Positive Joint Line Tenderness test

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39
Q

Synchondrosis; failure to complete fusion of the patella in childhood; not a fracture

A

Bipartite patella

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40
Q

Aching thigh or knee pain/hip pain; common in obese children (11-13 yo); loss of abduction and internal rotation

A

Slipped Capital Femoral Epiphysis (SCFE)

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41
Q

self limiting hip disorder caused by a varying degree of ischemia and subsequent necrosis of the femoral head; found in children 4-10 years old

A

Legg-Calve-Perthes Disease

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42
Q

Monoarticular arthritis in a young person

A

Neisseria gonorrhea infx until proven otherwise

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43
Q

Reduced active range with preserved passive

A

Soft tissue disoder

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44
Q

Reduced active and passive ROM

A

Joint problem

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45
Q

What are the ligaments that make up the lateral aspect of the ankle? (Lateral collateral ligament)

A

1) Anterior talofibular
2) Calcanofibular
3) Posterior talofibular

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46
Q

What are the ligaments that make up the medial aspect of the ankle? (Medial deltoid ligament)

A

1) Posterior tibiotalar
2) Tibiocalcanean
3) Tibionavicular
4) Anterior tibiotalar

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47
Q

Test used to check the anterior talofibular ligament

A

Anterior Drawer test

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48
Q

Test used to check the calcaneofibular ligament

A

Talar Tilt

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49
Q

What are the different fractures found at the base of the 5th metatarsal?

A

1) Avulsion of tuberosity
2) Jones fracture
3) Proximal diaphysis

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50
Q

Where does a Jones fracture occur? What joint does it go into? Why does this have to be caught?

A

1) Occurs at the junction of the metaphysis and diaphysis in the 5th metatarsal
2) Enters into the 4th-5th intermetatarsal joint
3) It has to be caught because this area has poor blood supply and can result in a nonunion of the bones

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51
Q

What is the treatment for a fracture of a maleoli (ankle fracture)?

A

1) Nonoperative for lateral maleoli break

2) Only operative if there are bi or tri-maleoli breaks

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52
Q

What is the treatment for a proximal diaphysis fracture? Avulsion of the tuberosity? Jones fracture?

A

1) Hard sole shoe
2) Hard sole shoe
3) Non-weight bearing cast for 6-8 weeks or surgery

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53
Q

How does an achilles rupture occur?

A

1) Forced dorsiflexion while gastrocnemius is contracting

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54
Q

How do you do a thompson test?

A

1) Pt. lays prone with knee bent at 90
2) Doctor squeezes calf
3) Look for plantar flexion

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55
Q

What are the motions required for supination of the ankle/foot?

A

1) Inversion
2) Plantar flexion
3) Adduction

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56
Q

What are the motions required for pronation of the ankle/foot?

A

1) eversion
2) Dorsal flexion
3) Abduction

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57
Q

History of pop with immediate diffuse swelling of the ankle and inability to walk?

A

1) Grade III sprain until proven otherwise

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58
Q

History of pop with goose egg swelling over anterior talofibular ligament and significant limp

A

1) Grade II

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59
Q

History of no pop and minimal swelling over the ankle; able to walk

A

1) Grade I sprain

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60
Q

What are the mechanics that occur in an inversion sprain?

A

1) Posterolateral glide of the talus
2) Eversion of the calcaneous
3) External rotation and anteromedial glide of the tibia
4) Posterior fibular head
5) Internal rotation of the femur
6) Posterior innominate on ipsilateral side
7) Forward torsion of sacrum (RoR or LoL)
8) Neutral Lumbar dysfunction

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61
Q

What are the Ottwa rules for Foot/Ankle Xrays?

A

Xray if:

1) Tenderness over inferior or posterior pole of either malleolus
2) Inability to bear weight
3) Tenderness along the base of the 5th metatarsal
4) Pediatric population
5) Suspect high ankle sprain or fibular head fracture

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62
Q

Keratotic lesion over a bony prominence on lesser toes due to excess pressure on skin

A

Corn

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63
Q

Corn located on the 5th toe dorsal laterally

A

Hard corn

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64
Q

Corn found in the web

A

Soft corn

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65
Q

What are the motions of the bones in a tarsal somatic dysfunction (change in the transverse arch)?

A

1) Cuboid rotates medially
2) Navicular rotates laterally
3) 2nd cuneiform glides inferiorly

66
Q

Tenderness distal to the lateral malleolus

A

1) Think jones fracture

67
Q

What is the treatment for a ruptured achilles tendon? What is the biggest risk of most invasive treatment?

A

1) Short leg cast and plantar flexion
2) Walking boot with posterior splint
3) Surgical fixation
4) Wound healing

68
Q

What is the major risk for surgical fixation of the achilles tendon?

A

1) Major risk is wound healing

2) cutting of the sural nerve

69
Q

What are the bacteria that causes Reactive arthritis?

A

1) Enteric causes such as Salmonella, Shigella, and Yersinia

2) Genitourinary causes such as Chlamydia

70
Q

Self-limited polyarthritis that has a lacy/malar rash, affects small joints symmetrically; can cause a decrease in reticulocyte count

A

Parvovirus B19 infection

71
Q

What is the time limit for acute polyarticular joint pain?

A

1) Pain that has been present for less than 6 weeks

72
Q

Polyarticular inflammatory process that affects large joints symmetrically; associated with axial findings, iritis, tendonitis, and aortic insufficiency

A

Ankylosing spondylitis

73
Q

What is required to make a diagnosis of psoriatic arthritis?

A

1) Psoriasis must be present
2) Inflammatory process (arthritis)
3) Pain in joint (arthalgia)

74
Q

What are the three causes for a malar rash?

A

1) Parvovirus B19
2) Dermatomyositis
3) Systemic Lupus erythematosus

75
Q

Lesion that occurs due to a direct blow to the thigh, may develop myositis ossificans. What is the treatment?

A

1) Quadriceps contusion

2) Treat with elevation, flex hip and knee to take off pressure

76
Q

What should you not do with a quadricep contusion?

A

Do not do ultrasound or use heating pads because it will cause an accumulation of blood

77
Q

Injury that occurs by direct blow to the iliac crest

A

Hip pointer

78
Q

What is more common in kids? Fractures in the pelvis or ligament/tendon strains? Why?

A

1) Fractures

2) Caused by skeletally immature apophysis or growth plate where muscles attach

79
Q

Inflammation and swelling of bursae lateral to the greater trochanter of the femur; positive ober’s test

A

Trochanteric bursitis

80
Q

Tenderness over groin and lesser trochanter; positive thomas test, positive Hip scouring test

A

Groin strain

81
Q

What are the ligaments of the hip?

A

1) Iliofemoral ligament
2) Ischiofemoral ligament
3) Pubofemoral ligament

82
Q

What are the external rotators of the hip?

A

1) Pirifromis
2) Superior and inferior gemelli
3) Obturator externus and internus
4) Gluteus maximus

83
Q

What are the internal rotators of the hip?

A

1) Gluteus medius

2) Gluteus minimus

84
Q

Anterior knee pain, Poor tracking of the patella in the femoral condyles leading to inflammation;weakness of the vastus medialis; Pain when going up stairs and after prolonged sitting, pos. patella femoral grinding test

A

Patellofemoral syndrome

85
Q

What test has the pt extend the knee and contracts the quads as the physician pushes the patella caudad into the trochlear groove? What does a positive indicate?

A

1) patellar grinding test

2) patellofemoral syndrome

86
Q

Overuse syndrome resulting in tightness of the iliotibial band, presents with lateral knee pain that worsens with running, positive obers test

A

IT band syndrome

87
Q

Foot Pain with first steps out of bed that gets better as the day goes on

A

Platar fasciitis

88
Q

What is the cause of plantar fascitis?

A

1) Results from the cumulative impact loading and repetitive microtrauma to the plantar fascia

89
Q

Most common deformity of the MTP joint: medial eminence of metatarsal becomes prominent, proximal phalanx drifts into valgus

A

Hallux valgus (bunion)

90
Q

What are the muscles of the rotator cuff?

A

1) Supraspinatus
2) Infraspinatus
3) teres minor
4) Subscapularis

91
Q

What are the innervations for the rotator cuff?

1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis

A

1) Suprascapular n.
2) Suprascapular n.
3) Axiallary n.
4) Subscapular

92
Q

What are the actions for the rotator cuff muscles?

1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis

A

1) First 15 degrees of abduction
2) External rotation
3) External rotation
4) Medial rotation

93
Q

How do you tell the difference between a anterior and posterior dislocation of the glenohumeral joint?

A

1) Anterior = held in external rotation, palpable anterior mass, space under the acromion
2) Posterior = held in internal rotation, decreased, caused by seizure, fall, or electrocution; light bulb sign

94
Q

What is a Bankart lesion? What does it occur with?

A

1) Lesion that occurs when the anterior/inferior labrum and inferior glenohumeral ligament pulls off the anterior glenoid
2) Associated with anterior glenohumeral dislocations

95
Q

What is a Hill Sachs Lesion? What is it associated with?

A

1) Depression in the posterior superior head of the humerus bone
2) Associated with a anterior glenohumeral dislocation

96
Q

What are complications of a glenohumeral dislocation?

A

1) Bankart lesions
2) Hill Sachs lesion
3) Greater tuberosity fracture
4) Rotator cuff tears
5) Axillary nerve injury
6) Recurrent dislocations

97
Q

Anterior labrum and inferior glenohumeral ligmanet pulls off the anterior glenoid

A

Bankart lesion

98
Q

Compression fracture of posterolateral head of humerus

A

Hill Sachs Lesion

99
Q

What is the grade of AC joint separation for sprain of AC ligament

A

Grade I

100
Q

What is the grade of AC joint separation for a tear of the AC and sprain of the CC ligaments

A

Grade II

101
Q

What is a grade of AC joint separation for a tear of both the AC and CC ligmanets

A

Grade III

102
Q

Shoulder pain, swelling and inability to use shoulder; caused by fall onto the shoulder or outstreched

A

Proximal Humerus Fracture

103
Q

Pop-eye arm; occurs while lifting when pt. hears a pop

A

Proximal biceps tear

104
Q

Numbness and shoulder weakness that occurs unilaterally; pain free C-spine; occurs in a short duration, Normal Xray

A

Burner/Stinger

105
Q

What are the origins of the biceps? Insertion?

A

1) Short = coracoid process
2) Long = superior portion of the glenoid
3) Radius

106
Q

What is associated with a proximal bicep tear?

A

Rotator cuff tear

107
Q

Pathological condition manifesting as pain or feeling of slipping due to excessive translation of humeral head on glenoid during active motion; +Apprehension test; occurs in pt. <40

A

Shoulder Instability

108
Q

What are the two types of chronic instability? What are their characteristics

A

1) TUBS (Traumatic, Unidirectional, Bankart lesion, Surgery often required)
2) AMBRI (Atraumatic, Multidirectional, Bilateral, Rehab., Inferior capsular shift)

109
Q

Pain generalized to the lateral upper arm at the deltoid insertion that is worse with overhead activity; Positive hawkins, neer, and empty can test; occurs in adults >40

A

Impingement

110
Q

Proximal pain along the anterior humerus that occurs in adults >40, occurs due to impingement or subluxation of tendon when transverse humeral ligaments are torn

A

Biceps tendonitis

111
Q

Positive empty can, positive lift off sign, external rotation weakness

A

Rotator cuff tear

112
Q

How do you differentiate adhesive capsulitis from a rotator cuff tear?

A

1) Adhesive capsulitis will have a decreased passive ROM while rotator cuff will have a normal passive ROM

113
Q

How do you differentiate adhesive capsulitis from arthritis?

A

1) Adhesive capsulitis will have normal xrays while arthritis will have decreased joint capsule space, osteophytes, ect.

114
Q

What does a positive Spurling’s test indicate?

A

1) Cervical disc disease

115
Q

What does a positive Adson’s test indicate?

A

1) Subclavian artery compression

116
Q

Name the dermatome location of the following:

1) C5
2) C6
3) C7
4) C8
5) T1

A

1) Anterolateral arm
2) Lateral arm and thumb
3) First two digits and back of arm
4) Last two digits and medial aspect of forearm
5) Anteromedial arm

117
Q

Name the nerve root for the following reflexes:

1) Biceps reflex
2) Brachioradialis reflex
3) Triceps reflex

A

1) C5
2) C6
3) C7

118
Q

Positive Cozen’s test; strained extensor muscle tendons

A

Lateral epicondylitis

119
Q

What is the cause for an anterior radial head dysfunction? posterior radial head dysfunction?

A

1) Fall backwards

2) Fall forward

120
Q

Positive Finklestein test. What is the cause?

A

1) DeQuervain’s Tenosynovitis

2) Overuse of tendons to radially deviate the wrist

121
Q

Pain or paresthesia in distribution of the ulnar nerve from the elbow to the 4-5th digit

A

Cubital Tunnel Syndrome

122
Q

What is the purpose of the Adson test?

A

1) Check the vascular component of the upper extremity
2) Check pulse with pt seated and arm at side
3) Check pulse with pt arm abducted

123
Q

What is the most common complications after a dislocation of the shoulder in a pt >40?

A

Rotator cuff tear

124
Q

What are the views of the shoulder that you need to get with a shoulder dislocation?

A

1) AP
2) Scapula Y
3) Axillary

125
Q

10 cc of lidocaine injected into subacromial space improves symptoms that occur most often with overhead activity

A

Positive Neer’s test

126
Q

Positive Speed’s test (forward elevation in supination)

A

Bicep tendonitis

127
Q

Pain or paresthesia in distribution of the ulnar nerve? What is the treatment

A

1) Cubital Tunnel syndrome

2) Elbow pad

128
Q

Radial Head dislocation found in children when adult pulls child up by wrist with elbow extended; child holds arm across body in flexed pronated position

A

Nursemaid’s elbow

129
Q

Fragility fracture of the forearm; often can result in a pinched median nerve

A

Distal radius fracture

130
Q

What are the different types of distal radius fracture?

A

1) Colles - distal radius fracture tilts back posteriorly
2) Smith’s - distal radius fracture that tilts anteriorly
3) Barton’s - scaphoid/lunate bones ram into radius
4) Chauffer’s - radial styloid fracture

131
Q

What motion is affected most by a distal biceps rupture?

A

1) Supination- biceps brachii is the primary supinator of the forearm

132
Q

What needs to be checked with a suspected elbow dislocation?

A

1) Neurovascular compromise

133
Q

How do you treat a Nursemaid’s elbow?

A

1) Have pt. flexed and quickly supinate their forearm

134
Q

Pt. comes in with arm flexed and pronated with severe pain

A

Nursemaid’s elbow

135
Q

What do you have to check with a distal humerus fracture?

A

1) Check to see if the radial nerve is intact

2) Will be marked with loss of wrist extension

136
Q

Pain on supination/pronation; presence of a fat pad on xray at the elbow

A

Proximal Radial head fracture

137
Q

What muscles does the median nerve innervate in the hand?

A

LOAF

1) Lateral 2 lumbricals
2) Opponens policus
3) Abductor pollicus brevis
4) Flexor pollicus brevis

138
Q

How should a distal radial fracture be treated?

A

1) Nonoperative
2) Surgery if broken in many parts
3) Bisphosphonates

139
Q

Why do you give bisphosphonates to a pt. with a distal radial fracture? What other fractures require bisphosphonates?

A

1) Defined as a fragility fracture

2) Femur neck fracture and lumbar compression fracture

140
Q

Pain in radial side of wrist; pain to palpation of the anatomical snuff box; occurs with fall with an out streched hand

A

Scaphoid fracture

141
Q

What is the treatment for a scaphoid fracture?

A

1) Thumb spica

142
Q

Fracture of the 5th MCP that causes ulnar side hand pain

A

Boxer’s Fracture

143
Q

Fracture of the 1st MCP at the base

A

Bennett Fracture

144
Q

Sudden passive flexion of the DIP; due to terminal extensor tendon being pulled off DIP

A

Mallet finger

145
Q

Overuse injury of the quadriceps muscles and the patellar tendon, generalized knee pain localized to the anterior knee

A

Patellar tendonitis

146
Q

Common knee pain in children (10-15) that occurs with high level of activity or rapid growth that results in boney deposition anteriorly

A

Osgood schlatter disease

147
Q

How should a dislocation of the elbow be treated?

A

1) Splint with the pt. arm in flexion and pronated

148
Q

Damage to C5 and C6 nerve roots

A

Erb-Duchenne’s palsy

149
Q

Inability to abduct pronated and medially rotated arm

A

Erb-Duchene’s Palsy

150
Q

Damage to C8 and T1 nerve roots

A

Klumpke’s palsy

151
Q

Isolated hand paralysis and horner syndrome (ptosis, miosis, anhidrosis)

A

Klumpke’s palsy

152
Q

What nerve is damaged in the following fractures:

1) Fracture of the surgical neck of the humerus
2) Fracture of the midshaft of the humerus
3) Fracture of the supracondylar humerus
4) Fracture of the medial epicondyle of the humerus

A

1) Axillary
2) Radial
3) Median
4) Ulnar

153
Q

What are the thenar muscles? What nerve supplies them?

A

Think: big OAF

1) Opponens policis (Oppose)
2) Abductor pollicis brevis (Abduct)
3) Flexor policis brevis (flexion)

Suppied by the median n (C5-T1)

154
Q

What are the hypothenar muscles? What nerve supplies them?

A

Think: little OAF

1) Opponens digiti minimi
2) Abductor digiti minimi
3) Flexor digiti minimi

155
Q

What motion do the lumbricals provide?

A

1) Flex at MCP joint

2) Extend PIP and DIP joints

156
Q

Describe what occurs during a muscle contraction?

A

1) Post-synaptic neuron has an action potential which causes influx of Ca
2) Influx of Ca causes synapitc release of synaptic ACh vesciles
3) ACh binds to ligand receptor Na channel
4) Activation of Na channel causes hyperpolarization
5) Action potential continues into the T tubule system/sacroplasmic reticulum
6) Ca is released from sacroplasmic reticulum
7) Ca binds to tropinin C causing converfational change that moves tropomyosin out of the myosin binding groove on actin filaments
8) Myosin releases bound ADP and is displaced on the actin filament

157
Q

What changes in the the sacromere occur during contraction?

A

think: HIZ shrinkage
1) H and I bands shorten
2) Z line to Z line shrinks

158
Q

What causes the release of Myosin from actin?

A

Binding of ATP to myosin head

159
Q

What band of the sacromere has both actin and myosin?

A

think: he’s got it All
1) A band
2) Get’s bigger with contraction

160
Q

What nerve runs with the deep brachial artery?

A

Radial nerve

Musculoskeletal (5 decks)

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