Diagnoses

Question 1

Olecranon Bursitis

Answer 1

the olecranon bursa lies superficial tot he posterior elbow joint. Posterior elbow distention and discomfort due to overuse/occupation/athletic injury. Region is often painless and ROM is normal

Question 2

“Little League Elbow”

Answer 2

Pain over the medial epicondyle, initially after throwing, progresses to persistent pain.
Most common elbow injury during childhood
As bone develops, most common injury seen evolves:
childhood- medial apophysitis
adolescence- medial epicondyle avulsion fracture
young adulthood- medial collateral ligament tea

Question 3

Radial head instability/ “Nursemaid’s elbow”

Answer 3

Annular ligament and/or radial head subluxation from annular ligament. Often result from trauma with traction of Child’s extended arm
Pain with palpation of radial head with anterior displacement of radial head and restriction to posterior glide

Question 4

Carpal Tunnel Syndrome

Answer 4

Entrapment of median nerve at the wrist in carpal tunnel produces pain and parathesia. Chronic cases may develop atrophy of intrinsic muscles of the hand. Obtain history about any repetitive movements, pregnancy, connective tissue disorder, etc.
Patient will have grip weakness and weakness with thumb abduction

Question 5

DeQuervain’s Tensynovitis

Answer 5

Pain/inflammation from repetitive overuse of tendons in first dorsal compartment. Patients complain of dorsolateral wrist and thumb pain occasionally with radiation into lateral hand and thumb. Patients will also have grip weakness. Pain may be worsened with thumb movements.

Question 6

Ulnar Nerve Entrapment “Handlebar Palsy”

Answer 6

Ulnar nerve gets entrapped in Guyon’s canal

Irritation leads to numbness, tingling, weakness and/or pain in the ulnar nerve distribution

Question 7

Gamekeeper’s thumb/ Skier’s Thumb

Answer 7

Tear of ulnar collateral ligament at MCP

Pain on medial aspect of MCP

Question 8

Mallet Finger

Answer 8

Extension tendon injury at DIP

Question 9

Trigger Finger

Answer 9

Inflammation and narrowing of flexor tendon sheath

Question 10

Jersey Finger

Answer 10

Avulsion of flexor digitorum profundus from fingertip

Question 11

Dupuytren’s Contracture

Answer 11

Abnormal connective tissue thickening in the palmar fascia

Question 12

Ganglion Cyst

Answer 12

Cause: unknown, irritation
Fluid filled sac along tendon sheath or joint capsules mobile, transilluminates, nontender (painless)
Commonly found on dorsum of wrist
more prominent with wrist flexion 
most resolve spontaneously 
AKA bible cyst

Question 13

Rheumatoid Arthritis

Answer 13

Autoimmune Inflammatory condition
Causes inflammation of joints, esp. in hands, wrists and knees
Inflammation in lining of the joint and tissue damage leading to chronic pain and deformity
Sx include: ulnar deviation of finger, Bouchard nodes (PIP), heberden nodes (DIP), subcutaneous nodules along the extensor surface of proximal ulnar or around the olecranon bursa

Question 14

Clubbed Fingers

Answer 14

Focal bulbous enlargement of terminal fingers
Angle between nail and proximal nail fold >180
Prolif. of CT between nail matrix and distal phalanx along with vasodilation with increased blood flow to digits
causes: unknown, associated w/ lung cancer, liver cirrhosis, cyanotic heart disease, bronchiectasis, e tc.

Question 15

Scaphoid Fracture

Answer 15

Most common carpal bone fracture
Due to falling on outstretched hand (FOOSH)
Pt complains of dull achiness deep in radial aspect, patent will also have decreased ROM, grip strength and tenderness inside the anatomical snuff box
Important to diagnosis because of avascular necrosis

Question 16

Colle’s Fracture

Answer 16

Fracture of distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand
classic “dinner fork”

Question 17

Smith Fracture

Answer 17

Same fracture as Colle’s but with ventral displacement

Question 18

Boxer’s Fracture

Answer 18

Fracture of the distal shaft of the 5th metacarpal

Question 19

Monteggia Fracture

Answer 19

Fracture at the proximal ulna

Dislocation of the radial head

Question 20

Galeazzi Fracture

Answer 20

Fracture of the distal radius

Dislocation of the ulnz

Question 21

Nightstick Fracture

Answer 21

Isolated fracture of the mid shaft/distal ulna from a direct blow

Question 22

Inversion ankle sprain

Answer 22

80-85% of all ankle sprain
Due to ankle inversion with plantar flexion
Ligaments involved:
-ATF
-Calcanofibular
- Posterior talofibular

Question 23

High Ankle Sprain

Answer 23

10% of all ankle sprains
Due to ankle eversion and rotation
Ligaments involved:
-Anterior inferior talofibular
-syndesmosis 
Pain worse w/ weight bearing

Question 24

Plantar Fasciitis

Answer 24

Inflammation at origin of plantar aponeurosis
worse w/ first steps of the day
point tenderness of calcaneus
pain with passive dorsiflexion
associated w/ tight calves, repetitive impact activities, high arches, obesity, new/changes in activity

Question 25

Morton’s Neuroma

Answer 25

Inflammation and thickening of tissue that surrounds the nerve between toes. Most common w/ 3rd and 4th toes (3rd web space)
Patient reports feeling like they are walking on a marble
Palpable in web space, replicated burning pain
can have radiation of pain/numbness of toes
Test using Mulder’s sign- clicking sensation upon palpating with one hand the third web space and other hand compressing the transverse arch together

Question 26

Turf Toe

Answer 26

Inflammation/pain at base of 1st MTP
burning pain at base of big toe
caused by hyperextension of great toe causing damage to the joint capsule
commonly linked w/ activities done on hard surface

Question 27

Achilles Tendonitis

Answer 27

Inflammation of achilles tendon
presents as a sharp heel pain and stiffness at mid-Achille tendon to insertion, pain is worse w/ strenuous exercising, better with walking
commonly associated with tight calves, sudden changes in activity, poor fitting shoes, incorrect running technique

Question 28

Diabetic Neuropathy

Answer 28

complication of diabetes
check with monofilament test
complete diabetic foot exam includes examine pulses, and checking for skin lesions

Question 29

Gout

Answer 29

buildup of monosodium rate crystals in joint space causing an inflammatory response
most commonly affects 1st metatarsalphalangeal joint but can also affect the mid-tarsal joints, ankles, knees, and/or fingers
swollen, tender, erythematous and painful joint

Question 30

Osgood-Schlatter Disease

Answer 30

Osteochondritis of tibial tubercle
caused by repetitive strain and chronic avulsion of ossification center of tibial tubercle, leading to a separation of proximal patella tendon insertion from tibial tubercle
commonly seen in children

Question 31

Ottawa Ankle Rules

Answer 31

used to exclude ankle fractures
Ankle imaging indicated if:
-bone tenderness at posterior edge of tip of the lateral or medial malleolus OR unable to bear weight/walk 4 steps

Foot imaging indicated if:
- bone tenderness at the base of 5th metatarsal or at the navicular OR unable to bear weight/walk 4 steps