FINAL 2 Flashcards
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
During physical exam which two tests below would you expect to be positive?
Empty can and painful arc
Hawkin-Kennedy
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
Based on the presentation, it’s more likely that the patient has which two
Shoulder impingement syndrome
Supraspinatus tendinitis/tendinosis
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
If you were to take x-ray studies of this patient’s cervical spine and shoulders, you would likely see
Evidence of humeral head elevation
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
To manage this patient the best course of action would be to
Prescribe exercises to rehab the rotator cuff and scapular stabilizers
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
Based on the presentation, your clinical impression is leaning towards
Panner’s disease
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
To further assess this patient radiographically your best study would be to
Shoot a radial-head capitellum view
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
Management of this presentation would include
Rest and splint the elbow for 3 weeks initially
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
The most likely sequelae of this type of presentation if left untrated is
Avascular necrosis and deformity of the capitellum
A 23 yo male pt presents with a dull ache in the wrist made worse by pronating the hand and ulnar deviating the wrist. They claim that they fell on an outstretched hand about 2 months ago. Forced dorsiflexion of the wrist aggravates the condition as does resisted pronation. They point to the area of the anatomical snuffbox.
The most likely clinical impression in this case is
Scaphoid fracture
A 23 yo male pt presents with a dull ache in the wrist made worse by pronating the hand and ulnar deviating the wrist. They claim that they fell on an outstretched hand about 2 months ago. Forced dorsiflexion of the wrist aggravates the condition as does resisted pronation. They point to the area of the anatomical snuffbox.
On follow up x-ray, you would look for evidence of
Proximal pole fracture
A 23 yo male pt presents with a dull ache in the wrist made worse by pronating the hand and ulnar deviating the wrist. They claim that they fell on an outstretched hand about 2 months ago. Forced dorsiflexion of the wrist aggravates the condition as does resisted pronation. They point to the area of the anatomical snuffbox.
A possible potential sequelae is
Preiser’s disease
A 45 yo female patient presents with well localized left lateral hip pain and a mild limp. She claims symptoms have worsened since she has been jogging in preparation for a half marathon. She claims that pain occasionally radiates to the low back, lateral thigh and knee. She is having trouble sleeping on that side. Internal rotation is restricted.
The most likely clinical impression is
Subtrochanteric bursitis
A 45 yo female patient presents with well localized left lateral hip pain and a mild limp. She claims symptoms have worsened since she has been jogging in preparation for a half marathon. She claims that pain occasionally radiates to the low back, lateral thigh and knee. She is having trouble sleeping on that side. Internal rotation is restricted.
Which physical assessments/diagnostic tests would be beneficial in confirming your suspected clinical impression
Ober test
A 45 yo female patient presents with well localized left lateral hip pain and a mild limp. She claims symptoms have worsened since she has been jogging in preparation for a half marathon. She claims that pain occasionally radiates to the low back, lateral thigh and knee. She is having trouble sleeping on that side. Internal rotation is restricted.
To manage this patient you would exclude
Refer to a neurological specialist for a consultation immediately
Rigorous side posture adjustments to the lumbopelvic region
A 27 yo man presents with sudden onset of right knee pain that began 2 weeks ago when he felt his knee twist while descending stairs. He reported a sense of painful giving way and since then has experienced feelings of sharp pain and catching on the antero-medial joint line. The pain is increased with activities involving bending of the knee with decreased active flexion noted. Swelling increases at the joint line by the end of the day and he has difficulty bending his knee to 90. He also states that the knee is stiff upon arising in the morning.
Which ortho test would be beneficial
McMurray
A 27 yo man presents with sudden onset of right knee pain that began 2 weeks ago when he felt his knee twist while descending stairs. He reported a sense of painful giving way and since then has experienced feelings of sharp pain and catching on the antero-medial joint line. The pain is increased with activities involving bending of the knee with decreased active flexion noted. Swelling increases at the joint line by the end of the day and he has difficulty bending his knee to 90. He also states that the knee is stiff upon arising in the morning.
Which is most likely clinical impression
Meniscus injury
A 27 yo man presents with sudden onset of right knee pain that began 2 weeks ago when he felt his knee twist while descending stairs. He reported a sense of painful giving way and since then has experienced feelings of sharp pain and catching on the antero-medial joint line. The pain is increased with activities involving bending of the knee with decreased active flexion noted. Swelling increases at the joint line by the end of the day and he has difficulty bending his knee to 90. He also states that the knee is stiff upon arising in the morning.
Which managment avenues would you pursue with this patient
Obtain x-rays of the knee based on the ottawa knee rules
Recommend crutches and co-managee with an orthopedist
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
If foot and first toe dorsiflexion elicited plantar foot pain the clinical impression would most likely be
Plantar fascitis
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
If passively flexing the second through fifth metatarsals elicited pain the clinical impression would most likely be
Metatarsalgia
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
If application of a 128 Hz tuning fork elicited pain at the second metatarsal the clinical impression would most likely be
Stress fracture
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
Managing this patient would exclue
Foot cast, crutches for 6 weeks, and calcium supplements
A 24 yo soccer player presents with left sided medial shin pain that worsens during soccer practice. He complains of a mild cramping sensation down the medial aspect of the lower leg that feels tight and is tender to the touch. He complains of an intermittent pins and needles sensation that will travel down into his arch followed by a mild burning and aching sensation into his big toe on the bottom of the foot. He relates taht sometimes he feels like he loses muscle control of his lower leg and it feels weak. He claims he’s had shin splints before and that this feels very different. There are no reports of LBP. The posterior border of the shin palpates as tense and the skin appears shiny.
The most likely clinical impression is
Deep posterior compartment syndrome
A 24 yo soccer player presents with left sided medial shin pain that worsens during soccer practice. He complains of a mild cramping sensation down the medial aspect of the lower leg that feels tight and is tender to the touch. He complains of an intermittent pins and needles sensation that will travel down into his arch followed by a mild burning and aching sensation into his big toe on the bottom of the foot. He relates taht sometimes he feels like he loses muscle control of his lower leg and it feels weak. He claims he’s had shin splints before and that this feels very different. There are no reports of LBP. The posterior border of the shin palpates as tense and the skin appears shiny.
A possible sequelae to this presentation is
Loss of tibialis posterior pulse
A 24 yo soccer player presents with left sided medial shin pain that worsens during soccer practice. He complains of a mild cramping sensation down the medial aspect of the lower leg that feels tight and is tender to the touch. He complains of an intermittent pins and needles sensation that will travel down into his arch followed by a mild burning and aching sensation into his big toe on the bottom of the foot. He relates taht sometimes he feels like he loses muscle control of his lower leg and it feels weak. He claims he’s had shin splints before and that this feels very different. There are no reports of LBP. The posterior border of the shin palpates as tense and the skin appears shiny.
To manage this patient, you would avoid what two
Strapping the shin with a tnesor bandage
Rest, ice, elevation and compression
