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Musculoskeletal > GOLD Musculoskeletal Conditions > Flashcards

GOLD Musculoskeletal Conditions Flashcards

1
Q

Where does a rupture of the Achilles tendon typically occur?

A

1-2 inches above its tendinous insertion on the calcaneus

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2
Q

List 3 of the most common MOIs for Achilles tendon rupture.

A

Pushing off of a weightbearing extremity with an extended knee

Unexpected dorsiflexion while weightbearing

Forceful eccentric contraction of the plantarflexors

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3
Q

When is the incidence of Achilles tendon ruptures the greatest? Why?

A

In adults 30-50 years old without history of heel or calf pain

Why?: Decreased blood flow to the area of the tendon, secondary to aging, increases susceptibility to rupture

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4
Q

List 5 characteristics of the clinical presentation of an Achilles tendon rupture.

A
  1. Pop or snap associated with severe pain at time of injury
  2. Swelling over the distal tendon
  3. Palpable defect in the tendon above the calcaneal tuberosity
  4. Pain and weakness with plantarflexion
  5. Positive Thompson test
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5
Q

Describe the most effective management of a patient with an Achilles tendon rupture.

A

Immobilization through casting or surgical approach for repair or reconstruction

Non-surgical treatment includes serial casting for ~10 weeks with heel lift to take stress of the tendon

PT is initiated following removal of the cast

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6
Q

What is Achilles tendinopathy?

A

Acute or chronic condition due to repetitive microtrauma that builds scar tissue in the area over time

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7
Q

What is adhesive capsulitis?

A

Characterized by restriction of shoulder ROM due to inflammation and thickening of the shoulder capsule

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8
Q

What is the difference between primary and secondary adhesive capsulitis?

A 
Primary = occurs spontaneously 
Secondary = occurs secondary to an underlying condition (i.e. disuse following repetitive trauma)
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9
Q

Adhesive capsulitis is commonly associated with _____ and ______.

A

Diabetes

Thyroid disease

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10
Q

List 3 characteristics of the acute phase of adhesive capsulitis.

A

Pain that radiates below the elbow
Pain that awakens the patient at night
PROM limited due to pain and guarding

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11
Q

List 3 characteristics of the chronic phase of adhesive capsulitis.

A

Pain localized around the lateral brachial region
Pain does not awaken patient at night
PROM is limited due to capsular stiffness

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12
Q

What motions are typically most limited in patients with adhesive capsulitis?

A

Shoulder abduction and ER

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13
Q

What imaging study can be used to detect the presence of adhesive capsulitis?

A

Arthrogram can detect decreased volume of fluid within the joint capsule

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14
Q

What medications are typically prescribed to treat the symptoms associated with adhesive capsulitis?

A

Acetaminophen for pain

NSAIDs for pain/inflammation

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15
Q

What differentiates adhesive capsulitis from bursitis?

A

Pain and throbbing over the lateral brachial region

Lasts a few days and usually resolves itself within a few weeks

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16
Q

What is the most common MOI for ankle sprains?

A

Inversion and plantarflexion

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17
Q

What ligaments make up with lateral complex of the ankle?

A

Anterior talofibular ligament (ATFL)
Calcaneofibular ligament (CFL)
Posterior talofibular ligament (PTFL)

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18
Q

What ligaments make up the medial complex of the ankle?

A

Deltoid ligament

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19
Q

What ligament is most likely to sustain damage during a lateral ankle sprain?

A

ATFL

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20
Q

What injury typically occurs prior to sprain or injury to the deltoid ligament? Why?

A

Fracture of the medial malleolus

Part of the deltoid ligament attaches to the medial malleolus, so there must be significant valgus stress at the ankle (which usually fractures the medial malleolus), to injure the deltoid ligament

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21
Q

List 4 characteristics of a lateral ankle sprain.

A

Pain or tenderness along the lateral aspect of the ankle
Antalgic gait
Limitations in ankle ROM (inversion and PF)
Ecchymosis and possible edema

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22
Q

What special tests can be used to confirm the diagnosis of an ankle sprain?

A

Anterior drawer test

Talar tilt test

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23
Q

List 4 of the most common motions that lead to an ACL injury.

A

Hyperflexion
Rapid deceleration
Hyperextension
Landing in an unbalanced position

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24
Q

Describe the 3 degrees of an ACL injury.

A

First degree = little to no instability
Second degree = minimal to moderate instability
Third degree = extreme instability

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25
Q

What is the unhappy triad? What is the most common MOI for this injury?

A

Injury to the ACL, MCL and medial meniscus

MOI = Combination of valgum, flexion and ER forces applied to the knee when the foot is planted

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26
Q

2/3 of the time there is also injury to the ____ when the ACL is torn.

A

Meniscus

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27
Q

What site is most commonly used for an ACL graft?

A

Patellar tendon

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28
Q

What is the most common MOI for a PCL tear?

A

Dashboard injury or forced knee hyperflexion as the foot is plantar flexed.

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29
Q

List 3 signs and symptoms of a PCL tear.

A

Effusion
Posterior tenderness
Positive posterior drawer test

30
Q

What is bicipital tendonitis? What repetitive motions typically lead to this condition?

A

Inflammation of the long head of the biceps tendon

Excessive abduction and ER can lead to inflammation of the tendon

31
Q

List 3 signs and symptoms of bicipital tendonitis/tendinopathy.

A

Deep ache directly in front and top of the shoulder
Exacerbated by lifting heavy or reaching overhead
Positive Speed’s and/or Yergason’s test

32
Q

A labral tear is most susceptible with ______.

A

Anterior damage or subluxation

33
Q

What labral tear most commonly leads to anterior glenohumeral joint instability?

A

Bankart lesion = a tear of the labrum below the middle of the glenoid socket

34
Q

List 6 characteristics of a glenoid labral tear.

A
  1. Shoulder pain that can not be localized to a specific point
  2. Pain is made worse with overhead activities or internal rotation
  3. Weakness
  4. Instability in the shoulder
  5. Pain with resisted elbow flexion
  6. Tenderness over the front of the shoulder
35
Q

What motion should be avoided for 12 weeks after a glenoid labral repair?

A

90 abduction and 90 of ER (apprehension position)

36
Q

What is lateral epicondylitis? Cause?

A

Inflammation or degenerative changes at the common extensor tendon

Cause: Repeated overuse of the wrist extensors, particularly the extensor carpi radialis brevis, leading to microtears and damage to the extensor tendon

37
Q

What conditions must be ruled out to confirm a diagnosis of lateral epicondylitis?

A

Radial nerve entrapment

Cervical radiculopathy

38
Q

What is medial epicondylitis? Cause?

A

Inflammation or degenerative changes at the flexor carpi radialis and pronator teres tendons

Cause: Repeated overuse of the wrist flexors and pronators, leading to microtears and damage to the tendons at the medial epicondyle

39
Q

What is the most common MOI of an MCL strain at the knee?

A

Direct blow against the lateral surface of the knee causing valgus stress and subsequent damage to the medial aspect of the knee

40
Q

List 3 signs and symptoms associated with an MCL strain.

A

Inability to fully flex or extend the knee
Pain and tenderness localized to the medial knee
Positive valgus stress test

41
Q

What is osteoarthritis?

A

Degenerative chronic disorder resulting from the biomechanical breakdown of articular cartilage in the synovial joints

42
Q

What is the difference between primary and secondary OA?

A 
Primary = idiopathic and due to age related changes
Secondary = occurs secondary to a predisposing condition (i.e. trauma), that has adversely altered the articular cartilage and subchondral bone of the affected joints
43
Q

List 2 characteristics of OA.

A

Deep joint pain exacerbated with prolonged activity

Morning stiffness

44
Q

What is psoriatic arthritis?

A

Inflammatory arthritis often associated with psoriatic skin lesions

45
Q

List 4 symptoms of psoriatic arthritis.

A
  1. Silver or grey scaly spots on the scalp, elbows, knees and spine
  2. Pitting of fingernails and toenails
  3. Pain
  4. Swelling in one or more joints, fingers and toes
46
Q

What is osteogenesis imperfecta?

A

Rare congenital disorder characterized by abnormal collagen synthesis leading to imbalance between bone deposition and resorption

Cortical and cancellous bones become very thin, leading to fractures and deformity of weight bearing bones

47
Q

What is a strong predictor of a child’s ability to ambulate in the future?

A

Ability to sit independently by 10 months of age

48
Q

What is arthrogryposis multiplex congenita?

A

Congenital deformity of skeleton and soft tissues leading to several non-progressive contractures at birth

49
Q

What is patellofemoral syndrome?

A

Abnormal tracking of the patella between the femoral condyles which can lead to damage or softening of the articular cartilage

Most commonly occurs when the patella is pulled too far laterally with knee extension

50
Q

List 3 characteristics of patellafemoral pain syndrome.

A

Retropatellar pain
Tenderness to lateral border of the patella
Crepitus when the patella is compressed into the trochlear groove (Clarke’s sign)

51
Q

What is plantar fasciitis?

A

Chronic overuse injury characterized by inflammation of the plantar fascia (aponeurosis) at its origin on the calcaneus

52
Q

List 4 symptoms associated with plantar fasciitis.

A
  1. Point tenderness over the calcaneal insertion of the plantar fascia
  2. Pain in the heel when first standing up in the morning
  3. Positive windlass test
  4. Limited DF ROM
53
Q

What tendon is most commonly involved with RTC tears?

A

Supraspinatus tendon

54
Q

What special tests can be used to identify a supraspinatus tear?

A

Drop arm test

Empty can test

55
Q

Describe the symptoms associated with a RTC tear.

A
  1. Pain in the lateral aspect of the shoulder, with sxs radiating into the upper arm and deltoid region
  2. Pain is exacerbated by generalized movement
56
Q

List 2 characteristics of a biceps tendon rupture.

A
  1. Pain with overhead reaching

2. Palpable mass in upper arm where the muscle mass has retracted (Popeye’s sign)

57
Q

What is the most common cause of RTC impingement and RTC tendinitis?

A

Repetitive overhead AROM leads to inflammation/impingements of the RTC tendons

58
Q

What is the difference between structural and nonstructural scoliosis?

A

Structural = an irreversible lateral curvature of the spine with a rotational component

Nonstructural = reversible lateral curvature of spine without a rotational component which straightens as the individual flexes the spine

59
Q

List 4 common postural findings seen in patients with scoliosis.

A
  1. Increased spacing between the elbow and trunk during standing
  2. Leg length discrepancy
  3. Uneven shoulder and hip heights
  4. Prominence on one side of the shoulder or breast (due to rotation of the curve)
60
Q

Describe the treatment for scoliotic curves <25 degrees, 25-45 degrees, and >45 degrees.

A

Less than 25 degrees = conservative treatment
25-40/45 degrees = bracing and orthosis
Greater than 40-45 degrees = Surgical spinal stabilization using a Harrington rod

61
Q

What is the difference between spondylosis and spondylolisthesis?

A

Spondylosis = fracture of the pars interarticularis (Scotty dog fracture)

Spondylolisthesis = anterior or posterior slippage of one vertebrate on another

62
Q

What occurs as a result of spondylolisthesis?

A

Stenosis of the spinal canal occurs secondary to vertebral slippage

63
Q

What motion should be avoided with patients with spondylolisthesis?

A

Extension

Focus on FLEXION!!

64
Q

What is the most common site for degenerative spondylolisthesis?

A

L4-L5 segment

65
Q

List 6 signs and symptoms associated with temporomandibular joint dysfunction.

A
  1. Pain
  2. Muscle spasm
  3. Limited ROM during depression/elevation of the jaw
  4. Headache
  5. Tinnitus
  6. Clicking or popping
66
Q

What condition can mimic the symptoms associated with TMD?

A

Myofascial pain syndrome affects the TMJ but produces pain secondary to muscle spasms

67
Q

What is torticollis?

A

Spasm and/or tightness of the SCM muscle

Results in lateral flexion towards the affected side and rotation away from the affected side

68
Q

List 3 possible causes of torticollis.

A

Fibrosis related to birth trauma
Forceps birth
Breech birth

69
Q

List 3 symptoms associated with osteosarcoma.

A
  1. Pain and swelling within the extremity
  2. Pain worse at night or with exercise
  3. Fracture in the affected extremity
70
Q

In 90% of cases of osteosarcoma, metastases appear in the _____ in early stages.

A

Lungs

71
Q

What is the primary type of bone cancer that affects those under the age of 20 and requires VERY AGGRESSIVE treatment?

A

Ewing’s sarcoma

Musculoskeletal (12 decks)

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