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Internal Medicine > JH IM Board Review - Office Orthopedics I > Flashcards

JH IM Board Review - Office Orthopedics I Flashcards

1
Q

Shoulder pain:

A

One of the MC musculoskeletal complaints.

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2
Q

Shoulder pain - In patients <40yr, symptoms are often caused by …?

A

Acute injuries (eg sports-related) injuries.

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3
Q

Shoulder pain - In older patients, symptoms are more likely caused by …?

A

CHRONIC, degenerative changes of the rotator cuff.

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4
Q

4 common disorders of the shoulder:

A
  1. Rotator cuff tendinitis.
  2. Rotator cuff tear.
  3. Adhesive capsulitis.
  4. Bicipital tendinitis.
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5
Q

Rotator cuff tendinitis - Cause:

A
  1. Overuse.

2. Inflammatory diseases such as RA.

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6
Q

Rotator cuff tendinitis - CP:

A

ANTEROLATERAL shoulder pain.

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7
Q

Rotator cuff tendinitis - Dx and evaluation:

A
  1. Pain with abduction < Pain with adduction.
  2. Pain with INTERNAL + EXTERNAL rotation.
  3. Pain with LATERAL PALPATION

+ Positive “IMPINGEMENT TEST”.

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8
Q

Impingement test?

A

Positive if relief of pain after injection of the subacromial bursa.

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9
Q

Rotator cuff tendinitis - Tx:

A
  1. Rest.
  2. NSAIDs.
  3. Physical therapy.
  4. Steroid injection.
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10
Q

Rotator cuff tear - Cause:

A
  1. Trauma.
  2. RECURRENT ROTATOR CUFF TENDINITIS.
  3. RA.
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11
Q

Rotator cuff tear - CP:

A

ANTEROLATERAL shoulder pain.

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12
Q

Rotator cuff tear - Dx and evaluation:

A
  1. Same as rotator cuff tendinitis.
  2. Positive “drop test” with full-thickness tear.

==> Drop test: Unable to maintain active shoulder abduction.

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13
Q

Rotator cuff tear - Tx:

A

Orthopedic evaluation for repair.

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14
Q

Adhesive capsulitis - Cause:

A

Prolonged shoulder immobilization.

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15
Q

Adhesive capsulitis - CP:

A
  1. Shoulder pain.

2. Loss of motion.

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16
Q

Adhesive capsulitis - Dx and evaluation:

A

PAINFUL + LIMITED, ACTIVE + PASSIVE motion.

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17
Q

Adhesive capsulitis - Tx:

A
  1. Physical therapy.
  2. Steroid injection.
  3. Possible orthopedics referral.
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18
Q

Bicipital tendinitis - Cause:

A

Overuse.

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19
Q

Bicipital tendinitis - CP:

A

Anterior shoulder pain.

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20
Q

Bicipital tendinitis - Dx and evaluation:

A
  1. Tenderness over bicipital groove.
  2. Positive “speed test”.
  3. Positive “Yergason sign”.
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21
Q

Speed test?

A

Pain with RESISTED SHOULDER FLEXION.

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22
Q

Yergason sign?

A

Pain with RESISTED FOREARM SUPINATION.

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23
Q

Bicipital tendinitis - Tx:

A
  1. Rest.
  2. NSAIDs.
  3. Physical therapy.
  4. Steroid injection.
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24
Q

Rotator cuff maneuvers and tendinopathies - Empty can test - Description:

A
  1. Patient abducts shoulder to 90 degrees with thumbs pointing downward.
  2. Patient then tries to elevate arms against resistance.
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25
Q

Empty can test - Rotator cuff tendon tested?

A

SUPRASPINATUS ==> Abduction.

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26
Q

External rotation resistance test - Descrition:

A
  1. Patient flexes both elbows to 90 degrees with both arms at sides.
  2. Patient then tries to externally rotate arms against resistance.
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27
Q

External rotation resistance test - Rotator cuff tendon?

A
  1. Infraspinatus.
  2. Teres minor.

==> EXTERNAL ROTATION.

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28
Q

Lift-off test - Description:

A
  1. Patient places the dorsum of his/her hand on the low back.
  2. Patient lifts the hand off the back against resistance by internally rotating the humerus.
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29
Q

Lift-off test - Rotator cuff tendon tested?

A

SUBSCAPULARIS ==> Internal rotation.

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30
Q

Supination resistance test - Description:

A
  1. Patient bends elbow to 90 degrees with arm against their body.
  2. Examiner holds the patient’s hand and provides resistance while the patient tries to rotate the arm such that the hand is palm up.
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31
Q

Supination resistance test - Tendon tested?

A

Biceps (NOT a rotator cuff tendon) ==> Supination.

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32
Q

Elbow - Lateral epicondylitis (“tennis elbow”) - Cause:

A

Repetitive WRIST EXTENSION + FOREARM SUPINATION.

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33
Q

Elbow - Lateral epicondylitis (“tennis elbow”) - CP:

A

LATERAL elbow pain.

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34
Q

Elbow - Lateral epicondylitis (“tennis elbow”) - Dx and evaluation:

A
  1. Tenderness over LATERAL epicondyle.

2. Pain elicited by resisted WRIST EXTENSION and FOREARM SUPINATION.

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35
Q

Elbow - Lateral epicondylitis (“tennis elbow”) - Tx:

A
  1. Rest.
  2. NSAIDs.
  3. Bracing.
  4. Physical therapy.
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36
Q

Elbow - Lateral epicondylitis (“tennis elbow”) - Corticosteroid injections:

A

HELPFUL IN SHORT-TERM RELIEF.

==> High rate of recurrence. NOT BETTER THAN PLACEBO over long term.

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37
Q

Medial epicondylitis (“golfer’s elbow”) - Cause:

A

Repetitive WRIST FLEXION + FOREARM PRONATION.

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38
Q

Medial epicondylitis (“golfer’s elbow”) - CP:

A

Medial elbow pain.

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39
Q

Medial epicondylitis (“golfer’s elbow”) - Dx and evaluation:

A
  1. Tenderness over medial epicondyle.

2. Pain elicited by resisted wrist flexion and forearm pronation.

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40
Q

Medial epicondylitis (“golfer’s elbow”) - Tx:

A

SAME AS FOR Lateral epicondylitis.

41
Q

Ulnar neuropathy - Cause:

A

TRAUMA to the ulnar nerve as it traverses the elbow joint.

42
Q

Ulnar neuropathy - CP:

A

POSTERO-MEDIAL forearm + 4th/5th digit pain and paresthesias.

43
Q

Ulnar neuropathy - Dx and evaluation:

A
  1. Tenderness with percussion over the cubital tunnel.

2. Decr. Sensation in the ulnar nerve distribution.

44
Q

Ulnar neuropathy - Tx:

A
  1. Modification of activity.
  2. NSAIDs.
  3. Splinting.
  4. Surgery is sometimes required for decompression.
45
Q

Radial neuropathy - Cause:

A

Compression of the MOTOR branch of the radial nerve as it traverses the elbow joint between:

==> RADIAL HEAD and SUPINATOR.

46
Q

Radial neuropathy - CP:

A

Proximal forearm ache + possible paresthesias radiating to dorsal radial surface of hand and forearm.

47
Q

Radial neuropathy - Dx and evaluation:

A
  1. Reproduction of pain with RESISTED SUPINATION.
  2. Reproduction of pain with ELBOW FLEXION while forearm is in SUPINATION.
  3. Diagnostic lidocaine injection at LATERAL epicondyle to differentiate etiology, as symptoms are similar to LATERAL EPICONDYLITIS.
48
Q

Radial neuropathy - Tx:

A
  1. Modification of activity.
  2. NSAIDs.
  3. Splinting.
  4. Surgery is sometimes required for decompression.
49
Q

Olecranon bursitis - Cause:

A
  1. Trauma.
  2. INFECTION ==> 2o to overlying CELLULITIS (MC gram(+) bacteria, esp. S.aureus).
  3. Gout/Pseudogout.
  4. RA.
50
Q

Olecranon bursitis - CP:

A

Pain + Swelling over olecranon process.

51
Q

Olecranon bursitis - Dx and evaluation:

A
  1. Inflamed olecranon bursa.
  2. Pain with flexion, but NOT EXTENSION.
  3. EXAMINATION OF BURSA FLUID CRITICAL TO DIAGNOSE INFECTION.
52
Q

Olecranon bursitis - Tx:

A
  1. Rest and treatment of the underlying cause.
  2. Management of gout.
  3. Drainage and antibiotics for infection.
53
Q

Carpal tunnel syndrome - Cause:

A

Median nerve compression at wrist.

54
Q

Carpal tunnel syndrome - Precipitating factors:

A
  1. Overuse.
  2. Synovitis.
  3. HYPOTHYROIDISM.
  4. Amyloidosis.
  5. Acromegaly.
  6. Pregnancy.
55
Q

Carpal tunnel syndrome - CP:

A
  1. Numbness and paresthesias in median nerve distribution (1st-3rd fingers + radial half of the 4th).
  2. NOCTURNAL EXACERBATION.
  3. Wasting of thenar eminence.
56
Q

Carpal tunnel syndrome - Dx and evaluation:

A
  1. Median nerve Tinel sign.
  2. Phalen sign ==> Provoke pain, paresthesia, and numbness with forced wrist flexion (reversed “prayer sign”).
  3. Abnormal nerve conduction test and electromyography.
57
Q

Carpal tunnel syndrome - Tx:

A
  1. Wrist splint.
  2. NSAIDs.
  3. Steroid injection.
  4. Surgical release.
58
Q

Ulnar tunnel syndrome - Cause:

A

Ulnar nerve compression at wrist.

59
Q

Ulnar tunnel syndrome - Precipitating factors:

A
  1. Overuse.
  2. Trauma.
  3. Ganglion cyst.
60
Q

Ulnar tunnel syndrome - CP:

A

Numbness and paresthesias in ulnar nerve distribution.

61
Q

Ulnar tunnel syndrome - Dx and evaluation:

A
  1. Ulnar nerve Tinel sign.

2. Abnormal nerve conduction test and electromyography.

62
Q

Ulnar tunnel syndrome - Tx:

A
  1. Wrist splint.
  2. NSAIDs.
  3. Surgical release.

==> NO STEROIDS (vs carpal).

63
Q

De Quervain tenosynovitis - Cause:

A

Abductor policis longus + Extensor policis brevis tendon inflammation.

64
Q

De Quervain tenosynovitis - Precipitating factors:

A
  1. Overuse.

2. RA.

65
Q

De Quervain tenosynovitis - CP:

A

Radial wrist pain extending from thumb.

66
Q

De Quervain tenosynovitis - Dx and evaluation:

A
  1. Tender over radial styloid.

2. Finkelstein test ==> Provoke pain with forced ulnar deviation of the wrist, with thumb enclosed by fist.

67
Q

De Quervain tenosynovitis - Tx:

A
  1. Wrist/thumb splint.
  2. NSAIDs.
  3. Steroid injection.
  4. Surgery.
68
Q

Trigger finger - Cause:

A

Inflammation + Stenosis of digital flexor tendon.

69
Q

Trigger finger - Precipitating factors:

A
  1. Overuse.

2. RA.

70
Q

Trigger finger - CP:

A

Tendon catches with flexion of digit.

71
Q

Trigger finger - Dx and evaluation:

A

Pain and palpable “catch” with digit flexion.

==> NODULE MAY BE PALPABLE.

72
Q

Trigger finger - Tx:

A
  1. Occupational therapy.
  2. Steroid injection.
  3. Surgical release.
73
Q

Dupuytren contracture - Cause:

A

Contracture of palmar fascia.

74
Q

Dupuytren contracture - Precipitating factors:

A
  1. Heredity.
  2. Alcohol.
  3. DM.
  4. Epilepsy (!).
75
Q

Dupuytren contracture - CP:

A

Unable to fully extend digits.

76
Q

Dupuytren contracture - Dx and evaluation:

A
  1. Flexion deformity of 4th > 5th > 3rd > 2nd digits.

2. Palpable thickening of palmar fascia.

77
Q

Dupuytren contracture - Tx:

A

Surgical excision in extreme cases.

78
Q

Trochanteric bursitis - Cause:

A
  1. Overuse.
  2. Inflammatory arthritis.
  3. Trauma.
  4. Associated with OBESITY.
79
Q

Trochanteric bursitis - CP:

A
  1. Deep aching lateral hip pain extending to buttock or lateral knee ==> Not to be mistaken for GROIN PAIN, which is suggestive of HIP JOINT pathology.
  2. Painful to LIE IN LATERAL DECUBITUS POSITION.
80
Q

Trochanteric bursitis - Dx and evaluation:

A
  1. Pain on PALPATION OVER GREATER TROCHANTER.

2. Pain with RESISTED HIP ABDUCTION.

81
Q

Trochanteric bursitis - Tx:

A
  1. Rest.
  2. NSAIDs.
  3. Steroid injection.
  4. Physical therapy.
82
Q

Meralgia paresthetica - Cause:

A
  1. Entrapment of lateral femoral cutaneous nerve.

2. Associated with obesity, pregnancy, diabetes, and tight clothing (!).

83
Q

Meralgia paresthetica - CP:

A

Numbness and paresthesias over ANTEROLATERAL thigh.

84
Q

Meralgia paresthetica - Dx and evaluation:

A
  1. ANTEROLATERAL thigh SENSORY deficit.

2. TENDER over INGUINAL ligament.

85
Q

Meralgia paresthetica - Tx:

A
  1. NSAIDs.

2. Treat underlying condition.

86
Q

Hip and knee - Iliotibial band syndrome - Cause:

A

Overuse of iliotibial band (eg running).

87
Q

Iliotibial band syndrome - CP:

A

Pain over lateral thigh above the joint line of the knee.

88
Q

Iliotibial band syndrome - Dx and evaluation:

A

Tender over LATERAL femoral condyle when FLEXING or EXTENDING the knee.

89
Q

Iliotibial band syndrome - Tx:

A
  1. Restrict exacerbating activities.
  2. NSAIDs.
  3. Physical therapy.
  4. Steroid injection.
90
Q

McMurray test (to evaluate meniscal tears):

A
  1. Flex the knee as much as possible.
  2. MEDIAL meniscus evaluated by EXTERNALLY rotating the foot and EXTENDING the knee.
  3. LATERAL meniscus evaluated by INTERNALLY rotating the foot and EXTENDING the knee.
91
Q

Chondromalacia patellae - Cause:

A

Patellofemoral cartilage degeneration.

92
Q

Chondromalacia patellae - CP:

A

ANTERIOR knee pain when CLIMBING STAIRS.

93
Q

Chondromalacia patellae - Dx and evaluation:

A

Tender with patellar compression.

94
Q

Chondromalacia patellae - Tx:

A
  1. Quadriceps strengthening exercises.
  2. NSAIDs.
  3. Rarely surgery.
95
Q

Meniscal injury - Cause:

A

Trauma.

96
Q

Meniscal injury - CP:

A
  1. Pain.
  2. Swelling.
  3. Catching.
  4. Locking.
  5. Buckling.
97
Q

Meniscal injury - Dx and evaluation:

A
  1. Tender joint margin.
  2. Pain with motion.
  3. Pain with McMurray test.
98
Q

Meniscal injury - Tx:

A
  1. Rest.
  2. NSAIDs.
  3. Physical therapy.
  4. Possible SURGICAL MENISCOTOMY.

Internal Medicine (106 decks)

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