Knee and Musculoskeletal Conditions

Question 1

Describe how the unhappy triad occurs

Answer 1

Common injury in contact sports due to lateral force impacting the knee when foot is planted on the ground

Question 2

What is damaged in the unhappy triad

Answer 2

ACL, MCL and medial meniscus (attached to MCL)
*lateral meniscus more common w ACL + MCL injury

Question 3

Presentation of unhappy triad

Answer 3

Acute pain and signs of joint instability

Question 4

What is prepatellar bursitis

Answer 4

Inflammation of the prepatellar bursa in front of the kneecap

Question 5

Causes of prepatellar bursitis

Answer 5

Repeated trauma or pressure from excessive kneeling (also called “housemaid’s knee”

Question 6

What is a popliteal cyst & what is it related to?

Answer 6

Aka Baker’s cyst
Popliteal fluid collection in gastrocnemius-semimembraneous bursa commonly communicating w the synovial space
Related to chronic joint disease (eg OA, RA)

Question 7

What is costochondritis

Answer 7

Inflammation of costochondral or costosternal junctions, may be due to minor trauma
Common in younger females

Question 8

Presentation of costochondritis

Answer 8

Presents with pleuritic chest pain and focal tenderness to palpation
May mimic myocardial infarction, pleuritis, or pulmonary embolism

Question 9

Tx of costochondritis

Answer 9

Analgesics, stretch therapy

Question 10

What is De Quervain tenosynovitis

Answer 10

Noninflammatory thickening of abductor pollicis longus and extensor pollicis brevis tendons = pain/tenderness at radial styloid

Question 11

Test for De Quervain tenosynovitis

Answer 11

Positive Finkelstein test (pain at radial styloid with active or passive stretch of thumb tendons)

Question 12

Who is at risk for De Quervain tenosynovitis

Answer 12

New mothers (lifting baby), golfers, racquet sport players, “thumb” texters

Question 13

What + cause of Duputryen contracture

Answer 13

Caused by fibroblastic proliferation and thickening of superficial palmar fascia
Typically involves the fascia at the base of the ring and little fingers

Question 14

Who is Duputryen contracture commonly seen in

Answer 14

Males >50 years of N European descent

Question 15

What is a ganglion cyst

Answer 15

Fluid-filled swelling overlying joint or tendon sheath, most commonly at dorsal side of wrist
Arises from herniation of dense connective tissue
Resolves spontaneously

Question 16

What is iliotibial band syndrome

Answer 16

Overuse injury of lateral knee that occurs primarily in runners
Pain develops 2° to friction of iliotibial band against lateral femoral epicondyle

Question 17

What is limb compartment syndrome

Answer 17

Increased pressure wi fascial compartment of a limb = venous outflow obstruction & arteriolar collapse = anoxia, necrosis, rhabdomyolysis that can lead to acute tubular necrosis

Question 18

Causes of limb compartment syndrome

Answer 18

Significant long bone fractures (eg, tibia), reperfusion injury, animal venoms

Question 19

Presentation of limb compartment syndrome

Answer 19

Severe pain and tense, swollen compartments with passive stretch of muscles in the affected compartment
5 Ps: pain, pallor, paresthesia, pulselessness, paralysis

Question 20

What are the late signs of irreversible muscle and nerve damage

Answer 20

Increased serum creatine kinase and motor deficits

Question 21

Cause of medial tibial stress syndrome and what is it

Answer 21

Aka shin splints
Common cause of shin pain and diffuse tenderness in runners and military recruits
Caused by bone resorption that outpaces bone formation in tibial cortex

Question 22

What is plantar fascitis

Answer 22

Inflammation of plantar aponeurosis characterized by heel pain (worse with first steps in the morning or after period of inactivity) and tenderness

Question 23

Associations in plantar fascitis

Answer 23

Obesity, prolonged standing or jumping (eg, dancers, runners), and flat feet

Question 24

What often coexists w plantar fascitis

Answer 24

Heel spurs

Question 25

What is temporomandibular disorders

Answer 25

Group of disorders that involve the temporomandibular joint (TMJ) and muscles of mastication

Question 26

Associations of temporomandibular disorders

Answer 26

TMJ trauma, poor head and neck posture, abnormal trigeminal nerve pain processing, psychological factors

Question 27

Presentation of temporomandibular disorders

Answer 27

Dull, constant unilateral facial pain that worsens with jaw movement, otalgia, headache, TMJ dysfunction (eg, limited range of motion)

Question 28

What is radial head subluxation, common in, caused by?

Answer 28

Aka nursemaid’s elbow
Common elbow injury in children < 5 years
Sudden pull on the arm = immature annular ligament slips over head of radius

Question 29

How is the injured arm in radial head subluxation presented

Answer 29

Slightly flexed and pronated position

Question 30

What is Osgood-Schlatter disease and who does it occur in

Answer 30

Aka traction apophysitis
Overuse injury caused by repetitive strain and chronic avulsion of the secondary ossification center of the prox tibial tubercle
Occurs in adolescents after growth spurt and common in running and jumping athletes

Question 31

Presentation of Osgood-Schlatter disease

Answer 31

Progressive anterior knee pain

Question 32

What is patellofemoral syndrome, exacerbation?

Answer 32

Overuse injury seen in young, female athletes as anterior knee pain
Exacerbated by prolonged sitting or weight-bearing on a flexed knee

Question 33

What is developmental dysplasia of the hip

Answer 33

Abnormal acetabulum development in newborns resulting in hip instability/dislocation

Question 34

Risk factor for developmental dysplasia of the hip

Answer 34

Breech presentation

Question 35

Tests for developmental dysplasia of the hip

Answer 35

Orotlani & Barlow maneuvers (manipulation of newborn hip reveals a “clunk”)
Confirmed w US (x-ray doesn’t show until 4-6 months)

Question 36

What is Perthes disease

Answer 36

Idiopathic AVN of femoral head

Question 37

Presentation of Perthes disease

Answer 37

Between 5-7 years (common in males) w insidious onset of hip pain that may cause the child to limp
Initial x-ray is often normal

Question 38

What is slipped capital femoral epiphysis, how it happens, diagnosis

Answer 38

Seen in obese young adolescents with hip/knee pain and altered gait
Increased axial force on femoral head = epiphysis displaces
Dx via x-ray