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MSK Flashcards

1
Q

What are the functions of the skeletal system?

A

Support
Protect
Movement
Mineral homeostasis
Blood cell production
Triglyceride storage

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2
Q

Where does red blood cell production occur

A

Red bone marrow

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3
Q

Where is triglyceride storage

A

Yellow bone marrow

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4
Q

What are the parts of a long bone

A

Diaphysis- shaft
Epiphyses - ends
Metaphyses - growth plate between shaft and end of long bone

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5
Q

What cells are a part of the microscopic structure of the bone

A

Osteoblasts - bone BUILDING
Osteocytes - Maintain by exchanging nutrients and wastes
Osteoclasts - DIGEST bone matrix for normal bone turnover

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6
Q

What are the three types of joints

A

Fibrous - dense irregular connective tissue
Cartilaginous - bones held together by cartilage
Synovial - have a synovial cavity and many other components such as ligaments

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7
Q

What is an example of fibrous joints

A

Sutures in the skull
They add strength to the joint

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8
Q

What is an example of interosseous membrane

A

Between long bones
Radius-ulna
Tibia-fibula

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9
Q

What are sacs that contain synovial fluid

A

Bursae

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10
Q

What is the function of ligaments

A

Connects bone to bone

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11
Q

What is the function of tendons

A

Connects muscle to bone

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12
Q

What is the function of cartilage

A

Covers ends of bones to absorb shock and reduce friction

(It’s in the join but IS NOT a cartilaginous joint)

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13
Q

What is the function of bursa

A

Decrease friction in areas where friction can occur with movement

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14
Q

What conducts most movement of bones/body parts and stabilizes body positions

A

Skeletal muscle

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15
Q

What are the four major function of muscular tissue in the body

A

Produce body movement
Stabilize body position
Store and move substances
Produce heat

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16
Q

What is a decrease in the angle between articulating bones

A

Flexion

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17
Q

What is an increase in angle between bones

A

Extension

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18
Q

What is bending beyond 180 degrees such as moving the humerus backwards behind the anatomical plane

A

Hyperextension

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19
Q

What is movement away from the midline

A

Abduction

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20
Q

What is movement toward the midline

A

Adduction

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21
Q

What is movement of distal end in a circle

A

Circumduction

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22
Q

What is a bone revolving around its own longitudinal axis

A

Rotation

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23
Q

What is movement of the soles of the foot medially

A

Inversion

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24
Q

What is movement of the soles of the foot laterally

A

Eversion

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25
Q

What is bending the foot toward the dorsum (standing on heels)

A

Dorsiflexion

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26
Q

What is bending the foot toward the plantar surface (standing on toes)

A

Plantarflexion

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27
Q

What is the scale used to evaluate muscle strength

A

0- no evidence of muscle function
Trace - muscle contraction but no or very limited joint motion
Poor - complete range of motion with gravity eliminated
Fair - complete range of motion against gravity
Good - complete range of motion against with some resistance
Normal - complete range of motion with full or normal resistance

3 or less = disability is present

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28
Q

What are the regions of the vertebral column

A

Cervical - 7
Thoracic - 12
Lumbar - 5
Coccyx - 4

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29
Q

What is cervical and lumbar vertebrae curves called

A

Lordotic

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30
Q

What is thoracic and sacral curves called

A

Kyphotic

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31
Q

What portion of the vertebrae is largest and strongest

A

Lumbar
L1-L5

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32
Q

What is the foundation for the pelvic girdle

A

Sacrum

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33
Q

What are the bones of the thorax

A

Ribs
Sternum
-Manubrium
-Body
-Xyphoid process

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34
Q

Which ribs are true ribs

A

R1-R7
- costal cartilage articulates DIRECTLY to the sternum

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35
Q

What are false ribs

A

R8-R10
Articulate with the sternum by cartilage of rib 7

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36
Q

What are floating ribs

A

R11-r12
Do not articulate with the sternum at all

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37
Q

What are the bones of the pectoral girdle

A

Clavicle
Scapula
Acromion
Coracoid

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38
Q

What articulates with the sternum medially and acromion laterally

A

Clavicle

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39
Q

What is part of the scapula that forms the “tip of the shoulder”

A

Acromion

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40
Q

What provides an attachment site for muscles and ligaments

A

Coracoid

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41
Q

What are the ligaments of the pectoral girdle

A

Acromioclavicular ligament
Coracoclavicular ligament
Coracoacromial ligament

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42
Q

What articulates with the head of the humerus to form the shoulder joint

A

Glenoid cavity

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43
Q

What deepens the glenoid and provides more stability to the joint

A

Glenoid labrum

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44
Q

What are the muscles of the rotator cuff

A

Supraspinatus - assists deltoid in abduction of the numerous at the shoulder
Infraspinatus - external rotation of the humerus at the shoulder joint
Teres minor
Subscapularis - internal rotation f the arm at the shoulder

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45
Q

What muscle abducts, flexes and rotates arm at the shoulder joint

A

Deltoid

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46
Q

What has multiple fibers in it and moves the scapula multi-directionally

A

Trapezius

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47
Q

What elevates the scapula and rotates downward

A

Levator scapula

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48
Q

What elevates and abducts the scapula and rotates downward as well as stabilizes the scapula

A

Rhomboid major

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49
Q

What muscle adducts and rotates arm medially at the shoulder as well as flexes the arm at the shoulder joint

A

Pectoralis major

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50
Q

What muscle extends, adducts and rotates the arm medially at the shoulder joint and draws arm downward and backward

A

Latissimus dorsi

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51
Q

What muscle extends the arm at the shoulder joint and assists with adduction and rotation of arm medially

A

Teres major

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52
Q

What muscle flexes and adducts the arm at the shoulder

A

Coracobrachialis

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53
Q

What are the bones of the elbow

A

Humerus
Radius
Ulna - olecranon is the proximal aspect of the ulna and is the medical term for elbow

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54
Q

What is the only hinge joint that supination and pronation occurs at

A

The elbow

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55
Q

What muscles move the radius and the ulna

A

Biceps brachii
Brachialis
Brachioradialis
Tricep brachii
Supinator
Pronator teres

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56
Q

What muscle flexes arm at the shoulder as well as flexes and supinates the forearm at the elbow

A

Biceps brachii

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57
Q

What muscle extends the forearm at the elbow joint and extends the arm at the shoulder

A

Triceps brachii

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58
Q

What muscle flexes the forearm at the elbow joint

A

Brachialis and brachioradialis

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59
Q

What muscle supinates the forearm

A

Supinator

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60
Q

What muscle pronates the forearm

A

Pronator teres

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61
Q

What are the bones of the hand

A

Carpals
Metacarpals - base body and head
Phalanges - numbered 1-5

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62
Q

What muscle flexes ad abducts the hand at the wrist

A

Flexor carpi radialis

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63
Q

What muscle flexes and adducts hand at the wrist

A

Flexor carpi ulnaris

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64
Q

What muscle weakly flexes hand at the wrist joints

A

Palmaris

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65
Q

What muscle flexes the hand at wrist and flexes phalanges of each finger at the PIP joint

A

Flexor digitorum superficialis

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66
Q

What muscle flexes phalanges of each finger at the DIP

A

Flexor digitorum profunus

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67
Q

What muscle extends and abducts the hand at the wrist JOINT

A

Extensor carpi radialis longus

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68
Q

What muscle extends and adducts hand at the wrist JOINT

A

Extensor carpi ulnaris

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69
Q

What muscle extends the hand at the wrist joint

A

Extensor digitorum

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70
Q

What nerve is sensation to little finger and 1/2 of ring finger

A

Ulnar - most of the intrinsic hand muscle motor supply

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71
Q

What nerve is to the palmar and dorsal aspect of first 3 and 1/2 fingers

A

Median nerve

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72
Q

What nerve is on the dorsum of the hand and lateral first three fingers and one half of fourth finger

A

Radial nerve

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73
Q

What special test is used to diagnose shoulder impingement or rotator cuff tears

A

Neers impingment sign

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74
Q

What special test reinforces a positive Neers and pain in the subacromial space is indicative of rotator cuff tears or tendinitis

A

Hawkins

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75
Q

What special test detects tears in the rotator cuff (supraspnatus)

A

Drop arm test

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76
Q

What special test evaluAtes the teres minor

A

Hornblower

Weakness is a positive sign

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77
Q

What special test is useful in diagnosing biceps tendonitits

A

Speeds test

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78
Q

What special test is for subscapularis strength and possible tendon rupture

A

Gerber lift off

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79
Q

What is a postive sulcus sign

A

A visible dimple and suggests that the patient has inferior shoulder instability

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80
Q

What is a positive O’Briens test

A

Pain is worse with thumbs down and relieved with forearm supination. Suggests labral pathology

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81
Q

What does the valgus stress test assess

A

Stability of the medial ligamentous structures

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82
Q

What does the varus stress test assess

A

The stability of the lateral collateral ligament

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83
Q

What is a positive elbow flexion test

A

Tingling, numbness, and parathesia of the ulnar nerve = positive for cubical tunnel (ulcer nerver) syndrome

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84
Q

What is a positive tinel sign

A

Reproduction of parenthesis into the ulnar nerve distribution - suggests ulnar nerve entrapment

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85
Q

What does a positive froments sign suggest

A

Suggests ulnar nerve paralysis

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86
Q

What is a type I clavicular separation

A

AC ligaments partially disrupted and coracoclavicular ligaments are intact.No superior separation of clavicle from acromion

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87
Q

What is a type II clavicular separation

A

AC ligaments are torn and CC are intact resulting in partial separation of the clavicle from Acromion

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88
Q

What is a type III clavicular separation

A

AC and CC ligaments are completely disrupted resulting in complete separation of the clavicle from acromion

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89
Q

What is type IV separation

A

AC and CC ligaments are completely disrupted with superior and prominently posterior displacement

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90
Q

What is a type V separation

A

AC and CC ligaments are completely disrupted with CC interspace more tan twice as large as opposite shoulder

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91
Q

What is type VI separation

A

Uncommon.
Clavicular periosteum and/or deltoid and trapezius muscle are torn resulting in wide displacement

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92
Q

What is the treatment for type I and II clavicle separation

A

Sling for 24-48 hours
Ice
Analgesics
Home exercise
Return to full duty as pain permits

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93
Q

What is the treatment for a type III separation

A

Ortho consult
Sling for 24-48 hours
Ice
Analgesic
Light duty until evaluated by Ortho

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94
Q

What is the treatment for IV-VI separations

A

Ortho - will require surgery
Sling until ortho
Ice
Analgesic
MEDEVAC

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95
Q

What is the most common bony injury

A

Fracture of the clavicle

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96
Q

What special tests will be performed with a suspected clavicle fracture

A

Cross body - positive with possible grinding
But is not required if obvious deformity is noted

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97
Q

What is the treatment for a clavicle fracture

A

Ice
Analgesic
Ortho
Midshaft fracture with minimal displacement and no Neuro vascular injury = figure 8 strap for 6-8wks

All fractures require referral - MEDEVAC

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98
Q

What is a gradual onset of anterior and lateral shoulder pain that is made worse with overhead activity and has associated night pain when sleeping on affected side

A

Impingement syndrome of the shoulder

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99
Q

What is the treatment for impingement syndrome of the shoulder

A

NSAIDs
Ice
Light duty
Home exercise
Physical therapy consult if failed local management

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100
Q

When would you refer to ortho on someone with impingement syndrome

A

Failed conservative management after 2-3 months or other pathology is suspected

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101
Q

What is another name for a rotator cuff tear

A

Musculotendinous cuff rupture
Rotator cuff rupture
Rotator cuff tendinitis

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102
Q

What is the likely cause of pain with someone who presents with chronic shoulder pain, specific injury triggered that triggered pain, night pain and difficulty sleeping on affected side or complaints of weakness, catching or grating especially with overhead activities

A

Rotator cuff tear

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103
Q

What special tests are performed on someone with a suspected rotator cuff tear

A

Drop arm - positive
Empty can - positive

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104
Q

Who does bicep tendon injuries most commonly occur in

A

People who pull, lift, reach or throw for work or recreation

  • weight lifters
  • rock climbers
  • degenerative tendinopathy of the tendon in older patients
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105
Q

How does a bicep tendon injury commonly present

A

Anterior shoulder pain that radiates dismally down the arm over the bicep muscle

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106
Q

What differentiates a bicep tendon injury and a rupture

A

Tendon rupture would be suspected if there was a single injury (a “pop”) with ecchymosis and swelling
- deformity only presents in severe cases

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107
Q

What is the mainstay of treatment for a bicep tendon injury

A

NSAIDs
Ice
Duty modification
Physical therapy/ HEP

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108
Q

What are the synonyms for shoulder instability

A

Dislocation
Multidirectional instability
Recurrent dislocation
Subluxation

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109
Q

What are the two instability patterns for the shoulder

A

TUBS - traumatic unilateral dislocation with a bankart lesion that can be successfully treated with surgery

AMBRI - a traumatic multidirectional instability that is commonly bilateral and is often successfully treated with rehab and occasion an inferior capsular shift surgery

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110
Q

What are the clinical symptoms of shoulder instability

A

“Shoulder feels like its slipping out of joint” when arm is abducted and externally rotated
Initial anterior dislocation is associated with trauma from a fall or forceful throwing
Recurrent dislocations may occur with positioning arm over head
Posterior dislocation will describe posterior directed force
Multidirectional instability may have vague symptoms but usually related to activity

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111
Q

What special tests will be postive with a shoulder dislocation

A

Sulcus
Apprehension test with anterior instability
Anterior/posterior drawer test - will have laxity
Jerk test - positive instability

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112
Q

What is the treatment for a shoulder dislocation

A

Reduce acute dislocations
Immobilize arm in a sling in a neutral direction
Light duty 2-3 weeks
Begin rotator cuff strengthening 2-3 weeks post reduction
Physical therapy consult

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113
Q

When would you refer for a shoulder dislocation

A

First time dislocation - medevac
Neuro vascular compromise requires orthopedic consult with possible surgery - medevac

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114
Q

What are some mechanisms of injury on someone who may have a SLAP lesion (labrum tear)

A

Falling back on an outstretched arm
Tries to prevent fall by grabbing an object
Suddenly tries to lift a heavy object
Forceful throwing or overhead activity
Chronic overuse vs acute injury

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115
Q

What are the symptoms of a SLAP tear

A

Anterior shoulder pain
Clicking or clunking of the shoulder in certain positions
Swelling, parathesias , severe night pain is uncommon

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116
Q

What special tests are recommended for evaluating a SLAP tear

A

O’Brien and speeds

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117
Q

Who is adhesive Capsulitis (frozen shoulder) more commonly seen in

A

Older populations 50-60s
Often associated with other disease and conditions

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118
Q

What are the three phases of adhesive capsulitis (frozen shoulder)

A

Diffuse, severe and disabling shoulder pain with increasing stiffness, last 2-9 months

Stiffness and severe loss of shoulder motion with pain less pronounced, lasts 4-12 months

Recovery phase - with stiffness and gradual return of shoulder motion that takes about 5-24 months to complete

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119
Q

What are the signs of someone who may have frozen shoulder

A

History of shoulder pain with complaints of
- severe pain that is worse at night, “nagging pain”
- decreased ROM in shoulder
- issues with various daily living tasks

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120
Q

What is the treatment for frozen shoulder

A

Early mobilization for those with shoulder injuries
- avoid slings when possible
Shoulder motion exercises
- PT consult
NSAIDS
Tylenol
Consider referral for steroid injections

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121
Q

What is lateral tendinitis

A

Tennis elbow

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122
Q

What is medial tendinosis

A

Golfers elbow or bowlers elbow

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123
Q

What are the symptoms of lateral epicondylitis

A

Gradual onset of pain in lateral elbow and forearm during activities involving gripping and wrist extension
- lifting
- turning screwdriver
- hitting backhand in tennis
- excessive typing
- less common, results from a direct blow to lateral aspect of the elbow

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124
Q

What is the clinical symptoms of someone with medial epicondylitis

A

Gradual onset of pain at the medial aspect of elbow, exacerbated by activities that involve wrist flexion and forearm pronation
- golf swing
- baseball pitch
- pull through stroke of swimming
- weight lifting
- bowling

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125
Q

What is the treatment for epicondylitis

A

Light duty
Limit repeative activities to allow for healing
Nsaids
Tennis elbow strap for comfort
Pain free stretching and forearm strengthening
PT consult if failed conservative treatment
Ortho consult
Steroid injections

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126
Q

What is likely the diagnosis of someone who has sudden (infection or trauma) or gradual swelling in the effected area, pain ranging in severity, limited ROM from pain or pressure, and as the mass diminishes in size the patient may feel firm lumps or nodules that result from scar tissue

A

Olecranon bursitis

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127
Q

What diagnostic testing is used for someone with suspected olecranon bursitis

A

Aspiration may be diagnostic and therapeutic
- lab testing of aspirate for WBC count, crystals, gram stain and culture
Radiographs to rule out a fracture

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128
Q

What is the treatment for olecranon bursitis

A

Light duty to avoid hyper flexion against hard surfaces

Mild cases:
- NSAIDs
- pressure wrap
- ice

Moderate to severe:
- fluid aspiration, refer to ortho for evaluation

Septic
- requires organism specific antibiotics- refer for treatment

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129
Q

Where is the most common site for cubical tunnel syndrome

A

Where the ulnar nerve passes in groove on the posterior aspect f medical epicondyle (cubital tunnel)

130
Q

What are the causes of nerve compression syndrome of the upper extremities

A

Direct blow to cubital tunnel
Nerve stretched from flexed elbow for prolonged periods of time
Cubits valgus (carrying angle greater than 10 degrees)
Osteophytes or scar tissue

131
Q

If someone has numbness and tingling in the 4th and 5th digits, elbow pain/ache that may radiate proximally to shoulder and neck, inability to do activities of daily living such as opening jars or turning a key in door (late signs)

A

Ulnar nerve compression

  • intrinsic muscle atrophy implies nerve compression of several months
132
Q

What is the treatment for ulnar nerve compression

A

Modify activities to limit elbow flexion and direct pressure on the ulnar nerve
Splint elbow or wrap towel around elbow
NSAIDs
Surgical decompression and transposition of ulnar nerve if 3-4 months of conservative management

133
Q

What is the common injury that results in ulnar collateral ligament tear

A

Overhead throwing motions (baseball pitcher)

134
Q

If someone presents with acute onset of a “pop” while throwing and experiences a gradual onset of symptoms with progressive medial elbow pain with valgus stresses, may also experience symptoms consistent with ulnar neuritis

A

Ulnar collateral ligament tear

135
Q

What is the treatment for ulnar collateral ligament tear

A

Light duty
Ice for acute injury
NSAIDs
Pain free elbow and wrist strengthening

136
Q

Who does elbow dislocations most commonly occur in

A

Children

Third most common dislocation in adults

137
Q

What does an elbow dislocation result from

A

Resulting from a fall on an outstretched hand (FOOSH)

138
Q

What is the treatment for an elbow dislocation

A

Ice
Pain management
Splint
Consider emergency reduction if delayed medevac time or neurovascular compromise
Repeat neuro checks after reduction

139
Q

How do you perform an elbow reduction

A

Extend elbow to 45 degrees
Slow, steady downward traction of forearm in line with long axis of humerus
Gentle pressure over olecranon tip
Repeat neuro checks

140
Q

What is the most common neuropathy of the upper extremity

A

Carpal tunnel

141
Q

Who is most commonly affected by carpal tunnel

A

Middle aged or pregnant women

142
Q

If someone has numbness and tingling into radial three digits of the hand, pain and paratheisis or numbness of the median distribution (then, index finger, long finger and radial half of ring finger), pain is worse at night and reports needing to rub hands to “get circulation back”. They also frequently drops objects or cannot open jars with twist lids and the pain is worse repetitive motion of the hand or stationary tasks

A

Carpal tunnel

143
Q

What is the treatment for carpal tunnel

A

Splint wrist in neutral position
NSAIDs
Light duty
Ergonomic modification
Ortho consult if failed conservative management

144
Q

What is precipitated by repetitive use of the thumb, pain/swelling and triggering phenomenon resulting in locking or sticking of the tendon as patient moves thumb and commonly effects middle aged women

A

De quervain tenosynovitis

145
Q

What is the treatment for de quervain tenosynovitis

A

NSAIDs
Thumb spica splint
Light duty

  • refer to ortho if failed conservative management
146
Q

What is the most commonly fractured carpal bone

A

Scaphoid fracture

147
Q

A patient presents with a pain on the radial side of the wrist in the anatomical snuff box as well as pain with wrist motion and gripping. they also describe a dorsiflexed wrist injury before the pain began. what is the likely diagnosis

A

Suspected scaphoid fracture

148
Q

What is the treatment for a suspected scaphoid fracture

A

Thumb spica splint
Light duty
Treatment strategy should focus on definitive diagnosis with radiographs or mri as soon as possible
Consult to ortho
Analgesics

149
Q

What is the most common soft tissue tumor of the hand that effects ages 15-40 years old, arising from capsules of a joint or a tendon synovial sheath

A

Ganglion of the wrist

150
Q

A patient present with a firm modular swelling in wrist that may vary in size and increases in size, and pain with wrist motion

A

Ganglion of the wrist

  • bump at MCV or on the dorsum of the finger distal to DIP would suggest hand or finger ganglion
151
Q

What is the treatment for a ganglion

A

Splint wrist or finger
NSAIDs
Consult to ortho for aspiration or surgical excision

152
Q

What is a rupture of the flexor digitorum profundus tendon from its distal attachment site and is common in contact sports. Commonly overlooked as a jammed finger

A

Jersey finger

  • ring finger is involved in 75% of cases
153
Q

What is rupture or avulsion of the insertion of the extensor tendon and base of distal phalanx, usually from a direct blow to the finger causing sudden forced flexion of the DIP/distal phalanx and has pain at the DIP joint

A

Mallet finger

  • commonly a flexed DIP at rest
154
Q

What is the treatment for mallet finger

A

Maximize function, minimize discomfort
- splint finger in full extension
- if fractured do not reduce
- 6-8 weeks of splinting, sleep with it on as well

155
Q

What is an extensor tendon rupture at insertion of middle phalanx, flexion of PIP/extension of DIP, and a painful PIP joint

A

Boutonnière deformity

156
Q

What is the treatment for boutonnière deformity

A

Splint PIP in extension for 3-6 weeks
Allow DIP to move freely
PT for ROM
Ortho consult for ongoing deformity

157
Q

What are the hip bones composed of

A

Ilium - largest most superior
Ischium - “sit bone”
Pubis - lower anterior portion

158
Q

What forms the socket for the head of the femur

A

Acetabulum

159
Q

What is the largest foramen in the body

A

Obturator foramen

160
Q

What muscle flexes and rotates thigh laterally

A

Psoas major
Iliacus

161
Q

What muscle helps lock the knee in extension

A

Gluteus Maximus
Tensor fascia latae

162
Q

What muscle abducts and rotates the thigh medially

A

Gluteus medius

163
Q

What muscle flexes and abducts the thigh at the hip joint

A

Tensor fascia latae

164
Q

What muscle adducts, rotates and flexes thigh at hip joint

A

Adductor longus

165
Q

What muscle adducts, flexes, rotates and EXTENDS thigh at the hip joint

A

Adductor magnus

166
Q

What muscle is the external rotation of thigh laterally and abducts

A

Piriformis

167
Q

What flexes and adducts the thigh

A

Pectineus

168
Q

What is the strongest bone in the body

A

Femur

169
Q

What are the bones of the knee

A

Femur
Patella
Tibia
Fibula
Patellar ligament

170
Q

What is the attachment site for the patella ligament

A

Tibial tuberosity

171
Q

What provides leverage for the quadriceps muscle and protects the knee

A

Patella

172
Q

What attaches to the tibia via the interosseous membrane

A

Fibula

173
Q

What strengthens the anterior surface of the knee

A

Patellar ligament

174
Q

What ligament strengthens the medial aspect of the knee

A

Medial collateral ligament (MCL)

175
Q

What ligament strengthens the lateral aspect of the knee

A

Lateral collateral ligament (LCL)

176
Q

What ligament extends posteriorly and laterally from the tibia to the femur and limits hyperextension of the knee/prevents anterior sliding of the tibia on the femur

A

Anterior cruciate ligament (ACL)

177
Q

What ligament extents anteriorly and medially from the tibia to the femur and prevents posterior sliding of the tibia on the femur

A

Posterior cruciate ligament (PCL)

178
Q

What are the fibrocartilage discs that fit between tibial and femoral condyles and allow the bones to “fit” together more appropriately as they are irregular in shape

A

Menisci

179
Q

Where is bursae located in the knee

A

Prepatellar
Pen anserine
Infrapatellar
Suprapatellar

180
Q

What muscle adducts and medially rotates the thigh as well as flexes the leg at the knee

A

Gracilis

181
Q

What muscles adducts the femur

A

Adductor magnus
Adductor longus
Pectineus

182
Q

What muscle extends the knee, flexes the hip and is located anterior to other quadricep muscles

A

Rectus femoris

183
Q

What muscles extend the knee

A

Vastus lateralis
Medialis
Intermedius

184
Q

What muscle flexes at the knee, weakly flexes the hip and abducts/laterally rotates the thigh

A

Sartorius

185
Q

What muscle extends thigh at the hip and flexes the leg at the knee joint

A

Bicep femoris (hamstrings)

186
Q

What extends the thigh at the hip and flexes leg at the knee

A

Semitendinosis.

187
Q

What muscle extends the thigh at the hip and flexes leg at the knee

A

Semimembranosis

188
Q

What are the seven bones (tarsals) of the ankle

A

Large talus (ankle bone)
Calcaneus (heel bone)
Cuboid (lateral)
Navicular (medial)
Cuneiforms (numbered 1-3 medial to lateral)
Metatarsals (1-5/ base, body and head)
Phalanges (1-5/base, body and head)

189
Q

What are the ligaments of the lateral ankle

A

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

190
Q

What is the ligaments of the medial ankle

A

Deltoid ligaments
- four fused into one
- connects the tibia to the talus, calcaneus and navicular bones

191
Q

What muscle dorsiflexes and inverts the foot

A

Tibalis anterior

192
Q

What muscle dorsiflexes and everts the foot as well as extends the toes

A

Extensor digitorum longus

193
Q

What muscle plantar flexes and Everts the foot

A

Fibularis longus

194
Q

What muscle plantar flexes the foot and flexes the leg at the knee

A

Gastrocnemius

195
Q

What muscle plantar flexes the foot

A

Soleus

196
Q

What muscle plantarflexes and inverts the foot

A

Tibalis posterior

197
Q

What muscle plantar flexes the foot and flexes the toes

A

Flexor digitorum longus

198
Q

What special test of the lower extremity detects gluteus medius muscle weakness

A

Trendelenburg test

199
Q

What special test detects hip and sacroiliac pathology

A

Faber test

200
Q

What special test is used to detect acetabular or femoral neck pathology such as osteoarthritis or osteonecrosis

A

Log roll test

201
Q

What special test is used to test for a tight piriformis impinging the sciatic nerve

A

Piriformis

202
Q

What special test assess for labral pathology, loose body or other internal derangement of the hip

A

Scour

203
Q

What special test detects flexion contractors or tightness of the hip

A

Thomas test

204
Q

What special test, tests for patellar instability

A

Patellar apprehension test

205
Q

What special test assesses for cartilage degeneration in the knee

A

Patellar grind test (clarke)

206
Q

What special test evaluates the health of the menisci in the knee

A

mcmurray test

207
Q

What does the varus stress test evaluate

A

Integrity of the LCL

Valgus evaluate integrity of the MCL

208
Q

What special test detects instability of the anterior cruciate ligament

A

Lachmans

209
Q

What special test assesses for posterior cruciate ligament stability

A

Posterior drawer test

210
Q

What special test is used to see if the PCL is Lax

A

Sag

Positive - tibia will sag down when knee is at rest

211
Q

What special test detects iliotibial band (ITB) contractures or tightness

A

Ober test

212
Q

What special test assesses integrity of the Achilles’ tendon

A

Thompson test

213
Q

What special test, tests for possible tibio/fibula syndemosis injury

A

Tib/Fib squeeze

(High ankle sprain)

214
Q

What does a posterior hip dislocation show in a physical exam

A

Affected limb short, hip is flexed in adducted and internally rotated position

215
Q

What does an anterior hip dislocation show in a physical exam

A

Hip held in abduction and externally rotated

216
Q

What is the treatment for a hip dislocation

A

MEDEVAC
Reduction - going to need narcotics
SIQ until eval by ortho

217
Q

What may also present with a fracture of a femoral shaft

A

Mostly caused by high energy trauma
- pulmonary injury
- vascular complications
- intra-abdominal
- head injuries

218
Q

What is the treatment for a femoral fracture

A

Immediate splinting and traction
MEDEVAC
Surgical management required
If open wound, apply dressing

219
Q

What is a common injury that occurs because of repetitive impact and is seen in military recruits, athletes and runners

A

Stress fracture of the femoral neck

220
Q

What is the likely cause of someone who has vague pain in anterior groin or thigh that is exacerbated by activity and weight bearing but relieved with rest. They may also report a story of increasing activity prior to the pain onset

A

Stress fracture of femoral head

221
Q

What is the treatment for a stress fracture of the femoral head

A

Analgesics
Ortho evaluation
Activity modification
- crutches
- non weight bearing

222
Q

What might be the cause of someone who has pain in the groin area with attempted weight bearing and a sensation of “coming apart” at the hip when bearing weight. This person may also be in shock and have other distracting injuries to the head, chest or abdomen

A

Pelvic fracture

223
Q

What is the treatment for a pelvic fracture

A

MEDEVAC
Hemodynamic resuscitation
No weight bearing
Narcotic pain management
PELVIC BINDER

224
Q

What might be the cause of someone with sudden onset of posterior or thigh pain that occurred while running, water skiing or other rapid movement and may of heard a “pop” at the onset of pain.

A

Thigh strain
- quadriceps strains are associated wit direct blows during contact sports that result in a contusion

225
Q

What is the treatment for a thigh strain

A

Initial treatment - prevention of further swelling or hemorrhage by having patient rest and elevate limb while applying ice and compressive wraps as needed

After some time - begin rehab with pain free stretching and strengthening of the injured muscle
NSAIDs

226
Q

What may be the cause of someone who has pain and tenderness over the greater trochanter (lateral hip pain) that may radiate distally to the knee or ankle and pain worsening when going from sit to stand but may decrease after warming up or return after 30 min to 1 hour of walking.

A

Trochanteric bursitis

227
Q

What is the treatment for trochanter bursitis

A

NSAIDs
Light duty
Hip strengthening
Refer to ortho if conservative management fails

228
Q

What does ACL tears result from

A

Rotational (twisting) or hyperextension force of the knee

229
Q

What might be the cause of someone who reports sudden pain and giving way of the knee from a twisting injury as well as heard a “pop”

A

ACL tear

230
Q

What is the treatment for an ACL tear

A

RICE
Light duty
Ortho consult
PT consult
Knee immobilizer

231
Q

What is the strongest ligament of the knee

A

PCL

232
Q

What does a PCL tear result from

A

Stretch or complete rupture of the ligament
- less common than the other ligament injuries

233
Q

What are the four injury patterns that suggest a PCL tear

A

Dashboard injury - direct force to the anterior knee with knee in flexion
Pure hyper flexion of the knee
Hyperextension - ACL goes first then the PCL
Fall onto a flexed knee with the foot in plantar flexion

234
Q

How does MCL and LCL tears result

A

MCL - Valgus force
LCL - Varus force

235
Q

What is the treatment for an MCL tear and LCL tear

A

Usually non-operative and heal within 4-6 weeks (MCL)
Grade III LCL tear requires surgery
Contact MO
PT
NSAIDS
rice
Hinged brace
Crutches and weight bear as tolerated
Ortho consult if conservative fails

236
Q

How does bursitis of the knee present

A

Prepatellar bursitis - dome shaped swelling over the anterior aspect of the knee
Pes anserine - mild swelling to the medial aspect of the knee

237
Q

What is the treatment for bursitis of the knee

A

Rice
NSAIDs
Light duty
Pain free LE stretching
Antibiotic treatment for septic bursitis

238
Q

What might be the cause of someone who has focal pain at the anterior lateral aspect of the knee that worsens with activity and is worse when running downhill, mostly during heel strike but only has minor discomfort when as rest

A

ITB syndrome

239
Q

What is the treatment for ITB syndrome

A

NSAIDs
Foam rolling
Light duty
Modified training regiment

240
Q

What might be the cause of someone who has locking, catching or popping with squatting or twisting

A

Meniscal tear

241
Q

What type of meniscus tear requires a more urgent orthopedic evaluation

A

Bucket handle tear - leading to a “locked knee”

242
Q

What is the treatment for a meniscal tear

A

Locked knee - urgent referral
RICE
NSAIDs
ROM and pain free strengthening exercises
Consult to ortho

243
Q

What may be the cause of anterior knee pain that is exacerbated by exercise, prolonged sitting, squatting, kneeling and climbing, descending stairs, running and jumping increases the pain

A

Patellar tendonitits - jumpers knee

244
Q

What is the treatment for patellar tendonitits

A

NSAIDs
Rice
Light duty
Pain free stretching and strengthening
Patellar tendon strap for comfort

245
Q

What might be the cause of diffuse aching anterior knee pain that is exacerbated by prolonged sitting, climbing stairs, jumping or squatting. No preexisting trauma and some patients may report a sense of instability or retropatellar catching or grinding sensation

A

Patellofemoral pain

246
Q

What is the treatment for Patellofemoral pain

A

NSAIDs
Ice
Light duty -active rest
Quad and hamstring flexibility and stregthening
Weight loss if obese
McConnel taping
Patellar tracking brace
Motion control shoe/inserts

247
Q

What might be the cause of someone who has swelling/fullness in the popliteal fossa, posterior knee pain, and knee stiffness

A

Popliteal cyst

248
Q

What must be considered in your differential in someone suspected to have a popliteal cyst

A

DVT

249
Q

What is the treatment for a popliteal cyst

A

NSAIDs and/or analgesic
Ice
Light duty

250
Q

How does osgood schlatter disease present

A

Ages 14-18 possibly later in males
Pain and swelling at the tibial tubercle
Anterior knee pain that increases gradually
Typically asymmetrical

VISUAL - normal to slight swelling/bony prominence of tibial tubercle

251
Q

What is the treatment for osgood schlatters disease

A

Usually benign and self limiting - resolves when the growth plate reaches skeletal maturity
NSAIDs
Protective pad
Avoid complete rest
Home exercise

252
Q

What may be the cause of pain that is localized to the distal third of the medial tibia and the patient has increased training intensity, pace or distance.

PALPATION: Tenderness along posterior medial crest of tibia in the middle to distal third of leg

A

Shin splints

253
Q

What is the treatment for shin splints

A

NSAIDs
Ice
Light duty
Gradual pain free return to running
Weight loss if needed
Proper running shoes

254
Q

What presents similar to shin splints but pain increases over weeks to months and also begins to occur or worsen at rest

A

Tibial stress fracture

255
Q

All patients with a suspected tibial stress fracture require what

A

Imaging
- plain radiographs, but negative X-rays can’t rule out a stress fracture
- MRI/Bone Scan/CT are better at detecting stress fractures

256
Q

What is the treatment for a tibial stress fracture

A

Rest/duty modification
Weight bearing mod
NSAIDs and Tylenol for pain
Duty modification for 12 weeks

257
Q

What might be the cause of severe leg pain out of proportion to apparent injury, persistent deep ache or burning pain, parasthesia and symptoms progress over a few hours

A

Compartment syndrome

258
Q

What are you looking for in your physical exam on someone who may be experiencing compartment syndrome

A

Seven P’s
- pain
- pallor
- parasthesias
- paresis
- poikilothermia
- pulselessness

259
Q

What is the treatment for compartment syndrome

A

Acute is a medical emergency requiring fasciotomy by a surgeon
Place limb in neutral position
Analgesics and oxygen
Rest
NSAIDs
Ice is contraindicated

260
Q

What is the largest tendon in the body

A

Achilles’ tendon

261
Q

Who is at risk for an Achilles’ tendon rupture

A

Athletes
30-40 year olds
Male
Obesity
Running mechanism issues
FLUOROQUINOLONE ANTIBIOTIC USE
Rheumatologic diseases

262
Q

What are the areas required to be checked for the Ottawa ankle rules when ruling out an ankle sprain

A

Posterior edge/tip of lateral malleolus
Posterior edge/tip of medial malleolus
Base of 5th metatarsal - navicular

263
Q

If someone reports pain localized to the dorsum of the mid foot with minimal swelling what might you suspect

A

Lisfranc fracture

264
Q

What is the treatment for a lisfranc fracture

A

Ortho
Non displaced = 6-8 weeks non weight bearing
Displaced = surgery
Analgesics
Medevac

265
Q

What might be the cause of pain and swelling aggravated by shoe wear, and the great toe pronates with resulting callus on medial aspect

A

Bunion

266
Q

What is the treatment for a bunion

A

Initial - patient education and shoe wear modification
Light duty
Ice

267
Q

What might be the cause of plantar pain in the forefoot, dysesthesia into the affected two toes or burning plantar pain

A

Morton neuroma

268
Q

What is the treatment for Morton neuroma

A

Wear low-heeled, softsoled shoe with wide toe box
Metatarsal pads

269
Q

What might be the cause of someone with pain that is most severe on awakening or when rising from a resting position, prolonged sitting or standing increases the pain, and the pain is focal over the medial calcaneal tuberosity and 1-2 cm distally along the plantar fascia

A

Plantar fasciitis

270
Q

What is the treatment for plantar fasciitis

A

NSAIDs
Light duty
OTC heel pads
Night splints may be helpful

271
Q

What might posterior heel pain arise from

A

Insertion of the Achilles’ tendon at the calcaneus - Achilles tendinosis
Retrocalcanel bursa
Prominent process of calcaneus impinging on retrocalcanel
Inflammation of the bursa between the skin and the Achilles’ tendon

272
Q

What might be the cause of pump bump that is irritated by shoe wear, pain after activity and antalgic gait

PALPATION: tenderness noted over heel or directly on Achilles’ tendon

A

Posterior heel pain

273
Q

What is the treatment for posterior heel pain

A

Light duty
Heel lift or open back shoes
Ice massage
Achilles stretch
Casting for 6 weeks in extreme cases

274
Q

What is an hyperextension injury of the first metatarsal and patients usually report swelling, tenderness and limited ROM of the first metatarsal

A

Turf toe

275
Q

What is the treatment for turf toe

A

Rice
NSAIDs
Stiff shoe inserts
Severe injury requires non weight bearing and immobilization for 1-2 weeks

276
Q

What is an intra-articular fracture

A

Crosses the joint line

277
Q

What is cervical radiculopathy

A

Clinical condition that involves the neck, shoulder or arm pain

Radiculopathy - affecting nerve root

278
Q

What might be the cause of neck, shoulder or arm pain, muscle weakness, sensory changes, diminished DTR, and headaches

A

Cervical radiculopathy

279
Q

What is the treatment for cervical radiculopathy

A

Spontaneous resolution in weeks to a couple months
NSAIDs, Tylenol, muscle relaxers
Pt or chiropractor

280
Q

What might be the cause of non-focal neck pain from the base of the skull to the cervicothoracic junction, trapezius and SCM that is worse with ROM, has paraspinal spasms, occipital headaches, irritability, fatigue or sleep disturbances

A

Cervical strain

281
Q

What is the treatment for a cervical strain

A

Soft c collar
NSAIDs and muscle relaxers
Massage
Return to activity as soon as possible

282
Q

What are red flags for imaging of the spine

A

Saddle anesthesia
Loss of bowel/bladder function
Lower extremity weakness

283
Q

What might be the cause of abrupt or gradual unilateral radicular leg pain that has various aggravating factors.

A

Herniated disk

Possible neurological involvement
- L4/L4, L5-S1 distribution
- L1-L4 refers pain to the anterior thigh

284
Q

What is the treatment for a herniated disk

A

Control pain
Lifestyle modification
Rehab
Consult chiro/pt

285
Q

Lumbar scoliosis greater than what degree is disqualifying

A

20 degrees

30 degrees for thoracic scoliosis

286
Q

What is the goal of treatment with scoliosis

A

Improve function
Quality of life
Stamina improvement
- correction of spinal deformity is not a realistic goal for all cases

287
Q

What might be the cause of reproducible chest pain that is exacerbated pain with palpation on physical exam and patient may also have viral illness or other cause of inflammation in the chest

A

Costochondritis

288
Q

What is the treatment for costocondritis

A

Most improve over a course of a few weeks
NSAIDs
Home stretching activity modification

289
Q

What might be the cause of knee pain that was initially sharp and then with time foes to an aching deep pain that is alleviated with rest and exacerbated with use.

VISUAL: bony swelling possible
PALPATION: Joint line tenderness
ROM: Limited

A

Osteoarthritis

290
Q

What is the treatment for osteoarthritis

A

Pain control
- NSAIDs
- Tylenol
Stop insult to cartilage
- weight reduction
- activity/lifestyle modification
Rehab
- Aerobic and strengthening exercises

291
Q

4 out of the 7 ACR criteria must be met to diagnosis Rheumatoid arthritis. What are the 7?

A

Morning stiffness for one hour duration of 6 weeks
Arthritis in 3 or more joints for 6 weeks
Swelling of the hand joints
Symmetrical joint swelling
Rheumatoid nodules
Positive RF factor
Erosions or osteopenia in hand X-RAY
May have myelopathy with c1-c2 involvement

292
Q

What is the treatment for rheumatoid arthritis

A

Medavice with GMO or refer to internal medicine
Typical pain medications
Physical therapy/surgery

293
Q

What is reactive arthritis

A

Spondyarthropathy that is preceded and precipitated by infection in the body:
- urinary tract infection
- diarrheal illness
- sexually transmitted infection

294
Q

How does reactive arthritis present

A

Acute onset joint pain 1-4 weeks after infection
- enthesistis = inflammation of insertion sites for ligaments, tendons, fascia
- dactlyitis = sausage fingers
- lower back pain
- nail changes
- conjunctivitis
- oral lesion

295
Q

What is the treatment for reactive arthritis

A

Treat infection if active
Symptoms are self limited and may last up to 6 months
NSAIDs for pain

296
Q

What is psoriatic arthritis

A

Associated with psoriasis

297
Q

How does psoriatic arthritis present

A

Pain and stiffness in affected joints
Stiffness sometimes alleviated by physical activity
Asymmetry distribution of joint pain
Skin lesions prior to pain
Nail lesions
Ocular lesions

298
Q

What is the treatment for psoriatic arthritis

A

Do not attempt to manage, refer to derm or rheumatology

299
Q

What is ankylosis spondylitis

A

Inflammatory arthritis of the spine
- potential cause of lower back pain

300
Q

How does ankylosing spondylitis present

A

Back pain
Bamboo spine in late stage cases - sever restricted back mobility

301
Q

What is the treatment for ankylosis spondylitis

A

Recognize and refer
Initial pain relief with NSAIDs
Expect use of demands after rheumatology referral
Minimize damage to spine

302
Q

What is gout

A

Monsodium urinate crystal deposition in joint and tissues
- i.e. uric acid deposition

303
Q

What are the common sites of involvement for gout

A

1st toe, ankle, knee, wrist, fingers and elbows

304
Q

How does gout present

A

Intense pain, redness and swelling that occurs within hours to days

LABS: Uric acid
NEEDLE SHAPED, NEGATIVE BIREFRINGENT (joint space fluid aspiration)

305
Q

What is the treatment for gout

A

Acute:
- NSAIDs = INDOMETHACIN
- colchicine
- steroids
Prophylaxis:
- allopurinol
- probenecid
DIET MODIFICATION:
- AVOID:
- meat
- seafood
- alcohol
- high fructose corn syrup

306
Q

What is pseudo gout

A

Similar to clinical presentation of gout but Uric acid levels are normal

307
Q

What is the treatment for pseudo gout

A

NSAID - indomethacin
Lifestyle changes

308
Q

What is the most common cause of septic arthritis

A

Staphylococcus aureus

309
Q

If someone presents to medical following a recent surgery that has severe pain, swelling and decreased mobility as well as fever and tachycardia what might be the cause

A

Septic arthritis

310
Q

What is the treatment for septic arthritis

A

Supportive if in shock (iv, monitors, vs, bolus of IVF)
IV antibiotics (ceftriaxone or vancomycin) - joint fluid aspirate helps determine the antibiotic needed
MEDEVAC

311
Q

What is virchow triad

A

Hypercoagulabilty
Venous stasis
Endothelial damage

312
Q

What might put someone at risk for a DVT

A

MSK surgery
Polytrauma
Spinal cord injury
Immobilization
Cancer history
Smoking
Diabetes
Estrogen use
Obesity
Age

313
Q

What are the symptoms of a fracture

A

Severe pain, swelling and decreased mobility
Limited weight bearing
Numbness, tingling pallor, ecchymosis, and deformity

314
Q

What are the classifications of a fracture

A

Skin integrity - broken skin = open fracture, bone doesn’t have to be the cause of skin break
Displacement/angulation/rotation
Orientation

315
Q

What is the treatment for a fracture

A

Four r’s
Recognition
Reduction
Retention of reduction while achieving union
Rehabilitate

316
Q

What further treatment may be required with fractures

A

Pain control
Rule out other life threatening injuries
Copious irrigation for open fractures
Tetanus prophylaxis

317
Q

When should you check pulses when splinting

A

Before and after

318
Q

What splints are required for the different types of fractures

A

Traction = femoral
Spine board/c-collar= spine
Sling = clavicle
Pelvic binder = pelvis
All should be in position of comfort/natural positioning and loose to allow for swelling/well padded

319
Q

What are the carpal bones

A

Scaphoid
Lunate
Triquetrium
Pisiform
Trapezium
Capitate
Hamate

  • scared lovers try positions that they can’t handle
320
Q

What are the muscle groups of the hip

A

Iliopsoas
Sartorius
Rectus femoris

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