MSK

Question 1

AC injury

Answer 1

young active pt
fall on shoulder- bike accident

s/s: pain on top of shoulder radiates to neck,
tender AC joint
dec. ROM of shoulder
pos. crossover test

dx: clinical, X-rays if unsure

tx; ice, sling 2-4 weeks, NSAIDS, early ROM each day

grading : 1-3 tx as above

grade IV-VI- both ligaments ruptures, significant displacement of clavicle- see orthro surgeon

Question 2

clavicle fx

Answer 2

most common fx in kids

s/s: pain over clavicle, tenting of skin
dec shoulder ROM
document pulses, sensation ,strength
fx at middle 1/3

dx: xray
if fx is more close to center of chest - worry about subclavian vein injury
tx: sling or figure of 8 splint, 3-4 weeks,
after 3-4 weeks start ROM

Question 3

rotator cuff disorders

Answer 3

chronic, overhead work or fall on hand. Pain begins as inflame, then becomes impingement then progress to tear

s/s: pain at great tuberosity, lateral shoulder
pain with abducting arm
positive Neer impingement and Hawkin’s sign

dx: MRI

tx: rest, ice, NSAIDS, PT, steroid injection
if no better after 6-12 weeks–> surgery

Question 4

biceps tendonitis

Answer 4

overuse of the beeps mm, usually heavy or excessive lifting

s/s: anterior shoulder pain
bicipitical groove tenderness

dx: clinical, xray to r/o other injury
tx: rest, ice, sling, NSAID, steroid injection ( no to god into sheath of tendon- can get a rupture

Question 5

proximal humerus fx

Answer 5

fall on an out-stretched hand
elderly lady with osteoporosis

s/s: pain, swelling proximal humerus with dec. should ROM
evaluate axillae a. /nerve

dx: xray
tx; sling and swath 4 x early ROM
surgery if head displaced or compound fx.

Question 6

shoulder dislocations

Answer 6

fall on externally, abducted arm

s/s: present with arm abducted and in ER
shoulder appears “ squared off”
evaluate axillary nerve and artery

dx; anterior dislocation
xray AP lateral and Y view
posterior rare ( electric shock or seizures)

tx: immediate close reduction with post reduction X-ray
sling/swath X 4 weeks, start RoM at 2 weeks

Question 7

tennis elbow ( lateral epicondylosis)-

Answer 7

overuse-repetive supination and wrist extension

s/s: point tenderness over lateral epicondyle, pain on resisted wrist extension

dx: clinical, xray to r/o arthritis or loose body
tx: rest, ice, NSAIDS, counter force strap, steroid injection

Question 8

medial epicondylosis

Answer 8

golfer’s/pitchers elbow
s/s: point tenderness over medial epicondyle, pain on resisted wrist flexion

dx: clinical, xray to r/o arthrites or loose body
tx: rest, ice, NSAIDS, steroid injection, stretching exercises

Question 9

suprcondylar fx

Answer 9

-common in children
kid falling off monkey bars

s/s: pain and swelling over the distal humerus,
check pulses and nerves

dx: X-ray look for posterior fat pad signs ( never normal0
bilat X-rays are helpful( hard to distinguish from growth place)

tx: non-diplaced–> long arm cast
displaced–> surgery

Question 10

radial head fx

Answer 10

FOSH injury

s/s: present splinting in flexion
swelling/ diffuse elbow pain over lat elbow

dx: xray- posterior fat pad 9 blood or fluid in joint)
tx: non-displaced or occur–> 2-4 weeks

Question 11

colles fx

Answer 11

distal radius fx

scenario: elderly person, fall FOSH

s/s: swelling/ tenderness/ contusion on distal radius/ulna

“silverfork” deformity
dx: xray-

tx: closed reduction and cast 6-8 weeks
if intra-articular or comminuted fx it requires surgery

Question 12

scaphoid fx

Answer 12

most common carpal fx
s/s: snuff box tenderness

tx: non-displaced-thumb spica cast 6-20 weeks
- if suspect fx: immobilize and repeat X-ray in 1 week or r/o with bone scan

high non-union rate with waist and proximal fracture

Question 13

boxer fracture

Answer 13

5th metacarpal fx

s/s: pain and swelling over the 5th metaphalange

tx: closed reduction and ulnar gutter splint
close f/u for loss of reduction

always suspect” closed fist syndrome” punch to teech= human bite= OR + IV

Question 14

de Quervains tenosynovitis

Answer 14

seen in chef’s, new mothers

s/s: pain along radial aspect of wrist
positive Finkelstein test

dx: clinical
tx: thumb spica splint for rest, NSAiDS, steroid injection

Question 15

trigger finger

Answer 15

s/s: painless nodule in flexor tendon initially but then it hurts

dx: clinically

tx: activity mod, splinting, NSAIDS
- steroid injection into tendon sheath
- surgical release

Question 16

carpal tunnel syndrome

Answer 16

medial nerve compression due to receptive wrist flexion

s/s: paresthesias in the thumb, index, and middle finger

postive Phalen and Tinel sign

dx: clinical, EMG/NCV is unsure of dx

tx: night-time splinting, steroid injection,
surgical release

Question 17

cervical fx

Answer 17

50% of all C-spine injuries are due to mVA

s/s: posterior mid-line tenderness, focal neuro deficits

dx: lateral X-rays
most injuries happen at c4-c6

tx: immobilization and surgical fixation

Question 18

ankylosing spondylitis

Answer 18

chronic inflame disease in spine and pelvis

s/s: diffuse LBP with morning stiffness
early exam often negative

progresses to dec. spine mobility and limited chest expansion

dx; X-ray early show sacroilitis
late show bamboo spine
increase in ESR

tx: PT for flexibility , pt edu
posture management
NSAIDS or TNF inhibitors

Question 19

kyphosis

Answer 19

progressive inc in the dorsal curve of the t-spine

causes: d/t osteoporosis, cancer, trauma, fracture

s/s: pain from acute fx or reconditioning of back mm
loss of ht.
hunchback deformity

dx: clinical
xray

tx: PT, light support
kyphplasty for new fx

Question 20

scoliosis

Answer 20

idiopathic lat curvature of spine > 10 degree

s/s: asymptomatic
painless spinal asymmetry
paraspinal hump

dx: clinical and X-ray to measure angle of Cobb
tx: tx depends on angle and age

40 degrees–> surgery

Question 21

LBP

Answer 21

s/s: low back pain radiates to buttock or leg, worse with long periods of standing

tenderness on paraspinal mm
dec. ROM
normal neuro

dx: clinical
xray to r/o causes if sxs persist

tx: rest, ice, NSAIDS, pT education
narcotics and mm relaxers for 3 days- bad thing

Question 22

herniated disc

Answer 22

s/s: pain in nerve distributing worse with flexion or valsalva
-motor weakness and diminished reflexes

lumbar disc; postive straight leg raise

dx: MRI

tx: rest/ice/NSAIDS, PT deuce epidural steroid injections
consider surgery if sxs no better in 6-12 weeks.

Question 23

cauda equina syndrome

Answer 23

sudden compression of l2-s4 nerve roots
disc herniation, epidural abscess, hematoma

s/s: saddle anesthesia

dx: MRI
tx: emergency tx

Question 24

spinal stenosis

Answer 24

narrowing of spinal canal or neural foramen

s/s: insidious onset of buttock and leg pain

numbness with ambulation
relief with sitting or flexion of spine

dx: MRI best

tx: rest, PT, NSAIDS, weight reduction
epidural steroids, nerve blocks
surgery when QOL impaired

Question 25

avascular necrosis

Answer 25

loss of blood supply to femoral head
causes: trauma, steroids and anti-retroviral use

s/s: dull, aching, groin pain
pain on IR and ER

dx: mRI
tx: refer for orthopedic evaluation.

Question 26

hip fx

Answer 26

d/t fall in elderly woman
femoral neck or IT fx

s/s: leg will be shortened

dx: xray

TX: ORIF

Question 27

hip dislocation

Answer 27

d/t high impact trauma

s/s: limbs shortened and internal rotated

dx: xray, CT to r/o fx of acetabulum
tx: immediate reduction with post reduction film

Question 28

tibial plateau fx

Answer 28

falling from ladder or window

s/s; pre

dx: X-ray use CT or MRI if unsure
tx: immobilize, non-weight bearing

depends on fx–> cast immobilize

Question 29

patellar fx

Answer 29

direct blows or forced flexion of the quad mm

s/s: pain and swelling of the soft tissue of anterior knee
inability to actively extend knee

dx: PE and xray

tx: 8 weeks immobilization
3 mm or step off

Question 30

ACL injury

Answer 30

forceful internal rotation of knee with planted foot

s/s: pt hears pop, sudden swelling instability
acute hemarthrosis
+ lachman test and anterior drawer sign

dx: clinical, confirm with mRI

tx: rest, ice, NSAIDS, bracing, PT with activity changes
young athletes or those with chronic movement= arthroscopic ACL reconstruction

Question 31

meniscal injuries

Answer 31

s/s : train of joint line pain, effusion an locking and clinics
positive McMurray and Apley test

dx: clinical, confirm with mRI

tx: RICE, NSAiDS and PT
arthroscopy for persistent sxs

Question 32

pre patellar bursitis

housemaid’s knee

Answer 32

s/s: palpable boggy swelling over patella

dx: clinical
tx: RICE, NSAIDS, usually self-limited

Question 33

ankle sprain

Answer 33

85% of injuries are inversions

ATF most commonly injured ligament

s/s: hear a pop following by swelling and contusion

pain over ligaments

dx: clinical X-ray if boney tenderness or pt unable to weight bear
tx: RICE, NSAiDS, supportive brace with WBAT for 4-6 weeks

Question 34

ankel fx

Answer 34

caused by eversion, inversion, or lateral rotation of ankle

s/s: pain, swelling, ecchymosis, instability
-check fibula for tenderness
check perineal nerve ( foot drop)

dx:
X-ray required if pain one the malleolar zone
- follow the Ottawa Ankle Rules
xramy if tenderness over the mid foot zone over the 5th metatarsal , navicular bone

tx:

Question 35

achilles tendon rupture

Answer 35

caused by pushing off or forcible plantar flexion
common 30-40

s/s: report a pop and feel weakness when walking
deformity noted proximal to attachment
postive Thompson test

dx: clinical, MRi for surgical planning
tx: plantar flexion cast 8-12 weeks

Question 36

avulsion fx

Answer 36

avulsion of 5th fx, inversion of foot causes a chip fx

s/s: pain/ ecchymosis at base of 5th MT

dx: xray
tx: hard shoe or cast w/ rapid return to wt. bearing

Question 37

stress fx

Answer 37

repetitive stress lead to bony resorption before new bone can be placed.

s/s: pain over bone without history of trauma
fx usually occur at tibia
metatarsal, calcaneus or sacrum

dx: clinical X-ray not + for 3-4 weeks
bone scan or MRi

tx: rest, activity modifiations or not-wt bearing for 4-8 weeks