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MSK Flashcards

1
Q

Most frequent sports injury?

A

Ankle sprains

Can lead to chronic pain, swelling, and functional instability (tend to reinjury the same ankle)

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2
Q

Common treatments for ankle sprain

A
  1. Ankle bracing
  2. Rehab
  3. Multifaceted prevention program
  4. Surgery
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3
Q

MOA of Ankle bracing?

A

The brace physiologically restricts ankle motion
Rigid braces more effective than taping
Recommend use for at least 6 months, but little to prevent future injury

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4
Q

Benefits of rehab for ankle sprain?

A

Preferable to bracing and surgery for acute ankle injury
Proprioceptive exercises may be protective from future injury
Resistance exercises only begin when pt has FROM and can bear full weight
Focus is on strengthening muscles

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5
Q

Benefits of multifaceted prevention program for ankle sprain?

A

Incorporates a variety of strategies to injury reduction/sprain prevention
Education on the importance of disciplined play (ie warm up/cool down, correct gear
Needs more research

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6
Q

Benefits of surgery for ankle sprain?

A

Reserved for patients that fail non-operative treatment.

Highly successful in treating chronic instability

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7
Q

Most common pharmacologica approach in sprains?

A

NSAIDs

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8
Q

Initial treatment of choice for an acute ankle sprain?

A

Functional rehabilitation

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9
Q

How many adults have low back pain?

A

Approx 2/3

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10
Q

Spondylolysis is a defect in?

A

the pars interarticularis of the vertebra

Can be congenital or due to stress fx

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11
Q

Spndylolistesis refers to?

A

Anterior displacement of vertebra
Occurs as a result of spodylolysis or degenerative disk dz
Process can contribute to narrowing of spinal canal -> spinal stenosis

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12
Q

Foot dorisflexion tests?

A

L5

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13
Q

Plantar strength, ankle reflex tests?

A

S1, L4

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14
Q

Therapy for nonspecific low back pain

A

Scheduled NSAIDs
Ciro, PT if pain persists > 3 wks
Rapid return to normal activities

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15
Q

Treatment for herniated intervertebral disks (w/o neurologic deficit)

A

NSAIDs, Chiro, PT x 1 month. Narcotics can be used for a short amount of time.
Epidural corticosteroids
CT or MRI if syx are persistant
Benefit of dikectomy is unclear for long term tx

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16
Q

Treatment for spinal stenosis

A

Avoid alcohol and sedatives to reduce the risk of falls
Encourage walking/cycling
NSAIDs, PT, epidural corticosteroids
Laminectomy in persistant pain
Spinal fusion if they also have degenerative spondylolithesis

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17
Q

Treatment for chronic low back pain w/o radiuclopathy

A

Intensive exercise
TCA, SSRI’s for those w/ depression (chronic pain causes neuronal hyperactivity)
Refer to multidisciplinary pain center

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18
Q

Best way to prevent back pain

A

Aerobic conditioning with back and leg strengthening

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19
Q

When is surgery a good option for back pain?

A

Pts with sciatica or other neurological process

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20
Q

Which nerve is affected in carpal tunnel syndrome?

A

Median n.

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21
Q

Pt demonstrats a “painful arc” on shoulder exam. Dx

A

Supraspinatus tendinitis

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22
Q

What is the most appropriate first line management for a small ganglion?

A

Reassure and review if not improving or enlarging

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23
Q

What are some red flags for back pain?

A

Pain that does not go away with rest
Pain w/ neurological syx
Hx of cancer
Fevers and chills

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24
Q

What type of limp is characterized by shortening of stance?

A

Antalgic

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25
Q

12 year old male is brought into the office for evaluation of hip pain and a limp. On Physical exam he is obese and limping. Xray shows narrowing of femoral joint. Dx?

A

Slipped capital femoral epiphysis

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26
Q

Your female patient is referred for evaluation after recent diagnosis with Graves disease. She has a large goiter and compressive symptoms. Management?

A

Radioiodine therapy

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27
Q

Most common compressive neuropathy of the upper extremity?

A

Carpal Tunnel syndrome

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28
Q

What is the most superficial structure in the carpal tunnel?

A

Meadian n.
Enters the space in the midline or just radial to the midline
nerve can divide in the forearm or in the tunnel

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29
Q

Why is the median n. susceptible to compression within the carpal canal?

A

Unyeilding fibrosseous borders of the canal

With edema/inflammation the pressure increases -> nerve irritation

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30
Q

Precipitating factors for acute CTS?

A

Wrist trauma
Infection
High pressure injection
Hemorrhage

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31
Q

Precipitating factors for chronic CTS

A 
More common than acute
Idiopathic
Anatomic
Systemic
Exertional
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32
Q

What causes anatomic chronic CTS?

A 
Persistent median a.
Infection
Ganglion cyst or Tumor
Trauma (edema, hemorrhage, scaring)
w/in carpal canal increases interstitial fluid pressure
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33
Q

What causes systemic chronic CTS?

A 
Obesity
Drug toxicity
Alcoholism
Diabetes
Pregnancy (3rd trimester)
Hypothyroidism
RA
Primary amyloidosis
Renal failure
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34
Q

What causes exertional chronic cTW?

A

Repetitive use of wrist and digits, repeat impact to the palm, and operation of vibrating tools

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35
Q

How do you dx CTS?

A

History - nocturnal pain, numbness, tingling of thumb and 1st two fingers. Improves with shaking
B/l common
Tinel’s sign, Phalen’s test
ABN EMG

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36
Q

How do you treat CTS?

A

Splinting, corticosteroids, diuretics, NSAIDS - idiopathic cases
Surgery - Trauma or infection, or chronic cases with denervation of abductor pollicis brevis m. (thenar atrophy) or pronounced sensory loss

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37
Q

Most common method to decompress CTS?

A

Open surgical release

Palmar fascia and TCL are incised

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38
Q

Most common complication of CTS surgery?

A

Incomplete release of TCL -> recurrent CTS symptoms
More common in endoscopic
Endoscopic and open surgery overall equivalent

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39
Q

What Xrays should be ordered for a shoulder injury?

A

AP and axillary lateral

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40
Q

Most common causes of shoulder pain?

A
  1. Impingement syndrom - rotator cuff is compressed against the acromion
  2. Rotator cuff tears
  3. Adhesive capsulitis
  4. Arthritis of glenohumoral and AC joint
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41
Q

Pain when pt elevates the arm in the scapular plane as high as possible

A

Painful arc sign

Rotator cuff tear

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42
Q

Pain when pt elevates arm in the plane of the scapula fully and return to their sides slowly. Or passive elevation of arm and pt quickly drops arm back to their side

A

Drop arm sign

Rotator cuff

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43
Q

Examiner passively elevates arm above the patients head and elicits pain in the front of the shoulder

A

Neer impingement

Impingement syndrome or rotator cuff tear

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44
Q

Pain when Pt’s arm is abducted 90 degrees and then rotate between neutral and internal rotation.

A

Hawkins impingement sign

Impingement syndrome

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45
Q

External rotation strength is tested b/l with pts arms and side and elbows flexed 90 degrees. Instruct pt to push against the examiner

A

Rotator cuff strength
Use to dx full-thickness or large rotator cuff tears
Partial thickness or small tears are unlikely to cause weakness on examin

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46
Q

Best test for bursitis or partial rotator cuff tear?

A

Neer impingement

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47
Q

+ Painful arc sign, drop-arm test, and external rotation strength test have high probability for?

A

Rotator cuff tear (91%)

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48
Q

What test should be ordered to confirm Rotator cuff tear?

A

MRI

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49
Q

How do you treat impingement syndrome?

A

PT
Can also offer a subacromial steroid injection
If no response x3 months consider decompression

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50
Q

If a pt has a rotator cuff tear that is repairable can they receive subacromial steroid injections?

A

Yes, but no more than two as this can weaken the remaining tendon and have poorer outcome after repair

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51
Q

When is a rotator cuff irreparable?

A

If MRI demonstrates fevere fatty atrophy of the muscles or if the humeral head has migrated up to the acromion.
This migration occurs several months after a tear.

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52
Q

Why do rotator cuff tears have an option to try PT for 3 months prior to surgery?

A

Approx half the time PT can make the tear painless
Reasonable option for those that really want to avoid surgery
Only offered to those with partial or small tears. PT makes large tears worse

53
Q

What are the risks of steroid injections?

A 
Infection
Anaphylaxis
Vagal response
Hyper glycemia in DM
Long term: tendon rupture
54
Q

What surgery is recommended for impingement syndrome?

A

Outpt arthroscopy
Recovery 3-4 months
Better outcomes if they participate in PT post surgery

55
Q

What are the benefits of rotator cuff surgery?

A

90% have excellent results
Result directly correlates with size of tear and amount of atrophy
Recovery takes 4-6 months + PT

56
Q

When does a adhesive capsulitis pt become a candidate for surgery?

A

If they do not respond to 12 months of PT

Capsular release

57
Q

Most common impingement syndrome of the shoulder?

A

Subacromial impingement syndrome
Painful arc of motion when pt reaches overhead
Can advance to a rotator cuff tear/tendonitis

58
Q

What are the 3 categories of subacromial impingment syndrome?

A

Primary external - outlet, rotator cuff obstruction dysfunction
Secondary external - instability, rotator cuff dysfuntion
Internal - repCetitive, rotator cuff microtrauma dysfunction =/- instability (posterior pain)

59
Q

What is a SLAP injury?

A

Superior labrum tear with anterior and posterior extension

60
Q

What is a HAGLE injury?

A

Humeral Avulsion of the Inferior Glenohumeral Ligament

61
Q

What is an ALPSA injury?

A

Anterior Labroligamentous periosteal sleeve avulsion

62
Q

Chronic labral tears can often cause?

A

Paralabral synovial cysts

63
Q

What are two risk factors for elbow injury?

A
  1. Asymmetic loss of shoulder internal rotation
  2. Weak scapular stabilizers
    Looking for strain or tear to the ulnar collateral ligament (UCL)
64
Q

Two causes of thumb pain

A
  1. DeQuervain tenosynovitis - abductor pollicis longus and extensor pollicis brevis
  2. First metacarpophalangeal (MCP) joint UCL laxity
65
Q

How do you grade ligament injuries?

A

Grade 1 - Tenderness no laxity
Grade 2 - tenderness, mild laxity
Grade 3 - tenderness, significant laxity

66
Q

Steroid injections are considered definitive (curative) treatment for?

A 
De Quervain tenosynovitis and 
Trochanteric bursitis (hip pain)
67
Q

Definitive tx for rotator cuff pain?

A

PT
+ injection of not responsive
Arthroscopy if failed conservative therapy

68
Q

Most common indication for intra-articular injection?

A

Arthritis

69
Q

Recommended time interval between injections?

A

3 months

70
Q

When is a soft tissue injection concerning?

A

When pt is a diabetic - close glycemic control for 5-21 days

71
Q

What are the contras for injection?

A 
Broken skin at the injection site
Known hypersensitivity to intra-articular agent
Osteochondral/intra-articular fx
Protestic joint
Severe joint destruction
Skin infection at site of infection
Unstable coagulopathy
72
Q

If a steroid has low solubility it will have?

A

Longer duration of action, but more cutaneous side effects

73
Q

Causes of bone pain

A 
Trauma
Cancer
Infection
Metabolic dz
Repetitive stress
74
Q

Most common cancers that cause bone metastasis?

A

Lung
Breast
Prostate

75
Q

Leading cause of mobility problems in the elderly?

A

OA

76
Q

What is the pathophys of OA?

A

Wear increases lysosomes and matrix proteins that break down cartilage and decreases rate in synthesis of new proteoglycans
Often follows changed biomechanics of the joint

77
Q

Tendinosis is the new preferred term for tendonitis because?

A

Bx do not reveal inflammatory cells

78
Q

Most commonly injured ligament in the ankle sprain?

A

Anterior talofibular ligament

+ ankle anterior drawer = torn ligament

79
Q

Which canal shape is predisoposed to lateral recess spinal stenosis?

A

Trefoil-shaped

Aging, disc herniation, facet joint hypertrophy, ligamentum flavum thickening and disc space narrowing also contribute

80
Q

What else can cause a narrowed spinal conal?

A

Aging, disc herniation, facet joint hypertrophy, ligamentum flavum thickening and disc space narrowing also contribute

81
Q

Why are nerve roots sensitive to injury?

A

Lack of protectic perineurium

82
Q

What is the pathophys of nerve injury in spinal stenosis?

A

Nerve root ischemia

83
Q

spinal stenosis should be considered to be caused by a combination of?

A
  1. Narrowing of the spinal canal
  2. Ischemia of the roots (venous HTN/engorgement, arterial insufficiency, biomechanics)
    May also have a inflammatory or instability (stretch) component
84
Q

How many levels of stenosis do you need to produce symptoms?

A

More than 1

85
Q

If L4 herniates, what nerve root will be affected?

A

L5-S1

Responds well to decompression

86
Q

Narrowing + ischemia means that spinal stenosis will respond to?

A

Decompression as well as vasodilators (calcitonin)

CVD drugs may be useful on this “back angina”

87
Q

Tendons connect?

A

muscle to bone

88
Q

3 theories for tendinosis?

A
  1. Mechanical - accumulation of micrtraumas, degeneration
  2. Vascular - hypovascularity of the tendon
  3. Neural - intradentous nerves lying close to the mast cells -> degranulation -> release substance P
89
Q

What is the main tx for tendonopathy?

A

Exercise as soon as tolerable- maintain fitness, flexibility, strength
Bracing, NSAIDs, injections, sclerosing agets (polidocanol), and PRP can be considered

90
Q

DDx for hip snapping in a young healthy athlete

A

Intra-articular - loose bodies, labral tears, synovial condromatosis, osteochondral fx, femoral acetabular impingement
extra-art = IT and glutues tendon snapping, ilipsoas tendon

91
Q

What causes femoral acetabluar impingement?

A

ABN contact between the femoral neck and the acetabulum

92
Q

How do you treat a snapping hip?

A

3 months of NSAIDs, rest, stretching
Add injections
Hip arthroscopy

93
Q

Which pts are most prone to ACL tears?

A

15-25 y/o females

Usually via noncontact

94
Q

Why are women more prone to ACL tears?

A

They have less knee and hip flexion during movement, increased valgus and internal rotation. Quadriceps domiant

95
Q

Athlete describing retropatellar and occasional medial or lateral pattellar aching

A

Patellofemoral pain
Usually exacerbated by hills, stairs, squatting, or prolonged sitting
Pay attention to lower limb alignment on exam
Also consider ITB tightness and meniscal tears

96
Q

How do you manage patellofemoral pain?

A

Bracing, activity modification

97
Q

which ligaments are injured in ankle sprains?

A

Anterior talogibuular ligment

Calcaneofibular ligament

98
Q

Ddx for a marathon runner with lower leg pain?

A

Muscle/tendon overload, bone overload, chronic exertional compartment syndrome, vascular causes

99
Q

Runners with a hypertrophied medial gastrocnemius m. are at risk for?

A

popliteal a. entrapment syndrome

100
Q

Most mobile joint in the body?

A

Shoulder

101
Q

Whcih two bones compose the shoulder girdle?

A

Clavicle scapula

102
Q

Which muscles attach to the scapula?

A

The rotator cuff

Supraspinatus, infra, teres minor, sub scap

103
Q

The clavicle provides protection to?

A

subclavian a. v.

brachial plexus

104
Q

What is a shoulder speration?

A

sprain or dislocation of the AC joint

105
Q

Who is at risk of a labral tear?

A

Folks with overhead activity like swimmers or pitchers

106
Q

Repetitive stress to the patellar tendinous insertion at the proximal tibia

A

Osgood-Schlatter dz (traction apophysistis)

107
Q

Young adults are more prone to? Vs elderly?

A

Young - septic arthritis, ligament injuries

Elderly - crystal depostition dz’s

108
Q

What type of joint is the knee?

A

Hinge

109
Q

Largest sesamoid bone in the body?

A

Patella

Encapsulated within the quadriceps tendon

110
Q

What lies under the patellar tendon?

A

Infrapatellar bursa

Hoffa fat pad

111
Q

which lower leg bone is medial?

A

Tibial

112
Q

Common insertion of the semitendinosis gracilis, sartoious tendons

A

Pes anserinus

Insert anteromedially just distal to the medial tibial plateau

113
Q

Inabillity to fully extend knee during exam?

A

Effusion, obstruction

114
Q

Securing the patella w/ inferior pressure and pt tightens quads producing pain

A

Patellofemoral syndrome

115
Q

Valgus stress tests the?

A

LCL (push on medial side of kee)

116
Q

Varus stress tests the?

A

MCL (push on lateral side of knee)

117
Q

Lachman tests the integrit of?

A

ACL tear

118
Q

The pivot-sift test - cradle lower leg in extension and flexing the knee with valgus stress

A

Pivot-shift, MacIntosh test

See laxity with ACL deficient knee

119
Q

Test of meniscal injury

A

McMurray
Pain or click = positive
external = lateral
internal = medial

120
Q

IF McMurray isn’t tolerable,what can you try?

A

Apley compression test - apply downward pressure on the foot and alternate external and internal rotation
Not as accurate as McMurray so consider MRI

121
Q

Pt lies on side to test ITB legnth

A

Ober

122
Q

What Xrays views should be ordered?

A

Anteroposterior (AP), lateral, oblique

123
Q

Patellar tilt can be imaged with?

A

Merchant or sunrise views

124
Q

What are the 3 functional parts of the vertebrae?

A
  1. Vertebral body - bears weight
  2. Vetebral (neural) arch - protects the neural elements
  3. Bony processes (spinous and transverse) - increase efficiency of the muscles
125
Q

How are lumbar vertebral bodies different from thoracic?

A

Lumbar do not have rub facets

126
Q

If ossification of the pars interarticularis fails to occur?

A

Spondylolysis

127
Q

3 layers of the meninges?

A

pia
arachnoid
dura mater - strongest

128
Q

Fibrosing disorders with slowly progressive thickening and shortening of the plamar facia -> debilitating digital contractures

A

Dupuytren disease
Especially affects smaller fingers
More likely in males, FHx
PAINLESS

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