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MSK Flashcards

1
Q

Arm abduction is achieved through ________ and _______ joint motion

A

Glenohumeral; scapulothoracic

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2
Q

There are _____ degrees of GH motion for every ______ degree of scapulothoracic motion during arm abduction

A

2;1 (120:60)

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3
Q

Direction of GH instability: of the three, which is most common?

A

Anterior GH instability, posterior GH instability, multi-directional instability;
anterior inferior most common direction

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4
Q

Complication of anterior GH instability?

A

Axillary nerve injury

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5
Q

Cause of posterior GH instability?

A

Seizure

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6
Q

Hill-Sachs lesion is a

A

compression fx of postero-lateral humeral head caused by abutment against anterior rim of glenoid fossa

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7
Q

Test to detect SLAP lesion

A

O’Brien’s test

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8
Q

Rotator cuff tears occur primarily in the _______ tendon

A

supraspinatus

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9
Q

With rotator cuff tears, can see pain during ROM with

A

repetitive overhead activities (swimming, throwing baseball)

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10
Q

What imaging study is gold standard to eval rotator cuff integrity?

A

MRI

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11
Q

Arthrogram is beneficial in assessing ______ rotator cuff tears, but

A

full thickness;

cannot delineate size of tear or partial tears

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12
Q

What is done during fxnal phase of rehab of rotator cuff tears?

A
  1. Continue strengthening, increasing power and endurance
  2. Perform activity-specific training
  3. Focus on scapular stabilizers and rotator cuff muscles
  4. CS injection (up to 3x/yr)
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13
Q

Shoulder arthrodesis position

A

50-degree abduction, 30-degree forward flexion, 50-degree internal rotation (50-30-50)

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14
Q

What is most common site of biceps tendon rupture? Name of sign?

A

Proximal end of long head of biceps tendon (distal rupture is rare); popeye sign;
seen in adults > 40 yoa with chronic history of impingement

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15
Q

How to treat deltoid strain/avulsion?

A
  1. Ice and immobilize acutely
  2. Stretch and progressive strengthening exercises
  3. If complete rupture or avulsion, surgical attachment
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16
Q

Types of scapular winging

A
  1. Medial scapular winging (serratus anterior weakness)

2. Lateral scapular wining (trapezius muscle weakness)

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17
Q

Most common prox humeral fx?

A

Surgical neck

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18
Q

In fx of surgical neck of humerus, the ______ is the principal abductor

A

supraspinatus

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19
Q

Complications of prox humeral fx?

A

Brachial plexus injuries;

Axillary nerve with surgical neck fx

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20
Q

Fusion position of elbow arthrodesis?

A

Unilateral: flexion at 90 degrees;
bilateral: flexion at 110 degrees in one arm, 65 in the other

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21
Q

For lateral epicondylitis, provocative test? Also management for tennis player after treatment?

A

Cozen’s test;

Decrease string tension, increase grip size

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22
Q

Provocative test for valgus extension overload syndrome of elbow?

A

VEO test; flex elbow to 30 degrees, repeatedly extend elbow fully while applying valgus stress;
can get pain at last 5-10 degrees of extension

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23
Q

Areas of compression for pronator syndrome:

A
  1. ligament of Struthers
  2. Lacertus fibrosus
  3. Pronator teres muscle
  4. B/w the two heads of FDS
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24
Q

With fx of humeral shaft, what nerve can be injured?

A

Radial nerve

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25
Carpal bones
Scaphoid, lunate, triquetrum, pisiform; | trapezium, trapezoid, capitate, hamate
26
Osteonecrosis of lunate AKA
Kienbock's disease
27
Hook of hamate fx can occur due to _________ or _________
direct trauma on palmar surface of wrist/hand; | avulsion from shear forces from adjacent/attached tendons during forceful twisting motion of the wrist
28
Cause of trigger finger; where does abnormal gliding occur?
Repetitive trauma causing inflammatory process to flexor tendon sheath of digits; A1 pulley
29
Skier's/gamekeeper's thumb: who gets it, what's disrupted, mech of injury, diagnosis, treatment
1. Skiers, basketball players, ball-handling athletes 2. UCL 3. Forceful radial deviation of prox phalanx at MCP joint with thumb in exposed abducted/extended position out of plane with palm 4. X-rays (stress radiographs) 5. Short arm cast with thumb spica 4-6 wks; may need surgery
30
Jersey finger results in patient being unable to
actively flex DIP joint
31
Internal rotators of the hip include:
``` TAGGGSS TFL Adductor magnus, longus, brevis Gluteus medius Gluteus minimus Gracilis Semitendinosus Semimembranosus ```
32
To assess for true leg length discrepancy, measure from
ASIS to medial malleolus
33
Hamstrings placed under maximal stretch when hip is
forced into flexion, knee into extension
34
Hamstring and hip flexor strains occur most likely during ______ phase of muscle contraction
eccentric
35
Most common type of hip dislocation
Posterior
36
Imaging required of AVN of femoral head
MRI of both hips; more sensitive to early changes and more specific than bone scan
37
What precautions are observed in posterior THA approach?
Avoid hip flexion over 90 degrees, hip adduction past midline, extreme hip internal rotation
38
Precautions observed in anterior approach?
Avoid hip extension, external rotation
39
Most common type of hip fx? What can change anatomically after surgery for this fx?
Intertrochanteric; leg-length discrepancy
40
Myositis ossificans is the formation of; What is the most common location?; what are most sensitive imaging modalities early on?
heterotopic ossification within muscle; quadriceps; MRI and bone scan greater than radiographs
41
ACL primary function is to; | in flexion, ACL draws
limit anterior tibial translation; | femoral condyles anteriorly
42
Arcuate popliteal ligament complex provides attachment for; | provides restraint to
posterior horn of lateral meniscus; | posterior tibial translation
43
Medial meniscus is ____ shaped, lateral meniscus is ____ shaped
C; O
44
Positive test for Lachman's yields
significant anterior movement with no distinct endpoint
45
Lachman's test more _____ than anterior drawer
sensitive
46
For meniscal tears, when to resect vs repair?
Resect with injury to inner 2/3; repair with injury to outer 1/3
47
ACL mech of injury usually; | terrible triad is what?
cutting, deceleration, hyperextension of knee; | ACL, MCL, medial meniscus
48
ACL treatment includes
1. Non-op if patients low demand based on activity; lower laxity 2. Reconstruction if younger, higher level pts, particularly grade 3 (do some ROM, then closed chain, then open chain, then resistive)
49
Most commonly injured ligament of the knee?
MCL
50
Patellofemoral pain syndrome, aka _____ or _______ knee; What can aggravate the condition?; what increases Q angle?
runner's, biker's; ascending or descending stairs; Internal torsion of femur, lateral insertion of infrapatellar tendon on tibia, genu valgum
51
Management of PFS?
1. Activity modification 2. Ice, NSAIDs acutely 3. Quad strengthening (particularly VMO) 4. Patellar taping and bracing
52
``` Patellar tendonitis (jumper's knee) is an overuse syndrome of the ________ _______ unit; what is it associated with? Most common site of involvement? ```
patellofemoral extensor; jumping, squatting, kneeling, climbing stairs; inferior pole of patella
53
For osteochondritis dissecans, most common area of involvement?
Medial femoral condyle in knee joint; other areas are distal humerus and femur, patella, elbow, talus
54
Functions of popliteus?
Internal rotation of the tibia, unlocks knee by laterally rotating the femur, limits anterior translation of femur
55
What is the main predisposing factor to shin splints? What's notable about when pain occurs?
Hyperpronation; | can improve with exercise, but WORSENS after completion of activity
56
Most commonly injured ligament in the ankle?
ATFL
57
Indications for surgery for ankle sprain
Grade 3, and 1. large bony avulsions 2. severe ligamentous damage on medial and lateral sides of ankle 3. severe recurrent injuries
58
Medial or lateral ankle ligaments stronger?
Medial
59
What sign is seen with tib post injury? What is weak?
Too many toes sign; can see weakness with inversion, plantar flexion
60
Maisonneuve fx is what?
Rupture of anterior tibfib ligament extending through interosseous membrane, often resulting prox fibular fx
61
What does SPLATT procedure stand for? What is technique? Why use it?
SPlit Anterior Tibial Tendon Transfer; TA tendon split, and portion of the tendon transferred to lateral foot; Tib ant spasticity
62
Complication of talar neck fx?
AVN, usually of talar body
63
Where is tenderness with plantar fasciitis? When is pain worst? How can you reproduce pain on exam?
medial aspect of heel at origin of plantar fascia and along plantar arch; In morning or start of weight-bearing activities; Hyperextension of great toe
64
Where is Morton's neuroma most likely to manifest?
Third metatarsal space (interdigital nerves)
65
Hammer toe is deformity of what? How to manage?
Lesser toes, with flexion of PIP joint; | high toe box
66
Turf toe is
sprain of first MTP joint capsule by forced hyperextension
67
What is more likely to cause tissue atrophy of superficial structures when injecting, triamcinolone or methylprednisolone?
Triamcinolone
68
For neck and back pain, how quickly do approx 50% cases resolve? 90% cases? When do approx 85% cases recur?
1-2 weeks; 6-12 weeks; Approx 1-2 yrs
69
For absenteeism, what is likelihood of return to work with 6 mos missed from work? 1 year? 2 years?
50%; 25%; 0%
70
What are the cervical uncinate processes?
spondylotic margins that approximate with body of superior vertebra, creating the uncovertebral joint (joint of Luschka)
71
Facet joints: what planes are the cervical, thoracic, and lumbar facets positioned in?
Cervical: frontal (coronal) Thoracic: frontal (coronal) Lumbar: sagittal in upper lumbar, frontal by L5-S1
72
Intervertebral disc made up of
nucleus pulposus (type II collagen), annulus fibrosus (type I collagen), vertebral endplate
73
With respect to aging, what aspects of the vertebral disc increase and decrease?
``` Increase: 1. Fibrous tissue 2. Cartilage cells 3. Amorphous tissue; Decrease: 1. Nuclear water content 2. Ratio of chondroitin:keratin 3. Proteoglycan molecular weight ```
74
Interspinous and supraspinous ligaments run from
C7-L3, spinous process to spinous process
75
With disc herniation, what region is higher prevalence?
L4-5, L5-S1; | C5-6
76
For disc herniation, what sort of traction can be used for cervical and lumbar regions respectively?
Cervical: 20-30 degrees flexion with 25 lbs resistance; Lumbar: could require increased force or split table to overcome friction
77
What changes in spine contribute to spinal stenosis? What level is most common?
Disc space narrowing, vert body osteophytosis, facet arthropathy, ligamentum flavum hypertrophy; L4-5
78
Most common type of spondylolisthesis in adolescents and young adults? In adults?
Isthmic (pars interarticularis fx), L5/S1; | Degenerative (L4-5)
79
Most common scoliosis curve?
Right thoracic
80
What is seen imaging wise for Scheuermann's disease?
Vert body wedging, irregular endplate, Schmorl's node
81
What can be used for cancer-related compression fx and osteoporotic fx?
Vertebroplasty/kyphoplasty
82
Vert body burst fx occurs mostly in
thoracolumbar region, involves anterior and middle columns
83
SI joint innervated by
L4/5 dorsal ramus, lateral branches of S1-3 dorsal rami
84
Vert body osteomyelitis and discitis most commonly seen in what part of spine? What are exceptions?
L-spine; C-spine with IV drug users; TL junction with TB
85
What are the Waddell's signs?
Distraction, overreaction, regionalization, simulation, tenderness

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