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PM&R > MSK > Flashcards

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
Q

Carpal bones

A

Scaphoid, lunate, triquetrum, pisiform;

trapezium, trapezoid, capitate, hamate

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26
Q

Osteonecrosis of lunate AKA

A

Kienbock’s disease

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27
Q

Hook of hamate fx can occur due to _________ or _________

A

direct trauma on palmar surface of wrist/hand;

avulsion from shear forces from adjacent/attached tendons during forceful twisting motion of the wrist

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28
Q

Cause of trigger finger; where does abnormal gliding occur?

A

Repetitive trauma causing inflammatory process to flexor tendon sheath of digits;
A1 pulley

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29
Q

Skier’s/gamekeeper’s thumb: who gets it, what’s disrupted, mech of injury, diagnosis, treatment

A
  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
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30
Q

Jersey finger results in patient being unable to

A

actively flex DIP joint

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31
Q

Internal rotators of the hip include:

A 
TAGGGSS
TFL
Adductor magnus, longus, brevis
Gluteus medius
Gluteus minimus
Gracilis
Semitendinosus
Semimembranosus
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32
Q

To assess for true leg length discrepancy, measure from

A

ASIS to medial malleolus

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33
Q

Hamstrings placed under maximal stretch when hip is

A

forced into flexion, knee into extension

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34
Q

Hamstring and hip flexor strains occur most likely during ______ phase of muscle contraction

A

eccentric

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35
Q

Most common type of hip dislocation

A

Posterior

36
Q

Imaging required of AVN of femoral head

A

MRI of both hips; more sensitive to early changes and more specific than bone scan

37
Q

What precautions are observed in posterior THA approach?

A

Avoid hip flexion over 90 degrees, hip adduction past midline, extreme hip internal rotation

38
Q

Precautions observed in anterior approach?

A

Avoid hip extension, external rotation

39
Q

Most common type of hip fx? What can change anatomically after surgery for this fx?

A

Intertrochanteric; leg-length discrepancy

40
Q

Myositis ossificans is the formation of;
What is the most common location?;
what are most sensitive imaging modalities early on?

A

heterotopic ossification within muscle;
quadriceps;
MRI and bone scan greater than radiographs

41
Q

ACL primary function is to;

in flexion, ACL draws

A

limit anterior tibial translation;

femoral condyles anteriorly

42
Q

Arcuate popliteal ligament complex provides attachment for;

provides restraint to

A

posterior horn of lateral meniscus;

posterior tibial translation

43
Q

Medial meniscus is ____ shaped, lateral meniscus is ____ shaped

A

C; O

44
Q

Positive test for Lachman’s yields

A

significant anterior movement with no distinct endpoint

45
Q

Lachman’s test more _____ than anterior drawer

A

sensitive

46
Q

For meniscal tears, when to resect vs repair?

A

Resect with injury to inner 2/3; repair with injury to outer 1/3

47
Q

ACL mech of injury usually;

terrible triad is what?

A

cutting, deceleration, hyperextension of knee;

ACL, MCL, medial meniscus

48
Q

ACL treatment includes

A
  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
Q

Most commonly injured ligament of the knee?

A

MCL

50
Q

Patellofemoral pain syndrome, aka _____ or _______ knee;
What can aggravate the condition?;
what increases Q angle?

A

runner’s, biker’s;
ascending or descending stairs;
Internal torsion of femur, lateral insertion of infrapatellar tendon on tibia, genu valgum

51
Q

Management of PFS?

A
  1. Activity modification
  2. Ice, NSAIDs acutely
  3. Quad strengthening (particularly VMO)
  4. Patellar taping and bracing
52
Q 
Patellar tendonitis (jumper's knee) is an overuse syndrome of the \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ unit; what is it associated with?
Most common site of involvement?
A

patellofemoral extensor;
jumping, squatting, kneeling, climbing stairs;
inferior pole of patella

53
Q

For osteochondritis dissecans, most common area of involvement?

A

Medial femoral condyle in knee joint; other areas are distal humerus and femur, patella, elbow, talus

54
Q

Functions of popliteus?

A

Internal rotation of the tibia, unlocks knee by laterally rotating the femur, limits anterior translation of femur

55
Q

What is the main predisposing factor to shin splints? What’s notable about when pain occurs?

A

Hyperpronation;

can improve with exercise, but WORSENS after completion of activity

56
Q

Most commonly injured ligament in the ankle?

A

ATFL

57
Q

Indications for surgery for ankle sprain

A

Grade 3, and

  1. large bony avulsions
  2. severe ligamentous damage on medial and lateral sides of ankle
  3. severe recurrent injuries
58
Q

Medial or lateral ankle ligaments stronger?

A

Medial

59
Q

What sign is seen with tib post injury? What is weak?

A

Too many toes sign; can see weakness with inversion, plantar flexion

60
Q

Maisonneuve fx is what?

A

Rupture of anterior tibfib ligament extending through interosseous membrane, often resulting prox fibular fx

61
Q

What does SPLATT procedure stand for? What is technique? Why use it?

A

SPlit Anterior Tibial Tendon Transfer;
TA tendon split, and portion of the tendon transferred to lateral foot;
Tib ant spasticity

62
Q

Complication of talar neck fx?

A

AVN, usually of talar body

63
Q

Where is tenderness with plantar fasciitis? When is pain worst? How can you reproduce pain on exam?

A

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
Q

Where is Morton’s neuroma most likely to manifest?

A

Third metatarsal space (interdigital nerves)

65
Q

Hammer toe is deformity of what? How to manage?

A

Lesser toes, with flexion of PIP joint;

high toe box

66
Q

Turf toe is

A

sprain of first MTP joint capsule by forced hyperextension

67
Q

What is more likely to cause tissue atrophy of superficial structures when injecting, triamcinolone or methylprednisolone?

A

Triamcinolone

68
Q

For neck and back pain, how quickly do approx 50% cases resolve? 90% cases? When do approx 85% cases recur?

A

1-2 weeks;
6-12 weeks;
Approx 1-2 yrs

69
Q

For absenteeism, what is likelihood of return to work with 6 mos missed from work? 1 year? 2 years?

A

50%;
25%;
0%

70
Q

What are the cervical uncinate processes?

A

spondylotic margins that approximate with body of superior vertebra, creating the uncovertebral joint (joint of Luschka)

71
Q

Facet joints: what planes are the cervical, thoracic, and lumbar facets positioned in?

A

Cervical: frontal (coronal)
Thoracic: frontal (coronal)
Lumbar: sagittal in upper lumbar, frontal by L5-S1

72
Q

Intervertebral disc made up of

A

nucleus pulposus (type II collagen), annulus fibrosus (type I collagen), vertebral endplate

73
Q

With respect to aging, what aspects of the vertebral disc increase and decrease?

A 
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
Q

Interspinous and supraspinous ligaments run from

A

C7-L3, spinous process to spinous process

75
Q

With disc herniation, what region is higher prevalence?

A

L4-5, L5-S1;

C5-6

76
Q

For disc herniation, what sort of traction can be used for cervical and lumbar regions respectively?

A

Cervical: 20-30 degrees flexion with 25 lbs resistance;
Lumbar: could require increased force or split table to overcome friction

77
Q

What changes in spine contribute to spinal stenosis? What level is most common?

A

Disc space narrowing, vert body osteophytosis, facet arthropathy, ligamentum flavum hypertrophy;
L4-5

78
Q

Most common type of spondylolisthesis in adolescents and young adults? In adults?

A

Isthmic (pars interarticularis fx), L5/S1;

Degenerative (L4-5)

79
Q

Most common scoliosis curve?

A

Right thoracic

80
Q

What is seen imaging wise for Scheuermann’s disease?

A

Vert body wedging, irregular endplate, Schmorl’s node

81
Q

What can be used for cancer-related compression fx and osteoporotic fx?

A

Vertebroplasty/kyphoplasty

82
Q

Vert body burst fx occurs mostly in

A

thoracolumbar region, involves anterior and middle columns

83
Q

SI joint innervated by

A

L4/5 dorsal ramus, lateral branches of S1-3 dorsal rami

84
Q

Vert body osteomyelitis and discitis most commonly seen in what part of spine? What are exceptions?

A

L-spine;
C-spine with IV drug users;
TL junction with TB

85
Q

What are the Waddell’s signs?

A

Distraction, overreaction, regionalization, simulation, tenderness

PM&R (12 decks)

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