MSK Disorders

Question 1

Important Hx for Extremity Injury?

Answer 1

Age
Hand Dominance
Occupation

Question 2

Key Exam Components for Extremity Injury?

Answer 2

1. Joint Above/Below (determine x-rays to order, assess for occult injury which may be missed due to distracting/obvious injury)
2. Motor
3. Vascular
4. Skin (open joint, open fx, cortical violation issues - BEFORE splint is placed)
   Compartments (“soft”)

Question 3

Salter-Harris Classifications?

Answer 3

SALTR
I - “Slip” - displacement at the growth plate (physis)
II - “Above” - fx of the bone above the growth plate (physis + metaphysis)
III - “Lower” - fx of bone below the growth plate (physis + epiphysis)
IV - “Through” - fx of bone through the growth plate (both above and below) (physis + meta + epiphysis)
V - “Ram” - Crush of growth plate (physis)

Question 4

Mechanism of Salter-Harris” fractures?

Answer 4

Epiphyseal plate is weak and can give way before the bone in an immature skeleton.

Question 5

Significance of Salter-Harris classification?

Answer 5

Potential for growth disturbance increases as you go up in the classification (SH V has greatest risk).

VERY bad with LE injury (short leg = back/knee problems..)

Question 6

Which SH fx is most common?

Least common?

Answer 6

SH II = Most common

SH V = Rare (1-2%)

Question 7

Which SH fractures can have normal X-rays?

Answer 7

SH V and I

Question 8

Names for growth plate, shaft and end of bones?

Answer 8

Physis = Growth Plate
Metaphysis = End of Bone distal to growth plate 
Epiphysis = Shaft above growth plate

Question 9

Types of incomplete fractures in kids?

Answer 9

1. Torus or Buckle Fx
2. Greenstick Fx
3. Salter-Harris Fx

Question 10

Fractures suspicious for NAT?

Answer 10

1. Any long bone fx age

Question 11

When should you think NAT?

Reporting?

Answer 11

Hx/PE not consistent with injury

Mandatory Reporting (CPS)

Question 12

Motor function of the radial nerve?

Answer 12

Extensors

Question 13

Motor function of the ulnar nerve?

Answer 13

Intrinsic Muscles

Question 14

Motor function of the median nerve?

Answer 14

“Tea Drinking” nerve - pincer grasp, flexor at wrist/elbow, pronators

Question 15

Function of the Recurrent Median Nerve?

Answer 15

“Million Dollar Nerve” (easily injured)

Thumb OAF (opposition, abduction, flexion)
Innervates the thenar eminence 

PURE MOTOR NERVE (No sensory deficit if injured)

Question 16

Ulnar Nerve Sensation?

Answer 16

Front & Back of 5th and lateral half of 4th fingers down to wrist.

Question 17

Median Nerve Sensation?

Answer 17

Palmer surface (expect 5th finger/part of 4th), and dorsal tips of fingers 2,3,4.

Question 18

Radial Nerve Sensation?

Answer 18

Dorsal surface (Except 5th finger/part of 4th), except the dorsal tips of the fingers.

Question 19

Why is the shoulder frequently dislocated?

Answer 19

Most mobile joint in the body = Huge ROM
Shallow Glenoid (low bony stability)

Question 20

Muscles of the Rotator Cuff?

Attachments?

Answer 20

SITS:
Supraspinatus, Infraspinatus, Teres Minor - attach to the greater tuberosity of the humerus

Subscapularis - attaches to lesser tuberosity of humerus

Question 21

Soft tissue components of the shoulder?

Answer 21

Capsule, Labrum, Bursa, Ligaments

Question 22

Options for shoulder X-rays?

Answer 22

Standard: AP, Lateral

Others: Transcap, Y, IR, ER, AO views, Axillary Views

Question 23

What is Adhesive Capsulitis?

Machanism?

Answer 23

Frozen Shoulder

• formation of adhesions between the joint capsule and humeral head
• stiffened glenohumeral joint w/signficant loss of ROM
• may follow injury or occur on it’s own

Question 24

How can adhesive capsulitis be avoided?

Answer 24

Codman’s Exercises - swing arm in pendulum motion w/light hand held weights for 5 min 1-2x daily