MSK prac exam injuries

Question 1

Ankle Sprain

Question 2

Achilles Rupture

Question 2

Achilles Tendinopathy

Question 3

Plantar Fasciopathy

Question 4

Ligament Injuries - ankle

Question 5

Ligament injuries - knee

Question 6

Ligament injuries - hip

Answer 6

ROM
MMT/IMT

Question 7

Ligament injuries - elbow

Question 7

Ligament injuries - shoulder

Question 8

Meniscus Injury

Question 9

PFPS

Question 10

Patellar Tendinopathy

Question 11

Hoffa’s Pad Syndrome

Question 12

Femoroacetabular impingement and Hip labral tear/injury

Answer 12

Mechanism of injury:

Structures involved: labrum,

Assessment:
1. FADDIR test (bring leg into end of range flexion, passive adduct and internally rotate hip, note pain response, if no pain then repeat and add compression. Looking for pain location and type of pain)
2. MMT/IMT (hip flexion/extension)

Differential Diagnosis:

Question 12

Gluteal Tendinopathy/ greater trochanter pain syndrome (GTPS)

Answer 12

Mechanism of injury: excessive compression and high tensile loads within tendons

Structures involved: gluteus maximus, medius and minimus tendons attaching to the greater trochanter

Assessment:
1. Adduction test: Patient side lying on unaffected side knees bent to 80-90 degrees. Stabilise the pelvis and passively adduct the hip. Ask the patient to perform isometric hold against resistance. pain provocation)
2. Hip ROM (flexion/extension/abduction)
3. Greater trochanter palpation

Differential diagnosis:

Question 12

SI dysfunction

Answer 12

Mechanism of Injury: primarily is due to a combination of axial loading and abrupt rotation

Structures involved:

Assessment:
1. FABER (stabilser hand on other side ASIS, figure 4 stretch)
2. Hip ROM (flexion, extension)
3. Cluster of Laslett (4 tests:
- distraction test (stand on symptomatic side, hands on both hips and distract apart, 3-6 moderate velocity thrusts and gradually increaseing pressure)
- thigh thrust test (stand on asymptomatic side, flex knee and other hand under sacrum, compress hands together, 3-6 higher velocity thrusts and gradually increasing pressure)
- compression test (pateint lays on asymptomatic side with knees and hips flexed, apply downward compression force over the anterior rum of the ilium)
- sacrul thrust test (prone position, hand over S2 and apply vertical pressure downwards)
2 positive tests - can rule in

Differential diagnosis?

Question 12

Hip muscles contracture

Question 12

RC tear

Question 12

Subacromial impingement syndrome

Answer 12

1. Subacromial impingement cluster: hawkins-kennedy, Neers, painful arc, empty can, resisted shoulder ER

Question 12

Shoulder instability

Question 12

Tennis elbow

Question 12

SLAP tear

Question 13

Cubital Tunnel Syndrome

Answer 13

Mechanism of injury: when a person frequently bends the elbows, leans on their elbow a lot, or has an injury to the area.

Structures involved: The cubital tunnel extends from the medial epicondyle of the humerus to the olecranon process of the ulna. Compression of the ulnar nerve

Assessment:
1. Elbow flexion test (the ‘what do you mean’ position, held for up to 3mins. Positive test - reproduction of pain, tingling or numbness along the ulnar nerve)
2. Tinel’s tap of the elbow
3. Wrist flexion and elbow flexion ROM (since the ulnar nerve innervates these movements)

Differential diagnosis:
1. Medial epicondylitis

Question 14

De Quervain’s Tenosynovitis

Answer 14

Mechanism of injury: overuse of the wrist (such as picking up a child, picking up grocery bags)

Structures involved: abductor pollicus longus and extensor pollicus brevis tendons

Assessment:
1. Finkelstein’s test (done actively by the patient by making a fist over their thumb and doing ulnar deviation. Positive test if pain aggravation at the tip of styloid process)
2. Thumb ROM (fulcrum at scaphoid, stationary arm pointer finger, moving arm thumb)

Differential diagnosis to rule out:
1. CMCJ OA - grind test

Question 15

Carpal Tunnel Syndrome

Answer 15

Mechanism of injury: repeated motions of the wrist such as typing, video games)

Structures involved: Median nerve (also in the tunnel are the tendons of the flexor digitorum profundus, flexor digitorum superficialis, flexor pollicus longus)

Assessment:
1. Phalen’s test (back of hands press together to compress the median nerve in the carpal tunnel, holding for 1min, positive test is indicated by tingling/numbness in thup, pointer or middle finger)

2. ROM: Wrist flexion and extension (ROM may be limited)

Question 16

1st CMCJ Osteoarthritis

Answer 16

Mechanism of injury: previous damage?

Structures involved: 1st carpometarcarpal joint

Assessment:
1. Grind test (stabilise wrist and hand, then apply an axial force down the thumb whilst rotating back and forth, positive test if there is any pain)
2. Thumb ROM

Differential diagnosis:
1. De Quervain’s - Finkelstein test

Question 17

Deep gluteal syndrome/piriformis syndrome