MSK/Rheum #2

Question 1

Clinical intervention for ankle dislocation

Answer 1

Closed reduction + posterior splint +/- ORIF in severe cases

Question 2

Posterior shoulder dislocations are MC from what events?

Answer 2

-Seizures, electric shock, trauma

Adducted and internally rotated

Question 3

In a shoulder dislocation, what must you do first?

Answer 3

Rule out an axillae nerve injury by doing pin prick test over deltoid.

Question 4

What radiographs are ordered for posterior shoulder dislocation?

Answer 4

Scapular “Y” and axillary lateral views best to distinguish anterior from posterior.

(Ice cream cone or light bulb sign)

Question 5

An anterior shoulder dislocation is MC from

Answer 5

A blow to an abducted, externally rotated arm that is extended.

Question 6

Complication to which nerve is the MC in a shoulder dislocation

Answer 6

Axillary nerve

Question 7

Treatment for anterior shoulder dislocation

Answer 7

• Reduction and immobilization

- Neurovascular compromise is uncommon

Question 8

Describe the typical mechanism and history of a patient with a meniscus injury

Answer 8

Rotational force of femur on tibia

-Now joint pain with locking and giving way

Question 9

Symptoms of a Meniscal Tear

Answer 9

• Positive McMurray Sign: pop or click the knee is flexed and externally rotated and extended
• Apley Test
• Joint Line Tenderness
• Joint effusion
• Swelling

Question 10

What type of meniscal tear is most common?

Answer 10

Medial is 3x more likely than lateral

Question 11

Lateral Epicondylitis, also known as (Tennis Elbow), is inflammation of the tendon insertion of which tendon due to repetitive pronation of forearm and excessive wrist extension.

Answer 11

Extensor Carpi Radialis Brevis Muscle

Question 12

What motions cause pain in lateral epicondylitis?

Answer 12

Gripping, forearm pronation and wrist extension against resistance

Question 13

Treatment for lateral epicondylitis

Answer 13

-Activity modification, RICE, NSAIDs, physiotherapy, steroid injections

Question 14

Idiopathic avascular necrosis of the femoral head

Answer 14

Legg-Calve Perthes Disease

Question 15

Demographics for Legg-Calve Perthes Disease

Answer 15

• Children 4-10 years old
• Males
• Obesity
• Coagulation Abnormalities (Factor V Leiden)

-DECREASED INCIDENCE IN AA

Question 16

Symptoms of Legg-Calve Perthes Disease

Answer 16

• Painless limping (worse with activity and at end of the day)
• Loss of abduction and internal rotation

Question 17

On a radiograph of Legg-Calve Perthes Disease, what is seen?

Answer 17

-Deformity, positive crescent sign (micro fractures with collapse of the bone)

Question 18

Treatment for Legg-Calve Perthes Disease

Answer 18

• Activity restriction (non-weightbearing initially)
• Physical therapy or brace/cast
• Surgical: Pelvic osteotomy if > 8 years old or severe disease

Question 19

With lumbar spondylosis, what diagnostic is initially used?

Answer 19

DEXA scan

Question 20

Symptoms of Marfan Syndrome

Answer 20

• MVP
• Aortic Root Dilation (Aortic Regurgitation, Aortic Dissection, and Aortic Aneurysms)
• Tall stature, long lanky fingers, arms and legs
• Pectus Carinatum (Pigeon Chest)
• Joint Laxity
• Ectopia Lentis (Malposition of lens of eyes)
• Myopia (nearsightedness)

Question 21

Mechanism of injury for MCL injury

Answer 21

Direct blow to outside of knee

• Femoral attachment is to medial epicondyle
• Tibial attachments are semimembranosus and posteromedial tibia

Question 22

With an MCL injury, what stress will cause pain?

Answer 22

Valgus

Question 23

With an LCL injury, what stress will cause pain?

Answer 23

Varus stress

Question 24

What is Meralgia Paresthetica?

Answer 24

Compression of the lateral femoral cutaneous nerve (outer thigh starting from inguinal ligament and extending down toward the knee)

Question 25

Meralgia Paresthetica is also known as

Answer 25

Bernhardt-Roth syndrome

Question 26

Treatment for Meralgia Paresthetica

Answer 26

• Weight loss
• Loose clothing
• Focal nerve block at inguinal ligament with combination of lidocaine and corticosteroids
• Surgical decompression

Question 27

What is a Monteggia Fracture?

Answer 27

Fracture to proximal 1/3 of the ulnar shaft + radial head dislocation

(MURder)

Question 28

What can occur in a Monteggia Fracture?

Answer 28

Radial nerve injury (70% of the time)

May develop a wrist drop

Question 29

Management of a Monteggia Fracture

Answer 29

ORIF

Question 30

Treatment for Myositis

Answer 30

-High dose corticosteroids

Question 31

Symptoms of Osteoarthritis

Answer 31

• Evening joint stiffness (worsens throughout the day)
• If morning stiffness present, short lived
• Hard, bony joint, decreased ROM, crepitus
• Heberden node (DIP enlargement)
• Bouchard node (PIP enlargement)

Question 32

What is shown on a radiograph for osteoarthritis?

Answer 32

Asymmetric joint narrowing, marginal osteophytes, subchondral bone sclerosis, bone cysts

Question 33

For labs for OA, what is unusual?

Answer 33

Lack of inflammatory markers

-Normal ESR, CRP, ANA, RF

Question 34

Treatment for OA

Answer 34

• Lifestyle modification: weight loss, exercise, assistive devices
• Acetaminophen preferred in elderly
• NSAIDs are more effective, but higher risk in elderly
• Intraarticular steroid injections, Sodium Hyaluronate, Glucosamine, Chondroitin