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Board Review > MSK/Sports Medicine > Flashcards

MSK/Sports Medicine Flashcards

1
Q

Name the 5 phases of Functional Rehabilitation

A

Phase I: Decrease Pain and Inflammation (Protection, Rest, Ice, Compression, Elevation)

Phase II: Restore Normal/Symmetric ROM

Phase III: Restore Normal/Symmetric Strength

Phase IV: Neuromuscular Control (Proprioceptive Re-training

Phase V: Sport Specific Training

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2
Q

DDX of Wrist Pain

A
  1. Muscle Strain- FCU, FCR
  2. TFCC Injury
  3. Scaphoid Fracture
  4. Sapholunate Ligament sprain
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3
Q

Wrist Flexor Strain

A

Injury to hyperdorsiflexed hand resulting in localized tenderness near insertions of FCR, FCU. Patients will have increase pain with resisted muscle testing or passive muscle stretching. There is less pain with passive wrist flexion of TFCC loading.

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4
Q

Triangular Fibrocartilage Injury

A

Injury to a hyperdorsiflexed hand resulting in localized swelling at the distal ulnar carpal joint. Patients will have pain with loading the joint in extension or ulnar deviation. Will exhibit decrease grip strength. Examiner will occasionally here a pop/click. Imaging is obtained to r/o fractures

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5
Q

Mallet Finger

A

Injury to the digit d/t forced flexion trauma i.e. basketball hitting an extended finger. Results in focal pain/swelling/deformity and pain with grasping and moving. On physical exam there is decrease ROM, tenderness to palpation and laxity with stress testing. X-rays are obtained to r/o fracture and dislocation

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6
Q

Treatment for Mallet finger

A

If PIP collateral ligaments are involved, splint in 30 degrees flexion/buddy tape. If volar plate injury, 4-6 weeks of extension. If DIP, 6-8 weeks of splinting in hyperextension.

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7
Q

Most likely diagnosis in a 12 y/o baseball player who suffered a twisting valves deviation of the right knee during play with MRI findings sig for inferomedial patella and at the right lateral femoral condyle with ruptured fibers at the medial patellofemoral ligament.

A

Patellar Dislocation. Classic MRI findings include edema at the inferomedial patella and lateral femoral condyle

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8
Q

Most frequently dislocated joint of the hand

A

Proximal Interphalangeal joint. Axial force to a hyperextended joint may result in dislocation in solar, dorsal or lateral dislocation. Avulsion fracture at the base of the middle phalange can occur at the volar plate attachment.

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9
Q

Lesions at the spinoglenoid notch, like those that occur in Superior labral cysts associated with posterior glenoid labral tears can result in weakness in what muscle(s)>

A

Infraspinatus only. The suprascapular nerve passes through the spinoglenoid notch to provide innervation to the infraspinatus after passing through the suprascapular notch under the superior transverse scapular ligament to innervated the supraspinatus muscle in the supraspinous fossa. A session proximal to the suprascapular notch would weakened both the infraspinatus and supraspinatus muscles

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10
Q

Wartenberg’s Sign

A

When 5th digit sticks out of the pocket when patient placed hand in their pocket. Caused by weakness in ulnar innervated palmer interossei which is responsible for finger adduction. Ulnar neuropathy at the elbow.

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11
Q

Bakody sign

A

C5-6 pathology relief when patient places hand on his head. This is due to decreased traction on the C5-C6 nerve roots

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12
Q

Surgical considerations for meniscus tear

A

Resection is recommend when the injury is localized within the 2/3 inner portion of the meniscus due to poor vascularity and decreased chance of healing. Otherwise repair can be considered.

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13
Q

Normal distance between the L5 and area marked 10 cm away during forward flexion of a healthy individual

A

Forward flexion should exceed 15 cm, any less, consider ankylosing spondylitis.

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14
Q

Exercise associated hyponatremia

A

Serum or plasma conc. less than 135 mol/l. Early sings and symptoms include nausea, vomiting and headaches but can progress in severity to include AMS, seizures, coma and respiratory distress from worsening cerebral edema. Risk factors include low body weight, female sex, four hours exercise duration, slow running or performance pace, race inexperience, excessive drinking behavior and extreme temps.

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15
Q

Anterior knee pain during squatting, prolonged sitting, descending stairs and runnier hills

A

Patellofemoral Pain

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16
Q

Most common site of maximum tenderness with navicular stress fracture

A

Dorsally between the tibias anterior and EHL tendons also known as the N-Spot

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17
Q

Lateral Epicondylosis

A

Tennis Elbow. Most commonly involve the ECRB. Predisposing factors include receptive microtrauma t common extensor tendon. Positive Cozen’s test

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18
Q

Lateral Femoral Cutaneous Syndrome or Meralgia Paresthetica

A

Pure Sensory condition that results in pain, synesthesia or hypoesthesias over the anterolateral thigh that can extend to the knee. Caused by compression of entrapment of the lateral femoral cutaneous nerve. Risk factors: large obese abdomen, tight fitting garments, pregnancy

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19
Q

Segond Fracture

A

Pathognomic finding of ACL tear. Avulsion off the lateral tibial plateau following a knee twisting injury.

20
Q

Treatment of 3r metatarsal stress fracture

A

Waling boot and 3 wk f/u. than progressed out of the boot and to PT. Seen in patients with abrupt significant change in type of forces to their MSK system i.e. patient who abruptly switches to barefoot running

21
Q

Leading cause of cardiac-related death in younger athletes

A

Idiopathic Hypertrophic Subaortic stenosis

22
Q

Length of time an abduction pillow is utilized after hip replacement surgery

A

6-12 weeks to prevent dislocation of the hip prosthesis

23
Q

Alternative diagnosis for lateral epicondylitis that does not respond to conservative therapy

A

Posterior Interosseous neuropathy. Mild compression can result in proximal and dorsal forearm pain without obvious muscle weakness, wasting or sensory deficits.

24
Q

In the frontal plane, movements and stabilization are controlled primarily by:

A

Quadratus lumborum

25
Q

Terrible Triad

A

Damage to the ACL, MCL and medial meniscus from valves stress on the knee

26
Q

Risk factors for entrapment neuropathy in musicians include:

A

Improper hand position
Small Hand size
Joint Laxity
Changes in performer’s practice schedule

27
Q

Femoral Neck Fracture positioning

A

Displaced fracture result in injured limb externally rotated, abducted and shortened

28
Q

Osteochondritis dissecans

A

Loss of integrity of subchondral bone in focal area of the joint. Usually caused by repetitive microtrauma. Treatment with splinting, rest and PT for Grade 1 (continuous with underlying bone) and grade 2 (parietal continuous). Once lesions become discontinuous, grade 3 or dislocated, grade 4; an orthopedic surgery referral is required

29
Q

Femoracetabular impingement

A

3 types: Cam, Pincher and mixed

Abnormal contact with acetabulum in hip flexion, adduction and internal rotation

30
Q

Intersection Syndrome

A

Due to inflammation of the Compartment 1: APL and EPB and Compartment 2: ECRL and ECRB. Patient will have pain and swelling 4-8 cm proximal to the wrist. Crepitus may be palpable with flexion and extension of the wrist.

31
Q

Little League Shoulder/Glenohumeral Epiphysiolysis

A

Repetitive stress injury due to overuse and improper rest. Typically young teenagers and likely result of torsional overload of the proximal humeral epiphysis during maximal shoulder external rotation during throwing cycle. Patient may complain of lateral deltoid pain. Look for subtle difference in bilateral shoulder X-ray. Treat with 6 week elimination of showing actives followed by 6 weeks of rehab. Patient can return to showing once they are tpainfree and completed rehab w/o setbacks

32
Q

Absolute contraindication to return to play in patient with cervical spinal cord neuropraxia

A
  1. MRI evidence of cord swelling
  2. Neurologic symptoms/signs > 36hrs
  3. Documented ligament instability
  4. Persistent cervical pain with loss of ROM
33
Q

Hypertrophic CMP

A
  1. asymmetric left ventricular wall thickening
  2. Genetic component that result in mutation to one of the sarcomere genes
  3. Murmur that increase with valsalva maneuver.
34
Q

Posterolateral corner knee components

A
  1. LCL
  2. Popliteus tendon
  3. Postereolateral joint capsule
  4. Bicep femoris tendon
  5. Peroneal nerve
  6. Lateral head of gastroc.
  7. Lateral meniscus
  8. Posterior meniscofemoral ligament
35
Q

Sinding-Larsen-Johansson Disease

A

Tenderness at the inferior pole of the patella.

36
Q

Strongest restraint to valgus stress in the elbow

A

Anterior bundle of the medial collateral ligament

37
Q

Tendinosis

A

Refers to a degenerative, non-inflammatory tendon injury characterized by absence of inflammatory cells. There’s cumulative microtrauma, hypovascularity with resultant delayed healing, neurally mediated degranulation of mast cells along with substance P release are thought to contribute to it’s pathophysiology

38
Q

In order to improve lower limb kinetic chain and decrease patellar tendon overload, what should be the goal of therapy in patient with patellar tendinopathy.

A

Strengthening the quadriceps and stretching the hamstrings.

39
Q

Likely diagnosis in 4 y/o presenting with right lateral ankle pain after landing awkward on a bean bag and turning his ankle inward. Theres pain and mild swelling laterally and 2-3 cm proximal to the distal aspect of the lateral malleolus. X-rays are appear normal.

A

Salter Harris I fracture, transverse fracture through the hypertrophic zone of the physis, typically not visible on radiographys, though there maybe widening of growth plate. No further imaging is needed. Patient will need a short-leg non-weight bearing cast for 3 weeks.

40
Q

Likelihood of second shoulder dislocation in young athletes

A

Greater than 60%

41
Q

Hook of hamate fracture

A

Presents with vague pain complaints on solar ulnar aspect of the hand. Seen in golfers, hockey and baseball players. Pain is provoked when attempting a tight grip. X-rays can be normal and CT scans should be ordered. Excision of the hook of the hamate is consider the treatment of choice although acute, non-displaced fractures may be treated non-operatively. Non-union rates greater than 50% and as high as 80% can occur with conservative treatment.

42
Q

Majority of throwing injuries in baseball pitchers occurs during which phases of throwing?

A

Between maximum internal rotation and deceleration

43
Q

Several biomechanics issues associated with patallofemoral arthralgia

A
  1. Tight/inflexible quadriceps
  2. Pes Planus
  3. Tight IT band
  4. Weak/ineffective vestals medialis
  5. Weak Hip abductors
    can all contribute to incorrect tracking of the patella.
44
Q

Pes Anserine Bursa

A

Lies between the MCL and the confluence of the Sartorius, Gracilis and semitendinosus muscle along the medial tibia distal to the jointline.

45
Q

Reduce grip strength, pain on ulnar side of wrist in 40 y/o Male cyclists with multiple falls. X-rays show sclerosis and fragmentation of the lunate.

A

Kienbock’s disease. Seen mostly in men 20-40 y/o. Tenderness to palpation over the lunate. Initial tx with cast or splint. Surgical referral for possible bone graft, osteotomy, excision or fusion in patients with poor healing

46
Q

Gluteus Minimus

A

Attaches to the Dorsal ilium between inferior and anterior gluteal lines and the greater edge of the sciatic notch. Inserts on the anterior surface of greater trochanter allowing abduction and medial rotation of the hip. It is innervated by the Superior gluteal nerve (L4, L5, S1) and gets its blood supply from the superior gluteal artery.

47
Q

Which muscle is weak in patients with a trendelenburg gait on the right?

A

Weak Gluteus Medius

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