MSK - UE and LE

Question 1

impingement syndrome (rotator cuff syndrome)

Answer 1

reduction in space below coracromial arch resulting in…

• supra/infraspinatus tendons compressed under acromion
• subacromial bursitis

Question 2

possible etiology of impingement

Answer 2

SITS weak -> deltoid hypertrophy -> humerus sup displaced

• bone spur (age)
• inflammation of coracromial joint

any/all

Question 3

tendonosis v tendonitis

Answer 3

damage v inflammation

Question 4

impingment complications

Answer 4

• tendonitis
• tendonosis
• rotator cuff tear (weakness)

Question 5

impingment symptoms

Answer 5

• pain w/ overhead motion of superiolateral shoulder
• decreased active ROM
• weakness abduction (tears)
• 1/5 ppl have no sx (dont look for it w MRI!)

Question 6

bursitis v tendonitis pain

Answer 6

burning and acute v intermittent + dull

Question 7

MC rotator cuff tear

Answer 7

supraspinatus

Question 8

2 tests for impingment

Answer 8

Neer, Hawkins

Question 9

imaging in shoulder pain

Answer 9

X-ray: arthritis, trauma, calcific tendonitis
MRI: bursistis, partial/full tear, tendonitis
US: r/o tears

Question 10

impingment tx

Answer 10

NSAID, rest, ice
lidocaine + methylprednisone <6 wk
PT: strengthen cuff, stretch
f/u 6 weeks - surgery if no improvement

Question 11

rot cuff tear etiology

Answer 11

• chronic impingment syndrome
• chronic dislocation
• acute trauma

Question 12

rot cuff tear sx

Answer 12

• “impingment” pain but past elbow
• WEAKness w/ overhead movmt
• NL passive ROM
• night pain
• many 40+ have asym partial

Question 13

3 tests for rot cuff

Answer 13

drop arm (all)
empty can (supraspinatus)
lift off (subscapularis)
external rot elbow (infraspin, teres minors)
ext rot lag (infraspin)

Question 14

rot cuff imaging

Answer 14

1. XR - AP, axillary, outlet view

2. MRI

Question 15

fatty atrophy prognosis

Answer 15

means chronic tear, unlikely for good surgery outcome

Question 16

rot cuff tx

Answer 16

<50% affected tendon: NSAID< steriod injection, PT
>50% affected tendon: prob surgery
complete tear - surgery ASAP

Question 17

post surg recover time (rot cuff tear)

Answer 17

12 weeks “normal”

6-12mo “total function” athletes

Question 18

biceps tendonitis: primary v 2ndary

Answer 18

1 - just occurs in this tendon

2- impingement syndrome 1st

Question 19

biceps tendonitis sx

Answer 19

• anterior shoulder pain- rad to bicep
• tenderness over bicepital groove
• +Neer, Hawkins

Question 20

tests for biceps tendonitis besides Neer and Hawkin

Answer 20

Speed - arm @ shoulder level, bend elbow against resistance

Yergason - pressure over biceptal groove, arm bent, bend elbow against ext rot

Question 21

biceps tendonitis imaging

Answer 21

• shoulder xray (impingment)

- MRI (edema around thickened tendon)

Question 22

biceps tendonitis tx

Answer 22

NSAID, PT, ice
US-guided steroid injections
surgery if conservative fails (cut labrum and re-attach)

Question 23

adhesive capsulitis - primary v 2ndary

Answer 23

1. AI, females, DM

2. postsurg, post trauma post immobilization

Question 24

adhesive capulitis - sx

Answer 24

gradual loss of active + PASSIVE ROM
worse @ end of motion
pain @ rest, @ night
STABILIZE SCAP during PE (masks tests)

Question 25

adhesive capsulitis pathophys

Answer 25

soft tissue contracture

local inflam response

Question 26

adhesive capsulitis tx

Answer 26

PT! ice, NSAID, steroid injection

Question 27

glenohumeral OA sx

Answer 27

constant pain, worse w/ activity
gradual onset
crepitus

Question 28

AC joint OA tx

Answer 28

mostly just steroid injections

Question 29

OA tx

Answer 29

ROM
NSAID
no steroids (delays labral healing)
surgery- arthoplasty

Question 30

lateral epicondylitis (tennis elbow)

Answer 30

repetitive strain wrist extension (backhand stroke)

Question 31

lateral epicondylitis (tennis elbow) sx

Answer 31

lateral elbow pain, radiating to forearm after activities
pain after shaking hands
weakened grip
ROM intact

Question 32

lateral epicondylitis tests

Answer 32

Cozens + Mills

Question 33

lateral epicondylitis diagnosis + tx

Answer 33

H+P

conservative, steroid, US (magnetic relief), surgery not superior to conservative

Question 34

medial epicondylitis “golfers elbow”

Answer 34

pain over medial epicondyle rad down

pain w/ wrist flexion

Question 35

medial epicondylitis

Answer 35

conservative, splinting, inj 2x
activity modification 1 mo
surgery - release flexor elbow

Question 36

olcranon bursitis etiology

Answer 36

trauma -> boggy swelling

not painful unless infected

Question 37

olcranon bursitis dx

Answer 37

imaging: r/o fracture
aspiration: if ? infection

Question 38

olcranon bursitis tx

Answer 38

conservative, splint, compress swelling
aspiration for pain relief but recur until fully healed
surgery after 12 wk failed conservative (remove bursa)

Question 39

de quervain “mommy thumb” muscle

Answer 39

abductor pollicis longus and extensor pollicis brevis overuse –> lateral wrist pain

Question 40

de quervain tests

Answer 40

Finkelsteins

Question 41

de quervain tx

Answer 41

conservative, thumb spica splint, injections

surgery: decompress tendon

Question 42

depuytren contracture

Answer 42

fibroproliferative dz of palama fascia

• genetics, men, N. Euro
• smoking/EtOH (lots), DM
• rep vibration

Question 43

depuytren presentation

Answer 43

painless nodule @ MCP joint in 1+ fingers, expands to form “cord” over tendon, finger is stuck flexed

Question 44

depuytren tx

Answer 44

gloves, fasciotomy if contracture has formed
tx = palliative
if untreated - disability in 5-6y

Question 45

depuytren dx

Answer 45

H & P, no role for imaging