Musculoskeletal

Question 1

Structures in anterior compartment of leg

Answer 1

1. Four extensor muscles of foot
2. Anterior tibial artery
3. Deep peroneal nerve

Most common site of acute compartment syndrome (p/w decreased sensation between 1st & 2nd toes + weakness with foot dorsiflexion)

Question 2

Unstable C-spine fractures

Answer 2

Jefferson’s fracture, B cervical facet dislocation, odontoid fracture (type II or III), atlanto-occipital dissociation, Hangman’s fracture & flexion teardrop fracture

“Jefferson Bit Off a Hangman’s Thumb”

Question 3

Biceps reflex nerve root

Answer 3

C5/6

Question 4

Triceps reflex nerve root

Answer 4

C7

Question 5

Brachioradialis nerve root

Answer 5

C6

Question 6

Patellar reflex nerve root

Answer 6

L4

Question 7

Achilles reflex nerve root

Answer 7

S1

Question 8

Posterior hip dislocation complications

Answer 8

• Sciatic nerve injury: loss of sensation to posterior leg & foot; loss of dorsi-/plantar flexion; loss of ankle DTR
• Femoral nerve injury: Loss of sensation over thigh; weak quadriceps; loss of knee DTR
• Femoral artery injury

Question 9

Stimson method

Answer 9

For shoulder dislocation; positions patient prone and utilizes hanging weight on affected arm to reduce dislocation

Question 10

Radiographic findings of slipped capital femoral epiphysis

Answer 10

widening of the physis –> displacement of femoral head from femoral neck (“ice cream off cone”)

Question 11

What is a Galeazzi fracture and what are the complications

Answer 11

• fracture to middle to distal 3rd of radius & dislocation/subluxation of distal radioulnar joint (DRUJ)
• anterior interosseus nerve (branch of median nerve) injury: paralysis of flexor pollicis longus & flexor digitorum profundus (loss of punch mechanism between thumb & index finger, AKA “OK” sign)

Question 12

What is a Monteggia fracture

Answer 12

Fracture to proximal/mid-ulna with radial head dislocation

Question 13

Describe perilunate dislocation

Answer 13

Dorsal dislocation of capitate and carpus relative to lunate, which remains in near-normal alignment with the radius

Question 14

Describe lunate dislocation

Answer 14

Radiolunate articulate disrupted with volar displacement of lunate (“spilled teacup sign”)

Question 15

Common feared complication of perilunate dislocation?

Answer 15

Median nerve palsy

Question 16

Mallet finger deformity pathophysiology, management & complication

Answer 16

• path: forced hyperflexion of distal phalanx –> disruption of extensor tendon at DIP –> unopposed flexion at DIP
• Mgmt: splint in slight hyperextension for 6-8 weeks
• comp: swan neck deformity

Question 17

Boutonniere deformity pathophysiology & management

Answer 17

• path: rupture of central slip over PIP joint (typically from jammed finger) –> volar migration of lateral bands –> PIP joint in flexion + DIP in hyperextension
• mgmt: splint PIP joint in full extension for 6 weeks

Question 18

Gamekeeper’s (skier’s) thumb pathophysiology, exam & management

Answer 18

• path: rupture of ulnar collateral ligament (2/2 forced abduction)
• exam: weak pincher grasp
• mgmt: thumb spica splint for 4-6 weeks

Question 19

S1 radiculopathy presentation

Answer 19

• Pain down posterior leg into foot
• Paresthesia on posterior aspect of leg & anterior aspect of foot
• Weak ankle plantarflexion (gastrocnemius), knee extension & flexion

Question 20

L3 radiculopathy presentation

Answer 20

• Weak hip flexion & adduction

- Paresthesias to anterior thigh

Question 21

L4 radiculopathy presentation

Answer 21

• Weak knee extension

- Paresthesias of lateral thigh, anterior knee & medial leg

Question 22

L5 radiculopathy presentation

Answer 22

• back pain radiating down lateral leg
• weak dorsiflexion & great toe extension
• hypoesthesia to lateral lower leg, dorsum of foot & webspace between 1st & 2nd toes

(most common lumbar radiculopathy)

Question 23

Scapholunate dissociation mechanism, pathophysiology, imaging & management

Answer 23

• mech: FOOSH
• path: rupture of scapholunate ligament
• img: widening of scapholunate joint space >3 mm (Terry-Thomas sign)
• mgmt: forearm volar splint

Question 24

Jones fracture pathophysiology & management

Answer 24

• path: transverse fracture through base of 5th metatarsal (diaphysis at least 1.5 cm distal to end of bone)
• mgmt: immobilization in posterior splint, non-weight bearing

Question 25

Pseudo-jones fracture pathophysiology & management

Answer 25

• path: avulsion fracture of tuberosity of base of 5th metatarsal (reaches articular surface)
• mgmt: compression dressing & weight bearing as tolerated (+/- hard-soled shoe)