Musculoskeletal Conditions - Bronze

Question 1

Anterior compartment syndrome

Answer 1

Pressure in anterior compartment of lower leg increases due to swelling.
Causes occlusion of blood flow, leading to ischemia and necrosis of nerves and muscles.
Acute injury is a medical emergency.
Chronic injury often due to athletic exertion and usually not a medical emergency.
Tightness and tenderness over muscle belly of tibialis anterior that does not decrease with elevation or pain meds. Increased pain with passive stretching or active use of muscle. Paresthesia/numbness in distribution of deep peroneal nerve.

Question 2

Colles’ Fracture

Answer 2

Transverse fracture of the distal radius, either intra or extraarticular. Dorsal displacement of radius. Often caused by FOOSH injury.
“Dinner fork” or “bayonet” deformity may be present.

Question 3

De Quervain’s tenosynovitis

Answer 3

Inflammation of tendons and synovium of the abductor pollicis longus and extensor pollicis brevis.
Due to repetitive activities involving thumb abduction and extension like racquet sports and repeated heavy lifting.
Pain in anatomical snuffbox, which can radiate into the forearm. Edema may be present.
More common in women and new mothers.

Question 4

Myositis Ossificans

Answer 4

Calcification of muscle due to poor treatment of muscle strain or contusion. Failing to apply cold, applying heat, or having intense therapy/massage too soon after injury may cause this condition.
Bone will grow 2-4 weeks after injury and will mature within 3-6 months.
Initial stage: typical symptoms of contusion. Pain with functional activities, stiffness with prolonged rest, swelling, tenderness, and bruising.
A few weeks after injury: further symptoms may suggest myositis ossificans. Hard lump in muscle belly, increase in pain and a decrease in ROM that had been previously improving.

Question 5

Osteochondritis Dissecans

Answer 5

Subchondral one and associated cartilage crack and separate from the end of the bone. Possibly due to loss of blood flow to affected area due to repetitive microtrauma.
Primarily affects knee joint but also elbow and ankle.
Symptoms are pain with activities, popping or locking, weakness, swelling, and decreased ROM.
Wilson’s test can rule out osteochondritis dessicans of the knee.

Question 6

Osteomyelitis

Answer 6

Infection of the bone often due to Staphylococcus aureus microbe (surgery, fracture, or puncture wound).
Prolonged structural damage to infected bone can lead to amputation.
Fever and chills; localized pain, edema, and erythema.

Question 7

Tarsal tunnel syndrome

Answer 7

At medial aspect of ankle, formed by flexor retinaculum, superior aspect of calcaneus, and medial wall of the talus and medial-distal tibia.
Tibial nerve, posterior tibial artery, and tendons of the flexor hallucis longus, tibialis posterior, and flexor digitorum pass through tunnel.
Occurs from compression of tibial nerve, causing motor and sensory disturbances.
Caused by intrinsic (tumor, scar tissue), extrinsic (crush injury, severe ankle sprain), or tension (pes planus, hindfoot valgus)

Question 8

Ulnar collateral ligament sprain - thumb

Answer 8

Due to excessive valgus force to MCP. Gamekeepers and skiers thumb.
Pain, tenderness, ecchymosis, and swelling. Instability and weakness with grasping.
Movement of greater than 30-35 deg with valgus force indicates complete tear.