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FPP/MSS > Musculoskeletal injuries > Flashcards

Musculoskeletal injuries Flashcards

1
Q

acute fracture

A

bone fracture due to sudden impact of large force exceeding strength of the bone

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2
Q

stress fracture

A

bone fracture due to repetitive sub maximal stresses; bone gradually breaks down more quickly than the body can repair it

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3
Q

pathologic fracture

A

bone fracture due to normal forces acting upon diseased bone

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4
Q

red flag signs for fracture

A

bleeding with/without bone fragments (open fracture - orthopedic emergency), bony point tenderness, pain with loading bone

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5
Q

hot, swollen, red, extremely painful (esp. with passive motion) joint - r/o?

A

septic joint

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6
Q

night pain - r/o?

A

tumor

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7
Q

deformity/loss of motion - r/o?

A

dislocation and/or fracture

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8
Q

rapidly progressing neurologic changes in forearm or leg - r/o?

A

compartment syndrome, esp. when accompanied by pallor, weak/absent pulse, pain with passive motion

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9
Q

pain with passive motion - r/o?

A

septic joint, compartment syndrome

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10
Q

significant, sudden onset of limb swelling, pain, and bluish skin changes - r/o?

A

deep vein thrombosis

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11
Q

point bony pain and bleeding - r/o?

A

open fracture

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12
Q

morning stiffness, better with rest - suspect?

A

arthritis

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13
Q

pain only with active motion (or resistance) - suspect?

A

muscle or tendon injury

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14
Q

pain with both active and passive motion - suspect?

A

articular injury/damage

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15
Q

weakness - suspect?

A

muscle or tendon injury

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16
Q

joint instability - suspect?

A

ligament injury

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17
Q

joint locking - suspect?

A

loose body or cartilage injury

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18
Q

basic strength grading scale

A 
5 = normal
4 = weak
3 = can only move against gravity 
2 = can move, but not against gravity
1 = muscle contraction, but no motion
0 = no contraction
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19
Q

basic reflex grading scale

A 
4+ = clonus
3+ = hyperactive, but no clonus
2+ = normal
1+ = hypoactive
0 = absent
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20
Q

pulse intensity grading scale

A 
0 = absent
1+ = faint, but detectable
2+ = diminshed
3+ = normal
4+ = bounding
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21
Q

shoulder abductors

A

deltoid, supraspinatus

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22
Q

shoulder adductors

A

pec major, latissimus dorsi

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23
Q

shoulder flexors

A

deltoid, coracobrachialis

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24
Q

shoulder extensors

A

latissimus dorsi, teres major, deltoid

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25
Q

shoulder external rotators

A

infraspinatus, teres minor

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26
Q

shoulder internal rotators

A

pec major, latissimus doors, teres major, subscapularis

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27
Q

scapular elevators

A

trapezius, levator scapulae

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28
Q

scapular retractors

A

rhomboids

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29
Q

scapular protractors

A

serratus anterior

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30
Q

painful arc of abduction - suspect?

A

pain during 80-150 deg. - rotator cuff injury

pain after 150 deg. - AC injury

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31
Q

full can test

A

tests supraspinatus

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32
Q

liftoff test

A

tests subscapularis

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33
Q

apprehension test

A

tests for joint laxity/dislocation of shoulder

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34
Q

sensory innervation of lateral shoulder

A

axillary n.

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35
Q

sensory innervation of lateral forearm

A

musculocutaneous n.

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36
Q

elbow valgus stress test

A

tests ulnar collateral ligament

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37
Q

Tinel’s sign

A

tapping over the median nerve in the carpal tunnel; replicates radicular pain in carpal tunnel syndrome

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38
Q

Phalen’s sign

A

holding wrists back-to-back in full flexion; replicates radicular pain in carpal tunnel syndrome

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39
Q

AC sprain signs

A

pain with overhead motions, deformity of superior shoulder, positive cross-chest test, painful arc of abduction over 150 deg.

40
Q

AC ligament injury grading

A

grade I - AC ligament stretch
grade II - AC ligament tear and CC ligament stretch
grade III - complete tears of both AC and CC ligaments (may or may not require surgery)
grade IV+ - complete tears of both AC and CC ligaments and clavicular displacement (requires surgery)

41
Q

shoulder dislocation treatment

A

usually sling, surgery for adolescent/high-level athletes; early mobilization and physical therapy for recurrent, non-traumatic dislocations

42
Q

signs of rotator cuff injury

A

positive impingement tests (Neer’s test, empty can test, Hawkins test), abduction weakness, painful arc of abduction (80-120 deg.), tender at insertion of supraspinatus on greater tuberosity of humerus; non-operative for minor injuries, surgical for large tear or youth/athlete

43
Q

signs of adhesive capsulitis

A

AKA frozen shoulder; painful, stiff shoulder, previous shoulder injury, limited passive and active ROM (esp. on external rotation)

44
Q

signs of medial epicondylitis

A

AKA “golfer’s elbow”; caused by overuse of wrist flexors; painful medial elbow with secondary weakness, tenderness over medial epicondyle, pain with resisted wrist flexion and forearm pronation

45
Q

signs of lateral epicondylitis

A

AKA “tennis elbow”; caused by repetitive extension; pain over lateral elbow radiating into forearm, weakness (advanced), tenderness over lateral epicondyle, pain with resisted wrist dorsiflexion and middle finger extension

46
Q

signs of scaphoid fracture

A

FOOSH, tenderness in anatomic snuffbox; may require MRI, CT, or bone scan

47
Q

signs of carpal tunnel syndrome

A

tingling and pain in median nerve distribution, worse at night, positive Tinel’s sign, positive Phalen’s sign, sensory loss of radial 3 1/2 fingers, thenar eminence atrophy, weakness of abductor policies braves and opponens, loss of 2-point discrimination

48
Q

signs of wrist ganglion

A

caused by overproduction of fluid by a joint/tendon sheath; firm, mobile lump, occasional pain

49
Q

apophysitis

A

irritation (rarely, avulsion) due to overuse/repetitive stress of growth plate; occurs because tendon/ligament is stronger than growth plate; may occur on patellar tendon insertion (Osgood Schlatter), achilles insertion (Sever’s), patellar tendon origin on inferior patellar pole (Sinding-Larsen-Johansson), sartorius/ASIS, rectus femoris/AIIS, medial epicondyle (little leaguer’s elbow); treated with relative rest

50
Q

signs of ankle sprain

A

forced ankle inversion, positive anterior drawer test, squeeze test (squeeze tibia and fibula together mid-shaft, pain at ankle is positive for high ankle sprain, pain at knee is positive for proximal fibula fracture associated with ankle injury), external rotation test

51
Q

signs of ulnar collateral ligament sprain

A

pain on valgus stress in 20 deg. of flexion (throwing athletes more common)

52
Q

back pain with history of cancer - r/o?

A

malignancy

53
Q

back pain with unexplained weight loss - r/o?

A

malignancy

54
Q

back pain with loss of bowel or bladder control - r/o?

A

myelopathy or stenosis

55
Q

back pain with significant weakness - r/o?

A

myelopathy or radiculopathy

56
Q

back pain with saddle anesthesia - r/o?

A

myelopathy or cauda equina syndrome

57
Q

back pain with hx of trauma - r/o?

A

fracture

58
Q

back pain with chronic corticosteroid use - r/o?

A

compression fracture

59
Q

back pain with immunosuppression - r/o?

A

infection

60
Q

back pain with fever - r/o?

A

infection

61
Q

back pain with IV drug use - r/o?

A

infection

62
Q

back pain with prior spine surgery - r/o?

A

hardware failure, adjacent segment disease, recurrent disc herniation

63
Q

back pain with weakness and/or numbness - suspect?

A

nerve involvement

64
Q

back pain with morning stiffness that improves with activity but not with rest (pt

A

spondyloarthropathy

65
Q

spondylolysis

A

fracture of the pars interarticularis

66
Q

spondyloisthesis

A

anterior displacement of one vertebrae on another

67
Q

spinal level landmarks

A 
hyoid bone - C3
thyroid cartilage - C4-5
first cricoid ring - C6
most prominent spinous process - C7
top of iliac crest - L4-5
PSIS - S2
68
Q

Hoffman sign

A

passive rapid flexion of middle finger distal phalanx; positive test is flexion of thumb, index finger; sign of upper motor neuron process (pathological reflex)

69
Q

straight leg raise test

A

lying supine, leg is raised with knee extended; positive test is reproduction of radicular symptoms with hip flexed between 30-70 deg.

70
Q

femoral stretch test

A

lying prone, knee is flexed to 90 deg. and thigh elevated; positive test is reproduction of anterior thigh radicular symptoms

71
Q

Spurling test

A

neck is placed in extension and rotation away from affected side; positive test is reproduction of ipsilateral radicular symptoms with axial pressure

72
Q

Lhermitte test

A

positive test is production of electrical shock sensation in limbs with cervical flexion

73
Q

signs and treatment of lumbar strain

A

low back pain after acute injury (lifting/twisting), localized muscle tenderness, reduced ROM; treatment includes rest, NSAIDs, muscle relaxant, PT

74
Q

signs and treatment of facet joint osteoarthritis

A

low back pain with gradual onset (cervical is worse with extension, lumbar is worse with standing/walking), pain provoked with active extension/relieved with flexion; treatment includes NSAIDs, mild analgesics, PT, possibly facet joint injections; either no imaging or plain X-rays

75
Q

signs and treatment of radiculopathy

A

pain/numbness/weakness in limb (lumbar: worse sitting/flexion, better standing/extension), SLR or Spurling positive, neurologic deficits, commonly caused by herniated disc; treatment includes relative rest, physical therapy, surgical discectomy (if progressive/severe), NSAIDs, oral or epidural corticosteroids, limited opioids, neuromodulators

76
Q

signs and treatment of lumbar stenosis

A

progressive back and leg pain (worse when standing/walking, better when sitting), shopping cart sign, flexed standing posture, reduced lumbar lordosis; caused by narrowing of the spinal canal; treatment includes NSAIDs, neuromodulators, PT, use of walker, epidural steroids, surgery for lumbar decompression (MRI, possibly CT or EMG)

77
Q

signs and treatment of cervical myelopathy

A

caused by cervical canal stenosis with spinal cord compression; pain, numbness, weakness in arms and/or legs, balance and gait difficulties, bowel/bladder dysfunction, upper motor neuron signs; treatment includes MRI, surgical decompression

78
Q

signs and treatment of compression fracture

A

usually anterior vertebral body wedge fracture of T10, T11, T12, or L1; sudden thoracic or lumbar pain, little to no trauma, hx of osteoporosis, tender over spinous processes, paraspinals, worse in lumbar flexion/better in extension; r/o malignancy/multiple myeloma in young pts; treatment includes plain X-rays, MRI, or CT, consider bracing, PT

79
Q

signs and treatment of ankylosing spondylitis

A
80
Q

signs and treatment of cauda equina syndrome

A

leg pain, numbness, weakness, saddle anesthesia, bowel/bladder dysfunction, reduced/absent reflexes, decreased rectal tone; may be caused by large herniated disc compressing cauda equina, epidural tumor, abscess, or hematoma; treatment is surgical emergency

81
Q

lower extremity inability to bear any weight - r/o?

A

fracture or dislocation

82
Q

hip adductors

A

adductor longus, adductor brevis, adductor magnus, gracilis

83
Q

hip abductors

A

gluteus medius, gluteus minimus, tensor fascia latae

84
Q

hip flexors

A

iliopsoas, rectus femoris, sartorius

85
Q

hip extensors

A

gluteus maximus, biceps femoris, semimembranosus, semitendinosus

86
Q

hip internal rotators

A

adductor longus, adductor brevis, adductor magnus, tensor fasciae latae, gluteus medius, gluteus minimus

87
Q

hip external rotators

A

gluteus maximus, piriformis, gemellus superior, gemellus inferior, obturator internus, quadratus femorus, obturator externus

88
Q

signs and treatment of slipped capital femoral epiphysis

A

overweight early adolescent, groin/knee/anteromedial thigh (may be bilateral, but not simultaneously), worse with activity; treatment includes plain x-rays, surgical fixation

89
Q

signs and treatment of transient synovitis of the hip

A

kids age 3-10, viral/post-vaccine/drug-induced, pt holds hip slightly flexed and refuses to bear weight, any motion causes pain; treatment includes labs (sed rate and mild leukocytosis), NSAIDs for 1-3 weeks

90
Q

signs and treatment of septic joint

A

caused by gonorrhea or skin flora; swollen, extremely painful knee, passive and active ROM very painful, red/hot knee, systemic signs (may be absent in diabetic or immunosuppressed pt); treatment includes surgical I&D followed by IV Abx

91
Q

signs and treatment of patellar dislocation

A

cutting with active quadriceps contraction, immediate pain and swelling, ecchymosis, effusion, positive apprehension test; usually lateral dislocation; treatment includes PT, eventual surgery if recurrent

92
Q

signs of ACL strain

A

twisting, non-contact, deceleration or hyperextension injury, pop and rapid effusion acutely, instability, positive Lachmann (drawer test at 20-30 deg. of flexion)

93
Q

signs and treatment of meniscal tear

A

twisting on a loaded knee, degenerative tears in older pts, locking and effusion, pain over joint line, pain with circumduction tests (i.e. McMurray); treatment includes PT and rest if no locking occurs, surgery if locking occurs

94
Q

signs of compartment syndrome

A

6 P’s: pain out of proportion, paresthesia, poikilothermia (coolness), paralysis, pallor, pulselessness; compartment pressure > 30 mmHg is diagnostic, compartment release usually required with pressure > 40 mmHg, definitely required with pressure > 60 mmHg

95
Q

signs and treatment of achilles tendon rupture

A

middle-aged male injured while playing basketball, heard “pop,” difficulty walking, defect in achilles, pain and weakness with plantar flexion; treatment includes immobilization or surgery

FPP/MSS (5 decks)

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