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MSS: post-midterm > Musculoskeletal injury clinical correlations > Flashcards

Musculoskeletal injury clinical correlations Flashcards

1
Q

If radiographs come back negative, what is the best next test to look for pathology?

A

MRI (avoids radiation, good to look for soft tissue injury)

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2
Q

What is the pneumonic helpful in forming a differential diagnosis?

A

**vindicate;

  • vascular
  • infection
  • neoplasm
  • drugs
  • inflammation/idiopathic
  • congenital
  • autoimmune
  • trauma
  • endocrine/metabolic
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3
Q

In what joints are effusions easily diagnosed (via xray)?

A
  • knee
  • elbow
  • ankle
  • wrist
  • fingers
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4
Q

Contrast inflammatory arthritis and osetoarthritis

A
  • inflammatory arthritis
    • rheumatoid arthritis
    • seronegative syndromes (ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
    • deposition diseases (gout)
  • osteoarthritis
    • **degenerative
    • osteophytes
    • asymmetric joint loss
    • predictable pattern
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5
Q

When is it best to order a radiologic test?

A

When the results will potentially change management options

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6
Q

What are the important characteristics to include when describing a fracture?

A
  • location/orientation
  • displacement
  • apposition (amount of contact between the fragmented parts)
  • angulation (displacement from normal axis)
  • intraarticular involvement (involves joint space?)
  • comminution (degradation)
  • open or closed?
  • associate injuries
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7
Q

What are the results of acute and chronic injury?

A
  • acute= inflammation
  • chronic= degeneration
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8
Q

What are the problems in ligament, muscle, and tendon injuries?

A
  • ligament= stability issues
  • muscle/tendon= active joint motion
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9
Q

Contrast traumatic, pathologic, and stress fractures

A
  • traumatic= high force exceed normal bone strength
  • pathologic= normal force exceed damaged bone strength
  • stress= repetitive submaximal forces gradually damages bone (“overuse” injury)
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10
Q

What are two major clinical findings that point towards a bone injury?

A

Point tenderness on exam and pain with indirect loading

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11
Q

What is usually the diagnosis when a patient complains of “joint locking”?

A

“Joint mice”/ loose body within the joint

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12
Q

What clinical finding points towards a cartilage injury?

A

Pain with both passive and active motions (just active pain is usually muscle)

**cartilage injuries have poor healing

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13
Q

Define dislocation

A

Complete displacement of a joint

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14
Q

Define subluxation

A

Transient, partial displacement of a joint

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15
Q

Define laxity

A

Normal variation in “joint looseness”

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16
Q

What is a maisonneuve fracture?

A

A fracture in the proximal fibula from rolling your ankle (force travels up the bone and fractures near the knee)

**positive squeeze test (hurts at the knee) and pain with external rotation

17
Q

What do the squeeze test and external rotation test look for?

A

Should both be negative for a lateral ankle sprain (Anterior TibioFibular Ligament tear)

**external rotation hurts with medial or high (tibiofibular syndesmosis) ankle sprains

**squeeze test hurts high ankle sprain or maisonneuve fracture

18
Q

What exam findings will be present for a peroneal ankle sprain?

A

**evulsion of the peroneal tendon at the base of the 5th metatarsal (tenderness of the tendon)

**pain with resisted eversion

19
Q

When are NSAIDs a helpful option in the treatment of inflammation?

A

When the inflammation is ACUTE (also Rest Ice Compression Elevation)

20
Q

What are three major requirements for the healing of a ligament?

A
  • good blood supply
  • damaged section approximated/guided to the correct area
  • relative rest

**can just brace (cast if concerned about taking brace off)

21
Q

Contrast an acute and chronic injury

A
  • Acute
    • know exact time of injury
    • gets worse with use
    • inflammation (NSAIDs helpful)
    • treat with RICE
  • Chronic
    • vague onset
    • pain gets better after warming up (for awhile)
    • degeneration
22
Q

What is the difference between compression and distraction loading?

A
  • compression= test joint surfaces and structures between surfaces (articular cartilage, menisci, labrum)
    • PUSH on a joint
  • distraction= to test structures surrounding joint (e.g. capsule and ligaments)
    • PULL on joint

**also shift stress (moving a joint as it’s meant to)

23
Q

What is capsulitis?

A
  • capsular thickening (inflammation and scarring)
  • idiopathic or post injury
    • risk factors= diabetes and thyroid disease
24
Q

What will the exam findings be for capsulitis?

A
  • limited/decreased range of motion
    • painful with decreasing ROM (freezing phase)
    • non-painful, stable ROM (frozen phase)
    • non-painful, improving ROM (thawing phase)
25
Q

Describe 3 common fractures of the 5th metatarsal

A
  1. avulsion (peroneus brevis)
  2. jones (metaphyseal-diaphysis junction)
  3. dancer’s (spiral fracture mid to distal diaphysis)
26
Q

What is Sever’s condition?

A

A type of bone injury in which the growth plate in the lower back of the heel, where the Achilles tendon attaches becomes inflamed and causes pain

27
Q

What is apophysitis?

A

**pain and inflammation of ossification centers from repetitive tension

  • before/during/after activity (all the time) pain
  • treat with activity as tolerated, stretching, ice, NSAIDs
  • complications= bony hypertrophy fracture
    • Osgood Schlatter (tibial tubercle)
    • Sever’s (calcaneal apophysitits)
28
Q

Describe indirect loading tests

A
  • axial loading (pressure on bone… e.g. push on straight finger)
  • bump test (pressure on area that hurts)
  • fulcrum test (loads the middle of the bone; press on opposite end without any joint involvement)
  • hop test (patient jumps)
29
Q

What is the best treatment of a bone fracture?

A

Immobilization

**avoid NSAIDs and tobacco

30
Q

Define enthesopathy

A

disorder of muscular or tendinous bony attachment

e.g. epicondylitis or shin splints

31
Q

Define tendinosis

A

chronic degenerative condition of tendon

(tendinitis= technically acute inflammation)

32
Q

Descibe lateral epicondylitis

A
  • “tennis elbow”
  • pain with resisted wrist and middle finger extension
  • pain with supination
33
Q

What is DOMS? When does it occur and what is its mechanism?

A
  • delayed onset of muscle soreness
  • 24-72 hours after new physicial activity
  • lasts 5-7 days
  • disruption of sarcolemma results in influx of intracelllar calcium (causes a proteolytic enzyme mediated myoprotein degradation)
34
Q

What are the three tests for impingement testing?

A
  • empty can test
  • hawkin’s test
  • neers test
35
Q

Describe the three grades of AC injury

A

**acromioclavicular sprain;

  • grade I= AC ligament stretch/sprain
  • grade II= AC ligament tear and coracoclavicular (CC) ligament stretch
  • grade III= AC and CC tear
36
Q

Define bursitis

A

Bursa= synovial lined sac that contains fluid and acts to reduce friction between structures

**bursitis= bursa inflammation (common in achilles, olecranon, subacromial, prepatellar and other knee locations)

37
Q

What is a joint ganglion?

A

Fluid filled soft tissue mass filled with collection of synovial or peritendinous fluid that arises from a joint or tendon sheath

**common location= wrist

38
Q

How can you distinguish between effusions, bursitis, and ganglions?

A
  • effusions
    • uniform and diffuse around joint
    • “attached” to joint; non-mobile
  • bursitis
    • localized, mobile
    • “squishable”
  • ganglion
    • usually relatively small near joints
    • fairly tense; described “like a marble”

MSS: post-midterm (26 decks)

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