Musculoskeletal & Sports Medicine Flashcards
What is the most likely diagnosis for an overweight African American pt presenting with slowly progressive genu varum (bowing) deformity, knee pain, medial collateral ligament laxity, internal tibial torsion and leg length discrepancy?
Blount Disease
(idiopathic tibia vara)
-females during infancy, males at older ages
What is the radiographic finding associated with Blount Disease (idiopathic tibia vara)?
prominent medial metaphyseal angulation (beaking) of tibia > 11 degrees
-also get widening of the physis and fragmentation of metaphysis
What disease is associated with the radiographic finding of sclerotic destruction in sunburst pattern usually during the 2nd decade of life and usually presents as wax and waning pain after injury with painful large soft tissue mass on examine?
Osteosarcoma (malignant bone tumor)
What disease is associated with the radiographic finding of an oval metaphyseal radiolucent lesion surround by sclerotic bone usually in pt presenting with nocturnal pain unrelated to activity?
Osteoid osteoman (benign bone lesion)
What disease is associated with the radiographic finding of lytic, multilaminar periosteal elevation of proximal metaphysis of long bones?
Ewing Sarcoma
What disease is assocaited with the radiographic finding of multiple broad based bony projections arising from the medial metaphysis of the distal femur/ proximal tibia/ proximal humerus?
Osteochondroma
What is the most likely diagnosis for a pt with chronic subacute back pain that worsens after activity and improves with rest, anterior wedging (> 5 degrees) of 3 consecutive vertebral bodies and Schmorl nodes on Xray and hyperkyphosis?
Scheuermann Disease (juvenile kyphosis)
(tx w/ bracing to prevent worsening if > 45 degress; spinal fusion for deformity> 70 degrees)
-pts unable to voluntarily correct kyphosis
A pt with secondary amenorrhea, an LH:FSH ratio > 3, elevated DHEAS, acne and hirsutism most likely suffers from….
PCOS
polycystic ovarian syndrome
What is genu valgum?
knock knees
What is genu varum?
Bowing of the legs
What is the normal physiologic development of the tibiofemoral angle (angle btw femur axis and the tibia axis) ? (3 steps)
- birth to 2 years: genu varus (bowing)
- 2-4 years: genu valgus (knock knee)
- 4 to 7 years: levels off to 4-7 degree in males and 5-9 degrees in female
What is the likely diagnosis of pt with elbow pain localized to the lateral epicondyle and resisted extension of wrist with elbow at 90 degrees reproduces pain?
Lateral Epicondylitis
(aka Tennis Elbow)
-due to repetitive one -handed back hand strokes
-Tx: RICE and change swing
What is a complication of severe scoliosis with Cobb angle of > 90 degrees?
Restrictive pattern on PFTs and Cor Pulmonale on ECHO
-especially if have neuromuscular disease
What is a complication of scoliosis with Cobb angle of > 60 but < 90?
Nocturnal alveolar hypoventilation
What is the most likely diagnosis of pt presenting with painful, enlarging, rounded mass of the quads/ brachialis/ deltoid muscles and has Xray finding of mature peripheral ossification with a distinct margin surrounding a radiolucent center of immature osteoid and primitive mesenchymal tissue?
Heterotopic bone (traumatic myositis ossificans)
due to blunt soft tissue trauma usually in active adolescent
What is the earliest time to perform a hip ultrasound on an infant who has risk factors for or concerns on physical exam for hip dysplasia?
6 weeks of age
can use plain xrays after 4-6 months of age
What is the most likely diagnosis for an obese pt presenting with hip/ knee/ thigh pain with painful limp with an antalgic abductor lurch gait and found to have restricted internal rotation, abduction and hip flexion?
SCFE (slipped capital femoral epiphysis)
-XRay findings of femoral head displaced in relation to femoral neck
What endocrine disorder is associated with SCFE (slipped capital femoral epiphysis)?
Hypothyroidism
what is the likely diagnosis for pt presenting with pain over the lateral femoral condyle during exercise and history of long distance running/ cycling/ downhill skiing/ weightlifting or playing soccer?
Iliotibial band Friction Syndrome
-iliotibial band passes over lateral femoral epicondyle
What is the best initial diagnostic test for suspected spondylolysis (chronic, progressive low back pain in gymnasts, ballet dancer, wrestler)?
anterioposterior, lateral, and oblique Xrays of lumbar region
-see a Scottie dog (fracture of pars interarticularis is collar around neck of a scottie dog)
What is the most likely diagnosis for a 3-12 year old male presenting iwth hip/knee pain and limp and holding affected leg in externally rotated position and has history of renal disease/ steroid use/ collagen vascular disease or sickle cell disease?
Legg-Calve-Perthes disease
-avascular necrosis of femoral head
What is the most likely diagnosis for a pt presenting with anterior knee pain worsened when going up or down stairs and pain elicited when pressure applied to patella over the distal femur?
Chondromalacia patella
-usually in athletic adolescent female
What is the most likely diagnosis for an athletic male (aged 8-18 years old) presenting with progressive worsening knee pain restricting athletic activity due to swelling and limited range of motion, sometimes with a popping/ giving way or locked up feeling, and unable to fully extend knee?
Osteochondritis dissecans
(dx: xray showing avascular bone/ radiolucency lesion along lateral portion of medial femoral condyle with fragment of partially attached subchondral bone)
What is the treatment for osteochondritis dissecans?
conservative therapy (restriction of activity until pain free and healing on repeat Xray) -if loose bodies, closed physes, or no improvement after 4-6 months, then surgery
What is the most likely diagnosis for a pt presenting with elbow pain, tenderness and pain around the medial epicondyle, and pain reproduced with flexion of the wrist/?
Medial Epicondylitis
Golfer’s Elbow
What is the most common cause of in-toeing (feet internal rotated) and when should intervention be considered?
internal tibial torsion (lateral malleolus is slightly anterior to medial malleolus when legs dangling in seated position)
intervention if persists beyond 8 years old
…. is when the forefoot is adducted; therefore, a line that bisects the base of the hindfoot forward to the toes passes lateral to between then 2nd and 3rd toe
Metatarsus Adductus
(if flexible/ can passively abduct past midline, will resolve by 1 year old)
(if not flexible, refer to Ortho for serial casting)
What is the likely diagnosis for an adolescent male going through growth spurt presenting with knee pain localized to tibial tubercle, worsened by direct trauma, kneeling, running, jumping, squatting, climbing stairs, or walking uphill, and pain reproduced by extending knee against resistance, stressing quad, or squatting with knee in full flexion?
Osgood- Schlatter
tx: RICE -> physical therapy and/or orthotics –> steroid injections
What is the most likely diagnosis for pt presenting with high-riding, hypoplastic
and rotated scapula, asymmetry of base of neck and shoulders, and possible torticollis/ scoliosis?
Sprengel deformity (associated with Klippel-Feil syndrome)
What is the likely diagnosis for pt presenting with high-riding, hypoplastic, and rotated scapula and fused and hypoplastic cervical vertebrae resulting in short, broad, webbed neck, low hairline and limited ROM?
Klippel-Feil syndrome
associated with anomalies of heart, lungs, kidneys
What is the most likely diagnosis for baseball pitched presenting with gradual medial onset pain, trouble loosening up, pain with harder and longer throws, and point tenderness over medial portion of elbow with mild limitation of full elbow extension and pain on resisted forearm pronation and wrist flexion?
Medial epicondyle apophysitis
Little League Elbow
What is the most likely diagnosis for pt presenting with chest pain secondary to fibrous tissues abnormality of the 8th, 9th and 10th ribs?
Slipping rib syndrome
pain due to intercostal nerve impingement
What is the most likely diagnosis for infant presenting with fixed cavus and adductus of forefoot with varus and equinus of hindfoot? and what is the treatment?
Congenital Clubfoot (equinus varus)
Stretching and casting
-increased incidence w/ 1st trimester smoking and positive family hx
What performance enhancing drug has side effects including peripheral edema (hands), insulin resistance, hyperglycemia, cardiolmegaly and myalgia/ athralgia?
Recombinant human growth hormone
What are common side effects of the performing enhancing drug erythropoietin? (4)
- Hypertension
- Myocardial infarction
- Stroke
- Thromboembolic disease
What is the cause for Osgood- Schlatter disease?
overuse injury resulting in repetitive strain and chronic avulsion of apophysis of tibial tubercle
-leads to separation of distal patellar tendon from bony insertion
What nutritional supplement due athletes who require brief periods of high intensity strength to perform optimally (like weightlifters, sprinters, hockey players, wrestlers, offensive/ defensive linemen, shot putters)?
Creatine
(combines with phosphate to make phosphocreatine forming new ATP and additional energy)
-can result in renal damage
What is the treatment for scoliosis < 20 degrees and minimal symptoms?
general activity encouraged without restrictions
What is the treatment for scoliosis between 25 and 45 degrees?
consider bracing
What is the treatment for scoliosis > 45 degrees?
Spinal fusion or placement of Harrington rod
What is the most likely diagnosis for pt presenting with knee pain along joint line, popping or locking sensation, and pain and popping in medial joint line with slow extension of left knee from flexed position (positive McMurray test) after twisting injury?
Medial meniscal tear
Why does the NCAA recommend that all collegiate athletes be tested for sickle cell trait?
possible sudden death from exertional rhabdomyolysis (exertional sickling)
What is the treatment for traumatic myositis ossificans?
Physical therapy and immoblizations
excision if not improved after 6-12 months
What is the most common mechanism of injury resulting in an ACL (anterior cruciate ligament) tear?
sudden deceleration and pivoting of knee
more common in sports where athlete makes sudden stops and quick changes in direction
What does a positive Lachman test suggest?
torn ACL (anterior cruciate ligament)
-anterior translation of tibia > 2mm different from unaffected leg when knee 30 degree flexed, femur stabilized at thigh and pull tibia forward)
What is a possible complication of Marfan’s syndrome that may limit physical participation in activities like scuba diving?
Spontaneous pneumothorax
True or false. Polydactyly is most common in African Americans.
True
occurs in the 6th to 7th week of embryogenesis
What is the most common etiology of transient synovitis?
proceeding viral URI
no fever during leg pain
What is the difference between heat exhaustion and heat stroke?
heat stroke has CNS abnormalities (altered mental status)
