ORTHO

Question 1

Dupuytren contracture

Answer 1

Dupuytren disease is a condition that affects the palmar fascia, which lies underneath the skin in the palm and fingers. It is usually first detected when nodules form under the skin, often times followed by pitting on the surface of the palm as the diseased tissue pulls on the overlying skin. As the disease progresses, bands of fascia in the palm develop into thick cords that can tether one or more fingers, and the thumb into a flexed position. The most common finger to be affected is the ring finger; the thumb and index finger are much less often affected. The disease begins in the palm and moves towards the fingers, with the metacarpophalangeal joints affected before the proximal interphalageal joints. In Dupuytren contracture, the palmar fascia within the hand becomes abnormally thick, which can cause the fingers to curl, and can impair finger function.

Question 2

Volkmann contracture

Answer 2

Volkmann contracture is a permanent flexion contracture of the hand at the wrist resulting in a claw-like deformity of the hand and fingers. It is most commonly associated with supracondylar fracture of the humerus. Volkmann contracture results from acute ischemia and necrosis of the muscle fibers of the flexor group of forearm muscles, where the muscles become fibrotic and shortened. Common causes include brachial artery occlusion, or compartment syndrome due to trauma.

Question 3

Swan neck deformity

Answer 3

Flexion at the DIP, and hyperextension at the PIP. It is commonly caused by injury or inflammatory conditions such as rheumatoid arthritis.

Question 4

Boutonniere deformity

Answer 4

flexion at the PIP, and hyperextension at the DIP. It is commonly caused by injury or inflammatory conditions such as rheumatoid arthritis.

Question 5

symptoms of a rotator cuff tear

Answer 5

shoulder pain at rest and at night, (particularly when lying on the affected shoulder), pain when lifting and lowering the arm or with specific movements (e.g. overhead motion), weakness when lifting or rotating the arm, and crepitus when moving the shoulder in certain positions.

Tears that happen acutely (e.g. fall) usually cause intense pain.

Depending upon the specifics of the tear, physical examination findings may include decreased external rotation, atrophy of the shoulder muscles, a palpable defect, painful arc, positive Neer sign, positive Hawkin-Kennedy test, positive empty/full-can tests, positive drop-arm test, and/or positive lift-off and belly-press tests.

Question 6

Patellar dislocation most commonly occurs in which direction

Answer 6

laterally

Question 7

positive Thompson test

Answer 7

No motion of the foot is observed when squeezing the gastrocnemius muscle

for evaluating for Achilles tendon rupture.

Question 8

Lateral epicondylitis

• 2/2?
• pain elicited by?

Answer 8

(“tennis elbow”)

• Repetitive overuse of the forearm wrist extensor muscles and tendons
• Pain can also be elicited with provocation tests such as passive flexion of the wrist, and application of resistance against active wrist extension (Cozen test).