Orthopedics

Question 1

What is the Adams test?

Answer 1

Screening test for scoliosis. Bend forward at the hips. Look for rib hump or asymmetric creases.

Question 2

What is the AAP screening guidelines for scoliosis?

Answer 2

Screen at ages 10, 12, 14, and 16.

Question 3

Scoliosis is classified into three groups based on age. What are the groupings and relative frequencies of incidence?

Answer 3

Infantile: rare
Juvenile: 3 to 10 years, 12 to 21%
Adolescent: most common, occurring after age of 10.

Question 4

Determinants regarding risk of progression and idiopathic scoliosis?

Answer 4

Girls tend to progress more than boys. The earlier the Tanner stage, the more likely to progress. Greater curvature equals greater progression.

Question 5

What are red flags and scoliosis

Answer 5

Pain
Left thoracic curve (because 90% are to the
neuro abnormalities
Spinal stiffness

Question 6

How is scoliosis diagnosed?

Answer 6

PA x-ray of the back while standing.

Question 7

When should you get an MRI and scoliosis?

Answer 7

Left curve
Unusual pain
Abnormal neuro exam.

Question 8

How is scoliosis

Answer 8

Avoid surgery if possible using bracing, orthotics.

Question 9

A 15-year-old gymnast presents with acute low back pain that is worse with extreme extension. What is the most likely diagnosis?

A: muscle strain
B: spinal stenosis
C: osteosarcoma
D: spondylolysis
E: spondylolisthesis

Answer 9

D: spondylolysis

Question 10

What is spondylolysis?

Answer 10

Stress fracture of the pars, Causes back pain with extension, frequently occurring in gymnasts, football, and weightlifting.

Question 11

What degree of curvature of spine meets criteria for idiopathic scoliosis?

Answer 11

10°

Question 12

What is spondylolisthesis?

Answer 12

Anterior slippage of a vertebral body on a lower level.

Question 13

What are the symptoms of spondylolisthesis?

Answer 13

Stiff back.
Tightening of hamstrings.
Pain behind knees or below.

Question 14

When is surgery indicated in spondylolisthesis?

Answer 14

Delay until after completing growth.

Fusion indicated of > 50% slippage and significant growth remaining.

Question 15

What is the non-surgical treatment for sponylolisthesis?

Answer 15

Strengthening of core muscles.
Hamstring stretches.
Postural training.
Limit aggravating activities. 
Orthotics.

Question 16

A 14 year old football player has scoliosis. What findings would make you consider getting an MRI to evaluate the spine?

Answer 16

Levo-curvature.
Neurological changes.
Pain.
Stiffness.

Question 17

A 16 year old female gymnast has increased pain in her back doing back flips. Which imaging test would you perform: PA view of the back or lateral view?

Answer 17

You’re thinking this is a pars fracture, spolnylolysis, so do the PA view of the back.

Question 18

A 13 year old baseball player complains of increased back stiffness and pain behind the knees and radiating downward. Which straight leg finding will you expect on exam?

Answer 18

You’re thinking sponylolisthesis, so straight leg will be limited and hamstrings will be tight.

Question 19

And obese, adolescent boy with no history of trauma has a dull ache in the hip. Pain is increased buy physical activity and relieved with rest. Internal rotation and flexion of the hip is decreased. Which of the following is the most likely diagnosis?

A: spondylolisthesis
B: Leg-Calvé-Perthes
C: slipped capital femoral epiphysis
D: Developmental dysplasia of the hip
E: Osgood-Schlatter disease

Answer 19

A: Slipped capital femoral epiphysis

Question 20

How common is it to have bilateral slipped capital femoral disease?

Answer 20

About 20% of cases. When unilateral, it is also common for the other hips to slip, in about 30 to 60% of cases.

Question 21

You have a 13-year-old obese girl in your office complaining of hip pain when she runs. You did a plain x-rays of her hips which was negative, but you are convinced she has slipped capital femoral disease.you expect the MRI to show what finding?

Answer 21

Widening of the physis with surrounding edema.

Question 22

True or false? Bands have been shown to help Osgood-Schlatter disease.

Answer 22

False. Ice before and after activity as well as NSAIDs help. Rest is mainstay of therapy.

Question 23

In the setting of Osgood-Schlatter disease, when would imaging be indicated?

Answer 23

If pain is atypical.
Pain not located at tibial tuberosity
Redness or warmth