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Ortho-Rheum > Orthopedics - Sports Medicine Injuries > Flashcards

Orthopedics - Sports Medicine Injuries Flashcards

1
Q

What are the common signs & symptoms associated with subacromial impingement syndrome?

A
  • Shoulder pain with overhead motion
  • Night pain with sleeping on shoulder
  • Pain with internal rotation
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2
Q

What tests do you do to look for impingement syndromes?

A

The Neer and Hawkins tests

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3
Q

What are the common signs & symptoms associated wtih rotator cuff tears?

A
  • Difficulty lifting the arm
  • Limited ROM
  • Weakness of rotator cuff muscles with resisted strength testing
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4
Q

What is a common cause of shoulder impingement syndrome after age 40?

A

Partial rotator cuff tears

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5
Q

What is the most commonly torn tendon in rotator cuff tears?

A

The supraspinatus

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6
Q

What test do you use to measure supraspinatus tendon strength?

A

The “open can” test

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7
Q

What test do you use to measure subscapularis tendon strength?

A

“Lift-off” or “belly-press” tests

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8
Q

What direction are most shoulder dislocations in?

A

The anterior direction (95%)

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9
Q

What test do you use to assess for shoulder instability?

A

The apprehension test - pain and apprehension with an shoulder that is abducted and externally rotated

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10
Q

What demographic have the highest rate of redislocation in a previously dislocated shoulder?

A

Patients age 21 years or younger (70-90%)

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11
Q

What are the common signs and symptoms of a dislocated shoulder?

A
  • Obvious deformity, humeral head is usually dislocated anteriorly
  • Acute pain that is improved w manual relocation of the shoulder
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12
Q

What are the common signs and symptoms of adhesive capsulitis (aka “frozen shoulder”)?

A
  • Very painful shoulder triggered by minimal or no trauma
  • Limited ROM (both passive and active)
  • Pain out of proportion to clinical findings during the inflammatory phase
  • Stiffness during the “freezing” phase and resolution during the “thawing” phase
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13
Q

Who typically gets adhesive capsulitis?

A
  • Patients 40-65 y/o, most often seen in women than men

- More likely in patients w endocrine disorders (DM, thyroid disease)

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14
Q

What are the three phases of adhesive capsulitis?

A 
Inflammatory phase (4-6 months)
Freezing phase (4-6 months)
Thawing phase (can take up to a year)
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15
Q

What is the second most common cause for primary care visits?

A

Low back pain

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16
Q

What are some of the “alarming” symptoms besides back pain that might suggest multiple myeloma or other malignancy?

A
  • Unexplained weight loss
  • Failure to improve with treatment
  • Pain for more than 6 weeks
  • Pain at night or rest
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17
Q

What are some of the “alarming” symptoms besides back pain that might suggest infection?

A
  • Fever
  • Pain at rest
  • Recent infection (UTI, cellulitis, pneumonia)
  • Hx of immunocompromise or IVDU
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18
Q

Along with back pain, what other symptoms suggest cauda equina syndrome?

A
  • Urinary retention or incontinence
  • Saddle anesthesia
  • Decreased anal sphincter tone or fecal incontinence
  • Bilateral lower extremity weakness
  • Progressive neurologic deficits
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19
Q

What are the risk factors for back pain due to vertebral fracture?

A
  • Corticosteroids
  • Age > 70 years
  • Hx of osteoporosis
  • Recent significant trauma
  • Very severe focal pain
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20
Q

What exam should be done if cauda equina syndrome is suspected?

A

A rectal exam, of course!

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21
Q

What are the common signs and symptoms of spinal stenosis?

A
  • Pain is usually worse with back extension and relieved by sitting
  • Occurs in older patients (50+)
  • May present with neurogenic claudication symptoms with walking (lewg symptoms that are worse after walking several minutes and relieved by sitting; due to a large disc herniation)
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22
Q

What are the common signs and symptoms of lumbar disk herniation?

A
  • Pain with back flexion or prolonged sitting
  • Pain is localized at the level of the affected disk and is worse with activivty
  • Radicular pain with compression of neural structures
  • Lower extremity numbness and weakness
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23
Q

What is the typical cause of lumbar disk herniation?

A
  • Bending or heavy loading with the back in flexion

- Degenerative disk disease in patients btw 30-50

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24
Q

What causes cauda equina syndrome?

A

Severe compression of the spinal cord

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25
Q

What disk is affected in lumbar disk herniation in 90% of the cases?

A

L5-S1

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26
Q

What is the most common type of traumatic injury to the neck?

A

Whiplash

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27
Q

What are the most common signs and symptoms of lateral epicondylitis?

A
  • Pain with the arm and wrist extended (eg pain while shaking hands, using a computer mouse, or hitting a backhand in tennis)
  • Pain/tenderness directly over the epicondyle
  • Hx of repetitive movements involving lifting with the wrist and elbow extended
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28
Q

What are the common signs and symptoms of medial epicondylitis?

A
  • Pain during motions in which the arm is repetitively pronated or the wrist is flexed (eg during a golf swing)
  • Pain/tenderness directly over the epicondyle
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29
Q

What tendon(s) does lateral epicondylitis involve?

A

The wrist extensors

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30
Q

What tendon(s) does medial epicondylitis involve?

A

The wrist flexors, and most commonly the pronator teres tendon

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31
Q

What are the common signs and symptoms of carpal tunnel syndrome?

A
  • Pain, burning, and tingling in the distribution of the median nerve
  • Initially, most bothersome during sleep
  • Later, weakness or atrophy, esp of the thenar eminence
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32
Q

Who typically presents w carpal tunnel syndrome?

A
  • Commonly seen during pregnancy and in patients with DM or rheumatoid arthritis
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33
Q

If someone were to have pain in the distribution of the median nerve, where would they have pain?

A
  • The palmar surfaces of the thumb, the index and long fingers, and the radial half of the ring finger
34
Q

What are the tests used to assess for carpal tunnel syndrome?

A
  • Tinel sign

- Phalen sign

35
Q

Who typically presents with Dupuytren Contracture?

A
  • White men over 50 y/o

- Higher incidence among alcoholics and those w cirrhosis

36
Q

What are the common signs and symptoms of Dupuytren Contracture?

A
  • Nodular or cord-like thickening of one or both hands (the 4th and 5th fingers are most commonly affected)
  • Tightness of the involved digits with inability to extend the fingers
37
Q

What is bursitis usually secondary to?

A

Trauma, infection, or arthritic conditions like gout, RA, or OA

38
Q

What are the two more common sites of bursitis?

A

Olecranon and prepatellar bursae

39
Q

Compared to arthritis, what is bursitis more likely to present with?

A

More likely to cause focal tenderness and swelling than arthritis
Less likely to affect range of motion of the adjacent joint than arthritis

40
Q

If someone has a Baker cyst that ruptures, what are the signs and symptoms?

A

Calf pain and swelling; mimics thrombophlebitis

41
Q

What bursa does a Baker cyst occur on?

A

The semimembranous-gastrocnemius bursa

42
Q

What are risk factors for hip fracture?

A
  • Osteoporosis
  • Female sex
  • Height over 5’8”
  • Age over 50 years
43
Q

What is the most sensitive test to identify a hip fracture?

A

Internal rotation of the hip

44
Q

What are the common signs and symptoms of a hip fracture?

A
  • Pain in the groin; pain radiating to the lateral hip, buttock, or knee can also commonly occur
  • If fracture is displaced, pt will not be able to bear weight and the leg may be externally rotated
  • Pain with deep palpation in the area of the femoral triangle
45
Q

What are the common signs and symptoms of osteoarthritis of the hip?

A
  • Pain deep in the groin on the affected side, especially with loading of the joint or dring motion
  • Problems with weight-bearing activities
  • Swelling
  • Loss of active and passive ROM (in severe OA)
46
Q

What does acute knee swelling (hemarthrosis) within 2 hours indicate?

A

Ligament injuries (ACL usually) or patellar dislocation or fracture

47
Q

What does the presence of grinding, clicking or popping with bending of the knee suggest?

A

Osteoarthritis or patellofemoral syndrome

48
Q

What does “locking” or “catching” of the knee when walking suggest?

A

An internal derangement, such as a meniscal injury or a loose body in the knee

49
Q

What can lateral “snapping” with flexion and extension of the knee indicate?

A

Inflammation of the IT band

50
Q

What does pain that is worsened with bending and walking downstairs suggest?

A

An issue with the patellofemoral joint (usually degenerative, such as chondromalacia of the patella or osteoarthritis)

51
Q

What does pain that occurs when rising after prolonged sitting suggest?

A

A problem with tracking of the patella

52
Q

What are the signs and symptoms of an ACL injury?

A
  • An injury involving an audible pop when the knee buckles
  • Acute swelling immediately (or within 4 hours)
  • Instability occurs with lateral movement activities and going down stairs
53
Q

What kind of activities do ACL injuries result from?

A 
Both contact (valgus blow to the knee) and non-contact (jumping, pivoting, and deceleration) activities
- Common in skiing, soccer, football, and basketball
54
Q

What test(s) do you use when suspecting ACL injury?

A

The Lachman test
The anterior drawer test
The pivot shift test

55
Q

What is the most commonly injured ligament in the knee?

A

The MCL

56
Q

What two ligaments commonly are injured concurrently?

A

MCL and ACL

57
Q

What are the signs and symptoms associated with collateral ligament injury?

A
  • Caused by valgus or varus blow or stress to the knee
  • Pain and instability in the affected area
  • Limited range of motion
58
Q

What tests are best to use to assess the collateral ligaments?

A
  • Varus (LCL) and valgus (MCL) stress testes
59
Q

What are the signs and symptoms of a PCL injury?

A
  • The knee may freely dislocate and reduce
  • Difficulty ambulating
  • The “sag sign”: the PCL injured knee has an obvious set-off at the anterior tibia which is “sagging” posteriorly
60
Q

When do PCL injuries typically occur?

A
  • Following an anterior trauma to the tibia, such as dashboard injury during a motor vehicle accident
61
Q

When suspecting a PCL injury, what else should you maintain a high suspicion for/

A

Neurovascular injuries

62
Q

What test should you use to check for a PCL injury?

A

Posterior drawer test

63
Q

What are the most sensitive signs of meniscus injuries?

A
  • Joint line pain and pain with deep squatting
64
Q

What can lead to a pain, clicking, and locking sensation or the knee?

A

Meniscal injuries

65
Q

What are the common signs and symptoms of meniscal injuries?

A
  • An antalgic gait
  • Difficulty with squatting
  • Catching or locking of the meniscal fragment
  • Effusion or joint line tenderness
  • Swelling that occurs during the first 24 hours after the injury or later
66
Q

What tests can be used when suspecting meniscal injury?

A
  • McMurray test
67
Q

What are the common signs and symptoms of patellofemoral pain?

A
  • Pain experienced with bending activities (kneeling, squatting, climbing stairs)
  • Lateral deviation or tilting of the patella in relation to the femoral groove
  • When maltracking, palpable and sometimes audible crepitus can occur
68
Q

What typically causes patellofemoral pain?

A
  • Trauma or a repetitive physical activity, such as running and jumping
69
Q

What tests can you use to assess stability of the patellofemoral joint?

A

The apprehension sign

70
Q

What test is used when suspecting chondromalacia of the patella?

A

The patellar grind test

71
Q

What are the two common etiologies for patellofemoral pain?

A
  • The ligaments and patella are too loose (hypermobility)

- Soft tissue are too tight which leads to excessive pressure on the joint

72
Q

How do you evaluate quadriceps and hip stabilizer strength?

A

A one-leg without support

73
Q

What do the majority of ankle injuries involve?

A

Inversion injuries affecting the lateral ligaments

74
Q

When should you consider chronic ankle instability?

A

If pain persists for more than 3 months following an ankle sprain

75
Q

What are the most common sports injuries seen in outpatient clinics?

A

Ankle sprains

76
Q

What is the most common mechanism of injury of an inversion ankle sprain?

A
  • Inversion and plantarflexion sprain which involves the anterior talofibular ligament
77
Q

What are the common signs and symptoms following a sprain?

A
  • Localized pain and swelling over the lateral aspect of the ankle
  • Difficulty weight bearing
  • Limping
  • Swelling, bruising over the lateral aspect of the ankle
  • The anterior, inferior aspect below the lateral malleolus is most often the point of maximal tenderness
78
Q

What tests can you do to assess for an inversion ankle sprain?

A
  • Anterior drawer test

- Subtalar tilt test

79
Q

What are the signs and symptoms of an eversion ankle sprain?

A
  • Severe and prolonged pain
  • Limited range of motion
  • Mild swelling
  • Difficulty with weight bearing
80
Q

What ligament is most often injured in an eversion ankle sprain?

A
  • The anterior tibiofibular ligmament
81
Q

What test can you do to assess for an eversion ankle sprain?

A
  • External rotation stress test

Ortho-Rheum (3 decks)

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