Pain (CRAM)

Question 1

Prednisone use with Hip pn & difficult to weight bear: Dx?

Answer 1

Avascular necrosis of hip

Question 2

Right lateral hip pain in pt running for 1st time in 10 years: Dx?

Answer 2

Greater trochanteric bursitis

Question 3

Positive Lachman’s test: Dx?

Answer 3

ACL tear

• Likely from pivot injury.

Question 4

Grating sensation in knee & Extension apprehension on compressing the patella: Dx?

Answer 4

Patellofemoral syndrome (aka chondomalacia)

• Due to repeated stress, misalignment, & muscular imbalance that damage the articular cartilage on the underside of kneecap.
• Tx is quadriceps exercise.

Question 5

Feeling of insecurity (giving away), intermittent swelling, and loose body on XR: Most common cause?

Answer 5

Osteochondritis dessicans

• Due to blood deprivation, cracks form in articular cartiage and underlying subcondral bone, causing swelling, pain, & instability (catching and locking).

Question 6

Exquisite, deep burning pain in ankle 6 weeks after mild sprain & cannot weight bear with foot, which is blue, mottled, cool, pale, and painful with slightest touch.

1) Dx
2) Tx

Answer 6

1) Reflex sympathetic dystrophy (aka Type 1 complex regional pain syndrome)
2) Oral corticosteriod

• Unknown cause, but usually occurs after trauma or surgery. It has variable course with pain, swelling, and vasomotor dysfunction of extremity.
• 3 stages: Acute, Dystrophic, & Atrophic

Question 7

Phantom limb pain or sensation: Best Tx approach?

Answer 7

Normalize experience and ongoing tactile stimulation

Question 8

Charcot foot: Therapeutic maneuver?

Answer 8

Off-loading with elevation

• This allows soft bones to self-repair.

Question 9

Post-herpetic neuralgia: Tx option?

Answer 9

TCA, Anticonvulsant, capsaicin, & opioids

Question 10

Trigerminal neuralgia: 1st line Tx?

Answer 10

Carbamazepine (AED)