SILVER Musculoskeletal Conditions

Question 1

What is the most common MOI for an intervertebral disc herniation?

Answer 1

Twisting and bending of the spine, often with the addition of an external load

Question 2

What structures make up an intervertebral disc?

Answer 2

Annulus fibrosus = outer cartilaginous ring

Nucleus pulposus = inner jelly like material

Question 3

What portion of the disc is most likely to be herniated? Why?

Answer 3

Posterolateral portion of the disc

Why?

1. Posterior disc is narrower in height than anterior disc
2. PLL is not as strong as the ALL
3. Posterior lamellae of the annulus are thinner

Question 4

What is a disc herniation?

Answer 4

Occurs when the nucleus pulposus bulges through the exterior wall of the annulus fibrosis

Question 5

What is the most common cause of disc herniations?

Answer 5

Gradual age related changes which causes the disks to lose water content overtime resulting in greater likelihood of tearing/rupturing the annulus fibrosis

Question 6

List 2 common sxs associated with lumbar disc herniations.

Answer 6

Low back pain
Radicular pain (numbness, tingling and weakness in the affected nerve distribution)

Question 7

What is the most common type of glenohumeral dislocation? MOI?

Answer 7

Anterior dislocation

MOI: External force or blow applied to the arm while it is in a position of abduction, external rotation, and extension (i.e. throwing a ball)

Question 8

List 4 injuries that are associated with anterior GH dislocation.

Answer 8

1. Hill Sachs lesion (compression fracture of the humeral head)
2. SLAP lesion
3. Bankart lesion (avulsion of the anterior-inferior capsule and glenoid labrum)
4. Axillary nerve injury

Question 9

List 3 signs and sxs associated with an anterior GH dislocation.

Answer 9

Visible deformity (palpable humeral head)
Severe pain
Significant ROM limitations

Question 10

What is the most common cause of a meniscal tear?

Answer 10

Twisting of the knee when it is in a semiflexed position with the foot planted on the ground

Question 11

Which meniscus is more susceptible to injury? Why?

Answer 11

Medial meniscus because it is more firmly attached to the tibia

Question 12

List 5 signs and sxs associated with meniscal tears.

Answer 12

Joint line pain
Tenderness
Swelling
Joint popping/clicking
Feelings of instability

Question 13

List 3 special tests used to asses the presence of a meniscal tear.

Answer 13

Thessaly’s test
McMurray’s test
Apley’s test

Question 14

What is Osgood Schlatter disease?

Answer 14

Traction apophysitis at the tibial tuberosity

Question 15

Describe the clinical presentation associated with Osgood Schlatter disease.

Answer 15

Localized pain and edema with point tenderness over the patellar tendon’s insertion at the tibial tubercle

Question 16

What is piriformis syndrome?

Answer 16

Compression or irritation to the proximal sciatic nerve due to piriformis muscle inflammation, spasm or tightness

Question 17

List 5 signs and symptoms associated with piriformis syndrome.

Answer 17

1. Restriction in internal rotation
2. Pain with palpation of piriformis muscle
3. Referral of pain to posterior thigh
4. Weakness in ER
5. (+) Piriformis test

Question 18

What is spinal stenosis?

Answer 18

Congenital narrowing of the spinal canal or intervertebral foramen, coupled with hypertrophy of the spinal lamina and ligamentum flavum or facets caused by age related changes or disease

Question 19

List 4 signs and symptoms associated with spinal stenosis.

Answer 19

1. Unilateral/Bilateral pain and paresthesia in back and LEs
2. Pain decreases with spinal flexion and increases with extension
3. Pain increases with walking
4. Pain relieved with prolonged rest or activity modification

Question 20

What 2 special tests may be performed to differentiate between spinal stenosis and intermittent claudication?

Answer 20

van Gelderen’s test

2 stage treadmill test

Question 21

What is trochanteric bursitis?

Answer 21

Inflammation of the deep trochanteric bursa due to direct/repetitive microtrauma or irritation by ITB

Question 22

Trochanteric bursitis is common in patients with ______.

Answer 22

Rheumatoid arthritis

Question 23

List 4 symptoms associated with trochanteric bursitis.

Answer 23

1. Pain at lateral hip which may radiate to lateral thigh
2. Point tenderness
3. Pain with passive ER and abduction
4. Pain with resisted hip flexion and abduction