Sports/MSK

Question 1

Degrees of Ligament Sprains

Answer 1

Grade 1: minor stretching, does not come to medical attention often
Grade 2: ligmaents partially torn, tenderness and swelling, bruising, some loss of fxn
Grade 3: ligament completely torn, significant pain

Question 2

chronic knee pain that locks and swells in adolescent boy

Answer 2

osteochondritis dissecans.
result of necrosis of the articular surface of a joint, dx’d with MRI, tx immobilization and surgical removal of fragments

Question 3

cutoffs for bracing and surgical correction of scoliosis

Answer 3

> 10 degrees lateral curvature
between 25-40 degrees when 2 years of growth still expected - brace
40 degrees - surgery
– idiopathic lumbar curve usually to left

Question 4

how should children with congenital scoliosis be screened

Answer 4

renal U/s and echo due to high association of anomalies, also spinal MRI due to high incidence of spinal abnormalities
– nonidiopathic scoliosis: can see widened pedicles, thoracic kyphosis

Question 5

when to intervene with kyphosis

Answer 5

20-40 degrees normal.

>60 degrees, check PFTs and intervene

Question 6

chronic upper back pain, bad posture, kyphosis

Answer 6

Scheuermann disease

Tx: NSAIDs, PT, observation

Question 7

patient falls back on posteriorly rotated, abducted arm

Answer 7

anterior humeral dislocation

Question 8

pain over distal clavicle, with prominence noted over area of point tenderness

Answer 8

acromioclavicular injury

Question 9

direct force to posterior shoulder, pain over sternoclavicular joint with possible respiratory discomfort

Answer 9

posterior sternoclavicular dislocation

Question 10

shoulder and upper arm pain

Answer 10

proximal humerus fracture

Question 11

most common complication of posterior humerus dislocation

Answer 11

brachial artery and ulnar nerve injury

Question 12

shoulder pain with elevating and lowering the arm without any deformity. usually presents as chronic pain

Answer 12

rotator cuff injury

Question 13

back pain at night relieved by NSAIDS

Answer 13

osteoid osteoma

Question 14

osteoid osteoma >1.5 cm

Answer 14

osteoblastoma

Question 15

talipes equinovarus

Answer 15

club foot; foot internally rotated and contracted achilles

Question 16

treatment of salter harris fractures

Answer 16

Type 1 (slip/straight thru physis) neg xray/tenderness only sign. Casting x 2-3 wks
Type 2 (above), closed reduction and casting for 3-6 weeks
Type 3 (lower), open reduction
Type 4 (through) reduction in OR to avoid growth disruption
Type 5 (ram) microvascular compromise

Question 17

posterior fat pad on elbow xray

Answer 17

suggests fracture and accumulation of fluid

Question 18

snuffbox pain

Answer 18

scaphoid bone fracture
Put in thumb spica splint. Follow-up orthopedic and radiographic evaluation should occur 7 to 10 days later, whether or not initial radiographs reveal a fracture.

Question 19

is weight training or power lifting safe for preadolescents?

Answer 19

just weight training, many reps with low resistance
Strength training can begin once the child has developed appropriate balance and postural support, generally at age 7 or 8. should be performed with close supervision. Begin with no or low resistance until technique is perfected. Weight load can be added and subsequently increased in 10% increments.

Question 20

Requirements needed to return to sports after ankle injury

Answer 20

full range of motion, full strength, no swelling, no pain, no joint instability

Question 21

point tenderness over distal radius without swelling

Answer 21

distal radial epiphyseal injury

tx: rest and splint wrist until healed

Question 22

side effect of androgen steroid withdrawal

Answer 22

depression