STEP UP TO MED MSK Flashcards
+ SPURLING MANEUVER TEST (Patient extends neck -> rotates and tilts to side of pain -> Reproduction of pain below shoulder joint = radicular pain) has HIGH SP, but LOW Se for ___?
CERVICAL ROOT COMPRESSION
+ EMPTY CAN TEST (Arms held out in front of the patient parallel to the ground with thumbs pointed DOWNWARD = fully pronated arm -> Examiner applies resistance and pt tries to maintain position -> Pain with resistance) is indicative of ___?
SUPRASPINATUS DEFECT
+ EXTERNAL ROTATION TEST (Arm held at patient’s side with flexed elbow 90deg. Pt asked to externally rotate the forearm against resistance -> Pain with resistance) is indicative of ___?
INFRASPINATUS DEFECT
+LIFT OFF TEST (Pt’s hand placed behind the back with dorsum of hand against back. Asked to lift hand off their back -> Pt can NOT bring their hand off their back) is indicative of ____?
SUBSCAPULARIS DEFECT - Defect in internal rotation
+NEER TEST (Pt’s fully pronated arm with thumb pointing downward -> forcibly flex above their head -> Pain with this maneuver) is indicative of ____?
ROTATOR CUFF IMPINGEMENT
+HAWKINS TEST (Pt’s arm is abducted to 90deg with elbow bent and examiner internally rotates shoulder -> Pain with this maneuver) is indicative of ___?
ROTATOR CUFF IMPINGEMENT
+CROSS ARM TEST (Pt’s arm held in front of them to 90deg and pt actively adducts the arm -> Pain at AC joint) is indicative of ___? Especially used to distinguish between which 2 pathologies?
AC JOINT DYSFUNCTION
Often confused with rotator cuff pathology
ADOLESCENT GIRL: ANTERIOR knee pain that is worsened by CLIMBING/DESCENDING stairs = ___? Associated with inadequate hip abductor and core strength
What is the Tx?
PATELLOFEMORAL SYNDROME
TX = QUADS/HAMSTRINGS REGHAB (stretching/strengthening)
Rare surgical intervention
POSITIVE GRIND TEST + PINPOINT TENDERNESS TO JOINT = ___
What is the management?
SCAPHOID FRACTURE
1st = Hand radiograph + Secondary thumb spica splinting
Negative GRIND TEST + POSITIVE FINCKELSTEIN TEST = ___
What is the management?
DE QUERVAIN TENOSYNOVITIS
Rest, thumb spica splinting
What is the management for FOREARM WRIST FRACTURES?
SHORT ARM CAST
Best way to diagnose FIBROMYALGIA?
Structured Sx history
What is 1st line Tx for CHRONIC MIDSUBSTANCE ACHILLES TENDINOOPATHY? What is the 2nd line Tx?
1ST = ECCENTRIC EXERCISE 2ND = THERAPEUTIC ULTRASONAGRAPHY
What are the only 2 shoulder pathologies that can SELECTIVELY limit PASSIVE EXTERNAL ROTATION?
LOCKED POSTERIOR DISLOCATION + OSTEOARTHRITIS
**Rotator cuff tears do NOT limit passive external rotation
Where can you inject glucocorticoids for ROTATOR CUFF TENDINITIS?
SUBACROMIAL SPACE
What is the management for a POSTERIOR MID-SHAFT FRACTURE?
BRACE
Pin point tenderness on the plantar surface of the foot where the medial calcaneus meets the calcaneal aponeurosis = __?
What is the first line Tx?
PLANTAR FASCITIS
HEEL INSERTS = 1st line Tx
What is an indication for pts to return to sports after STRESS FRACTURES, particularly in teenage athletes?
NORMAL PE and ability to walk without pain
Most heal in 6-10wks with conservative management (non-weight bearing + activity limitation)
Recurrent knee effusions + Tenderness along medial or lateral joint lines + POSITIVE MCMURRAY TEST = ___?
MENISCAL Tear/degeneration
2/2 specific injury or degenerative process
What is a sign of INTRA-ARTICULAR pathology warranting further investigation?
RECURRENT KNEE EFFUSION
PAIN + CATCHING + POPPING due to pathology: Area of necrotic bone + degenerative change sin overlying cartilage = ___?
Option for intervention?
OSTEOCHONDRITIS DISSECANS (OCD) - Bone/cartilage piece can separate from the underlying bone and become a loose body in the joint Intervention - ARTHROSCOPIC removal
Pain over the lateral knee where the IT band attaches to the proximal tibia in RUNNERS + CYCLISTS = ____?
ILIOTIBIAL (IT) BAND SYNDROME
Rupture of a cyst 2/2 intra-articular pathology (e.g. meniscal tear) resulting in pain/swelling -> extends into the calf and mimics DVT/ thrombophlebitis = ___?
What is the prognosis?
BAKER CYST
Most them resolve spontaneously
ANTERIOR knee pain at the inferior pole of the patella due to OVERUSE (running and jumping sports) = __?
What is the Tx for it?
PATELLAR TENDINITIS
Tx= Activity modification + Quads/Hamstring rehab (strengthening/stretching program)
Pain along the MEDIAL PATELLA + SNAPPING of the knee with walking +/- intermittent effusion typically seen in athletes/overuse = ___?
Dx of EXCLUSION
Tx = ?
PLICA SYNDROME
Tx = CONSERVATIVE, NSAIDS, STEROID INJECTIONS
If conservative management fails, arthroscopic release of plica
What are the three ligaments making up the lateral aspect of the ankle? Which of these is most commonly injured?
ANTERIOR TALOFIBULAR LIGAMENT (ATFL) + CALCANEOFIBULAR LIGAMENT (CFL) + POSTERIOR TALOFIBULAR LIGAMENT
ATFL most commonly injured in EVERSION injury
What are the ligaments making up the medial aspect of the ankle?
DELTOID LIGAMENTS - Not commonly injured in an inversion ankle sprain
According to the Ottawa rules, when are ANKLE RADIOGRAPHS NOT INDICATED (2)?
1) If pt can walk 4 steps at time of injury + At time of eval
2) If there is NO BONY TENDERNESS over distal 6cm of either malleolus
What is the first step of ALL ACUTE ANKLE sprains?
RICE + PHYSICAL THERAPY (Eventually gain full ROM, strength, proprioception - PERONEAL TENDON STRENGTHENING + PROPRIOCEPTIVE TRAINING)
What is the grading system of ankle sprains?
GRADE 1: Partial rupture of ATFL
GRADE 2: Complete rupture of ATFL + Partial rupture of CFL
GRADE 3: Complete rupture of ATFL + CFL
When do you need orthopedic evaluation for ankle sprains?
CHRONIC ANKLE INSTABILITY due to RECURRENT ANKLE SPRAINS
Generally even grade 3 (worst) ankle sprains don’t need surgery
Most common cause of knee pain = ?
Most common cause of shoulder pain = ?
KNEE Most common = OSTEOARTHRITIS
SHOULDER Most common = ROTATOR CUFF/SUPRASPINATUS TENDINITIS (Impingement syndrome)
What is the pathology of IMPINGEMENT SYNDROME? What is the pain exacerbated by? What pathology can impingement syndrome lead to?
Impingement of the GREATER TUBEROSITY on the ACROMION? Pain with OVERHEAD ACTIVITY
Can lead to ROTATOR CUFF PATHOLOGY over time
What is the Tx of IMPINGEMENT SYNDROME?
CONSERVATIVE 1: PHYSICAL THERAPY -Strengthen shoulder musculature
CONSERVATIVE 2: SUBACROMIAL STEROID INJECTIONS - Temporary relief
If conservative mgmt fails, SURGERY (ACROMIOPLASTY) - Very effective
If there’s weakness on shoulder abduction (e.g. + POSITIVE CAN TEST), what should be suspected?
What is the best way of diagnosing this?
ROTATOR CUFF TEAR
**MRI = Best test for diagnosis of rotator cuff tear
INFLAMMATION/DEGENERATION of EXTENSOR tendons of the forearm caused by REPETITIVE SUPINATION/PRONATION = ?
LATERAL EPICONDYLITIS (Tennis elbow)
What is the 1st line of Tx for LATERAL EPICONDYLITIS tennis elbow (3)?
1st = SPLINTING FOREARM (COUNTERFORCE BRACE) - do NOT split or wrap elbow itself + PHYSICAL THERAPY (strengthening/stretching forearm extensors) + ACTIVITY MODIFICATION
What is the 2nd line of Tx for LATERAL EPICONDYLITIS tennis elbow? What is 3rd line?
2nd line = Steroid injections (if PT/activity modification fails to resolve pain)
3rd line = Surgery (if all conservative mgmt fails) but rarely necessary for this condition
Pain distal to medial epicondyle exacerbated by WRIST FLEXION caused by OVERUSE of flexor pronator muscle = ?
Tx = ?
MEDIAL EPICONDYLITIS (Golfer elbow) Tx same as lateral epicondylitis (Tennis elbow) - forearm counterforce brace/PT/activity modification -> Steroid injection -> surgery
Pain at the radial aspect of the wrist in region of RADIAL STYLOID radiating to the elbow/thumb caused by INFLAMMATION of abductor pollicis longus/extensor pollicis brevis with POSITIVE FINKELSTEIN TEST = ?
Tx = ?
DE QUERVAIN TENOSYNOVITIS
Tx = Thumb spica splint + NSAIDS
Local cortisone injections can be helpful -> surgery if conservative mgmt fails
Name the 4 TENDINITIS and 2 BURSITIS commonly tested.
TENDINITIS: SUPRASPINATUS (rotator cuff) tendinitis = impingement syndrome, LATERAL EPICONDYLITIS (tennis elbow), MEDIAL EPICONDYLITIS (golfer elbow), DE QUERVAIN TENOSYNOVITIS
BURSITIS: OLECRANON BURSITIS, TROCHANTERIC BURSITIS
EFFUSION (swelling) +/- pain at the elbow with spongy “bag of fluid” = ?
What is the Tx?
If infection is suspected, what must be done?
OLECRANON BURSITIS
CONSERVATIVE
If infection is suspected, DRAINAGE is necessary
What are two main distinguishing features of OSTEOARTHRITIC HIP PAIN vs TROCHANTERIC BURSITIS?
OSTEOARTHRITIC: GROIN PAIN + NO point tenderness
TROCHANTERIC BURSITIS: LATERAL HIP PAIN over the greater trochanter/BUTTOCK PAIN + EXQUISITE TENDERNESS over the greater trochanter
What is the Tx of TROCHANTERIC BURSITIS?
NSAIDS + Activity modification
If that fails, cortisone injections into bursa
DDx of HAND NUMBNESS (as seen in carpal tunnel syndrome):
1) CERVICAL RADICULOPATHY (NERVE ROOT compression in cervical spine)
2) PERIPHERAL NEUROPATHY - Diabetes
3) MEDIAN NERVE Compression in FOREARM
Loss of ACTIVE + PASSIVE ROM is more indicative of __.
Loss of ACTIVE ROM is more indicative of __.
Lose ACTIVE + PASSIVE = JOINT DZ
Lose ACTIVE = MUSCLE DZ
CONTRACTURE of the joint capsule in a DM/hypothyroid pt = __?
ADHESIVE CAPSULITIS
SUBACUTE shoulder pain aggravated by movement Ddx:
ROTATOR CUFF TENDINOPATHY + ROTATOR CUFF TEAR + IMPINGEMENT SYNDROME + LABRAL TEAR
