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STEP: Family Medicine > STEP UP TO MED MSK > Flashcards

STEP UP TO MED MSK Flashcards

1
Q

+ 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 ___?

A

CERVICAL ROOT COMPRESSION

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2
Q

+ 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 ___?

A

SUPRASPINATUS DEFECT

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3
Q

+ 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 ___?

A

INFRASPINATUS DEFECT

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4
Q

+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 ____?

A

SUBSCAPULARIS DEFECT - Defect in internal rotation

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5
Q

+NEER TEST (Pt’s fully pronated arm with thumb pointing downward -> forcibly flex above their head -> Pain with this maneuver) is indicative of ____?

A

ROTATOR CUFF IMPINGEMENT

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6
Q

+HAWKINS TEST (Pt’s arm is abducted to 90deg with elbow bent and examiner internally rotates shoulder -> Pain with this maneuver) is indicative of ___?

A

ROTATOR CUFF IMPINGEMENT

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7
Q

+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?

A

AC JOINT DYSFUNCTION

Often confused with rotator cuff pathology

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8
Q

ADOLESCENT GIRL: ANTERIOR knee pain that is worsened by CLIMBING/DESCENDING stairs = ___? Associated with inadequate hip abductor and core strength
What is the Tx?

A

PATELLOFEMORAL SYNDROME
TX = QUADS/HAMSTRINGS REGHAB (stretching/strengthening)

Rare surgical intervention

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9
Q

POSITIVE GRIND TEST + PINPOINT TENDERNESS TO JOINT = ___

What is the management?

A

SCAPHOID FRACTURE

1st = Hand radiograph + Secondary thumb spica splinting

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10
Q

Negative GRIND TEST + POSITIVE FINCKELSTEIN TEST = ___

What is the management?

A

DE QUERVAIN TENOSYNOVITIS

Rest, thumb spica splinting

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11
Q

What is the management for FOREARM WRIST FRACTURES?

A

SHORT ARM CAST

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12
Q

Best way to diagnose FIBROMYALGIA?

A

Structured Sx history

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13
Q

What is 1st line Tx for CHRONIC MIDSUBSTANCE ACHILLES TENDINOOPATHY? What is the 2nd line Tx?

A 
1ST = ECCENTRIC EXERCISE 
2ND = THERAPEUTIC ULTRASONAGRAPHY
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14
Q

What are the only 2 shoulder pathologies that can SELECTIVELY limit PASSIVE EXTERNAL ROTATION?

A

LOCKED POSTERIOR DISLOCATION + OSTEOARTHRITIS

**Rotator cuff tears do NOT limit passive external rotation

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15
Q

Where can you inject glucocorticoids for ROTATOR CUFF TENDINITIS?

A

SUBACROMIAL SPACE

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16
Q

What is the management for a POSTERIOR MID-SHAFT FRACTURE?

A

BRACE

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17
Q

Pin point tenderness on the plantar surface of the foot where the medial calcaneus meets the calcaneal aponeurosis = __?
What is the first line Tx?

A

PLANTAR FASCITIS

HEEL INSERTS = 1st line Tx

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18
Q

What is an indication for pts to return to sports after STRESS FRACTURES, particularly in teenage athletes?

A

NORMAL PE and ability to walk without pain

Most heal in 6-10wks with conservative management (non-weight bearing + activity limitation)

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19
Q

Recurrent knee effusions + Tenderness along medial or lateral joint lines + POSITIVE MCMURRAY TEST = ___?

A

MENISCAL Tear/degeneration

2/2 specific injury or degenerative process

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20
Q

What is a sign of INTRA-ARTICULAR pathology warranting further investigation?

A

RECURRENT KNEE EFFUSION

21
Q

PAIN + CATCHING + POPPING due to pathology: Area of necrotic bone + degenerative change sin overlying cartilage = ___?
Option for intervention?

A 
OSTEOCHONDRITIS DISSECANS (OCD) - Bone/cartilage piece can separate from the underlying bone and become a loose body in the joint 
Intervention - ARTHROSCOPIC removal
22
Q

Pain over the lateral knee where the IT band attaches to the proximal tibia in RUNNERS + CYCLISTS = ____?

A

ILIOTIBIAL (IT) BAND SYNDROME

23
Q

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?

A

BAKER CYST

Most them resolve spontaneously

24
Q

ANTERIOR knee pain at the inferior pole of the patella due to OVERUSE (running and jumping sports) = __?
What is the Tx for it?

A

PATELLAR TENDINITIS

Tx= Activity modification + Quads/Hamstring rehab (strengthening/stretching program)

25
Q

Pain along the MEDIAL PATELLA + SNAPPING of the knee with walking +/- intermittent effusion typically seen in athletes/overuse = ___?
Dx of EXCLUSION
Tx = ?

A

PLICA SYNDROME
Tx = CONSERVATIVE, NSAIDS, STEROID INJECTIONS

If conservative management fails, arthroscopic release of plica

26
Q

What are the three ligaments making up the lateral aspect of the ankle? Which of these is most commonly injured?

A

ANTERIOR TALOFIBULAR LIGAMENT (ATFL) + CALCANEOFIBULAR LIGAMENT (CFL) + POSTERIOR TALOFIBULAR LIGAMENT

ATFL most commonly injured in EVERSION injury

27
Q

What are the ligaments making up the medial aspect of the ankle?

A

DELTOID LIGAMENTS - Not commonly injured in an inversion ankle sprain

28
Q

According to the Ottawa rules, when are ANKLE RADIOGRAPHS NOT INDICATED (2)?

A

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

29
Q

What is the first step of ALL ACUTE ANKLE sprains?

A

RICE + PHYSICAL THERAPY (Eventually gain full ROM, strength, proprioception - PERONEAL TENDON STRENGTHENING + PROPRIOCEPTIVE TRAINING)

30
Q

What is the grading system of ankle sprains?

A

GRADE 1: Partial rupture of ATFL
GRADE 2: Complete rupture of ATFL + Partial rupture of CFL
GRADE 3: Complete rupture of ATFL + CFL

31
Q

When do you need orthopedic evaluation for ankle sprains?

A

CHRONIC ANKLE INSTABILITY due to RECURRENT ANKLE SPRAINS

Generally even grade 3 (worst) ankle sprains don’t need surgery

32
Q

Most common cause of knee pain = ?

Most common cause of shoulder pain = ?

A

KNEE Most common = OSTEOARTHRITIS

SHOULDER Most common = ROTATOR CUFF/SUPRASPINATUS TENDINITIS (Impingement syndrome)

33
Q

What is the pathology of IMPINGEMENT SYNDROME? What is the pain exacerbated by? What pathology can impingement syndrome lead to?

A

Impingement of the GREATER TUBEROSITY on the ACROMION? Pain with OVERHEAD ACTIVITY

Can lead to ROTATOR CUFF PATHOLOGY over time

34
Q

What is the Tx of IMPINGEMENT SYNDROME?

A

CONSERVATIVE 1: PHYSICAL THERAPY -Strengthen shoulder musculature
CONSERVATIVE 2: SUBACROMIAL STEROID INJECTIONS - Temporary relief

If conservative mgmt fails, SURGERY (ACROMIOPLASTY) - Very effective

35
Q

If there’s weakness on shoulder abduction (e.g. + POSITIVE CAN TEST), what should be suspected?

What is the best way of diagnosing this?

A

ROTATOR CUFF TEAR

**MRI = Best test for diagnosis of rotator cuff tear

36
Q

INFLAMMATION/DEGENERATION of EXTENSOR tendons of the forearm caused by REPETITIVE SUPINATION/PRONATION = ?

A

LATERAL EPICONDYLITIS (Tennis elbow)

37
Q

What is the 1st line of Tx for LATERAL EPICONDYLITIS tennis elbow (3)?

A

1st = SPLINTING FOREARM (COUNTERFORCE BRACE) - do NOT split or wrap elbow itself + PHYSICAL THERAPY (strengthening/stretching forearm extensors) + ACTIVITY MODIFICATION

38
Q

What is the 2nd line of Tx for LATERAL EPICONDYLITIS tennis elbow? What is 3rd line?

A

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

39
Q

Pain distal to medial epicondyle exacerbated by WRIST FLEXION caused by OVERUSE of flexor pronator muscle = ?
Tx = ?

A 
MEDIAL EPICONDYLITIS (Golfer elbow) 
Tx same as lateral epicondylitis (Tennis elbow) - forearm counterforce brace/PT/activity modification -> Steroid injection -> surgery
40
Q

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 = ?

A

DE QUERVAIN TENOSYNOVITIS
Tx = Thumb spica splint + NSAIDS

Local cortisone injections can be helpful -> surgery if conservative mgmt fails

41
Q

Name the 4 TENDINITIS and 2 BURSITIS commonly tested.

A

TENDINITIS: SUPRASPINATUS (rotator cuff) tendinitis = impingement syndrome, LATERAL EPICONDYLITIS (tennis elbow), MEDIAL EPICONDYLITIS (golfer elbow), DE QUERVAIN TENOSYNOVITIS

BURSITIS: OLECRANON BURSITIS, TROCHANTERIC BURSITIS

42
Q

EFFUSION (swelling) +/- pain at the elbow with spongy “bag of fluid” = ?
What is the Tx?
If infection is suspected, what must be done?

A

OLECRANON BURSITIS

CONSERVATIVE
If infection is suspected, DRAINAGE is necessary

43
Q

What are two main distinguishing features of OSTEOARTHRITIC HIP PAIN vs TROCHANTERIC BURSITIS?

A

OSTEOARTHRITIC: GROIN PAIN + NO point tenderness
TROCHANTERIC BURSITIS: LATERAL HIP PAIN over the greater trochanter/BUTTOCK PAIN + EXQUISITE TENDERNESS over the greater trochanter

44
Q

What is the Tx of TROCHANTERIC BURSITIS?

A

NSAIDS + Activity modification

If that fails, cortisone injections into bursa

45
Q

DDx of HAND NUMBNESS (as seen in carpal tunnel syndrome):

A

1) CERVICAL RADICULOPATHY (NERVE ROOT compression in cervical spine)
2) PERIPHERAL NEUROPATHY - Diabetes
3) MEDIAN NERVE Compression in FOREARM

46
Q

Loss of ACTIVE + PASSIVE ROM is more indicative of __.

Loss of ACTIVE ROM is more indicative of __.

A

Lose ACTIVE + PASSIVE = JOINT DZ

Lose ACTIVE = MUSCLE DZ

47
Q

CONTRACTURE of the joint capsule in a DM/hypothyroid pt = __?

A

ADHESIVE CAPSULITIS

48
Q

SUBACUTE shoulder pain aggravated by movement Ddx:

A

ROTATOR CUFF TENDINOPATHY + ROTATOR CUFF TEAR + IMPINGEMENT SYNDROME + LABRAL TEAR

STEP: Family Medicine (2 decks)

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