Week 3

Question 1

which is more common, an anterior or posterior shoulder dislocation?

Answer 1

anterior (95%)

Question 2

what tests would you use to test if someone has a shoulder dislocation?

Answer 2

apprehension test, AP xray and lateral scapula (glenohumeral) xray. MRI to detect soft tissue injury.

Question 3

Tx for shoulder dislocation?

Answer 3

reduction, sling 2-4 weeks, PT. Bankart lesion requires surgery (anterior inferior tear of the glenoid labrum).

Question 4

acromioclavicular joint sprain/separation clinical presentation.

Answer 4

result of downward force to superior acromion while clavicle remains in fixed position. graded by Rockwood classification (1-6 scale w/ 6 most severe)

Question 5

acromioclavicular joint sprain/dislocation workup

Answer 5

PE and xray

Question 6

acromioclavicular joint sprain/dislocation management

Answer 6

depends on severity, RICE. 1-3 are typically nonsurgical. 4-6 are typically surgical.

Question 7

clavicle fracture clinical presentation

Answer 7

direct trauma, swelling, deformity (shoulder sags frward and down), eccymosis, pain. crepitis, pt. unable to raise arm.

Question 8

clavicle fracture workup

Answer 8

assess neurovascular function (even though it’s rare). you could do this w/ Adson test.

Question 9

clavicle fracture managment

Answer 9

mild/proximal: rest, sling 3-4 weeks

comminuted mid/proximal w/ displacement: ORIF

Question 10

lateral epicondylitis of the elbow workup

Answer 10

tennis elbow test (have pt. resist as you push down on the dorsal surface on the hand). xray is often normal. MRI if no improvement in 3 months

Question 11

lateral/medial epicondylitis of the elbow managment

Answer 11

ice, stretching, counterforce elbow brace, NSAIDs, corticosteroid injections

Question 12

medial epicondylitis of the elbow workup

Answer 12

golfer’s elbow test (have patient try to flex hand against resistance). xray is often normal. MRI if no improvement in 3 months.

Question 13

clinical presentation of lateral epicondylitis of the elbow

Answer 13

tenderness of lateral epicondyle (tennis elbow), pain w/ arm and wrist extension.

Question 14

clinical presentation of medial epicondylitis of the elbow

Answer 14

tenderness of the medial epicondyle (golfer’s elbow), pain w/ pronation and supination and hand flexion.

Question 15

ulnar collateral ligament injury of the thumb (gamekeeper’s thumb) clinical presentation

Answer 15

partial or complete disruption of the ulnar collateral ligament. pain over ulnar border of the thumb. sometimes there is a lump (stener lesion).

Question 16

ulnar collateral ligament injury of the thumb workup

Answer 16

xray can be used to ID avulsions. MRI to differentiate full from partial thickness.

Question 17

ulnar collateral ligament injury of the thumb management

Answer 17

thumb spica cast for 6 weeks for partial tears or non-displaced avulsions. full-thickness tears require surgery.

Question 18

mallet finger clinical presentation

Answer 18

loss of DIP extension w/ PROM. unopposed flexor digitorum profundus pulls the joint into flexion. soft tissue or boney mallet fingers look similar. DIP rests in flexion.

Question 19

mallet finger workup

Answer 19

xray hand to find if Fx

Question 20

mallet finger management

Answer 20

if joint is congruent splint in extension for 8 weeks

Question 21

meniscal tears clinical presenation

Answer 21

joint line pain w/ deep squatting or duck walk. pain, clicking, locking, antalgic gait. effusion rarely sets in immediately.

Question 22

meniscal tears workup

Answer 22

McMurray, modified McMurray, or Thessaly can be confirmatory. xray is usually normal, can show joint space narrowing. MRI is best (T2 weighted)

Question 23

meniscal tears management

Answer 23

analgesics and PT. acute tears can be treated arthroscopically w/ meniscus repair or debridement.

Question 24

anterior cruciate ligament injury of the knee clinical presentation

Answer 24

audible pop w/ buckling of knee. acute effusion. instability w/ lateral movement/going downstairs. after swelling resolves, pt. can walk w/ stiff knee gait.

Question 25

ACL injury of knee workup

Answer 25

Lachman test w/ pt. supine and knee flexed 20-30 degrees. anterior drawer test. pivot shift test. xray usually negative but useful to r/o Fx. MRI is best.

Question 26

ACL injury of knee management

Answer 26

young/active pts. require ACL reconstruction. PT for hamstring and core strength. ACL brace for stability.

Question 27

PCL injury of knee clinical presentation

Answer 27

usually follows anterior trauma to tibia (ex: dashboard in MVA). knee may freely dislocation. often associate w/ injury to other collateral ligaments o knee. difficulty w/ ambulation. pain w/ bending. pallor and numbness may suggest knee dislo/possible injury to popliteal a.

Question 28

PCL injury of knee workup

Answer 28

sag sign. posterior drawer test. xray not diagnostic but required to r/o Fx. MRI is best.

Question 29

PCL injury of knee management

Answer 29

isolated PCL can be treated non-operatively. immobilization brace in extension and crutches. PT to increase ROM.

Question 30

medial and lateral collateral ligament injuries of the knee clinical presentation

Answer 30

valgus or varus blow to knee. pain/instability on affected side. limited ROM. MCL is commonly injured with ACL. minimal swelling.

Question 31

medial and lateral collateral ligament injuries of the knee workup

Answer 31

valgus/varus stress tests. graded on a scale of 1-3 (3 is worst). xray to r/o Fx but not diagnostic. MRI not required for isolated MCL injury. used to eval possible ACL injury. yes for LCL injury.

Question 32

MCL/LCL injuries of the knee management.

Answer 32

MCL: brace and PT
LCL: usually requires surgery.

Question 33

Achilles tendon rupture clinical presentation

Answer 33

caused by sudden forceful dorsiflexion of foot. rupture is usually 3-6 cm proximal to tendon insertion. at site of POOREST blood supply. Typically 30-50yo athlete. sudden pain, audible pop, immediate weakness. weak plantar flexion.

Question 34

Achilles tendon rupture workup

Answer 34

Thompson test (calf squeeze) xray not helpufl unless there is a calcaneal avulsion. MRI is very sensitive but not often needed b/c physical exam is diagnostic.

Question 35

Achilles tendon rupture management

Answer 35

primary surgical repair and post-op cast for active individuals. cast immobilization for sedentary individuals. (will require recasting every 2 weeks to finally get foot back into normal position).