Ortho & MSK

Question 1

Girl with anterior knee pain and tenderness at tibial tubercle - Diagnosis ?

Answer 1

Osgoode Schlatter disease (Tibial apophysitis )

Question 2

Osgoode Schlatter disease symptoms

Answer 2

tenderness at tibial tubercle
anterior knee pain, atraumatic
adolescent, associated with grow spurt

Question 3

DDx of Osgood Schlatter disease

Answer 3

Isolated anterior knee pain DDx:
- Patellofemoral pain syndrome (adult, worsened by prolonged sitting or climbing stairs)
- quadriceps or patellar tendinopathy (jumper’s knee)
- prepatellar bursitis
- patellar subluxation or dislocation
- distal patellar apophysitis (SindingLarsen-Johannson
syndrome

Question 4

Management of Osgood Schlatter disease

Answer 4

• Activity limitation
• Ice
• Anti-inflammatories (NSAIDs)
• Protective padding
• Quadriceps/hamstring strengthening
• Time

Question 5

Diagnosis of Osgood Schlatter disease

Answer 5

clinical diagnosis

Work-up of anterior knee pain: a plain x-ray of the knee to rule out fractures, neoplasm, or infection

Question 6

management of PFS (Patellofemoral Syndrome)

Answer 6

• Ice, analgesic medication, nonsteroidal anti-inflammatory drugs (NSAIDs), and activity modification
• Patellar taping techniques/ A neoprene knee sleeve with the patella cut out
• Rehabilitation program
• Orthotics or appropriate footwear

Question 7

symptoms of lateral epicondylitis

Answer 7

• max tenderness 1 cm distal to the epicondyle
• pain with resisted supination, extension/dorsiflexion
• pain with isolated resisted extension of the middle finger

Question 8

Rx for lateral epicondylitis (Tennis elbow)

Answer 8

• topical NSAIDs
• bracing
• PT
• steroid injection
• topical nitrates
• acupuncture
• Surgery (no laser)

Question 9

symptoms of medial epicondylitis

Answer 9

• gradual onset of medial elbow pain +/- grip weakness
• max tenderness at 5-10 cm distal/anterior to the medial epicondyle (insertion of flexor-pronator insertion)
• pain during resisted pronation
• pain with resisted wrist flexion

Question 10

Rx of medial epicondylitis

Answer 10

• rest/ice
• bracing (wrist extension)
• PT
• steroid injection
• Sx

Question 11

Carpel tunnel syndrome symptoms

Answer 11

positive Flick sign
positive Phalen sign
positive Tinel sign on flexor retinaculum
decreased grip strength
thenar eminence atrophy/ wasting
abductor pollicis brevis weakness (abduction of thumb weakness )
paresthesia over 1st, 2nd, 3rd and radial side of 4th fingers
nocturnal awakening

Question 12

symptoms of de Quervain tenosynovitis

Answer 12

pain localized along the radial side of the wrist

possible pain radiation up forearm and distal into thumb

Question 13

signs of de Quervain tenosynovitis

Answer 13

Finkelstein test - pathognomonic: grasp pt’s thumb and quickly deviate the hand and wrist ulnarly reproduce pain

Eichoff maneuver ++

Question 14

Imaging to diagnose de Quervain tenosynovitis

Answer 14

NO imaging needed, clinical diagnosis

order x-ray to rule out distal radius/ scaphoid fracture, arthritis or wrist instability

Question 15

Rx of de Quervain tenosynovitis

Answer 15

• rest, avoid thumb flexion, ulnar deviation
• splinting (radial thumb spica extension holding the wrist in nuetral position and thumb in 30 degree flex/abduction, 14% efficacy)
• NSAIDs
• corticosteroid injection of 1st dorsal compartment (most common and effective treatment)
• refractory pain after 6 mo: surgery to release fibro-osseous roof of first dorsal compartment

Question 16

shoulder pain DDx

Answer 16

• rotator cuff tendinopathy/ tear
• shoulder impingement
• adhesive capsulitis (frozen shoulder)
• glenohumeral dislocation
• clavicular fracture

Question 17

non-pharmacological management for shoulder impingement

Answer 17

rest 
ice 
NSAIDs 
modified work 
Physiotherapy 
consider corticosteroid injection