Basic LL MSK Exam

Question 1

ROM: adduction

Answer 1

30. adductor longus, a brevis, a magnus, gracilis

Question 2

ROM: abduction

Answer 2

45. glut medius, glut minimus, TFL

Question 3

ROM: flexion

Answer 3

110. iliopsoas, rectus femoris, sartorius

Question 4

ROM: extension

Answer 4

10. glut max, biceps femoris, semimembranosus, semitendinosus

Question 5

ROM: internal rotation (medial)

Answer 5

30. a longus, a brevis, a magnus, TFL, glut medius, glut minimus

Question 6

ROM: external rotation (lateral)

Answer 6

40. glut max, piriformis, gemellus, obturator internus, glut inferior, quadratus femoris, obturator externus

Question 7

basic knee exam: appearance

Answer 7

popeye deformities, muscle wasting, prepatellar bursa

Question 8

basic knee exam: palpation

Answer 8

effusion, quad & patellar tendons, tibial tubercle, joint line

Question 9

basic knee exam: ROM

Answer 9

flexion 130. functional 0-110 extension

Question 10

basic knee exam: joint stability

Answer 10

LCL (varus) and MCL (valgus) stress, ACL, PCL

Question 11

basic ankle exam: x rays for?

Answer 11

bony point tenderness at posterior edge w/wo tip of either malleolus. bony point tenderness at navicular and base of 5th metatarsal, inability to walk (4+ steps) immediately after injury/in ER

Question 12

squeeze test

Answer 12

to rule out fibular head fracture (maisonneuve fracture) and syndesmotic/high ankle sprain

Question 13

slipped capital femoral epiphysis (SCFE) history

Answer 13

classically overweight early adolescent w history of groin or knee pain, may be referred to anteromedial thigh. often bilaterally.

Question 14

slipped capital femoral epiphysis (SCFE) etiology + presentation + exam

Answer 14

repetitive overload. vague stx, worst w activity. limitation of internal rotation on exam.

Question 15

slipped capital femoral epiphysis (SCFE) tests + treatments

Answer 15

plain x-rays. surgical fixation.

Question 16

transient synovitis of the hip: etiology

Answer 16

3-10 yo. usually viral, post-vaccine or drug-induced.

Question 17

transient synovitis of the hip: examination

Answer 17

usually hold hip slightly flexed & externally rotated. resistance to abduction and internal rotation. any motion causes pain, can’t bear weight.

Question 18

transient synovitis of the hip: tests + treatment

Answer 18

sed rate elevated, mild leukocytosis. NSAIDs 1-3 wks.

Question 19

septic joint etiology + exam

Answer 19

gonorrhea or skin flora. swollen and painful knee, passive & active ROM painful. red, hot. usually has systemic signs UNLESS diabetic or immunosuppressed

Question 20

septic joint treatment + compilcation

Answer 20

often requires surgical incision and drainage followed by IV antibiotics. can cause articular surface destruction

Question 21

patellar dislocation epidemiology + history

Answer 21

usually lateral dislocation. cutting w active quad contraction. immediate pain & swelling.

Question 22

patellar dislocation exam + treatment

Answer 22

ecchymosis, effusion. w/ positive apprehension test. PT (surgery if recurrent)

Question 23

ACL sprain etiology + exam

Answer 23

twisting non-contact, deceleration or hyperextension. + lachmann test (knee at 20-30 degree flexion, stabilize femur; check anterior translation and endpoint of tibia)

Question 24

ACL sprain history

Answer 24

acute: pop and rapid effusion. chronic: instability

Question 25

meniscal tear etiology + history

Answer 25

usually d/t twisting on a loaded knee. or degenerative tear. locking & effusion.

Question 26

meniscal tear exam + treatment

Answer 26

pain over joint line, pain w circumduction tests. if locked, needs reduction (surgery). if no locking, PT and relative test.

Question 27

compartment syndrome pathology

Answer 27

elevation of pressures in muscular compartment high enough to interfere with perfusion

Question 28

compartment syndrome etiology

Answer 28

acute: severe bleed, d/t fracture chronic exertional: from hypertrophied muscle in tight compartment w exercise (increases muscle bulk up to 20%). leg>>forearm.

Question 29

compartment syndrome presentation

Answer 29

1. pain out of proportion (early) 2. paresthesia (early) 3. poikilothermia (coolness) 4. paralysis (late) 5. pallor (late) pulselessness (late and rare)

Question 30

compartment syndrome pressures (acute injury)

Answer 30

0-10 = normal 10-30 = elevated, not dangerous 30-40 = potentially dangerous in acute compartment syndrome 40-60 = usually dangerous, usually requires compartment release > 60 = consistently dangerous, requires urgent release

Question 31

ankle sprains etiology + exam

Answer 31

forced inversion. anterior drawer test: 3-5 mm more than uninjured. squeeze test. external rotation test + = suspicious for high ankle

Question 32

achilles tendon rupture history+ exam

Answer 32

hear pop, feels like someone hit them in back of ankle. difficulty walking. defect in achilles on exam- pain and weakness with plantar flexion.

Question 33

achilles tendon rupture treatment

Answer 33

acute immobilization or surgery