Bonus MSK

Question 1

radial n. roots:

Answer 1

C5-T1

Question 2

The radial nerve innervates extensors of the arm, forearm, wrist, and fingers, including:

Answer 2

Triceps brachii (all heads)
Anconeus
Brachioradialis
Extensor carpi radialis longus & brevis
Extensor digitorum
Extensor carpi ulnaris
Extensor pollicis longus & brevis
Extensor indicis
Extensor digiti minimi
Abductor pollicis longus
Supinator

Question 3

The radial nerve provides cutaneous sensation to:

Answer 3

Posterior arm

Posterior forearm

Dorsal hand (lateral side, especially base of thumb)

Dorsal proximal lateral 3.5 fingers (excluding fingertips)

Question 4

Fingertip sensation is usually ___ nerve

Answer 4

median
(radial does not reach palmar side of digits)

Question 5

___ is the deep motor branch of the radial nerve that continues after passing through the __.

Answer 5

PIN

supinator

Question 6

Radial Nerve Entrapments

Answer 6

Crutch Palsy

High radial nerve injury

Radial tunnel syndrome

Posterior interosseous
nerve syndrome

Wartenberg’s syndrome

Question 7

Crutch Palsy:

Answer 7

Very high nerve palsy (everything is lost)

Axilla injury

Motor: Loss of elbow extension, wrist and digit extension loss, weak supination

Sensory: Paresthesia posterior lateral arm, forearm, wrist, posterior aspect of thumb and radial 2.5 fingers

Question 8

High radial nerve injury:

Answer 8

Humerus spiral groove or shaft fracture (everything above spared)

Motor: Triceps spared, wrist drop & thumb extension weakness

Sensory: Paresthesia posterior forearm, wrist, posterior aspect of thumb and radial 2.5 fingers (3.5 digits total)

Question 9

Radial tunnel syndrome:

Answer 9

Compression of posterior interosseous nerve in the radial tunnel

Pain over the radial tunnel, 5 cm distal to the lateral epicondyle (below)

• Mimics Lateral Epicondylitis
• Pain on radial aspect of proximal forearm – most common presenting symptom
• No sensory symptoms and no motor weakness to little muscle weakness due to pain
• Symptoms aggravates by resisted supination, finger extension positioning of the arm in elbow extension, forearm pronation and wrist flexion

Question 10

Radial tunnel vs lateral epicondylitis
Definition:

Answer 10

RT: Compression of the posterior interosseous nerve (PIN) within the radial tunnel

LE: Overuse injury causing microtears of ECRB tendon at lateral epicondyle

Question 11

Radial tunnel vs lateral epicondylitis
Cause:

Answer 11

RT: Nerve entrapment (often due to repetitive motion)

LE: Tendinopathy from repetitive wrist extension/supination

Question 12

Radial tunnel vs lateral epicondylitis
Pain Location:

Answer 12

RT: 3-5 cm distal to lateral epicondyle (over radial tunnel)

LE: At or just over the lateral epicondyle itself

Question 13

Radial tunnel vs lateral epicondylitis
Tenderness:

Answer 13

RT: Over radial tunnel, more distal

LE: Localized to lateral epicondyle

Question 14

Radial tunnel vs lateral epicondylitis
Numbness/weakness:

Answer 14

RT: Possible weak grip, no true numbness (PIN = motor)

LE: Usually no sensory or motor involvement

Question 15

Posterior interosseous nerve syndrome:

Answer 15

Compression of posterior interosseous nerve between the two heads of supinator muscle

• Pure motor
• Pain in the deep forearm, lateral elbow.
• Weakness of the wrist extensors (ECRL spared) can do radial deviation
• Patients typically present with dropped fingers and thumb.
• The function of the Extensor carpi radialis longus is always preserved, and so the wrist can extend and radially deviate even in cases of severe neuropathy

Question 16

Wartenberg’s syndrome:

Answer 16

Cheiralgia paresthetica: Compression of superficial sensory branch under extensor carpi radialis longus and brachioradialis

Mechanism: Trauma, tight watch, handcuffs.

• Pain/sensory disturbances on radial side of the dorsum of the hand; Pain reproduced with flexion and ulnar deviation
• No motor loss
• Special test: (+) Tinel’s sign at site of compression

Question 17

A baseball pitcher presents with right elbow and forearm pain, localized to
the lateral epicondyle. On examination, there is weakness in the wrist
extensors and pain with active wrist extension (forearm pronated, wrist
radially deviated). What is the MOST LIKELY diagnosis?
A. Lateral epicondylitis (Tennis elbow)
B. Medial epicondylitis
C. Radial tunnel syndrome
D. Ulnar collateral ligament injury

Answer 17

A. Lateral epicondylitis (Tennis elbow)

Question 18

Adhesive Capsulitis Stages:

Answer 18

stage 1
stage 2: freezing/painful
stage 3: frozen
stage 4: thawing

Question 19

Adhesive Capsulitis: Stage 1

Answer 19

0-3 months

Mild signs and symptoms - achy at rest (when sleeping on that side) and sharp at extremes of ROM

Capsular pattern - loss of external rotation and abduction is present

Synovitis more than contracture of capsule

No strength loss

Question 20

Adhesive Capsulitis: Stage 2 Freezing/ painful

Answer 20

3–9 months with progressive loss of ROM and persistence of pain

The motion loss in stage II adhesive capsulitis reflects a loss of capsular volume and a response to the painful
synovitis

loss of motion in all planes, as well as pain in most of the range

Question 21

Adhesive Capsulitis: Stage 3 Frozen

Answer 21

9-15 months

Painful stiffening of the shoulder and a significant loss of ROM.

Pain only with movements

Atrophy of rotator cuff muscles, deltoid, biceps and triceps

Poor scapulohumeral rhythm with scapular hike

Loss of axillary fold and ROM with capsular restriction.

Question 22

Adhesive Capsulitis: Stage 4 Thawing

Answer 22

15-24 months

Pain lessens but stiffness persists

Slow and steady recovery

Question 23

Adhesive Capsulitis typically affects:

Answer 23

Women > Men

Age 40–60 years

Often non-dominant arm

Can be bilateral (though usually sequential)

Question 24

Adhesive Capsulitis Common Risk Factors:

Answer 24

Diabetes Mellitus (especially Type I)

Thyroid disorders (especially hypothyroidism)

Post-surgical or post-immobilization (e.g., after rotator cuff repair, mastectomy)

Autoimmune conditions

Shoulder trauma or overuse injuries

Question 25

Adhesive Capsulitis Treatment:

Answer 25

● Corticosteroids injection ● Stretching determined by irritability ● Joint mobilizations - posterior glide ● Manipulation under anesthesia ● Modalities - ultrasound, e-stim, etc. ● Patient education ** strengthening not helpful in the beginning = its a capsule problem

Question 26

A clinician is evaluating a patient with concerns of shoulder pain and concludes that this patient is potentially in the freezing stage of idiopathic frozen shoulder. Which of the following MOST ACCURATELY describes this stage? A. Pain that increases with movement and is present at night. Loss of ER with intact rotator cuff strength B. Pain at rest with limited motion in all direction C. Pain only on movement. Atrophy of deltoid, biceps, triceps and rotator cuff muscles D. Minimal pain with significant capsular restriction from adhesions

Answer 26

B. Pain at rest with limited motion in all direction

Question 27

Shoulder Instability Types:

Answer 27

Anterior Instability Posterior Instability Inferior Instability

Question 28

Anterior Shoulder Instability:

Answer 28

Most common MOI: Abduction, ER, and extension and is common in sports Special test: Load and shift test, anterior apprehension test, anterior release and surprise test humeral head brought forward

Question 29

Posterior Shoulder Instability:

Answer 29

Rare MOI: Flexion, IR, adducted position, like trying to open a very heavy door Special test: Posterior apprehension test, Kim test, jerk test humeral head pushed back

Question 30

Inferior Shoulder Instability:

Answer 30

Very rare MOI: typically elicited by carrying heavy objects in hand Special test: Sulcus sign humeral head drops down

Question 31

Shoulder Instability Treatment:

Answer 31

The goal is to restore dynamic stability and control to the shoulder using the dynamic stabilizers to contain the humeral head A brief period of sling immobilization No mobs!!

Question 32

Anterior Instability Treatment:

Answer 32

Posterior capsule stretching, perform stability exercises for scapula and rotator cuff, avoid doing exercises like chest press, pull down, push ups like movements

Question 33

Posterior Instability Treatment:

Answer 33

Stability exercises, avoid push ups and weight bearing exercises early on.

Question 34

Inferior Instability Treatment:

Answer 34

Stability exercises, avoid weighted shrugs, elbow curls, etc.

Question 35

Club Foot is called:

Answer 35

Congenital Talipe Equinovarus

Question 36

Club Foot =

Answer 36

Birth defect where feet point inward * Usually bilateral * Most common in boys * Symptoms: > High longitudinal arch > Tight gastroc/soleus complex > Smaller foot appearance * Interventions: Casting begins several weeks after birth and splinting

Question 37

Sever’s Disease is called:

Answer 37

Calcaneal Apophysitis

Question 38

Sever’s Disease =

Answer 38

Heel pain caused by swelling and irritation at the growth plate MOI – tight gastroc/soleus complex, repetitive stress activities (jumping, running, dancing), recent growth spurt Common in young adolescents, ages 8-13 years old

Question 39

Sever’s Disease Examination:

Answer 39

* Limited ankle DF (tight gastroc + achilles) * TTP over posterior-inferior heel (achilles insertion) * Pain increases with weightbearing and resolves with rest * (+) Squeeze Test (achilles tendonitis or tear) * X-ray to confirm

Question 40

A 10-year-old presents with heel pain and swelling that began 5 days ago after a dance competition. The physical therapist finds a positive squeeze test and limitations in dorsiflexion. What is the MOST LIKELY diagnosis? A. Achilles tendonitis B. Sever's Disease C. Gastrocnemius strain D. Calcaneal stress fracture

Answer 40

B. Sever's Disease

Question 41

Ankle Sprains:

Answer 41

Lateral Ankle Sprain High Ankle Sprain Medial Ankle Sprain

Question 42

Lateral Ankle Sprain:

Answer 42

Highest incidence in active individuals (runners and athletes) * Most commonly affects the ATFL * TTP distal to lateral malleolus * Decreased PF and Inversion AROM/PROM * MOI: Forced PF with IR/inversion injury * (+) Talar Tilt, Anterior Drawer

Question 43

High Ankle Sprain:

Answer 43

Involves the tibiofibular ligaments Forced DF with ER/eversion injury Pain with weight bearing and heel raises TTP over anterior aspect of tibiofibular joint (+) Kleiger, DF compression, and Squeeze tests

Question 44

Medial Ankle Sprain:

Answer 44

Deltoid ligament involved Very rare increased risk of avulsion fracture from on the medial malleolus Forced Eversion injury TTP distal to medial malleolus Decreased eversion (+) Talar Tilt

Question 45

Compartment Syndromes:

Answer 45

Acute Anterior Compartment Syndrome Chronic Exertional Compartment Syndrome

Question 46

Acute Anterior Compartment Syndrome =

Answer 46

* Traumas (fractures, dislocations, etc.) * 5p’s - pain, pallor, paresthesia, paralysis, and pulselessness * Medical emergency * Pain or tightness over anterior lower leg (increased pressure) * Weakness in DFs and toe extensors (anterior tibialis, extensor hallicus longus and digitorum longus) * Edema (swelling) * Intervention - Fasciotomy = surgery cut through muscle belly to relieve pressure

Question 47

Chronic Exertional Compartment Syndrome =

Answer 47

* Repetitive activities (running, dancing, jumping, etc.) causing exercised induced swelling * No pain at rest - but shortly into activity and near end * Pain or tightness over anterior lower leg * Weakness in DFs and toe extensors * Edema - swelling goes down quickly * Possible numbness/tingling (not as common) * Interventions – activity modifications (gradually increase), stretching (DF and posterior chain), strengthening, NSAIDs

Question 48

A patient reports of deep aching pain and tightness in the anterior lower leg that consistently starts after 15 minutes of running and resolves with rest. On examination there is no redness, tenderness or vascular compromise. Based on this presentation, which of the following is the MOST LIKELY diagnosis? A. Acute compartment syndrome B. Chronic exertional compartment syndrome C. Ankle sprain D. Stress fracture of the tibia

Answer 48

B. Chronic exertional compartment syndrome

Question 49

Ottawa Ankle Rules (When to Order an X-Ray) Ankle X-ray series is needed if:

Answer 49

Pain in the malleolar zone AND any of the following: 1) Bone tenderness at the posterior edge or tip of the lateral malleolus 2) Bone tenderness at the posterior edge or tip of the medial malleolus 3) Inability to bear weight both immediately after injury and in the clinic (4 steps)

Question 50

Ottawa Ankle Rules (When to Order an X-Ray) Foot X-ray series is needed if:

Answer 50

Pain in the midfoot zone AND any of the following: 1) Bone tenderness at the navicular 2) Bone tenderness at the base of the 5th metatarsal 3) Inability to bear weight (same as above)