Clinical Aspect (Sports Medicine) Flashcards
(160 cards)
1
Q
What are the muscles of the anterior compartment of the thigh?
A
1) Pectineus
2) Iliopsoas
3) Sartorious
4) Recuts femoris
5) Vastus Lateralis
6) Vastus intermedius
7) Vastus medialis
2
Q
What is the innervation for the anterior compartment of the thigh?
A
Femoral nerve (Posterior L2-4)
3
Q
What is the innervation of the posterior compartment of the thigh?
A
Tibial nerve (L4-S2)
4
Q
What are the muscles of the posterior compartment of the thigh?
A
1) Semimembranous
2) Semitendinosus
3) Biceps femoris
5
Q
What is the function of the ACL?
A
1) To prevent hyperextension
2) To prevent anterior motion of the tibia on the femur
6
Q
What is the function of the PCL
A
1) To prevent hyperflexion
2) To prevent posterior motion on the femur
7
Q
Quick effusion after trauma; Positive Lachman’s test; Positive anterior drawer test; Imaging shows a Segon fracture
A
ACL tear
8
Q
What is the result to damage of the common peroneal nerve?
A
1) Loss of dorsiflexion and most eversion
9
Q
Deep, achy, or sharp pain with motion of the hip, tenderness over groin and lesser trochanter; positive thomas test,
A
Groin Strain
10
Q
What are the risk factors for a stress fracture?
A
1) Low calcium nutrition
2) Female athlete who stops menstruation
3) Eating disorder
4) Osteoporosis
11
Q
What are the tendons of the Pes tendons? What are their innervations?
A
SGT FOS
1) Sartorius, Gracilis, Semitendinosous
2) Femoral, Obturator, sciatic
12
Q
Loss of dorsiflexion and most eversion of the knee. What ligament is most likely torn? What nerve is damaged?
A
1) LCL tear
2) Common peroneal nerve damage
13
Q
Opening to varus stress at 30 degrees flexion; hit lateral and below the knee
A
LCL tear
14
Q
Opening to valgus stress at 30 degrees flexion
A
MCL tear
15
Q
How do you treat a patella dislocation:
A
Extend the knee and push patella over medial
16
Q
Pt. has a hip that is severely painful and is short, adducted, and internally rotated
A
Posterior Hip Dislocation
17
Q
Pt. has a hip that is severely painful and is flexed, abducted, and externally rotated
A
Anterior Hip Dislocation
18
Q
What is the treatment of a hip dislocation?
A
1) Emergent reduction with sedation or anesthesia
19
Q
What is synovitis on physical exam indicate?
A
1) Inflammatory arthritides
20
Q
Sudden onset of joint pain in seconds or minutes
A
1) Fracture
2) Internal derangement
3) Trauma
4) Loose body
21
Q
Onset of joint pain over several hours or days
A
1) Infection
2) Crystal deposition
3) Inflammatory arthritic conditions
22
Q
Joint pain associated with intravenous drug use or immunosuppression; fever
A
Septic arthritis
23
Q
Urethritis, conjunctivitis, diarrhea, and rash
A
Reiter syndrome
24
Q
Eye inflammation and low back pain
A
Ankylosing spondylitis
25
Hilar adenopathy and erythema nodosum
Sarcoidosis
26
What is the sensitivity and specificity of the ANA test?
ANA has:
1) high sensitivity (good for ruling out)
2) Low specificity (not good for ruling things in)
27
What is a Segon Fracture?
1) small avulsion frx of proximal part of the tibia that is seen just proximal to fibular head
2) Pathognomonic for ACL tear
28
What is a Pellegrini Stieda Lesion?
1) Calcification of the medial femoral condyle
| 2) Pathognomonic for MCL tear
29
What is the general treatment for an MCL tear?
1) Hinge Knee brace with early ROM
| 2) PT for quad strength
30
Knee pain that can occur acutely or chronically; Positive joint line tenderness, McMurray, Apley, Thessally
Meniscal tear
31
Knee pain found in pt younger than 40; can't extend knee; high riding patella
Patellar Tendon Rupture
32
Knee pain found in pt. older than 40; can't extend knee; low riding patella
Quadriceps tendon rupture
33
Knee pain with acute hemarthrosis; valgus force and external rotation of tibia and knee flexion; most common in females
Patella dislocation
34
Fracture of the patella found in 8-12 year old; child equivalent of patellar tendon rupture; extensor lag
Patella Sleeve Fracture
35
What is the first step in tx. for a pt. with a patellar sleeve fracture?
1) Immediate referral to ortho
36
What is the most sensitive AND specific diagnostic imaging test in confirming an ACL tear and evaluating for concomitant injuries of the knee?
MRI
37
What is required before ACL reconstructive surgery?
1) Improve ROM of the knee
| 2) Quadriceps strengthening
38
What is the best test for indicating a meniscal tear?
Positive Joint Line Tenderness test
39
Synchondrosis; failure to complete fusion of the patella in childhood; not a fracture
Bipartite patella
40
Aching thigh or knee pain/hip pain; common in obese children (11-13 yo); loss of abduction and internal rotation
Slipped Capital Femoral Epiphysis (SCFE)
41
self limiting hip disorder caused by a varying degree of ischemia and subsequent necrosis of the femoral head; found in children 4-10 years old
Legg-Calve-Perthes Disease
42
Monoarticular arthritis in a young person
Neisseria gonorrhea infx until proven otherwise
43
Reduced active range with preserved passive
Soft tissue disoder
44
Reduced active and passive ROM
Joint problem
45
What are the ligaments that make up the lateral aspect of the ankle? (Lateral collateral ligament)
1) Anterior talofibular
2) Calcanofibular
3) Posterior talofibular
46
What are the ligaments that make up the medial aspect of the ankle? (Medial deltoid ligament)
1) Posterior tibiotalar
2) Tibiocalcanean
3) Tibionavicular
4) Anterior tibiotalar
47
Test used to check the anterior talofibular ligament
Anterior Drawer test
48
Test used to check the calcaneofibular ligament
Talar Tilt
49
What are the different fractures found at the base of the 5th metatarsal?
1) Avulsion of tuberosity
2) Jones fracture
3) Proximal diaphysis
50
Where does a Jones fracture occur? What joint does it go into? Why does this have to be caught?
1) Occurs at the junction of the metaphysis and diaphysis in the 5th metatarsal
2) Enters into the 4th-5th intermetatarsal joint
3) It has to be caught because this area has poor blood supply and can result in a nonunion of the bones
51
What is the treatment for a fracture of a maleoli (ankle fracture)?
1) Nonoperative for lateral maleoli break
| 2) Only operative if there are bi or tri-maleoli breaks
52
What is the treatment for a proximal diaphysis fracture? Avulsion of the tuberosity? Jones fracture?
1) Hard sole shoe
2) Hard sole shoe
3) Non-weight bearing cast for 6-8 weeks or surgery
53
How does an achilles rupture occur?
1) Forced dorsiflexion while gastrocnemius is contracting
54
How do you do a thompson test?
1) Pt. lays prone with knee bent at 90
2) Doctor squeezes calf
3) Look for plantar flexion
55
What are the motions required for supination of the ankle/foot?
1) Inversion
2) Plantar flexion
3) Adduction
56
What are the motions required for pronation of the ankle/foot?
1) eversion
2) Dorsal flexion
3) Abduction
57
History of pop with immediate diffuse swelling of the ankle and inability to walk?
1) Grade III sprain until proven otherwise
58
History of pop with goose egg swelling over anterior talofibular ligament and significant limp
1) Grade II
59
History of no pop and minimal swelling over the ankle; able to walk
1) Grade I sprain
60
What are the mechanics that occur in an inversion sprain?
1) Posterolateral glide of the talus
2) Eversion of the calcaneous
3) External rotation and anteromedial glide of the tibia
4) Posterior fibular head
5) Internal rotation of the femur
6) Posterior innominate on ipsilateral side
7) Forward torsion of sacrum (RoR or LoL)
8) Neutral Lumbar dysfunction
61
What are the Ottwa rules for Foot/Ankle Xrays?
Xray if:
1) Tenderness over inferior or posterior pole of either malleolus
2) Inability to bear weight
3) Tenderness along the base of the 5th metatarsal
4) Pediatric population
5) Suspect high ankle sprain or fibular head fracture
62
Keratotic lesion over a bony prominence on lesser toes due to excess pressure on skin
Corn
63
Corn located on the 5th toe dorsal laterally
Hard corn
64
Corn found in the web
Soft corn
65
What are the motions of the bones in a tarsal somatic dysfunction (change in the transverse arch)?
1) Cuboid rotates medially
2) Navicular rotates laterally
3) 2nd cuneiform glides inferiorly
66
Tenderness distal to the lateral malleolus
1) Think jones fracture
67
What is the treatment for a ruptured achilles tendon? What is the biggest risk of most invasive treatment?
1) Short leg cast and plantar flexion
2) Walking boot with posterior splint
3) Surgical fixation
4) Wound healing
68
What is the major risk for surgical fixation of the achilles tendon?
1) Major risk is wound healing
| 2) cutting of the sural nerve
69
What are the bacteria that causes Reactive arthritis?
1) Enteric causes such as Salmonella, Shigella, and Yersinia
| 2) Genitourinary causes such as Chlamydia
70
Self-limited polyarthritis that has a lacy/malar rash, affects small joints symmetrically; can cause a decrease in reticulocyte count
Parvovirus B19 infection
71
What is the time limit for acute polyarticular joint pain?
1) Pain that has been present for less than 6 weeks
72
Polyarticular inflammatory process that affects large joints symmetrically; associated with axial findings, iritis, tendonitis, and aortic insufficiency
Ankylosing spondylitis
73
What is required to make a diagnosis of psoriatic arthritis?
1) Psoriasis must be present
2) Inflammatory process (arthritis)
3) Pain in joint (arthalgia)
74
What are the three causes for a malar rash?
1) Parvovirus B19
2) Dermatomyositis
3) Systemic Lupus erythematosus
75
Lesion that occurs due to a direct blow to the thigh, may develop myositis ossificans. What is the treatment?
1) Quadriceps contusion
| 2) Treat with elevation, flex hip and knee to take off pressure
76
What should you not do with a quadricep contusion?
Do not do ultrasound or use heating pads because it will cause an accumulation of blood
77
Injury that occurs by direct blow to the iliac crest
Hip pointer
78
What is more common in kids? Fractures in the pelvis or ligament/tendon strains? Why?
1) Fractures
| 2) Caused by skeletally immature apophysis or growth plate where muscles attach
79
Inflammation and swelling of bursae lateral to the greater trochanter of the femur; positive ober's test
Trochanteric bursitis
80
Tenderness over groin and lesser trochanter; positive thomas test, positive Hip scouring test
Groin strain
81
What are the ligaments of the hip?
1) Iliofemoral ligament
2) Ischiofemoral ligament
3) Pubofemoral ligament
82
What are the external rotators of the hip?
1) Pirifromis
2) Superior and inferior gemelli
3) Obturator externus and internus
4) Gluteus maximus
83
What are the internal rotators of the hip?
1) Gluteus medius
| 2) Gluteus minimus
84
Anterior knee pain, Poor tracking of the patella in the femoral condyles leading to inflammation;weakness of the vastus medialis; Pain when going up stairs and after prolonged sitting, pos. patella femoral grinding test
Patellofemoral syndrome
85
What test has the pt extend the knee and contracts the quads as the physician pushes the patella caudad into the trochlear groove? What does a positive indicate?
1) patellar grinding test
| 2) patellofemoral syndrome
86
Overuse syndrome resulting in tightness of the iliotibial band, presents with lateral knee pain that worsens with running, positive obers test
IT band syndrome
87
Foot Pain with first steps out of bed that gets better as the day goes on
Platar fasciitis
88
What is the cause of plantar fascitis?
1) Results from the cumulative impact loading and repetitive microtrauma to the plantar fascia
89
Most common deformity of the MTP joint: medial eminence of metatarsal becomes prominent, proximal phalanx drifts into valgus
Hallux valgus (bunion)
90
What are the muscles of the rotator cuff?
1) Supraspinatus
2) Infraspinatus
3) teres minor
4) Subscapularis
91
What are the innervations for the rotator cuff?
1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis
1) Suprascapular n.
2) Suprascapular n.
3) Axiallary n.
4) Subscapular
92
What are the actions for the rotator cuff muscles?
1) Supraspinatus
2) Infraspinatus
3) Teres minor
4) Subscapularis
1) First 15 degrees of abduction
2) External rotation
3) External rotation
4) Medial rotation
93
How do you tell the difference between a anterior and posterior dislocation of the glenohumeral joint?
1) Anterior = held in external rotation, palpable anterior mass, space under the acromion
2) Posterior = held in internal rotation, decreased, caused by seizure, fall, or electrocution; light bulb sign
94
What is a Bankart lesion? What does it occur with?
1) Lesion that occurs when the anterior/inferior labrum and inferior glenohumeral ligament pulls off the anterior glenoid
2) Associated with anterior glenohumeral dislocations
95
What is a Hill Sachs Lesion? What is it associated with?
1) Depression in the posterior superior head of the humerus bone
2) Associated with a anterior glenohumeral dislocation
96
What are complications of a glenohumeral dislocation?
1) Bankart lesions
2) Hill Sachs lesion
3) Greater tuberosity fracture
4) Rotator cuff tears
5) Axillary nerve injury
6) Recurrent dislocations
97
Anterior labrum and inferior glenohumeral ligmanet pulls off the anterior glenoid
Bankart lesion
98
Compression fracture of posterolateral head of humerus
Hill Sachs Lesion
99
What is the grade of AC joint separation for sprain of AC ligament
Grade I
100
What is the grade of AC joint separation for a tear of the AC and sprain of the CC ligaments
Grade II
101
What is a grade of AC joint separation for a tear of both the AC and CC ligmanets
Grade III
102
Shoulder pain, swelling and inability to use shoulder; caused by fall onto the shoulder or outstreched
Proximal Humerus Fracture
103
Pop-eye arm; occurs while lifting when pt. hears a pop
Proximal biceps tear
104
Numbness and shoulder weakness that occurs unilaterally; pain free C-spine; occurs in a short duration, Normal Xray
Burner/Stinger
105
What are the origins of the biceps? Insertion?
1) Short = coracoid process
2) Long = superior portion of the glenoid
3) Radius
106
What is associated with a proximal bicep tear?
Rotator cuff tear
107
Pathological condition manifesting as pain or feeling of slipping due to excessive translation of humeral head on glenoid during active motion; +Apprehension test; occurs in pt. <40
Shoulder Instability
108
What are the two types of chronic instability? What are their characteristics
1) TUBS (Traumatic, Unidirectional, Bankart lesion, Surgery often required)
2) AMBRI (Atraumatic, Multidirectional, Bilateral, Rehab., Inferior capsular shift)
109
Pain generalized to the lateral upper arm at the deltoid insertion that is worse with overhead activity; Positive hawkins, neer, and empty can test; occurs in adults >40
Impingement
110
Proximal pain along the anterior humerus that occurs in adults >40, occurs due to impingement or subluxation of tendon when transverse humeral ligaments are torn
Biceps tendonitis
111
Positive empty can, positive lift off sign, external rotation weakness
Rotator cuff tear
112
How do you differentiate adhesive capsulitis from a rotator cuff tear?
1) Adhesive capsulitis will have a decreased passive ROM while rotator cuff will have a normal passive ROM
113
How do you differentiate adhesive capsulitis from arthritis?
1) Adhesive capsulitis will have normal xrays while arthritis will have decreased joint capsule space, osteophytes, ect.
114
What does a positive Spurling's test indicate?
1) Cervical disc disease
115
What does a positive Adson's test indicate?
1) Subclavian artery compression
116
Name the dermatome location of the following:
1) C5
2) C6
3) C7
4) C8
5) T1
1) Anterolateral arm
2) Lateral arm and thumb
3) First two digits and back of arm
4) Last two digits and medial aspect of forearm
5) Anteromedial arm
117
Name the nerve root for the following reflexes:
1) Biceps reflex
2) Brachioradialis reflex
3) Triceps reflex
1) C5
2) C6
3) C7
118
Positive Cozen's test; strained extensor muscle tendons
Lateral epicondylitis
119
What is the cause for an anterior radial head dysfunction? posterior radial head dysfunction?
1) Fall backwards
| 2) Fall forward
120
Positive Finklestein test. What is the cause?
1) DeQuervain's Tenosynovitis
| 2) Overuse of tendons to radially deviate the wrist
121
Pain or paresthesia in distribution of the ulnar nerve from the elbow to the 4-5th digit
Cubital Tunnel Syndrome
122
What is the purpose of the Adson test?
1) Check the vascular component of the upper extremity
2) Check pulse with pt seated and arm at side
3) Check pulse with pt arm abducted
123
What is the most common complications after a dislocation of the shoulder in a pt >40?
Rotator cuff tear
124
What are the views of the shoulder that you need to get with a shoulder dislocation?
1) AP
2) Scapula Y
3) Axillary
125
10 cc of lidocaine injected into subacromial space improves symptoms that occur most often with overhead activity
Positive Neer's test
126
Positive Speed's test (forward elevation in supination)
Bicep tendonitis
127
Pain or paresthesia in distribution of the ulnar nerve? What is the treatment
1) Cubital Tunnel syndrome
| 2) Elbow pad
128
Radial Head dislocation found in children when adult pulls child up by wrist with elbow extended; child holds arm across body in flexed pronated position
Nursemaid's elbow
129
Fragility fracture of the forearm; often can result in a pinched median nerve
Distal radius fracture
130
What are the different types of distal radius fracture?
1) Colles - distal radius fracture tilts back posteriorly
2) Smith's - distal radius fracture that tilts anteriorly
3) Barton's - scaphoid/lunate bones ram into radius
4) Chauffer's - radial styloid fracture
131
What motion is affected most by a distal biceps rupture?
1) Supination- biceps brachii is the primary supinator of the forearm
132
What needs to be checked with a suspected elbow dislocation?
1) Neurovascular compromise
133
How do you treat a Nursemaid's elbow?
1) Have pt. flexed and quickly supinate their forearm
134
Pt. comes in with arm flexed and pronated with severe pain
Nursemaid's elbow
135
What do you have to check with a distal humerus fracture?
1) Check to see if the radial nerve is intact
| 2) Will be marked with loss of wrist extension
136
Pain on supination/pronation; presence of a fat pad on xray at the elbow
Proximal Radial head fracture
137
What muscles does the median nerve innervate in the hand?
LOAF
1) Lateral 2 lumbricals
2) Opponens policus
3) Abductor pollicus brevis
4) Flexor pollicus brevis
138
How should a distal radial fracture be treated?
1) Nonoperative
2) Surgery if broken in many parts
3) Bisphosphonates
139
Why do you give bisphosphonates to a pt. with a distal radial fracture? What other fractures require bisphosphonates?
1) Defined as a fragility fracture
| 2) Femur neck fracture and lumbar compression fracture
140
Pain in radial side of wrist; pain to palpation of the anatomical snuff box; occurs with fall with an out streched hand
Scaphoid fracture
141
What is the treatment for a scaphoid fracture?
1) Thumb spica
142
Fracture of the 5th MCP that causes ulnar side hand pain
Boxer's Fracture
143
Fracture of the 1st MCP at the base
Bennett Fracture
144
Sudden passive flexion of the DIP; due to terminal extensor tendon being pulled off DIP
Mallet finger
145
Overuse injury of the quadriceps muscles and the patellar tendon, generalized knee pain localized to the anterior knee
Patellar tendonitis
146
Common knee pain in children (10-15) that occurs with high level of activity or rapid growth that results in boney deposition anteriorly
Osgood schlatter disease
147
How should a dislocation of the elbow be treated?
1) Splint with the pt. arm in flexion and pronated
148
Damage to C5 and C6 nerve roots
Erb-Duchenne's palsy
149
Inability to abduct pronated and medially rotated arm
Erb-Duchene's Palsy
150
Damage to C8 and T1 nerve roots
Klumpke's palsy
151
Isolated hand paralysis and horner syndrome (ptosis, miosis, anhidrosis)
Klumpke's palsy
152
What nerve is damaged in the following fractures:
1) Fracture of the surgical neck of the humerus
2) Fracture of the midshaft of the humerus
3) Fracture of the supracondylar humerus
4) Fracture of the medial epicondyle of the humerus
1) Axillary
2) Radial
3) Median
4) Ulnar
153
What are the thenar muscles? What nerve supplies them?
Think: big OAF
1) Opponens policis (Oppose)
2) Abductor pollicis brevis (Abduct)
3) Flexor policis brevis (flexion)
Suppied by the median n (C5-T1)
154
What are the hypothenar muscles? What nerve supplies them?
Think: little OAF
1) Opponens digiti minimi
2) Abductor digiti minimi
3) Flexor digiti minimi
155
What motion do the lumbricals provide?
1) Flex at MCP joint
| 2) Extend PIP and DIP joints
156
Describe what occurs during a muscle contraction?
1) Post-synaptic neuron has an action potential which causes influx of Ca
2) Influx of Ca causes synapitc release of synaptic ACh vesciles
3) ACh binds to ligand receptor Na channel
4) Activation of Na channel causes hyperpolarization
5) Action potential continues into the T tubule system/sacroplasmic reticulum
6) Ca is released from sacroplasmic reticulum
7) Ca binds to tropinin C causing converfational change that moves tropomyosin out of the myosin binding groove on actin filaments
8) Myosin releases bound ADP and is displaced on the actin filament
157
What changes in the the sacromere occur during contraction?
think: HIZ shrinkage
1) H and I bands shorten
2) Z line to Z line shrinks
158
What causes the release of Myosin from actin?
Binding of ATP to myosin head
159
What band of the sacromere has both actin and myosin?
think: he's got it All
1) A band
2) Get's bigger with contraction
160
What nerve runs with the deep brachial artery?
Radial nerve
