High Yield 7 Flashcards

Question

What imaging modality is useful, and what view are needed for the foot

Answer 1

XR good, wt bearing for foot alignment, non wt bearing for FB, mass or ?osteomyelitis AP (dorsoplantar), medial oblique, lateral Sesamoid view (for sesamoid OA) PA axial + lateral calcaneus (for heel pain) US or MRI for morton’s neuroma, plantar fasciitis MRI for occult # or mass CT for Lisfranc injuries

Answer 2

XR (wt bearing for alignment, non wt bearing for trauma or mass) AP, mortise, mediolateral lateral Calcaneal or heel projections for heel pain Broden view for posterior subtalar joint for intra-articular # or arthritis Stress views (AP w/ varus stress) for ligamentous laxity (get bilateral) CT for complex hindfoot # MRI for tendons + ligaments + occult # US for tendon injuries

Answer 3

XR should include ankle + knee joints. Useful for trauma, FB, mass AP, mediolateral lateral MRI or bone scan for stress #

Answer 4

XR good for arthritis AP, mediolateral lateral Trauma: AP, mediolateral lateral + lateromedial crosstable lateral Merchants + sunrise view for patella alignment MRI for internal derangement (less helpful when obvious OA on XR) CT for occult tib plateau # + for surgically planning

Answer 5

XR should include hip + knee Nontraumatic: AP proximal + distal, mediolateral lateral to include knee, lateral frog leg hip AP proximal + distal, cross table lateral femur, inferosuperior lateral to include proximal femur

Answer 6

XR for trauma Nontrauma: AP pelvic, frog leg lateral Trauma: AP pelvis, crosstable lateral, oblique pelvis CT for full assessment of trauma

Answer 7

XR good for screening for sacroiliitis AP pelvis, AP oblique of each SI joint MRI good for sacroiliitis

Answer 8

XR not often used PA, lateral, Townes CT best

Answer 9

XR useful in facial trauma Occipitofrontal, occipitomental, occipitomental w/ 30 degree cranial angulation, lateral face Mandible views: Occipitofrontal, AP axial, inferosuperior oblique Nose views: coned down occipitofacial, lateral CT for further assessment of facial trauma

Answer 10

XR AP, lateral, AP odontoid, swimmers view (if C7-T1 not visualised on lateral view) Flexion-extension series (to assess for stability, delay for 10 days after acute injury) - flexion + extension lateral, AP CT for acute trauma MRI or CT for chronic pain/ radiculopathy

Answer 11

XR AP, lateral CT for any # MRI in cases of long tract signs

Answer 12

XR AP pelvis, AP lumbar, lateral lumbar

Answer 13

XR AP, AP caudal, lateral

Answer 14

XR - scoliosis series Used for measuring Cobb angle PA + lateral wt bearing

Answer 15

PA erect chest

Answer 16

True positive / (true positive + false negative)

Answer 17

SPIN: Stands for "Specific test when Positive rules IN the disease" proportion of people without a disease who test negative for it True negative / (true negative + false positive) eg doppler US for DVT, nitrites on UA for UTI

Answer 18

the probability that a person with a positive test result has a disease or condition True positive / (true positive + false positive)

Answer 19

the likelihood that a person with a negative test result does not have a disease or condition True negative / (true negative + false negative)

Answer 20

Probability of detection (true positive rate) Highly sensitive test will have few false negatives

Answer 21

Probability of healthy people measured as a negative test (true negative rate) Highly specific test has few false positives Doppler US for DVT, UA nitrites for UTI

Answer 22

The rate of new cases of a disease Usually number of new cases in a given time frame Equivalent to risk of getting disease

Answer 23

Actual number of cases alive Point prevalence = actual number of cases on a particular date in time Period prevalence = actual number of cases during a given period

Answer 24

Systematic review or meta analysis of all RCTs

Answer 25

Well designed, well controlled trial with no randomization

Answer 26

Case control or cohort study

Answer 27

Systematic reviews of descriptive and qualitative studies

Answer 28

Single descriptive study (case report)

Answer 29

Opinions, expert committee reports

Answer 30

Number of pts needed to treat to prevent 1 additional bad outcome Inverse of absolute risk reduction

Answer 31

ARR = 0.5-0.4 = 0.1 NNT = 1/0.1 = 10

Answer 32

The difference in event rates between the control and treatment groups Control event rate (CER) - experimental event rate (EER) The difference in risk between a treatment and control group. It tells us how much a treatment reduces risk compared to no treatment.

Answer 33

Indicates how many pts need to be exposed to a RF over a specific period to cause harm to one patient Inverse of attributable risk

Answer 34

The ratio of risk between an exposed and unexposed group. It shows how many times more (or less) likely the outcome is in the exposed group. Incidence with exposure / incidence without exposure If 20% of smokers develop lung cancer and 1% of non-smokers do, then Smokers are 20 times more likely to develop lung cancer than non-smokers.

Answer 35

The difference in risk between an exposed and unexposed group. It tells us how much of the disease risk is due to the exposure Incidence with exposure - incidence without exposure If 20% of smokers develop lung cancer and 1% of non-smokers do, then: AR=20%−1%=19% This means 19% of lung cancer cases in smokers are attributable to smoking.

Answer 36

What is the research question? Is it concerned with impact of intervention, causality or determining magnitude of health problem? Is it a well stated research question? What is the study type? Is the study type appropriate to the research question? How useful are the results produced by this type of study? What are the outcome factors and how are they measured? Are all relevant outcomes assessed? Is there measurement error? How important are omitted outcomes? What are the study factors and how are they measured? Is measurement error an important source of bias? What important potential confounders are considered? Are potential confounders examined and controlled for? Is confounding an important source of bias? What are the sample frame and sampling method? Is there selection bias? Does this threaten the external validity of the study? In an experimental study, how were the subjects assigned to groups? In a longitudinal study, how many reached follow up? In a case control study, are the controls appropriate? Are statistical tests considered? Were the tests appropriate for the data? Are CI given? Is the power given if a null result? Are results presented as absolute risk reduction + relative risk reduction? Are the results significant? Was the sample size adequate? Is the study useful? Are ethical issues considered? Does the paper have ethics approval? What conclusions did the authors reach about the study question? Do the results apply to the population?

Answer 37

Perthe’s - femoral head Kienbock’s - Lunate Kohler’s - navicular Freiburg - 2nd metatarsal Osteochondritis dissecans - medial femoral condyle, capitellum, talar dome

Answer 38

Osgood schlatter - tibial tubercle Sinding Larsen Johansson disease - inferior pole of patella Sever’s - calcaneus

Answer 39

Disruption of endochondral ossification at growth plates or articular cartilage Due to mechanical stress, vascular compromise, genetic predisposition, and sometimes repetitive trauma, leading to bone necrosis, fragmentation, and eventual remodeling

Answer 40

Cast immobilisation four weeks

Answer 41

Sling x3 wk

Answer 42

Cast non wt bearing x4-6 wks

Answer 43

Cartilage at end of long bones that grow to allow lengthening of bone Solidify in teens

Answer 44

Type 1 - # Straight across growth plate Type 2 - # Above growth plate Type 3 - # beLow the growth plate Type 4 - # Through the growth plate Type 5 - ERasure of growth plate

Answer 45

Type 1, 2 + 3 = rotating/ twisting force Type 4 + 5 = compression/ crushing force Type 5 can also be caused by bone infection

Answer 46

Type 1-3 = closed reduction Type 4+5 = open reduction

Answer 47

Incomplete # that occur when bone is exposed to angulation + rotational bending forces Bone fractures on tension side but not compression side Most common in forearm

Answer 48

show tearing of periosteum + cortex on the convex side of affected bone

Answer 49

Ice Splint Reduce - May need to complete # to adequately reduce Immobilize NSAIDs FU XRs at 2 + 6 wk post injury

Answer 50

Controlling external bleeding Assess for NVI Pain control Traction or reduction Immobilisation Elevation

Answer 51

Diagnostic LA providing temporary pain relief allows more accurate physical exam Joint aspiration for dx of gout, pseudogout, septic arthritis, hemarthrosis Therapeutic Decrease pain Increase ROM Treatment of conditions

Answer 52

Crystalline arthropathies Osteoarthritis Inflammatory arthritis Bursitis Tendonosis Ganglion cysts Nerve entrapments Fasciitis Trigger points

Answer 53

Infection (overlying cellulitis) Lack of informed consent Allergy to injection medications Injection into weight-bearing tendons such as Achilles and patella due to high risk of rupture

Answer 54

Brittle or uncontrolled diabetes Coagulopathy (safe in patients with international normalized ratio [INR] <3.5) Previous joint replacement/hardware History of avascular necrosis History of steroid or hyaluronic acid (HA) flare

Answer 55

Gloves 3-5ml syringe (unless aspiration is planned) Needles: 18G for drawing up 18G for large aspiration or HA injection 22G 1.5” for medium to large joints 25G 1.5” for small joints 22G 3.5” for hip injections in large pts Chlorhexadine swabs Gauze Band aids LA Lidocaine - onset in 3-5 mins, lasts 1-2hrs Bupivacaine - onset 5 mins, lasts 3-4hrs Viscosupplementation Synvisc (sodium hyaluronate)

Answer 56

bleeding, infection, tendon rupture, steroid flare, fat pad or soft tissue atrophy, and skin depigmentation

Answer 57

rest, ice, NSAIDs and usually resolves spontaneously after 24 to 36 hr.

Answer 58

rest, ice, NSAIDs and usually resolves spontaneously after several days. HA flare can be more drastic than steroid flare, and severe flares may require synovial aspiration and cultures to distinguish between pseudosepsis and true infection.

Answer 59

Rest joint for several hours Monitor for signs of infection Ice for pain control Resume activities after 3-5 days

Answer 60

Palpate tender nodule Inject 1ml 1% lidocaine directly

Answer 61

For diagnosis + management of rotator cuff sprain or tear or impingement Anatomy The subacromial space is bordered superiorly by the coracoacromial ligament stretching between the coracoid process and acromion. The contents of the subacromial space include the subacromial bursa, supraspinatus tendon, and tendon of the long head of the biceps. Lateral approach: Use 5-mL syringe with 22-gauge or 25-gauge 1½-inch needle 4-mL anesthetic (can combine 2 mL 1% lidocaine and 2 mL 0.25% bupivacaine [Marcaine]) 1 mL (40 mg) Kenalog The lateral edge of the acromion is palpated The needle is inserted at the midpoint of the acromion and angled slightly upward under the acromion to full length (up to hub of needle)

Answer 62

Useful in OA, RA + adhesive capsulitis to improve ROM Use when conservative therapy has failed Anatomy The glenohumeral joint is a ball and socket joint composed of the clavicle, scapula, and humerus. The glenoid cavity is very shallow but contains a lip of fibrous tissue called the glenoid labrum, which deepens the glenoid and increases shoulder joint stability. Posterior approach Use 3-mL syringe with 22-gauge or 25-gauge 1½-inch needle 1 to 2 mL anesthetic 1 mL (40 mg) Kenalog Posterior approach: The distal, lateral, and posterior edges of the acromion are palpated, and the soft spot 1 cm below the posterolateral corner is marked with the needle cap The needle is inserted just inferior to the posterolateral edge of the acromion. The needle is directed anteriorly and may need to be walked into the joint. Accuracy can be significantly improved with ultrasound guidance.

Answer 63

Indicated for shoulder pain d/t pathology of AC joint if conservative therapy has failed Anatomy The AC joint can be palpated as a narrow indentation at the distal end of the clavicle, about one thumb’s width medial to the lateral edge of the acromion. The joint line runs obliquely medially at approximately a 20-degree angle. Approach: Use 3-mL syringe with 25-gauge 5/8- to 1-inch needle ½ mL 1% lidocaine ½ mL (20 mg) Kenalog Palpate the depression of the AC joint at the distal clavicle and mark it with the needle cap Insert the needle at a 15- to 20-degree angle (needle pointed more medially) Avoid repetitive or heavy lifting afterwards

Answer 64

Indicated for elbow pain d/t arthritis or trauma if conservative therapy has failed Anatomy The elbow joint is composed of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The elbow joint can be approached via the triangle formed by the lateral olecranon, head of the radius, and lateral epicondyle. Approach: Use 3-mL syringe with 25-gauge 1-inch needle 5- to 10-mL syringe with 20-gauge or 22-gauge needle if aspirating 1 mL 1% lidocaine without epinephrine ½ mL (20 mg) Kenalog Place the patient’s arm on the table at a 45-degree angle. Mark the soft depression in the center of the triangle formed by the lateral olecranon, head of the radius, and lateral epicondyle with the needle cap The needle is inserted into the elbow joint between the lateral epicondyle and the radial head Instruct the patient to perform flexion/extension ROM exercises to disperse the fluid within the joint.

Answer 65

Anatomy The origin of the common extensor tendon is at the lateral epicondyle. The origin of the common flexor tendon is at the medial epicondyle. Use 3-mL syringe with 25-gauge 5/8- or 1-inch needle ½ mL 1% lidocaine without epinephrine ½ mL (20 mg) Kenalog Lateral epicondyle: Place the patient’s arm on the table at a 45-degree angle with the lateral elbow facing up: Palpate the area of most tenderness over the epicondyle and mark this with the cap of the needle. The needle is inserted down to the bone of the lateral epicondyle Medial epicondyle: Medial epicondyle: Place the patient’s arm on the table at a 45-degree angle with the medial elbow facing up: Palpate the area of most tenderness over the epicondyle and mark this with the cap of the needle. The needle is inserted down to the bone of the medial epicondyle. Take care not to inject the ulnar nerve because it traverses posterior to the medial epicondyle in the cubital tunnel. If the patient experiences pain or numbness in the ulnar nerve distribution while the needle is inserted, then back out and reposition the needle more anteriorly before injecting cortisone. At this time, doing this injection without ultrasound guidance increases the risks of injury to the ulnar nerve. Aftercare Consider an elbow extension splint to rest the elbow and/or wrist splint to avoid wrist flexion/extension for 1 to 2 wk to allow the injection to take effect. The patient should avoid repetitive wrist extension or flexion.

Answer 66

Indicated for arthritis or trauma if conservative therapy has failed Anatomy The wrist joint capsule is not continuous but has septa, which makes the wrist injection sometimes difficult. The radiocarpal joint can be palpated just distal to the distal radius in a depression near the scapholunate articulation. Approach: Use 3-mL syringe with 25-gauge 5/8- or 1-inch needle 5- to 10-mL syringe with 20-gauge or 22-gauge 5/8- or 1-inch needle for aspiration ½ mL 1% lidocaine without epinephrine ½ mL (20 mg) Kenalog Palpate the depression distal to the distal radius near the scapholunate articulation. The needle is inserted into the wrist joint If aspirating, withdraw fluid with 5- to 10-mL syringe, then stabilize needle and exchange 3-mL syringe containing steroid mixture and inject. If injecting, use 3-mL syringe with 25-gauge 1-inch needle and inject fluid into joint. Have patient perform wrist flexion and extension exercises to disperse the fluid through the wrist joint. Consider wrist splint x1-2 wks

Answer 67

Anatomy The dorsal wrist has six compartments containing tendons. The 1st dorsal compartment contains the abductor pollicis longus and the extensor pollicis brevis tendons. de Quervain tenosynovitis occurs when the tendon sheath becomes inflamed and thickened causing pain, swelling, and occasional triggering. Approach Use 3-mL syringe with 25-gauge 5/8- or 1-inch needle ½ mL 1% lidocaine without epinephrine ½ mL (20 mg) Kenalog Palpate the area of most tenderness over the 1st dorsal compartment and mark this with the needle cap. The needle is inserted into the tendon sheath between the abductor pollicis longus and extensor pollicis brevis tendons at ~30-degree angle. Ultrasound dramatically increases accuracy of this injection and improves outcomes. An elliptical shaped bulge occurs with the injection of the bolus of fluid into the sheath. Consider thumb spica wrist splint for 1-2 wks

Answer 68

Indicated d/t arthritis Anatomy The thumb CMC joint is composed of the saddle-shaped base of the 1st metacarpal as it articulates with the trapezium. The thumb CMC joint can be approached on the extensor surface proximal to the 1st metacarpal, taking care to avoid the radial artery and extensor pollicis tendons. Approach Use 3-mL syringe with 25-gauge 1-inch needle for injection ½ mL 1% lidocaine without epinephrine (if using) ½ mL (20 mg) triamcinolone suspension (Kenalog) Place the patient’s hand and forearm on the table palm down. Palpate the CMC joint between the base of the 1st metacarpal and the wrist trapezium between the extensor pollicis longus and extensor pollicis brevis tendons. Mark the depression at the base of the 1st metacarpal with needle cap. To avoid the radial artery, the needle should enter on the ulnar side of the extensor pollicis brevis tendon. Distraction of the thumb can increase the space to get the needle into the joint. Corticosteroid alone can be injected without anesthetic, given the small size of the CMC joint. Usually, not more than ½ mL volume will fit into the joint space. Thumb spica splint x1-2 wks

Answer 69

Anatomy The carpal tunnel is bounded by the carpal bones dorsally and the transverse carpal ligament (flexor retinaculum) ventrally. The contents of the tunnel include the median nerve and flexor tendons of the hand. Approach Use 3-mL syringe with 25-gauge 1½-inch needle 1½ mL 1% lidocaine without epinephrine ½ mL (20 mg) Kenalog Have the patient lay the hand palm up on the table and make a fist with slight wrist flexion. Observe the tendons of the palmaris longus (10% of the population will not have one) and the flexor carpi radialis. Mark a spot with the needle cap 4 cm proximal to the distal palmar crease between the two tendons mentioned above. With the fist clenched and the wrist slightly flexed, the needle is inserted at a shallow angle (~20 degrees) along the tendon sheath, aiming toward the ring finger. Have the patient slowly extend the wrist and fingers noticing the needle advance toward the carpal tunnel. This indicates proper needle placement Ask the patient if they feel any increased pain or numbness. If they do, remove the needle because it may be in the median nerve. DO NOT INJECT INTO THE MEDIAN NERVE. Wrist splint x1-2 wks

Answer 70

Anatomy Nodule or thickening occurs in the flexor tendon, which catches on the A-1 proximal pulley making finger extension difficult. Approach Use 3-mL syringe with 25-gauge 5/8- to 1-inch needle ½ mL 1% lidocaine ½ mL (20 mg) Kenalog Palpate the tender nodule on the palm of the hand and mark with needle cap. Injection site is either directly into the nodule or at the proximal interphalangeal digital crease. Insert needle at a 45-degree angle—when you feel rubbery resistance, you are at the level of the tendon. Back needle out slowly until it is no longer in tendon and the fluid flows easily within the tendon sheath Finger splint x1-2 wks After 3 days, start extension exercises—hold finger in extension 10 sec × 10 times for one set. Complete three sets per day. Avoid repetitive gripping or use padded gloves for any vibrating tools (i.e., jackhammers).

Answer 71

Anatomy Ganglion cysts are the most common soft tissue tumors of the hand and wrist, more commonly in women (3:1). These thick mucin-filled cysts may out pouch from synovial or tendon sheaths from trauma or repetitive irritation. Ganglion cysts are often connected to an underlying ligament or joint, most commonly at the scapholunate joint (60–70%), and next most frequently at the volar wrist (20–25%), and thirdly at the palmar flexor tendon sheath (10–12%). Approach Use 5- to 10-mL syringe with 18- to 22-gauge 1-inch needle if aspirating viscous cyst contents 3-mL syringe with 22-gauge 1-inch needle if injecting ½ to 1 mL 1% lidocaine without epinephrine (if using) ½ mL 40 mg/mL (20 mg) triamcinolone suspension (Kenalog) Position the patient in sitting position with his or her arm on the table with the ganglion cyst facing upward. Aspirate using the 18-gauge needle—the thick mucoid cyst contents may be difficult to aspirate and may actually be more effectively milked out of the puncture site after the needle is removed. First, aspirate the cyst contents if possible and then stabilize the needle position with a hemostat, remove the aspiration syringe, secure the syringe with the steroid mixture, and inject.

Answer 72

Indicated for bursitis, greater trochanteric pain syndrome indicated if pain persists despite conservative therapy, including avoiding direct pressure and repetitive trauma, ice, NSAIDs, and stretching of the iliotibial band, tensor fascia lata, external hip rotators, hip flexors, and quadriceps. Anatomy The trochanteric bursa lies superficial to the greater trochanter of the femur, between the trochanteric process and the gluteus medius/iliotibial tract. Tenderness to palpation over the trochanteric process is the classic finding for trochanteric bursitis. Approach Use 6-mL syringe with 21- to 22-gauge 1½- to 2-inch needle for thin patients 21- to 22-gauge 3.5-inch spinal needle may be needed for heavier patients. 5 mL 1% lidocaine without epinephrine and/or 0.25% bupivacaine 1 mL 40 mg/mL (40 mg) triamcinolone suspension (Kenalog) Lay the patient in lateral recumbent position, with the affected side up. Flex the patient’s hip at 50 degrees, and flex the knees 60 to 90 degrees. Palpate the greater trochanteric process and identify the point of maximal tenderness, which usually corresponds well to the most superficial point of bony prominence. Mark this area with the needle cap. Cleanse the skin with alcohol swab and then Betadine × 3 or chlorhexidine × 45 sec. Position the needle perpendicular to the skin and advance toward the site of maximal trochanteric tenderness. Advance the needle until the tip reaches bone level to ensure delivery of the steroid below the tendon. Never inject under pressure, which may indicate placement within the tendon. Withdraw the needle 2 to 3 mm to remain within the trochanteric bursa. For acute bursitis, the 5 to 6 ml of corticosteroid and lidocaine can be directly injected into the bursa. For chronic bursitis, a clockwise peppering motion may help break up scar tissue—each time, the needle should reach the level of bone and then inject. Avoid pressure to area afterwards, rest x3 days Repeat in 6-12 wks if pain relief was <50%

Answer 73

Indicated for bursitis Anatomy The olecranon bursa overlies the olecranon process at the proximal ulna. Olecranon bursitis is visible as posterior elbow swelling, often described as a golf ball or goose egg over the elbow tip. Approach Use 3-mL syringe with 25-gauge 1-inch needle if injecting 5- to 10-mL syringe with 18- to 22-gauge needle if aspirating 1 mL 1% lidocaine without epinephrine ½ mL 40 mg/mL (20 mg) triamcinolone suspension (Kenalog) Place the patient’s arm on the table at maximal elbow flexion to accentuate the swelling. Palpate over the olecranon bursa for fluctuance. Cleanse the skin with alcohol swab and then Betadine × 3 or chlorhexidine × 45 sec. Aim the needle perpendicular to the olecranon bursa. Aspirate bursa fluid until the bursa is flat. If infection has been ruled out, inject steroid/lidocaine into bursa. Compressive elbow sleeve may help fluid reaccumulation Avoid direct pressure afterwards Consider posterior splint or elbow pads for 1-2 wks

Answer 74

Indicated for chronic bursitis if not improving w/ conservative rx Anatomy Use 5- to 10-mL syringe with 18- to 22-gauge 1-inch needle if aspirating 1 mL 1% lidocaine without epinephrine (optional) ½ mL 40 mg/mL (20 mg) triamcinolone suspension (Kenalog) The prepatellar bursa lies between the patella and the overlying skin. Prepatellar bursitis is visible as a well-circumscribed region of swelling over the patella. Approach Position the patient in supine position with the knee flexed at 30 degrees on a pillow. Position the affected leg with patella facing upward. Cleanse the skin with alcohol swab and then Betadine × 3 or chlorhexidine × 45 sec. The prepatellar bursa swelling should be clearly visible. Aspirate by approaching from the side of the visible prepatellar swelling. Pressure dressing after

Answer 75

For bursitis - can be done w/ conservative therapy Anatomy Use 3-mL syringe with 25-gauge 1-inch needle 1 mL 1% lidocaine without epinephrine ½ mL 40 mg/mL (20 mg) triamcinolone suspension (Kenalog) The pes anserine bursa lies between the conjoined tendon of the sartorius, gracilis, and semitendinosus muscles and the tibial insertion of the medial collateral ligament. Diagnosis is made by tenderness to palpation over the anserine bursa, ~2 cm below the medial joint line at the proximal medial tibia. Swelling is not usually visible with anserine bursitis. Approach Lay the patient in supine position. Position the affected leg with the medial joint line accessible. Identify the anserine bursa 1 to 2 cm below the middle of the medial joint line. The point of maximal tenderness along the medial tibial plateau often serves to identify the ideal injection site—mark this site with the needle cap. Cleanse the skin with alcohol swab and then Betadine × 3 or chlorhexidine × 45 sec. Insert the needle perpendicular to the skin. Advance the needle to the level of bone to find the bursa space between the conjoined tendons and the tibia. Inject the steroid/lidocaine mixture into the bursa—resistance to flow should be minimal. Sleep w/ cushion between knees

Answer 76

Indications: dx of knee effusion, treatment of OA, crystalline dz, synovitis Anatomy The knee joint consists of the femoral–tibial and femoral–patellar joints, with stabilization from the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments. Approach Use 3-mL syringe with 25-gauge 1-inch needle for injection 20- to 60-mL syringe with 18- to 22-gauge 1½-inch needle if aspirating 5- to 10-mL syringe with 21- to 22-gauge 1½-inch needle for injecting 5 to 7 mL 1% lidocaine without epinephrine and or 0.25% bupivacaine (if using) 1 mL 40 mg/mL (40 mg) triamcinolone suspension (Kenalog) For the supine medial or lateral midpatellar approach, position the patient’s knee either in full extension, which gives the most patellar mobility, or slightly flexed at 5 degrees with a rolled towel supporting underneath. The needle is advanced parallel to the floor directed straight toward the patellar midpole. Repeat injection can be done after 3 mo if the steroid injection afforded adequate pain relief—average duration of effect for joint steroid injections is 4 wk.

Answer 77

Indicated to dx ankle effusions or to treat OA, crystalline dz, synovitis Anatomy The ankle joint consists of the articulation of the tibiotalar and talofibular joints. The ankle joint space can be approached either medially or laterally. Use 3-mL syringe with 25-gauge 1-inch needle for injection Extra 3- to 5-mL syringes if needed for aspiration of effusion ½ to 1 mL 1% lidocaine without epinephrine (if using) ½ mL 40 mg/mL (20 mg) triamcinolone suspension (Kenalog) Medial approach Identify the soft spot between the anterior tip of the medial malleolus and the medial edge of the tibialis anterior tendon: Palpate down to feel the tibiotalar joint line—mark this site with the needle cap. Advance the needle in a posterolateral direction and inject. Having an assistant apply mild eversion/plantarflexion pressure may help to open the joint. Lateral approach Identify the triangular depression between the lateral tibia, fibula, and the talus: Palpate down to feel the tibiotalar joint line—mark this site with the needle cap. Advance the needle in a posteromedial direction. If aspirating, remove as much fluid as possible and then stabilize the needle in the joint with a hemostat and switch between the aspiration and therapeutic syringes. Keep the needle hub and syringe tips sterile. After securing the therapeutic syringe, inject the steroid/lidocaine mixture. Repeat injection can be done after 3 mo if the steroid injection afforded adequate pain relief—average duration of effect for joint steroid injections is 4 wk.

Answer 78

2nd line after conservative therapy failed Anatomy The plantar fascia supports the medial longitudinal arch of the foot and stretches between the base of the phalanges and the medial tuberosity of the calcaneus. The plantar fascia lies deep to the fat layer of the heel. On physical exam, the plantar fascia insertion point on the calcaneus is usually markedly tender to palpation. Approach Use 3-mL syringe with 25-gauge 1.5-inch needle for injection ½ mL 1% lidocaine without epinephrine (if using) ½ mL 40 mg/mL (20 mg) triamcinolone suspension (Kenalog) Position the patient in the lateral recumbent position with the painful side down. Position the affected foot medial side up. Palpate the maximal point of tenderness at the plantar fascia insertion on the calcaneus, usually in the middle of the heel—this gives the injection target depth along the width of the heel. Find the medial edge of the calcaneus and mark with needle cap—this marks the injection point along the length of the foot. Cleanse the skin with alcohol swab and then Betadine × 3 or chlorhexidine × 45 sec. Apply ethyl chloride for topical cooling. Inject perpendicular to the medial foot, aiming just distal to the calcaneal edge in order to avoid the heel fat pad. If the calcaneus is reached with the needle tip, walk the needle off the bony edge and then down to the depth of the point of maximal tenderness. Inject the steroid/lidocaine mixture.

Answer 79

Indicated if conservative therapy has failed Anatomy Morton neuroma usually develops between the 2nd and 3rd or between the 3rd and 4th metatarsal heads. Tenderness to palpation between the metatarsal heads usually confirms the diagnosis. Approach Use: 3-mL syringe with 25-gauge 1-inch needle for injection ½ mL 1% lidocaine without epinephrine (if using) ½ mL 40 mg/mL (20 mg) triamcinolone suspension (Kenalog) Lay the patient in a supine position with a bent knee and the foot flat on the table. Identify the point of maximal tenderness between the metatarsal heads on the dorsal foot—mark entry site with needle cap. Cleanse the skin with alcohol swab and then Betadine × 3 or chlorhexidine × 45 sec. Apply ethyl chloride for topical cooling. Advance the needle at a 45-degree angle proximally toward the point of maximal tenderness or nodule—aim toward the heel and stop at the level of the interdigital fullness. Do not inject at the level of the plantar fat pad to avoid fat pad atrophy.

Answer 80

Indicated for dx of gout or for treatment of OA, RA, gout Approach Use: 3-mL syringe with 25-gauge 5/8- to 1-inch needle 1 mL 1% lidocaine without epinephrine ½ mL (20 mg) Kenalog or equivalent Lay the patient in a supine position with a bent knee and the foot flat on the table. Flex and extend the 1st MTP joint to identify the joint line and mark with needle cap. Cleanse the skin with alcohol swab and then Betadine × 3 or chlorhexidine × 45 sec. Distal traction may help open the joint space. Aim the needle distally toward the toe and enter at a 60-degree angle to match the joint slope. The joint lies fairly superficially, and the injection solution should flow freely within the joint.

Answer 81

Individual: Injury, depression, self harm, eating disorders Relational: Sexual harassment, sexual abuse, physical abuse, forced physical exertion, emotional abuse, neglect, bullying, doping Organisational: Abuse from spectators, discrimination, unhealthy training programs, hazing, medical mismanagement, age cheating

Answer 82

Unexplained or unwarranted injuries Decline in performance Nightmares, avoidance Aggressive behaviour or intense anger Acting out sexually Self-destructive behaviour Appearing sad or withdrawn Difficulty forming new relationships or trusting others Drug or alcohol use Change behaviour patterns Fear of certain adults

Answer 83

Actively listen to athlete, provide empathy, acknowledge courage in speaking out, assure athlete experiences not their fault, encourage disclosure, do not denigrate the perpetrator, keep accurate records, ensure athlete safety, stop the abuse (report disclosure to authorities including police and sporting organisation), support teammates and family members, encourage whistleblowing culture

Answer 84

Mental burnout, overtraining, conflict with coaches or teammates, school or work issues due to increased time demands Concussion, debilitating injury illness Eating disorders, violence, or harassment

Answer 85

Provide timely access to support Provide services in the least restrictive manner Ensure support is available Spend adequate time with the individual in crisis Ensure that people intervening have appropriate training and competence Help the individual to regain a sense of control Attend to issues of culture, gender, race, age, sexual orientation and communication needs Insure services trauma informed Take measure to reduce the likely of future emergencies

Answer 86

Grade 1: disruption of some collagen fibres Localised tenderness, minimal inflammation, normal range and end fill on ligament stress test but maybe painful, little functional deficit Grade 2: disruption of considerable proportion of collagen fibres Significant tenderness, considerable swelling, increased ligament laxity but definite endpoint, moderate functional deficit Grade 3: complete disruption of collagen fibres Audible pop, immediately painful but may become pain-free, considerable swelling, significantly increased ligament laxity with no designable endpoint, significant functional deficits

Answer 87

Stage 1 = reactive tendinopathy - tendon cells activate + proliferate, occurs w/ trauma + acute overload Stage 2 = tendon disrepair - increased matrix breakdown, myofibroblasts appear, cells more rounded (chondrocytic). Collagen separates which allows ingrowth of vessels. Seen in overloaded tendons in young (but can occur at any age) Stage 3 = degenerative tendinopathy - end stage overuse progression of cell changes to point of apoptosis. Large areas of disordered matrix w/ ingrown vessels, heterogenous on pathology

Answer 88

Normal bony outgrowth that arises from a separate ossification centre + fuses w/ bone Site of tendon or ligament attachment Weakest link of the muscle - tendon unit in the skeletally immature

Answer 89

Traction injury - repeated microavulsion of apophysis caused by disproportionate growth of bone in relation to associated myotendonous units

Answer 90

Pain during + after activity, insidious onset Localised tendnerness + swelling, pain w/ resisted activation + passive stretching

Answer 91

Hypertrophied, fragmented or separated apophysis - XR can also be normal

Answer 92

Relative rest from activities that cause pain (inadequate protection can lead to avulsion #), ice, NSAIDs, stretching, PT, 4 wks pain free then gradual RTP

Answer 93

Increase liver glucose output mainly from glycogenolysis, also gluconeogenesis. Increased adipose tissue lipolysis. Increased whole body oxygen uptake Increased heart rate and cardiac output Increased ventilation Increased ATP turnover in muscle, creased glucose uptake and lipolysis in the muscle increased oxygen neutralisation, CO2 and heat production and increased blood flow Release of myokines

Answer 94

Prepares the body by increasing your heart rate and breathing, vasodilation. Increases muscle temperature, which improves flexibility Reduces risk of injury Improves performance Helps with mental preparation Warming up slowly increases your heart rate, which helps reduce stress on your heart.

Answer 95

Identify type and severity of injuries Identify risk factors and injury mechanisms Introduce measures to reduce future risk or severity of injuries

Answer 96

Athlete fitness Human factors Protective equipment Sports equipment Environment

Answer 97

Increase hamstring strength and increased hip range of motion

Answer 98

Taping or bracing for one after an ankle sprain Balance board training program

Answer 99

Structured warm up targeting strength, balance and neuromuscular control (eg FIFA 11)

Answer 100

Structured training program Technique modification Nutritional strategies to prevent stress fractures Modifying risk factors such as shoes and sporting equipment Managing the rate of load increase

Answer 101

Active recovery (low intensity work after exercise) Massage within 2 hrs Neuromuscular electrical stimulation ASAP Stretching Cold water immersion ASAP, max 10 mins, temp 10-15 degrees Compression clothing ASAP for min 60 mins Nutrition - replacing fluids (1.5x weighed fluid loss) + fuel (carbs) + repair (protein) Optimal sleep

Answer 102

Joint mobilisation and manipulation Soft tissue therapy Dry needling Taping Therapeutic ultrasound Transcutaneous electrical nerve stimulation (TENS) Neuromuscular stimulators Laser Electromagnetic therapy Shockwave therapy

Answer 103

Treating intramuscular trigger points for pain relief

Answer 104

Restriction of range of motion Altering anatomical alignment Cutaneous stimulation for pain relief Improved proprioception

Answer 105

Patellofemoral pain Ankle sprain de Quervains tenosynovitis Plantar fasciitis Shoulder pain

Answer 106

Increased blood flow, metabolic activity Treatment of acute bone fractures

Answer 107

Short term pain relief

Answer 108

Enhance recovery, improved performance, reduced muscle soreness

Answer 109

Pain relief

Answer 110

Treatment of tendinopathy

Answer 111

Inflammation Phase (0–3 days): Characterized by redness, swelling, heat, and pain. The goal is to remove debris and prepare for repair. Proliferation Phase (4–21 days): Fibroblasts produce collagen, and new blood vessels form to support tissue repair. Remodeling Phase (21 days to months): Collagen is reorganized to increase tensile strength, and the tissue matures.

Answer 112

VO₂ max is the maximum rate of oxygen uptake during intense exercise. It reflects aerobic capacity and is influenced by: * Cardiac output: Heart rate × stroke volume. * Muscle efficiency: Oxygen extraction by working muscles. * Lung function: Oxygen exchange efficiency. How to improve it: * Endurance training: Interval training and long-distance running are effective. * High-intensity interval training (HIIT) can boost VO₂ max rapidly.

Answer 113

180/30/L1, referring to forward flexion/ ext rotation / int rotation.

Answer 114

0 = neutral, so if the knee passes through neutral from hyperextension to full flexion, it will be the middle number. If there is a loss of full extension, the 0 precedes the degree of full extension. Documenting Knee Range of Motion: If a person has 10 degrees of knee hyperextension and 130 degrees of knee flexion, it would be documented as 10-0-130. If a person has a 10 degree contracture and loss of full knee extension with 130 degrees of knee flexion, it would be documented as 0-10-130.

Answer 115

PCL resists posterior translation of the tibia + hyeprflexion of the knee

Answer 116

The lactate threshold is the exercise intensity at which blood lactate begins to accumulate faster than it can be cleared. This marks the transition from predominantly aerobic metabolism to significant anaerobic metabolism. Expressed as a percentage of VO₂ max (e.g., 60–90% of VO₂ max in well-trained athletes).

Answer 117

Piriformis muscle in the buttock irritates or compresses the sciatic nerve

Answer 118

Pain or tenderness in the buttocks, especially after prolonged sitting or activity. Sciatic-like symptoms, such as pain radiating down the back of the thigh and into the leg. Worsening pain with certain movements, such as sitting, climbing stairs, or squatting

Answer 119

FADDIR might be positive

Answer 120

not necessarily needed, MRI if so

Answer 121

Overuse or injury of the piriformis muscle (e.g., from running, cycling, or prolonged sitting). Trauma

Answer 122

Conservative Management: Stretching and strengthening exercises, particularly for the piriformis and surrounding muscles. Avoiding aggravating activities and maintaining good posture. Non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. Physical therapy, including manual therapy or dry needling. Advanced Treatments: Corticosteroid injections around the piriformis muscle for persistent cases. Botox injections to relax the muscle. Surgery: Rarely needed and reserved for severe, refractory cases.

Answer 123

Lumbar disc herniation or radiculopathy. Sacroiliac joint dysfunction. Gluteal tendinopathy.

Answer 124

1) monitoring concentrations using trusted source of ozone, nitrous oxide + particulate matter 2) exercising in the morning or in locations when seasonal events are less likely - When ambient air pollution concentrations are high, it may be favourable to relocate an exercise bout indoors after considering the indoor air quality and potential co-exposures (e.g., indoor temperatures). ● Indoor air quality can also be improved by controlling indoor sources of air pollution, optimizing ventilation, and using portable air cleaners fitted with HEPA filters. 3) minimizing pre-exercise and intra-transport exposures: Minimize exposure to air pollution during transportation to exercise facilities by closing vehicle windows, turning on air conditioning, and using cabin air filters. 4) wearing face masks in areas of high particulate matter 5) optimizing antioxidant consumption. For at least one week prior to exercising in an environment with high O3 levels, athletes may consider consuming 250-650 mg of vitamin C and 75-100 mg of vitamin E, and 25 mg of βcarotene. 6) Athletes with asthma and/or EIB should continue to use medications as prescribed by their physicians. 7) Consecutive multi-day exposures to ozone prior to competition may also attenuate the pulmonary effects of ozone pollution. 8) During exercise, athletes should aim to minimize the total inhaled dose of air pollution and maximize distances from significant sources of air pollution (e.g., major traffic arteries).

Answer 125

Look for presentations H+P with athlete to explore (do you feel safe? Etc) Report to MCFD if a child, encourage adult to report to authorities, report to sport dispute resolution centre of Canada for all cases

Answer 126

Maintain focus on well being of athlete Educate athletes, coaches, staff, parents Ensure organizations have policies for athlete protection (codes of practice, education, training, complaint reporting, support mechanisms) Know duty to report

Answer 127

Respect professional boundaries Understand and follow universal code of conduct Ensure organization has policies + codes of conduct in place that you follow Accurate + timely record keeping

Answer 128

1. All Canadian youth soccer players should engage in exercise programs that incorporate neuromuscular, proprioceptive, agility, and strength training in their routine practice and warm-ups 2. These NMT programs should be commenced at least by the early teenage years 3. During the performance of the ACL injury prevention program in training, the coaches and trainers should give effective feedback on the performance of the drills, and players should learn from watching each other perform the tasks 4. National and provincial soccer governing bodies should develop age-specific ACL injury prevention programs and monitor these programs for effectiveness 5. Soccer teams should collaborate with a qualified health or physical education professional in the institution of an ACL injury prevention program for the team’s training sessions 6. Professionals can lead by educating teams 7. Ongoing research needed 8. Ongoing understanding, development, and refinement of implementation strategies are needed to improve compliance and uptake of the prevention programs

Answer 129

Group of exercises to prevent injury

Answer 130

Reduced oxygen availability at altitude can impair endurance performance. Acclimatization strategies are essential to mitigate performance decrements. Individual responses to altitude vary; personalized plans are recommended.

Answer 131

Live High–Train Low (LHTL): Living at high altitude to stimulate physiological adaptations while training at lower altitudes to maintain training intensity. Live High–Train High (LHTH): Both living and training at high altitude; may lead to reduced training intensity due to hypoxia. Live Low–Train High (LLTH): Living at low altitude and performing high-intensity training sessions at high altitude; less common due to logistical challenges.

Answer 132

Increased ultraviolet radiation at altitude necessitates skin and eye protection. Cold temperatures require appropriate clothing to prevent hypothermia.

Answer 133

Fractures, sprains + strains, upper >lower limb

Answer 134

Trampolines should not be used for recreational purposes at home (including cottages and temporary summer residences) by children or adolescents. Health care professionals, including family physicians and pediatricians, should warn parents of the dangers of trampolines as a recreational toy at routine health care visits. Parents should be advised to avoid the purchase of trampolines for the home, as enclosures and adequate supervision are no guarantee against injury. Trampolines should not be regarded as play equipment and should not be part of outdoor playgrounds. Physicians should advocate for legislation to require warnings of trampoline dangers to be put on product labels. More research on trampoline injuries sustained in supervised settings, such as schools, gym clubs, and training programs, should be conducted to assess the risk of injury in these settings.

Answer 135

* Encourages range of motion, strength, and fitness, especially with aquatic exercises. * Improves aerobic fitness, muscle strength, disease activity, quality of life, and reduces pain and medication use. * Sports participation does not exacerbate the disease.

Answer 136

* Potential for joint strain, muscle atrophy, fractures, and cardiovascular complications. * Children with cervical arthritis are at higher risk for spinal injuries during contact sports.

Answer 137

* Safe participation in moderate fitness, strengthening, and flexibility exercises. * Gradual return to full activity after flare-ups. * Screen for C1-C2 instability before contact sports, use mouthguards for jaw issues, and eye protection as needed.

Answer 138

* Regular exercise reduces bleeding episodes, strengthens muscles around joints, and increases joint stability. * Aerobic and weight-bearing exercises improve bone health, coagulation, and overall fitness.

Answer 139

* Reduced fitness, muscle strength, and anaerobic power due to hemophilia. * Participation in contact sports poses risks of bleeding and injury.

Answer 140

* Children should receive appropriate factor prophylaxis and undergo joint function assessments. * Avoid high-risk contact sports without medical clearance. * Use protective equipment and physical therapy, and have a clear plan for managing acute bleeds.

Answer 141

* Regular exercise improves fitness and may reduce exercise-induced bronchospasm (EIB) severity. * Swimming is particularly beneficial due to lower EIB triggers. * Exercise can enhance exercise capacity and quality of life.

Answer 142

* Children can participate in any activity if symptoms are well-controlled. * Use inhaled beta2-agonists 15-30 minutes before exercise. * Avoid scuba diving if asthma symptoms persist or spirometry is abnormal.

Answer 143

* High-intensity exercise may trigger EIB, especially in dry or cold environments. * Endurance sports may increase bronchial hyperresponsiveness.

Answer 144

* Exercise improves aerobic fitness, lung function, and survival rates. * Activities like swimming, walking, and jogging strengthen respiratory muscles. * Strength training improves muscle mass, FEV1, and weight gain.

Answer 145

* Exercise may trigger coughing, oxygen desaturation, and fatigue due to lung disease. * Potential for pneumothorax during scuba diving and dehydration during prolonged exercise. * Avoid contact sports for those with liver dysfunction or enlarged spleen.

Answer 146

* Encourage physical activity with individualized programs. * Avoid scuba diving and monitor hydration, especially for those with diabetes or liver complications.

Answer 147

1) Don’t order an MRI for suspected degenerative meniscal tears or osteoarthritis 2) Don't prescribe opioids as first line treatment for acute or chronic non-cancer musculoskeletal pain 3) Don’t order orthotics for asymptomatic children with pes planus (flat feet) 4) Don’t order an MRI as an initial investigation for suspected rotator cuff tendinopathy 5) Don’t immobilize ankle inversion sprains with no evidence of bony or syndesmotic injury 6) Don't use single-use vials of anesthetic agents such as xylocaine to prepare injections for patients 7) Don't recommend strict rest until symptom resolution after an acute sports-related concussion

Answer 148

1) Don’t order knee radiographs to diagnose Osgood Schlatter Disease in children 2) Don’t order ultrasound as an initial investigation for shoulder/knee injuries in children 3) Don’t order scoliosis radiographic series for back pain 4) Don’t order thoracic spine radiographs if there is clinical concern about scoliosis 5) Don’t order oblique radiographic views for investigation of spondylolysis 6) Don’t order a head CT scan for minor head injuries/concussion 7) Don’t immobilize a joint with suspected amplified pain syndrome (complex regional pain syndrom 8) Don’t order follow-up radiographs for buckle fractures of the distal radius if there are no clinical symptoms at the time of follow-up

Answer 149

Mental health challenges do not always disable athletes; they may still participate in training/competition. RFP and RTP decisions should be based on symptom severity, stability, and functional impairment. Sports psychiatrists should be involved in assessment and management. Limited research on RFP/RTP for primary mental health issues compared to concussion. Athletes may continue competing without proper assessment or return prematurely without adequate support. The study calls for more global data and better mechanisms for supporting mental health recovery in athletes.

Answer 150

Spinal cord- syrinx or syringomyelia, compressive myelopathy (neck or thorax), Brain- stroke, tumor, hemorrhage (subdural etc), infection. Nerve root – disc herniation, Brachial plexus – trauma or traction Peripheral nerve – compression, fracture.

Answer 151

Dysphagia, dysarthria, diplopia, dysmetria (reduced coordination) – as these symptoms could signify a problem in the brainstem

Answer 152

Dematome + myotome assessment CN exam Rectal tone, perianal sensation Ability to bear down

Answer 153

refer to neurosurg, often observed with serial imaging, can be decompressed

Answer 154

Any noxious or painful stimulus from the skin, abdominal organs, bones, joints etc can amplify the muscle stretch response and worsen spasticity. An increase in spasticity can be a sign of infection or injury in athletes with a spinal cord injury or other conditions of the central nervous system.

Answer 155

Neurological- has there been any change in the strength or sensation? - suggests a new problem with the spinal cord- syrinx, compression Do you have a Baclofen pump? Genitourinary - change in bladder pattern? New incontinence, frequency of catheterizations, blockage of catheter, change in color of urine (pyuria or hematuria) Gastrointestinal - Change in bowel function (constipated, diarrhea, nausea, vomiting, blood in stool), intraabdominal injury or infection? Skin – any new sores, ingrown toe nails Musculoskeletal – any trauma or swelling of extremities Vascular – change in color or swelling of a leg or arm? Infectious- look for infection! Fever, chills, rigors, malaise etc

Answer 156

Check vitals – BP/HR/ Temp * Check for change in strength and sensation if suspicious for problem with spinal cord. * Check each system Genitourinary – urine, check genitals for infection or injury, Gastrointestinal- bowel for constipation, abdominal exam (may not have pain so need to have high index of suspicion for problem), * Skin – look for new sores; check nails, MSK- check for new injuries, fractures, joint injuries, or infection. Need to look at legs, and spine particularly carefully, Vascular - any signs of ischemia or deep vein thrombosis, Infection- look for signs

Answer 157

- neurovascular compromise - autonomic dysreflexia - fat emboli with large long bone fractures / increased DVT risk post-injury - pressure sores from immobility or attempts at casting (should be avoided) - further patient disability: loss of independence with mobility / transfers - Inquire about the functional implications of the fracture (just because they don’t walk on it doesn’t mean they don’t use it)

Answer 158

Fracture DVT heterotopic ossification (HO) infection impending pressure sore. Patients with a spinal cord injury (SCI) are at highest risk for a DVT in the months immediately following the injury. Heterotopic ossification is the formation of bone in ectopic sites. It has been reported to occur in 16-35% of persons with SCI. The bone formation can lead to severe joint restriction.

Answer 159

BWS is a potentially life-threatening syndrome that appears to be reversible if sufficient dosages of GABAergic drugs are given in time. abrupt change in mental status increased spasticity pruritis hyperthermia myoclonus or seizure instigated by a sudden cessation of Baclofen.

Answer 160

Restart baclofen, benzos ABCs

Answer 161

impaired thermoregulation due to impaired reflex vasodilation + inability to dissipate excess heat predictably. UTI Resp infections Infected pressure uclers DVT heterotopic ossification

Answer 162

1) residual limb pain d/t neuroma, bone overgrowth (including pediatric bony overgrowth, heterotopic ossification & bone spurs), poor prosthetic fit, skin lesions 2) phantom pain 3) residual limb skin problems - friction or pressure ulcers, abraisions 4) contralateral limb overuse injury

Answer 163

Spasticity mechanical and neuropathic pain pressure sores autonomic instability (autonomic dysreflexia, orthostatic hypotension, impaired thermoregulation) urinary tract infections insufficiency fractures contractures.

Answer 164

assigns a neurological level and degree of distal preservation of: sensory and motor function rectal sensation voluntary anal contraction Typically expressed as C, T or L and numeric assignment for neurologic level followed by impairment severity rating A, B, C, D or E. i.e. “C5 ASIA A spinal injury”

Answer 165

A - Complete: no sensory or motor function is preserved B - Sensory Incomplete: sensory but no motor function is preserved C - Motor Incomplete: motor preservation below the neurologic level, and more than half of key muscles below last normal level have a muscle grade ≤3. Must have some spared sensation or motor S4/5. D - Motor Incomplete: motor function preserved below the neurologic level, and at least half of key muscles below last normal level have muscle grade >3. Must have some spared sensation or motor S4/5. E - Normal: sensory and motor function are normal. May have reflex abnormalities

Answer 166

1. best corrected visual acuity of less than 20/60, or significant central field defect, 2. significant peripheral field defect 3. reduced peak contrast sensitivity

Answer 167

B 1: From no light perception to inability to recognize a hand B 2: From ability to recognize a hand up to visual acuity of 2 / 60 OR a visual field <5 degrees B 3: From visual acuity above 2/60 to visual acuity of 6/60 OR a visual field of 5-20 degrees

Answer 168

As a baby: hypotonia, poor feeding and motor delay. Persistence of primitive reflexes beyond 4-7mo eg persistence of the asymmetric tonic neck reflex (fencer pose) and Moro (startle) reflex beyond 6 months As an adult: Abnormal gait patterns poor walking efficiency and speed kyphosis scoliosis rotational deformities hip subluxation and contractures. This leads to long term issues with pain, abnormal bone growth and early OA. Retinopathy of prematurity strabismus esotropism + exotropism visual field deficits Hearing impairments Urinary symptoms including frequency, incontinence, and difficulty urinating Seizure disorders Osteoporosis and increased risk of pathological fracture

Answer 169

Spina bifida occulta meningocele myelomeningocele

Answer 170

Post traumatic seizure disorder and need for anti-seizure medications Hydrocephalus – may have ventriculo-peritoneal shunt Spasticity Ataxia Aphasia Dysarthria Visual Field Deficits Cognitive impairments Behavioral impairments

Answer 171

rotator cuff and impingement problems * Bicipital Tendonopathy * Glenohumeral Instability+/- 2* impingement * Osteolysis of the distal clavicle * Labral injuries * Osteoarthritis of the Glenohumeral Joint * Osteoarthritis of the Acromioclavicular joint * Myofascial Pain Syndrome * Suprascapular Neuropathy * Cervical Pathology (Facet Joint, Cervical Root, Deg Disc Disease, Syringomyelia/Syrinx)

Answer 172

Equipment repair kit (allen key, multitool, duct tape) Foley catheter Glycerin suppositories Leg bag Captopril 25mg SL Lidocaine jelly Gabapentin + baclofen

Answer 173

Osteoarthritis (OA) of large joints (e.g., knee, hip, shoulder) Inflammatory arthritis (e.g., rheumatoid arthritis, gout, psoriatic arthritis) Bursitis, tendinitis, or synovitis Rotator cuff impingement Plantar fasciitis

Answer 174

Symptomatic knee osteoarthritis (moderate evidence) May be considered for other large joints (e.g., hip, shoulder) in certain cases.

Answer 175

Mild-to-moderate osteoarthritis (especially knee and hip OA) Chronic tendinopathies (e.g., lateral epicondylitis, patellar tendinitis, Achilles tendinopathy) Rotator cuff tears Ligament sprains or partial tears Early cartilage damage

Answer 176

Chronic musculoskeletal pain (e.g., low back pain, neck pain) Ligament or tendon laxity Osteoarthritis in specific joints (e.g., knee, sacroiliac joint)

Answer 177

Early osteoarthritis Cartilage defects or degeneration Experimental use in sports injuries and degenerative joint disease

Answer 178

Potent anti-inflammatory effect Rapid pain relief, often within 1-3 days Can improve joint mobility and function Useful for acute flares of arthritis or severe pain Variable; typically 4-8 weeks but can be shorter in advanced osteoarthritis. Not a long-term solution; recommended to limit to 3-4 injections per joint per year.

Answer 179

Post-injection flare (transient increase in pain) Joint infection (rare but serious, <0.1%) Skin or subcutaneous fat atrophy at the injection site Depigmentation of the skin at the injection site Tendon rupture if injected near tendons Accelerated cartilage degeneration with repeated use in weight-bearing joints

Answer 180

Provides lubrication and shock absorption to the joint May reduce pain and improve function, particularly in early-to-moderate OA Delays the need for surgical intervention in some cases Typically 6-12 months, though some patients report relief up to 1 year. Effectiveness is variable and may take several weeks to notice

Answer 181

Local joint swelling, pain, or stiffness post-injection Rare systemic allergic reaction Joint infection (rare) Limited evidence for benefit in severe OA

Answer 182

Promotes tissue repair and regeneration by delivering growth factors May provide longer-lasting pain relief compared to steroids Minimal systemic side effects (autologous blood product) Some evidence suggests delaying progression of OA Variable; typically 6 months to 1 year or more for OA. May require multiple injections (e.g., 2-3 spaced weeks apart).

Answer 183

Pain, swelling, or stiffness at the injection site Risk of infection (rare) Limited evidence for effectiveness in advanced OA Expense (not typically covered by insurance in Canada)

Answer 184

Stimulates local healing response by injecting irritant solutions (e.g., dextrose, saline) Evidence for pain reduction and improved function in some studies Non-steroidal alternative for chronic joint or ligament pain Varies; typically requires multiple injections (e.g., 3-6 sessions) over weeks to months.

Answer 185

Injection site pain or irritation Risk of local infection (rare) Transient inflammation Limited high-quality evidence for efficacy in large-scale studies

Answer 186

Potential for cartilage regeneration and joint repair Pain reduction and possible delay of disease progression Experimental but promising for OA Expense (not covered by insurance) Limited high-quality evidence for widespread use Risk of infection or inflammatory reaction Highly variable; data suggests effects may last 1-2 years in some cases.

Answer 187

GTPS is an overuse syndrome that causes lateral hip pain due to pathology in the gluteal tendons (gluteus medius and minimus) and/or trochanteric bursa. It is more of a gluteal tendinopathy rather than a true bursitis.

Answer 188

Overuse (long-distance running, repetitive hip movements). Biomechanical issues (leg length discrepancy, weak gluteal muscles, pes planus). Tight IT band (excessive compression on the gluteal tendons). Obesity and female sex (wider pelvis = increased hip adduction forces).

Answer 189

Lateral hip pain (gradual onset, worsens with activity). Pain aggravated by: Running, prolonged walking, climbing stairs. Lying on the affected side (compression of the tendons/bursa). Standing on one leg for prolonged periods. No significant groin pain Exam: Tenderness over the greater trochanter. Pain with resisted hip abduction (suggests gluteal tendinopathy). Positive Trendelenburg sign (if severe gluteal weakness). Ober test may be positive (IT band tightness).

Answer 190

Relative rest PT for stretching + strengthening glute, hip stability NSAIDs Steroid inj 6-12 wks for improvement Consider PRP