1
Q
- Pain in groin area with attempted weight bearing
- Sensation of ““coming apart”” at the hip with bearing weight
- Presentation depend on severity - antalgic gait vs gross deformities
- Edema, ecchymosis, TTP, Limited ROM
A
Pelvic Fracture
2
Q
- Initial symptoms very similar to shin splints however pain becomes more focal and time for recovery is longer
- Pain at rest and pain that suddenly increases in intensity around site
- Point tenderness in the tibia
- Pain with resisted plantar flexion
A
Tibial Stress Fracture
3
Q
- "”Too much, too fast, too soon””
- Anterior knee pain that is exacerbated by exercise is the hallmark
- Superior pole of the patella or inferior pole of the patella
- Exacerbated by prolonged sitting, squatting, or kneeling in some cases
- Visual mild infrapatellar bursa swelling
A
Quadriceps/Patellar Tendonitis
4
Q
•Chronic in nature and followed by exercise
•Associated with prolonged walking or running with gradual onset of pain symptoms
•Do not experience pain at rest
•Anterior compartment is most commonly involved
**MEDEVAC**
A
Chronic Exertional Compartment SYndrome
5
Q
- Lateral deviation of great toe at MTP joint, pronation results in callus on medial end of great toe
- Pain and swelling aggravated by shoe wear
- Tenderness over the joint
- May have numbness or tinging over the medial aspect of the great toe
A
Bunion
6
Q
- Pain and tenderness over the greater trochanter (lateral hip pain) that may radiate distally to the knee or ankle or proximally into the buttock
- Pain is worse when going from sitting to standing
- May decrease after warming up but returns after 30 mins to 1 hour of walking
- Unable to lie on the affected side
- Point tenderness over the lateral greater trochanter is essential finding
- Trendelenburg and Faber Test
A
Trochanter Bursitis
7
Q
•Severe pain, swelling, decreased mobility, difficulty bearing weight, fever and tachycardia
•Direct inoculation, hematogenous spread, or from a bone infection common in post surgical PTs and Hx of previous STI
**MEDEVAC**
A
Septic Arthritis
8
Q
- Lateral curvature of the spine that is more than 10 degrees that may be from spinal degeneration or from childhood
- If they are symptomatic, they shouldn’t be in the Navy
- May present with increasing pain or difficulty in performing work tasks
A
Scoliosis
9
Q
- Pain along the plantar fascia that is most severe on awakening or when rising from a resting position
- Prolonged standing and walking increase the pain; sitting typically relieves symptoms
- Focal pain directly over the medial calcaneal tuberosity and 1-2cm distally along the plantar fascia
A
Plantar Fascitis
10
Q
- Severe pain
- Fixed extremity
- Numbness/tingling
- Severe tenderness
- Decreased ROM
POSTERIOR DISLOCATION (most common) •Affected limb is short, hip is fixed in adducted and internally rotated position
ANTERIOR DISLOCATION
•Hip held in abduction and external rotation
***DUH on the MEDEVAC**
A
Hip Dislocation
11
Q
- Pain to injured muscle of the hip that is exacerbated by activity
- Mild ecchymosis or edema
- Tenderness to affected muscle group (groin, inner thigh, ASIS/anterior thigh)
- Strength limited by pain
- Thomas test for hip flexor tightness
A
Hip Strain
12
Q
- Inflammatory arthritis of the spine that presents as back pain in almost all patients
- Periarticular features Uveitis, Psoriasis, and Inflammatory Bowel Disease
- Large joints involved; sacroiliac joint, spine, hip, shoulder
- Peripheral arthritis common, chest wall inflammation, enthesitis, dactylitis
A
Ankylosing Spondylitits
13
Q
- Chest pain that is able to be exacerbated by palpation on physical exam (reproducible pain)
- Likely secondary to viral illness and other causes of inflammation
A
Costochondritis
14
Q
- Pain over AC joint
- Pain on lifting affected arm
- Type III-VI presents with obvious deformity
- Patient supports arm in adducted position
- AC joint tender to palpation
- Any motion, especially abduction, causes pain
- Decreased general muscle strength due to pain
** Type I-II = Retain
Type III = Maybe/MEDADVICE
Type IV-VI = MEDEVAC
A
Acromioclavicular (AC) Injury
15
Q
•Caused by high energy trauma
•Severe pain in thigh
•Unable to bear weight
•Obvious deformity, edema, possible open injury
•Severe tenderness over fracture
•Affected limb may be shorter than unaffected side
**MEDEVAC**
A
Femoral Shaft Fracture
16
Q
- Hyperextension injury of the first MP joint and presents with swelling, tenderness, and limited motion
- Antalgic gait, passive flexion and extension of the great toe is painful and ROM is limited
A
Turf Toe
17
Q
- Extensor tendon rupture at insertion on middle phalanx
- Flexion of PIP/Extension of DIP
- History of trauma
- Painful PIP joint
A
Boutonniere Deformitiy
18
Q
- Non-radicular focal neck pain from the base of the skill to the cervicothoracic junction usually caused by a whiplash mechanism
- Worse with ROM
- May present with occipital headaches, irritability, fatigue, sleep disturbances, and difficulty concentrating
- TTP to involved areas but neurological examination is intact
A
Cervical Strain
19
Q
- Numbness and tingling into radial three digits of the hand (1st, 2nd, 3rd digit)
- Pain and paresthesias or numbness of the median distribution (thumb, index finger, long finger, and radial half of ring finger)
- Worse at night, patients report the need to rub hands together to get ““circulation back””
- Frequently drops objects or cannot open jars with twist lids
- Worse after repetitive motion of the hand or stationary tasks of the wrist that require long term flexion or extension
- Tenderness over carpal tunnel
- Phalen and Tinel Sign
A
Carpal Tunnel Syndrome
20
Q
- Usually caused by a compressive source
- Neck, shoulder or arm pain with muscle weakness, sensory changes, headaches and diminished DTR’s
- Positive Spurling Test
- Extension and axial rotation will often reproduce pain symptoms
A
Cervical Radiculopathy
21
Q
“ANTERIOR INSTABILITY
•Sensation of the shoulder slipping out of joint when arm is abducted and externally rotated
•Associated with trauma from a fall or forceful throwing motion
•Recurrent dislocations may occur by positioning arm overhead
POSTERIOR DISLOCATION
•PT will describe force that is posteriorly dislocated
MULTIDIRECTIONAL INSTABILITY
•Ability to voluntarily dislocate shoulder
GENERAL
•General tenderness noted throughout shoulder
•Limited to no AROM or PROM if currently dislocated
•Positive Sulcus Test with inferior laxity
•Positive Apprehension Test with anterior instability
•Positive Anterior/Posterior Drawer Test for anterior/posterior laxity
•Positive Jerk Test for posterior instability
**First time dislocations or evidence of neurovascular compromise require orthopedic evaluation for possible surgery - MEDEVAC**
A
Shoulder Instability (Dislocation)
22
Q
- Chronic shoulder pain for several months
- Specific injury that triggered pain
- Night pain and difficulty sleeping on affected side
- Complaints of weakness, catching and grating especially overhead activities
- Shoulder may appear sunken; indication of atrophy of infraspinatus muscle
- Tenderness over greater tuberosity and grating sensation at tip of the shoulder
- Positive Drop Arm Test and Empty Can Test
A
Rotator Cuff Tear
23
Q
- Patients often report a sprain where the pain is localized to the dorsum of the midfoot
- Swelling, edema, ecchymosis in the plantar arch or tarsometatarsal joint
- Maximum tenderness and swelling over the tarsometatarsal joint rather than the ankle ligaments
A
Lisfranc Fracture
24
Q
- Injury caused by stretch or complete rupture of the ligament
- Four injury patterns; dashboard (posteriorly directed force), hyperflexion, hyperextension injury to the knee (ACL first then PCL ruptures), fall on a flexed knee with foot in plantar flexion
- Positive Posterior Drawer and Sag Test
A
PCL Knee Tear
25
* Caused by a direct blow to the finger causing forced flexion of the DIP/distal phalanx
* Pain at the DIP joint with possible swelling, ecchymosis, and deformity
* Usually a flexed DIP joint at rest
* Inability to extend DIP joint fully
Mallet Finger
26
•Mild swelling to medial aspect of the knee
•Focal tenderness to medial flare of the tibia jut below the tibial plateau
•ROM may be limited by pain or pressure
\*\*IF Septic, MEDEVAC\*\*
Pes Anserine Bursitis
27
* Excessive wrist and hand flexion (overuse injury)
* Gradual onset of pain at medial aspect of the elbow exacerbated by activities that involve wrist flexion and forearm pronation such as; golf swing, baseball pitching, pull-through stroke during swimming, weight lifting, bowling
Medial Epicondylitis
28
* Usually fractured from falls with outstretched hand (FOOSH)
* PT will described a dorsiflexed wrist injury
* Pain in the radial side of the wrist in the anatomical snuffbox
* Pain with wrist motion and gripping
* Tenderness in the snuffbox region and over the scaphoid tubercle on the underside of wrist
Scaphoid Fracture
29
* Overuse causes chronic avulsion of the ossification center of the tibial tubercle commonly found in age range 14-18 (males)
* Anterior knee pain that increases gradually over time that is exacerbated by direct trauma, kneeling, running, jumping, and other activities that is relieved by rest
* Typically asymmetrical, occasionally bilateral
* Slight swelling and tenderness to tibial tubercle
Osgood Schlatter Disease
30
* Precipitated by repetitive use of the thumb (commonly affects middle aged women)
* Pain at radial aspect of the wrist exacerbated by movement of thumb or wrist
* May present with occasional edema in the distal radius region
* Tenderness over the radial styloid
* Positive Finklestein Test
de Quervian Tenosynovitis
31
* Acute pain and swelling of the DIP/Distal phalanx
* Inability to actively flex the DIP joint
* Common in contact sports (grabbing a jersey and being pulled away from your grip)
Jersey Finger
32
* Hamstring strain typically reports a sudden onset of posterior thigh pain that occurred while running, water skiing, or some other rapid movement
* A ""pop"" may be perceived at the onset of pain
* Quadriceps strains are associated with direct blows during contact sports that results in a contusion
* Ecchymosis, TTP, pain while attempting to flex/extend at the knee
Thigh Strain
33
* Firm nodular swelling in the wrist that may vary in size and increase in size
* May be painful; pain may increase with wrist motion
* Bump at the MCP or on the dorsum of the finger distal to the DIP (hand and finger)
* Smooth, round, multilobulated structure on the dorsoradial aspect of wrist that becomes more prominent with flexion
* May be tender to palpation
* Ganglion will transilluminate
Ganglion of the Wrist/Hand
34
* Symptoms of locking, catching, or popping through ROM can develop
* Moderate to severe effusion with tenderness over the medial or lateral joint lines
* ROM usually normal
* ""Locked knee"" associated with bucket handle tears
* Positive McMurray Test
Meniscal Tear
35
s•Vague pain in anterior groin or thigh that is exacerbated by activity and relieved with rest
•Hx of increasing activity prior to onset of symptoms
•Antalgic gait, tenderness to proximal thigh/groin, limited ROM particularly internal rotation
•Pain to groin or thigh with straight leg raise
\*\*MEDEVAC\*\*
Femoral Neck Stress Fracture
36
* Occurs with repetitive flexion and extension of the knee
* Focal pain to the anterolateral aspect of the knee that worsens with activity that resolves to discomfort at rest
* Tenderness to direct palpation over/near the lateral femoral condyle
* Positive Obers Test
IT Band Syndrome
37
* Plantar pain in the forefoot most commonly between the third and fourth toes (third web space)
* Occasionally numbness in the adjacent toes or burning plantar pain that is aggravated by activity
* Patients feel like they are ""walking on a marble"" or there is a ""wrinkle in my sock""
* Positive Metatarsal Squeeze Test
Morton Nueroma
38
* Numbness and tingling in the 4th and 5th digits
* Elbow pain/ache
* May radiate proximally to shoulder and neck
* Inability to do activities of daily living (ADL) such as opening jars or turning keys are late signs
* Positive Tinel Sign
Ulnar Nerve Compression
39
* Asymmetric distribution of joint pain and stiffness in affected joints with the majority having skin lesions prior to pain
* Most common manifestation is well demarcated erythematous plaques with silver scales
Psoriatic Arthritis
40
•Sensation of being stuck violently in the back of the ankle
•Possible ""pop"" followed by acute onset of pain
•Ecchymosis, edema, foot malalignment and possible impaired plantarflexion
•Positive Thompson test
\*\*If complete Tear, MEDEVAC\*\*
Achilles Tendon Rupture
41
"•Spondylarthropathy that is preceeded and precipitated by infection of the body such as UTI, STI, and Diarrheal illnesses
•Acute onset of joint pain 1-4 weeks after infection"
Reactive Arthritis
42
* Results from a fall on an outstretched hand
* Extreme pain, swelling, inability to bend elbow with obvious deformity
* Tenderness noted through joint
* All ROM will be limited by pain and inability to move joint
* Possible neuropathy
\*\*MEDEVAC\*\* duh...
Elbow Dislocation
43
* Sudden pain and giving way of the knee from a twisting or hyperextension-type injury
* 1/3 report an audible "pop" as the ligament tears and PTs usually unable to continue participating in sports due to pain and/or instability
* Moderate to severe effusion, possible hemarthrosis and knee tenderness
* ROM limited by pain and effusion with locking/popping sensation
* Positive Anterior Drawer and Lachmans Test
ACL Knee Tear
44
•Insidious onset of small joints first and occurs bilaterally
•4 of 7 ACR Criteria: morning stiffness (1 hour for 6 weeks), arthritis (3 joints for 6 weeks, swelling of hand joints (6 weeks), symmetrical joint swelling (6 weeks), rheumatoid nodules, positive RF factor, erosions or osteopenia in hand Xray, may have myelopathy
•Nodules, swelling/hypertrophy, swan neck deformity, lateral drift of toes may be present
•Boggy sensation on palpation, ROM diminished and painful, reduced grip strength, numbness and tingling on affected nerve
\*\*MEDADVICE\*\*
Rheumatoid Arthritis
45
* Common in older populations (50s-60s)
* Associated with other diseases; diabetes, thyroid disease, autoimmune disorders, stroke, Parkinsons, HIV medication use
* Commonly occurs AFTER shoulder injuries
* ROM reduction is most significant finding with external rotation and abduction are most affected
* Varying degrees of tenderness
* Neurovascular intact
* Shoulder will appear normal on visual inspection
Adhesive Capsulitis
46
Stages of Adhesive Capsulitis
PHASE ONE (Freezing phase)
•Diffuse, severe, and disabling shoulder pain with increasing stiffness that lasts for 2-9 months
PHASE TWO
•Stiffnes and severe loss of shoulder motion with pain less pronounced that last for 4 to 12 months
PHASE THREE (Recovery phase)
•Recovery phase with stiffness and gradual return of shoulder motion that takes about 5 to 24 months to complete
47
* Acute onset of pain on the ulnar aspect of the elbow with a ""pop"" while throwing
* Gradual onset of symptoms with progressive medial elbow pain with valgus stresses
* Excessive overhead throwing motion (baseball pitcher)
Ulnar Collateral Ligament Tear
48
PHASE ONE (Freezing phase)
•Diffuse, severe, and disabling shoulder pain with increasing stiffness that lasts for 2-9 months
PHASE TWO
•Stiffnes and severe loss of shoulder motion with pain less pronounced that last for 4 to 12 months
PHASE THREE (Recovery phase)
•Recovery phase with stiffness and gradual return of shoulder motion that takes about 5 to 24 months to complete
Stages of Adhesive Capsulitis
49
* Excessive wrist and hand extension (overuse injury)
* Gradual onset of pain in lateral elbow and forearm during activities involving gripping and wrist extension such as; lifting, turning screwdriver, hitting backhand in tennis, excessive typing, direct blow to lateral aspect of elbow (less common)
Lateral Epicondylitis
50
* Destruction of cartilage due to ""wear and tear"" that commonly appears on hips, knees, spine, and hands
* Sharp pain that is exacerbated with use, and alleviated with rest
* May have bony swelling, joint line tenderness and crepitus
Osteoarthritis
51
* Intense pain (even to light touch), redness, swelling to the first toe, ankle, knee, wrist, fingers, and elbow
* Most patients will have hyperuricemia
* ROM limited and guarded
Gout
52
* Diffuse aching anterior knee pain exacerbated by prolonged sitting, climbing stairs, jumping, or squatting
* Usually no pre-existing trauma
* PT reports sense of instability or a retropatellar catching or grinding sensation
* Tenderness noted to medial and/or lateral subpatellar borders
* May find crepitus with patellar mobility
* Patellar Apprehension Test and Hamstring Flexibility
Patellofemoral Pain Syndrome
53
* Gradual onset of pain with prolonged walking or running activity localized usually to the distal third of the medial tibia
* TTP along the medial crest of tibia in the middle to distal third
Shin Splints
54
•Severe leg pain out of proportion to apparent injury
•Persistent deep ache or burning pain
•Seven "P"s - Pain, Pallor, Paresthesia, Paresis, Poikilothermia, Pressure, Pulselessness
•Tense, shiny skin that might be pale
•Tenderness, tense compartment, coolness of skin and increased pain with any ROM
\*\*MEDEVAC\*\*
Acute Compartment Syndrome
55
* Result from valgus (MCL) or varus (LCL) forces
* Positive Varus/Valgus Testing
LCL/MCL KNee Tear
56
* Inversion injuries are most common
* Swelling , ecchymosis, and weight bearing status post-injury
* TTP over ATFL, CFL, or PTFL
* Check areas required for the Ottawa Ankle Rules (posterior edge of lateral/medial malleolus, base of 5th metatarsal, navicular bone)
* Positive Anterior Drawer - ATFL
* Positive Talar Tilt - CFL
* Positive Tib/Fib squeeze - Syndesmosis
Ankle Sprain
57
* Risk stratify with different back pain etiologies; non-specific, compression fx, radiculopathy, systemic disease
* Lower back pain and sacroiliac tenderness
* Supine/Seated Straight Leg Raise Test
Lower Back Pain
58
Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
•Night pain and difficulty sleeping on affected side
•TTP to: greater tuberosity, lesser tuberosity or bicipital groove
•ROM and muscle tests limited due to pain
•Positive Neer and Hawkins Tests
Impingement Syndrome
59
* Sudden(infection or trauma) or gradual (chronic) swelling in the affected area
* May occur secondary to trauma, inflammation or infection of the elbow
* Pain ranges in severity
* Limited elbow flexion/extension due to pain
* Tenderness over the elbow accompanied by a large mass
Olecranon Bursitis
60
•Virchow's Triad - Hypercoagulability, venous stasis, endothelial damage
•Usually presents as pain in the limb, edema, and erythema
•Keep an eye out for risk factors; surgery, polytrauma, spinal cord injuries, Hx of blood clots, immobilization (recent PCS), Hx of cancer, clotting conditions, estrogen use (BC), smoking, diabetes, obesity, age
•PT may present febrile
•Positive Homan's Sign (pain with ankle dorsiflexion)
\*\*MEDEVAC\*\*
Deep Vein Thrombosis
61
MOI
•Falling back onto an outstretched arm (FOOSH)
•Tries to prevent falling by grabbing onto an object
•Suddenly tries to lift a heavy object
•Forceful throwing, excessive overhead activity
•Chronic overuse vs acute injury
SYMPTOMS
•Anterior shoulder pain (in overuse injury)
•Clicking/clunking of the shoulder in certain positions
•Swelling, paresthesia, severe night pain (uncommon)
•Posterior shoulder tenderness common (special attention to biceps tendon)
•Inspect ROM and scapular motion (may be normal)"
Labrum Tear/SLAP leasion
62
* ""Pump bump"" that is irritated by shoe wear
* Start up pain, pain after activity and antalgic gait
* Calcaneal prominence may be edematous and tender to palpation
Posterior Heal Pain
63
* Abrupt or gradual onset of unilateral radicular leg pain aggravated by various factors with possible neurologic involvement
* Weaknesses and numbness depends on affected myotomes
* Seated/Supine/Crossed Straight Leg Raise
Herniated Disc
64
* Swelling/fullness in the popliteal fossa
* Popliteal knee pain, stiffness
* Edema to the popliteal fossa
* Flexion may be limited by pain and excessive joint fluid
Popliteal Cyst
65
* Common in people who pull, lift, reach, or throw for work/recreation (rock climbers/weight lifters)
* Anterior shoulder pain that radiates distally down the arm over the bicep muscle
* Aggravated by lifting, pulling and overhead activity
* Tendon rupture would be suspected if there was a single injury (""pop"" heard)
* Shoulder will appear normal on visual inspections typically
* Neurovascular intact
* TTP in bicipital groove of the humerus
* Positive Jurgenson and Speeds Test
BICEPS Tendon Tear
66
•Dome shaped swelling over the anterior aspect of the knee
•Tenderness to fluid filled dome shape over patella
•ROM may be limited by pain or pressure
\*\*IF Septic, MEDEVAC\*\*
Prepatellar Bursitis
67
* Gentle pressure over fracture will elicit pain
* Pain with arm motion
* Bony deformity, bump, as well as shoulder droop
* Grinding when PT attempts to move arm
* Positive Cross-Body Test with possible grinding
\*\*MEDEVAC\*\*
Clavicle Fracture
68
* Severe pain, swelling, decreased mobility, limited or no weight bearing, numbness, tingling, pallor, ecchymosis, or deformity present (it going to be obvious)
* Crepitus or visible deformity with guarded ROM
CLASSIFICATION BY:
•Skin integrity
•Displacement/angulation/rotation
•Orientation
\*\*MEDEVAC\*\*
Fracture
FEP MDT S/Sx's
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Decks in class (11)
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