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Post TAV II > MSK > Flashcards

MSK Flashcards

1
Q

What are the functions of the skeletal system

A

Support
Protection
Movement
Mineral homeostasis
Blood cell production
Triglyceride storage

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2
Q

Where does blood cell production occur within

A

Red bone marrow

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3
Q

Where does triglyceride storage take place within

A

Yellow bone marrow

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4
Q

What bones are longer than wide such as thighs, legs, arms, fingers, toes

A

Long bones

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5
Q

What bones are almost cube shaped such as most wrist and ankle bones

A

Short bones

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6
Q

What bones are thin and extensive surface such as cranial bones, sternum, ribs and scapulae

A

Flat bones

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7
Q

What bones do not fit in the above categories such as vertebrae, and facial bones

A

Irregular bones

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8
Q

What are the parts of a long bone

A

Diaphysis - the shaft
Epiphyses - ends of the long bone
Metaphyses - contains the “growth plate” and is located BETWEEN the shaft and and end of bone

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9
Q

What cells make up the microscopic structure of the bone

A

Osteoblasts - bone building cells
Osteocytes - maintain bone, exchange nutrients and waste within the blood
Osteoclasts - digest bone matrix for normal bone turnover

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10
Q

What type of joint has no cavity, just dense irregular connective tissue

A

Fibrous joints

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11
Q

What type of joints have no cavity and the bones are held together by cartilage

A

Cartilaginous joints

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12
Q

What type of joints have synovial cavities and many other components such as ligaments

A

Synovial joints

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13
Q

What is located in the skull between bones of the skull and add strength to the joints

A

Sutures: example of fibrous joints

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14
Q

What is a dense irregular tissue between long bones such as the radius-ulna, and tibia-fibula

A

Interosseous membrane: examples of fibrous joints

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15
Q

What allows articulating bones fit more tightly

A

Articulate discs (menisci)

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16
Q

What are sacs that contain synovial fluid and are located where friction can occur (decreases friction)

A

Bursae

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17
Q

What are the functions of ligaments

A

Composed of connective tissue
Found throughout the skeletal system
Function to connect bone to bone
Ligaments are commonly injured by spraining or tearing of ligaments

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18
Q

What is the function of tendons

A

Tough band of fibrous connective tissue
Functions to connect muscle to bone: skeletal muscle contracts and moves bones via tendons, very dense and more capable of withstanding tension

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19
Q

What are the different types of muscular tissue in the body

A

Skeletal muscle
Cardiac muscle
Smooth muscle

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20
Q

What are the functions of the different types of muscles together

A

Produce body movement
Stabilize body positions
Store and move substances
Produce heat

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21
Q

What is the decrease in the angle between articulating bones

A

Flexion

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22
Q

What is the increase in angle between articulating bones

A

Extension

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23
Q

What is the bending beyond 180 degrees, such as moving humerus backwards behind the anatomical plane

A

Hyperexenstion

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24
Q

What is the movement of the bone away from the midline

A

Abduction

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25
Q

What is the movement of bone toward the midline (add to the body/move closer)

A

Adduction

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26
Q

What is the movement of distal end in a circle

A

Circumduction

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27
Q

What is when the bone revolves around it’s an longitudinal axis

A

Rotation

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28
Q

What is the movement of the soles of the foot medially

A

Inversion

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29
Q

What is the movement of the soles laterally

A

Eversion

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30
Q

What is bending the foot toward the dorsum (standing on heels)

A

Dorsiflexion

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31
Q

What is bending the foot toward the plantar surface (standing on toes)

A

Plantarflexion

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32
Q

What is important family history information to gather in the HPI

A

Congenital abnormalities
Scoliosis or back problems
Joint disorders: arthritis and/or gout
Genetic disorders: skeletal dysplasia

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33
Q

What is important exam equipment to have for an MSK patient

A

Tape measure

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34
Q

When assessing range of motion, passive range of motion should meet what standards

A

Passive range of motion typically exceeds active range of motion by 5 degrees, and should be the same as the contralateral side

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35
Q

What does zero represent on the grade strength scale

A

No evidence of muscle function (including muscle twitch, 0/5)

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36
Q

What does trace represent on the grade strength muscle scale

A

Muscle contraction but no or very limited joint motion (1/5)

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37
Q

What does poor represent on the grade strength scale

A

Complete range of motion with gravity eliminated (2/5)

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38
Q

What is fair on the grade strength scale

A

Complete range of motion against gravity (3/5)

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39
Q

What does good represent on the grade strength scale

A

Complete range of motion against with some resistance (4/5)

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40
Q

What does normal represent on the grade strength scale

A

Complete range of motion with full or normal resistance (5/5)

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41
Q

What are the regions of the vertebral column

A

Cervical - 7 vertebrae
Thoracic - 12 vertebrae
Lumbar - 5 vertebrae
Coccyx - 4 fused vertebrae

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42
Q

What is lordotic

A

Cervical and lumbar vertebrae

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43
Q

What is kyphotic

A

Thoracic and sacral curves

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44
Q

Which vertebrae is larger than cervical vertebrae

A

Thoracic vertebrae

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45
Q

Which vertebrae are the largest and strongest

A

Lumbar vertebrae

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46
Q

What provides foundation for the pelvic girdle

A

The sacrum

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47
Q

What does the manubrium, body and symphonies process make up

A

The sternum

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48
Q

What are true ribs

A

R1-R7
Costal cartilage articulates directly with the sternum

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49
Q

Which ribs are false ribs

A

R8-R10
Articulate with the sternum bi cartilage of rib 7

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50
Q

Which ribs are floating ribs

A

R11-R12
Do NOT articulate with the sternum at all

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51
Q

What articulates with the sternum medially and the acromion laterally

A

The clavicle

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52
Q

What bones make up the pectoral girdle

A

Clavicle
Scapula
Acromion
Coracoid

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53
Q

What is the part of scapula that forms the “tip of the shoulder”

A

The acromion

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54
Q

What are the ligaments of the pectoral girdle

A

Acromioclavicular ligament
Coracoclavicular ligament
Coracoacromial ligament

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55
Q

What is shallow, allowing only about 25% of numeral head to make contact

A

The glenoid cavity

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56
Q

What articulates with the head of the numerous to form the shoulder joint

A

The glenoid cavity

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57
Q

What forms a ring around the glenoid cavity

A

The glenoid labrum

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58
Q

What deepens the glenoid and provides more stability to the joint

A

The glenoid labrum

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59
Q

What are the muscles of the rotator cuff

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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60
Q

What assists deltoid in abduction of the humerus at the shoulder

A

Supraspinatus

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61
Q

What provides external rotation of the humerus at the shoulder joint

A

Infraspinatus

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62
Q

What extends arm at shoulder and rotation of the arm externally

A

Teres minor

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63
Q

What provides internal rotation of the arm at the shoulder

A

Subscapularis

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64
Q

What abducts, flexes, and rotates arm at shoulder joint

A

Deltoid

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65
Q

Multiple fibers in this large muscle move the scapula multi-directionally

A

Trapezius

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66
Q

Elevates scapula and rotates downward

A

Levator scapula

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67
Q

Elevates and adducts scapula and rotates downward as well as stabilizes the scapula

A

Rhomboid major

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68
Q

Adducts and rotates arm medially at the shoulder and flexes arm at the shoulder joint

A

Pectoralis major

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69
Q

Extends, adducts, and rotates arm medially at the shoulder joint, draws arm downward and backward

A

Latissimus dorsi

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70
Q

Extends arm at the shoulder joint, assists with adduction and rotation of arm medially

A

Teres major

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71
Q

Flexes and adducts arm at shoulder

A

Coracobrachialis

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72
Q

What are their bones of the elbow

A

Humerus
Radius
Ulna

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73
Q

What is the olecranon

A

The medical term for elbow

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74
Q

What additional movement occurs in the elbow other than flexion and extension

A

Supination - moving the palm up
Pronation - moving the palm down in the opposite direction

*pronation and supination occur ONLY at the elbow

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75
Q

What flexes arm at the shoulder, flexes and supinates forearm at the elbow

A

Bicep brachii

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76
Q

What flexes forearm at the elbow joint

A

Brachialis
Brachioradialis

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77
Q

What extends forearm at the elbow joint and extends arm at shoulder

A

Tricep brachii

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78
Q

What supinates forearm

A

Supinator

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79
Q

What pronates the forearm

A

Pronator teres

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80
Q

What are the bones of the hand

A

Carpals
Metacarpals
Phalanges

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81
Q

What flexes and abducts hand at the wrist

A

Flexor carpi radialis

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82
Q

What flexes and adducts hand at the wrist

A

Flexor carpi ulnaris

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83
Q

What weakly flexes hand at the wrist joint

A

Palmaris

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84
Q

What flexes hand at wrist and flexes phalanges of each finger at the PIP joint

A

Flexor digitorum superficialis

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85
Q

What flexes hand at wrist and flexes phalanges at the DIP joint

A

Flexor digitorum profundus

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86
Q

What extends and abducts hand at the wrist joint

A

Extensor carpi radialis longus

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87
Q

Extends and adducts hand at the wrist joint

A

Extensor carpi ulnaris

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88
Q

What extends hand at wrist joint, extends phalanges of each finger

A

Extensor digitorum

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89
Q

Which nerve is responsible for motor supply to most of the intrinsic hand muscles and provides sensation to little finger and 1/2 of ring finger

A

Ulnar nerve

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90
Q

Which nerve provides sensation to the palmar and dorsal aspect of first 3 and a half fingers

A

Median nerve

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91
Q

Which nerve provides sensation to dorsum of the hand and lateral first three fingers and half of the 4th finger

A

Radial nerve

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92
Q

What special test is used to diagnose shoulder impingement or rotator cuff tears

A

Neer’s impingement sign

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93
Q

What test reinforces a positive Ne’er sign for impingement

A

Hawkin’s Impingement Sign

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94
Q

How does a positive empty can test present

A

Pain focal to the middle aspect subacromial space

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95
Q

What special test detects tears in the rotator cuff

A

Drop arm test

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96
Q

What special test evaluates the teres minor and weakness indicates a positive sign

A

Hornblower’s test

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97
Q

What test is helpful in diagnosing bicep tendonitis

A

Speed’s test

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98
Q

What special test evaluates the Subscapularis strength and possible tendon rupture

A

Gerber /lift-off test

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99
Q

What does a positive Jobe Relocation test/Relocation test of Jobe indicate

A

Test is positive if relief of pain and apprehension occurs/ suggest anterior glenohumeral instability

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100
Q

What is a a positive sulcus sign

A

A positive sulcus suggest that the patient has inferior shoulder instability

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101
Q

What does a positive Obrien’s test present as and suggest

A

Pain is worse with thumbs down, relieved with forearm supinated
Suggest labra pathology

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102
Q

What is the vagus stress test assessing

A

The stability of the medial ligamentous structures

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103
Q

What is the varus stress test assessing

A

The stability of the lateral collateral ligament in the lateral capsule

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104
Q

If pain is present during the long finger test, what does that indicate

A

Pain to the lateral epicondyle is positive for lateral epicondyle

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105
Q

Inability to flex the DIP may indicate what

A

Injury to the profundus or median ulnar nerve injury

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106
Q

A positive tinel sign suggests what

A

Carpal tunnel syndrome

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107
Q

Pain in the dorsalradial aspect of the wrist indicates a stenosis tenosynovitis of the abductor pollicis longus and extensor brevis can be detected by what special test

A

Finkelstein

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108
Q

What can the Phalen maneuver suggest

A

Carpal tunnel syndrome

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109
Q

What can Froments sign suggest

A

Ulnar nerve paralysis

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110
Q

What special test can observe inability to actively extend the distal interphalangeal joint, suggesting extensor tendon avulsion

A

Mallet Finger Test

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111
Q

What is a type I AC injury described as

A

No superior separation of clavicle from acromion

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112
Q

What is a type II AC injury described as

A

Partial separation of the clavicle from acromion

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113
Q

What is type III AC injury described as

A

Complete separation of the clavicle from the acromion

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114
Q

What is a type IV AC injury described as

A

Completely disrupted with superior and prominently posterior displacement

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115
Q

What is a type V AC injury described as

A

Completely disrupted with CC interspace more than twice as large as opposite shoulder

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116
Q

What is a type VI AC injury described as

A

UNCOMMON
Clavicle lies in either the subacromial space or subcoracoid space

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117
Q

What is the treatment for an AC injury

A

Type I and II:
Sling x24-48 hours, ice, analgesics, HEP that focuses on ROM , RTFD as pain permits (usually within 4 weeks)

Type III:
Ortho consult, sling x 24-48 hours, ice, analgesics, HEP that focuses on ROM, LLD until evaluated

Type IV - VI:
Ortho consult, MEDEVAC

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118
Q

What is the most common bony injury

A

Fracture of the clavicle

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119
Q

What special test can be performed to detect a fracture of the clavicle

A

Cross-body test with possible grinding is a positive test

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120
Q

What is the treatment of a clavicle fracture

A

Ice
Analgesics
Ortho consult
Mid-shaft fracture with minimal displacement and no neuron vascular injury: figure-of-8 strap for 6-8 weeks

All fractures require referral - MEDEVAC/ painful nonunion after 4 months of treatment

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121
Q

What are the sx for impingement syndrome of the shoulder

A

Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
Night pain and difficulty sleeping on affected side

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122
Q

What is the treatment for impingement syndrome of the shoulder

A

NSAIDS
Ice
LLD and HEP for shoulder stretching and strengthening
PT consult if failed local management
*Ortho consult if failed conservative management after 2-3 months or other pathology is suspected

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123
Q

What are the synonyms of rotator cuff tear

A

Musculotendinous cuff rupture
Rotator cuff rupture
Rotator cuff tendinitis

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124
Q

What are the sx of rotator cuff tear

A

Chronic shoulder pain
Specific injury that triggered pain
Night pain and difficulty sleeping on the affected side
Complaints of weakness, catching and grating especially with overhead activities

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125
Q

What is the tx for rotator cuff tear

A

NSAIDs
Ice
LLD and HEP
PT consult if failed local management
Ortho consult if failed rehab over 3-6 months

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126
Q

What is the clinical presentation of someone with a bicep tendon injury

A

Anterior shoulder pain that radiates distally down the arm over bicep muscle and aggravated by lifting, pulling, or overhead activities

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127
Q

What is the tx for bicep tendon injury

A

NSAIDS, ice, duty/activity modification, PT/HEP
*if rupture is suspected then ortho consult

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128
Q

What some synonyms for shoulder instability

A

Dislocation
Multidirection instability
Recurrent dislocation
Subluxation

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129
Q

Define instability of the shoulder

A

Anterior, posterior, inferior or multidirectional glenohumeral laxity due to traumatic or atraumatic pathology

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130
Q

Define subluxation of the shoulder

A

Humeral head partially slips out of socket with spontaneous reduction

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131
Q

Define dislocation of the shoulder

A

Humeral completely slips out of glenoid fossa with spontaneous reduction or sometimes requiring manual manipulation

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132
Q

What are the specific instability patterns of the shoulder

A

TUBS: traumatic unilateral dislocations with a Bankart lesion that can be successfully treated with surgery
AMBRI: atraumatic multidirectional instability that is commonly bilateral and is often treated with rehab and occasionally an inferior capsular shift (surgery)

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133
Q

What is a sx of shoulder instability

A

Patient with anterior instability will describe the sensation of the shoulder slipping out of the joint when arm is abducted and externally rotated.

134
Q

What special tests can be performed for as patient with shoulder instability

A

Sulcus test - positive with inferior laxity
Apprehension test - positive with anterior instability
Anterior/posterior drawer test - anterior/posterior laxity
Jerk test - posterior instability

135
Q

What is the treatment for shoulder instability

A

Reduce acute shoulder dislocations: Stimson technique or longitudinal traction
Immobilize arm in a sling in neutral position
Light duty to include no active use of arm for 2-3 weeks
Begin rotator cuff strengthening 2-3 weeks post reduction
PT consult
Ortho consult

136
Q

What lesions involve injury to the superior glenoid labrum and the biceps anchor complex

A

Superior labrum anterior posterior (SLAP)

137
Q

What are some MOI’s for Labrum tears/SLAP lesion

A

Falling back onto an outstretched arm
Tries to prevent falling by grabbing hold of an object
Suddenly tries to lift a heavy object
Forceful throwing, excessive overhead activity
Chronic overuse vs acute injury

138
Q

What is a concern for adhesive capsulitis that is raised when a patient with history of shoulder injury complains of:

A

Severe pain that is worse at night
Nagging pain

139
Q

What is the treatment for adhesive capsulitis

A

Early mobilization for those with shoulder injuries must avoid slings when possible
Shoulder motion exercises - PT consult
NSAIDs
Tylenol
Consider referral for steroid injection

140
Q

What are the synonyms for lateral and medial epicondylitis

A

Lateral tendinosis: tennis elbow
Medial tendinosis: golfer’s elbow/bowler’s elbow

141
Q

What are the clinical sx of LATERAL epicondylitis

A

Gradual onset of pain in lateral elbow and forearm during activities involving gripping and wrist extension
Lifting
Turning screwdriver
Hitting backhand in tennis
Excessive typing

142
Q

What are the clinical sx of MEDIAL epicondylitis

A

Gradual onset of pain at medial aspect of the elbow, exacerbated by activities that involve wrist flexion and forearm pronation
Golf swing
Baseball pitching
Pull-through stroke of swimming
Weight-lifting
Bowling
Many forms of manual

143
Q

What is the treatment for olecranon bursitis

A

Mild cases: NSAIDs, pressure wrap, ice

Moderate - severe cases: should undergo aspiration of fluid - refer for orthopedic evaluation

Septic olecranon: requires organism specific antibiotics - refer for treatment

144
Q

What are the more common nerve compression symptoms

A

Cubital tunnel syndrome
Median nerve compression

145
Q

What is the treatment for ulnar nerve compression

A

Splint elbow or wrap towel around elbow to avoid greater than 90 degree flexion at night
Surgical decompression and transposition of ulnar nerve if 3-4 months of conservative management failed

146
Q

What are the symptoms of a patient with ligamentous injury

A

Acute onset patient will describe a “pop” while throwing
Most commonly patients experience a gradual onset of sx with progressive medial elbow pain with valgus stresses

147
Q

What diagnostic tests can be performed for ligamentous injury

A

AP and lateral radiographs are needed to rule out fracture
MRI with contrast is a reasonable diagnostic tool for ulnar collateral ligament pathology

148
Q

What is the treatment for a patient with ligamentous injury

A

Light duty-activity modification
Ice for acute injury
NSAIDs
Pain free elbow and wrist stretching and strengthening activities

149
Q

What is a result from a fall on an outstretched hand (FOOSH)

A

Elbow dislocation

*most common dislocation in children and third most common in adults

150
Q

What is the treatment for an elbow dislocation

A

Ice
Appropriate pain management
Splint
Consider emergency reduction if delayed MEDEVAC time or neuromuscular compromise
Repeat neurovascular check after reduction

*reduction should be performed as soon as possible by an orthopedic surgeon - refer for treatment ASAP
*patients with neurovascular compromise or bony injury require immediate referral/MEDEVAC

151
Q

What is the most common neuropathy of the upper extremity and caused by any condition that reduces the size or space of the carpal tunnel resulting in median nerve entrapment

A

Carpal tunnel syndrome

152
Q

What special test can be used to dx carpal tunnel syndrome

A

Phalen maneuver and tinel sign

153
Q

What is the treatment for carpal tunnel syndrome

A

Splint wrist in neutral position - especially at night
NSAIDs
Light duty for activity modification
Ergonomic modifications
Ortho consult if failed conservative management

154
Q

What special test can be used to dx de quervain tenosynovitis

A

Positive finklestein test

155
Q

What is the treatment for de quervain tenosynovitis

A

NSAIDs
Thumb spica splint
light duty-activity modification

*ortho consult with failed conservative management

156
Q

What diagnostic testing an be used for a patient with a suspected scaphoid fracture

A

Scaphoid series radiographs should be obtained at time of injury
If normal but pain persists for 2-3 weeks, then studies should be repeated
If radiographs are still normal, an MRI should be ordered

157
Q

What is the treatment for a suspected scaphoid fracture

A

Thumb spica splint
Light duty - no use of affected hand
Consult to ortho
Analgesics as needed

158
Q

What age group is most affected by ganglion of the wrist

A

Affects ages 15-40 years old

159
Q

What occurs through degeneration or tearing of the joint capsule or tendon sheath, a connection to the joint or tendon sheath with a one way valve established - synovial fluid can enter but flow freely back into synovial cavity

A

Ganglion of the wrist

160
Q

What special test can be performed to test presence of a ganglion of the wrist

A

Ganglion will transilluminate
Solid tumors will not

161
Q

What is the treatment for a ganglion of the wrist

A

Splint wrist or finger
NSAIDs
Consult to ortho for aspiration or surgical excision

*persistence of a painful or bothersome cyst that recurs after aspiration requires referral

162
Q

What is a rupture of the flexor digitorum profundus tendon from its distal attachment, common in contact sports and often overlooked as “jammed” finger

A

Jersey finger

163
Q

What is the inability to actively flex the DIP joint and requires you to obtain plain films to rule out avulsion fracture or MRI if the dx is still in question

A

Jersey finger

164
Q

What is the treatment for Jersey finger

A

Splint the finger with PIP and DIP joint slightly flexed and all cases require referral to ortho

165
Q

What is a rupture, laceration, or avulsion of the insertion of the extensor tendon and base of distal phalanx/ usually occurs with a direct blow to the finger causing sudden forced flexion of the DIP or distal phalanx and pain in the DIP joint

A

Mallet finger

166
Q

What is the inability to extend the DIP joint fully

A

Mallet finger

167
Q

What is the treatment for Mallet finger

A

Maximize function, minimize discomfort
Splint the finger in full extension for 6-8 weeks

168
Q

What is an extensor tendon rupture at insertion on middle phalanx causing a painful PIP joint, deformity for up to 3 weeks

A

Boutonnière Deformity

169
Q

What is the treatment for Boutonnière Deformity

A

Splint PIP joint in extension for 3-6 weeks and allow DIP to move freely

170
Q

What do the hip bones consist of

A

Ilium
Ischium
Pubis

171
Q

What forms the socket for the head of the femur

A

Acetabulum

172
Q

What is the largest foramen in the body and formed by articulation of the ischium and pubis

A

Obturator foramen

173
Q

What flexes and rotates thigh laterally

A

Psoas major
Iliacus

174
Q

What extends and rotates thigh laterally and helps lock knee in extension

A

Gluteus maximus

175
Q

What abducts and rotates thigh medially

A

Gluteus medius

176
Q

What flexes and abducts thigh at hip joint and helps lock knee in extension

A

Tensor fascia latae

177
Q

What adducts, rotates, and flexes thigh at hip joint

A

Adductor longus

178
Q

What adducts, flexes, rotates, and extends thigh at the hip joint

A

Adductor magnus

179
Q

What does the external rotation of thigh laterally and abducts

A

Piriformis

180
Q

What flexes and adducts thigh

A

Pectineus

181
Q

What is very large and heavy, the strongest bone in the body and its head articulates with the acetabulum

A

Femur

182
Q

What is the projection from femur at the side of the hip

A

Greater trochanter

183
Q

What develops in the tendon of the quadriceps femur is muscle and functions to provide leverage for the quadricep muscle as well as to protect the knee

A

Patella

184
Q

What is larger, medial, weight bearing bone of the lower leg and forms the medial malleolus at the distal end

A

Tibia

185
Q

What is the attachment site for the patella ligament

A

Tibial tuberosity

186
Q

What is the non-weight bearing bone lateral to the tibia

A

Fibula

187
Q

What extends from the patella to the tibial tuberosity and strengthens the anterior surface of the knee

A

Patellar ligament

188
Q

What strengthens the medial aspect of the knee

A

Medial Collateral Ligament (MCL)

189
Q

What strengthens the lateral aspect of the knee

A

Lateral Collateral Ligament (LCL)

190
Q

What extends posterior LH and laterally from the tibia to femur and limits hyper extension of the knee and prevents anterior sliding of the tibia on the femur

A

Anterior Cruciate Ligament (ACL)

191
Q

What extends anteriorly and medially from the tibia to the femur and prevents posterior sliding of the tibia on the femur

A

Posterior Cruciate Ligament (PCL)

192
Q

What are fibrocartilage discs that fit between tibial and femoral condyles and allow the bones to “fit” together more appropriately as they are irregular in shape

A

Menisci

193
Q

What are sac filled structures filled with fluid and reduce friction

A

Bursae

194
Q

What are the anterior bursae of the knee

A

Prepatellar
Pes anserine
Infrapatellar
Suprapatellar

195
Q

What adducts and medially rotates thigh and flexes leg at the knee

A

Gracilis

196
Q

What adducts the femur

A

Adductor magnus
Adductor longus
Pectineus

197
Q

What extends the knee, flexes the hip and located anterior to other quadriceps muscles

A

Rectum feoris

198
Q

What only extends the knee

A

Vastus lateralis
Medial is
Intermedius

199
Q

What flexes the knee, weakly flexes the hip, abducts and laterally rotates the thigh

A

Sartorius

200
Q

What extends thigh at the hip and flexes the leg at the knee joint

A

Biceps femoris (hamstrings)

201
Q

What extends the thigh at the hip and flexes leg at the knee

A

Semitendinosis
Semimembranosis

202
Q

What is formed by the distal end of tibia and fibula

A

Ankle mortis

203
Q

What are the bones that form the ankle

A

Large talus (ankle bone)
Calcaneus (heel bone)
Cuboid (lateral)
Navicular (medial)
Cuneiforms (numbered 1-3 medial to lateral)
Metatarsals
Phalanges

204
Q

What extends from talus to fibula
Connects talus and anterior fibula

A

Anterior talofibular ligament (ATFL)

205
Q

What extends from calcaneus to fibula

A

Calcaneofibular ligament (CFL)

206
Q

What connects the tibia to the talus, calcaneus, and navicular bones and are four ligaments fused into one

A

Deltoid ligaments = Medial ankle

207
Q

What dorsiflexes and inverts the foot

A

Tibialis anterior

208
Q

What dorsiflexes and everts the foot and extends the toes

A

Extensor digitorum longus

209
Q

What plantarflexes and everts the foot

A

Fibularis longus

210
Q

What plantarflexes foot and flexes leg at the knee

A

Gastroneumius

211
Q

What only plantarflexes the foot

A

Soleus

212
Q

What plantarflexes and inverts the foot

A

Tibialis posterior

213
Q

What plantarflexes the foot and flexes toes

A

Flexor digitorum longus

214
Q

What special test detects gluteus medius muscle weakness

A

Trendelenburg test

215
Q

What detects hip and sacroiliac pathology

A

Fabre test

216
Q

What test can illicit pain in the hip or groin, particular with internal rotation is positive

A

Log roll test

217
Q

What tests for a tight piriformis impinging the sciatic nerve

A

Piriformis test

218
Q

What tests for labra pathology, loose body, or other internal derangement of the hip

A

Scour test

219
Q

What test detects flexion contractures or tightness of the hip and is positive if the hip does not fully extend or lumbar curve arches (lordosis)

A

Thomas test

220
Q

What test for patellar instability

A

Patellar apprehension test

221
Q

What evaluates the health of the menisci

A

McMurray test

222
Q

The varus stress test evaluates the integrity of what

A

Lateral collateral ligament

223
Q

The valgus stress test evaluates the integrity of what

A

The medial collateral ligament

224
Q

What detects instability of the anterior Cruciate ligament

A

Lachmans

225
Q

What test indicates if the PCL is injured the proximal tibia falls back

A

Posterior drawer

226
Q

What test determines if the PCL is lax then the tibia will sag down when the knee is at rest

A

Sag test

227
Q

What detects iliotibial band contractures or tightness

A

Ober test

228
Q

What detects anterior instability of the ankle joint

A

Anterior drawer test

229
Q

What assesses the integrity of the Achilles’ tendon

A

Thompson test

230
Q

What tests for tibiofibular sydesmosis injury

A

Tib/Fib squeeze

231
Q

What presents with the affected limb short, hip is fixed in ADDUCTED and internally rotated position

A

Posterior hip dislocation

232
Q

What presents as hip held in ABDUCTION and external rotation

A

Anterior hip dislocation

233
Q

What is the treatment for any hip dislocation

A

MEDEVAC

Reduction performed ASAP to reduce osteonecrosis or if blood supply is disrupted

234
Q

What is mostly caused by high energy trauma and clinical sx of severe pain in thigh, and unable to bear weight

A

Fracture of the femoral shaft

235
Q

What is the treatment for a fracture of the femoral shaft

A

Immediate splinting and traction
MEDEVAC

236
Q

What often occurs in patients who undergo repetitive impact such as military recruits, athletes, runners and have vague pain in anterior groin or thigh

A

Stress fracture of the femoral neck

237
Q

What is the treatment for stress fractures of the femoral neck

A

Analgesics
Ortho eval
Activity modification

238
Q

What presents with clinical sx of pain in groin area with attempted weight bearing, sensation of “coming apart” at the hip with bearing weight and presents with distracting injuries, shock, multi system trauma

A

Pelvic fracture

239
Q

What is the treatment for a pelvic fracture

A

MEDEVAC
Hemodynamic resuscitation
Activity modification - no weight bearing
Pain management - narcotics
Pelvic binder

240
Q

What results from acute or overuse injury with pain over injured muscle and it’s exacerbated by activity

A

Hip strain

241
Q

What is the treatment for hip strain

A

NSAIDs
Duty modification
Send to ortho if failed conservative management

242
Q

What presents with a “pop” that may have been perceived at the onset of pain and the posterior thigh muscles are injured more often than the anterior thigh muscles

A

Thigh strain

243
Q

What is the treatment for thigh strain

A

Prevention of further swelling and hemorrhage by having the patient rest and elevate the limb while applying ice and compressive wraps as needed
NSAIDs

244
Q

What is inflammation and hypertrophy of the greater trochanteric bursa that may develop without apparent cause and can be the cause of lateral hip pain

A

Trochanteric bursitis

245
Q

What dx presents with patients usually have pain and tenderness over the greater trochanter, pain may radiate distally to the knee or ankle, worse when going from sit to stand, may decrease after warming up but return after 30 to 1 hour of walking and unable to lie on affected side

A

Trochanteric bursitis

246
Q

What is the treatment for trochanteric bursitis

A

NSAIDs
Duty modification
Hip strengthening and stretching
Refer to ortho if conservative management failed

247
Q

What results from rotational or hyper extension force and limits anterior translation of the tibia on the femur

A

Anterior Cruciate Ligamentous tear of the knee

248
Q

What special tests are done for a patient with ligamentous tear of the knee

A

Anterior drawer test and Lachman (negative in many patients who have an ACL tear)

249
Q

What is the treatment for an anterior cruciate ligament tear

A

RICE
Duty modification
Ortho consult
PT consult
A knee immobilizer or ROM brace

250
Q

What dx could be provided to a patient who has suffered a dashboard injury, a pure hyperflexion injury to the knee, a hyperextension injury to the knee or fall onto a flexed knee with the foot in plantar flexion

A

Posterior cruciate ligament tear

251
Q

What special test can be performed for a PCL tear

A

Posterior drawer test
Sag test

252
Q

What is the treatment for a PCL tear

A

RICE
NSAIDs/Tylenol
Duty modification
Ortho Consult
PT consult

253
Q

What is the treatment for an MCL tear

A

Usually non-operative and heal within 4-6 weeks
Contact MO

254
Q

What is pain focal to the anterior lateral aspect of the knee that worsens with activity (worse downhill running, mostly heel strike) and discomfort or complete resolution at rest

A

IT band syndrome

255
Q

What special test is performed for patients with IT band syndrome

A

Obers

256
Q

What presents with mechanical sx such as locking, catching, and popping can then develop and patients will usually experience pain with twisting or squatting

A

Meniscal tear

257
Q

What special test is performed for a patient with a suspected meniscal tear

A

McMurray test will be positive

258
Q

What has anterior knee pain as a hallmark and patients often point to a tender spot where sx concentrate and location depends on site of insertion site involved (superior/inferior pole of the patella), pain is exacerbated by exercise, prolonged sitting, squatting, kneeling, climbing or descending stairs, running or jumping

A

Quadricep/patellar tendinitis

259
Q

What presents with clinical sx of diffuse aching anterior knee pain, exacerbated by prolonged sitting, climbing stairs, jumping, squatting with no typical pre-existing trauma

A

Patellofemoral pain

260
Q

What is another name of popliteal cyst

A

Bakers cyst

261
Q

What presents with clinical sx swelling/fullness in the popliteal fossa, posterior knee pain, knee stiffness

A

Popliteal cyst

262
Q

What presents with anterior knee pain that increases gradually over time, exacerbated by direct trauma, kneeling, running, jumping and relieved with rest (typically asymmetric, occasionally bilateral)

A

Osgood Schlatter Disease

263
Q

What is characterized by pain and swelling at the tibial tubercle with insertion site of the patellar tendon

A

Osgood Schlatter Disease

264
Q

What is the treatment for Osgood Schlatter Disease

A

Usually benign and self-limited (leave that shit alone)

265
Q

What presents with clinical sx of gradual onset of pain with prolonged walking or running activity, pain is localized to the distal third of the medial tibia, increase in training intensity, pace or distance

A

Shin splints

266
Q

What presents with tenderness along posterior medial crest of tibia in the middle to distal third of the leg

A

Shin splints

267
Q

What is the treatment for shin splints

A

NSAIDs
Ice
Duty modification
Pain free return to running
Weight loss if needed
Proper running shoes

268
Q

What presents with initial sx similar to shin splints, gradual increase in pain related to physical activity, pain at rest, pain that suddenly increases in intensity around site of more mild sx

A

Tibial stress fractures

269
Q

What is the treatment for stress fractures

A

Rest/duty modification
Expect duty modification for roughly 12 weeks

270
Q

What presents with severe leg pain out of proportion to apparent injury, persistent deep ache or burning pain, parasthesias

A

Compartment syndrome

271
Q

What physical exam findings will indicate compartment syndrome

A

Seven P’s:
Pain, pallor, parasthesias, paresis, poikilothermia, pressure, pulselessness

272
Q

What is the treatment for compartment syndrome

A

Medical emergency: requires fasciotomy

Place limb in neutral position

*ice is contraindicated

273
Q

What is the largest tendon in the body

A

Chilled tendon

274
Q

Achilles’ tendon rupture has what personnel as risk factors

A

Athletes
Age (30-40 years old)
Male gender
Obesity
Running mechanics issue
Fluoroquinolone antibiotic use associated
Rheumatologist diseases

275
Q

What special test can better examine Achilles’ tendon rupture

A

Thompson test

276
Q

What is the treatment for Achilles’ tendon rupture

A

Light duty
Ice
NSAIDs
Consider Achilles’ tendon support
Physical therapy

277
Q

What extends from talus to fibula
Connects talus and posterior fibula

A

Posterior Talofibular ligament (PTFL)

278
Q

What has four separate divisions, is large, strong and less commonly injured

A

Deltoid ligament = medial ankle ligaments

279
Q

What is the most common ankle sprain

A

Inversion injury

280
Q

What special test can be performed on an ankle sprain

A

Anterior drawer test - ATFL
Tamar tilt - CFL
Tib/fib squeeze

281
Q

What is a critical injury that involves the second tarometatarsal joint and may occur in athletics or as a result of tripping

A

Lisfranc fracture

282
Q

What has clinical sx of patients often reporting a sprain, pain localized to the dorsum of the midfoot and relatively mild swelling

A

Lisfranc fracture

283
Q

What is the treatment for a Lisfranc fracture

A

Ortho consult
Non-displaced injuries are treated with 6-8 weeks of non-weight bearing cast immobilization
Fractures or dislocations that are displaced require surgery
NWTB
Analgesics
MEDEVAC

284
Q

What presents with pain and swelling, aggravated by shoe wear, are the principal complaints/the great toe pronates with resulting callus on the medial aspect

A

Bunion

285
Q

What is the treatment for a bunion

A

The initial treatment is patient education and shoe wear modification
Light duty
Ice

Refer if persistent pain despite shoe modifications

286
Q

What condition is most common between the third and fourth toes and presents with plantar pain in the forefoot is the most common presenting sx, dysesthesias into the affected two toes or burning plantar pain that is aggravated by activity is common

A

Morton neuroma

287
Q

What presents with pain that is often most severe on awakening or when rising from a resting position because. The first few steps stretch the plantar fascia

A

Plantar fasciitis

288
Q

What has clinical sx of “pump bump” that is irritated by shoe wear, start-up pain, pain after activity, natal gif gait and can originate at the insertion of the Achilles’ tendon at the calcaneous, retrocalcaneal bursa, prominent process of the calcaneus impinging on the retrocalcaneal bursae or Achilles’ tendon or inflammation of the bursa between the skin and the Achilles’ tendon

A

Posterior heel pain

289
Q

What is the treatment for posterior heel pain

A

Duty modification
Heel lift or open back shoes
Ice massage
Achilles stretch
Casting for 6 weeks in extreme cases

290
Q

What is a hyperextension injury of the first metatarsal

A

Turf toe

291
Q

What is the treatment for turf toe

A

RICE
NSAIDs
Stiff shoe inserts
Severe injury requires protective weight bearing or immobilization for 1-2 weeks and with 4-6 week period of rest from sports

*intra-articular fractures can require open reduction/urgent surgical intervention is necessary for an irreducible dislocation

292
Q

What is a clinical condition that involves neck, shoulder, or arm pain, muscle weakness, sensory changes, diminished deep tendon reflexes

A

Cervical Radiculopathy

293
Q

What is a nucleus purposes prolapse from intervertebral disc and will irritate nerve root if compression occurs

A

Disc herniation

294
Q

What is a ligamentous, facet joints, muscular, disc injury, usually self-limiting, commonly from whiplash mechanism or may have no mechanism of injury

A

Neck sprain. = cervical strain

295
Q

What is the treatment for neck sprain/cervical strain

A

Soft cervical collar for 1-2 weeks and reassurance
NSAIDs

296
Q

What is the second most common primary care complaint and is the most common cause f disability in people under 45

A

Lower back pain

297
Q

What is the specific time frame for acute vs chronic in regards to lower back pain

A

Acute: up to 4 weeks
Subacute: 4-12 weeks
Chronic: over 12 weeks

298
Q

What are the red flags for lower back pain

A

Saddle anesthesia
Loss of bowel/bladder function
Lower extremity weakness

299
Q

What special test can be done for lower back pain

A

Seated/supine straight leg raise

300
Q

What is the treatment for lower back pain

A

Control pain
Activity modification
Early mobility (if acute)
Core stabilization through rehab

301
Q

What presents with abrupt or gradual onset, unilateral radicular leg pain, aggravated by various activity, possible neurological involvement and the pain is from mechanical compression or chemical irritation of nerve root

A

Herniated disc

302
Q

What is the treatment for herniated disc

A

Control pain
Activity modification
Rehab
Consider chiro/PT

303
Q

What would be reasons to MEDEVAC a patient presenting with lower back pain or a herniated disc

A

Cauda equina syndrome sx
Severe nerve rot paralysis
Radicular sx that persist more than 6 weeks without severe sx

304
Q

What may be from spinal degeneration or from childhood, mostly minor deviations from normal and asx, sx patients disqualified from service

A

Scoliosis

305
Q

What is chest pain that is said to be reproducible

A

Chostochondritis

306
Q

What affects the knee joint from approximately 80% of cases but can also affect the hand, spine, and hip, and presents with pain that is exacerbated with use, alleviated with rest, pain is aching, deep in later stages and has sharp pain in beginning stages

A

Osteoarthritis

307
Q

What is the treatment for osteoarthritis

A

Control pain
Stop insult to cartilage
Rehab

308
Q

What can occur from autoimmune disorders in mostly small joints and bilateral: hands, finger, wrists, feet, ankle with an insidious onset and in the distal joints first

A

Rheumatoid arthritis

309
Q

What is the treatment for a patient with rheumatoid arthritis

A

Medadvice with GMO or refer to internal medicine
Control with NSAID/Tylenol, DMARD

310
Q

What is preceded and precipitated by infection in the body along with UTI’s STI’s, or diarrheal illness

A

Reactive arthritis

311
Q

What is the treatment for reactive arthritis

A

Treat infection if active
Sx are self-limiting but may last up to 6 months
NSAIDs for pain

312
Q

What is a common inflammatory skin disease with a most common manifestation of well-demarcated erythematous plaques with silver scale

A

Psoriatic arthritis

313
Q

What is the treatment for a patient with psoriatic arthritis

A

Do not attempt to manage these patients:
Refer to rheumatology and derm
Treat sx in the interim with NSAIDs
DMARDs to be considered by specialist

314
Q

What presents as back pain in almost all patients, “bamboo spine” severe restriction in back mobility seen in about half of patients in later stages of disease progression

A

Ankylosis spondylitis

315
Q

What is the treatment for ankylosing spondylitis

A

These patients must be recognized and rerferred

316
Q

What presents with intense pain, redness, swelling and common sites are the 1st toe, ankle, knee, wrist, fingers, elbow and is a mono sodium urate crystal deposition in joints and tissues

A

Gout

317
Q

What is the treatment for Gout

A

Acute episode: NSAID (indomethacin), Colchicine, steroids

Prophylaxis: Allopurinol (overproducers), Probenecid (underexcretors)

diet modification: avoid meat, seafood, alcohol, high-fructose corn syrup

318
Q

What presents with normal urine acid levels, intensely painful, joint swelling, erythema, large joints such as the knees are often affected and has a treatment of only NSAID and no preventative treatment

A

Pseudogout

319
Q

What is an infection of the joint space that occurs with direct inoculation, hematogenous spread, from a bone infection, staphylococcus aureus is the most common cause and presentation is severe pain, swelling, decreased mobility, difficulty bearing weight, fever, tachycardia, post-surgical patients

A

Septic arthritis

320
Q

What is the treatment for septic arthritis

A

MEDEVAC
IV antibiotics
Supportive if having shock

321
Q

What is virchows triad

A

Hypercoagulability
Venous stasis
Endothelial damage

322
Q

What is venous clot formation that often occurs in the lower extremities

A

Deep vein thrombosis

323
Q

What is a disruption in the bone from repetitive or forceful trauma that presents with pain, swelling, decreased mobility, limited weight-bearing, numbness, tingling, pallor, ecchymosis, and deformity

A

Fracture

324
Q

What type of fracture is in a atomic alignment

A

Non-displaced

325
Q

What type of fracture is not in an anatomical alignment, described as a percentage

A

Displaced

326
Q

What type of fracture is distal fragment overlaps proximal fragment

A

Bayonetted

327
Q

What type of fracture are the fragments separated

A

Distracted

328
Q

What type of fracture has a deviation at an angle

A

Angulation

329
Q

What is the treatment of a fracture

A

Recognition
Reduction
Retention of reduction while achieving union
Rehab

MEDEVAC

330
Q

What factors decrease healing in a fracture

A

Smoking
Skeletal maturity
Oblique/comminuted/segmental fractures
Marked displacement
Intraarticular fracture

Post TAV II (7 decks)

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