MSK Flashcards

Question

Imaged with musculoskeletal ultrasound, normal tendon structure looks a) hypoechoic, with hyperechoic septa. b) hypoechoic , with fascicular pattern. c) hyperechoic, with fibrillar echotexture. d) hyperechoic, with posterior acoustic shadowing.

Answer 1

Answer:(c) Commentary: Musculoskeletal ultrasound is an imaging modality that is able to identify and characterize various soft tissue structures. Normal tendons appear as hyperechoic(bright echo) structures with fibrillar or fiber-like pattern. Normal muscle appears as a hypoechoic(low echo) structure with hyperechoic septa. Bone appears as a very hyperechoic structure with posterior acoustic shadowing. Posterior acoustic shadowing is an artifact that refers to the anechoic region(no echo) deep to the bone surface. 2012

Answer 2

Answer: (c) Commentary: Spondylolysis is a defect in the pars interarticularis. These CT images(sagittal and axial) show evidence of an L5 pars interarticularis fracture. Spondylolysis is common in the athletic population, particularly among athletes who perform repetitive flexion-extension. Herniated discs and Tarlov cysts are not seen in these images and are more readily evaluated on MRI. Facet degeneration is often diagnosed by CT scan but is not seen on these images. 2012

Answer 3

Answer (b) Commentary: Wrist splints are shown to effectively decrease symptoms of carpal tunnel syndrome in the short-term. Splints should be worn at night and during the day if possible. Brace should place wrist in neutral (up to 5o of extension): note that many off-the-shelf carpal tunnel braces place the wrist in excessive extensions. A thumb spica splint is not effective in treating carpal tunnel syndrome. Conservative treatment is essential in mild to moderate cases of carpal tunnel syndrome. Surgical referral should be considered for patients with weakness or worsening symptoms not improved with conservative treatment. Platelet rich plasma injections are not an effective treatment for carpal tunnel syndrome. 2012

Answer 4

Answer: A Commentary: In open kinetic chain exercises the most distal segment moves around a fixed proximal segment. In closed kinetic chain exercises the proximal segment moves around a fixed distal segment. Static muscle contractions occur when the muscle is contracted but the proximal and distal segments do not move. There are no mixed kinetic chain exercises. 2009

Answer 5

Answer: C Commentary: Nondisplaced or minimally displaced avulsion fractures of the 5th metatarsal base can occur with inversion ankle sprains. These generally are treated nonsurgically with a short course of immobilization (1-2 weeks) with a postoperative shoe or a short walking boot. Displaced fractures may require screw or pin fixation. It is important to differentiate an avulsion fracture of the base from a fracture of the metaphyseal-diaphyseal junction (Jones fracture), since treatment is different. 2009

Answer 6

D Though not all inversion ankle injuries result in the rupture of the ankle ligaments, when rupture does occur, isolated anterior talofibular ligament ruptures occur in 65% of the cases. Combined anterior talofibular ligament and calcaneofibular ligament ruptures occur in approximately 20% of cases. The tibiotalar and tibiocalcaneal ligaments are part of the deltoid ligament complex and are not involved in classic lateral ankle injuries. 2014

Answer 7

A is correct The painter’s history implies a meniscus tear. Because you know the painter must climb ladders, and stand and bend for long periods of time, further evaluation is in order to assess the best treatment options. The patient’s mechanism of injury and symptoms do not suggest an infectious etiology, making a septic joint unlikely. Return to a modified job may facilitate healing while still encouraging the patient to continue to work. 2014

Answer 8

Option a is correct. This patient has osteonecrosis or avascular necrosis of the femoral head. Risk factors include glucocorticoid, alcohol, and tobacco use. When pain limits mobility and conservative management has failed, total hip replacement is indicated. Platelet rich plasma is still experimental for its primary indications of lateral epicondylitis, patellar tendinopathy, and Achilles tendinopathy. 2014

Answer 9

Option a is correct. The first goal is to reduce inflammation and irritation. Rest, nonsteroidal anti-inflammatory agents, and ice each help accomplish that first goal. Aggressive stretching of sore muscles does not accomplish the first goal of reducing inflammation and irritation. Strengthening should not begin until pain is controlled and stretching is tolerated without pain. Muscle activation refers to techniques designed to elicit specific muscles within a functional muscular complex that may not be efficiently contracting in response to neural excitation. 2014

Answer 10

Option d is correct. The iliotibial band (ITB) is a fibrous band and increasing its tensile force increases compressive forces against the fat pad underneath the band. Biomechanical contributions to ITB syndrome include hip flexor imbalance, dynamic knee valgus, contralateral hip drop. Activating and strengthening gluteus maximus, the most powerful femoral external rotator, can help prevent dynamic knee valgus and prevent ITB syndrome. Using the rectus femoris instead of the iliopsoas to generate hip flexion may lead to compensatory tensor fascia lata (TFL) activity causing hypertonicity of the TFL and hip flexor imbalance. Although strengthening hip abductors is helpful, the abductors to be strengthened should be the gluteus minimus and medius, not the TFL. Strengthening hip adductors can increase dynamic knee valgus tendencies , exacerbating symptoms. Activating and strengthening gluteus medius, quadratus lumborum, and external obliques prevents contralateral pelvic drop. 2014

Answer 11

Option a is correct. Aseptic loosening is the most predominant cause of long-term failure of hip arthroplasty at 10 years or longer after surgery. Infection in the joint within a year of the operation is due to direct contamination at the time of surgery; afterwards it is due to hematogenous seeding. Heterotopic ossification, if it occurs, does not change after 6 to 12 weeks postoperatively even though the bone continues to mature. Low bone density does not happen as a result of hip arthroplasty. 2014

Answer 12

Option d is correct. The triangular fibrocartilage complex (TFCC) is a stabilizer of the distal radioulnar joint (DRUJ). Athletes who participate in repetitive loading of the wrist may be susceptible to degenerative changes, or a fall on an outstretched arm can cause acute injuries. Scaphoid fractures typically present with dull and aching pain in the anatomic snuffbox at the radial wrist. De Quervain syndrome refers to tenosynovitis of the abductor pollicis longus and extensor pollicis brevis, and it presents with pain over the radial styloid. It often occurs in racquet sport athletes. Pulley injuries most often occur in climbers, and presents with pain over the volar aspect of the phalanx 2014

Answer 13

Option d is correct. The pronator quadratus, flexor pollicis longus, and the lateral half of flexor digitorum profundus are innervated by the anterior interosseous nerve. The brachioradialis is innervated by the radial nerve, the extensor indicis proprius by the posterior interosseous nerve, and the extensor hallucis longus by the deep peroneal nerve. 2014

Answer 14

Option a is correct. Disc herniations at L4-L5 and L5-S1 comprise 98% of all lumbar disc herniations. If radicular symptoms are present then the L5 and S1 nerve roots are most likely involved. 2014

Answer 15

Answer: D Commentary: Nachemson measured the relative pressure changes within the third lumbar disc with changes of position. Standing erect was the reference position and pressures decreased with lying supine and increased in the seated position. Seated and flexed forward further increased disc pressures. Several other positions were evaluated 2009

Answer 16

Answer: D Commentary: The weight for cervical traction is most beneficial at 25 to 35 pounds of force. Positioning the neck at 20o to30o of flexion provides the maximal effect of distraction between the vertebrae 2009

Answer 17

Answer: D Commentary: Patellofemoral arthralgia is thought to result from tracking problems of the patella within the trochlear groove. Several biomechanical issues, such as tight and inflexible quadriceps, pes planus, tight iliotibial band, weak and ineffective vastalis medialis, and weak hip abductors, may contribute to incorrect tracking of the patella. The Ober test assesses the tensor fascia lata and iliotibial band for contracture and inflexibility. 2009

Answer 18

Answer: C Commentary: Real time ultrasound is less costly than magnetic resonance imaging (MRI) and has similar sensitivity and specificity in diagnosing medial epicondylitis. Plain radiographs and electrodiagnostic studies will not help localize or confirm your diagnosis of medial epicondylitis, but may help with diagnosing a fracture or nerve injury, respectively 2009

Answer 19

Answer: C Commentary: The patient has a common peroneal nerve palsy which can occur after total knee arthroplasty. Weak quadriceps strength and inadequate knee flexion may cause difficulty with ambulation, but not the loss of ankle dorsiflexion. Tibialis anterior tendon tear will cause difficulty with ankle dorsiflexion, but is not a common complication after knee arthroplasty. Also, acute tendon tears present with sudden pain and palpatory defect 2009

Answer 20

Answer: D Commentary: Muscle force generation varies depending on the type of muscle contraction and the speed of the contraction. Eccentric contractions produce greater torque than isometric contractions and isometric contractions produce greater force than concentric muscle contractions. As the speed of contraction increases, eccentric contractions produce greater force. The opposite is true for concentric contractions, which generate greater forces at slower speeds 2009

Answer 21

Answer: D Commentary: This patient sustained an injury to her triangular fibrocartilage complex. This structure is a stabilizer of the distal radioulnar joint and is composed of an avascular articular disc and radioulnar ligament complex. It is often injured with repetitive wrist activities or compressive loads. Tears to it are best imaged by MRI arthrogram. Injury to this complex would not be optimally evaluated on plain films, bone scan, or computed tomography scan 2009

Answer 22

Answer: B Commentary: A hematoma places the nerve at risk for injury by 400%, since the expanding fluid will lead to an acute compression neuropathy 2009

Answer 23

Answer: C Commentary: Corticosteroid injection for de Quervain tenosynovitis has been shown to be more effective treatment than splinting and anti-inflammatory medications 2009

Answer 24

Answer: C Commentary: The American College of Rheumatology states that the criteria for osteoarthritis of the hip are hip pain along with 2 of the three findings: erythrocyte sedimentation rate less than 20mm/hr, radiographic evidence of femoral/acetabular osteophytes, radiographic evidence of joint space narrowing. 2009

Answer 25

Answer:D Commentary: This patient has radiographic evidence of femoroacetabular impingement. Two types have been described, cam impingement and pincer impingement. Cam impingement is described more commonly in active males and describes a non-spherical femoral head or osseous abnormalities of the femoral head-neck junction. These bony abnormalities have abnormal contact with the acetabulum in hip flexion, adduction, and internal rotation. Pincer impingement describes abnormal contact between the femur and the acetabulum due to overcoverage of the femoral head from an abnormally deep or retroverted acetabulum. 2009

Answer 26

Answer: C Commentary: Patients whose symptoms are consistent with lateral epicondylitis or “tennis elbow” but who do not respond to conservative treatments should be considered to have a posterior interosseous neuropathy. Mild neural compression of the posterior interosseous nerve may present with proximal and dorsal forearm pain without obvious muscle weakness, wasting, or sensory deficits. 2009

Answer 27

Answer: A Commentary: The initial assessment should include checking his bone density to establish a diagnosis of osteopenia/osteoporosis and then identifying secondary risk factors (such as hypogonadism, corticosteroid use, excessive alcohol use). Once a diagnosis is established, prescribing weight-bearing and strengthening exercises are important. Obtaining a nuclear bone scan is not as helpful. Swimming is a non-weight bearing exercise 2009

Answer 28

Answer: C Commentary: Using a wrist/hand splint can improve the symptoms of carpal tunnel syndrome for up to 1 year. Therapeutic ultrasound and oral corticosteroids have been shown to provide only short-term relief. Tendon glide maneuvers have not been shown to affect the outcome of carpal tunnel syndrome. 2009

Answer 29

Answer: A Commentary: HIV myopathy commonly presents with proximal muscle weakness, myalgia (in 25%-50% of cases), and weight loss. Vacuolar myelopathy causes spinal cord dysfunction, such as paraparesis, ataxia, posterior column sensory loss, spasticity, and neurogenic bowel and bladder. CPK would not be elevated in fibromyalgia or as a result of antiretroviral medications. Antiretroviral medications are associated with neuropathies, not myopathies 2009

Answer 30

Answer: D Commentary: Repeatedly lifting the shoulder past 60 degrees of flexion or abduction is associated with an increased prevalence of shoulder disorders. 2009

Answer 31

Answer: B Commentary: Assessment of cervical spinal stenosis on lateral radiograph can be made by calculating the ratio of the anteroposterior (AP) diameter of the vertebral canal to the AP diameter of the vertebral body at the same level. This ratio is called the Pavlov ratio. A normal ratio is 1.0 with less than 0.82 indicating stenosis. The Torg ratio is the same as Pavlov ratio. 2009

Answer 32

(c) "Little league elbow," seen in throwing athletes with immature skeletons, is a conglomeration of different diagnostic entities caused by valgus and extension-overload. Medial epicondylar avulsion can frequently occur. Separation from 3--5mm can be managed nonsurgically. However, separations greater 5mm usually require surgery. 2008

Answer 33

(b) Up to 33% of individuals with symptoms from whiplash-associated disorders have chronic symptoms. Symptoms associated with whiplash-associated disorders include neck pain, arm pain, paresthesias, temporomandibular joint dysfunction, headache, dizziness, visual disturbances, and difficulty with memory and concentration. 2008

Answer 34

(c) The patient has a navicular stress fracture until proven otherwise. It is among the most common stress fractures in athletes. Physical examination reveals tenderness over the so-called “N” spot between anterior tibialis and extensor hallicus longus tendons as well as pain with weight bearing and hopping. Strict non-weight bearing cast immobilization for 6 weeks should be implemented. Magnetic resonance imagining or bone scan can confirm the diagnosis. 2008

Answer 35

(c) The diagnosis is reactive arthritis / seronegative spondyloarthropathy that develops after certain genitourinary or gastrointestinal infections, most commonly in young men. Non-gonococcal urethritis and conjunctivitis is the remainder of the clinical triad. Heel pain is one of the most frequent and distinctive clinical features, along with low back pain radiating into the buttocks. Periostitis and erosions occur in the ankle joint in individuals with a several month history of heel pain. Osteophytes and subchondral cysts are typical of osteoarthritis. Avascular necrosis is not typical. Ref: Arnett FC. Seronegative spondyloarthropathies: reactive arthritis and enteropathic 2008

Answer 36

(a) Deformity in the spine presents with malalignment of in the pelvis as either contralateral or ipsilateral drop. Two other causes of ipsilateral pelvic drop are contralateral hip abductor weakness and short ipsilateral limb. Weak hip extensors are a cause of backward lean. In stance, a backward lean of the trunk substitutes for weak hip extensors. 2008

Answer 37

``` (c) Computed tomography (CT) scans with thin cuts through the area of the pars interarticularis can identify the healing pattern of a pars stress fracture. ``` 2008

Answer 38

(d) Risk factors for chronic whiplash-associated pain include presence of preexisting degenerative disc disease, preexisting loss of cervical lordosis, female gender, awkward head position at time of impact, presence of radiating pain into upper limbs, and prior history of headache. A famous Lithuanian study showed no incidence of long-term whiplash pain in a country that had no compensation system for whiplash. 2008

Answer 39

(d) TENS therapy has not been shown to provide benefit for angina. It has been proven to have a beneficial effect in all the other diagnoses. 2008

Answer 40

(c) Cervical traction is proven effective for illnesses that involve nerve root irritation or compression of nerve roots. 2008

Answer 41

(a) Since it occurs lateral to the intervertebral disc, a far lateral disc herniation is a relatively unusual location for disc herniation. A far lateral disc herniation can actually impinge the nerve root exiting above that intervertebral level. 2008

Answer 42

(b) Sustained traction is the use of force greater than that applied in continuous traction, but less than that used in intermittent traction, and the application time is 20--60 minutes. This time frame makes sustained traction more practical in clinical use. Continuous traction is the use of low force of traction over long periods of time, 20--40 hours. Intermittent traction is the use of greater forces, but for shorter periods of time, 10--60 seconds. There is no pulsed traction. 2008

Answer 43

(b) The natural history of spinal stenosis is generally benign. While decompressive surgery achieves satisfactory results in the great majority of individuals, the difference in outcomes with their nonsurgical cohorts becomes narrower with time. 2008

Answer 44

Answer (d) Commentary: This is a description of piriformis syndrome. Although some positive findings on needle examination may be seen with piriformis syndrome, electrodiagnostic studies are oftennormal. On the other hand, positive findings are expected in cases of lumbar radiculopathy. Conservative treatment of piriformis syndrome begins with piriformis stretching (FAIR positionis a good position for this) and nonsteroidal anti-inflammatory drugs (NSAIDs), followed bylumbosacral stabilization, hip strengthening, and myofascial release. Botulinum toxin relievespain via multiple mechanisms and is increasingly used in the treatment of myofascial dysfunction.A lumbar stabilization exercise program and botulinum toxin injection of the lumbar paraspinals may help relieve some of this patient’s pain if he also has low back pain, but would not addressthe main issue, piriformis syndrome. Stretching exercises of the iliotibial band and corticosteroidinjection of the greater trochanteric bursae would be the treatment for greater trochantericbursitis. A lumbar stabilization exercise program and corticosteroid lumbar epidural spinalinjection would treat a lumbar radiculopathy 2011

Answer 45

Answer: (b) Commentary: This woman presents with symptoms most consistent with medial tibial stresssyndrome (MTSS) or what has been termed “shin splints.”Pain from MTSS occurs along thelower third of the posteromedial border of the tibia. A stress fracture is unlikely in this lowmileage runner who has had only 2 weeks of running activity. Stress fractures generally have afocal area of pain and are not relieved with further running. Anterior tibialis tendinitis presentswith anterolateral pain along the dorsal aspect of the ankle. Tarsal tunnel syndrome is associatedwith numbness and tingling in the foot. 2011

Answer 46

Answer: (b) Commentary: While theories have been proposed regarding how lumbar supports may treat andprevent lumbar strains, evidence-based medicine does not demonstrate consistent findings tosupport their use. Studies have shown that there is very low compliance with consistent use oflumbar supports. There have been no consistent findings showing that lumbar supports prevent excessive spinal motion or increase intra-abdominal pressure without increasing abdominalmuscle activity. Outcomes studies do not demonstrate 2011

Answer 47

Answer: (c) Commentary: The O’Brien active compression test is used to evaluate and differentiate labral tears (superior labrum anterior posterior -- SLAP tears) from acromioclavicular joint pathology and pain. The Hawkin test is an impingement test of the shoulder and is not intended to evaluatetears of glenoid labrum. The bowstring sign is used to identify lumbar nerve root compression.The Apley scratch test is used to assess the range of motion of the shoulder. 2011

Answer 48

Answer: (c) Commentary: The most common etiology of thoracic outlet syndrome(TOS) in sports is likely related to repetitive overhead motion. Hypertrophy of sport-specific musculature may predispose to TOS. The role of anatomic variations is uncertain in TOS and may be common in patients with and without this disorder. Fractures of the clavicle and hyperextension injuries of the neck may be causes of TOS in the setting of trauma 2011

Answer 49

Answer: (b) Commentary: The radiographic findings are typical for avascular necrosis which can be due to trauma, high doses and/or prolonged use of steroids, heavy alcohol use, and certain systemic diseases (diabetes, systemic lupus erythematosus). Obesity and older age are risk factors for developing osteoarthritis. Typical radiographic findings of osteoarthritis include joint space narrowing, osteophytes, subchondral cysts and sclerosis; collapse of bone is not seen. Hypothyroidism is not a risk factor for avascular necrosis 2011

Answer 50

Answer: (a) Commentary: Pregnant women frequently develop low back pain, and a sacroiliac belt can behelpful. A cruciform anterior spinal hyperextension (CASH) brace is generally used for osteoporotic compression fractures. A silesian belt is a type of suspension for transfemoral prostheses. The Minerva brace is a cervicothoracic orthosis. 2011

Answer 51

Answer: (c) Commentary: The indications for surgery for pathological fractures from cancer are life expectancy of greater than 1 month with a fracture of a weight-bearing bone, and greater than 3 months for fracture of a non-weight-bearing bone. If pain persists following radiation, fractures should be managed surgically. Healing rates are low following pathologic fractures, with 1 review of 123 patients reporting a 35% incidence of fracture healing. Fractures of the pelvis are generally treated conservatively, unless pain persists after radiation or unless they involve the acetabulum. 2011

Answer 52

Answer: (a) Commentary: Fatigue-resistant type 1 fibers are recruited initially followed by type 2b fibers. There are no type 1b fibers. 2011

Answer 53

(a) A telltale sign of cervical cord involvement is bilateral symptoms. In this case, the athlete should be treated as having a potential spinal cord injury and should have his cervical spine immobilized. The football helmet should not be removed, since the cervical spine may fall into extension in the act of removing the helmet. If the airway needs to be accessed, then the face guards should be removed using special equipment. If the athlete suffered and recovered from a temporary “stinger,” involving 1 limb, he may return to play as long as his neurologic examination is normal. 2007

Answer 54

(b) Recurrent dislocations should be treated with surgery at some point if the athlete would like to return to contact sports. Various anterior shoulder dislocation techniques that can be applied to reduce the shoulder, most by external rotation of the shoulder or by using gravity 2007

Answer 55

(d) Based on the clinical presentation, radial nerve injury is the most likely cause of the patient’s symptoms. Considering the location of the trauma the other possibilities seem less likely. In a posterior interosseous nerve injury one would not expect any sensory problems 2007

Answer 56

(b) Whole body-vibration is associated with increased frequency of low back pain. Some studies have found a correlation between increased frequency of disc protrusion and occupational driving. The exposure to vibration will likely facilitate continued symptoms in this worker, and relative rest is indicated during the initial stages of recovery. There is no predetermined length of physical therapy that is associated with recovery. Workers with low back pain and leg pain must learn to sit without increasing symptoms. Complete avoidance will not necessarily improve recovery and is not practical. The driver can likely perform some duties with restrictions. The employer has the responsibility to provide a job that meets the restrictions set by the physician. If the employer is unable to provide a job with these restrictions then the employee must remain off work. 2007

Answer 57

(d) Temporary weaknesses of peri-articular muscles typically occurs after knee arthroplasty along with loss of full flexion and extension due to pain, edema, and the procedure itself. Ankle dorsiflexion is not typically weak following TKA and therefore peroneal nerve injury due to a hematoma would be suspected, especially since the patient is on warfarin. This injury requires surgical exploration and decompression. Sciatic nerve stretch injury, posterior tibialis tendon rupture, and inadequate pain control would not present as ankle dorsiflexion weakness 2007

Answer 58

(a) The work by Marras and colleagues showed that increasing the horizontal distance from the trunk of an object being carried increased the risk of developing a low back disorder. This increase in distance increased the forces consistently on the anterior column of the spine. Although the other options can all place the worker at risk for a low back injury, only the increased carrying distance from the trunk has been shown to be the most predictive of a low back injury. 2007

Answer 59

(d) The United States Department of Labor has determined that computer work is associated with a significant number of musculoskeletal disorders, many of which are considered cumulative trauma disorders. Examples include cervical and thoracic myofascial pain, rotator cuff tendonitis, medial and lateral epicondylitis, de Quervain tenosynovitis, and carpal tunnel syndrome. 2007

Answer 60

(b) Ultrasound is typically an inexpensive treatment that may help with pain and bone maturation, however, it is contraindicated near arthroplasties and therefore not a good treatment in this case. Further contraindications include use of ultrasound: near pacemaker, near spine or laminectomy site, near brain, eyes, or reproductive organs, is someone with malignancy or skeletal immaturity, or near sites where methyl methacrylate was applied. 2007

Answer 61

(a) Wrist strengthening, acupuncture, and shock wave therapy all help in the treatment of epicondylitis. However, low intensity laser treatment is not proven beneficial. 2007

Answer 62

(a) Occult cervical fractures are most often seen at the C1 and C7 levels. By adding computed tomography (CT) scanning to the evaluation of trauma patients, a significant number of occultcervical fractures can be diagnosed. Of spinal fractures, 5% to 30% are multiple and may appear atnoncontiguous levels. Thus, radiographic evaluation of the entire spinal axis is necessary whenever injury at 1 region of the spine is detected. 2006

Answer 63

(d) Loisel, in1997, performed a randomized controlled trial that showed that the injured worker with low back pain returned to regular work activities 2.41 times faster if the worker received therapeutic functional rehabilitation and ergonomic intervention when compared to usual care. 2006

Answer 64

(b) Muscles within any radiation field are at risk for fibrosis and contracture. The pectoralis major andminor muscles are commonly shortened following radiation to the chest wall, an integral component of breast conservation therapy. Radiation-induced shortening of the pectoralis muscles pulls the scapula into a protracted and depressed position which places tension on the medial and superior scapular stabilizers. To achieve long-term relief, this patient will require stretching of thepectoralis muscles. 2006

Answer 65

(c) Total knee arthroplasty is the surgery of choice in persons with severe pain and loss of function. A synovectomy provides temporary pain relief and decreased swelling. Hemiarthroplasty is contraindicated in rheumatoid arthritis due to total joint involvement. Arthrodesis would not provide the range of motion needed for stairs, ambulation, and dressing 2006

Answer 66

(b) This is a common clinical conundrum. Medial tibial stress syndrome (frequently and improperly referred to as shin splints) represents a range of pathology from posterior tibialis tendonitis to periostitis. Fredericson et al determined that stress fractures, which will require more aggressive treatment, have more focal pain and pain with percussion testing. Pain from a stress fracture worsens as run goes on and often hurts after a run. A magnetic resonance image or bone scan can make a definitive diagnosis. 2006

Answer 67

(a) A functional capacity evaluation (FCE) is the next best choice for this worker. An FCE will determine functional deficits the worker has by assessing work simulated activities. Work conditioning may be helpful because it includes aerobic conditioning but does not provide information and training regarding specific work tasks. His physical findings are minimal so additional physical therapy may not be recommended. These minimal physical exam findings in a 63-year-old man may indicate a nontraumatic incomplete cuff tear that may be a part of normal aging. In this setting, conservative management remains appropriate. Incomplete rotator cuff tears can be found in the asymptomatic population, especially over the age of 50. 2006

Answer 68

(c) While data on sacroiliac joint provocative tests have been equivocal in the literature, recent evidence has shown thigh thrust and pelvic distraction maneuvers to be helpful. The Thomas test is used to assess hip flexor contracture. The Gillet test is a sacroiliac joint motion test and not a provocation test. The FADIR maneuver is used to assess piriformis tightness and provocation 2006

Answer 69

A. A runner does not typically stress his/her ACL: The history of a non-contact ACL injury is usually of a movement with "cutting" action, rapid acceleration or deceleration, or twisting. 2015

Answer 70

This woman has myofascial dysfunction with one or more trigger points. Trigger points are treated with dry needling, anesthetic, or botox. CS injection into skeletal muscle can cause atrophy and necrosis. There is no indication for a joint or epidural injection. Findings more specific for AC joint, GH joint, RTC pathology, and stenosis are not noted. 2015

Answer 71

a. Spontaneous AA subuluxation may be present in individuals with ankylosing spondylitis. Minor trauma, such as a fall, may complicate a spontaneous subluxation by increasing pressure on the spinal cord and producing long-tract signs along with an occipital headache. Although epidural hematoma also typically occurs after a fall, symptoms are more acute and usually associated with altered consciousness and bruising or skull fracture. GBS, or acute inflammatory polyneuropathy, is not associated with fall or headache. occipital neuralgia does not produce generalized weakness. 2015.

Answer 72

a Pregnant women frequently develop low back pain, and a sacroiliac belt can be helpful. A cruciform anterior spinal hyperextension (CASH) brace is generally used for osteoporotic compression fractures. A Silesian belt is a type of suspension for transfemoral prosthesis. The Minerva brace is a cervicothoracic orthosis. 2015.

Answer 73

c serial casting can be useful for treatment contractures. This otherwise healthy patient should not have spasticity, so botulinum toxin would be inappropriate. There was no mention of neurological weakness, so electrical stimulation would also be inappropriate. A Heel lift would be helpful if the patient had a limb length discrepancy, but it would not help to correct the contracture. 2015.

Answer 74

a lumbar extension, created when walking downhill, decreases spinal canal diameter and worsens neurogenic claudication symptoms. Neurogenic claudication is classically improved when a person changes from a standing or walking position to a seated position. Lumbar flexion (forward trunk lean) with uphill walking may improve leg pain because lumbar flexion increases spinal canal diameter. Anterior pelvic tilt is associated with lumbar extension and increased pain. 2015.

Answer 75

c An increased risk of fracture exists when cortical bone destruction affects 50% or more of the bone's circumference, more than 60% of its diameter, more than 1.3cm of the length in the femoral neck, or more than 2.5cm of the lower limbs long bone is involved. 2015.

MSK Flashcards

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