MSK II FINAL Flashcards
(130 cards)
1
Q
What is the most common cause of lateral elbow pain in individuals over 35 years old?
A
Lateral epicondylitis (tennis elbow).
2
Q
What elbow injury is common in children under 5 years old and involves a radial head subluxation?
A
Nursemaid’s elbow.
3
Q
What condition presents with insidious lateral elbow pain, locking, and decreased ROM in adolescents?
A
Osteochondritis dissecans.
4
Q
What special test is used to assess medial (ulnar) collateral ligament integrity?
A
Valgus stress test at 20–30 degrees flexion.
5
Q
A positive moving valgus stress test reproduces pain between what range of elbow flexion?
A
Between 70–120 degrees flexion.
6
Q
What elbow injury involves axial compression, varus force, and external rotation leading to posterolateral rotatory instability?
A
Lateral (radial) collateral ligament (LCL) sprain.
7
Q
What pathology would present with posterior elbow pain, catching, clicking, and is worsened by full extension?
A
Olecranon impingement syndrome.
8
Q
Which elbow injury is associated with valgus extension overload in throwers?
A
Posterior elbow impingement.
9
Q
What radiographic findings are associated with radiocapitellar chondromalacia?
A
Loss of joint space, marginal osteophytes, and possible loose bodies.
10
Q
What is the expected end-feel for passive elbow flexion?
A
Soft-tissue approximation.
11
Q
What is the expected end-feel for passive elbow extension?
A
Bony end-feel.
12
Q
What are common differential diagnoses for medial elbow pain?
A
Medial epicondylitis, MCL sprain, ulnar nerve compression.
13
Q
A patient has pain with axial load and supination-pronation at the radiocapitellar joint. What is a likely diagnosis?
A
Radiocapitellar chondromalacia.
14
Q
What is a sign of significant elbow effusion seen on observation?
A
Loss of the elbow dimples.
15
Q
What deformity results from a decreased carrying angle (<10 degrees)?
A
Cubitus varus (“gunstock deformity”).
16
Q
What is the classic mechanism of injury for Nursemaid’s Elbow?
A
Sudden traction on an extended and pronated arm (radial head subluxation).
17
Q
What symptom commonly indicates a radial head fracture?
A
Lateral elbow pain + inability to fully supinate/pronate.
18
Q
What special test assesses ulnar nerve subluxation at the elbow?
A
Tinel’s sign over the ulnar groove.
19
Q
What is the purpose of the “milking maneuver” special test?
A
Assesses medial (ulnar) collateral ligament integrity (valgus stress).
20
Q
What pathology is characterized by crepitus, catching, locking, and lateral elbow pain during flexion and pronation-supination?
A
Radiocapitellar chondromalacia.
21
Q
Loss of elbow extension with a springy end-feel should make you suspicious for what?
A
Intra-articular loose body.
22
Q
Pain localized at the medial epicondyle worsened with resisted wrist flexion is most consistent with what diagnosis?
A
Medial epicondylitis (golfer’s elbow).
23
Q
What nerve is most commonly injured with a medial elbow injury?
A
Ulnar nerve.
24
Q
What exam finding is strongly suggestive of a loose body in the elbow joint?
A
Springy end-feel during extension.
25
What are signs of Volkmann’s ischemic contracture?
Severe forearm pain, pallor, pulselessness, paresthesia, paralysis.
26
What is the normal elbow carrying angle in females?
13–16 degrees.
27
What is the normal elbow carrying angle in males?
11–14 degrees.
28
What is a Galeazzi fracture?
Fracture of the distal radius with dislocation of the distal radioulnar joint (DRUJ).
29
A fall on an outstretched hand (FOOSH) with pain and deformity at the elbow raises suspicion for what injuries?
Radial head fracture, supracondylar fracture, or elbow dislocation.
30
What is the most common elbow fracture in adults?
Radial head fracture.
31
What structure is commonly injured in a throwing athlete who felt a “pop” followed by medial pain and swelling?
Medial (ulnar) collateral ligament (MCL) sprain.
32
What is the mechanism of injury for a lateral (radial) collateral ligament (LCL) sprain?
Axial compression + varus force + external rotation.
33
What clinical test assesses posterolateral rotatory instability?
Lateral pivot-shift test of the elbow.
34
What elbow instability involves valgus displacement and is commonly seen in FOOSH injuries?
Valgus instability.
35
What elbow instability involves varus displacement and can be associated with olecranon fractures?
Varus instability.
36
What structure stabilizes the elbow against valgus forces?
Medial (ulnar) collateral ligament complex.
37
What type of elbow instability is described as "gross instability in multiple planes" following a severe dislocation?
Combined instability (valgus + varus + posterolateral).
38
What deformity results from a lateral epicondylar fracture?
Cubitus valgus.
39
What deformity results from a supracondylar fracture?
Cubitus varus.
40
What is the classic "triangle sign" at the elbow used for?
To assess if the olecranon and epicondyles are aligned (normal: isosceles triangle at 90° flexion; straight line in extension).
41
When passive elbow flexion causes ulnar nerve symptoms, what should you suspect?
Ulnar nerve entrapment.
42
What diagnosis is suggested by tenderness at the radial tunnel 4-5 cm distal to the lateral epicondyle with resisted supination?
Radial tunnel syndrome (PIN compression).
43
What exam finding may indicate TFCC injury?
Pain with ulnar deviation + clicking, or positive ulnar fovea sign.
44
What condition causes crepitus or catching in the posterior elbow and worsens with full extension?
Olecranon impingement syndrome.
45
What nerve involvement causes weakness and numbness in the ulnar distribution and may be provoked by elbow flexion?
Cubital tunnel syndrome.
46
What wrist condition is caused by overuse of the abductor pollicis longus and extensor pollicis brevis tendons?
DeQuervain’s tenosynovitis.
47
What special test is used to diagnose de Quervain’s tenosynovitis?
Finkelstein’s test.
48
A FOOSH injury followed by pain in the anatomical snuffbox suggests what fracture?
Scaphoid fracture.
49
What is the most common complication of a scaphoid fracture?
Avascular necrosis due to poor blood supply.
50
What condition is characterized by pain and crepitus 4-8 cm proximal to the radial styloid from overuse?
Intersection syndrome.
51
What wrist injury involves a fracture of the distal radius with dislocation of the distal radioulnar joint?
Galeazzi fracture.
52
What is the most common fracture of the distal radius caused by FOOSH in elderly patients?
Colles’ fracture.
53
What deformity is associated with Colles’ fracture?
“Dinner fork” deformity (dorsal displacement of distal radius).
54
What test is used to assess for scaphoid fracture or instability?
Scaphoid compression test or axial loading through the thumb.
55
What wrist condition is caused by compression of the median nerve in the carpal tunnel?
Carpal Tunnel Syndrome (CTS).
56
What are two special tests used to assess for CTS?
Phalen’s test and Tinel’s sign at the wrist.
57
What pathology causes pain on the ulnar side of the wrist, often following a twisting injury or FOOSH, and affects the fibrocartilage between ulna and carpal bones?
TFCC (Triangular Fibrocartilage Complex) injury.
58
What diagnosis is associated with pain and numbness in the radial hand and thumb area that worsens at night?
Carpal Tunnel Syndrome.
59
What nerve involvement is suggested by numbness over the dorsal thumb and base of the wrist?
Superficial radial nerve (can mimic DeQuervain’s).
60
What is the classic deformity in rheumatoid arthritis affecting the MCP joints?
Ulnar drift (ulnar deviation + palmar subluxation).
61
What deformity involves PIP flexion and DIP hyperextension, often seen in RA?
Boutonnière deformity.
62
What deformity involves PIP hyperextension and DIP flexion?
Swan-neck deformity.
63
What joint is most commonly affected by osteoarthritis in the hand?
1st CMC joint (base of the thumb).
64
What are conservative treatments for 1st CMC OA?
Splinting, thermal modalities, joint protection education.
65
What test provokes pain in the 1st CMC joint by grinding the trapezium on the 1st metacarpal?
Grind test.
66
What is the normal ROM for wrist flexion and extension?
Flexion: 80–90°, Extension: 70–90°.
67
What is the normal ROM for radial and ulnar deviation?
Radial: ~15–20°, Ulnar: ~30–45°.
68
What is the normal ROM for forearm pronation and supination?
~80–90° for both.
69
What joint play movement at the radiocarpal joint improves wrist flexion?
Posterior (dorsal) glide.
70
What joint play movement at the radiocarpal joint improves wrist extension?
Anterior (palmar) glide.
71
What joint play improves radial deviation at the wrist?
Ulnar (medial) glide.
72
What joint play improves ulnar deviation at the wrist?
Radial (lateral) glide.
73
What joint play improves supination at the distal radioulnar joint (DRUJ)?
Anterior glide of the radius on the ulna.
74
What condition presents with “myelopathy hand,” including loss of finger abduction/extension due to cervical pathology?
Cervical myelopathy.
75
What hand condition is characterized by clubbing (bulbous enlargement of fingertips)?
Cardiovascular or pulmonary disease (e.g., COPD, endocarditis).
76
What do 'spoon nails' (koilonychia) suggest?
Iron deficiency anemia, coronary disease, or exposure to harsh detergents.
77
What are Beau’s lines on the fingernails, and what do they indicate?
Transverse depressions across nails — history of systemic stress or trauma.
78
Persistent wrist/hand swelling after trauma likely suggests what?
Carpal fracture (especially scaphoid).
79
What nerve distribution is affected if a patient has numbness over the palmar aspect of digits 1-3 and half of 4?
Median nerve (Carpal Tunnel Syndrome).
80
What nerve distribution is affected if numbness is over the dorsal thumb and first web space?
Radial nerve (superficial branch).
81
What condition involves pain worse at night and is relieved by hand shaking or flicking?
Carpal Tunnel Syndrome (positive Flick Sign).
82
What is the figure-eight method used for?
Measuring hand swelling (volume assessment for edema).
83
What condition is characterized by inability to simultaneously flex the PIP and MCP joints (but can flex them separately)?
Extensor plus deformity.
84
What cervical condition is associated with nerve root compression leading to arm pain, numbness, and weakness?
Cervical radiculopathy.
85
What special test combination forms the cluster for diagnosing cervical radiculopathy?
Spurling’s test, Distraction test, ULTT (median nerve bias), Cervical rotation <60° to involved side.
86
What test is positive when cervical extension and sidebending with axial compression reproduces radicular symptoms?
Spurling’s test.
87
What test alleviates radicular symptoms with manual cervical traction?
Distraction test.
88
What does a positive Upper Limb Tension Test (ULTT) with median nerve bias suggest?
Neural tension or cervical radiculopathy (C5-C7).
89
What are signs of cervical myelopathy?
Bilateral UE/LE symptoms, hand clumsiness, gait imbalance, hyperreflexia, UMN signs (Babinski, Hoffman’s).
90
What are red flag symptoms that suggest vertebrobasilar insufficiency?
Dizziness, diplopia, dysarthria, dysphagia, drop attacks.
91
What is Lhermitte’s sign, and what does it suggest?
Electric shock down spine with neck flexion; suggests cervical myelopathy or MS.
92
In cervical disc dysfunction, what symptom behavior worsens with coughing, sneezing, or Valsalva?
Radicular pain (increased intradiscal pressure).
93
What cervical ROM is usually most limited with disc herniation?
Rotation toward the involved side.
94
What thoracic joint dysfunction is aggravated by deep breathing or arm elevation?
Costovertebral or costotransverse joint dysfunction.
95
Pain referred to the posterior thoracic spine between T4–T6 could indicate what visceral issue?
Stomach ulcer.
96
What sensation should you assess during a UQS for C5?
Lateral upper arm (deltoid area).
97
What is the key muscle strength test for C6 in a UQS?
Wrist extension.
98
What deep tendon reflex is associated with C7 in a UQS?
Triceps reflex.
99
What is the normal ROM for cervical flexion and extension?
Flexion: ~50°, Extension: ~60°.
100
What is the normal ROM for cervical rotation to each side?
~80°.
101
What are red flag signs suggestive of possible cancer causing thoracic spine pain?
Unexplained weight loss, night pain, failure to improve with conservative care.
102
What symptom behavior strongly suggests cervical instability following trauma?
Neck pain that worsens with upright posture and improves lying down, plus facial dysesthesias with movement.
103
What is the purpose of the Hawkins-Kennedy Test?
To assess for subacromial impingement.
104
What is a positive Hawkins-Kennedy Test?
Pain with passive shoulder flexion and internal rotation.
105
What does the Neer’s Test assess?
Subacromial impingement.
106
What is a positive Neer’s Test?
Pain with passive shoulder flexion (arm raised overhead) with scapular stabilization.
107
What does the Empty Can (Jobe’s) Test assess?
Supraspinatus muscle or tendon pathology.
Rotator cuff
108
What is a positive Empty Can Test?
Pain and/or weakness during resisted abduction with the shoulder internally rotated (thumb down).
109
What does the Drop Arm Test assess?
Full-thickness rotator cuff tear (especially supraspinatus).
110
What is a positive Drop Arm Test?
Inability to smoothly lower the arm from abduction, or sudden dropping of the arm.
111
What does the Apprehension Test assess?
Anterior shoulder instability (possible labral or capsular injury).
112
What is a positive Apprehension Test?
Patient shows apprehension or fear of dislocation when shoulder is abducted and externally rotated.
113
What is primary adhesive capsulitis?
Idiopathic, progressive loss of active and passive shoulder ROM, particularly external rotation.
114
What are the four stages of adhesive capsulitis?
1. Freezing (painful, progressive loss of ROM)
2. Frozen (stiff, less pain)
3. Thawing (gradual ROM improvement)
4. Recovery (minor residual limitations)
115
During which stage of adhesive capsulitis is pain at rest and night pain most severe?
Stage 1 (Freezing).
116
When does pain decrease and ROM deficits become the primary issue in adhesive capsulitis?
During Stage 2 (Frozen stage).
117
Which shoulder motion is typically lost first in adhesive capsulitis?
External rotation.
118
What is the typical presentation of a rotator cuff tear?
Painful weakness with overhead movement, difficulty with abduction and external rotation.
119
What are signs of a massive rotator cuff tear?
Inability to initiate abduction and a positive Drop Arm Test.
120
What pathology is suggested by anterior shoulder pain and a history of repetitive overhead activities?
Biceps tendinitis.
121
What diagnosis is suspected with pain localized over the AC joint and pain reproduced with cross-body adduction?
AC joint pathology (e.g., arthritis or sprain).
122
What is the primary concern following an anterior shoulder dislocation?
Damage to the anterior inferior labrum (Bankart lesion) and/or recurrent instability.
123
What are the normal ROM values for shoulder movements?
Flexion: 160–180°
External rotation: 90°
Internal rotation: 70–90°.
124
What two motions make up TMJ mouth opening?
Early phase: rotation of the condyle
Late phase: anterior translation of the condyle along the articular eminence.
125
In TMJ, deviation of the jaw toward one side during opening suggests what?
Hypomobility (or joint dysfunction) on the side of deviation.
126
What does deflection of the jaw during opening indicate?
An interruption (like a disc displacement) that does not correct itself during opening.
127
What is the normal range of TMJ mouth opening?
40–50 mm (about 3 finger widths vertically between upper and lower teeth).
128
What TMJ condition is suggested by a 'click' during opening or closing?
Disc displacement with reduction.
129
What TMJ condition is suggested by limited opening without any click, and deviation toward the affected side?
Disc displacement without reduction (or 'closed lock').
130
What are common symptoms of TMJ dysfunction?
Jaw pain, clicking or popping, limited ROM, headaches, ear pain, neck pain.
