MSK injuries

Question 1

joint space is a type of potential space

Answer 1

similar to pleural or pericardial space

negative hydrostatic pressure → draws fluid into it

Question 2

most common type of hip dislocation

Answer 2

posterior dislocation:
femoral head slips out of acetabulum posteriorly
can occur from MVA

Question 3

structures injured in posterior hip dislocation

Answer 3

medial and lateral circumflex femoral arteries: br. of deep femoral artery (below greater trocanter, ring around upper femur, supplies femoral neck)
femoral vein
femoral nerve
head of femur

Question 4

tx of posterior hip dislocation

Answer 4

closed (no surgery) reduction (put bone back in place) by pulling on femur with continous traction

Question 5

unhappy triad

Answer 5

lateral force applied to planted leg
MCL
ACL
lateral meniscus (more common) or medial meniscus (attached to MCL, part of original definition)

Question 6

anterior drawer test

Answer 6

pull tibia anteriorly

suggests ACL injury

Question 7

ACL

Answer 7

attaches to tibia anteriorly

Question 8

PCL

Answer 8

attaches to tibia posteriorly

Question 9

most common cause of knee pain

Answer 9

patellofemoral syndrome

Question 10

anterior knee pain that worsens with activity

no tender tendon

Answer 10

patellofemoral syndrome

Question 11

cause of patellofemoral syndrome

Answer 11

contact between back of patella and distal femur

Question 12

pain when palpate inferior patellar tendon

Answer 12

patellar tendonitis

Question 13

treatment of patellofemoral syndrome

Answer 13

strengthen quad muscles
stretch exercises: hamstrings, calves, hip, iliotibial band
minimize activities that put stress on knee (squat, kneel, jog, bike)
maximize walking: keep knee moving

Question 14

caused by friction/pressure anterior to patella

Answer 14

prepatellar bursitis = “housemaid’s knee” = on knees to clean floor

Question 15

caused by friction/pressure on tibial tuberosity (inferior to patella)

Answer 15

infrapatellar bursitis = “clergyman’s knee”

Question 16

what is the name for the pad of tissue between a bone + tendon

Answer 16

bursa: ↓friction with movement

Question 17

what is the name for the pad of tissue between bones

Answer 17

cartilage: ↓friction with movement

Question 18

what is name for stretching ligaments too far and causing microtears

Answer 18

sprain

Question 19

what is name for stretching muscle and possibly its tendon

Answer 19

strain

Question 20

treatment for an ankle sprain

Answer 20

RICE
Rest - no weight bearing, crutches
Ice - 20 minutes q 2 hrs for 1st 48 hrs
Compression - ACE bandage
Elevation - ↓swelling due to gravity
NSAIDs within 1st 48 hrs
ROM exercises: marbles with toes, circles with foot, trace alphabet

Question 21

most common type of ankle sprain

Answer 21

lateral ankle sprain

Question 22

most common ligaments injured in ankle sprain (most common → more severe injury)

Answer 22

1) anterior talofibular liagment (ATFL - Always Tears First Ligament)
2) calcaneofibular ligament
3) posterior talofibular ligament

Question 23

medial ankle ligaments

Answer 23

deltoid ligament (rarely injured)

Question 24

name this condition:
heal pain beneath the calcaneus or in medial arch
local point tenderness at medial tubercle of calcaneus
worse with first steps in morning and after weight bearing
+/- heel spur on xray

Answer 24

plantar fasciitis

Question 25

plantar fascia attaches

Answer 25

calcaneus to proximal phalanges of each toe

Question 26

treatment of plantar fasciitis

Answer 26

can take 2 years to recover: NSAID dorsiflexion with night splints stretching of plantar fascia and achilles tendon OTC heel insert local steroid injection surgical release of plantar fascia in severe cases

Question 27

what are the rotator cuff muscles

Answer 27

``` SItS Supraspinatous - most common rotator cuff injury Infraspinatous teres minor Subscapularis ```

Question 28

action of supraspinatous m.

Answer 28

initiates first 15° of arm abduction (raise arm up from side of body) (before deltoid m.)

Question 29

action of infraspinatous m.

Answer 29

lateral rotation of arm (external rotation) | injured with pitching

Question 30

action of teres minor m.

Answer 30

lateral rotation of arm (external rotation) | adduction

Question 31

action of subscapularis m.

Answer 31

medial rotation of arm (internal rotation) | adduction

Question 32

test for supraspinatous m. function

Answer 32

empty can test abduct to 90, 30 degrees of forward flexion, pronate arm with thumb to ground, add resistance to forearm positive test: pain + weakness with resistance

Question 33

name the condition: rotator cuff muscles + tendon + bursa trapped by acromion process during abduction most commonly involves: subacromial bursa + supraspinatous tendon/muscle

Answer 33

shoulder impingement

Question 34

repetitive overhead activity (baseball pitch, tennis, swimming) can cause

Answer 34

shoulder impingement

Question 35

impingement between head of humerus + coracoacromial arch can cause

Answer 35

subacromial bursitis

Question 36

treatment of subacromial bursitis

Answer 36

NSAIDs | steroid injection in bursa

Question 37

name this condition: | head of humerus rotates out of glenoid cavity

Answer 37

dislocated shoulder

Question 38

name this condition: | clavicle separates from acromion and coracoid process of scapula

Answer 38

separated shoulder

Question 39

name the condition: severe shoulder adhesions that lock the shoulder in place after disuse of shoulder (cast, splint) or prolonged immobilization normal xray arthrogram (inject dye in joint) shows constriction of joint capsule and loss of axillary + subscapularis spaces common in >50 yo, women, diabetics

Answer 39

adhesive capsulitis (frozen shoulder)

Question 40

treatment of adhesive capsulitis

Answer 40

can take 1 year to recover: glenohumeral joint injection: ↓inflammation/adhesions subacromial joint injection: ↓pain, ↑ ROM heat + analgesia PT to ↑ROM break adhesions under anesthesia

Question 41

"popeye" lesion

Answer 41

biceps tendon rupture

Question 42

injury after lifting heavy item can tear at elbow or shoulder after injury: muscle bulge when contract

Answer 42

biceps tendon rupture

Question 43

treatment for biceps tendon rupture

Answer 43

older: still can function, no surgery younger: limited function, need surgery

Question 44

↑fluid/inflammation over olecranon process on elbow | not tender

Answer 44

olecranon bursitis | inject needle to remove fluid

Question 45

most commonly fractured carpal bone

Answer 45

scaphoid

Question 46

punched someone with knuckles of clenched fist tender anatomical snuff box +/- normal xray

Answer 46

scaphoid racture

Question 47

complication of scaphoid fracture

Answer 47

avascular necrosis: presents with painful arthritis | blood supply to scaphoid is distal to proximal

Question 48

fall on outstretched hand causes

Answer 48

damage to hook of the hamate → ulnar nerve injury

Question 49

painless thickening/contraction of flexor tendon on palm of 1 or more fingers (ring finger - 4th finger most common) may have family hx >40 yo, male, alcoholism, diabetes, smoking

Answer 49

depuytren contracture

Question 50

treatment for depuytren contracture

Answer 50

radiation inject with bacterial collagenase definitive: surgery → PT

Question 51

repetitive wrist extension

Answer 51

``` lateral epicondylitis ("tennis elbow") wrist extensor tendon attached to elbow ```

Question 52

repetitive wrist flexion

Answer 52

medial epicondylitis ("golfers elbow")