MSK / Sports / Anatomy Flashcards
(106 cards)
1
Q
Treatment of bursitis, tendinitis, tendinopathy, regional MSK
A
Change/Avoid precipitating action
-Rest, Ice/Heat, Splinting
-PT
-NSAIDs
-IA GC
-Surgery (bursectomy, tenosynovectomy, reattach ruptured tendons)
2
Q
** MC nonarticular shoulder pain **
A
Impingement
-Subacromial bursitis
-Bicipital tendinitis
3
Q
Pathophys shoulder impingement
A
Superior translation of humeral head closer to coracoacromial arch during abduction due to inflamed or weak rotator cuff from overuse/strain
4
Q
Shoulder impingement syndrome stages
A
1: <25yo - tendon hemorrahge & edema
-2: 25-40yo - tendinitis, fibrosis of subacrmoail bursa
-3: >40yo - tear of rotatorcuff or bicipital tendon
-
-*1,2 reversible
5
Q
Shoulder impingement sx & XR
A
Pain with flexion, abduction, internal rotation actively
-Less / no pain with passive
-No inflammatory signs of swelling, redness, warmth
-X-ray shows less than 8 mm space between humeral head and acromion
6
Q
Causes of impingement syndrome
A
Impingement syndrome= encroachment of tendons of rotator cuff
-Repetitive use with overhead work
-Rotator cuff inflammation + reflex inhib
-AC osteophytes
-Hydroxyapatite deposition
-Glenohumeral multi-directional instability
7
Q
Rotator cuff tests ( and muscle tested)
A
-Empty Can Test ( supraspinatus)
-Resisted external rotation ( infraspinitis and teres minor)
-Liftoff test (Subscapularis)
-Subacromial impingement: Neer (supraspinatus) & Hawkins Kennedy
8
Q
** Rotator cuff muscles, action, and insertion**
A
Supraspinatus = Abduction (from 0 to 15 degrees) and external rotation
– Top of the greater tuberosity of the humerus
-
-Infraspinatus = Abduction and ER
– Middle of the greater tuberosity of the humerus
-
-Teres minor = ER, adduction
– Bottom of the greater tuberosity of the humerus
-
-Subscapularis = IR, adduction
– Lesser tuberosity of the humerus
9
Q
Impingement syndrome treatment
A
PT, NSAIDs, IA GC x6mo before considering surgical decompression unless full thickness tear
10
Q
Physical exam findings for rotator cuff tears
A
Shoulder muscle atrophy
-Positive drop arm test
-“Hikes” shoulder when asked to lift the arm
11
Q
Bicipital tendonitis presentation
A
Anterior shoulder pain worse actively (less passively)
12
Q
Describe two tests for bicipital tendonitis
A
-+ Yergason’s (resisted supination)
-+ Speeds
13
Q
** What is frozen shoulder **
A
Contraction of joint capsule w/ pain and reduced ROM by 50% actively and passively
-Decreased volume of joint capsule seen on arthroscopy
-
-Rarely simultaneously bilateral
-40-50% sequential bilateral
14
Q
** Frozen shoulder phases , how long does it last**
A
1: increasing pain and stiffness x 2 to 9 months
-2: substantial stiffness but LESS PAIN x 4 to 12 months
-3: pain and function improves over 5 to 26 months.
-
-Resolves within 2 years
15
Q
** Frozen shoulder RF **
A
DM, DLPD
-Thyroid disease,
-Paraneoplastic (ovarian Ca -shoulder/hand syndrome)
-
-Prolonged immobilization,
-Post injury (eg rotator cuff tears, proximal humerus fracture, shoulder surgery)
-Stroke, Parkinson’s,
-
-Autoimmune disease,
-Antiretroviral therapy for HIV,
-
-Genetic predisposition,
16
Q
Frozen shoulder testing and most affected ROM
A
Significant reduction in active AND passive ROM
-ER and ABduction MOST affected
-
-Injection test: lidocaine into SA bursa. Ongoing sx = frozen shoulder (vs SA bursitis, rotator cuff)
17
Q
** Three causes of nonarticular elbow pain **
A
Lateral epicondylitis (tennis elbow).
-Medial epicondylitis (golfer’s/bowler’s elbow).
-Olecranon bursitis.
-
-Radiculpathy
-Elbow sprain (MCL)
-Paneer’s disease - AVN of capitellum
-Nursemaid elbow (Radial head subluxation)
-Little league elbow (Medial epicondyle avulsion fracture)
18
Q
Lateral epicondylitis Features
A
Pain with turning screwdriver, shaking hands, tennis backhand (wrist extension with elbow in full extension)
-Pain, swelling, warmth at origin of extensor carpi ulnaris, extensor carpi radialis longus and brevis, and extensor digitorum
19
Q
Lateral epicondylitis DDX
A
Elbow arthritis,
-Loose body in the elbow joint,
-Radial nerve or posterior interosseous nerve compression
-Cervical spondylosis with radiculitis.
20
Q
Medial epicondylitis Features
A
Pain, swelling, and warmth at the origin of flexor carpi ulnaris, flexor carpi radialis, and pronator teres
21
Q
Epicondylitis Tx
A
Counterforce brace 10 cm distal to joint line
-Wrist splinting to prevent flexion/extension
-NSAID
-PT
-
-Surgery after 6mo conservative treatment
-
-Controversial: GC injection
22
Q
Olecranon bursitis features
A
Limited flexion, normal extension
-Pain, swelling, warmth over extensor surface of elbow
23
Q
Olecranon bursitis DDX
A
Trauma,
-RA, PsA, Gout/CPPD
-HD
-Infection, HIV
-DM, Alcohlism
24
Q
Tendons involved with De Quervain’s stenosing tenosynovitis
A
Tendinitis involving the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons
25
De Quervain’s stenosing tenosynovitis Tests
Finkelstein - thumb in fist + wrist moves ulnarly
-Wrist hyperflexion and abduction of the thumb (WHAT) test - force against thumb abduction
26
De Quervain’s Tx
Forearm based thumb spica splint.
-IA GC
-Surgery
27
What is intersection syndrome
Distal forearm pain/swelling/crepitus (6-8cm proximal to radial styloid) where APL/EPB cross over the extensor carpi radialis longus and extensor carpi radialis brevis tendons in the wrist (from repetitive wrist dorsiflexion eg rowers)
28
** Greater trochanteric pain syndrome (GTPS) presentation and exam maneuvers **
Pain w/ lying on side, walking, climbing stairs, rising from seated, hip ER/abduction
-1. POSITIVE Trendelenburg (pelvis tilts towards unaffected side when standing on affected leg bc of glute weakness)
-2. Single leg stand x30s = pain
-3. Tender over greater trochanter (superoposterior facet or posterior corner)
-4. Pain with resisted ABduction or external DErotation
-5. Positive FABER
29
** 4 causes of Trendelenburg gait **
-Neuronal injury to superior gluteal nerve,
-Gluteus medius muscle dissection during THA, glute medius abscess/tendinitis
-Developmental dysplasia
-Dislocation of the hip,
-Legg-Calve-Perthes,
-SCFE slipped capital femoral epiphysis,
-AVN
-Myositis,
-Muscular dystrophy (associated with OA),
30
** 2 Muscles and 1 nerve involved with Trendelenburg gait **
Gluteus minimis, Gluteus medius
-Superior gluteal nerve (L4-S1)
31
** Greater trochanteric pain syndrome (GTPS) causes**
Repetitive loading of gluteus medius and minimus
-Overuse (running, stairs),
-Standing on one leg
-Leg length discrepancy
-Scoliosis
-Arthritis of hip, knee or foot
-Anything causing painful foot: plantar fasciitis, Achilles tendinopathy, Morton neuroma
-Trauma
-Bed bound pressure on GTB
32
Greater trochanteric pain syndrome (GTPS) Tx
NSAID
-PT
-GC injection
33
** Reasons for refractory GTPS **
ITB tightness / Snapping hip (positive Ober or J sign - hip abduction w/ flexion)
-Leg length discrepancy → Gait abN
-Gluteus tendon rupture/tear
34
ITB syndrome presentation
Lateral knee pain where distal ITB goes over lateral femoral condyle
-Noble test - pressure over lateral femoral condyle while knee is extended causes pain
-Ober test
35
Affected Bursa and location
-Weavers bottom
-Housemaids knee
-Goosefoot
-Baker’s cyst
Weavers bottom = ischial bursitis (superficial to ischial tuberosity)
-Housemaids knee = prepatellar
-Goosefoot = pes anserine (6cm below anteromedial knee joint line; between MCL and conjoined sartorius/gracilis/semitendinosus)
-Bakers = popliteal fossa cyst/fullness
36
Pes anserine bursitis presentation
Knee pain lying in bed with knees opposed
-Worse w/ going UP stairs
37
Pes anserine bursitis RF
Obese
-Valgus
-Pes planus
38
Patellofemoral syndrome presentation
Anterior knee pain
-Worse with stairs
-Caused by dynamic valgus
39
Anterior knee pain DDX
Patellar malalignment/tracking abnormality Tendinitis quadriceps/patellae
-Tight ITB
-Meniscal pathology
-Blunt trauma, occult fracture
-Osteochondritis dissecans (patella)
-Bursitis, infrapatellar/prepatellar, Pes anserine
-Postsurgical neuroma
-Referred pain from hip
-Radicular pain from lumbosacral spine
40
Tests for:
--ACL injury
--Meniscus tear
ACL:
-- Anterior drawer
-- Lachman
-- Pivot shift
-Meniscal
-- Apleys
-Mcmurrays
41
Baker’s cyst pathophys and findings with bursitis and rupture
Communication between semimembranosus/ gastrocnemius bursa and knee joint.
-One way valve traps fluid from knee to bursa
-
-Fullness in popliteal fossa (minimal pain)
-Rupture = crescent sign (ecchymoses inferior to the medial malleolus)
42
Ankle sprains
MC = Low ankle sprain: Inversion involving lateral ligaments (anterior talofibular and calcaneofibular)
-High ankle = Injury to anterior tibiofibular syndesmosis
43
Common overuse injuries in runners
Achilles tendinitis
-Posterior tibialis tendinitis
44
Heel pain causes
* Achilles enthesitis/tendinitis
* Plantar fasciitis.
* Retrocalcaneal (Achilles) bursitis.
* Heel fat pad atrophy.
45
Achilles tendinitis findings and if rupture
Heel or posterior leg pain (worse w dorsiflexion)
-Most tender and swollen 2-3cm prox to attachment to calcaneus
-May rupture spontaneously
-Positive “Thompson test” (kneel on chair, squeeze/push calf to knee shows NO plantar flexion)
46
Achilles rupture Tx
Cast
-Percutaneous Suture repair
-Open direct surgical repair
47
Plantar fasciitis RF
-Obesity,
-Pes planus/cavus
-Short Achilles tendon,
-Standing/running on hard surfaces
48
Plantar fasciitis Tx
Avoid weight-bearing
-Heel cup/cushioning, orthotics
-Stretching plantar fascia and Achilles (“soda can roll”)
-NSAIDs.
After 2-3mo of pain:
-- Nightsplint to hold foot in minimal dorsiflexion
-- Consider GC injection
-After 6-12mo pain
-- Consider surgery referral
49
Posterior tibial tendinitis presentation and when rupture
Medial ankle pain
-Pain/swelling at posterior tibial tendon
-MORE pain w/ resisted foot INVERSION
-If ruptures:
-- Acquired pes planus (long arch flattened)
-- Too many toes (hindfoot valgus, forefoot abduction)
-- Heel rise sign (cannot stand on toes of affected foot while other foot in air)
50
rheumatic disorders commonly involve the neck
RA: C1–C2 (atlantoaxial) subluxation
-JIA: C2–C3 fusion, C1–C2 subluxation, fusion of apophyseal joints
-Ank spond: Ankylosis, C5–C6 fracture, C1-C2 subluxation
-DISH: Anterior longitudinal ligament ossification, stiffness
-OA: C5–C7 spondylosis
-PM: Flexor muscle weakness
-PMR: Pain and stiffness
-Fibromyalgia: C2, C5–C7 tender points
51
most common causes of neck pain?
Cervical strain and/or myofascial pain (r/o posture, work ergonomic, sleeping issue)
-Cervical spondylosis (OA), discogenic neck pain, or facet joint pain
-Cervical whiplash syndrome (abrupt flexion/extnesion)
52
Neck pain - differentiate between a bony or muscular disorder?
Rotation/Laterl bending:
--Ipsilateral pain in direction of movement = BONY pain; vs contralateral pain/tightness = muscular disorder
53
Provocative tests for diagnosing cervical radiculopathy due to nerve root compression within the foramina of the cervical vertebrae
Spurling’s maneuver
-Shoulder abduction test
-Upper limb tension test
-Traction/neck distraction test
-Valsalva maneuver
54
Sensory, Motor, Reflex for
-C5, 6, 7, 8, T1
-L4, L5, S1
-See notes
55
What is Lhermitte’s sign?
Electric-like shock propagating down the spine as a result of brisk neck flexion (eg SC compression, MS) - in myelopathy NOT radiculopathy
56
Back pain types and examples
-* Mechanical: degenerative disk disease, nonspecific low back pain/strain (with or without psychogenic compo- nent), pregnancy, discogenic, spondylolisthesis, facet arthritis, fractures, etc.
-* Radicular: foraminal nerve root compression, spinal stenosis.
-* Inflammatory: ankylosing spondylitis.
-* Infiltrative: cancer, infectious (osteomyelitis, abscess, and discitis).
-* Referred: intraabdominal pathology (e.g., abdominal aneurysm, nephrolithiasis)
57
Back pain physical exam provocation
Sitting (worse with discogenic),
-Walking (worse with spinal stenosis—relieved with forward flexion)
-Supine (pain unrelieved if cancer or infection),
-Valsalva maneuver (worse with intrathecal or radicular process),
-Lumbar extension (worse with spinal stenosis and facet arthritis) versus flexion (worse with lumbar strain or fibromyalgia)
58
maneuvers on physical exam suggest lumbar spine nerve root irritation?
-* Femoral nerve stretch test: (L2 to L4) = most sens/spec
-* Straight-leg raise (Lasegue’s sign): evaluates the sciatic nerve roots (L4 to S1)
-* Crossed-straight leg test: this test causes contralateral radiating pain when the unaffected leg is elevated. It is usually seen in patients with a herniated disc and is more specific but less sensitive than the straight-leg raise test;
-* Slump test:
59
tests have been identified as suggesting a behavioral or nonorganic cause for back pain?
Waddell’s
-Shoes and socks and situp not typically possible w/ organic severe pain
-Mankopf’s (pulse increases by 5% w/ pain()
-O’Donoghue’s - organic = greater passive ROM than active
60
Define spondylosis, spondylitis, spondylolysis, and spondylolisthesis
Spondylosis = OA of the intervertebral disc and/or facet joints
-Spondylitis = inflammation of the vertebral column
-Spondylolysis = defective (separated) pars interarticularis, the bony bridge joining the superior and inferior articular processes of the vertebrae
-Spondylolisthesis = bilateral spondylolysis causing forward subluxation of vertebrae
61
** 4 causes of enthesopathy that are not PsA or SpA**
Inflammatory (Enthesitis)
-- All seronegative SpAs (PsA, AS, Reactive, IBD associated)
-- Behcet’s
-- CPPD
-- SAPHO
-Non-inflammatory
-- Repetitive mechanical stress from sports (MC: epicondyles, achilles, shoulder)
-- DISH
-- T2DM
-- Local trauma
-- Obesity with excess mechanical load (esp knees)
62
3 types of nerve injury
Neurapraxia (mild compression/traction) causing slowing and gain of fcn sx
-Axonotmesis (more severe) causes loss of function
-Neurotmesis = most severe = nerve transected
63
** DDX for entrapment neuropathy eg CTS **
-* Polyneuropathies.
-* Brachial plexopathy.
-* Radiculopathy.
-* Raynaud’s phenomenon.
-* Chronic regional pain syndrome.
-* Vasculitis.
-* Tendinitis
64
**Diseases assoc’d w/ CTS**
PRAGMATIC
-Pregnancy (20%)
-RA (any inflammatory arthritis)
-Acromegaly
-Glucose (diabetes)
-Mechanical (overuse, occupational)
-Amyloid
-Thyroid (myxedema)
-Infection (tuberculosis, fungal)
-Crystals (gout, pseudogout)
65
CTS Sx and Tests
Numbness commonly affects the index, middle, and radial side of the ring finger
-Tinel
-Phalen
-Durkan: Direct median nerve compression
66
Radial nerve palsy presentation
Wrist drop
-MCP finger extension weakness
67
MC entrapment neuropathy
* Median nerve entrapment: CTS, anterior interosseous nerve syndrome (can’t flex thumb/index finger to form O due to compression distal to lateral epicondyle), pronator teres syndrome (median nerve compressed by pronator teres - pain w/ pronation)
-* Ulnar nerve entrapment: cubital tunnel syndrome, ulnar tunnel syndrome.
-* Thoracic outlet syndrome (TOS).
-* Radial nerve entrapment: Saturday night palsy, posterior interosseous nerve.
-* Suprascapular nerve entrapment.
-* Meralgia paresthetica.
-* Piriformis syndrome
-* Peroneal nerve palsy.
-* Tarsal tunnel syndrome.
68
Piriformis pathology and provocative maneuvers
Sciatic nerve entrapped by piriformis from overuse, weak glutes, fat wallet → radiating pain from butt to legs worse w/ sitting,
-Tender over greater sciatic notch
-Pain with resisted hip ABduction and ER whiel seated
-Pain w/ hip flexion, adduction, IR (FAIR) while supine
69
Cause for painless vs painful foot drop
Painless = peroneal nerve compression over fibular head
Painful foot drop may suggest L5 radiculopathy, trauma, lumbar plexopathy, or mononeuritis multiplex
70
Peroneal nerve palsy symptoms
Painless foot drop
-Decreased foot eversion and dorsiflexion
71
Gain of function entrapment neuropathy symptoms
* Paresthesia
-* Spontaneous pain
-* Hyperalgesia
-* Allodynia.
72
Loss of function entrapment neuropathy symptoms
* Hypoesthesia or anesthesia
-* Muscle weakness and atrophy (2/2 denervation)
73
** Finger flexor tenosynovitis pathophys **
Localized tenosynovitis/thickening of flexor tendons near A1 pulley at metacarpal head, preventing smooth gliding of tendon
-Inflammation causes nodular enlargement of tendon distal to pulley
74
** List examples of all the kinds of joints (fibro-cartilage etc) and then tell which (of 7) kinds of synovial joints are listed.**
Synarthrosis/Fibrous (separated by thin fibrous tissue)-Sutures (skull), gomphoses (tooth in socket), syndemosis (interosseous ligament between radius and ulna)
-Ampiarthrosis/Cartilaginous (bound by flexible fibrocartilage allowing limited movement)
--Synchondroses: 2 ossification centers developing bones separated by hyaline cartilage (epiphyseal growth plate)
--Symphyses: 2 bones connected w/ fibrocartilage (eg pubic symphysis or intervertebral disk)
-
-Synovial
--Gliding: SI, AC, SC, intercarpal, intertarsal, vertebrocostal
--Hinge: elbow, knee, ankle, interphalangeal
--Pivot: atlas/axis, proximal radio-ulnar
--Ellipsoid: radiocarpal joints, MCP 2-5, MTP
--Saddle: 1st CMC
--Ball and socket: shoulder, hip
-
75
** what is a bunion / hallux valgus and Tx**
Deviation of proxomal phalanx laterally w/ 1st metatarsal head deviated medially → bunion deformity
-Tx: modified shoes w/ space for 1st MTP, orthotic, splinting, stretching, bunion pads, ice, NSAIDs
-Surgery (arthrodesis - fuse; arthroplasty - replace; osteotomy - realign; bunionectomy; tentomy - pull bones back)
76
**List the flexors of the elbow. **
Biceps brachii
-Brachialis
-Brachioradialis
-Pronator teres
77
**List 4 active movements of wrist.**
Flexion,
-Extension,
-Ulnar deviation,
-Radial deviation
78
**Name the tendon anterior to the median nerve in the carpal tunnel **
The flexor retinaculum (but this is a ligament) lies anterior, maybe that’s what they are asking? Otherwise, the palmaris longus tendon
79
** How many and which flexor tendons pass through carpal tunnel **
Flexor digitorum profundus (four tendons)
-Flexor digitorum superficialis (four tendons)
-Flexor pollicis longus (one tendon)
80
**What are joint movements at the AC and SC joints. **
AC: limited joint motion. Clavicle rotates a few degrees with small amount of translation
-SC:
-- Elevation & depression
-- Protraction and retraction
-- Axial rotation
-Both participate in scapulo humeral rhythm
81
Sprain vs Strain
Sprain = injury to ligament
-Strain = injury to muscle-tendon junction
82
** How would you differentiate L5 radiculopathy from peroneal neuropathy?**
**Ankle inversion: WEAK in L5, STRONG in peroneal lesion
-Hip abduction: WEAK in L5, STRONG in peroneal lesion**
-Tinel @ fib head: NEGATIVE in L5, POSITIVE in peroneal c
83
** Explain how you would perform an ankle injection including consent process.**
SEE UOFT Question
-
-Explain procedure
-Benefits
-Risks of needle and GC
-Explain alternatives
-Prepare equipment
-Setup
-Procedure
-Aftercare
84
**Label the 4 tendons of the volar aspect of the forearm.**
From radial to ulnar:
-Flexor carpi radialis
-Palmaris longus
-Flexor digitorum superficialis
-Flexor carpi ulnaris
85
** Extensor tendon compartments of the wrist**
1: APL/EPB
2: Extensor carpi radialis longus and brevis
Lister’s
3: EPL
4:Extensor indicis and extensor digitorum
5:Extensor digiti minimi
6:Extensor carpi ulnaris
86
Entrapment neuropathy features
Gain of fcn:
-Paresthesia
-Pain
-Hyperalgesia
-Allodynia
-Loss of fcn:
-Hypoesthesia/anesthesia
-Muscle weakness/atrophy
87
** what nerve passes through the tarsal tunnel**
Tibial nerve
88
** list 4 causes of tarsal tunnel syndrome
Extrinsic causes:
-Poorly fitting shoes,
-Trauma/Fracture (talus, calcaneus, medial malleolus)
-Valgus deformity
-DM
-Inflamm arthritis
-Hypermobility
-Generalized lower extremity edema,
-Post-surgical scarring
Intrinsic causes:
-Tendinopathy,
-Tenosynovitis,
-Perineural fibrosis,
-Osteophytes,
-Hypertrophic retinaculum,
-Space-occupying lesions (varicose veins, ganglion cyst, lipoma, neoplasm, and neuroma).
-Arterial insufficiency can lead to nerve ischemia.
89
** Tarsal tunnel syndrome tests **
Tinels sign: percuss posterior to medial malleolus
-Tourniquet test – apply pressure over the flexor retinaculum
-Holding the ankle for 10 seconds in dorsiflexion and eversion
-Sensory loss over plantar surface;
-Atrophy of intrinsic foot musculature if severe
90
** Tarsal tunnel syndrome what is it and presentation **
Compression of posterior tibial nerve inside the flexor retinaculum/tarsal tunnel
-Symptoms: Pain, paresthesia, aching on sole of foot
91
Morton’s neuroma pathophys and sx
Entrapment of interdigital plantar nerve by the transverse metatarsal ligament (btwn 3rd/4th or 2nd/3rd metatarsal heads)
-Sx: dysesthesia between 2 toes, palpable click as neuroma forced down
92
**Origin and insertion of the following:
-- Flexor Carpi Ulnaris
-- Brachioradialis
-- Biceps brachii **
Flexor Carpi Ulnaris
-- Origin: medial epicondyle
-- Insertion: Base of 5th metacarpal
-Brachioradialis
-- Origin: lateral supracondylar ridge of humerus
-- Insertion: radius - base of styloid process
-Biceps brachii
-- Origin: scapula(Supraglenoid tubercle & coracoid process)
-- Insertion: radius - radial tuberosity
93
** List order of tibialis posterior, flexors, and neurovascularu structures**
**T**ibialis posterior
-Flexor **D**igitorum longus
-Posterior Tibial **A**rtery
-Posterior Tibial **V**ein
-PosteriorTibial **N**erve
-Flexor **H**allucis longus
94
** List the borders of the tarsal tunnel and provided 5 lines**
Superior: medial malleolus
Anterior: tibia
-Posterior: posterior process of the talus
-Lateral: Calcaneus
-Inferior: Abductor hallucis
-
-and flexor retinaculum (laciniate ligament),
95
** Ulnar nerve entrapment - signs on exam**
-Percuss or pressure ulnar groove (Tinel test)
-Percuss over Guyon's canal
-Sustained maximal elbow flexion x1min with wrist in neutral position OR
-Hypothenar atrophy
-Weak finger adduction eg pinch paper (catch little finger in pocket)
-Decreased sensation to pinprick and light touch in all ulnar territories
96
** Ulnar nerve sites of entrapment **
-Cubital tunnel
-Ulnar tunnel /Guyon’s canal
97
Causes of ulnar nerve entrapment
Cubital tunnel
- Elbow synovitis, osteophytes,
- Prolonged flexion
- DM
Ulnar tunnel
- Trauma, laceration
- Ganglion cyst
- Distal vascular anomalies
- External pressure (prolonged resting on flat surface eg anesthesia)
98
Types of thoracic outlet syndrome
Vascular:
-- Subclavian artery: ischemic sx
-- Venous occlusion: edema, engorged superficial veins, thrombosis
-
-Neurologic
-- Weakness of hand intrinsic muscles
-- Sensory loss in ulnar distribution over hand/forearm
99
Thoracic outlet syndrome test
Adson manuever - palpate radial pulse while inhaling, extending neck, turning head ipsilaterally (cervical rib) and contralaterally (scalenus anticus syndrome). Positive if pulse drops and symptoms reproduced
-Hyperabduction maneuver
-Costoclavicular maneuver
100
Thoracic outlet syndrome Tx
-ROM, PT for posture
-Avoid hyperabduction
-Botox
-Surgery
-Refractory: Cervical rib or fibrous band resection
101
** C7 injury; What is the clinical presentation, motor deficit, Sensory deficit, reflexes. **
Posterior forearm pain, paresthesia of 3rd finger, might have neck pain
-Motor deficit: elbow and finger extension, wrist flexion
-Sensory deficit: 3rd finger
-Reflexes: decreased tricep reflex
102
** RA patient comes in with numbness in hands – differential diagnosis (3)?
-Name 2 investigations?**
DDX:
-CTS
-Atlantoaxial instability +/- cord compression
-Peripheral neuropathy from vasculitis
-Raynauds
-
-Ix:
-NCS/EMG
-C spine XR
-Polyneuropathy workup: B12, TSH, A1C, SPEP
103
**Patient with pain at groin, radiating to thigh and knee, burning sensation anterior thigh, hip ROM normal, SLR normal
-What nerve root is affected?
-Give one test to do on physical exam and how would you do it?
L2-L3 - sounds like Meralgia paresthetica, but they say nerve roots which implies not just the sensory branches
-
-Test:
-L2-L3 nerve root: Femoral nerve stretch test; patient lies prone, knee flexed to 90 degrees, then hip passively extended; reproduction of anterior thigh pain is positive test
-Meralgia: direct pressure over nerve where it exists pelvis
-Motor/reflexes should be normal
-Typical symptoms include burning dysesthesias and pain over the anterolateral thigh, unaffected by hip rotation or straight leg raise. In some patients, these symptoms may be elicited by performing Tinel’s test at the site of entrapment.
104
Meralgia paresthetica pathology, causes, and symptoms
Lateral femoral cutaneous nerve compression at inguinal ligament medial to ASIS → burning pain and dysesthesia over anterolateral thigh
-Cause
--Obesity,
--Preg
--Trauma
--Surgical injury (eg appendectomy
--Tight belts
--DM
105
**List causes of protrusio acetabuli **
Primary – middle aged women, associated with OA, may be familial
Secondary
-RA, AS
-Pagets, Osteomalacia
-Osteogenesis imperfecta
-Marfan
-Iatrogenic (surgery), Acetabular fracture
-Neoplasm, Infection (TB)
106
** what is protrusio acetabuli**
AP pelvis XR: medial protrusion of acetabulum >= 3 mm beyond ilio-ischial line (>6mm in women)
