muscoloskeletal

Question 1

Coronoid what attaches

Answer 1

: AMCL (anterior bundle of the medial collateral ligament)
: mid 1/3 of capsule
: deep head of brachialis

Question 2

LCL complex (think PLRI) - 4 components

Answer 2

: LUCL ( inserts at tubercle, primary restraint)
: LRCL (inserts in annular )
: ALCL
: Annular ligament

Question 3

varus stress test

Answer 3

performed by stabilizing the femur and palpating the lateral joint line

Question 4

MCL complex (think (posteromedial rotational instability) PMRI)- 3 components

Answer 4

: AOL/ AMCL (0 – 90 flexion)
: POL (> 90 flexion )
: Transverse (coopers ligament) useless

Question 5

Primary stabilisers

Answer 5

: Ulnohumeral (Bony)
: MCL complex
:LCL complex

Question 6

Secondary constraints

Answer 6

: Radiocapitellar joint
: AP Capsule
: common flexors and extensors origins

Question 7

Cubitus valgus

Answer 7

a medical deformity in which the forearm is angled away from the body to a greater degree than normal when fully extended

Question 8

Cubitus varus

Answer 8

a common deformity in which the extended forearm is deviated towards midline of the body

Question 9

Ulnar neuritis, or cubital tunnel syndrome

Answer 9

inflammation of the ulnar nerve in the arm that results in numbness or weakness in the hand

Question 10

elbow

Answer 10

look and compare
feel
range of motion
strength

Question 11

suppurative flexor tenosynovitis

Answer 11

tenderness along tendon sheath
fusiform swelling
finger held in flexion
pain with massive flexion

Question 12

motor actions of nerves

Answer 12

Radial nerve: thumb extension
Median nerve: thumb abduction
Ulnar nerve: cross finger, abduct fingers

Question 13

Dupuytren’s contracture

Answer 13

hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position

Question 14

signs in thumb

Answer 14

Froments sign - It tests the strength of the adductor pollicus of the thumb, which is innervated by the ulnar nerve and is weakened in ulnar nerve palsy
Wartenberg sign- involuntary abduction of the fifth (little) finger
Jeane sign - weak and unstable pinch with hyperextension of the thumb metacarpophalangeal

Question 15

Glenohumeral Joint Stability

Answer 15

Static
Articular congruency
Scapular inclination
Labrum (50% depth)
Vacuum effect
Glenohumeral ligaments

Dynamic
Rotator cuff
Long Head of Biceps

Question 16

T-sign (Neer‟s sign)

Answer 16

Impingement against coracoacromial arch

Pain between 70-110º

Question 17

Popeye sign

Answer 17

a pronounced bulging muscle in the distal aspect of the biceps region of the arm. It is clinically apparent with a complete long head of biceps tendon tear which causes distal migration of the long head of biceps muscle

Question 18

MRI use on shoulder

Answer 18

Best for soft tissue evaluation and bone oedema
T1 weighted sequences (Fat bright, fluid/bone dark)- Useful for Hill-Sachs lesion
T2 weighted sequences (Fluid bright, bone dark)- Rotator cuff and labral pathology

Question 19

Ultrasound of shoulder

Answer 19

Excellent to assess rotator cuff

Limited value for intraarticular structures

Question 20

Neurological examination

Answer 20

must test for senstation, motor and reflexes
C5- deltoid and biceps
C6- biceps, wrist extensors
C7- triceps, wrist flexorss, finger extensors
C8- interossei mm, figer flexors
T1- interossei mm

Question 21

Examine for myelopathy

Answer 21

L’hermitte’s
Finger escape
Grip and release
Hoffman’s- Indicative of corticothalamic dysfunction
Radial reflex

Question 22

Thoracic outlet syndrome

Answer 22

a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed.
This can cause pain in your shoulders and neck and numbness in your fingers

Question 23

Carpal tunnel syndrome

Answer 23

symptoms usually start gradually and include: Tingling or numbness. You may notice tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected

Question 24

Neurological Examination of spine

Answer 24

L4- tibialis ant

L5- extensor hallucis longis

Question 25

cervical myelopathy

Answer 25

Some causes includes degenerative mostly like osteophytes, trauma, tumours, epidural abscesses or cervical kyphosis. Neck pain and stiffness, extremety paresthesias Gait imbalance, clumsiness of the hands

Question 26

Rheumatoid cervical spondylitis

Answer 26

Present in 90% of patients with RA Atlantoaxial subluxation Basilar invagination Subaxial subluxation >4mm or 20% may indicate cord compression

Question 27

Ankylosing spondylitis/ Bechterew's disease

Answer 27

``` strikes before 45yrs some but not all pts are HLA- B27 M>W treat with NSAIDs and biologics can cause: uveitis, IBD, psoriasis ```

Question 28

Scheuermann's disease

Answer 28

self-limiting skeletal disorder of childhood where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior causing kyphosis.

Question 29

Spondylolisthesis

Answer 29

causes one of the lower vertebrae to slip forward onto the bone directly beneath it 82% L5 S1; 11% L4 L5 Complain of axial back pain, leg pain due to radiculopathy, neurogenic claudication Most patients treated nonoperatively. AAA, lifestyle modifications and Physio

Question 30

Cauda Equina syndrome

Answer 30

Bilateral leg pain, bowel and bladder dysfunction and saddle anesthesia as well as lower limb sensory motor changes Disc herniations, spinal stenosis, tumours, trauma, spinal epidural haematoma, epidural abscess. Patient requires urgent surgical decompression within 48 hours With delayed presentation sexual dysfunction, urinary dysfunction requiring catheterization, chronic pain and persistent leg weakness will occur

Question 31

Spinal TB

Answer 31

begins in metaphysis of anterior vertebral body May spread via the Anterior longitudinal ligament to contiguous bodies and in 15% to non contiguous or skip lesions Paraspinal abscess formation occurs in more than 50% Severe kyphosis can form in chronic conditions-gibbus

Question 32

vertebra plana

Answer 32

also known as the pancake or silver dollar or coin-on-edge vertebra, is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced compression fracture

Question 33

causes of vertebra plana

Answer 33

``` Infection Malignancy/Multiple Myeloma Eosinophylic Granuloma Lymphoma/Luekemia TB/Trauma ```

Question 34

Radicular pain, or radiculitis

Answer 34

pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column