Orthopedics - Sports Medicine Injuries Flashcards
(81 cards)
1
Q
What are the common signs & symptoms associated with subacromial impingement syndrome?
A
- Shoulder pain with overhead motion
- Night pain with sleeping on shoulder
- Pain with internal rotation
2
Q
What tests do you do to look for impingement syndromes?
A
The Neer and Hawkins tests
3
Q
What are the common signs & symptoms associated wtih rotator cuff tears?
A
- Difficulty lifting the arm
- Limited ROM
- Weakness of rotator cuff muscles with resisted strength testing
4
Q
What is a common cause of shoulder impingement syndrome after age 40?
A
Partial rotator cuff tears
5
Q
What is the most commonly torn tendon in rotator cuff tears?
A
The supraspinatus
6
Q
What test do you use to measure supraspinatus tendon strength?
A
The “open can” test
7
Q
What test do you use to measure subscapularis tendon strength?
A
“Lift-off” or “belly-press” tests
8
Q
What direction are most shoulder dislocations in?
A
The anterior direction (95%)
9
Q
What test do you use to assess for shoulder instability?
A
The apprehension test - pain and apprehension with an shoulder that is abducted and externally rotated
10
Q
What demographic have the highest rate of redislocation in a previously dislocated shoulder?
A
Patients age 21 years or younger (70-90%)
11
Q
What are the common signs and symptoms of a dislocated shoulder?
A
- Obvious deformity, humeral head is usually dislocated anteriorly
- Acute pain that is improved w manual relocation of the shoulder
12
Q
What are the common signs and symptoms of adhesive capsulitis (aka “frozen shoulder”)?
A
- Very painful shoulder triggered by minimal or no trauma
- Limited ROM (both passive and active)
- Pain out of proportion to clinical findings during the inflammatory phase
- Stiffness during the “freezing” phase and resolution during the “thawing” phase
13
Q
Who typically gets adhesive capsulitis?
A
- Patients 40-65 y/o, most often seen in women than men
- More likely in patients w endocrine disorders (DM, thyroid disease)
14
Q
What are the three phases of adhesive capsulitis?
A
Inflammatory phase (4-6 months) Freezing phase (4-6 months) Thawing phase (can take up to a year)
15
Q
What is the second most common cause for primary care visits?
A
Low back pain
16
Q
What are some of the “alarming” symptoms besides back pain that might suggest multiple myeloma or other malignancy?
A
- Unexplained weight loss
- Failure to improve with treatment
- Pain for more than 6 weeks
- Pain at night or rest
17
Q
What are some of the “alarming” symptoms besides back pain that might suggest infection?
A
- Fever
- Pain at rest
- Recent infection (UTI, cellulitis, pneumonia)
- Hx of immunocompromise or IVDU
18
Q
Along with back pain, what other symptoms suggest cauda equina syndrome?
A
- Urinary retention or incontinence
- Saddle anesthesia
- Decreased anal sphincter tone or fecal incontinence
- Bilateral lower extremity weakness
- Progressive neurologic deficits
19
Q
What are the risk factors for back pain due to vertebral fracture?
A
- Corticosteroids
- Age > 70 years
- Hx of osteoporosis
- Recent significant trauma
- Very severe focal pain
20
Q
What exam should be done if cauda equina syndrome is suspected?
A
A rectal exam, of course!
21
Q
What are the common signs and symptoms of spinal stenosis?
A
- Pain is usually worse with back extension and relieved by sitting
- Occurs in older patients (50+)
- May present with neurogenic claudication symptoms with walking (lewg symptoms that are worse after walking several minutes and relieved by sitting; due to a large disc herniation)
22
Q
What are the common signs and symptoms of lumbar disk herniation?
A
- Pain with back flexion or prolonged sitting
- Pain is localized at the level of the affected disk and is worse with activivty
- Radicular pain with compression of neural structures
- Lower extremity numbness and weakness
23
Q
What is the typical cause of lumbar disk herniation?
A
- Bending or heavy loading with the back in flexion
- Degenerative disk disease in patients btw 30-50
24
Q
What causes cauda equina syndrome?
A
Severe compression of the spinal cord
25
What disk is affected in lumbar disk herniation in 90% of the cases?
L5-S1
26
What is the most common type of traumatic injury to the neck?
Whiplash
27
What are the most common signs and symptoms of lateral epicondylitis?
- Pain with the arm and wrist extended (eg pain while shaking hands, using a computer mouse, or hitting a backhand in tennis)
- Pain/tenderness directly over the epicondyle
- Hx of repetitive movements involving lifting with the wrist and elbow extended
28
What are the common signs and symptoms of medial epicondylitis?
- Pain during motions in which the arm is repetitively pronated or the wrist is flexed (eg during a golf swing)
- Pain/tenderness directly over the epicondyle
29
What tendon(s) does lateral epicondylitis involve?
The wrist extensors
30
What tendon(s) does medial epicondylitis involve?
The wrist flexors, and most commonly the pronator teres tendon
31
What are the common signs and symptoms of carpal tunnel syndrome?
- Pain, burning, and tingling in the distribution of the median nerve
- Initially, most bothersome during sleep
- Later, weakness or atrophy, esp of the thenar eminence
32
Who typically presents w carpal tunnel syndrome?
- Commonly seen during pregnancy and in patients with DM or rheumatoid arthritis
33
If someone were to have pain in the distribution of the median nerve, where would they have pain?
- The palmar surfaces of the thumb, the index and long fingers, and the radial half of the ring finger
34
What are the tests used to assess for carpal tunnel syndrome?
- Tinel sign
| - Phalen sign
35
Who typically presents with Dupuytren Contracture?
- White men over 50 y/o
| - Higher incidence among alcoholics and those w cirrhosis
36
What are the common signs and symptoms of Dupuytren Contracture?
- Nodular or cord-like thickening of one or both hands (the 4th and 5th fingers are most commonly affected)
- Tightness of the involved digits with inability to extend the fingers
37
What is bursitis usually secondary to?
Trauma, infection, or arthritic conditions like gout, RA, or OA
38
What are the two more common sites of bursitis?
Olecranon and prepatellar bursae
39
Compared to arthritis, what is bursitis more likely to present with?
More likely to cause focal tenderness and swelling than arthritis
Less likely to affect range of motion of the adjacent joint than arthritis
40
If someone has a Baker cyst that ruptures, what are the signs and symptoms?
Calf pain and swelling; mimics thrombophlebitis
41
What bursa does a Baker cyst occur on?
The semimembranous-gastrocnemius bursa
42
What are risk factors for hip fracture?
- Osteoporosis
- Female sex
- Height over 5'8"
- Age over 50 years
43
What is the most sensitive test to identify a hip fracture?
Internal rotation of the hip
44
What are the common signs and symptoms of a hip fracture?
- Pain in the groin; pain radiating to the lateral hip, buttock, or knee can also commonly occur
- If fracture is displaced, pt will not be able to bear weight and the leg may be externally rotated
- Pain with deep palpation in the area of the femoral triangle
45
What are the common signs and symptoms of osteoarthritis of the hip?
- Pain deep in the groin on the affected side, especially with loading of the joint or dring motion
- Problems with weight-bearing activities
- Swelling
- Loss of active and passive ROM (in severe OA)
46
What does acute knee swelling (hemarthrosis) within 2 hours indicate?
Ligament injuries (ACL usually) or patellar dislocation or fracture
47
What does the presence of grinding, clicking or popping with bending of the knee suggest?
Osteoarthritis or patellofemoral syndrome
48
What does "locking" or "catching" of the knee when walking suggest?
An internal derangement, such as a meniscal injury or a loose body in the knee
49
What can lateral "snapping" with flexion and extension of the knee indicate?
Inflammation of the IT band
50
What does pain that is worsened with bending and walking downstairs suggest?
An issue with the patellofemoral joint (usually degenerative, such as chondromalacia of the patella or osteoarthritis)
51
What does pain that occurs when rising after prolonged sitting suggest?
A problem with tracking of the patella
52
What are the signs and symptoms of an ACL injury?
- An injury involving an audible pop when the knee buckles
- Acute swelling immediately (or within 4 hours)
- Instability occurs with lateral movement activities and going down stairs
53
What kind of activities do ACL injuries result from?
```
Both contact (valgus blow to the knee) and non-contact (jumping, pivoting, and deceleration) activities
- Common in skiing, soccer, football, and basketball
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54
What test(s) do you use when suspecting ACL injury?
The Lachman test
The anterior drawer test
The pivot shift test
55
What is the most commonly injured ligament in the knee?
The MCL
56
What two ligaments commonly are injured concurrently?
MCL and ACL
57
What are the signs and symptoms associated with collateral ligament injury?
- Caused by valgus or varus blow or stress to the knee
- Pain and instability in the affected area
- Limited range of motion
58
What tests are best to use to assess the collateral ligaments?
- Varus (LCL) and valgus (MCL) stress testes
59
What are the signs and symptoms of a PCL injury?
- The knee may freely dislocate and reduce
- Difficulty ambulating
- The "sag sign": the PCL injured knee has an obvious set-off at the anterior tibia which is "sagging" posteriorly
60
When do PCL injuries typically occur?
- Following an anterior trauma to the tibia, such as dashboard injury during a motor vehicle accident
61
When suspecting a PCL injury, what else should you maintain a high suspicion for/
Neurovascular injuries
62
What test should you use to check for a PCL injury?
Posterior drawer test
63
What are the most sensitive signs of meniscus injuries?
- Joint line pain and pain with deep squatting
64
What can lead to a pain, clicking, and locking sensation or the knee?
Meniscal injuries
65
What are the common signs and symptoms of meniscal injuries?
- An antalgic gait
- Difficulty with squatting
- Catching or locking of the meniscal fragment
- Effusion or joint line tenderness
- Swelling that occurs during the first 24 hours after the injury or later
66
What tests can be used when suspecting meniscal injury?
- McMurray test
67
What are the common signs and symptoms of patellofemoral pain?
- Pain experienced with bending activities (kneeling, squatting, climbing stairs)
- Lateral deviation or tilting of the patella in relation to the femoral groove
- When maltracking, palpable and sometimes audible crepitus can occur
68
What typically causes patellofemoral pain?
- Trauma or a repetitive physical activity, such as running and jumping
69
What tests can you use to assess stability of the patellofemoral joint?
The apprehension sign
70
What test is used when suspecting chondromalacia of the patella?
The patellar grind test
71
What are the two common etiologies for patellofemoral pain?
- The ligaments and patella are too loose (hypermobility)
| - Soft tissue are too tight which leads to excessive pressure on the joint
72
How do you evaluate quadriceps and hip stabilizer strength?
A one-leg without support
73
What do the majority of ankle injuries involve?
Inversion injuries affecting the lateral ligaments
74
When should you consider chronic ankle instability?
If pain persists for more than 3 months following an ankle sprain
75
What are the most common sports injuries seen in outpatient clinics?
Ankle sprains
76
What is the most common mechanism of injury of an inversion ankle sprain?
- Inversion and plantarflexion sprain which involves the anterior talofibular ligament
77
What are the common signs and symptoms following a sprain?
- Localized pain and swelling over the lateral aspect of the ankle
- Difficulty weight bearing
- Limping
- Swelling, bruising over the lateral aspect of the ankle
- The anterior, inferior aspect below the lateral malleolus is most often the point of maximal tenderness
78
What tests can you do to assess for an inversion ankle sprain?
- Anterior drawer test
| - Subtalar tilt test
79
What are the signs and symptoms of an eversion ankle sprain?
- Severe and prolonged pain
- Limited range of motion
- Mild swelling
- Difficulty with weight bearing
80
What ligament is most often injured in an eversion ankle sprain?
- The anterior tibiofibular ligmament
81
What test can you do to assess for an eversion ankle sprain?
- External rotation stress test
