PANCE - MSK review

Question 1

MC type of shoulder dislocation

Answer 1

anterior

Question 2

anterior shoulder dislocation presentation

Answer 2

ABducted, externally rotated, and extended arm

Question 3

assoc injuries of ANTERIOR shoulder dislocation

Answer 3

axillary nerve injury***
- MOST IMPORTANT
- loss of sensation in shoulder badge distribution
- access for axillary nerve dysfxn before AND after reduction

hill-sachs lesion
- cortical depression in humeral head due to glenoid rim

bankart lesion
- injury of the anterior (inferior) glenoid labrum

Question 4

dx of anterior shoulder dislocation

Answer 4

XR of shoulder

Question 5

tx of anterior shoulder dislocation

Answer 5

reduce and immobilize w sling

access for axillary nerve dysfunction before and after reduction!

Question 6

POSTERIOR shoulder dislocation presentation

Answer 6

ADDucted and internally rotated

Question 7

SITS muscles

Answer 7

Supraspinatus

Infraspinatus

Teres MINOR

Subscapularis

Question 8

rotator cuff PE test

Answer 8

empty can test (AKA job’s test)
- gold standard bc isolates the supraspinatus

neer test

hawkings test

Question 9

adhesive capsulitis presentation

Answer 9

reduced passive AND active ROM

Question 10

adhesive capsulitis RF

Answer 10

DM

hypothyroidism

Question 11

dx of adhesive capsulitis

Answer 11

clinical dx
- confirmed w > 50% reduction in BOTH passive and active ROM in > 2 planes
*esp external rotation and ABduction

Question 12

tx of adhesive capsulitis

Answer 12

gentle ROM exercises*

Question 13

supracondylar humerus fracture

Answer 13

fracture of distal humerus

MC in children 2-7 y/o

MC type of pediatric elbow fx

Question 14

supracondylar humerus fracture mechanism of injury

Answer 14

FOOSH w elbow hyperextended

Question 15

complications of a supracondylar humerus fracture

Answer 15

volkmann ischemic contracture
- claw like deformity –> fixed flexion of hand, fingers, & wrist

Question 16

dx of supracondylar humerus fracture

Answer 16

XR
- posterior fat pad sign

Question 17

• are sometimes the ONLY sign of a radial head fx

Answer 17

FAT PADS

Question 18

monteggia fracture (MUGR)

Answer 18

proximal ulnar fracture w radial head dislocation

Question 19

monteggia fracture (MUGR) tx

Answer 19

open reduction for ulna & closed reduction for radius

Question 20

galeazzi fracture (MUGR)

Answer 20

radial midshaft fracture w distal ulnar joint dislocation

Question 21

galeazzi fracture (MUGR) tx

Answer 21

open reduction for radius & closed reduction for ulna

cast forearm in supination to reduce distal ulnar joint

Question 22

lateral epicondylitis (tennis elbow)

Answer 22

overuse injury of common EXTENSOR tendon and EXTENSOR carpi radialis brevis due to repetitive wrist EXTENSION

Question 23

lateral epicondylitis (tennis elbow) PE

Answer 23

localized tenderness over LATERAL epicondyle

pain w resisted wrist EXTENSION

Question 24

medial epicondylitis (golfer’s elbow)

Answer 24

overuse injury of the proximal tendons of the pronator teres and FLEXOR carpi radialis due to repetitive forearm pronation and wrist flexion

*golfers are PROs that like to FLEX

Question 25

medial epicondylitis (golfer's elbow) PE

Answer 25

pain w resisted wrist FLEXION

Question 26

RF for carpal tunnel

Answer 26

- 3rd trimester of preg - DM 1 & 2 - hypothyroidism

Question 27

De Quervain tenosynovitis patho

Answer 27

thickening of the abductor pollicis longus (APL), extensor pollicis brevis (EPB), and tunnel in 1st extensor compartment *apples with extra peanut butter are delicious = APL & EPB - de quervain

Question 28

tx of De Quervain tenosynovitis

Answer 28

thumb spica splint x 3 weeks

Question 29

L1 findings

Answer 29

1 = I pain, paresthesia, and sensory loss in INGUINAL region

Question 30

L2, L3, L4 findings

Answer 30

seen in older pt w spinal stenosis anterior aspect of thigh into knee

Question 31

L5 findings

Answer 31

MC radiculopathy of lumbar spine! lateral aspect of the leg into the foot *top of foot! esp between 1st & 2nd toes reduced dorsiflexion reduced toe extension reduced foot inversion and eversion NORMAL reflexes

Question 32

S1 findings

Answer 32

posterior aspect of leg into the foot from the back reduced leg extension (gluteus maximus) reduced plantar flexion sensation loss in lateral aspect of foot ankle reflex lost!

Question 33

S2, S3, S4 findings

Answer 33

sacral or butt pain that radiates down posterior aspect of leg OR into perineum urinary & fecal incontinence sexual dysfxn

Question 34

weak ankle dorsiflexion and loss of knee jerk

Answer 34

L4

Question 35

walking on HEELS is HARDER than walking on toes

Answer 35

L5

Question 36

walking on TOES is HARDER than walking on heels

Answer 36

S1

Question 37

upper extremity weakness, decreased sensation and reflexes, positive spurling test, pain at rest

Answer 37

posterolateral herniation at C5-C6 or C6-C7

Question 38

loss of sensation in middle finger

Answer 38

C7

Question 39

loss of sensation along ulnar aspect of forearm

Answer 39

T1

Question 40

loss of sensation at radial aspect of forearm, thumb, and index finger

Answer 40

C6

Question 41

weakness of finger abductors

Answer 41

T1

Question 42

weakness of finger flexors

Answer 42

T8

Question 43

weakness of deltoid, supraspinatus, and infraspinatus

Answer 43

C5