Soft Tissue Injuries

Question 1

inflammation of the thin, fluid-filled sacs around the elbow that act as cushions between bones and soft tissue

Answer 1

olecranon bursitis

Question 2

type of olecranon bursitis typically caused by repeated trauma or leaning on the elbow for a long time

Answer 2

inflammatory bursitis (aseptic)

Question 3

type of olecranon bursitis caused by a skin break due to scrape or bite

Answer 3

infectious

Question 4

a patient presents with red, hot, swollen, tender elbow, decreased ROM, elbow warm to touch, without pain with axial load. Dx?

Answer 4

olecranon bursitis

Question 5

how is olecranon bursitis diagnosed?

Answer 5

H&P

Question 6

what is the treatment for inflammatory olecranon bursitis? (4)

Answer 6

NSAIDs
RICE
elbow pads
+/- aspiration/steroid injections

Question 7

what is the treatment for infectious olecranon bursitis? (2)

Answer 7

empiric antibiotics
+/- I&D

Question 8

what is the treatment for infectious olecranon bursitis that does not improve with abx and I&D?

Answer 8

surgical bursectomy

Question 9

what are the usual organisms in infectious olecranon bursitis? (2)

Answer 9

staph
strep

Question 10

defined as a chronic tendinosis

Answer 10

epicondylitis

Question 11

also known as tennis elbow; causes tendinosis and inflammation of the extensor carpi radialis brevis muscle

Answer 11

lateral epicondylitis

Question 12

lateral epicondylitis occurs d/t overuse injury at the origin of what?

Answer 12

common extensor tendon

Question 13

a patient presents with pain with resisted wrist extension, pain with gripping, pain with passive wrist flexion, and TTP over extensor carpi radialis brevis with resisted wrist extension and elbow in full extension. Dx?

Answer 13

lateral epicondylitis

Question 14

also known as golfer’s elbow; injury d/t overuse of the flexor-pronator mass

Answer 14

medial epicondylitis

Question 15

medial epicondylitis involves what?

Answer 15

all common flexor tendons, except palmaris longus

Question 16

a patient presents with medial elbow pain, pain with gripping, and tenderness with gripping or resisted wrist flexion and pronation. Dx?

Answer 16

medial epicondylitis

Question 17

how to diagnose lateral and medial epicondylitis?

Answer 17

H&P

Question 18

what is the treatment for lateral and medial epicondylitis? (5)

Answer 18

NSAIDs
RICE
physical therapy
bracing
steroid injections for inflammation

Question 19

when can surgery be considered for lateral and medial epicondylitis?

Answer 19

after 6 months of failed conservative treatment

Question 20

peripheral compressive neuropathy of the ulnar nerve within the medial elbow

Answer 20

cubital tunnel syndrome

Question 21

what is the 2nd most common compression neuropathy of the upper extremity?

Answer 21

cubital tunnel syndrome

Question 22

where is the most common site of compression in cubital tunnel syndrome?

Answer 22

between the 2 heads of flexor carpi ulnaris and aponeurosis

Question 23

a patient presents with paresthesia of the small finger, ulnar half of the ring finger, and ulnar dorsal of the hand. it is worse with full elbow flexion and at night while sleeping. Dx?

Answer 23

cubital tunnel syndrome

Question 24

what will be seen in physical exam of a patient with cubital tunnel syndrome? (2)

Answer 24

loss of adductor pollicis (pinky)
positive tinel’s test

Question 25

what is the non-op treatment for cubital tunnel syndrome? (2)

Answer 25

NSAIDs nighttime extension splinting in 45 degrees

Question 26

what is the op treatment for cubital tunnel syndrome when conservative tx fails and when patient is having weakness?

Answer 26

ulnar nerve decompression

Question 27

peripheral compression neuropathy of the median nerve at the level of the wrist

Answer 27

carpal tunnel syndrome

Question 28

what is the most common compression neuropathy of the upper extremity?

Answer 28

carpal tunnel syndrome

Question 29

a patient presents with pain and numbness in thumb, index, middle finger, and radial side of ring finger; they have weakness with grip and pain is worse at night while sleeping. Dx?

Answer 29

carpal tunnel syndrome

Question 30

what will be seen in physical exam of a patient with carpal tunnel syndrome? (3)

Answer 30

thenar atrophy positive phalen test (wrist flexion) positive tinel's test

Question 31

what is the non-op treatment for carpal tunnel syndrome? (3)

Answer 31

NSAIDs nighttime splinting +/- steroid injections

Question 32

what is the op treatment for carpal tunnel syndrome when non-op fails or when patient has weakness?

Answer 32

carpal tunnel release

Question 33

mucin-filled synovial cyst; most commonly on the hand/wrist

Answer 33

ganglion cyst

Question 34

where is a ganglion cyst most common?

Answer 34

dorsal carpal of wrist

Question 35

how do ganglion cysts usually present?

Answer 35

asymptomatic

Question 36

what is the non-op treatment for a ganglion cyst?

Answer 36

bracing

Question 37

what is the 2nd line treatment for a ganglion cyst?

Answer 37

aspiration

Question 38

why is aspiration of a ganglion cyst on the volar aspect avoided?

Answer 38

radial artery

Question 39

what is the op treatment for a ganglion cyst if severe symptoms or neurovascular manifestations?

Answer 39

surgical resection

Question 40

mechanical impingement of a flexor tendon on the hand; thickens and forms a nodule that catches on the flexor tendon sheath

Answer 40

trigger finger

Question 41

trigger finger is most common in which 2 fingers?

Answer 41

ring finger long finger

Question 42

a patient presents with finger pain at the A1 pulley, has clicking, and the finger is locked in flexed position at the PIP joint. Dx?

Answer 42

trigger finger

Question 43

where does a patient have tenderness if they have trigger finger?

Answer 43

MCP joint

Question 44

what is the non-op treatment for trigger finger? (3)

Answer 44

NSAIDs splinting steroid injections

Question 45

what is the operative treatment for a trigger finger?

Answer 45

surgical release of A1 pulley

Question 46

thickening and contraction of the palmer fascia that leads to flexion of the fingers making it difficult to extend

Answer 46

dupuytren's contracture

Question 47

which fingers are most commonly affected by dupuytren's contracture?

Answer 47

ring finger small finger

Question 48

a patient presents with their finger held in flexion, is unable to extend it, has decreased ROM, and painful fascia; a nodular band of thick tissue is seen along the palm of the hand which is TTP. Dx?

Answer 48

dupuytren's contracture

Question 49

which joint is most affected by dupuytren's contracture?

Answer 49

MCP joint

Question 50

what is the non-op treatment for dupuytren's contracture?

Answer 50

**hand therapy** steroid injections + clostridial injections by hand surgeon

Question 51

what is the op treatment for dupuytren's contracture?

Answer 51

palmar fasciectomy

Question 52

a thumb collateral ligament injury caused by radially-directed force, causing hyper-abduction of the thumb's MCP joint

Answer 52

gamekeeper's thumb (Ulnar Collateral Ligament Injury)

Question 53

a patient presents with pain at the ulnar side of the thumb's MCP joint, increased pain with pinch/grasp. Dx?

Answer 53

gamekeepers thumb (Ulnar Collateral Ligament Injury)

Question 54

what imaging diagnoses a gamekeeper's thumb?

Answer 54

thumb xrays +/- stress views

Question 54

what exam showing radial instability in 20 degrees indicates an injury to the ulnar collateral ligament of the thumb?

Answer 54

radial-ulnar stress exam

Question 55

what is the non-op treatment for a grade 1-2 partial gamekeeper's thumb?

Answer 55

thumb spica splint

Question 56

what is the treatment for a grade 3 gamekeeper's thumb?

Answer 56

UCL repair

Question 57

what is the treatment for a chronic gamekeeper's thumb?

Answer 57

UCL reconstruction with tendon graft

Question 58

inflammation of the 1st dorsal compartment, involving the extensor pollicis brevis and abductor pollicis longus at the base of the thumb

Answer 58

De Quervain's tenosynovitis

Question 59

a patient presents with pain on the radial side of the wrist that is worse with gripping, they have tenderness over the 1st dorsal compartment at the radial styloid, and has resisted radial deviation. Dx?

Answer 59

De Quervain's tenosynovitis

Question 60

what test causes pain when grasping the thumb in closed fingers with ulnar deviation?

Answer 60

finkelstein test

Question 61

what is the non-op treatment for De Quervain's tenosynovitis (3)

Answer 61

thumb spica splint NSAIDs steroid injections

Question 62

what is the op treatment for De Quervain's tenosynovitis?

Answer 62

surgical release of 1st dorsal compartment

Question 63

common cause of hip pain in which impingement occurs in the bursa, causing it to become irritated or inflamed

Answer 63

trochanteric hip bursitis

Question 64

where does trochanteric hip bursitis occur?

Answer 64

deep to IT band and superficial to abductor muscles

Question 65

a patient presents with pain to lateral side of their hip, has point tenderness, but has normal ROM. Dx?

Answer 65

trochanteric hip bursitis

Question 66

what is the treatment for trochanteric hip bursitis? (3)

Answer 66

RICE / heat anti-inflammatories physical therapy

Question 67

what can be used to treat trochanteric hip bursitis if the patient cannot do physical therapy?

Answer 67

steroid injections

Question 68

swelling and inflammation of the anterior knee bursa associated with pain during kneeling

Answer 68

prepatellar bursitis

Question 69

a patient presents with pain and swelling over their anterior knee, is warm to touch, decreased ROM, and tender to touch. Dx?

Answer 69

prepatellar bursitis

Question 70

what should be done during diagnosis of prepatellar bursitis? (2)

Answer 70

aspiration w/ gram stain + culture xray to r/o foreign body

Question 71

what is the most common organism in prepatellar bursitis?

Answer 71

staph aureus

Question 72

what is the non-op treatment for prepatellar bursitis? (3)

Answer 72

RICE NSAIDs aspiration

Question 73

what is the op treatment for prepatellar bursitis if it is septic?

Answer 73

I&D

Question 74

a patient presents with pain/lump in the back of the knee with swelling in the knee or lower leg. they have a normal knee exam but have decreased ROM with flexion. Dx?

Answer 74

popliteal (baker's) cyst

Question 75

what 3 imaging can be used to diagnose popliteal (baker's) cyst?

Answer 75

knee xray ultrasound (determines size) MRI (shows inflammation)

Question 76

what is the non-op treatment for a popliteal (baker's) cyst? (4)

Answer 76

RICE NSAIDs steroid injections aspiration

Question 77

what is the op treatment for popliteal (baker's) cyst?

Answer 77

surgery with arthroscopy

Question 78

a patient presents with sharp pain and redness in the leg/calf, has bruising along their ankle. Dx?

Answer 78

baker's cyst rupture

Question 79

what is the treatment for a baker's cyst rupture?

Answer 79

self-limiting

Question 80

what is a complication of baker's cyst rupture?

Answer 80

compartment syndrome

Question 81

which ligament is most commonly involved in an ankle sprain?

Answer 81

anterior talofibular ligament

Question 82

what 2 tests can be used to assess a possible ankle sprain?

Answer 82

squeeze test external rotation stress test

Question 83

what imaging should be done for an ankle sprain?

Answer 83

3 view xray

Question 84

what is the treatment for an ankle sprain? (4)

Answer 84

RICE anti-inflammatories ankle brace or walking boot physical therapy

Question 85

caused d/t limited blood supply, prone to injury within the hypo vascular zone and occurs 4-6 cm above the calcaneal insertion

Answer 85

Achilles tendon rupture

Question 86

a patient has a loss of resting foot tone, weakness to plantarflexion, and has a positive thompson test. Dx?

Answer 86

achilles tendon rupture

Question 87

what should always be done for a patient with an achilles tendon rupture?

Answer 87

refer to ortho

Question 88

which patients should have non-op treatment of an achilles tendon rupture? (3)

Answer 88

sedentary patient elderly co-morbidities

Question 89

what type of achilles tendon rupture can receive op treatment?

Answer 89

acute rupture < 6 weeks

Question 90

compressive neuropathy of the foot causing pain d/t compression of the interdigital nerve

Answer 90

interdigital neuroma (morton's neuroma)

Question 91

what ligament is responsible for interdigital neuroma?

Answer 91

transverse intermetatarsal ligament

Question 92

which webspaces are most commonly affected by interdigital neuroma?

Answer 92

3rd and 4th webspace

Question 93

a patient presents with pain to forefoot that is worse with tight shoes, has TTP between metatarsal heads, and a mulder's click when compressing the metatarsal heads. Dx?

Answer 93

interdigital neuroma (morton's neuroma)

Question 94

what imaging is most helpful when diagnosing interdigital neuroma? what will it show?

Answer 94

ultrasound oval hypoechoic mass

Question 95

what is the non-op treatment for an interdigital neuroma?

Answer 95

change in shoe wear steroid injections

Question 96

what is the op treatment for interdigital neuroma?

Answer 96

neurectomy

Question 97

inflammation of the aponeurosis of the calcaneus origin with pain along the plantarmedial heel

Answer 97

plantar fasciitis

Question 98

a patient reports pain with 1st step out of bed that is relieved with walking, and is worse at the end of the day. they are tender over the medial side of the plantar heel and dorsiflexion of the great toe increases pain. Dx?

Answer 98

plantar fasciitis

Question 99

what may present in an xray of plantar fasciits?

Answer 99

plantar heel spur

Question 100

what is the treatment for plantar fasciits? (4)

Answer 100

**stretching** heel cushion inserts night splints walking boot

Question 101

what is the last treatment option for plantar fasciitis since it can cause fat pad atrophy?

Answer 101

steroid injections