Soft Tissue Injuries

Question 1

Most accurate diagnostic test for soft tissue injuries

Answer 1

MRI

Question 2

X-ray

Answer 2

• best initial test
• indicated if there is no improvement for 6 weeks
• done to r/o fracture, tumor, arthritis

Question 3

Treatment for ACUTE soft tissue injuries

Answer 3

RICE for first 2-3 days + short course NSAIDS

• REST (mobility devices), ICE (20 min at a time), COMPRESSION (elastic bandage), ELEVATION
• Acute pain and swelling subsides = physical therapy

Question 4

Treatment for CHRONIC soft tissue injuries

Answer 4

-Relative rest
- Pain Control
- Physical Therapy
Corticosteroid injections: if no response to pain control and relative rest for 6 weeks
- Surgery: if no response to conservative therapy for 6 months

Question 5

Rotator Cuff Tendonitis

Answer 5

• pain with overhead activities
• • Neers
• • Hawkins
• painful arc syndrome
• night pain
• ROM normal

Question 6

Rotator Cuff Tendonitis Tx

Answer 6

relative rest, rehabilitation

Question 7

Rotator Cuff Tear

Answer 7

• pain and weakness on abduction
• • open can
• • drop arm test
• > 50 y/o
• decreased ROM

Question 8

Adhesive Capsulitis of the Shoulder (Frozen Shoulder)

Answer 8

• pain and limited ROM (active and passive)

Question 9

Osteoarthritis

Answer 9

• pain with activity RELIEVED WITH REST
• crepitus
• limited active and passive ROM

Question 10

Cervial Radiculopathy

Answer 10

• • pain (neck, shoulder, and forearm); poorly localized
• • sensory (numbness/parasthesia)
• • motor deficits
    + reduced reflexes

Question 11

Olecranon Bursitis

Answer 11

• minimally tender fluctuant swelling

- no limitation in ROM

Question 12

Septic Olecranon Bursitis

Answer 12

• tender, red, warm, full active and passive ROM

Question 13

Lateral Epicondylitis (tennis elbow)

Answer 13

• pain over the LATERAL aspect of the elbow with WRIST EXTENSION
• Tx: rest

Question 14

Median Epicondylitis (Golfer’s Elbow)

Answer 14

• pain over the MEDIAN aspect of the elbow with WRIST FLEXION

Question 15

Carpal Tunnel Syndrome

Answer 15

• pain/numbness 1st, 2nd, 3rd, fingers
• • tinel
• • Phalen
• thenar atrophy
• Tx: Splint in neutral position

Question 16

De Quiervain’s Tendinitis (washerwoman’s thumb)

Answer 16

• pain over radial side of hand exacerbated by thumb movements
• • finkelstein

Question 17

Acute infectious tenosynovitis

Answer 17

• s/p puncture wound/bite
• symmetric swelling of the digit
• “sausage-like”
• pain with passive extension and slightly flexed digit at rest

Question 18

Scaphoid Fracture

Answer 18

• s/p fall on outstretched hand
• • snuff box tenderness
• won’t be seen on x-ray
• cast/splint (thumb/spica cast) needed then send to ortho

Question 19

Trochanteric Bursitis

Answer 19

• lateral hip pain worse with direct pressure
• unaffected by weight bearing
• no limitations in ROM
• • trochanteric tenderness
• Tx: NSAID, relative rest - if not helpful steroids then surgery

Question 20

Hip Osteoarthritis

Answer 20

• insidious onset of anterior/groin pain worse with weight-bearing or walking relieved with rest
• Pt >50 y.o
• • crepitus
• • limited ROM

Question 21

Avascular Necrosis of the hip

Answer 21

• pts with chronic alcohol use, steroid use, sickle cell disease *****
• anterior hip/groin pain worse with weight bearing and walking relieved by rest
• Tx: surgery
• diagnosed by MRI

Question 22

Lumbosacral radiculopathy

Answer 22

• posterior hip (buttocks) pain extending to the knee accompanied by back pain, paresthesia
• normal hip ROM, + straight leg, + motor/sensory deficits, reduced reflexes

Question 23

ACL injury

Answer 23

• back to front
• Lachman + anterior drawer test
• sport injury

Question 24

PCL injury

Answer 24

• front to back
• posterior drawer test
• knee hitting dashboard

Question 25

Meniscal tear

Answer 25

- s/p vigorous sport activity - lateral or medial knee pain - exacerbated by twisting movement - sensation of "locking" or "giving away" - + McMurray test

Question 26

Patellar tendonitis/patellar bursitis

Answer 26

- ANTERIOR knee pain exacerbated by activity (repetitive knee flexion) - no limitation in passive ROM

Question 27

Osgood-Schlatter Disease

Answer 27

- young active child 9-14 yrs who have undergone a rapid growth spurt - pain and swelling of TIBIAL TUBERCLE exacerbated by activity and relieved by rest - Tx: REST

Question 28

Slipped capital femoral Epiphysis

Answer 28

- chronic or intermittent pain in hip or knee exacerbated with activity - painful limp - OBESE children 12-14 y.o - limited ROM - leg may be externally rotated - Tx: Surgery - Test: lateral x-ray

Question 29

Ankle sprain

Answer 29

- s/p acute inversion/eversion injury - pain and swelling, maybe "pop" sensation - + laxity on stretch tests - anterior drawer ankle test

Question 30

Ottawa Rules

Answer 30

- ankle x-ray required if there is any pain in malleolar zone and 1) bone tenderness at posterior edge or tip of lateral malleolus 2) posterior edge or tip of medial malleolus 3) inability to bear weight - foot x-ray required if pain in midfoot zone and 1)bone tenderness at base of 5th metatarsal 2) bone tenderness at navicular 3) inability to bear weight

Question 31

Achilles tendon strain/tear

Answer 31

- s/p injury - pain in the back of the ankle - may feel "popping" sensation - + Thompson test

Question 32

Plantar fasciitis

Answer 32

- chronic heel pain (plantar surface) with a few steps in the morning - pain gets better with walking - common in runners and pt with inappropriate footwear - Tx: supportive shoes, relative rest, splints sometimes at night

Question 33

Morton Neuroma

Answer 33

- burning pain in ball of the foot "walking on pebbles" - numbness between 3rd and 4th toes - + squeeze metatarsal joints test - issue with narrow shoes