Sports Medicine

Question 1

What is subacromial impingement? What 2 tests can you do?

Answer 1

Impingement of any rotator cuff tendons within cuff, can lead to tears if chronic, overhead activities

1 - Neer (arm in air, internally rotate near the ear, pos if pain)

2 - Hawkins (arm at 90 degrees with bended elbow like escorting someone to dance, internally rotate, pos if pain)

Question 2

What is the most commonly torn rotator cuff tendon? What test can you do?

Answer 2

Supraspinatous (first 15 degrees of abduction)

Jobe/empty can test (internally rotate with thumb down, push down as patient tries to push up, pos if pain)

Question 3

Where does biceps tendinitis most commonly occur? What does it look like if it ruptures? How do you treat these?

Answer 3

Most common = proximal long head in bicipital groove

Rupture = Popeye sign (visible bulge), ecchymosis, pain, audible snap

Tx = conservative for tendinitis +/- steroid injections, reattach tendon in young person if ruptures

Question 4

How do you test for acromiocalvicular separation?

Answer 4

Cross arm / adductor test - PAIN is pos

X-RAY

Question 5

How does a labrum tear present? How do you treat it?

Answer 5

Shoulder instability (pain, locking, clicking)

“dead arm” - fatigue, numbness, tingling w/ overhead movements

Tx = PT, surgery if refractory

Question 6

De Quervian Tenosynovitis

Answer 6

Pain and tenderness of radial wrist from overuse of thumb abduction and extension

Ex ) mom holding infant, texting, bowling

Finkelstein test (flex thumb in and deviate wrist to ulnar side)

Tx - NSAIDs, thumb spicca splint, steroid injection

Question 7

How do you treat avascular necrosis of femoral head?

Answer 7

Total hip replacement

Question 8

Knee Ligament Injury Mechanisms & Tests

Answer 8

ACL - non-contact, from cutting

PCL - posterior force on planted leg like dashboard in car accident

MCL - valgus stress

LCL - RARE

Ant/Post Drawer
Lachman (more sensitive)
Valgus/Varus stress tests

Question 9

How does a meniscal tear present? Mechanism? Tx?

Answer 9

Pop followed by pain and significant effusion in first 24 hours

Pop, lock, clicking w/ movement

Joint line tenderness

Medial - cut on a planted flexed knee
Lateral - squatting or wrestling

Tx - if mild NSAIDs and rest, if severe and last 3-4 wks in young patient do surgery

Question 10

McMurray Test

Answer 10

For meniscal tears

Lay supine, flex hip and knee, palpate joint line

Then rotate tibia out to apply valgus force (checks medical), rotate tibia in to apply varus force (checks lateral)

Pos if popping, clicking, pain

Question 11

Jones Fracture

Answer 11

5th metatarsal fracture (pinky toe)

Commonly occurs w/ ankle sprains, when heel up but forefoot planted

Tx = 6-8 wks in cast w/o wt bearing

Question 12

Tarsal Tunnel Structures & Syndrome

Answer 12

“Tom, Dick And Very Nervous Harry”

Tibialis anterior
Digitorum longus
Artery
Vein
Nerve (tibial nerve)
Hallicus longus 

Entrapment of tibial nerve in medial tunnel –> pain, tingling, burning

Tx - NSAIDs, possible tunnel release if nerve damage

Question 13

Morton Neuroma

Answer 13

Numbness and burning between 3rd and 4th toes

Mulder sign - squeeze toes in lateral-medical direction and palpate to feel crepitus

Tx - hard sole shoes

Question 14

How do you diagnose atlanto-axial instability?

Answer 14

Lateral neck x-ray with flexion and extension

Question 15

Pes anserine

Answer 15

Bursitis of medical knee

Pain inferior/distal to medical joint line

Where gracilus, sartorius and semitendinosus insert)

Question 16

Osgood Schlatter v. Patellofmoral Syndrome

Answer 16

OS - avulsion at tibial tuberosity in adolescents as they grow, pain localized to tibial tuberosity (tendon insertion site)

Patellofemoral - overuse injury (esp runners), pain more localized to the patella intself

**Both anterior knee pain, both conservative mgt (NSAIDs)

Question 17

How do you treat nursemaid’s elbow?

Answer 17

Hyperpronation OR supination with hyperflexion while applying force on radial head

INSTANT PAIN RELIEF