Sports Medicine

Question 1

Describe two tests for subacromial impingement syndrome.

Answer 1

• Neer: internally rotate the outstretched arm and have the patient raise it
• Hawkins: place the patient’s arm in 90 degrees of shoulder and elbow flexion, then internally rotate the arm

Question 2

Describe the pathophysiology, presentation, and treatment of lateral epicondylitis.

Answer 2

• due to inflammation of the common extensor origin or extensor carpi radialis
• presents with pain over the distal lateral epicondyle and weakness of grip strength
• treat with rest, NSAIDs, PT, a counterforce sleeve, or steroid injections

Question 3

Describe the pathophysiology, presentation, and treatment of medial epicondylitis.

Answer 3

• due to inflammation of the common flexor tendon
• presents with pain over the medial epicondyle worse with valgus stress
• treat with rest, NSAIDs, PT, a counterforce sleeve, or steroid injections

Question 4

Describe the pathophysiology, presentation, diagnosis, and treatment of De Quervain tenosynovitis.

Answer 4

• due to inflammation of the extensor pollicis braves and abductor pollicis longus following repeated thumb abduction and extension
• presents as pain and tenderness over the radial side of the rest, often in new mothers constantly holding the baby
• diagnosis is with the finkelstein test: patient closes fist with thumb across the palm, producing pain
• treat with thumb spica splint, NSAIDs, and steroids

Question 5

How is a scaphoid fracture managed?

Answer 5

• the best initial test is a radiograph
• if this is negative, place in a spica splint for 2 weeks
• repeat radiograph at that time
• if this is negative, continue to treat for total of 4-6 weeks
• if symptoms persist, get a CT
• displaced fractures more than 2mm need ORIF

Question 6

What is the Lachman test?

Answer 6

• a test of ACL tear that is more sensitive than anterior draw
• involves pulling anteriorly on the tibia with the knee flexed to 30 degrees rather than 90

Question 7

What causes patellofemoral knee syndrome?

Answer 7

overuse, muscular imbalance of the quadriceps, or poor biomechanics

Question 8

Describe the associated conditions, diagnosis, and treatment of atlantoaxial instability.

Answer 8

• associated with rheumatoid arthritis and Down syndrome
• diagnosed with lateral flexion and extension x-rays
• treat with surgical fusion and use caution when intubating

Question 9

How is nursemaid’s elbow reduced?

Answer 9

perform hyperpronation followed by supination with hyperflexion

Question 10

What causes supra patellar bursitis?

Answer 10

this bursa communicates with the joint space of the knee and becomes inflamed in those with osteoarthritis

Question 11

Describe the presentation and treatment of plantar fasciitis.

Answer 11

• presents with heel pain and tenderness at the rear of foot, which worsens with the first steps of the day
• treat with stretching and steroid injection

Question 12

Describe the presentation and treatment of stress fractures.

Answer 12

• typically presents with pain over the 2nd metatarsal

- treat with rest as well as wide and hard-soled footwear

Question 13

Describe the presentation, diagnosis, and treatment of a Jones fracture.

Answer 13

• presents with pain over the 5th metatarsal and may be complicated by delayed healing
• diagnose with radiographs
• for non-displaced fractures, cast and don’t bear weight
• for displaced fractures, ORIF

Question 14

Describe the presentation, diagnosis, and treatment of a Morton Neuroma.

Answer 14

• presents with numbness and burning pain between the 3rd and 4th digits; squeezing the metatarsals causes pain and crepitus
• US or MRI to confirm the diagnosis
• treat with metatarsal support pads followed by injections or surgery