T2- MSK

Question 1

OA s/s usually appear during the _______ generation of life.

Answer 1

4-6th

Question 2

What are Heberden Nodes associated with and where are they found?

Answer 2

Associated with OA and found in the DIP joints.

Question 3

What are Bourchards nodes associated with and where are they found?

Answer 3

Associated with OA + RA - found in the PIP joint.

Question 4

Knee arthritis is ________% of the compartment.

Answer 4

> 70%

Question 5

What is an “empty can” test and what does it assess for?

Answer 5

Rotator cuff test.
Supraspinatus.

Question 6

What are the 4 muscles of the rotator cuff and what do they do?

Answer 6

SITS
Supraspinatus - abduction of the arm 1st 15%
Infraspinatus - lateral rotation (external rotation)
Teres minor - lateral/external rotation
Subscapularis - medial/internal rotation.

Question 7

How can we test the full array of rotator cuff muscles?

Answer 7

Empty can test - Supraspinatus
Arms at side with elbow’s flexed at 90*. Anchor elbow at side and have the patient resist against external and internal rotation (infraspinatus and teres minor)
Lift off test - either on back or on stomach = subscapularis.

Question 8

When assessing for rotator cuff TEARS, there will be pain AND _________

Answer 8

Weakness.

Question 9

Why would you use provocative tests in assessing for shoulder pain? What are some examples?

Answer 9

To isolate which muscle, tendon, joint space, etc is causing the pain.
-Apply scratch test (over and under) - ROM in rotator cuffs
-Neer’s test - forced flexion of the arm (lifted above the head) while hands are pronated. Pain = impinged rotator cuff tendons under choracromion arch.
-Hawkin’s test - forward elevated to 90* and forcibly internally rotated - same as Neers and more sensitive
-Drop arm test
-Cross-arm test - pain in acromeoclavicular joint isolates the joint itself as the issue - acromiocavicular arthritis.

Question 10

Stability tests for the shoulder.

Answer 10

Aprehension test.
Relocation test

Question 11

Patients with rotator cuff tendinitis usually have concomitant ________

Answer 11

Biceps tendinitis.

Question 12

What does Yergason test test for? What is another test to test for this same issue?

Answer 12

Biceps tendinitis.
Arms at side, flex elbows at 90*. The provider resists the patient’s attempt to supinate and flex the elbow.
Speeds Maneuver.

Question 13

What is the Speeds maneuver and what does it test for?

Answer 13

Arm in 60* flexion, elbow in 20-30* flexion and supinated. Provider resists flexion of arm while palpating the biceps tendon - tendinitis

Question 14

What is the “clunk sign” and what does it test for?

Answer 14

Pt supine with arm rotated and loaded from extension through forward flexion. Clunk = glenoid labral tear.

Question 15

When is it not pathological to have a sulcus sign?

Answer 15

Teens. They are just naturally lax and have some degree of instability.

Question 16

What is spurling’s test? When would you use it and when would you NOT use it?

Answer 16

If patient c/o shoulder pain that radiates down the arm past the elbow, it could have origins in the c-spine (compression, radiculopathy)
Place the patient’s head in slight extension and rotate towards affected shoulder, then axial load. If this reproduces the patient’s pain, then get imaging (x-ray and ct c-spine)
Do not do this if patient has recent neck trauma or surgery.

Question 17

For acromioclavicular injury (clavicular subluxation) - which is worse - Type I or type V?

Answer 17

type V is worse, and type VI is rare (displaced underneath the coracoid).

Question 18

Keep a close eye on olecranon bursitis - it could progress to

Answer 18

Septic arthritis easier than other joints - thinner skin and more susceptible to bumping and bruising

Question 19

If your patient has a bump under the skin on top or underneath their wrist that may wax and wane, tender or not, transiluminates, firm but mobile and isolated, what could it be?

Answer 19

Ganglion cyst.

Question 20

What are 2 tests to check for carpal tunnel syndrome?

Answer 20

Phalen’s (upside down praying hands) and tunnels (tapping on the anterior aspect of the wrist)

Question 21

Carpal tunnel is the impingement of the _________ nerve underneath the wrist fascia.

Answer 21

Median

Question 22

________ works very well for carpal tunnel.

Answer 22

Splinting.

Question 23

Dequarvains’ tenosynovitis affects what tendons?

Answer 23

Extensor policis breves and abductor policis longus

Question 24

What are some red flags for back pain?

Answer 24

Hx of cancer,
Nocturnal pain (unrelenting)
Wt. loss
Fever, chills, night sweats
Age <15 or >50
Neuro deficits such as saddle anesthesia or incontinence.

Question 25

What is the difference between spondylOSIS, spondyloLYSIS, and spondyloLISTHESIS

Answer 25

SpondylOSIS = DJD affecting vertebrae and intervertebral discs SpondyloLYISIS = fracture of pars interarticularis SpondyloLISTHESIS = displacement of one vertebra on another (slipped disc?)

Question 26

A CT can isolate/better visualize bony abnormalities than an MRI.

Question 27

If you have an _________ injury, you can walk fine, but the minute you try to run, you have unilateral hip to knee pain (most commonly just above the knee laterally)

Answer 27

IT band.

Question 28

Difference between Patelofemoral pain syndrome (PFPS) Patellar tendinitis

Answer 28

PFPS - abnormal tracking of patella (usually to lateral side), F>M, anterior knee pain with posterior patellar pain, worse with squatting, jumping, stairs, hill running and prolonged sitting. No swelling. “Giving out” sensation. Rocking patella may elicit pain, possible tight ITB. Patellar tendinitis - “jumper’s knee.” Either quadriceps tendon at patellar insertion OR patellar tendon at tibial tubercle insertion. Athletes, changes in exercise level or weight gain. Point tender to anterior lower knee. Stairs is most common precipitator of pain. “Popping: of the knee. Crepitus with ROM, mild swelling of infra patellar bursa, possible quadriceps atrophy.

Question 29

What is lachman;s test?

Answer 29

More accurate than anterior drawer test - knee at 20-30* flexion and pull forward.

Question 30

Tests for meniscal injury.

Answer 30

Thessaly test, mcMurray test, Apley.

Question 31

Grade I, II and III ankle sprain?

Answer 31

I - mild sprain II - partial tear III - complete tear.

Question 32

Shin splints are inflammation of the _________ that insert along the _________ shaft of the tibia.

Answer 32

Muscles Mid-distal

Question 33

What is Haglund deformity?

Answer 33

A swelling noted at the back of the heel that is TTP when the foot is plantar flexed. It can be a sign of Achilles tendinitis.

Question 34

Why does the knee “give out” with PFPS?

Answer 34

Because the pain impulse firing inhibits the quadriceps muscle contraction.

Question 35

What is a painful bump on the anterior inferior knee due to chronic thickening of the proximal tibial tubercle from pulling of the patellotibial ligament?

Answer 35

Osgood-schlatter.

Question 36

Polyarthralgia is pain in _______ or more joints.

Answer 36

5