MSK

Question 1

TIBIAL STRESS FRACTURE

Answer 1

• Present as point tenderness at fracture site. - Cannot do hopping test.
• Xrays may be negative for up to 6 weeks. MRI if high risk.
• Treat with rest, minimize weight bearing and ortho consult if HR. Pneumatic compression device can be used.

Question 1

QUADRICEP AND PATELLAR TENDON RUPTURE

Answer 1

Quadricep is above the patella and patellar is the connection between tibia and femur. Disruption of this complex will present with inability to extend.

Question 2

SUBACROMIAL IMPINGEMENT SYNDROME

Answer 2

Causes subacromial tendon to be squeezed between humeral head and acromion.
- Hard to differentiate between these but rotator cuff will have some weakness
- Neers (hand up) and Hawkins (Chicken) positive
- Treatment is NSAIDs, rehab, steroid injection

Question 3

PES ARSENIS PAIN SYNDROME

Answer 3

Pes arsenus is a point around medial knee where satorius, gracilis and semitendinosis attach. It presents with medial knee pain. Valgus stress test is negative and rules not MCL tear. Supportive is Tx.

Question 4

PATELLOFEMORAL PAIN SYNDROME

Answer 4

Common in adolescent girls. Pain present with running, squatting and presents with anterior knee pain.
Treatment is RICE and supportive

Question 5

OSGOOD SCHLATTER

Answer 5

Common in males 10-15 years. Point tenderness at tibial tuberosity (Apophysitis)
Tx: Supportive post activity and icing. Can do as tolerated.

Question 6

SACRO-ILIAC JOINT DYSFUNCTION

Answer 6

posterior hip pain with low back pain. FABER test will positive

Question 7

PYRIFORMIS MUSCLE PAIN

Answer 7

Log roll test positive but will present with posterior pain too

Question 8

FIFTH METATARSAL FRACTURE TX

Answer 8

Non-displaced can be treated with compressive bandage and as tolerated weight bearing
Displaced: <3mm needs short boot and >3mm needs ortho ref
Tuberosity avulsion Fx can be treated with compression bandage.

Question 9

WHICH FRACTURES REQUIRE CT IMAGING?

Answer 9

Displaced radial and tibial plateau fractures

Question 10

SUPRACONDYLAR FX

Answer 10

FOOSH. 5-7y olds.
Ant interosseous nerve (OK), radial, median affected
Tx: ND- Long arm splint (humerus) x 3 weeks, repeat XR in 1 wk
D- Refer

Question 11

BUCKLE/TORUS FX

Answer 11

• Common wrist fx in kids.
• Stress makes bone bulge out but not break all the way
• Usually FOOSH.
• Just put a splint/brace x 3 wks

Question 12

CLAVICLE FX Treatment

Answer 12

• If ND: Just treat with a sling or figure 8 sling
• If comminuted, displaced or shortening in Adults= Sx

Question 13

MOST COMMONLY AFFECTED NERVE IN RADIAL FX

Answer 13

Median

Question 14

SCAPHOID FX TX

Answer 14

ND: Thumb splint
D: need Ref

Question 15

BOXER FX

Answer 15

4th/5th metacarpal.
Tx: Immobilize with ulnar/volar splint, ace wrap or short arm cast.
If angulation >40, refer

Question 16

JERSEY FINGER

Answer 16

Ruptured flexor digitorum. Cannot flex. Usually ring finger. Need surgery

Question 17

MALLET FINGER

Answer 17

Ruptured extensor digitorum. Cannot extend. Need splint for 8wks.

Question 18

BOUTINNIERE DEFORMITY

Answer 18

Injury to PIP joint. Causes: locked finger, RA
Tx: Splint in extension then night splinting

Question 19

MALLEOLAR FX

Answer 19

Medial or lateral, short boot with protected WB
Post: No WB for 4-6wks

Question 20

PATELLAR FX

Answer 20

Direct blow. Focal patellar tenderness. Inability to extend.
Tx: knee immobilizer or Sx if displaced.

Question 21

LATERAL EPICONDYLITIS

Answer 21

Lateral epicondyle tenderness and pain with wrist movement.

Question 22

SEVERS DISEASE TX

Answer 22

Calcaneal stress fracture
Stretching exercises, NSAIDs, heel cups

Question 23

MOTOR NEUROMA

Answer 23

Numbness and pain between 3rd and 4th metatarsals.

Question 24

SEPTIC ARTHRITIS IMAGING MODALITY

Answer 24

Ultrasound

Question 25

HIP MSK

Answer 25

Ant: Labral Lateral: Greater trochanteric syndrome Posterior: iliosacral

Question 26

OTTAWA ANKLE RULES

Answer 26

Malleolar tenderness AND - Post malleolar tenderness OR - Inability to bear weight

Question 27

OTTAWA FOOT RULES

Answer 27

Midfoot tenderness AND - Navicular (Medial) or 5th Met (Lateral) tenderness OR - Inability to bear weight

Question 28

OTTAWA KNEE RULES

Answer 28

- >55 y - Patellar tenderness or fibular head tenderness - Inability to walk - Cant flex knee 90 degrees

Question 29

ILIOTIBIAL SYNDROME

Answer 29

Lateral knee and hip pain. Common in cyclists. Tx is supportive.

Question 30

LITTLE LEAGUE SHOULDER

Answer 30

Can get xray which will show sclerosis/demineralization Tx: Stop playing

Question 31

CUBITAL TUNNEL SYNDROME

Answer 31

Compresses Ulnar nerve. Innervation affected and motor (Finger abduction affected)

Question 32

TENNIS ELBOW

Answer 32

Lateral epicondylitis. Occurs in adults Epicondyle tenderness and weak grip strength Tx: Dont overuse. Counterforce brace for 6 weeks

Question 33

LEGG CALVE PERTHES

Answer 33

B>G and in kids. Caused by temporary interruption of blood supply Usually supportive treatment Presenting with limp and hip pain

Question 34

TARSAL TUNNEL SYNDROME

Answer 34

- kinda like plantar fasciitis - medial ankle pain and parasthesia - Positive tinel sign (tapping over and reproducing symptoms)

Question 35

BEST TEST FOR MENISCAL TEARS

Answer 35

Thessaly. Stand on one leg and rotate internally and externall

Question 36

KNEE SOFT TISSUE FEATURES

Answer 36

- Meniscus: Small effusion, inability to extend - Collaterals: Valgus/Varus instability - Cruciate: pop sensation and large effusion

Question 37

TUFT FRACTURES

Answer 37

Distal phalynx fractures. Just need splinting.