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59 Cards in this Set
- Front
- Back
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How do you diagnose an effusion of the knee joint space?
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“Milk” any fluid in the supra-patellar extension into the joint space proper, then ballot
and also observe for para-patellar fullness. |
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How do you diagnose a meniscus injury?
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Check for joint line tenderness; positive McMurray and Lachman tests; and/or possible
“locking”. |
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What does a positive McMurray test indicate?
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To perform the test, the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole with the other hand. The examiner then places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress. The other hand rotates the leg externally while extending the knee. If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the medial meniscus
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What does a positive Lachman test indicate?
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1. The knee is flexed at 30 degrees.
2. Examiner pulls on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur. 3. An ACL-deficient knee will demonstrate increased forward translation of the tibia at the conclusion of the movement. |
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What is the most common knee injury?
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Medial ligament sprain
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What physical exam technique is used to check for medial or lateral collateral ligament sprains?
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With knee in 20-30
degrees of flexion, check for laxity on valgus stress (varus stress if lateral ligament). |
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A positive anterior drawer test indicates damage to the...
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ACL
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A positive posterior drawer test indicates damage to the...
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PCL
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A patient has point tenderness 3-4 cm below patella on anterior-medial tibia, where hamstring
reflections insert in a “goose foot” pattern. Diagnosis? |
Anserine bursitis
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What is anserine bursitis?
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Pes anserine bursitis is an inflammatory condition of the medial (inner) knee at the bursa of the pes anserinus.
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Patient with tender apophysis of calcifying tibial tubercle who is a teen. Diagnosis? Is the joint involved?
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Osgood-Schlatter's disease with no joint space involvement.
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This is a linear tenderness superior to fibular head and lateral femoral condyle (no
laxity or fluid). |
Ileo-tibial band syndrome
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This is a 2-4cm round cystic mass in popliteal fossa. Fluid is often “reducible” into joint
space in prone position. Mass is not inflamed and may not be tender. |
Baker's cyst
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What is a Baker's cyst
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This is a 2-4cm round cystic mass in popliteal fossa. Fluid is often “reducible” into joint
space in prone position. Mass is not inflamed and may not be tender. |
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How does an ACL tear occur?
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landing from a jump, pivoting or decelerating suddenly, fixed foot and valgus stress
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audible pop heard or felt, pain, tense swelling minutes after injury, feels unstable (bones shifting or giving away). Which structure is damaged?
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ACL
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What are classic signs of an ACL tear?
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effusion (if acute), limited ROM due to effusion or other internal derangement), joint line tenderness if accompanying meniscal damage.
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What are the diagnostic tests for an ACL injury?
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Lachman’s, Anterior Drawer, pivot shift
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What imaging is best for an ACL injury?
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X-ray usually nondiagnostic; MRI sensitive and specific.
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What is the best treatment for an ACL injury?
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braces and crutches, early PT, analgesia usually with NSAIDs, consider
surgical repair |
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Twisting injury or deep squat though patient may not recall a specific injury. Diagnosis?
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Meniscus tear
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What are symptoms of a meniscus tear?
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catching, medial or lateral knee pain, swelling
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What are physical exam techniques used in the diagnosis of a meniscal tear?
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joint line tenderness, effusion if acute, McMurray’s sign
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What is the imaging modality of choice for a meniscal tear?
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X-ray may show joint space narrowing or early osteoarthritis changes
MRI specific and sensitive |
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What is the treatment of choice for a meniscal tear?
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RICE, PT, surgical repair possible
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Valgus or varus stress to knee, blow to lateral or medial leg with planted foot. What structure is injured?
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Collateral ligament
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What two signs indicate a PCL injury?
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Posterior drawer sign and the Sag sign
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Anterior knee pain, worse with bending or going up stairs. Diagnosis?
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Patellofemoral pain
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What physical exam finding is consistent with patellofemoral pain?
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1. Crepitus under the knee cap
2. Tender over facets of patella, apprehension sign suggests possible instability |
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What are the X-ray signs of patellofemoral pain?
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X-rays may show lateral deviation or lift
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What are the treatment options for patellofemoral pain?
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1. If too loose/weak, strengthen quads, correct and support alignment
2. If too tight, stretch hamstrings, correct alignment 3. Surgery is last resort, lateral release or patellar realignment |
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How do you determine if the origin of a shoulder injury is articular?
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Inability for AROM (active range of motion)and PROM (passive range of motion) =
articular. |
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How do you determine if the origin of a shoulder injury is extra articular?
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Inability for AROM while PROM is normal or less compromised = extra-articular (i.e. the
greater the loss of PROM, the greater the joint mobility is limited). |
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Tenderness in the sub-acromial area (lateral or anterior) and inability to actively abduct the arm, especially in an “uncomfortable” 60-120 degree range (painful arc). Note: if no AROM > 15-30 degrees (scapular elevation) then possible complete
tear. Diagnosis? |
Rotator cuff tendonitis/Impingement
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Define rotator cuff tendonitis or impingement.
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Check for tenderness in the sub-acromial area (lateral or anterior) and inability to actively abduct the arm, especially in an “uncomfortable” 60-120 degree range (painful arc). Note: if no AROM > 15-30 degrees (scapular elevation) then possible complete
tear. |
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What is the treatment for rotator cuff tendonitis? (5 answers)
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1. NSAIDs
2. frequent comfortable AROM especially: Codman’s pendulum shoulder circle exercises (to prevent frozen shoulder), rest from resistive and repetitive lifting. 3. Consider P.T. for corrective shoulder girdle mechanics. 4. Consider possible subacromial steroid-xylocaine injections. 5. Surgical repair for tears. |
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This is an inability to move Shoulder actively or passively (abduction > flexion and
external rotation > internal rotation). Diagnosis? |
Adhesive capsulitis or frozen shoulder.
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How do you treat adhesive capsulitis?
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Treatment is repeated AROM, stretching. Frequently necessitates referral to P. T. for
mobilization and corrective shoulder girdle mechanics). |
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This presents with tenderness in the sub-acromial area (lateral or anterior) and with
uncomfortable overhead mobility in all directions. It is often not the only condition present. |
Bursitis; may also present with tendonitis
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What is the treatment for bursitis?
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1. NSAIDs
2. frequent comfortable AROM especially: Codman’s pendulum shoulder circle exercises (to prevent frozen shoulder), rest from resistive and repetitive lifting. 3. Consider P.T. for corrective shoulder girdle mechanics. 4. Consider possible subacromial steroid-xylocaine injections. 5. Surgical repair for tears. |
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Patients have point tenderness in the bicepital groove of the humerus and positive Yergason’s sign (pain with resisted elbow flexion and forearm supination). Diagnosis?
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Bicepital tendonitis
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How do you treat bicepital tendonitis?
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Same treatment as rotator cuff tendonitis.
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What are the three treatment options for patellofemoral pain?
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1. If too loose/weak, strengthen quads, correct and support alignment
2. If too tight, stretch hamstrings, correct alignment 3. Surgery is last resort, lateral release or patellar realignment |
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What are the "Ottowa" rules for radiographing ankle sprains?
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1. inability to bear weight (four steps) both immediately and in the emergency
department 2. bone tenderness at the posterior edge or tip of either malleolus (localized). |
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Partial tear, intact joint. What grade is the joint injury?
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Grade 1
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partial tear; joint motion abnormal if manipulated/stressed. What grade is the joint injury?
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Grade 2
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complete tear with frank instability. What grade is the joint?
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Grade 3
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An inflamed plantar nerve characterized by severe "burning" pain in the third web space. Diagnosis?
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Interdigital Morton's neuroma
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What are the treatment options for a Morton's neuroma?
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1. This can be relieved by padding and taping to disperse weight away from the
neuroma. 2. Shoes with art support (orthotic) and wide toe boxes should be used, high heels should be avoided. 3. Steroid-xylocaine injections can be used to reduce inflammation. 4. Consider surgery if conservative treatment fails. |
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The classic presentation of this disease is heel pain with the first few steps in the AM.
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Plantar fasciitis
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What is the treatment for plantar fasciitis?
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1. R.I.C.E, NSAIDs, orthotics (arch supports, heel lift), weight loss.
2. NEVER go without shoes. |
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What are the sensory signs of carpal tunnel syndrome?
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Numbness around the volar pads of thumb, index long and radial side of ring
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What are the motor signs of carpal tunnel syndrome?
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1. weak opposition
2. base of thumb wasting. 3. Positive Tinel’s (tap median nerve at wrist) or Phalen’s (hold wrist into flexion > 60 seconds) reproduce numbness or paresthesias. |
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What are the sensory and motor manifestations of ulnar nerve injury?
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sensory: numbness volar aspects of ring and small
motor: weakness/wasting Abd. DM |
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This is caused by cumulative/repetitive stress and is a tendonitis of the abductor
pollicis longus and extensor pollicis brevis within the first dorsal compartment (snuffbox). Patients are usually tender to palpation over first compartment and have a positive Finklestein’s test (tuck thumb into fist and cock wrist into ulnar deviation). Note the differential diagnosis includes arthritis/DJD of the carpal/metacarpal joint and scaphoid fracture (caused by trauma). Distinction can be made with positive “grind” test or tap down through tip of thumb to reproduce pain symptom. Diagnosis? |
DeQuervain's tenosynovitis
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What is the treatment for DeQuervain's tenosynovitis?
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thumbspica splint, P.T. for function recovery
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Are caused by cumulative/repetitive stress and are comprised of small tear in the overlying ligaments that allow synovial herniation. This is one of the most visible and
common soft tissue disorders of the hand. Diagnosis? |
Ganglion cyst
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What is the treatment for ganglion cyst?
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Do nothing unless troublesome, painful, or very large. If so, then aspiration or excision is indicated.
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This is caused by infection and is an inflammation of a synovial membrane with purulent effusion into the joint capsule, usually due to bacterial infection. Suspect if signs or symptoms of:
fever 6 swelling pain non-weight bearing/disuse erythrocyte sedimentation rate higher than 40 mm/h WBC count higher than 12,000/mL Diagnosis? |
Septic arthritis
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