UE and LE differential Diagnosis MSK

how does avascular necrosis present?

positive FABIR test

can be unilateral

pain increases with activity

dull aching or throbbing pain in groin and lateral hip

how does osteoarthritis present?

positive Scouring

pain with movement especially less than 1 hour in morning

anterior thigh pain increases with weight bearing

most limited with IR

how does femoroacetabular impingement present?

positive FADIR test

structural variations of the proximal femur or acetabulum

anterior hip/groin/lateral hip

achy or sharp pain

aggravated by sitting

how does piriformis syndrome present?

positive FAIR test

tenderness over the sciatic notch

pain with active external rotation, passive internal rotation

pain over buttock, posterior thigh and back of leg

what are the different pediatric hip conditions that could be present with ages?

hip dysplasia (0-2 years)

Legg calve parthes (2-13)

Slipped Capital Femoral epithesis (10-17)

what is legg calve perthes disease?

abnormal blood flow to the femoral head which causes flattening of the femoral head

pain worsens with activity

extension, abduction, IR is limited

conservative treatment/ bracing is needed

what is slipped capital femoral epiphysis?

overweight or traumatic

displacement of femoral head due to slippage of growth plate

limping pain worsens with activity

flexion, abd, and IR limitation

need surgical treatment to stabilize

what should you avoid with hip replacmenet?

open chain exercises for up to 6 weeks

how does patellofemoral pain present?

positive clarke test and step down test

aggravted by sitting (movie goers sign)

pain at end range knee flexion with PROM

tenderness over anterior knee with patella compression

how does osgood schlatter disease?

8-13 years old

traction apophysitis of tibial tubercle

pain with activites such as running, jumping, squating

knee extension against resistance

how does patellear tendinopathy present?

inflammation of patellar tendon

gradual onset

single leg hop test, high step up test are positive

end range knee flexion is painful (tenderness over inferior to superior patella)

what is mechanism of injury for ACL?

hyperextension injury, valgus force, planted foot

deep pain, strong pop heard

what is the mechanism of injury for the PCL?

hyperflexion injury/ dashboard injury

pop heard

what diagnosis has pain with stair descent and prolonged sitting

patellofemoral pain syndrome

what are some key points about ACL repair?

graft is most vulnerable at 6-8 weeks

avoid CKC 60-90

avoid OKC 0-45 degrees

no ankle cuff weights distal to tibia initially

progress based on strength and function not time alone

what are the ottawa knee rules?

you must get a radiograph if patient is 55 years or older

pain on palpation of patella

tenderness at the head of the fibula

inability to flex the knee greater than 90 degrees

inability to weight bear for at least 4 steps

what are the ottawa ankle rules?

bone tenderness at the posterior edge of the distal 6 cm of the lateral or medial malleolus

inabilty to bear weight for at least 4 steps both immediately after injury and at the time of evaluation

what are the ottawa ankle rules?

bone tenderness at the naviuclar bone

bone tenderness at the 5th metatarsal

inability to bear weight for greater than 4 steps

what are some signs and symptoms of tarsal tunnel?

pain, numbness, tingling over medial malleolus

positive tinel sign

pain with passive extreme dorsiflexion and eversion as well as ankle plantarflexion and inversion

how does medial tibial stress syndrome present?

posterior-medial lower leg pain

aggravated with exercising over invovled lower extremity

pain with active combined plantarflexion and inversion

tenderness over posteromedial calf

how does achiles tendinitis present?

aggravted with jumping, running

painful active PF, pain with passive overpressure to DF, restricted range of DF

tenderness over posterior ankle

how does plantar fasciitis present?

pain over sole of foot

positive windlass test

aggravted with weight bearing espeically first thin in the morning

pain with passive overpressure to great toe extension

what are some signs and symptosm of high ankle sprain?

invovles tibiofibular ligaments

forced DF/ER w/ eversion

pain with weight bearing when the heel raises

positive Kleiger and squeeze tests

what is the intervention for compression within the interscalene triangle? and what test shows it?

adsons maneuver

stretch the scalenes

what is the intervention for compression at the costoclavicular space and what test?

military brace test

mobilization of the first rib

what is the intervention for compression at the axillary interval?

wright test, roos test, allen test

stretch the pec minor

how does subacromial impingement present?

(neer, hawkins, yocum, empty can)

painful arc 60-120 degrees

pain at night, anterior/lateral pain

how does rotator cuff tear present?

positive ER lag sign, drop arm, hornblower’s sign, IR lag sign, lift off sign,

loss of strength and pain

weakness and atrophy

how does SLAP labrum present?

positive O-brien test, biceps load, clunk test

clikcing, clunking, joint locking

deep anterior shoulder pain

how does AC joint injury present?

positive horizontal adduction, paxinos sign, AC sheer test

pain at the top of the shoulder

painful arc at the top of shoulder

how does bicipital tendinitis present?

positive speeds and yeargesons test

pain with overhead movements

pain with full extension to flexion, active LR is limited when arm is 90 degrees abducted

what are some things that you should be cautious of with a SLAP repair?

limit passive or assisted elevation of UE to 60 degrees for 2 weeks

no active contraction of biceps for 6 weeks

avoid tension on the biceps (elbow extension with shoulder extension for 4 to 6 weeks)

what is the time frame for large and small rotator cuff tears for strengthenigng?

large tears- 12 weeks before strengthening can be initiated

small tears- 8 weeks

what is the difference between stage 2 and stage 3 of adhesive capsulitis?

stage 2: progressive loss of ROM with los of motion in all planes as wel as pain in all range and at REST

stage 3; painful stiffneing of the shoulder and significant loss of ROM, pain only with movements

what is the muscles and tests done for lateral epicondylitis?

extensor carpi radialis breivs

cozens, mills, maudselys

what are the muscles invovled with medial epicondylitis?

pronator teres and flexor carpi radialis

offload to reduce pain and gradual progressive strengthening of wrist flexors

what is the motor innervation of the ulnar nerve?

MAFIA

medial lumbricals (4th and 5th)

adductor pollicis

FCU/ FDP ulnar side

interossei

abductor digiti minimi

what muscles open the mouth?

lateral pterygoid

what muscles close the mouth?

temporalis

masseter

medial pterygoid

what side is affected with hypomobility and hypermobility of the TMJ?

hypomobility- decreased mouth opening and deviation to the same side as pain

hypermobility- increased mouth opening and deviation to the opposite side as pain

what is disc displacement with reduction?

clicking heard, no deviation, no difficulty with mouth opening

what is the difference between synovitis and casulitis?

synovitis: pain and limited mouth opening, no deviation

capsulitis: pain, limited mouth opening and deviation to same side