Orthopedic and Rheumatologic Conditions: Tests, Fractures, Sprains, and Diseases

Q: Pivot-Shift Test — We are testing

A: ACL

Q: Pivot-Shift Test — Position

A: Supine

Q: Pivot-Shift Test — Movement

A: Hip ABD + FLX to 30°, slight valgus at fibular head, move from EXT → FLX

Q: Pivot-Shift Test — Positive test

A: Clunk, "giving way," tibial sublux/drop

Q: Grade I Sprain

A: Microscopic tear; no joint laxity; joint intact

Q: Grade II Sprain

A: Partial ligament fiber tearing; moderate laxity; bracing + exercise

Q: Grade III Sprain

A: Complete ligament rupture; marked instability; surgery

Q: Closed fracture

A: Simple fracture; skin intact; broken bone

Q: Compound fracture

A: Open fracture; skin open; broken bone

Q: Incomplete fracture

A: Hairline; partial break; skin closed

Q: Greenstick fracture

A: One‑sided fracture; common in children; broken bone

Q: Comminuted fracture

A: Multiple fragments; crushed pieces

Q: Avulsion fracture

A: Bone pulled off at tendon/ligament insertion

Q: Pathological fracture

A: Non‑traumatic fracture due to disease

Q: Compression fracture

A: Pressure collapse fracture; vertebral compression

Q: Heterotopic Ossification

A: Bone formation in soft tissue

Q: Myositis Ossificans

A: Bone deposit in muscle; follows severe contusion; form of HO

Q: Type I strain

A: Muscle fibers damaged; nerves/vascular intact

Q: Type II strain

A: Muscle fibers + nerves damaged; ECM/vascular intact

Q: Type III strain

A: Muscle fibers, nerves, ECM, and blood supply damaged

Q: Osteochondritis Dissecans

A: Subchondral necrosis; bone/cartilage fragment detaches; medial femoral condyle

Q: Osteonecrosis (Chandler's)

A: Complete ischemia of femoral head

Q: Legg-Calve-Perthes Disease

A: Children; worsens with activity; femoral epiphysis necrosis

Q: Osteocondritis Deformans

A: Necrosis of proximal femur; self‑limiting; treat by seating femoral head

Q: Osteoarthritis (OA)

A: 20-30 min morning gel; most common MSK disease; wear‑and‑tear

Q: OA features

A: Heberden/Bouchard nodes; weight‑bearing joints; crepitus

Q: Spondylosis

A: OA of spine; decreased disc height; degenerative

Q: Spondylolysis

A: Pars interarticularis defect; posterior arch defect

Q: Spondylolisthesis

A: Anterior slip of vertebra (L4-L5); ↑ lumbar lordosis; bilateral pars defect

Q: Lumbar spinal stenosis

A: Narrowed canal; flexion relieves; extension painful

Q: Rheumatoid Arthritis

A: Autoimmune systemic joint disease; women; flares/remissions

Q: RA features

A: Bilateral symmetric deformities; >30 min gel; chronic

Q: RA deformities

A: Boutonniere, swan neck; pannus; synovial destruction

Q: Still's Disease

A: High fever + rash; RA‑like; children

Q: Ankylosing Spondylitis

A: Starts at SI; pain ↑ with rest; Marie‑Strumpel disease

Q: Ankylosing Spondylitis features

A: Axial inflammation; spinal fusion; bamboo spine

Q: Reiter's Syndrome

A: Reactive arthritis; venereal disease; urethritis + conjunctivitis + arthritis; males; HIV+

Q: Psoriatic Arthritis

A: Onset may be 20 yrs later; flares/remissions; stiffness after immobility

Q: Gout

A: High uric acid; great toe; heavy alcohol

Q: Gout features

A: Purine foods; urate crystals in joints/kidneys; inflammatory arthritis

Q: Disc protrusion

A: Annulus intact; nucleus bulges; mild HNP

Q: Disc extrusion

A: Nucleus pushes through annulus; against PLL

Q: Sequestrated disc

A: Nucleus free in canal; severe HNP; age‑related

Q: Cervical Facet Syndrome

A: C‑spine facet degeneration; pain with EXT + ROT; referred shoulder/scap pain

Q: Thoracic Outlet Syndrome

A: Compression of subclavian A/V + brachial plexus; radiculopathy

Q: Subacromial Impingement

A: Reduced subacromial space; painful arc; tendon crowding

Q: Stage I Shoulder Impingement

A: Reversible; <25 yrs; repeated stress

Q: Stage II Shoulder Impingement

A: Irreversible; fibrosis/tendinitis; age 20-40

Q: Stage III Shoulder Impingement

A: Degeneration; rotator cuff tears; >40 yrs

Q: Acute Calcific Supraspinatus Tendinitis

A: Toothpaste‑like calcium; ADD relieves; painful arc

Q: Chronic Calcific Supraspinatus Tendinitis

A: Semi‑solid; hard to aspirate; may need surgery

Q: Bankart Lesion

A: Avulsion of capsule + labrum; anterior‑inferior dislocation

Q: Hill‑Sachs Lesion

A: Posterolateral humeral head impaction; instability

Q: Adhesive Capsulitis

A: Frozen shoulder; ↓ ROM; capsular pattern; post‑fracture

Q: AC Sprain — 1st degree

A: Partial AC tear; no instability; minimal dysfunction

Q: AC Sprain — 2nd degree

A: Complete AC tear; partial coracoacromial tear; moderate pain

Q: AC Sprain — 3rd degree

A: Complete AC + coracoacromial rupture; marked pain/limits

Q: Lateral Epicondylitis

A: Wrist extensor tendon injury; pain with resisted EXT; radial nerve involvement

Q: Medial Epicondylitis

A: Wrist flexor overuse; pain at medial epicondyle; median/ulnar nerve involvement

Q: Medial Valgus Stress Overload

A: MCL/UCL injury; valgus stress; high‑speed extension

Q: Cubital Tunnel Syndrome

A: Ulnar nerve compression; valgus instability; increased carrying angle

Q: Tardy Ulnar Nerve Palsy

A: Delayed neuropathy; valgus deformity; burning/aching

Q: Elbow dislocation

A: 2nd most common; radial head fx; triceps contraction

Q: Bicipital Tendinitis

A: Long head biceps inflammation; positive Speed/Yergason; pain with elbow FLX

Q: Biceps Tendon Rupture

A: Popeye deformity; distal bulge

Q: Supracondylar Fx Type I

A: Distal humerus; posterior displacement; risk of Volkmann's contracture

Q: Supracondylar Fx Type II

A: Distal humerus; anterior displacement; posterior trauma

Q: Volkmann's Contracture

A: Ischemia; loss of radial pulse; discoloration

Q: Gunstock Deformity

A: Varus deformity; radial head fx; altered carrying angle

Q: Colles Fracture

A: Distal radius dorsal displacement; FOOSH; dinner‑fork deformity

Q: Smith Fracture

A: Reverse Colles; volar displacement; fall on dorsum

Q: Scaphoid Fracture

A: Snuffbox pain; wrist hyperextension; high AVN risk

Q: Boxer's Fracture

A: 4th/5th MC neck fracture; punching injury

Q: Bennett Fracture

A: Base of 1st MC fracture

Q: Skier's Thumb

A: UCL sprain; valgus stress; thumb hyperextension

Q: De Quervain's Syndrome

A: 1st dorsal compartment; positive Finkelstein; radial wrist pain

Q: Trigger Finger

A: Tendon thickening; catching/locking

Q: Mallet Finger

A: Extensor hood injury; DIP flexion; possible PIP hyperextension

Q: Dupuytren's Contracture

A: Palmar contracture of ulnar digits; nodules; associated with diabetes

Q: Carpal Tunnel Syndrome

A: Median nerve compression; thenar atrophy; weak grip

Q: ORIF

A: Open reduction internal fixation; surgical; hardware

Q: CRIF

A: Closed reduction internal fixation; small puncture; painful

Q: External Fixator

A: Pins from external frame into bone

Q: Hyaline Cartilage

A: 80% water; low friction; Type II collagen

Q: Fibroelastic Cartilage

A: Type I collagen; meniscus

Q: Heberden's Nodes

A: OA; DIP osteophytes

Q: Bouchard's Nodes

A: OA; PIP osteophytes

Q: Bone Spurs

A: Osteophytes

Q: Viscerogenic Pain

A: Organ‑related; kidney/back pain

Q: Neurogenic Pain

A: Nerve‑related back pain

Q: Vasculogenic Pain

A: Vascular back pain

Q: Spondylogenic Pain

A: Soft‑tissue back pain

Q: Psychogenic Pain

A: Non‑organic back pain

Q: Anterior Shoulder Dislocation

A: ER + ABD + EXT; most common GH dislocation

Q: Type II SLAP Lesion

A: Detachment of superior labrum + biceps anchor

Q: Supraspinatus — Origin

A: Supraspinous fossa

Q: Supraspinatus — Insertion

A: Greater tubercle (superior facet)

Q: Supraspinatus — Nerve

A: Suprascapular (C5-6)

Q: Supraspinatus — Action

A: Shoulder ABD; humeral head stabilization

Q: Infraspinatus — Origin

A: Infraspinous fossa