MSIII Midterm Exam Study Guide

What is the main risk factor for ankle sprains?

History of ankle sprains

During AC separation, the clavicle pops:

Up and back

Most common mechanism of injury for anterior shoulder dislocation:

Fall on an externally rotated arm

Fracture of the anterior rim of the glenoid with the attached labrum

Bony bankart

Tear of the superior labrum extending from anterior to posterior - may be associated with the long head of the biceps tendon and recurrent anterior stability

Hill-sachs

Compression fracture of the posterolateral margin of the humeral head

SLAP Lesion

De Quervain Tenosynovitis (All Peanut Lovers Eat Peanut Butter)

APL and EPB are affected

Ulnar nerve injuries are characterized by a:

Claw hand deformity

The claw hand deformity is a key characteristic of an:

Ulnar nerve injury, lower plexus injury, and Klumpky’s palsy

Median nerve injuries are characterized by:

The Ape hand deformity or benediction sign

What’s the cause of primary frozen shoulder?

No known cause

What’s the cause of secondary frozen shoulder?

A period of pain or immobilization (RA, OA, trauma)

Which patients have a higher likelihood of developing frozen shoulder?

40-65yo, women, diabetes mellitus, and thyroid disease

Which stage of frozen shoulder (adhesive capsulitis) is characterized by pain at night that increases with movement and ER is limited?

Stage 1

Which stage of frozen shoulder (adhesive capsulitis) is characterized by persistent and intense pain at rest and ROM is limited in all directions?

Stage 2

Which stage of frozen shoulder (adhesive capsulitis) is characterized by pain only with movement, significant adhesions, and limited ROM in all directions?

Stage 3

What is a common compensation for patient’s in stage 3 of frozen shoulder?

Excessive scapulothoracic movement

Which stage of frozen shoulder (adhesive capsulitis) is characterized by minimal pain but significant capsular restrictions, motion is gradually improving

Stage 4

Which motions are the most limited with Frozen Shoulder (Adhesive Capsulitis)

ER and abduction

After an MUA surgery for frozen shoulder, which position is often required of pts to sleep in for up to 3 weeks?

Shoulder in passive abduction

Which motions are restricted for post-op glenohumeral arthroplasty pts?

Extension past neutral, and apley internal rotation

What muscle is it important not to stress following a TSA or an RTSA?

Subscapularis

Compromise of the structural integrity of the musculocutaneous structures (vascular changes, collagen degeneration) is known as:

Intrinsic Impingement/rotator cuff disease/tendinopathy

Which type of extrinsic impingement is characterized by an abdnormal acromion shape

Primary extrinsic impingement

Which type of extrinsic impingement syndrome is characterized by hypermobility or instability of GH leading to increased translation of humeral head?

Secondary extrinsic impingement

Which type of extrinsic impingement is characterized by mechanical entrapment of posterior supraspinatus tendon between humeral head & labrum due to repeated elevation, horizontal abduction, maximal ER (throwing position)

Internal extrinsic impingement

Which special tests test for subacromial pain or impingement?

Neer impingement, Hawkin’s kennedy, empty can, painful arc, and anterior apprehension

Which shoulder pathology is associated with an active inflammatory process in the bursa or tendons in the subacromial space?

Tendonitis/bursitis/Tendonalgia/Tenonopathy

Which special tests detect bicipital Tendonitis/Tendonalgia

Speeds test and Yergason’s test

What is this a depiction of?

Subacromial decompression

Which procedure is designed to restore or increase the volume of the subacromial space

and provide adequate gliding room for the cuff tendons?

Subacromial decompression

If the pt has inferior shoulder instability, what special test will they be positive for?

The sulcus sign

Which direction of shoulder hypermobility/dislocation is due to a posteriorly directed force on distal humerus or forearm when humerus is in a position of elevation, ER, horizontal abduction?

Anterior dislocation

Which direction of shoulder hypermobility/dislocation is due to a force applied to the arm when humerus positioned in flexion, ADD, IR (FOOSH)?

Posterior dislocation

A fracture of the anterior rim of the glenoid with the attached labrum is called a…

Bony bankart

A tear of the Superior Labrum extending from Anterior to Posterior – may be associated with tear of long head of biceps tendon & recurrent anterior instability of GH is called a…

SLAP lesion

A compression fracture at the posterolateral margin of humeral head is called a…

hill-sachs fracture

Bony bankart

What common nerve injury is associated with a humeral neck fracture?

Axillary nerve

What nerve is compressed during a humeral shaft fracture?

Radial nerve

Formation of bone in atypical locations of the body (muscle-tendon unit, capsule, ligaments)

Myositis Ossificans /Heterotopic Ossificans (HO)/ Ectopic Bone Formation

In which scenario is a pt have about a 40% of developing Myositis Ossificans?

After an elbow fracture

In which bone is it most common to develop Heterotopic Ossificans (HO)?

Brachialis

Which tests would be positive in the presence of lateral elbow tendinopathy?

Mill’s test and Cozen’s test

Which muscles are most commonly involved in lateral epicondylalgia?

ECRB and ED

Which muscles are involved in medial elbow tendinopathy/epicondylagia (golfer’s elbow)

The wrist flexors (common flexor tendon)

• Excessive repetitive use of wrist & forearm muscles

• Strain exceeds of the strength of the tissues when demand EXCEEDS repair process

• With repetitive trauma, collagen weakening occurs

• Involved nerves may be sensitized

These are all possible causes/ characteristics of:

Tendinopathy

True/false: Medial and lateral tendinopathy would be good pt scenarios to incorporate ULNT

True

What is the MOI for a Colle’s fracture?

FOOSH

What is the most commonly fractured carpal?

Scaphoid

What is the main concern with a scaphoid fracture?

Avascular necrosis

What is the main sign of a scaphoid fracture?

Tenderness & swelling in the anatomical snuff box

Which muscles are involved is De Quervain Tenosynovitis?

APL and EPB

Pathological breakdown of the tendon structure results from continued or repetitive loading of the involved muscle or tendon beyond its ability to adapt

De Quervain Tenosynovitis

What is the most common ligament injury in the hand?

Thumb UCL sprain (gamekeeper’s thumb)

What is the MOI for a thumb UCL sprain?

Traumatic valgus force to the thumb MCP

What is the most common entrapment neuropathy in the UE?

Carpal tunnel syndrome

Which pathology is characterized by sensory loss and motor weakness that occurs with entrapment of the median nerve?

Carpal Tunnel Syndrome

Which tests would be positive for carpal tunnel syndrome?

Phalan’s test and Tinel’s test

What are the two key element of CRPS?

Disproportionate pain to the inciting incident, no other diagnosis that

explains signs & symptoms

Which type of CRPS is characterized by NO nerve origin and abnormal sweating?

Type 1

Which type of CRPS develops after a nerve injury?

Type 2

What is the main indication that separates and ORIF from a THA?

Extracapsular hip fracture (ORIF) or Intracapsular hip fracture (THA)

What is the underlying pathology that accounts for most total hip procedures?

Osteoarthritis

Which surgical approach to THA has the highest incidence of dislocation?

Posterior/posterolateral

Precautions for posterolateral THA:

Hip flexion >90, IR and adduction past neutral

Which THA approach has a delayed recovery of abductors and normal gait?

Anterior/anterolateral

Anterolateral THA precautions:

Hip flexion >90, extension, ER, and adduction past neutral

“Pain typically presents in the mid-buttock area & may radiate through the sciatic nerve distribution – may also impact hip, coccyx, groin”

This describes:

Piriformis syndrome

“May occur from acute (direct impact) or cumulative trauma (running with repetitive friction between ITB & greater trochanter) the lateral hip irritating the trochanteric bursa”

This describes:

Trochanteric Bursitis

“Displacement of femoral head out of acetabulum – goal of treatment is to brace to reduce femoral head into acetabulum & maintain reduction”

This describes which pediatric pathology?

Congenital Hip Dyslasia

“Portion of femoral head undergoes avascular necrosis →infarcts → necrotic bone absorbed & replaced – gradual & painful onset, relieved by rest & aggravated by WB”

This describes which pediatric pathology?

Legg-calve-perthes disease

“Weakening of epiphyseal plate of upper femur → femoral neck displaces – treat with surgery (removable pins)”

This describes which pediatric pathology?

Slipped capital femoral epiphysis

If the patient has a tight IT band, which special test will they be positive for?

Ober test

If the patient has a hip flexor contracture, which special test will they be positive for?

Thomas test

If the patient ha a tight rectus femoris, which special test will they be positive for?

Ely Test

Which test will be positive in the case of hamstring contractures?

Tripod test

Which test tests for limitation in general hip ROM?

FABER (Patrick) test

Which muscle may be tight/overactive in the case of trochanteric bursitis?

TFL

With Trochanteric Bursitis, when would discomfort be experienced?

Asymmetrical standing

Which type of fixation is most likely to loosen over time?

Cemented

Which type of fixation may be followed by WB restrictions for up to 8 weeks?

Uncemented

No ___ in ___-_____ position for 2 weeks after cemented and 4-6 weeks after uncemented TKA to avoid varus and valgus stressed to the operated knee.

SLRs in side-lying

Embryologic synovial tissue remnant causes joint irritation.

What is this?

Plica Syndrome

Irritation of infrapatellar fat pad from trauma or overuse.

What is this?

Fat Pad Syndrome

Irritation of IT band as it passes over lateral femoral condyle – may be from tight TFL or glute max.

What is this?

IT Band friction syndrome

Which syndrome is caused by prolonged kneeling or recruitment of minor trauma to the anterior knee

Prepatellar bursitis (housemaid’s knee)

Osteochondritis dissecans of patella or femoral trochlea can cause:

Pain with squatting, stooping, ambulation, and stair. Joint may be loose.

What is softening of the cartilaginous posterior surface of the patella called?

Patellar Chondromalacia

Which PF pathology occurs during adolescence from overuse during rapid growth?

Apophysitis / Osgood-Schlatter disease

During recovery from an ACL reconstruction, avoid squatting > __ degrees knee flexion

60

During recovery for ACL reconstruction, avoid resistance on the _____ during hip or quad strengthening + avoid resisted extension < __ degrees

Tibia, 45

After a PCL reconstruction, postpone ____ ___ _____ for 6-12 weeks in prone or standing

Active knee flexion

Which part of the meniscus is the most vasularized/ has the most blood supply?

The lateral/outer portion

Which special tests test the meniscus?

McMurray and Apley tests

Which special tests test the ACL?

Lachman, anterior drawer, and lateral pivot shift

Which special tests test the PCL?

Posterior sag sign, and posterior drawer

Which special test tests for MCL knee injurie?

Valgus Abduction Stress test

Which special test tests for LCL knee injurie?

The Varus Adduction Stress test

Which special tests assess for swelling in the knee joint?

The brush test and patellar tap test