Bonus Class MSK

What are the nerve roots associated with the radial nerve?

C5-T1

Describe the Ottawa Ankle Rules for when an ankle radiograph should be performed

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

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

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

Describe the Ottawa Ankle Rules for when a foot radiograph should be performed

bone tenderness at navicular bone

bone tenderness at base of the fifth metatarsal

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

What are the different types of compartment syndrome?

acute anterior compartment syndrome

chronic exertional compartment syndrome

Describe acute anterior compartment syndrome

traumas (fractures, dislocations)

pain, pallor, paresthesia, paralysis, pulselessness

medial emergency

pain or tightness over anterior lower leg

weakness in dorsiflexors and toe extensors

edema

intervention (fasciotomy)

Describe chronic exertional compartment syndrome

repetitive activities (running, jumping) causing exercised induced swelling

no pain at rest

pain or tightness over anterior lower leg

weakness in dorsiflexors and toe extensors

edema

possible numbness/tinging

interventions (activity modification, stretching, strengthening, NSAIDs)

What are the different types of ankle sprains?

lateral ankle sprain

high ankle sprain

medial ankle sprain

Describe lateral ankle sprain

most common

affects anterior talofibular ligament

TTP distal to lateral malleolus

forced plantarflexion with internal rotation/inversion injury

What special tests will be positive for a lateral ankle sprain?

talar tilt

anterior drawer

calcaneal tilt test

Describe high ankle sprain

involves talofibular ligament

forced dorsiflexion with external rotation/eversion injury

pain with weight bearing and heel raises

TTP over anterior aspect of tibiofibular joint

What special tests will be positive for high ankle sprain?

kleiger

dorsiflexion compression

squeeze test

Describe medial ankle sprain

deltoid ligament involved

very rare

increased risk of avulsion fracture from on the medial malleolus

forced eversion injury

TTP distal to medial malleolus

What special tests will be positive for medial ankle sprain?

talar tilt

What is another name for Sever’s disease?

calcaneal apophysitis

Describe sever’s disease

heel pain caused by swelling and irritation at the growth plate

What is the MOI for severe’s disease?

tight gastroc/soleus

repetitive stress activities (jumping, running, dancing)

recent growth spurt

What population do you see Sever’s disease?

common in young adolescents

8-13 years

Describe what you would find in your examination for a patient with Severe’s disease

limited ankle dorsiflexion

tenderness to touch over posterior inferior heel

pain increases with weight bearing and resolves with rest

positive squeeze test

x ray

What is another name for clubfoot?

congenital talipes equinovarus

Define congenital talipes equinovarus

birth defect where feet point inward

usually bilateral

most common in boys

What are the symptoms of congenital talipes equinovarus

high longitudinal arch

tight gastroc/soleus

smaller foot appearance

What are the interventions for congenital talipes equinovarus?

casting begins several weeks after birth and splinting

The special test belly press assesses what?

subscapularis

The special test external rotation lag sign assesses what?

infraspinatus tear

The special test horn blowers test assesses what?

teres minor

The special test hawkins kennedy test assesses what?

impingement

The special test Jobe’s (empty can) test assesses what?

supraspinatus/impingement

The special test bear hug assesses what?

subscapularis

The special test neer’s assesses what?

impingement

The special test painful arc assesses what?

impingement

What are the different types of shoulder instability?

anterior instability

posterior instability

inferior instability

What is the prevalence of anterior instability?

most common

What is the prevalence of posterior instability?

rare

What is the prevalence of inferior instability?

very rare

What is the MOI of anterior instability?

abduction

external rotation

extension

common in sports

What is the MOI of posterior instability?

flexion

internal rotation

adducted position

like trying to open a heavy door

What is the MOI of inferior instability?

carrying heavy objects in hand

What special tests are for anterior instability?

load and shift test

anterior apprehension test

anterior release and surprise test

What are the special tests for posterior instability?

posterior apprehension test

kim test

jerk test

What are the special tests for inferior instability?

sulcus sign

What is the treatment for anterior instability?

posterior capsule stretching

stability exercises for rotator cuff and scapula

avoid chest press, pull downs, push ups

What is the treatment for posterior instability?

stability exercises

avoid push ups and weight bearing exercises early on

What is the treatment for inferior instability?

stability exercises

avoid weighted shrugs and elbow curls

What is the treatment for adhesive capulitis?

corticosteroid injection

stretching

joint mobs (posterior inferior glide)

manipulation under anesthesia

modalities

patient education

What are the stages of adhesive capsulitis?

stage 1

stage 2: freezing/painful

stage 3: frozen

stage 4: thawing

Describe stage 1 of adhesive capsulitis

0-3 months

mild signs and symptoms

achy at rest and sharp at extremes of ROM

loss of external rotation and abduction

synovitis more than contracture of capsule

Describe stage 2 of adhesive capsulitis

3-9 months with progressive loss of ROM and persistence of pain

loss of motion in all planes

pain in most of the range

Describe stage 3 of adhesive capsulitis

9-15 months

painful stiffening of the shoulder and significant loss of ROM

pain only with movements

atrophy of rotator cuff, deltoid, biceps, and triceps

poor scapulohumeral rhythm

loss of axillary fold and ROM

Describe stage 4 of adhesive capsulitis

15-24 months

pain lessens but stiffness persists

slow and steady recovery

What are the different types of radial nerve entrapments?

crutch palsy

high radial nerve injury

radial tunnel syndrome

posterior interosseous nerve syndrome

wartenberg’s syndrome

Define crutch palsy

very high nerve palsy

axilla injury

Define high radial nerve injury

humerus spiral groove or shaft fracture

Define radial tunnel syndrome

compression of posterior interosseous nerve in the radial tunnel

Define posterior interosseous nerve syndrome

compression of posterior interosseous nerve between the two heads of supinator muscle

Define wartenberg’s syndrome

Cheiralgia paresthetica

compression of superficial sensory branch under extensor carpi radialis longus and brachioradialis

Describe the motor involvement in crutch palsy

loss of elbow extension

wrist and digit extension loss

weak supination

Describe the sensory loss of crutch palsy

paresthesia posterior lateral arm, forearm, wrist, posterior aspect of thumb and radial 2.5 fingers

Describe the motor involvement in high radial nerve injury

triceps spared

wrist drop and thumb extension weakness

Describe the sensory involvement in high radial nerve injury

paresthesia posterior forearm, wrist, posterior aspect of thumb and radial 2.5 fingers

Describe the involvement in radial tunnel syndrome

pain over the radial tunnel

5 cm distal to lateral epicondyle

pain on radial aspect of proximal forearm

no sensory symptoms and no motor weakness to little muscle weakness due to pain

Describe how symptoms aggravate in radial tunnel syndrome

resisted supination

finger extension positioning of the arm in elbow extension

forearm pronation and wrist flexion

Describe the impairments in posterior interosseous nerve syndrome

pure motor

pain in the deep forearm, lateral elbow

weakness of wrist extensors

dropped fingers and thumb

extensor carpi radialis longus always preserved

wrist can extend and radially deviate

What is the MOI for wartenberg’s syndrome

trauma

tight watch

handcuffs

What special tests would be positive for wartenberg’s syndrome

tinel’s sign at site of compression

Describe impairments in wartenberg’s syndrome

pain/sensory disturbances on radial side of dorsum of the hand

pain reproduced with flexion and ulnar deviation

no motor loss

What muscles are innervated by the posterior interosseous nerve?

extensor pollicis longus

extensor pollicis brevis

extensor indicis

abductor pollicis longus

extensor carpi ulnaris

extensor digitorum

extensor digiti minimi

supinator

extensor carpi radialis brevis

The radial nerve splits into?

superficial sensory nerve

posterior interosseous nerve

The radial nerve is both?

sensory and motor

The radial nerve is which part of the brachial plexus?

posterior cord

What is the motor innervation of the radial nerve?

brachioradialis

extensor muscles

anconeus

supinator

triceps

What is the sensory innervation of the radial nerve?

2.5 fingers and thumb (not tips of fingers)

base of thumb (palmar aspect)

supplies on dorsum of hand

The thenar eminance is supplied by the?

median nerve

The tips of fingers are supplied by?

median nerve