Shoulder Exam
These are the leading causes of shoulder pain in the ambulatory setting.
What are:
1. ROTATOR CUFF INJURY
2. Subacromial bursitis
3. Deltoid burisitis
4. Biceps tendonitis/bursitis
This common medical problem presents in newly active patients with swelling and tenderness BELOW the medial knee joint line.
What is PES ANSERINE BURSITIS?
DAILY DOUBLE...Show & Tell
This is the MSK exam format that should be used to evaluate any joint?
1. Inspect (effusion)
2. Palpate (tenderness, bursitis)
3. ROM
4. Special Maneuvers
This class of medications are used what patients have acute inflammatory conditions.
What are NSAIDS
DAILY DOUBLE... (name the anti-inflammatory doses of these medications)
Q1
A1
This rotator cuff muscle is most commonly injured
What is SUPRASPINATUS MUSCLE?
This is the compartment of the knee that is most commonly the first site of primary osteoarthritis.
What is MEDIAL JOINT LINE?
A shoulder MRI is indicated when this physical exam maneuver is abnormal
What is positive DROP ARM test?
Daily double: Is contrast needed?
These treatments constitute "conservative management" for knee osteoarthritis.
What are weight loss, PT, Tylenol 1g TID, SHORT term PO/topical NSAIDS?
Remember, PO NSAIDS are NOT a long term tx option.
DAILY DOUBLE: In randomized trials, which of the above treatments have been shown to have lasting impact on OA pain?
Q2
A2
Found on exam by limited range of motion (in particular extension), this common secondary injury can lead to significant functional impairment.
What is ADHESIVE CAPSULITIS?
Daily double: What referral is most helpful with patients with limited ADLs due to adhesive capsulitis?
This is the most common anatomic cause of acute "flairs" in knee osteoarthritis.
What is a MENISCAL INJURY?
Daily double: What are the physical exam maneuvers we perform to diagnose meniscal injuries?
A 60yo patient is presenting with subacute on chronic lateral hip pain. No recent trauma or injuries. What are the top two diagnoses in your differential?
What are hip osteoarthritis vs. trochanteric bursitis.
DAILY DOUBLE...How can you differentiate these on exam?
This common cause of acute elbow swelling and pain should NOT be injected with steroids, due to high risk of infection.
What is olecranon bursitis?
Q3
A3
These are the four specific points to palpate in the shoulder.
What are acromioclavicular joint, BICEPS, SUBACROMIAL, and DELTOID bursa?
Daily double: Show & Tell--how do you locate these?
This is the reason we do not routine perform anterior/posterior drawer tests for patients with chronic knee pain in the ambulatory setting.
What is LOW PRETEST PROBABILITY of a full ACL/PCL tear.
DAILY DOUBLE...Show & Tell--demonstrate how to correctly do an anterior drawer test.
What is up to 30 minutes?
This is the typical lifespan of a knee replacement.
What is 15 years?
Q4
A4
These physical exam maneuvers can be useful in diagnosing both a supraspinatus injury and a subacromial bursitis.
What are Hawkins Test and Painful Arc Tests?
Daily double: Show & Tell
This physical exam maneuver has your patients twisting and turning to make common knee diagnosis (show and tell)
What is the THESSALY MANEUVER?
Name that diagnosis:
1. 60F obesity and DM2 presenting with years of chronic BL knee pain, R>L. No clear joint deformity, though occasional “flairs” with swelling, usually on “inside” of the knee.
2. 30M overweight who recently started a new exercise routine and notices that he has anterior knee pain, with some cracking of the joints, especially when climbing stars.
3. 40F obesity and HTN who notes swelling below her R-knee after starting a new exercise routine. On “inside” of knee under joint line
1. What is OSTEOARTHRITIS
2. What is PATELLOFEMORAL SYNDROME
3. What is PESANSERINE BURSITIS
You are seeing a 65 y.o. patient with morbid obesity (BMI 45), HTN, preDM and knee pain 2/2 osteoarthritis that has been refractory to conservative management. This is this patient's best surgical treatment option.
What is a GLP1 vs BARIATRIC SURGERY?
Q5
A5