Clinical Vignettes
55-year-old male presents to the emergency department with a sudden onset of severe pain, swelling, and redness in his right great toe. On exam first (MTP) is warm, erythematous, swollen, and exquisitely tender. Good ROM of the joint. What is most likely diagnosis ?
Gout
The physical exam test that involves laying a patient prone and squeezing the calf to look for plantar flexion is called __ and tests for __.
Thompson test
Achilles Tendon Rupture
What are two common special tests on physical exam used to diagnose carpal tunnel?
Phalen and Tinels
16 yo presents after a fall on outstretched hand with tenderness over her anatomical snuffbox. Imaging is negative for any fractures. What is your plan and follow up instructions?
Immobilize with thumb spica and orthopedic follow up in about 2 weeks for repeat XR
scaphoid fracture
Plantar heel pain that is worse with the first few steps in the morning and improves with ambulation = ?
Plantar Fasciitis
20 year M who presents after a bar fight. X-ray shows a fracture of the neck of the 5th metacarpal with angulation.
What type of split would you use to immobilize it?
Ulnar gutter
What is the most commonly involved ligament in low ankle sprains?
Anterior talofibular ligament (ATFL)
This deformity is often caused by forced flexion of extended DIP joint. And on exam you will see DIP joint flexed to 40°, unable to fully extend
Mallet finger
Obese adolescent male with atraumatic hip pain and limping =
Slipped capital femoral epiphysis (SCFE)
___ is the most common injury associated with acute compartment syndrome
Tibial fracture
23 yo F presenting after a bicycle accident. Fell on her L lateral shoulder. On exam she has swelling and tenderness to the anterior shoulder. She is able to touch her opposite shoulder. This is the classic vignette of what type of fracture?
Clavicle
___ is the most dangerous potential complication of a knee (tibiofemoral) dislocation and needs to be identified immediately.
Popliteal artery injury
A boxers fracture refers to the fracture of what bone?
5th metacarpal
15 yo M presents after a fall on outstretched hand. Imaging shows a distal radius fracture with the distal segment protruding downward (volar). What type of fracture is this?
Smiths fracture
What knee ligament injury is associated with valgus stress?
MCL
80 yo F who presents with severe R shoulder pain and immobility after a mechanical GLF. Her arm is internally rotated with very little ROM and decreased sensation over lateral aspect of right shoulder. Whats your most most likely diagnosis and what associated injury are you worried about?
Anterior shoulder dislocation with axillary nerve injury
How does the classic presentation of a hip fracture and hip dislocation differ on physical exam?
Fracture: shortened and EXTERNALLY rotated
Dislocation: shortened and INTERNALLY rotated (posterior)
40-year-old woman comes to the emergency department because she has pain in her right arm two hours after she fell in her home. Physical examination shows swelling and deformity of the right arm. The patient is unable to dorsiflex the wrist. X-ray studies show a spiral midshaft fracture of the humerus. Which nerve is most likely affected by this fracture?
Radial
Describe the 5 types of fracture in the Salter-Harris Classification System
Type I: Straight across -> disrupts physis
Type II: Above -> physis and goes through metaphysis
Type III: Lower -> physis and goes down to epiphysis
Type IV: Through -> crosses epiphysis, physis and metaphysis
Type V: ER -> erasure, compression of growth plate
55-year-old presenting with atraumatic swelling of his right knee x3 days. Also, for the past two days, he has felt feverish. On physical examination, the right knee is red, warm to touch, and tender. A large effusion is noted and ROM is limited due to pain. What is the most important next step for diagnosis?
Aspiration
45 yo M presenting with pain and swelling in his left knee x 2 weeks. No injury but he works in flooring which involves prolonged periods of kneeling. On exam there is swelling, redness, warmth and extreme tenderness directly over the patella. He is able to fully extend and flex his knee. What is your most likely diagnosis?
Prepatellar bursitis
If you diagnose your patient with a calcaneus fracture, what other common concurrent injury do you need to be concerned about due to mechanism of injury?
Spinal compression fracture
In a closed clavicle fracture, what finding requires emergent orthopedic consultation?
Skin tenting
7 yo girl fell from jungle gym and landed on an outstretched left hand. She has elbow pain and swelling with limited ROM. An XR shows an anterior fat pad and disrupted anterior humeral line. What specific type of fracture is this concerning for?
Supracondylar fracture
What are the The "5 P's" are associated with compartment syndrome?
Pain, pallor, paresthesia, pulselessness and paralysis