Bone Histology and Shoulders
The cylindrical structural units that make up compact bone and what are they comprised of
What are the two types of Olecranon bursitis? Bonus points if you can describe the main differences ( presentation/cause)
Aseptic (students or miners elbow): results from chronic microtrauma and presents as a painless, fluctuant posterior swelling with full, painless active and passive elbow range of motion; the joint itself is unaffected
Septic: results from a bacterial infection ( usually staph aureus and presents with marked erythema, local warmth, and systemic fever
Name 3 out of the 7 common physical therapy exercises.
Closed Kinetic Chain: Shoulder and knee rehab, dynamic stability
Concentric: Increase muscle mass and strength
Core Stability: Relief of low back pain or pregnancy related pelvic pain
Eccentric: Sport specific strengthening to prevent injury
Isometric: Muscle toning/ strengthening when joint mobility is not advised; quad exercises to treat patellofemoral pain syndrome
Isotonic: General muscle conditioning
Open Kinetic Chain: Functional improvement in activities of daily living
Name 2 out of the 4 urgent surgical referral scenarios.
1. Septic Joint
2. Spinal Cord Compression
3. Type 2 or 3 open fractures
4. Infected Hardware or Dead Bone (sequestrum)
What causes Nurse Maids elbow and how do you treat it?
pronated forearm + elbow extended + axial longitudinal traction
hyperpronation
What are osteoclasts primary job and what are the two ways it can accomplish it?
Osteolysis
1. Demineralization, in which they release H⁺ ions to create an acidic microenvironment that dissolves the mineral phase
2. Lysis of the organic components, in which they release collagenase and gelatinase to digest the type 1 collagen left behind.
Ruptured distal biceps leads to what notable deformity?
a retracted muscle belly, described as the "Reverse Popeye" deformity (the bulge migrates proximally rather than distally
What is phonophoresis and what conditions can it help treat?
Ultrasound used to deliver therapeutic medications to tissue under the skin.
Inflammatory conditions such as tendonitis, arthritis, and bursitis.
Name 3 of the causative organisms of bone infections mentioned in the SDL.
1. Staph aureus (most common- osteomyelitis, spondylodiscitis, spinal epidural abscesses, septic arthritis and periprosthetic joint infection)
2. Coagulase-negative staphylococci (prosthetic joint infections)
3. Pseudomonas aeruginosa (healthcare associated osteomyelitis)
4. Salmonella ( osteomyelitis)
5. Neisseria gonorrhoeaea (septic arthritis)
6. Mycobacterium tuberculosis (spondylodiscitis)
7. Brucella (spondylodiscitis)
8. Bartonella henselae ( Cat scratch fever)
9. Fungi
What area of the humerus is affected in Little League shoulder?
Growth plate (physis) of the proximal humerus
Where is GH OA typically felt?
AC OA is felt superiorly
What is the most common carpal instability and how does it present on a radiograph?
Scapholunate dissociation, results from disruption of the scapholunate interosseous ligament (SLIL), and is recognized radiographically as the Terry-Thomas sign
What is a Colles fracture and what does it have a high risk of?
A common type of broken wrist where the radius breaks near the wrist and tilts upward.
High rate of acute median nerve compression (acute carpal tunnel syndrome)
What is the mode of inheritance for Osteogenesis imperfecta and what type of collagen is affected?
An 11-year-old girl is evaluated in the emergency department after falling onto an outstretched arm while ice skating. Radiographs of the distal radius reveal a fracture line extending horizontally across the growth plate and propagating proximally into the metaphysis, producing a triangular metaphyseal fragment (Thurstan-Holland sign). How is this growth plate injury classified under the Salter-Harris system?
Salter-Harris II
A 65-year-old male presents with superior shoulder pain that is provoked when he reaches across his chest to touch his opposite shoulder. Physical examination demonstrates localized tenderness along the superior aspect of the shoulder girdle. Which movement plane selectively loads and provokes the affected joint in this patient?
AC joint and Adduction (cross-body) and forward flexion
A 61-year-old male of Scandinavian descent presents with progressive inability to fully extend his right ring and small fingers. He reports painless nodular thickenings in his palm that have gradually formed tight cord-like bands. On examination, flexion contractures are noted at the fourth and fifth metacarpophalangeal joints. He is unable to place his palm flat against the examination table (positive Hueston tabletop test). What is the primary pathological process responsible for this condition?
Fibroproliferation of the palmar fascia: Dupuytren contracture "Viking Disease" is a benign fibroproliferative disorder of the palmar fascia leading to nodule formation, band shortening ( flexor cords) and progressive flexion contractures of the MCP and PIP joints
A 34-year-old male recreational athlete presents with chronic right Achilles tendon pain and stiffness. Physical examination reveals localized thickening and focal tenderness 3cm proximal to the calcaneal insertion. As part of his physical therapy plan, the physician prescribes exercises specifically designed to decelerate the limb and control resistance while the muscle lengthens under strain. Which type of contraction is being prescribed?
Eccentric Contraction
A 62-year-old male presents to the emergency department with acute onset of severe right knee pain, swelling, and warmth. Arthrocentesis yields cloudy synovial fluid, and polarized light microscopy demonstrates negatively birefringent, needle-shaped crystals. Synovial white blood cell count is $62,000mm^3. What do you initially believe the condition is and what is the most appropriate next step in management?
Gout and sending synovial fluid for testing (gram stain and culture)
A 13-year-old active male basketball player presents with a 2-month history of localized right knee pain. The pain is exacerbated by sprinting, jumping, and climbing stairs, and improves with rest. Physical examination reveals an enlarged, prominent right tibial tuberosity with marked point tenderness. Pain is reproduced with resisted active right knee extension. What is the primary pathophysiological process responsible for these symptoms?
Osgood-Schlatter: Repetitive strain/traction of the patellar tendon at its insertion on the immature tibial tuberosity secondary to frequent quad contractions
A 58-year-old male presents with right shoulder pain radiating down his arm into his hand with associated numbness and tingling in his index finger. On physical examination, his active and passive shoulder range of motion is completely normal and symmetrical. Right cervical rotation and lateral flexion reproduce his arm pain. According to the diagnostic workflow for shoulder pain, what is the most appropriate classification for this patient's condition?
Extrinsic Shoulder Pathology
A 28-year-old male presents with difficulty buttoning his shirt and executing fine motor tasks with his right hand following a forearm contusion during a rugby match. On physical examination, when asked to make an "OK" sign with his thumb and index finger, he forms a flat pad-to-pad pinch instead of a tip-to-tip circle. Sensation is completely intact across the entire hand and digits. Which nerve structures is most likely affected?
Anterior Interosseous Nerve (AIN): A pure motor branch of the median nerve that innervates the flexor policies longs (FPL) and flexor digitorum profundus (FDP) to the index finger. Loss of function prevents a person from making the tip to tip OK sign (Kiloh-Nevin "OK sign")
A 22-year-old college athlete presents with radial wrist pain after landing on an outstretched hand. Physical examination demonstrates marked tenderness within the anatomical snuffbox and pain with axial compression of the first digit. Initial radiographs show no clear fracture line. What anatomical feature explains the elevated risk of avascular necrosis (AVN) in this condition if left unimmobilized?
Retrograde blood supply from the dorsal carpal branch: The scaphoid receives majority of its blood supply via retrograde flow entering at the distal pole/dorsal ridge from the dorsal carpal branch of the radial artery, rendering the proximal area vulnerable
A 2-month-old firstborn male infant born via oligohydramnios complicated pregnancy is evaluated for a foot deformity. Examination shows an isolated medial deviation of the forefoot with a convex C-shaped lateral border and a concave medial border. The hindfoot remains in a neutral position. Bleck's heel bisector line projects through the 3rd and 4th interdigital space. What is the correct classification of the severity of this deformity and can you identify an associated condition requiring screening?
Bleck's Heel Bisector Line grades Metatarsus Adductus (MTA) based on where a line projected through the heel exits: Normal (2nd/3rd interdigital space), Mild (3rd digit), Moderate (3rd/4th interdigital space), and Severe (4th/5th digits or lateral to 5th toe).
MTA has an associated 10% co-occurrence with developmental dysplasia of the hip (DDH); every infant with MTA requires a thorough hip examination.
A 6-year-old boy presents with an insidious, 3-week history of a painless antalgic gait. His mother reports that he occasionally complains of mild discomfort in his left thigh and knee after playing outdoors. On physical examination, passive range of motion of the left hip demonstrates significantly restricted internal rotation and abduction. Anteroposterior and frog-leg lateral radiographs demonstrate early joint space widening and increased opacity of the femoral epiphysis. Compromise of which vascular structure is primarily implicated in this condition?
Medial femoral circumflex artery: Legg-Calve-Perthes disease is idiopathic avascular necrosis of the capital femoral epiphysis caused by disrupted blood flow from reticular branches of the medial femoral circumflex artery