Hip + Thigh
What is the most important treatment for trochanteric bursitis?
Aggressive IT band stretching
What is the concept of "start-up" pain in plantar fasciitis and why does it occur? How can it be prevented?
Severe pain in the foot after getting out of bed for the first time that day. Due to toes curling in sleep so plantar fascia will be stretched significantly when standing. Prevented by stretching prior to getting out of bed
How do shin splints vs stress fractures present in physical exam?
shin splints- diffuse tenderness along medial tibia
stress fracture- focal tenderness along tibia
Tennis elbow is characterized by tenderness along the ________ epicondyle, the common origin of __________ tendons
lateral; extensor
How does treatment of AC joint sprain vary based on grade of sprain?
Grades 1-2 treated conservatively w/ sling and therapeutic exercise. Grade 3 treated conservatively at first, then surgery if persistent symptoms. Grades 4-6 surgical treatment
What is a pathologic fracture?
Bone has been weakened by something else, usually cancer
What type of muscles in the hip/thigh are often strained? What sort of contraction is usually the cause?
Biarticulate muscles- hamstrings, quadriceps, and adductors
Usually result from eccentric contraction
Special tests to evaluate for:
Lateral ankle sprain (2)
Medial ankle sprain (1)
Syndesmosis/high ankle sprain (1)
Medial: eversion stress test
Syndesmoses: Kleiger's test
What are exacerbating factors for patellofemoral pain syndrome? What is management?
stairs, running, prolonged sitting
Stretch hamstrings, strengthen quads and hip abductors
What should you look for on MRI that would indicate a torn UCL?
T sign
In atraumatic/congenital shoulder instability laxity is due to __________ ____________, and the problem is at a _______ level due to collagen stretching
capsular redundancy; cellular
What is a sail sign? What is its significance?
Anterior fat pad of elbow pushed out or posterior fat pat visible on XR- indicates there is a fracture around the elbow
In what population is snapping hip syndrome most common? How does it present?
What specific ROM findings would indicate achilles rupture? What special test could be performed for further evaluation?
pain with: passive dorsiflexion, active plantarflexion, resistive plantarflexion
Thompson Test (squeeze calf, foot should plantar flex)
How do MCL, ACL, and meniscus injuries present differently in terms of effusion?
MCL- no effusion because it is extra-articular
ACL- immediate effusion
meniscus- effusion the following day
Which tendons are affected in Dequervain's Tenosynovitis? What might you feel on palpation?
abductor pollicis longus and extensor pollicis brevis, snowball crepitus
Explain the classification of SLAP tears Type I-IV. Which is most common?
Type I- fraying of the labrum
Type II- anchor disruption, superior labrum pulled away (most common)
Type III- bucket-handle tear of superior labrum, biceps anchor intact
Type IV- bucket handle and biceps tendon torn
Describe the difference between a Colles fracture and a Smith fracture. What are the names of the deformities caused by each?
Colles- distal radius with dorsal tilt, causes a silver fork deformity
Smith: distal radius with volar tilt, garden spade deformity
What are the two special tests performed to evaluate for intraarticular hip pathology? Describe or demonstrate
Hip scouring and log roll
What is the most common mechanism of injury for a Lisfranc injury? What are some key presenting features ? What sort of radiographs should you be certain to obtain?
axial load, especially MVC
cannot walk, point tenderness over tarsometatarsal joint, bruising on the plantar surface
weight bearing views
What are the three management options for chondral injury?
autologous chondrocyte implantation, osteochondral plug transfer (autologous or cadaveric), or microfracture
Special Tests
UCL elbow (2)
Distal biceps tendon tear (1)
DeQuervain's Tenosynovitis (1)
Gamekeeper/Skiers Thumb (1)
Carpal Tunnel Syndrome (4)
UCL: valgus stress test, milking maneuver
Distal biceps tendon tear: hook test
DeQuervain's: Finkelstein's test
G/S Thumb: valgus stress test
CTS: Tinel sign, Phalen test, reverse falen test, carpal compression test
Explain the different symptoms someone would experience with Thoracic Outlet Syndrome with:
nerve involvement
venous involvement
arterial involvement
Nerve- numbness, tingling, weakness
Venous- swollen, mottled, discolored
Arterial- lots of pain 2/2 claudication
Describe the "intrinsic plus" position for splinting
What are the three kinds of femoroacetabular impingement? What is the difference between them?
CAM- femoral neck involved
pincer- acetabulum involved
mixed- both
What are the Ottawa Ankle Rules? Explain them
If patient has tenderness over the posterior edge of the lateral malleolus, posterior edge of medial malleolus, navicular, or base of the 5th metatarsal they should get XRs
Special Tests :/
ACL (3)
MCL (1)
Patellofemoral Pain Syndrome (1)
Knee effusion (2)
Acute meniscus tear (4)
ACL: Lachman, anterior drawer, pivot shift
MCL: Valgus stress test
PFPS: patella grind
Knee effusion: sweep, ballotable patella
Acute meniscus tear: Apley's compression/distraction, McMurray's, Bounce Home, Thessaly
Mallet finger is caused by an injury to the ________ tendon at the _____ joint. Jersey finger is an injury to the _____ tendon at the ______ _______ _____. Gamekeeper's and Skier's thumb both reference injuries to the _______, with the only difference being _______
extensor; DIP
FDP tendon; volar distal phalanx
UCL; acuity
Special Tests for
Biceps/SLAP (4)
Anterior labral tear (2)
Posterior labral tear (2)
Inferior labral tear (1)
AC Joint Sprain (2)
Subacromial Syndrome (2)
RCT (4)
Biceps/SLAP: Yergason, Speed's, O'Brien's, Crank
Anterior labral tear: Anterior Apprehension, Jobe relocation
Posterior labral tear: Posterior apprehension, Jerk test
Inferior labral tear: Sulcus sign
AC Joint Sprain: Cross body test, piano key sign
Subacromial Syndrome: Neer's impingement, Hawkins-Kennedy
RCT: Empty can, External Rotation, Internal Rotation, Drop Arm
Weber A- fibular fracture parallels plafond, conservative tx
Weber B- spiral or oblique at plafond, extending proximally. If stable conservative tx, if unstable ORIF
Weber C- fx is proximal to plafond, always surgical