MSK - Hip, Pelvis, Leg, Ankle, & Foot
A post partum patient comes to your clinic for return to exercise advice. Your patient is eager to return back to her normal exercise routine status post cesarean section 3 weeks prior. At what time frame would resuming vigorous activities be appropriate? 8-12 weeks 4-8 weeks 0-4 weeks 12-16 weeks
4-8 weeks allows appropriate healing time for the pelvic floor and the surgical incision. Pelvic floor muscle strengthening exercises should be recommended as they can begin right after childbirth. Reference: O'Suillivan and Siegelman - National Physical Therapy Review and Study Guide
22-year-old professional football player sustained a direct blow to the foot with the ankle held in external rotation. Imaging confirms a syndesmotic sprain without diastasis or ankle instability. What is the next best step in treatment? Surgical referral Non-weight bearing CAM boot or cast for 2-3 weeks RICE principles Immediate PT
A CAM boot or cast and non-weight bearing for 2-3 weeks is the treatment of preference.
A prominence of the posterior superior calcaneal tuberosity that contributes to inflammation of the overlying tissues and the Achilles tendon is called a: Morton's neuroma Haglund deformity Beck's process Baxter's tubercle
A Haglund deformity is associated with Achilles tendonitis. Morton's neuroma typically develops between the 3rd and 4th toes.
A 50-year-old patient reports great toe pain without trauma. On exam, you note pain with end-range extension. Imaging shows a dorsal osteophyte. What is the next best step in management? Kinesiotaping Surgical debridement Corticosteroid injection Morton's extension orthotic
A Morton's extension orthotic with a stiff foot plate is the treatment of choice for hallux rigidis. Hallux rigidus is a common foot condition characterized by pain and loss of motion of the 1st MTP joint in adults due to degenerative arthritis. Morton's extension orthotic is a rigid carbon foot orthotic that extends to the distal tip of the hallux
A 19-year-old dancer reports posteromedial ankle pain and locking of the great toe. There is pain with forced plantar flexion of the ankle. What is the most likely diagnosis? Plantaris tendonitis Calcaneus apophysitis Flexor hallucis longus injury Soleus tendonitis
A flexor hallucis longus injury is common in dancers.
A grade II ankle sprain involves damage to which ligaments? Complete ATFL and partial CFL tear Partial ATFL tear Complete ATFL and CFL tear Partial ATFL and partial CFT tear
A grade II ankle sprain describes a complete ATFL and a partial CFL tear. Referenced from Cuccurullo Board Review
normal Q-angle for males is: 5 degrees (+/- 3) 14 degrees (+/- 3) 18 degrees (+/- 3) 22 degrees (+/- 3)
A normal Q-angle for men is 14 degrees (+/- 3).
Which of the following is not an indication for a hemiarthroplasty of the hip after a femoral neck fracture? A patient with Parkinson's disease Severe osteoporosis Pathologic hip fractures Pre-existing sepsis
A patient with pre-existing sepsis is not a candidate for a hemiarthroplasty. The remaining answers are proper indications.
To assess the integrity of the ATFL, which physical exam test is best? Talar tilt Anterior drawer laxity in dorsiflexion Resisted eversion Anterior drawer laxity in plantarflexion
A positive anterior drawer test performed with the ankle in plantarflexion is the best test of the answer choices listed to assess for an ATFL injury. A positive anterior drawer test in dorsiflexion best assesses the CFL.
When doing an exam on your patient with ankle swelling, you note a positive anterior drawer test with the ankle in plantar flexion but a negative talar tilt test. Your diagnosis is a: Grade I sprain Ankle dislocation Grade III sprain Grade II sprain
A positive anterior drawer test with the ankle in plantar flexion and a negative talar tilt, which test the integrity of the ATFL and CFL is most likely indicative of only a grade II sprain. If the anterior drawer test is positive, the ATFL is most likely torn and the CFL is most likely to be sprained, not torn, resulting in a negative talar tilt test. Cuccurullo Board Review
What is the most common surgical procedure performed for the treatment of medial tibial stress syndrome that has not improved with conservative treatment? Tibial debridement A posterior fasciotomy No surgery is indicated Tibialis anterior tendon shortening
A posterior fasciotomy is the most common surgical procedure performed for medial tibial stress syndrome.
What percentage of patients with an ACL tear have a stable to mild instability of the knee? 10% 95% 33% 66%
About 1/3 of patients will have a stable to mild instability of the knee after an ACL tear. Source: https://ace-pt.org/knee-instability-acl-reconstruction/
What percentage of patients with an ACL tear have a moderate to severe unstable knee? 2/3 10% 1/3 95%
About 2/3 of patients with have a moderate to severely unstable knee. 1/3 will only have mild instability
Considering that pain is controlled, a patient with a posterior hip dislocation will be unable to: Adduct the hip Flex the hip Extend the hip Abduct the hip
After a posterior hip dislocation, the hip will be adducted and internally rotated. Therefore, the patient will not be able to abduct it.
An apparent leg length discrepancy can be indicative of: Longer tibia Longer femur All of the above Hip adduction deformity
After determining no true leg length discrepancy exists (there is a difference between apparent and true), check for an apparent leg length discrepancy, one of which can be a hip adduction deformity.
Which should be included as part of the treatment plan for myositis ossificans? None of the above Ultrasound Massage Heat
All of the above should be avoided with myositis ossificans as these can worsen myositis ossificans. Conservative treatment consists of rest, immobilization, and anti-inflammatories. Referenced from Cuccurullo Board Review
Which is associated with medial tibial stress syndrome? Triceps surae inflexibility Weak "core muscles" All of the answers listed Hyperpronation
All of the answers listed are associated with medial tibial stress syndrome. Source: Medial tibial stress syndrome: conservative treatment options (nih.gov)
A college football running back sustained a hip pointer. Which muscle(s) originate at this area of injury? All of the muscles listed Tensor fascia lata Gluteus medius Sartorius
All of the muscles listed attach at the hip pointer area, the iliac crest. A hip pointer injury is a contusion of the iliac crest, usually following a direct collision. https://www.orthobullets.com/sports/3090/iliac-crest-contusion-hip-pointer
An 18-year-old cross-country runner present to your clinic with right knee pain. She denies any injury, but states that she recently introduced plyometrics to her training routine. She has no medical problems and does not take any medications. She has a history of occasional "foot pain" when in season that has kept her out of previous meets. On exam, there is tenderness to palpation to the distal femur, but no pain with active resisted knee flexion or extension. The fulcrum test is positive. Otherwise, the hip and knee exam are normal. X-rays of the right femur and knee are normal. What is the most likely diagnosis? Plica syndrome Patellofemoral pain Osteochondral defect Distal femoral stress fracture
Considering the history and a positive fulcrum test, the most likely diagnosis is a distal femoral stress fracture. Stress fractures of the femoral shaft are uncommon and mostly occur in the proximal third of the femur. https://www.jospt.org/doi/pdf/10.2519/jospt.1985.7.1.20
When returning to running after symptom resolution of medial tibial stress syndrome, training should start at what percent of pre-injury level for intensity and distance? 30% 10% 80% 50%
Counsel your patient to return to running at about a 50% pre-injury level for intensity and distance to prevent recurrence of symptoms. Cited in the Cuccurullo Board Review text.
Saphenous neuritis can be confirmed with EMG/NCS. True False
EMG/NCS may be needed to rule out other causes, but cannot confirm the diagnosis, which is based on clinical exam and a local nerve block at the adductor canal.
Which type of exercise should be included in an Achilles tendonitis rehabilitation program? Eccentric exercises Isometric exercises Isokinetic exercises Concentric exercises
Eccentric exercises are the recommended treatment for Achilles tendonitis.
Which is most associated with slipped capital femoral epiphysis? Cushing's disease Growth hormone deficiency Diabetes Type I Addison's disease
From Cuccurullo: Endocrine testing should be done to rule out: Growth hormone deficiency Hyperthyroidism Hypothyroidism Panhypopituitarism Multiple endocrine neoplasia
Which ligament limits external rotation while the hip is in flexion? Ligamentum capitus femoris Ishiofemoral Iliofemoral Pubofemoral
From Cuccurullo: The iliofemoral ligament is also known as the Y-ligament of Bigelow, and is the strongest ligament in the body. The iliofemoral ligament extends from the anterior inferior iliac spine to intertrochanteric line Its function is to prevent external rotation while the hip is in flexion.
Medial meniscal injuries most commonly occur: Knee extension and an anterior force During an axial force with a posterior force During an open kinetic chain movement With a valgus or varus force to a planted foot with a flexed knee
From Emedicine.com: common mechanism of injury is a varus or valgus force directed to a flexed knee. When the foot is planted and the femur is internally rotated, a valgus force applied to a flexed knee may cause a tear of the medial meniscus. A varus force on a flexed knee with the femur externally rotated may lead to a lateral meniscus lesion.
After a meniscus repair, your patient should be full weight bearing around: 2-3 months 4-6 weeks 1-2 days 7-10 days
Full weight-bearing is postponed for 4-6 weeks to reduce forces at the repair site.
Does a grade 3 MCL tear require surgical or non-surgical management?
If the MCL is the only injury the patient has sustained, these are usually treated non-operatively. If the patient has other injuries such as, other involved ligaments, avulsions, or entrapment of ligaments, then surgery may be indicated. Source: http://medboardreview.com/mcl/
Your 49-year-old female patient reports deep gluteal pain with numbness and tingling down the posterior thigh. Pain is worse when walking upstairs and the FAIR test is positive. What is the best step in treatment? Lumbar TFESI Stretching of the external rotators of the affected hip Surgical referral Hip extension exercises
This case is representative of piriformis syndrome, which responds to stretches of the hip external rotators. The FAIR (flexion, Adduction, Internal Rotation) test. Positive test is when pain is produced in the gluteal/sciatic region that mimics their typical pain. If pain is provoked in the anterior thigh, consider hip impingement syndrome.
A 79-year-old female with past medical history of significant osteoarthritis comes to your clinic for back pain. During your history, she mentions she fell onto her knees because the pain in her back was so significant. She reports her left knee has been painful since that time and she has had trouble walking due to pain and swelling. She can actively extend the leg but it is painful. You decide to get x-rays and the result demonstrates a vertical non-displaced patella fracture that does not involve the inferior or superior poles. How would you treat the patient? Crutches and non-weight bearing Refer to orthopedic surgery Knee immobilized in extension and full weight bearing Knee immobilized in extension and toe touch weight bearing
If the knee extensor mechanism is intact, the fracture is nondisplaced/minimally displaced, or the fracture is a vertical pattern that non-operative treatment is pursued. Typically, the knee is immobilized in extension and full weight bearing is allowed. Source: Patella Fracture - Trauma - Orthobullets
A 58-year-old male comes to your clinic to be seen for horrible pain in his legs. He admits to using cocaine earlier in the day and walking many, many miles just to see you. During history and exam, you are worried about acute compartment syndrome. In this condition, muscle necrosis can develop how quickly? 1 weeks 24 hours 12 hours 4 hours
Muscle necrosis can happen quickly, as soon as 4 hours. Source: Cuccurullo Board Review
Noble's test is positive with which pathology? Distal femoral stress fracture Infrapatellar fat pad impingement Osteochondral defect ITB syndrome
Noble's test is positive with ITB syndrome. Source: Nobles Test (fpnotebook.com)
A 35-year-old male comes to your office for knee pain. He reports it is worse with stairs and after sitting down for a long time. After, sitting he feels a sharp pain at the anterior knee. Patella compression is painful. The patella seems to track laterally with knee extension. Which of the following may help to improve biomechanics that can contribute to patellofemoral syndrome? Correct overpronation Vastus lateralis strengthening Hamstrings strengthening Calf strengthening
Overpronation correction and strengthening of the vastus medialis is important in correcting patellofemoral syndrome.
At what degree of knee flexion will a patient with IT band syndrome likely experience the most pain? 60 degrees 120 degrees 30 degrees 90 degrees
Pain of the lateral knee will be worse at 30 degrees of knee flexion.
PCL-deficient knee puts more force on the: ACL Posterior compartment Lateral compartment Patellofemoral compartment
Patellofemoral compartment Because of increased force in the patellofemoral compartment, patients with a PCL-deficient knee are more prone to patellofemoral arthritis.
What is the most common knee condition experienced in adolescents and young adults? Patellofemoral Pain Plica Syndrome Patella Tendonitis Meniscus Injury
Patellofemoral pain syndrome is the most common. Latt., Raiszadeh K., Fithian D. Patellofemoral Joint Injuries. In: Kibler W.B. Orthopaedic Knowledge Update: Sports Medicine. Rosemond: The American Academy of Orthopedic Surgeons. 2009:119-134.
A 41-year-old female reports terrible medial plantar heel pain that is worse when getting out of bed in the morning. On exam, you note pes cavus and a BMI of 50. She is tender to palpation at the medial tuberosity of the calcaneus. What is the next best step in treatment to help to resolve this ailment? Achilles tendon stretches Shock wave treatment Corticosteroid injection Custom shoe orthotic
Providing Achilles tendon stretches is of upmost importance in treating plantar fasciitis.
A 60-year-old runner presents to your clinic with hip pain, found to be a femoral neck stress fracture. As you know, compression side stress fractures typically respond to conservative measures. Which side of the femoral neck are compression fractures seen? The lateral cortex The anterior cortex The inferior cortex The superior cortex
The inferior-medial cortex is the compression side, the superior-lateral cortex is the tension side. Tension side fractures require percutaneous screw fixation. Superior-lateral stress fractures typically occur in older age, while inferior-medial cortex occurs in the younger, active population.
The iliacus inserts onto the: Mid femur Lesser trochanter Posterior femur Greater trochanter
The iliacus inserts onto the lesser trochanter. https://www.orthobullets.com/anatomy/10054/iliacus
Which is the best imaging modality to diagnose a pubic ramus stress fracture? MRI Bone scan CT X-ray
An MRI is the best imaging modality because it provides more diagnostic information including the fracture line and the periosteal edema compared with a bone scan. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684998/
A 17-year-old female soccer player presents to clinic reporting vague anterior pelvic pain that is worse with adduction or abduction of either leg. The most likely diagnosis is: Hip pointer Hip labral tear Sports hernia Osteitis pubis
Anterior pelvic pain that is vague and worse with adduction and abduction is most likely osteitis pubis. Inflammation of the pubis symphysis usually found in athletic endeavors consisting of repetitive kicking or hip abduction/adduction. Tx: non op, rest, NSAIDs, activity modification
Positive pain with the Apley's distraction test indicates: Patellofemoral syndrome Plica syndrome Ligament damage Meniscal damage
Apley's distraction test is indicative of a ligament injury. Apley's Grind test indicates a meniscal injury. Cuccurullo Board Review
What is in the anterior compartment of the lower leg?
The tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius are the muscles in the anterior compartment. In addition to the muscles, the deep peroneal nerve and the anterior tibial vessels live in this compartment.
Which is(are) included in total hip precautions following a hip replacement? Avoid hip extension past 10 degrees Avoid hip external rotation past 10 degrees Avoid abduction over 10 degrees Avoid flexion over 90 degrees
Avoid hip flexion over 90 degrees, is important to prevent complications. Excessive internal rotation and adduction past midline are also part of precautions. Source: Cuccurullo Board Review
Housemaid's knee is inflammation of the: Prepatellar bursa Infrapatellar bursa Suprapatellar bursa Pes anserine bursa
Housemaid's knee is inflammation of the prepatellar bursa.
A 22-year-old male presents with calf pain with exercise. Compartment pressures are within normal limits. What is the next best test? Doppler ultrasonography MRI No further imaging is indicated EMG/NCS
Doppler ultrasonography or angiography would be the next most reasonable step considering calf pain that is worse with exertion. Considering that compartment pressure is normal, the next diagnosis to rule out would be popliteal artery entrapment syndrome, which is most common in men less than 30 years of age. The study should be performed with the foot in neutral and with dorsiflexion and plantar flexion of the foot.
A 18-year-old female runner comes to your clinic for pain when running. During the history, you learn that she gets a tight feeling in her lower leg followed by tingling on the dorsal surface of her foot. She reports this usually occurs at the 6 minute part of each run. How long should conservative measures be used to treat exertional compartment syndrome before surgery is indicated? One year 6 months It is a surgical emergency 3 months
Exertional compartment syndrome is not a surgical emergency. Conservative treatments (activity modifications and anti-inflammatories) should be tried for 3 months before a surgical referral is made.
The Q-angle is determined by drawing a line from the ASIS to the central patella to the medial malleolus. True False
False. The Q-angle is measured with one line from the ASIS to the central patella. Another line is drawn from the tibial tuberosity through the central patella. The Q angle is typically measured for evaluation of patellofemoral pain syndrome.
Which is the main risk factor for medial tibial stress syndrome? Hyperpronation Running more than 20 miles per week Hill running without proper training All of the risk factors listed are about equal
Hyperpronation is the main predisposing risk factor according to Cuccurullo Board Review
A 39-year-old construction worker falls off of a scaffold and reports severe foot pain. On imaging, the radiologist reports a Hawkin's II fracture. Your next best step in management is: Urgent surgical referral Weight bearing as tolerated with a CAM boot Immediate closed reduction, non-weight bearing and 1 week follow up Non-weight bearing with light dorsiflexion exercises directed by PT
Hawkin's II and above talar neck fractures require an urgent surgical referral secondary to the increased risk of AVN. Hawkin's I fractures require immediate closed reduction and short leg cast for 8-12 weeks (NWB for first 6 weeks)
The most common complication after a hip fracture is: DVT Heterotopic ossification Osteonecrosis Depression
Heterotopic ossification is the most common complication. https://pubmed.ncbi.nlm.nih.gov/2117012/
Which increases the Q-angle? Hip adduction Hip extension Hip abduction Hip flexion
Hip adduction and internal rotation can increase the Q-angle. A 10-degree increase in the Q-angle can increase patellofemoral contact pressures by 45% at 20 degrees of knee flexion. Source: Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact - PubMed (nih.gov)
Initial treatment of Hoffa's syndrome includes: Surgical intervention All of the answer choices listed Corticosteroid injection Taping and physical therapy
Hoffa's syndrome (infrapatellar fat pad irritation) is typically first treated with taping and physical therapy. A corticosteroid injection can be used in recalcitrant cases. If these measures fail, then orthopedic intervention is recommended. Source: Evaluation and treatment of disorders of the infrapatellar fat pad - PubMed (nih.gov)
Is SCFE treated with bracing or surgical intervention?
In almost all cases these patients need to be taken to the operating room for percutaneous fixation.
A 12-year-old boy presents with hip pain. You are concerned about growth plate instability. Your diagnosis is confirmed. On MRI, the femoral head is displaced: Anterior, inferiorly Laterally, inferiorly Posterior, inferiorly Medial, inferiorly
In slipped capital femoral epiphysis, the femoral head is displaced posteriorly and inferiorly.
A 22-year-old female soccer player was kicked in the thigh during play and diagnosed with a quadriceps contusion. What is the next step in treatment? Cold therapy and immobilization in 120 degrees of knee flexion for 24 hours Cold therapy and immobilization in extension for 24 hours Frequent passive ROM to prevent an extension contracture Massage therapy to prevent a hematoma formation
In the acute phase, cold therapy and immobilization in 120 degrees of flexion for 24 hours is the initial treatment for a quadriceps contusion. https://www.orthobullets.com/sports/3103/quadriceps-contusion
Which factor(s) increase the Q-angle? Medial positioned medial tuberosity Genu varum Tight medial retinaculum Increased femoral anteversion
Increased femoral anteversion increases the Q-angle. Basically, any biomechanical factor that causes the tibial tuberosity to be laterally displaced in relation to the central patella or ASIS will increase the Q-angle.
A 22-year-old basketball player suffered a hamstring injury and completed 4 weeks of physical therapy. When can the athlete return to play? When there is no pain with passive or active range of motion When the strength of the injured hamstring equals that of the quadriceps About 2 weeks When the hamstring is at least 90% as strong as the hamstring on the healthy leg
It is likely safe to return when hamstring strength of the injured side is about 90% of the contralateral side. https://www.orthobullets.com/sports/3102/hamstring-injuries
At what angle of knee flexion are the medial and lateral patella facets in contact with the sulcus? 90 30 45 60
Maximum contact occurs at 45 degrees.
A Morton's neuroma is most commonly found: Between the 2nd and 3rd metatarsals Between the 3rd and 4th metatarsals Between the 1st and 2nd metatarsals Between the 4th and 5th digits
Morton's neuroma is most commonly found between the 3rd and 4th metatarsals.
Most ACL injuries occur: With an LCL Without contact During contact with the knee After a fall
Most ACL injuries occur during a non-contact pivoting injury.
Which is implicated in the development of pes planus? Tarsal tunnel syndrome Posterior tibial tendon dysfunction Peroneal tendon dysfunction Anterior tibial tendon dysfunction
Posterior tibial tendon weakness or tear is indicated in pes planus, due to its contribution to the medial arch.
After ankle surgery, when can a patient return to driving? 6 weeks 12 weeks 9 weeks 2-3 weeks
Proper braking response time after ankle surgery occurs at about nine weeks. Source: Ankle Fractures - Trauma - Orthobullets
An acute peroneal tendon subluxation is best treated with: Immediate surgery RICE principles Short leg cast immobilization for 6 weeks Gentle stretching and resisted eversion exercises
Short leg cast immobilization and protected weight bearing for 6 weeks is the recommendation.
Sinus tarsi syndrome is a sprain of the: Talocalcaneal ligament Posterior tibiofibular ligament Deltoid ligament Transverse tibiofibular ligament
Sinus tarsi syndrome is an injury to the talocalcaneal ligament.
Which is an indication for an x-ray after ankle injury according to the Ottowa Ankle Rules? Tenderness at the base of the 5th metatarsal Positive anterior drawer and talar tilt test Cuboid bone tenderness Ankle swelling
Tenderness of the base of the 5th metatarsal is an indication for an x-ray, according to the Ottawa Ankle Rules. --Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus --Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus --Bony tenderness at the navicular --Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
The primary function of the ACL is to limit___?
The ACL limits anterior tibial displacement.
A 14-year-old basketball player comes to your office for ankle pain and swelling. He reports he went up for a rebound and landed on a teammates foot. He does not remember what happened, but he then fell to the ground with immediate pain and difficulty placing weight on that ankle. Which ligament is the most commonly injured ankle ligament? PTFL Deltoid ATFL CFL
The ATFL is the most commonly injured ankle ligament.
A 16-year-old gymnast with a known history of acetabular dysplasia presents with intra-articular vaguely painful snapping of the hip. You order an MRI and expect to find pathology at: Greater trochanter Anterosuperior labrum Pubic symphysis Myotendinous junction of the iliopsoas
The anterosuperior labrum is the most common location of a hip labral tear. A hip labral tear is a traumatic tear of the acetabular labrum, mostly common seen in acetabular dysplasia Treatment is a nonoperative trial to include NSAIDs, rest and physical therapy. Arthroscopic labral debridement versus repair is indicated for patients with progressive symptoms who failed nonoperative management. https://www.orthobullets.com/sports/3097/hip-labral-tear
The Lisfranc ligament attaches: The navicular to the medial cuneiform The medial cuneiform to the 2nd metatarsal The medial cuneiform to the 1st metatarsal The 2nd metatarsal to the 3rd metatarsal
The Lisfranc ligament attaches the medial cuneiform to the 2nd metatarsal.
Which ligament has an attachment to the meniscus? MCL PCL LCL TCL
The MCL has an attachment to the medial meniscus, where the ACL also attaches. This is why with a severe force to the knee, the patient can experience the "unhappy triad" (torn ACL, MCL, and medial meniscus).
Which is the most commonly injured knee ligament? LCL ACL MCL PCL
The MCL is the most common ligament injury.
A 22-year-old male comes to your clinic for groin pain. He reports his skate got caught in another player's stick resulting in him performing a split. He had sudden onset of groin pain which he locates to the mid thigh in the medial side. Resisted adduction causes him pain. The most common muscle injured in an adductor muscle strain is the: Gracilis Adductor brevis Adductor magnus Adductor longus
The adductor longus is the most common muscle injured in an adductor strain. https://www.orthobullets.com/sports/3101/adductor-strain
Which compartment of the leg is most commonly affected in exertional compartment syndrome? Anterior Medial Lateral Posterior
The anterior compartment is most commonly affected about 70% of the time. This is an exercise-induced condition of the leg characterized by reversible ischemia to muscles within a muscular compartment. Source: Exertional Compartment Syndrome - Knee & Sports - Orthobullets
Which action(s) can be performed by the gluteus medius? Hip external rotation Hip internal or external rotation Hip extension Hip internal rotation
The anterior fibers can internally rotate the hip, while the posterior fibers can externally rotate the hip. The gluteus medius is also a primary abductor. https://www.orthobullets.com/anatomy/10062/gluteus-medius
Which muscle originates at the ischial spine, inserts onto the greater trochanter and abducts the flexed hip? Superior gamellus Quadratus femoris Piriformis Obturator internus
The describes the superior gamellus. Piriformis originates from the sacrum and gluteal surface of ilium and inserts onto the greater trochanter. The quadratus femoris originates at the obturator ring and inserts onto the intertrochanteric crest. The origin of obturator internus is the obturator foramen/membrane and inserts on the greater trochanter.
A 19-year-old football player has a non-contact knee injury as he was trying to avoid a defender. Your exam is concerning for an ACL injury. MRI confirms this but also identifies a posterolateral corner injury. Which test could you have performed to possibly identify this on previous visit? Sag Test Pivot Shift Test Anterior Drawer Test Dial Test
The dial test evaluates for potential posterolateral corner injuries. The test can be performed in either prone or supine. When prone, flex the knees to about 30 degrees. The examiner should then cup the heels and provide an external rotational force. This is then repeated with the knees flexed to 90 degrees. A positive test occurs when there is more than 10 degrees of external rotation in the injured knee compared to the non-injured knee. Review the following reference to distinguish between positive test in 30 degrees vs 90 degrees. Dial Test - Physiopedia (physio-pedia.com)
A 20-year-old female presents with left thigh pain after performing plyometric exercises. She describes a vague, anterior thigh pain. There is tenderness to palpation of the distal femur but no pain with active-resisted quadriceps extension. The fulcrum test is positive. X-rays are normal. Which diagnosis is the most likely? Distal femoral stress fracture Patellofemoral Syndrome Jumper's Knee Quadriceps Strain
The history provided with a positive fulcrum test is most indicative of a distal femoral stress fracture.
A 5-year-old has confirmed avascular necrosis of the femoral head and awaiting surgery. The patient's father asks how his daughter should hold her leg until surgery. You advise: The leg should stay in extension and internally rotated The leg should be abducted and externally rotated The leg should be abducted and internally rotated The leg should be adducted and internally rotated
The idea is to keep the femoral head in the acetabulum as much as possible. To do this, abduction and internal rotation are recommended.
The vascular supply to the ACL is the: Femoral artery Saphenous artery Middle genicular artery Tibial artery
The middle genicular artery is the vascular supply to the ACL.
Name the two types of medial tibial stress syndrome and which muscles are usually indicated in each.
The most common type is posterior medial also known as medial. The tibialis posterior or soleus are usually indicated in this syndrome. The less common of the two is anterior lateral where the tibialis anterior is usually the culprit.
You are seeing a triathlete in your clinic who has recently increased her mileage. She has also included more downhill running workouts into her regimen because she read that eccentric downhill exercises may be beneficial. However, she has a new onset of right posterior knee pain. She states that she can push on the sore spot in the back of her knee best when sitting cross-legged and pushing over the posterolateral corner. What is the source of her pain? Popliteal tendonitis Short-head of the biceps femoris tendonitis PCL sprain LCL sprain
The most likely scenario is popliteal tendonitis considering downhill running and method of palpation. Remember, the posterolateral corner complex is made up of the arcuate ligament, fibular collateral ligament, and popliteus muscle tendon.
Where is the most common site of a hamstring rupture? There is no area that is more prone Myotendinous junction Distal hamstrings insertion Ischial tuberosity
The myotendinous junction is the most common area of hamstring injury.
What is the normal Q-angle for women? 17 degrees (+/- 3) 12 degrees (+/- 3) 8 degrees (+/- 3) 22 degrees (+/- 3)
The normal Q-angle for a woman is 17 degrees (+/- 3).
A 34-year-old female comes to your office for anterior knee pain. She reports the pain is worse after she has been sitting for a prolonged time and when she is going down hill on hikes. On exam you notice that her VMO may be slightly weak. You ask the patient to lie supine with her leg extended. You then place your hand on her thigh, cupping the patella. You then ask the patient to contract her quad. Which test did you just perform? Apprehension test Apley grind test Thessaly's test Patellofemoral grind test
The patient likely has patellofemoral syndrome and the test that was performed was the patellofemoral grind test.
What is the purpose of the popliteus? Externally rotate the knee Unlocks the knee Extend the knee Prevents anterior motion of the femur
The popliteus helps to unlock and bring the knee out of full extension.
Which ligament limits excessive abduction of the hip? Ligamentum capitis femoris Pubofemoral Iliofemoral Obturator ligament
The pubofemoral ligament limits excessive abduction and extension of the hip.
Your 55-year-old patient presents with lancinating right hip pain and quadriceps atrophy, An EMG/NCS is consistent with sensory and motor axonal loss on the right, but not the left. What is the next best step? Begin gabapentin Steroid taper Refer for a transforaminal injection Glucose testing
These findings are consistent with diabetic amyotrophy. Diabetic amyotrophy is a proximal diabetic neuropathy. The typical symptoms are fairly sudden onset and usually occur on one side of the body but may involve both sides. A radiculopathy is not likely to affect the dorsal root ganglion, resulting in a sensory axonal neuropathy. Frequently, patients are unaware that they have diabetes.
A 72-year-old female comes to clinic reporting a 2nd toe deformity and dorsal toe pain with footwear. On exam, the 2nd toe has an extended DIP, a flexed PIP and a slightly extended MTP. What is your diagnosis? Mallet toe Claw toe Hammer toe Club toe
This describes a hammer toe. Review all of the different types of "toes." The hammer toe is the only one with an extended DIP. Treatment is a trial of nonoperative management with shoe modification. Surgical management is indicated for progressive deformity, fixed contractures, and dorsal toe ulcerations.
A 62-year-old female comes to clinic for the evaluation of hip pain. After taking the history you believe it is intraarticular in nature. You ask the patient to lie supine and then flex her hip with an extended knee to about 30 degrees. You then apply downward pressure and the patient reports a reproduction of her hip pain. What is the name of the test you just performed? Ely test Thompson test Stinchfield's test Scour test
This explains the stichfield test and can help further classify hip/low back pain. Pain in the anterior groin with this maneuver indicates a positive test.
A Maisonneuve fracture is: Fracture of the proximal fibula associated with a high ankle sprain Fracture of the cuboid associated with an ATFL/CFL tear Fracture of the proximal tibia associated with a positive Hopkin's test Fracture of the distal tibia and fibula associated when landing on flat feet after a jump
This is a fracture of the proximal fibula resulting from external rotation forces on the lower extremity.
What is the name for the sign when a patient describes anterior knee pain after prolonged sitting?
This is called the movie theater sign and is classic of patellofemoral pain syndrome. Source: http://medboardreview.com/movie-theater/
A 41-year-old male patient just began a new workout program. He reports painless popping of the hip when he does sit ups. Ober's test is negative. What is the most likely cause? A sports hernia A hip labral tear The iliopsoas tendon sliding over the femoral head The sartorius sliding over the greater trochanter
This most likely represents the iliopsoas tendon sliding over the femoral head, also known as coxa saltans. Snapping can be reproduced by passively moving the hip from a flexed and externally rotated position to an extended and internally rotated position. https://pubmed.ncbi.nlm.nih.gov/10790668/
The incidence of lower extremity stress fractures in runners is highest in the: Tibia Fibula Metatarsals Calcaneus
Tibia stress fractures have the highest incidence in runners. Referenced from Cuccurullo Board Review
Which provides the primary vascular supply to the knee? Popliteal artery Femoral artery Saphenous artery Tibial artery
Tibial artery From Emedicine: Many vessels are involved in forming the arterial anastomosis around the knee joint. This anastomosis is formed by the superior, middle, and inferior genicular branches of the popliteal artery; the descending genicular branch of the femoral artery; and the descending branch of the lateral circumflex femoral artery, the circumflex fibular artery, and the anterior and posterior tibial recurrent arteries.
To assess for a true leg length discrepancy you will: Compare lengths between the pubic symphysis and the heels Compare lengths between each PSIS and medial malleolus Compare lengths between each ASIS and medial malleolus Compare the heights of the PSIS when standing
To determine a true leg length discrepancy, measure from two fixed bony points, the ASIS and medial malleolus.
What is the success rate of one or more corticosteroid injections for trochanteric bursitis? 60-100% 30-50% 10-30% 0-10%
Trochanteric bursitis corticosteroid injections are extremely effective at 60-100%.
What shoe changes can be made to treat a morton's neuroma?
You should have the patient wear shoes with a wide toe box and you can place a metatarsal pad into the shoe.
