Ortho 1 Final
What is pincer impingement associated with?
- increased center-edge angle - positive crossover sign (radiographic finding associated with cranial acetabular retroversion) - coxa profunda
What are the callus presentation in forefoot varus?
- increased shear loading = on 2nd-3rd met heads - level for push off = medial aspect of 1st ray - medial side of hallux rubs against inside shoe secondary to push off on abducted forefoot = pinch callus - uncompensated = 5th metatarsal
What are the disadvantages of soft foot orthosis?
- ineffective for weight transferring, limiting joint motion, and for stabilizing deformities - bulky
What is the biopsy appearance of stage 1 adhesive capsulitis?
- inflammatory cell infiltrate - hypervascular, hypertrophic synovitis - normal capsular tissue
What are key structures in the lateral or peroneal compartment?
- peroneus brevis - peroneus longus - superficial peroneal nerve - proximal portion of the common peroneal nerve - peroneal artery
What are the disadvantages of rigid foot orthosis?
- poor shock absorption - easily aggravates bony/soft tissue lesions over plantar surface of foot
What are key structures in the deep posterior compartment?
- popliteus - tibialis posterior - FHL - FDL - tibial nerve - posterior tibial artery - peroneal artery
What factors is attributed to the development of ITB syndrome?
- position of prominent lateral femoral condyle - hip abductor tightness - hip adductor weakness - decreased flexibility - cavus foot types - genu varum - excessive pronation - limb length discrepancy - running errors
For Colles and Smith fracture, surgical interventions, which are typically open or closed reduction and/or ORIF are indicated by what criteria?
- post reduction that is > 3 mm OR - dorsal (Colles)/frontal (Smith) angulation that is > 10° OR - intraarticular displacement > 2 mm
Besides pincer impingement, what other conditions is associated with retroverted acetabulum?
- posterior coverage deficiency - posterior instability
What are the three common sites of involvement for peroneal tenosynovitis?
- posterior to lateral malleolus at peroneal sulcus - peroneal trochlea - peroneus longus tendon under cuboid tuberosity
According to O'Driscoll's classification, what are the special tests for *perched (subluxed) elbow*?
- posterolateral rotatory instability test (*pivot shift*) - varus stress test
According to O'Driscoll's classification, what are the special tests for *posterior dislocation of elbow*?
- posterolateral rotatory instability test (*pivot shift*) - varus stress test - valgus stress test
What criteria must one meet to be diagnose CRPS Type II or causalgia?
- presence of continuing pain, allodynia, or hyperalgesia after a nerve injury not necessarily limited to the distribution of injured nerve - evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain - diagnosis is excluded by the existing conditions that would otherwise account for degree of pain and dysfunction
What complications are possible with Bristow-Du Toit surgeries?
- problems with metal hardware - proximity to musculocutaneous nerve
What are general principles for Phase III (3-6 months) of hip fracture rehabilitation?
- progression to full weight-bearing - progressive resistive exercise - neuromuscular reeducation - progression to high-level functional rehabilitation - return to play and return to work.
What are compensations for forefoot varus?
- pronation of STJ during mid-stance and terminal stance in order for first met head to contact ground - full compensationL excessive calcaneal eversion (STJ pronation)
What structures in the *forearm* are innervated by the median n.?
- pronator teres - FCR - palmaris longus - FDS
What are conservative interventions for MCL injuries?
- prophylactic bracing - early ROM isolated MCL injuries respond well to these
What are the advantages of soft foot orthosis?
- provides pressure relief and shock absorption - reduces shear, compression, and tensile forces
According to O'Driscoll's classification, what are the damaged structures with *perched (subluxed) elbow*?
- radial collateral ligament - ant/post joint capsule (ulnar collateral ligament is injured but not significantly damaged)
__________ fracture is a "T" or "Y" shaped condylar fracture pattern that includes the volar-ulnar fragment of a Bennett's fracture with the addition of a dorsal-radial fragment.
Rolando's fracture worse, more guarded prognosis than Bennett's
T or F: Risk of recurrence of anterior dislocations are inversely proportional to the severity of the injury
True; patients with serious injuries tend to avoid movements that could possibly reinjure the structure again but it is not the case with dislocations
Patient presents with TTP of wrist just ventral to ulnar styloid process. She c/o ulnar-sided wrist pain with end range wrist extension, ulnar deviation, and/or axial loading, particularly with crepitus, clicking and/or grinding at wrist especially with supination and pronation.
TFCC disorder
What are the surgical management for femoral neck fracture for patients with severe arthroplasty?
THA
T or F: with a fall in an outstretched hand, it is possible for the elbow to dislocate while preserving the functional integrity of the anterior oblique fibers of ulnar collateral ligament
True
T or F: There are no ideal treatment for Essex-Lopresti
True treatment options include radial head replacement, interosseous membrane tightening, decreasing the length of ulna, osseous union between radius and ulna
T or F: damage of neurovascular structures is very rare despite close anatomic proximity to the joint
True; but if it happens, *ulnar n.* is the most common nerve to be injured
T or F: after birth, the hip is naturally lax and the femoral head may spontaneously dislocate and relocate
True; most hips are prone to dislocation at birth
What is contact trauma?
a severe twist or valgus blow to the patella
What is the most common negative outcome of an elbow dislocation?
a slight loss of elbow ROM (usually a flexion contracture of about 10 deg)
Angioblastic tendinosis refers to degenerative changes that occur when?
a tendon failed to properly heal after injury
What is an important long-term management for lateral epicondylitis patients?
activity, work, and tool modification and HEP
What type of slipped capital femoral epiphysis occurs with significant trauma with resultant pain, restricted hip abduction, and IR?
acute
What is a type III SLAP tear?
bucket handle tear of the superior labrum with an intact biceps
What is a type IV SLAP tear?
bucket handle tear of the superior labrum with extension into biceps
What is the lesser common tear that responds poorly to conservative treatment and is characterized by only being on the bursa side of the tendon?
bursa side tears
How does the forefoot compensate for excessive rearfoot pronation in a forefoot supinatus?
by DF the first ray and and PF the fifth ray (twisting) result of long term comepsation for excessive subtalar joint pronation
How is forefoot varus measured?
by observing the vertical bisection of calcaneus when held in subtalar neutral, relative to a line bisecting the met heads
In a nursemaid's elbow, how is the radial head reduced?
by supinating the forearm with the elbow in full extension if it does not work, it is supinated with the elbow in flexion
How is rearfoot varus measured?
by the angle formed by a line bisecting the distal 1/3 of the posterior leg and a line bisecting the posterior calcaneus
Interventions for lateral epicondylitis is usually non surgical but if surgical interventions are indicated, what does it involve?
excision of the abnormal angio fibroblastic tissue at the origin of the ECRB m.
Injury to TFCC is most often secondary to a fall or landing on an ___________ and ___________ deviated hand and/or fully pronated/supinated forearm.
extended; ulnarly
Conservative treatment for radial tunnel syndrome consists of rest, NSAIDs, and wrist splinting in 30° of __________ and elbow splinting in 90° of _________ for 4-6 weeks or wrist cock-up splints for 3-6 months.
extension; flexion
The menisci move forward with __________ and backwards with ___________.
extension; flexion
The ACL becomes taut in _____________ of the knee and is a secondary restraint to _______________ motion in full extension as well as rotation.
extension; varus-valgus
Activity modification for radial tunnel syndrome should prevent use of ________________ muscle groups.
extensor-supinator
What is the mechanism of injury for trimalleolar fractures?
extreme ER and characterized by excessive posterior movement of the talus, which shears off part of the posterior margin of the tibia and avulsion injures can fracture the malleolus below joint line
Based on the *Morrey* anatomical classification scheme for stiff elbows, which type of elbow stiffness involves the skin, muscle, capsule, and bone (non-union, malunion, and heterotropic ossification)?
extrinsic
___________ factors are abnormalities or variations involving the foot and/or hip.
extrinsic
For radial tunnel syndrome, stretching of _________________ should be a part of interventions.
extrinsic wrist extensors and flexors
Prognosis of Legg-Calvè-Perthes disease is _____ if the onset is between 5-9 yo and with >1/2 femoral head involved.
fair
What cause instability or dislocation in the shoulder jojint?
force that is large enough to overcome dynamic stability as well as disrupt static supportive structures
For radial tunnel syndrome, soft tissue/functional massage to ____________________ should be a part of interventions.
forearm flexors and extensors
_____________ is a structural deviation of MTJ that involves eversion of the forefoot on the rearfoot.
forefoot valgus the lateral foot will be unable to properly contact the ground during stance; normal mid-stance pronation is delayed
_______________ is a structural deviation of the MTJ joint that involves inversion of the forefoot relative to the rearfoot.
forefoot varus secondary to insufficient frontal plane torsion during normal development of foot
What motion is optimal for evaluating scapular dyskinesis dynamically?
forward flexion
How can improper posture cause impingement tendinosis and rotator cuff disease?
forward head posture combined with increased thoracic kyphosis reduces the anterior entrance of subacromial space and can cause compression of supraspinatus tendon
_____________ is attributed to factors such as developmental factors, neuromuscular disorders, coxa vara, wider pelvis, weak abductors.
knee valgus
______________ is attributed to factors such as developmental factors, neuromuscular disorders, coxa valga, and weak hip adductors.
knee varus
47-year old female presents to the clinic with c/o catching sensation in the shoulder especially with overhead activities. These catching sensations would typically lead to significant shoulder pain, weakness and stiffness, and loss of endurance and ROM of the shoulder. Patient does not remember injuring shoulder recently but recalls falling on lateral shoulder 2-3 years prior to onset of symptoms. What condition is likely present?
labral tear
Posterior shoulder pain may be more indicative of ________________.
labral tear or detachment
What could be damaged in excessive acetabular anteversion?
labrum of the posterior edge of the acetabulum
A tear measuring between 3-5 cm is considered _________________ sized.
large
A 15-month old baby presents to the clinic with limping, toe walking, and waddling. The child walks on their toes on the R side. During examination, you see patient has excessive joint laxity and limited abduction ROM on the R side *(<60° in 90° hip flexion)*. What condition does this patient present with?
late diagnosis of developmental dysplasia of the hip
Anteversion cause the trochlear groove will become oriented medially relative to the tibial tubercle and ______________ vector forces will increase during quad contraction.
lateral
The normal twist of femur is described as anterior torsion or relative __________ rotation of the head and neck of femur rather than as a femoral IR.
lateral
Where does paresthesia occur for pronator teres entrapment?
lateral 3 1/2 fingers and palm of the hand
The anterior interosseous nerve arises 5-8 cm distal to the _______ and supplies deep muscles on the __________ forearm.
lateral epicondyle; anterior
Which of the following is *NOT a structural factor* that may cause narrowing of subacromial space: - bony changes and variations - tendon thickening - long head of bicep rupture - fractures - increased prominence of greater tuberosity
long head of bicep rupture *this is a functional factor*
The posterior tibial nerve passes through a fibro-osseous canal within the lacinate ligament and terminates into the ________________.
medial and lateral plantar nerves
_______________ may result from poorly managed Little Leaguer's elbow.
medial epicondyle fractures
What is the typical shoe wear of an overpronator?
medial part inside the shoe
What is an extracapsular hip fracture involves both trochanters where one or both trochanters may be fractured or separated?
pertrochanteric
_____________ bursitis are often present in runners with tight medial hamstrings, swimmers, and individuals involved in sports that require side-to-side movement.
pes anserine breast-stroker's
__________ is a deformity in which the medial longitudinal arch of the foot is high and does not flatten on weight bearing.
pes cavus supinated foot increased WB stresses placed on the lateral foot and metatarsals may result in lateral foot pain, symptomatic intractable plantar keratosis and metatarsalgia
___________ is a deformity characterized by reduced or absent medial longitudinal arch.
pes planus the medial border of the foot touches or almost touches the ground
What is the most common complication of anterior dislocation?
reoccurence athletes less than 20 yo have a greater risk for reoccurence
DeQuervain's tenosynovitis is linked to what movement?
repetitive movement involving forceful hand gripping combined with ulnar deviation
What is the common cause of compression in the radial tunnel?
repetitive pronation, supination, or wrist flexion and extension
________________ lasted shoes have fabric from the upper that is wrapped around without the use of a board; characterized by a seam down the middle of the foot pad.
slip
What stage of adhesive capsulitis present with the following signs and symptoms: - profound stiffness - pain is minimal - significant motion loss - gradual improvement in motion
stage 4
What stage of Legg-Calvè-Perthes disease presents with the following: - femoral neck and head retain any residual deformity from the repair process
stage 4: healed (residual)
Valgus stress injuries can be classified via ____________.
stages of elbow instability
___________ is the reattachment of anterior capsule and labrum to the glenoid.
staple capsulorrhaphy
______________ describe over-use injuries that occur secondary to repetitive tissue damage and is due to failed or faulty healing of a tendon.
tendinosis this is a chronic pathology without acute inflammation
Which of the following is *NOT a functional factor* that may cause narrowing of subacromial space: - abnormal scapular motion - tendon thickening - capsular laxity - abnormal scapular position - long head of biceps laxity
tendon thickening *this is a structural factor*
In a Bennett's fracture, what causes the displacement of the metacarpal shaft in a dorsal, proximal and radial direction in which a small fragment is held in place?
the pull of - abductor pollicis longus - extensor pollicis longus - extensor pollicis brevis - adductor pollicis
What is the condition in which the movement of the finger is arrested for a moment in flexion or extension and then continues with a jerk, snap, or pop?
trigger finger
25-year old basketball player presents to the clinic with pain on his R foot. He reports that it begun after an acute injury where his tibia ER on a planted foot. Patient is unable to WV on R side. R LE presents with gross swelling and signs and symptoms of instability. What condition is most likely present?
trimalleolar fracture
_____________ is a fracture through both malleoli and the posterior process of the tibia (aka the third malleoli).
trimalleolar fracture
______________ fractures are often present in osteoporotic elderly women and is often the precursor to multiple system failure.
trochanteric
T or F: a subacromial lidocaine injection in someone who is suspected to have proximal biceps tendinosis may help rule out cuff disease
true
A septic arthritic knee aspirate will appear ___________.
turbid
Mallet finger in children typically entails __________ injury.
trans epiphyseal (growth plate)
What is an intracapsular hip fracture half way down the neck of the femur?
transcervical
A ____________ fracture is a fracture of distal humerus that is classified as either a flexion or extension type of injury based on the position of elbow during impact.
transcondylar fracture
According to O'Driscoll's classification, what are the damaged structures with *3b posterior dislocation of elbow*?
- radial collateral ligament - ant/post joint capsule - ulnar collateral ligament (*posterior AND anterior oblique*)
According to O'Driscoll's classification, what are the damaged structures with *3a posterior dislocation of elbow*?
- radial collateral ligament - ant/post joint capsule - ulnar collateral ligament (*posterior oblique*)
What are the surgical management for femoral neck fracture for low functioning patients?
- reduction and screw fixation - hemiarthroplasty
What are the possible causes of trauma that results in Kienböck's disease?
- repeated compression of lunate between radius and capitate which results in stress fractures - avulsion of capsular structures - a horizontal fracture of one pole of the lunate
T or F: tendinopathies are self-limiting conditions that take only a few weeks to resolve
False; they are most likely uncooperative to treatment and may take months to years to resolve
T or F: reoccurrence of adhesive capsulitis in the same shoulder is common
False; uncommon
A physical therapist is looking at radiographs of someone with a suspected SCFE. Radiographs show femoral head displaced > 1/2 of the width of the femoral neck. What does this indicate?
Grade III displacement
____________ is a common source of lateral knee pain and is caused by repetitive irritation and friction of the ITB fascia.
ITB friction syndrome common in runners with slower cadence due to decrease flexion angle
________________ is an injury of the plantar plate or a collateral ligament ranging from minor ligamentous stretching to dislocation of an MTP joint.
turf toe related to sports where a force pushes big toe into HE
__________ is shoulder arthroplasty that is performed when RTC are not repairable.
RSA
Greater lateral shoulder pain may be more indicative of ______________.
RTC disease
__________ are common after anterior dislocation of shoulder.
RTC tear
What are the normal Q-angle values?
- 13° for men - 18° for women
What are the two most common surgical approaches to an ACL repair?
- patellar tendon graft - hamstring graft
What can elicit pain in tibial stress fractures?
- percussion - tuning fork - ultrasound
According to AO-OTA, what group of trochanteric fractures are simple pertrochanteric area fractures below the lesser trochanter?
A1.3
According to AO-OTA, what group of trochanteric fractures are multi fragmentary pertrochanteric area fractures with one intermediate fragment?
A2.1
According to AO-OTA, what group of trochanteric fractures are multi fragmentary pertrochanteric area fractures with 2 intermediate fragments?
A2.2
Shoulder pain in the ___________ part of the shoulder is one of the characteristics of secondary impingement.
anterior
What are the normal values for angle of inclination?
- 150° in infants - 125° in normal adults - 120° in elderly person larger in men and smaller in women
What is the normal acetabular anteversion?
- 18° for males - 21° for females
What are the normal values for angle of anteversion?
- 40° in newborns - 15° in adults range is 8-30° and decreases with age
According to Ottawa Knee Rule, what presentations indicates radiographs for knee pathologies?
- 55 years or older - isolated tenderness of patella - tenderness of head of fibula - inability to flex the knee 90° - inability to bear weight for 4 steps immediately and in emergency department, regardless of limping
What does the acronym AMBRI stand for?
*A*traumatic, *M*ultidirectional, *B*ilateral (usually), *R*ehabilitation (responds well to PT), *I*nferior capsular shift (used if rehab fails)
What does the acronym TUBS stand for?
*T*raumatic onset, *U*nidirectional (usually anterior, *B*ankart lesion, *S*urgery (usually indicated
What are common risk factors for the development of adhesive capsulitis?
- *DM* - *thyroid dysfunction* - hyperlipidemia - cardiovascular disease - Dupuytren's contracture - autoimmune diseases - breast cancer treatment - micro trauma
What structures are involved in a ALRI rotatory instability?
- *a*rcuate complex - middle portion of the *l*ateral capsule - poste*r*ior-lateral capsule
What structures are involved in a AMRI rotatory instability?
- *a*rcuate complex - middle portion of the *m*edial capsule - poste*r*ior-medial capsule
What conditions are associated with increased alpha angle greater than 55°?
- *cam type* femoral acetabular impingement - early OA - labral tears
What structures are involved in a PLRI rotatory instability?
- *p*osterior portion of *l*ateral complex - a*r*cuate complex
What conditions are associated with increased acetabular depth (coxa profunda)?
- *pincer type* femoral acetabular impingement - early OA - labral tears
According to the Ottawa Knee Rule, knee radiographs are required when injured if what criteria are met?
- 55+ years old - isolated tenderness of the patella - tenderness of the head of fibula - inability to flex knee to 90° - inability to bear weight for 4 steps immediately and in emergency department regardless of limping
What is the recommended immobilzation time for unstable shoulder?
- <20 yo = 6 weeks - 20-30 yo = 2-3 weeks - >30 yo = 10-14 days - >40 yo = 3-5 days
What is an abnormal EMG finding for conduction asymmetry between hands in carpal tunnel syndrome?
- > 1 ms for motor - 0.5 ms for sensory
What are the superior borders of subacromial space?
- AC joint - anterior edge and under surface of the anterior 1/3 of the acromion - coracoacromial ligament
What hormonal factors contribute to ACL injuries?
- ACL fibroblasts have estrogen receptors - synthesis of collagen by fibroblast is reduced when estrogen is present - high level of estrogen may decrease neuromuscular control of the knee - increased estrogen levels noted during premenstrual/ovulation phases may alter motor control
What three knee injuries are often associated with one another?
- ACL tear - medial meniscal tear - MCL tear "Unhappy Triad" or "Terrible Triad"
What structures in the *hand* are innervated by the median n.?
- APB - FPB - opponens pollicis - 1st and 2nd lumbricals
What is the arthroscopic appearance of stage 2 adhesive capsulitis?
- Christmas tree synovitis - some loss of axillary fold
What structures in the *forearm* are innervated by the anterior interosseous n.?
- FDP (first half or 2nd and 3rd digits) - FPL - pronator quadratus
What are the three presentations of developmental dysplasia of the hip?
- Frank dislocation - Dislocatable - Subluxable
What conditions are associated with FAI?
- LBP - sports hernia - hypermobility
What are risk factors for Dupuytren's contracture?
- MI - shoulder immobilization (often associated with shoulder hand syndrome) - chronic invalidism - alcoholism - epilepsy - pulmonary TB - diabetes - liver disease
Besides cervical radiculopathy, what must be ruled out when suspecting carpal tunnel syndrome?
- MS - spinal cord lesions/tumors - peripheral neuropathy (diabetic, alcoholic, toxic)
What are mechanism of injuries for PCL?
- MVA in which a flexed knee hits the dashboard - hyperflexion with or wiothout an anterior tibial force just below the knee, or with a downward force applied to thigh - hyperextension with or without a knee varus or valgus and with or without a distinct traumatic episode
What are the most commonly used tests for impingement in the shoulder?
- Neer's sign: humerus forcefully abducted or elevated in the scapular plane against a firmly fixed scapula - Hawkin's sign: shoulder and elbow are passively flexed to 90° and shoulder is forcibly IR
What complications may arise from ACL injuries?
- OA following ACL injury, especially with meniscal injury - arthrofibrosis
What are the interventions for displaced scaphoid fractures?
- ORIF in most cases - bone graft in some instances
What are interventions for trimalleolar fractures?
- ORIF of both malleoli - posterior process of tibia does not need open fixation - below knee cast for 6-10 weeks
How are comminuted radial head fracture (Type III) managed?
- ORIF with early ROM
What does knee valgus increase?
- Q angle - lateral force acting on patella
What two conditions are mostly associated with Smith fractures?
- RSD - median nerve compression a precaution is to monitor the possible onset of these conditions in patients with this injury
What must be ruled out when there is a suspected GH dislocation?
- RTC injuries - axillary nerve injury - fracture - vascular injuries
What are key structures that occupy the subacromial space?
- RTC tendons - long head of biceps tendon - subacromial bursa - coracoacromial ligament
What are surgical management for partial thickness tears that are less than 3 cm?
- debridement of partial-thickness tears alone - debridement with arthroscopic subacromial decompression - arthroscopic repair of delaminated partial-thickness tear - arthroscopic subacromial decompression with mini-open repair of the partial thickness tear - open repair of the tear with acromioplasty
What characteristics are associated with coxa valga?
- decrease Q angle - hip OA - pseudo leg length discrepancy
What are the possible areas of entrapment for anterior interosseous syndrome?
- deep head of pronator teres - origin of FDS of 3rd digit - origin of palmaris profundus and FCRB
What are positive special tests for cubital tunnel syndrome?
- Wartenberg's sign - Froment's sign - Tinel's sign behind medial epicondyle
What are some conservative management and preoperative rehab for FAI?
- activity modification - restore joint mobility - restore hip abductor strength - restore hip flexors and adductor flexibility - restore core and paraspinal muscle strength
What are the risk factors for hip fractures?
- advancing age - osteoporosis - smoking - falls
What are differential diagnoses for supracondylar fracture?
- anterior interosseous nerve injury of median n. - brachial artery injury - radial n. injury
What is the intervention for Stage I Kienböck's disease?
- anti-inflammatory medications - immobilization
What are surgical management for full thickness tears that are greater than 3 cm?
- arthroscopic - mini-open - open
Where do tibial stress fractures often occur?
- at the junction of the middle and distal thirds - posterior medial tibial plateau - distal to tibial tuberosity
During a fall on the outstretched hand, the elbow undergoes which of the following movements?
- axial loading force - hyper-supination - valgus moments while passively flexing
What is the mechanism of injury for anterior dislocation?
- axial loading of the arm in *abd and ER* - axial loading of the arm in *ext, abd, ER*
What is the mechanism injury of posterior instability and dislocations?
- axial loading of with adducted and IR arm - axial loading of arm with adducted, flexed, IR arm
Possible areas of entrapment of median n. in pronator teres syndrome may occur at?
- between two heads of pronator teres - lacertus fibrosus (aponeurosis of biceps) - arch of FDS - ligament of Struthers - abnormal anatomy of pronator teres
What does accelerated rehabilitation protocols encourage?
- brace-free full ROM - full weight bearing within 24-72 hours if complications are not present
What signs does stage 1 adhesive capsulitis present?
- capsular pain on deep palpation - empty end feel at extremes of motion - full motion under anesthesia
What may be linked to presentation of achilles tendinitis?
- changes in running program - hill climbing (due to increased DF = greater tensile loads of gastroc/soleus - running on roads/sidewalks with camber - inappropriate footwear - excessive pronators
What are contributory or predisposing factors for carpal tunnel syndrome?
- colles fracture - diabetes - neuropathy - ganglia or tumor within carpal tunnel - hemodialysis - hypothyroidism - osteoarthritis - pregnancy/oral conraceptive - RA - tenosynovitis
What is the arthroscopic appearance of stage 3 adhesive capsulitis?
- complete loss of axillary fold - minimal synovitis
What are examples of active mechanisms that keep the shoulder joint stable?
- compression of joint surfaces - neuromuscular control - dynamic stabilizers and musculature
What is the surgical intervention for femoral neck fractures in the presence of structurally unstable bone?
- compression screw - hemiarthroplasty
What criteria must one meet to be diagnose CRPS Type I or reflex sympathetic dystrophy?
- continuing pain, allodynia, or hyperalgesia with which pain is disproportionate to any inciting event - diagnosis is excluded by the existing conditions that would otherwise account for degree of pain and dysfunction
What are foot orthoses used for?
- correct alignment and support - prevent, correct, and/or accommodate for foot deformities - provide shock absorption - improve the overall function of foot and LE function
10-30% of patients will die within the first year after a hip fracture due to what complications?
- decubitus ulcers - nonunion fracture - infection - deep vein thrombosis - heterotopic ossification - hardware failure
In cam impingement, what does progressive articular cartilage injury inside the acetabulum due to repetitive motion result in?
- delamination separation of uncalcified articular cartilage from calcified cartilage - chondral defects - increased tension forces on labrum which leads to labral tears
What are complications with splinting hip dysplasia patients?
- delay of normal development (walking) - skin irritation
Angioblastic tendinosis is characterized by?
- dense fibroblasts - vascular hyperplasia - disorganized collagen - *absence* of acute inflammatory cells - large numbers of macrophages, lymphocytes, and neutrophils (chronic inflammation)
What would a smaller center-edge angle result in?
- diminished coverage of the head of the femur - increased risk of superior dislocation of head of femur
What mechanisms of injury is usually associated with a rupture of PCL?
- direct blow to the proximal tibia - a fall on the knee with the foot in plantar flexion - hyperextension of knee
What special tests might come out negative if patient has anterior interosseous syndrome?
- direct pressure over nerve (may or may not elicit symptoms) - Tinel's sign - Phalen's test this is because it is only a motor nerve
Which type of femoral head fractures require a surgical emergency?
- displaced, transverse fracture - fracture with vascular compromise
What 3 predisposing factors of patella instability are referred to as the "Miserable"?
- excessive ER of tibia - femoral anteversion - genu valgum
What foot deformities are noted with peroneal tenosynovitis?
- excessive forefoot varus - excessive rearfoot varus - rigid forefoot valgus
A Q-angle greater than 18° is associated with the following:
- femoral anteversion - genu valgum - increased external torsion of tibia - lateral displacement of tibial tubercle - chondromalacia patallae - subluxing patella (larger lateral force vector) - tight lateral retinaculum
What are the three categories hip fractures are divided into?
- femoral neck fractures - intertrochanteric fractures - subtrochanteric fractures
What is the arthroscopic appearance of stage 1 adhesive capsulitis?
- fibrinous synovial inflammatory reaction - no adhesions or capsular contracture
What are the possible areas of entrapment of posterior interosseous nerve?
- fibrous bands that lie anterior of radial head - radial recurrent vessels - proximal origin of ECRB or fibrous bands within ECRB - proximal edge of supinator muscle - distal border of supinator muscle
What is phase 2 of meniscal post-operative management?
- flexibility - endurance training - isokinetic strengthening - CKC
What is the recommended shoe type for supinators?
- flexible with soft midsole and good shock absorption - curved last - slip lasted - short/medium heel counter - flexible midsole
Which conditions do you see swan neck deformity of the fingers?
- flexor synovitis - dermatomyositis/polymyositis - juvenile chronic arthritis - rheumatic fever - rheumatoid arthritis (MOST COMMON) - systematic lupus erythematosus
What are the typical lower extremity deformities of supinators?
- forefoot valgus - rearfoot valgus - pes cavus - tibial valgus
What are the typical lower extremity deformities of an overpronators?
- forefoot varus - rearfoot varus - pes planus - tibial varus
What are the conditions typically associated with Bennett's fracture?
- fractures of trapezium - MCP UCL injuries
What are special tests that will provoke radian tunnel syndrome?
- full forearm pronation and wrist flexion - resisted elbow flexion with full forearm supination - resisted supination with elbow fully extended - resisted 3rd digit extension with elbow fully extended - paresthesia during pressure over radial n.
What is the arthroscopic appearance of stage 4 adhesive capsulitis?
- fully mature adhesions - identification of intra-articular structures is difficult
What are key structures in the superficial posterior compartment?
- gastrocnemius - plantaris - soleus - branches of tibial nerve - posterior tibial artery - popliteal artery - peroneal artery - sural arteries
A Q-angle less than 13° is associated with the following:
- genu valgum - patella alta - chondromalacia patallae
What is the biopsy appearance of stage 3 adhesive capsulitis?
- hypercellular, collagenous tissue with a thin synovial layer - similar features to other fibrosing conditions
What is the biopsy appearance of stage 2 adhesive capsulitis?
- hypertrophic, hypervascular synovitis - perivascular, subsynovial capsular scar
What are arthrology factors that can affect patellar instability?
- hypoplasia of the medial patellar facet - shallow femoral sulcus
What are acute treatments for achilles tendinitis?
- ice massage - active DF using low resistance - gentle stretching of calf - eccentric calf exercises
What are interventions for Grade I and II MCL injuries?
- immediate ROM - WBAT
What are factors that may contribute to scapular dyskinesis?
- impaired posture - muscle inflexibility and soft tissue extensibility deficits - impaired muscle function (neuromuscular) - proprioceptive dysfunction - structural variations
What characteristics are associated with coxa vara?
- increased Q angle - weak gluteus medius - pseudo leg length discrepancy
What is the typical clinical presentation for meniscal injuries?
- interruption in ease of motion - intermittent swelling - stiffness - clicking - catching - tenderness - audible popping/clicking with movements - anterior > posterior migration tenderness occurring from extension to flexion over joint line
What foot injuries are noted with peroneal tenosynovitis?
- inversion ankle injuries - lateral malleolar fractures - stress fractures - calcaneal fractures
What are examples of passive mechanisms that keep the shoulder joint stable?
- joint arthrology - intact capsule and labrum - ligamentous and capsular restraints - soft tissues - concavity of the glenoid and labrum - negative intra-articular pressure - adhesive and cohesive properties of joint fluid
What is the intervention for Stage II and III Kienböck's disease?
- joint leveling procedures as ulnar lengthening - radial shortening - partial arthrodesis - carpal fusions to unload lunate
What are special tests to determine inversion ankle sprains?
- joint position and proprioception - ankle mortise instability - anterior drawer - inversion stress testing
What examination findings are most predicative of meniscal injuries?
- knee pain - twisting mechanism injury - catching/locking - delayed onset of effusion - MCPS greater than 3
What are surgical interventions for patellar dislocation?
- lateral retinacula release - repair of the lax medial joint capsule - redirection of line of pull of the patellar tendon by way of the semitendinosus tendon
What is the benefit of ORIF surgery over conservative treatments after a Type II radial head fracture?
- less residual pain - better strength - better ROM - lower incidence of severe posttraumatic OA
What is the clinical presentation of Kienböck's disease?
- limitation of extension of the wrist and general ROM limitations - TTP dorsal aspect of lunate - weakened grip - TTP over region
How can ACL injuries be prevented?
- maintain quadriceps and hamstrings muscle balance/strength, neuromuscular control, and flexibility - ACL prevention programs and training strategies - proper footwear and surface conditions
What are the differential diagnosis for Colles fracture?
- median/ulnar n. damage - compartment syndrome - RSD
What are general principles for Phase I (0-6 weeks) of hip fracture rehabilitation?
- mobilization of adjacent joints and associated soft tissues - protective weight-bearing - adherence to surgical precautions
What is phase 1 of meniscal post-operative management?
- modalities - ROM exercises - isometric strengthening of hip, quads, and hamstrings - stationary bicycle
What presentations of carpal tunnel syndrome are indications for surgery?
- moderate to significant thenar muscle atrophy and/or weakness - moderate to significant and longer standing alterations and/or loss of sensation - positive consequential EMG findings (fibrillation potentials) - symptoms that do not improve with appropriate physical rehab (symptoms that last longer than 6 mos-1 year)
What are the interventions for non displaced scaphoid fractures?
- molded cast immobilization with short arm or long arm cast OR a combination of both - ORIF
What is the recommended shoe type for overpronators?
- motion control and stability - strait or minimally curved - board or strobel last - medium or long heel encounter - very firm/rigid heel counter and midsole
What signs does stage 2 adhesive capsulitis present?
- motion restricted in flex/abdIR/ER - some motion loss under anesthesi
What are additional complications and factors distal humerus fractures present?
- narrow supracondylar isthmus - inadequate subchondral metaphyseal supporting bone - osteopenia in elderly patients
How are marginal displaced radial head fractures (Type II) managed?
- non-operatively (stable) or ORIF (stable AND unstable) - if without block to elbow rotation, intervention is predominately surgical
What are pre-surgical interventions for ACL rehabilitation?
- obtaining full knee ROM - full reduction of intra-articular inflammation/swelling
What are surgical interventions for infants with hip dysplasia and are older than 3-5 months?
- open surgical reduction - femoral and/or pelvic osteotomy
It is suspected that primary afferent nocioceptive mechanisms in CRPS demonstrate abnormally heightened sensation resulting in ___________.
- pain - allodynia - hyperalgesia
What are the 5 Ps associated with compartment syndrome?
- pain - pallor - paresthesia - pulselessness - paralysis
What are the clinical presentation for Colles and Smith fractures?
- pain - swelling - ecchymosis/bruising - limited ROM - tenderness to palpation - ligamentous injury - possible wrist deformity
What is the clinical presentation of Rolando's fracture
- pain and swelling localized to the *proximal end of first metacarpal* - may/may not be present with visible deformity - pain to palpation on site of fracture
What are important diagnostics for radial head fractures?
- pain over radial head/associated tissues - hemarthrosis - limited pronation/supination
What are conservative treatments for pronator teres syndrome?
- restore flexibility in pronator and supinator muscles - relative rest and activity modification (gripping and squeezing) - long-arm splinting with elbow at 90° and forearm in neutral rotation - corticoid steroid injection
What is the intervention for Bennett's/Rolando's fractures?
- short arm cast if non displaced - open reduction with external fixation if displaced (usually Rolando's)
What signs does stage 3 adhesive capsulitis present?
- significant loss of motion - tethering at ends of motion - no improvement under anesthesia
What signs does stage 4 adhesive capsulitis present?
- significant motion loss - gradual improvement in motion
What are common precautions for type 2 SLAP lesions?
- sling for 4-6 weeks - no ext and end-range ER/IR - no active elbow flexion with shoulder flexion for 6 weeks - no joint mobs in the direction of tear
What would nerve conduction velocity and EMG studies show in a positive pronator teres syndrome?
- slowed conduction velocity across the forearm - slowed denervation potentials of FPL and APB
Why are female athletes 2-8x more likely to suffer from ACL injury?
- smaller intercondylar notch width - larger Q-angle - hormonal factors and the effects of estrogen on ligaments
What are the advantages of semi rigid foot orthosis?
- softer and more flexible than rigid - often more comfortable than rigid - provides pressure relief and shock absorption - best choice for patients at risk of skin breakdown
What does X-ray in a stiff elbow help determine?
- status of fracture - bony alignment - bony abnormalities
What are general principles for Phase II (6 weeks-3 months) of hip fracture rehabilitation?
- strengthening and endurance exercises. - progressive weight-bearing - continuance of surgical precautions in some cases; however, most restrictions are discontinued between 8 to 12 weeks post-op
What are primary differential diagnoses for tendinosis and RTC disease?
- subacromial bursitis - capsular changes and restrictions - degenerative cuff changes/degenerative changes in general - degenerative changes of the long head of biceps - RTC tears - long head of biceps brachii tendon tear or rupture - loss of humeral head restraint
What fall mechanism would likely cause a labral tear in the shoulder?
- sudden force on an outstretched and supinated arm - fall resulting in impact to lateral shoulder
What alterations to sympathetic nervous system do CRPS patients present with?
- sympathetic nervous system hyperactivity - sympathetic-afferent fiber coupling - end-organ hypersensitivity to norepinephrine
According to the Ottawa Ankle Rules, the following criteria indicate radiographs for ankle pathologies:
- tenderness along the tip of the posterior edge of the distal 6cm of the lateral malleolus - tenderness along the medial malleolus - inability to bear weight for 4 steps also - tenderness at base of 5th metatarsal - tenderness over navicular bone - inability to bear weight for 4 steps
What are the clinical presentation for scaphoid fractures?
- tenderness in snuff box - pain with pinching, pronation, and compression testing of thumb - decrease wrist flexion and radial deviation ROM and decreased grip strength
Where do most ACL tears occur in?
- the middle of the ligament - avulsion at femur attachment
What will MRI and MRI arthrogram of a shoulder with adhesive capsulitis reveal?
- thickening of cortical humeral ligament, thickening of the capsule - thickening and fibrotic changes of the axillary recess
Besides daily biomechanics, what are other mechanisms that may cause an entrapment of AIN?
- thrombosis of ulnar collateral vessels - aberrant radian artery - enlarged bicipital bursa near origin of AIN - Monteggia fracture
What are common causes of plantar fascitis?
- tibia vara - rearfoot varus - forefoot varus - ankle equinus - compensated forefoot valgus - limb-length differences - poor footwear
What is the mechanism of injury for longitudinal medial meniscal injuries?
- tibial ER in flexion followed by sudden extension - sudden tibial abduction followed by sudden extension
What are key structures in the anterior tibial compartment?
- tibialis anterior - EDL - EHL - peroneus tertius - deep peroneal nerve - anterior tibial artery
What are common mechanisms of injury for ACL?
- twisting/pivoting - rapid change in direction while running/jumping - sudden stops/deceleration during running - direct contact a the knee (especially when foot is firmly planted on the ground) - falling off ladder - hyper extension - valgus with tibial ER - varus with tibial IR
What are the advantages of rigid foot orthosis?
- very strong/durable - most effective for weight transferring, limiting joint motion, and for stabilizing deformities
What are the disadvantages of semi rigid foot orthosis?
- weaker and less durable - often bulkier as compared to rigid - less effective for weight transferring, limiting joint motion, and for stabilizing deformities
What are interventions for Grade III MCL injuries?
- weeks of immobilization - NWB
When does pain occur in patellar compression syndrome?
- when tense retinaculum passes over the trochlear groove - when increased patellofemoral stresses are not cushioned by the articular cartilage causign subsequent subchondral bone pressure
According to AO-OTA, what group of trochanteric fractures are multi fragmentary pertrochanteric area fractures with more than 2 intermediate fragments?
A2.3
Fragment displacement in medial epicondyle fractures that are greater than _____cm and/or valgus instability are treated with ___________.
1 cm; internal fixation
Resolution of Osgood-Schlatter's occur _________ years after onset if properly managed.
1-2 it is resolved after tubercle fuses to tibia at ~15 years of age
Describe the typical scenario of secondary impingement
1. biceps and cuff weakness lead to overloading of passive restraint mechanisms = GH laxity 2. dynamic stabilizers (biceps and RTC) will attempt to compensate but over time will fatigue and/or weaken 3. abnormal translation of the humeral head will occur and mechanical impingement of the cuff will occur beneath coracoacromial arch
What are the five signs in the Meniscal Pathology Composite Score (MPCS)?
1. catching/locking 2. pain with forced HE 3. pain with max flexion 4. pain or audible click with McMurray's 5. Joint line tenderness to palpation when all five signs are present, MCPS has been reported to have 92% positive predictive value
Quadriceps rupture usually occurs _______ *cm* of the superior pole of the patella.
2
What is the distance of the lateral meniscus anterior-posterior excursion?
10-12 mm
What is the normal distance between the acromion and humeral head as shown in radiographs?
10-15 *mm*
What is the elbow's functional arc?
100°
Due to its poor vascularity, the proximal part of scaphoid often requires ORIF and __________ months of immobilization.
12-24
Stiff elbow is characterized by loss of elbow range of motion (<_____° flexion, <______° extension, <______° rotation on either direction) and prolonged immobilization.
120; 30; 45
Since non-displaced scaphoid fractures are often difficult to diagnose with X-ray in general, radiographs may not be reliable with non-displaced fractures until _______ days.
14-21
Radiographs detect metatarsal shaft stress fractures by _______ days.
14-28
Shoulder dislocations are common in individuals between the age of ________ and _________ years of age and older.
15-20 (athletes); 70 (falls)
Fragments in proximal humeral fracture are identified if they present with greater than ______ *cm* of displacement or if they are angulated _____° or greater.
1; 45
Where will callus form in a forefoot valgus?
1st and 5th met heads due to lack of shock absorption
What compensations are seen with a plantarflexed first ray?
1st ray DF and subtalar pronation
Bone scans detect metatarsal shaft stress fractures by ______ days.
2
Achilles tendinitis pain presents typically _______ cm proximal to insertion.
2-6
In a rearfoot varus, callus formation secondary to increased sheer forces are seen on the ___________ met heads.
2nd and 3rd
Arthrometry with more than _____ *mm* of anterior excursion of the tibia on the femur as compared to the contralateral side is indicative of an ACL tear.
3
The lateral _________ and palm are cutaneously innervated by the median n.
3 1/2
A common surgical procedure for GH dislocation is ORIF of tuberosity if displaces greater than ______ *mm*.
3-5
According to AO-OTA, what group of trochanteric fractures are intertrochanteric fractures that are simple and oblique?
A3.1
According to AO-OTA, what group of trochanteric fractures are intertrochanteric fractures that are simple and transverse?
A3.2
What is the cell count/mm2 in a normal knee aspirate?
200 monocytes
What is the cell count/mm2 in a degenerative knee aspirate?
2000 monocytes
What is the cell count/mm2 in a RA knee aspirate?
2000-50,000 half monocytes, half neutrophils
What is considered a normal center-edge angle?
25-30°
According to AO-OTA, what group of trochanteric fractures are intertrochanteric fractures with a medial fragment?
A3.3
T or F: Patient should be encouraged to be as mobile as possible after a patellar displacement occurs.
False; relocation of displaced patella *followed by immobilization* until PT begins *4-6 weeks* after the injury
What stage of patellar tendonitis presents with pain at the start of activity, lessens with activity, and then worsens after activity?
Stage II
In Colles fracture, the fracture often occur ______ cm away from articular surface.
4
After anterior dislocation, younger patients are often in a sling for _____ weeks to prevent reoccurence and older patients are usually in a sling for _____ weeks to prevent capsular restrictions.
4-6; 1-2
Due to its excellent vascularity, the middle and distal parts of the scaphoid bone only require _________ weeks of immobilization.
4-8
What is the most common age for Legg-Calvè-Perthes disease?
4-8 yo
What is the the functional flex/ext ROM for ADLs?
30-130°
Unstable elbow dislocations typically present in a brace that allows for flexion from about ______°.
30-90
At about _____° knee flexion, ITB passes over the lateral femoral condyle and friction is produced.
30°
PT begins ____ weeks after achilles tendon rupture.
8-10
It is common for patients at the stage 3 or thawing stage of adhesive capsulitis to regain ___% of their pre-morbid ROM.
80
T or F: Forearm pronation is more problematic with elbow stiffness
False; supination is more problematic because shoulder abduction can compensate for lack of pronation
What is the average duration of adhesive capsulitis?
9-12 mos
The menisci transmit >50% of the load placed across the joint in the first ____° of flexion, with greater load transmitted in TKE.
90
What is an abnormal EMG finding for distal sensory latencies in carpal tunnel syndrome?
> 3.5 ms
What is an abnormal EMG finding for distal motor latencies in carpal tunnel syndrome?
> 4.5 ms
What is the cell count/mm2 in a septic arthritic knee aspirate?
>50,000 neutrophils
T or F: the optimal intervention for transverse, non-displace femoral head fracture is bed rest without surgical intervention
True
T or F: overall recovery of tendinosis is usually shorter than tendinitis because it does not consist of inflammation
False; tendinosis takes longer to recover because it is a more chronic condition
Study findings reported that athletes with scapular dyskinesis have _____% greater risk of developing shoulder pain than those without dyskinesis.
43
Arthrogram of a shoulder with adhesive capsulitis will show reduced joint volume of at least 50% and will be around _____ *ml*.
5-10 (compared to normal 20-30 ml)
Sorenson et al. identified prevalence of acute rotator cuff injury in over _____% of patients in the ER with acute shoulder trauma and inability to abd above 90°.
50% 1/3 present with full-thickness tear in one or more of RTC tendons
What is the functional pron/sup ROM for ADLs?
50° in either direction
What is the distance of the medial meniscus anterior-posterior excursion?
6-8 mm
Clinical presentation of Legg-Calvè-Perthes disease to fragmentation takes up to ____________.
6-8 mos
Supraspinatus outlet view showing less than _____ *mm* of outlet space between humeral head and acromion is indicative of a cuff tear.
7
Surgical repair of bicep tendon rupture in younger adults are often done between ______ to ______ days.
7-10
Disruption of the central third of the interosseous membrane in an Essex- Lopresti injury can decrease radioulnar stability by up to ____%.
70
T or F: You will expect to see sensory loss with AIN entrapment
False; there is no sensory loss because AIN is purely a motor nerve
What type of scaphoid fracture is described by the following: acute, unstable, displaced or mobile (waist)
Type B2
T or F: younger adults with GH dislocation should be encouraged to move right away to promote healing while older adults will need to be immobilized for a longer amount of time to prevent re-dislocation
False; it is indicated for older adults to immediately start gentle ROM after to prevent capsular restrictions and adhesive capsulitis
T or F: pertrochanteric fractures are more stable than intertrochanteric fractures
False; less
T or F: Instability is the main reason for primary impingement
False; main reason for *secondary* impingement primary instability does not present with GH instability
Greater anterior shoulder pain may be more indicative of _________________ (anterior/superior shoulder) and ________________ (anterior shoulder/arm).
AC impingement; biceps tendinosis
What is the most commonly injured knee ligament?
ACL
Individuals who sustain acute meniscal tears may report a history similar to those reporting an ____________.
ACL tear popping sensation while changing direction suddenly with or without contact
The snapping in a trigger finger is due to the result of thickened part of flexor tendon passing under ___________.
A1 pulley
According to AO-OTA, what group of trochanteric fractures are simple pertrochanteric area fractures along the intertrochanteric line?
A1.1
According to AO-OTA, what group of trochanteric fractures are simple pertrochanteric area fractures through the greater trochanter?
A1.2
What type of instability occurs when the tibia is subluxed anteriorly and to the side as the femur moves into lateral rotation?
ALRI most common
What type of instability occurs with ER of tibia with a flexed knee and a fixed foot causes the tibia to sublux on the medial side in an anterior direction?
AMRI prior meniscal injury may be a precursor
What diagnostic testings are used for intercondylar fractures?
AP and lateral radiography and CT
What diagnostic testings are used for supracondylar fractures?
AP and lateral radiography and CT
What diagnostic testings are used for transcondylar fractures?
AP and lateral radiography and CT
T or F: ACL injuries are least likely to occur on dry surfaces
False; more likely to occur
T or F: Colles and Smith fracture indicates aggressive physical therapy post reduction
False; not indicated!
______________ lesion is an avulsion of the capsule and glenoid labrum off of the anterior rim of the glenoid resulting from traumatic anterior dislocation of the shoulder.
Bankart can contribute to instability resulting in recurrent dislocation
_____________ fracture is an intraarticular fracture of the proximal end (base) of first metacarpal (ligamentous attachment of trapezium).
Bennett's
_____________ is a procedure in which the tip of the coracoid and associated tendons is transferred to the neck of the scapula which creates a sling mechanism for ER and abduction.
Bristow-Du Toit Modified Bristow is no longer used due to many complications
_____________ is a painless thickening and contracture of the palmar fascia which passes from the palm into the fingers secondary to fibrous proliferation that result in flexion deformities and loss of function of fingers.
Depuytren's
Shoulder findings in CRPS if present, will commonly include ______ distribution and may be intermittent to constant, mild to severe, and exacerbated with movement.
C5 similar to adhesive capsulitis which can develop with CRPS
Which of the following is *NOT a structural factor* that may cause narrowing of subacromial space: - acromioclavicular arthrosis/osteophyte formation - calcific tendinitis - coracoacromial ligament hypertrophy - C5/C6 radiculopathy - degenerative changes
C5/C6 radiculopathy *this is a functional factor*
What is the most important diagnosis that must be ruled out when someone presents with symptoms of carpal tunnel syndrome?
C6 radiculopathy
What type of scaphoid fracture is described by the following: acute, unstable, proximal pole
Type B3
What type of scaphoid fracture is described by the following: acute, unstable fracture-dislocation
Type B4
T or F: The anterior interosseous syndrome supplies flexor digitorum profundus
False; only deep muscle in the anterior forearm not supplied by this nerve
What is the most accurate special test for carpal tunnel syndrome?
Durkan's Test
T or F: full return to basic and advanced ADL's and high level athletics and manual labor is not possible after elbow dislocation injuries
False; patient should be able to get back to basic and advanced ADL's but might be limited with high level athletics and manual labor
What is the type of radial head fracture with rupture of interosseous membrane and disruption or dislocation of the distal radioulnar joint?
Essex-Lopresti
What is the differential diagnosis for a radial head fracture?
Essex-Lopresti injury
What must be ruled out if little leaguer's shoulder is suspected?
Ewing's sarcoma
T or F: all adhesive capsulitis patients will have full ROM after recovery
False; 20% will have residual ROM limitations
T or F: CRPS type II has a higher incidence than CRPS type I
False; CRPS type I > CRPS type II
T or F: CRPS pain is limited to one single peripheral nerve distribution
False; NOT limited to one single peripheral nerve distribution = cardinal feature of CRPS
T or F: In a normal hip, the alignment of the opening of the acetabulum is retroverted
False; anteverted
T or F: cyst-like ultrasonographic abnormalities in tendons are indications for surgery
False; asymptomatic athletes can have cyst-like ultrasonographic abnormalities
T or F: surgery provides rapid relief of symptoms in tendinopathy patients
False; can take 4-6 month to recover
T or F: Fractures of the epicondyle are considered articular fractures
False; considered extra-articular
T or F: radial head fractures are easy to diagnose via radiograph whether it is displaced or non displaced
False; difficult of non displaced
T or F: management of resting state loads across GH joint require dynamic stabilizers like musculature.
False; does NOT require musculature--do NOT confuse with normal muscle tone
T or F: Bilateral dislocations in developmental dysplasia of the hip is easier to distinguish
False; harder because there will be limited abduction in both sides and might be mistaken as the norm
T or F: lower rates of collagen turnover in damaged tendons is an intrinsic cause of tendinosis and RTC disease
False; higher rates are more indicative of damage because when something has been damaged, it is usually replaced with Type III collagen which is weaker
T or F: lateral epicondylitis (tennis elbow) is a type of tendonitis
False; it is an *angiofibroblastic tendinosis*
T or F: early ROM following non-surgical and surgical management for Type II radial head fracture is contraindicated
False; it is common after surgery
T or F: aggressive PROM/AROM is indicated for proximal humeral fractures
False; it is contraindicated because it can further displace bony fragments and delay healing have to be in a sling for 3-4 weeks
What type of scaphoid fracture is described by the following: acute, unstable, comminuted
Type B5
__________ is described as the femoral head completely out of the acetabulum but is reducible via the Ortolani maneuver.
Frank dislocation
According to Garden, what grade of femoral neck fracture is characterized by incomplete/impacted fracture?
Grade 1
What grade of PCL and LCL injury is characterized by the following: - up to 5 mm of joint space opening - solid end feel
Grade 1
What grade of ankle sprain is described below: - mild/minimal sprain with no ligamentous tear - mild tenderness - some swelling - no joint instability
Grade 1
What grade of inversion ankle sprain has suspected anterior talofib ligament involvement?
Grade 1
What grade of turf toe is described below: stretching of the capsular and ligamentous structures around the first MTP joint
Grade 1 treat with relative rest and proper footwear and orthotics to reduce stresses on the plantar plate and to provide stability
According to Garden, what grade of femoral neck fracture is characterized by non-displaced fracture?
Grade 2
What grade of PCL and LCL injury is characterized by the following: - up to 10 mm of joint space opening - solid end feel
Grade 2
What grade of ankle sprain is described below: - moderate sprain consisting of incomplete or partial rupture - moderate to severe tenderness - obvious swelling and ecchymosis - evidence of joint instability - evidence of partial functional loss - may include: significant but incomplete ligament tear, complete tear of one structure and an incomplete tear of another, a partial tear of several structures
Grade 2
What grade of inversion ankle sprain has suspected anterior talofib ligament and calcaneal fib ligament involvement?
Grade 2
What grade of turf toe is described below: a partial tear of the capsular and ligamentous structures around first MTP joint
Grade 2 treat with up to two weeks of MTP immobilization then treat as grade 1 with the addition of taping and restoration of ROM and strengthening PRN
According to Garden, what grade of femoral neck fracture is characterized by incomplete displacement in varus malalignment?
Grade 3
What grade of ankle sprain is described below: - complete tear of ligament - severe tenderness with obvious swelling, ecchymosis, and hemorrhage - evidence of ankle joint instability - inability to walk
Grade 3
What grade of inversion ankle sprain has suspected anterior talofib ligament, calcaneal fib ligament, and posterior talofib ligament involvement?
Grade 3
What grade of PCL and LCL injury is characterized by the following: - greater than 10 mm of joint space opening - other ligamentous injuries
Grade 3 isolated grade 3 with an avulsion or "pull-off" of the ligament at the bony insertion site is clear indication for surgery
What grade of turf toe is described below: - tearing of plantar plate from its origin of metatarsal head-neck junction and impaction of proximal phalanx into the metatarsal head dorsally - a sesamoid fracture
Grade 3 treat with up to 4-6 weeks of immobilization followed by grade 2 interventions
According to Garden, what grade of femoral neck fracture is characterized by complete displacement fracture with no engagement of the true fragments?
Grade 4
What grade of MCL injury is described below: - microtrauma with no elongation - tenderness to ligament - normal valgus laxity (0-5 mm)
Grade I
A physical therapist is looking at radiographs of someone with a suspected SCFE. Radiographs show femoral head displaced up to 1/3 width of the femoral neck. What does this indicate?
Grade I displacement
What grade of MCL injury is described below: - increased valgus laxity (5-10 mm) - firm end-feel on valgus stress at 20° flexion
Grade II
A physical therapist is looking at radiographs of someone with a suspected SCFE. Radiographs show femoral head displaced >1/3 and <1/2 of the width of the femoral neck. What does this indicate?
Grade II displacement
What grade of MCL injury is described below: - increased valgus laxity (>10 mm) - soft end-feel on valgus stress at 30° flexion
Grade III
_____________ lesion is a compression fracture of posterolateral aspect of humeral head due to the impact of the humeral head against the anterior-inferior rim of the glenoid during dislocation.
Hill-Sachs
A 34-year old patient presents to the clinic with sharp pain at anterolateral joint line during terminal knee extension and tenderness medial and lateral to the patellar tendon. She also presents tenderness on patellar compression during terminal knee extension. What condition is present?
Hoffa's disease fat pad is caught between patella and femur indicated by sharp pain during TKE
What two hip ROM are often limited in FAI?
IR and flexion
A 43-year old runner presents to the clinic with pain localized over lateral femoral condyle that is exacerbated during downhill running. He reports that the pain radiates toward lateral joint line and proximal tibia. Discomfort is often relieved by rest. Upon examination of his running footwear, you discover excessively worn out lateral heel and excessive rigidity of the shoes. When asked how often he stretches, patient states that he does not have an adequate stretching program. Patient is positive during Ober test, noble compression test, Renee creak test, and Thomas test. What condition does he present with?
ITB friction syndrome
According to Thomposon and Epstein, what type of *posterior hip dislocation* presents with fracture of femoral head?
Type V have 4 subtypes
T or F: in contrast to MCL injuries, concurrent injury to other ligamentous and/or meniscal structures is only noted with extreme forces, especially with violent tibial IR
True
____________ disease is described as the avascular necrosis/osteolysis of the lunate bone following trauma to the wrist
Kienböck's disease
Patient presents to the emergency room after a direct blow to medial knee. Injury resulted in warmth and swelling, however patient still has full ROM. Knee is TTP on posterolateral aspect. Posterolateral drawer and varus stress test are positive. What is most likely injured?
LCL
An 8-year-old Asian male presents to the clinic with a painless limp, ER hip. and a leg-length discrepancy. He c/o pain in the anterior knee, groin, and inner thigh. During examination, you discover limited abduction and IR, muscle atrophy of the upper thigh, and palpable muscle spasms. Radiographs show flattening appearance of the femoral head combined with increased density and changes in density. What condition is most likely present?
Legg-Calvè-Perthes disease
____________ disease is an aseptic necrosis (transient ischemic necrosis) of the upper end of the femur which involves necrosis of part or all of the femoral epiphysis and collapse followed by a gradual return in vascularity.
Legg-Calvè-Perthes disease the femoral head can become flat and extruded laterally to the extent that it shifts away from its normal position under the acetabulum
T or F: occurrence of adhesive capsulitis in the nondominant UE is more common
True
An __________ injury typically results secondary to a valgus stress.
MCL a lateral blow to the knee is the most common mechanism of injury
What is the most limiting feature of Dupuytren's contracture?
MCP > PIP contractures
What special tests might come out positive if patient has anterior interosseous syndrome?
MMT for - radial 1/2 of flexor digitorum profundus - flexor pollicis longus - pronator quadratus and EMG this is because it is only a motor nerve
____________ is the transfer of subscapularis tendon which typically results in limited motion.
Magnuson-Stack not ideal for athletes
What type of rotational ankle fractures presents with the following: - complete disruption of tibiofibular syndesmosis - diastasis caused by ER of talus and transmission of force to proximal fibula - high fracture fibula - torn interosseous membrane torn longitudinally
Maisonneuve fracture
What is a common elbow fracture that is associated with dislocation of the head of the radius with fracture of the upper *one-third* of the shaft of the ulna?
Monteggia fracture rare (5% of fractures)
_____________ is a type of foot orthosis that fully extends under the great toe with the remainder ending at the web space.
Morton's extension length
___________ is when the second toe is longer that the first toe.
Morton's foot
What should be the weight bearing status of a femoral neck patient pending orthopedic consultation?
NWB or TTWB
_________ is a procedure that involves detaching the capsule from the neck of the humerus and shifting it to the opposite side of the inferior portion of the neck of humerus.
Neer capsular shift
T or F: plain film arthrography is useless for diagnosis adhesive capsulitis
True
Meniscal injuries are associated with development of knee ________.
OA surgeons are more adamant about removing menisci completely after injuries due to this
What is a required intervention for fractures in the mid portion of radius and ulna?
ORIF
What is the surgical intervention for femoral neck fractures in the presence of healthy bone tissue?
ORIF
What is the preferred intervention for an elderly patient with trochanteric fracture?
ORIF with compression screw-plate or Edner's nails placed under radiograph
_________________ syndrome is osteochondritis of the tibial tubercle possibly due to trauma from excessive traction by patella tendon on not fully formed epiphyseal insertion.
Osgood-Schlatter's aka juvenile traction osteochondritis
What helps the ACL prevent hyperextension of the knee?
PCL
40-year old female reports to the clinic with deep burning pain in the dorsal forearm near the insertion of wrist extensors. Patient reports worsening of pain when she plays tennis recreationally. She also reports paresthesia in the first dorsal web space. When MMT was tested, it shows that she has considerable weakness and symptoms when wrist and finger extensors as well as abductor pollicis longus were tested. She also presented symptoms when supination was resisted. What nerve is most likely affected in this situation?
PIN entrapped in the radial tunnel
What type of instability occurs with a blunt trauma to the anteromedial tibia (direct blow to knee) with leg in ER, fixed, and varus position?
PLRI
Depending on the degree of valgus, what ligament is usually injured in a radial head fracture?
UCL
26-year old league bowler presents to the clinic with intermittent pain and numbness along the ulnar side of the thumb. Theres is a mass TTP at the base of the thumb. Tinel's sign as well as direct pressure is positive. What possible intervention can be beneficial for this patient's condition?
Patient has bowler's thumb and can benefit from: - rest from bowling - re-drilling thumb hole of bowling ball to *increase* thumb extension and abduction - PT - medication - injection - surgical decompression if conservative treatment does not work
23-year old college baseball player presents to the clinic with posterior superior shoulder pain and localized point tenderness. The PT performs anterior apprehension test which reproduce the patient's symptoms. She them performed a posterior glide which relieved the symptoms. Explain the pathology of this condition.
Patient presents wil PII the humeral head translates anteriorly causing undersurface of the cuff to forcefully contact/impinge against posterior superior glenoid rim and labrum
A 12-year old male reports to the clinic with c/o anterior knee pain, swelling, and tenderness over the inferior pole of the patella. Mom reports that he have had gradual worsening of symptoms. You discover swelling over inferior patellar pole with relatively weak quads and hip flexors, and tight hamstrings. You also discover a prominence on the inferior patellar pole while the patient is supine and knee is hyper flexed. What is the prognosis of the patient?
Patient presents with SLJS There is usually no residual disability once the condition resolves The patient will return to pre-injury status within 2-14 months
What helps maintain the normal stability and function of the shoulder complex?
passive and active mechanisms
____________ uses subscapularis tendon along with a capsular shift where each layer is placated and results in a tighter repair but limited motion.
Putti-Platt not ideal for athletes
______________ represents lateral force vectors acting on the patella and is formed by the intersection of the ASIS to mid patella, and tibial tubercle to mid patella.
Q-angle
________________ lesion is a fracture if the anterior medial humeral head that can occur with posterior dislocations.
Reverse Hill-Sachs
_________________ syndrome is the apophysitis of the inferior patellar pole and sometimes the superior patellar pole due to excessive traction on patellar tendon due to chronic extensor mechanism overload, and avulsion of patellar ligament fibers that have undergone necrosis and calcification.
Sinding-Larsen-Johansson
What stage is posterolateral rotatory instability?
Stage 1
What stage of adhesive capsulitis presents with the following capsular change: hypertrophic and hypervascular synovitis with an otherwise normal capsule.
Stage 1
What stage of chondromalacia patellae involves softening and blistering of the cartilage?
Stage 1
Pain following activity may indicate what in Jobe clinical classification of internal impingement in athletes?
Stage 1 pure impingement without instability
A bursal thickness that measures from 1.5 to 2.0 mm may indicate what stage in Neer's stages of subacromial impingement?
Stage 1 - less than 25 years of age - intermittent pain with overhead activities - edema/hemmorhage - reversible cuff edema - non-surgical management
What stage of adhesive capsulitis presents with pain referred to the deltoid insertion and pain at night?
Stage 1 (freezing)
What are the three stages of CRPS?
Stage I: acute Stage II: dystrophic Stage III: atrophic
What is the radiographic staging in Kienböck's disease?
Stage I: normal Stage II: sclerosis Stage III: lunate collapse Stage IV: carpal arthritis
45-year old female who had previous history of breast cancer treatment presents to the clinic with diffuse shoulder pain that is aggravated with rapid unguarded movement and is present at night. Patient reports that she is uncomfortable lying on affected shoulder. Patient does not use the arm as much due to pain. She presents with normal AROM/PROM but has pain at the end range of motion. MMT shows she is strong but with has pain with resistance. Joint play and end feel assessment at the end range provokes pain in all directions. What condition is likely present?
Stage 1 adhesive capsulitis aka "the freezing stage" 0-9 mos
22-year old female presents to the clinic with an aching shoulder pain located in the anterior lateral shoulder and down the upper arm that is usually brought on with activity. Greater tuberosity and anterior portion of the acromion is TTP. When AROM of GH abduction was tested, patient c/o of pain during 60-120° into the motion. MMT of abduction and elbow flexion is also painful. What condition does this patient most likely present?
Stage 1 impingement tendinosis (edema and inflammation) conservative management
What stage is perched (subluxed)?
Stage 2
What stage of adhesive capsulitis presents with the following capsular change: progressive hypertrophic and hypervascular synovitis with progressive fibroplastic scar formation in the underlying capsule.
Stage 2
What stage of chondromalacia patellae reveals fissures within the cartilage?
Stage 2
Pain during warm-up, disappearing during activity and reappearing after activity may indicate what in Jobe clinical classification of internal impingement in athletes?
Stage 2 - primary instability with capsular and labral injury - secondary internal or subacromial impingement
A bursal thickness that measures over 2.0 mm may indicate what stage in Neer's stages of subacromial impingement?
Stage 2 - 25-40 years old - fibrosis and tendinosis - irreversible tendon changes - conservative and surgical management
What stage of adhesive capsulitis presents with severe night pain and stiffness?
Stage 2 (frozen)
53-year old female who with IDDM presents to the clinic with severe pain in the shoulder that she reports had gradually increased in the last 4 months. Pain is described as intense and usually awakens her from sleep. She localizes the pain in C5 distribution down to the forearm. AROM/PROM are limited in all directions. Limitations present a capsular pattern. Overpressure and end-feel assessment was painful. Atrophy in involved shoulder is significant. Patient presents with scapulothoracic substitution in which is more apparent in flexion and abduction. What condition is likely present?
Stage 2 adhesive capsulitis aka "the frozen stage" 4-12 mos
35-year old male presents to the clinic with long-standing complaints of aching shoulder pain and shoulder stiffness. He also c/o pain during activities that is not relieved by rest and is present at night. AC joint is TTP. During AROM, patient presented with movement alterations and compensations. He also c/o catching sensation at 100° while lowering arm. What condition does this patient most likely present?
Stage 2 impingement tendinosis (fibrosis and tendinitis/tendinosis) usually not clinically reversible conservative management and some surgical procedures (arthroscopic subacromial decompression, open, mini-open, or arthroscopic RTC repair)
What stage of adhesive capsulitis presents with the following capsular change: end stages of synovitis without significant hypervascularity and dense scar tissue.
Stage 3
What stage of chondromalacia patellae is reached when fibrilation of the cartilage occurs, causing a "crabmeat" appearance?
Stage 3
A bursal thickness that is a partial or full-thickness tear of the rotator cuff may indicate what stage in Neer's stages of subacromial impingement?
Stage 3 - over 40 years of age - significant tendon degeneration - rotator cuff tear, biceps tendon rupture, and bony changes - surgical management
Pain during and after activity, limited activity participation, and pain that may interfere with ADLs and sleep may indicate what in Jobe clinical classification of internal impingement in athletes?
Stage 3 primary instability secondary to ligamentous laxity with secondary impingement
What stage of adhesive capsulitis presents with profound stiffness and pain occurring only at the end ROM?
Stage 3 (thawing)
56-year old female presents to the clinic with increased pain with basic ADLs that disturbs her sleep at night. She also presents progressive weakness, especially with GH abduction and ER. During observation, PT notices significant atrophy over supraspinatus and infraspinatus mm.. During ROM testing, patient presents with limited AROM and PROM, pathological end feel, and capsular restrictions. What condition does this patient most likely present?
Stage 3 impingement tendinosis (tendon degeneration and rupture) not clinically or surgically reversible cuff repair and acromioplasty and post-op PT
What stage is posterior dislocation?
Stage 3a or 3b the difference between the two stage is that 3b is more progressed in a sense that both posterior and anterior oblique fibers of the UCL is damaged
What stage of adhesive capsulitis presents with profound stiffness but no pain?
Stage 4
What stage of chondromalacia patellae reveals cartilage defects with subchondral bone exposure?
Stage 4
Pain before, during, and after activity and pain interfering with ADL's and sleep may indicate what in Jobe clinical classification of internal impingement in athletes?
Stage 4 instability without impingement
What stage of patellar tendonitis presents with pain after activity that resolves with rest?
Stage I
49-year old patient presents to the clinic with moderate to severe burning constant pain and increased sensitivity to touch. The description of pain from the patient does not match with any injuries. She also presents with swelling and joint stiffness with warmth and redness in the affected limb. Skin is blotchy and purple. Patient also presents limited shoulder ROM, particularly in elevation. What condition is likely present?
Stage I (acute) CRPS lasts up to 3 mos
54-year old female presents to the clinic with intense pain and hyperesthesia to touch and a pronounced allodynia. She c/o increased stiffness and extreme pain with motion. Swelling is constant with formation of tough edema, making skin wrinkles disappear. Edema is noted in the dorsum of hand. Skin is cool, pale, and clammy and appears shiny. Wrist assumes a flexed posture. Radiographs show osteoporosis. What condition is likely present?
Stage II (dystrophic) CRPS 3-9th month (last for about 2 months)
A 28-year old basketball player presents to the clinic with insidious onset of knee pain. Patient c/o weakness and giving away of knee during short duration, high intensity activities. He states that he has pain at the start of activity which goes away during activity, but worsens after activity. There is pain and tenderness over inferior patellar pole and patella tendon insertion. He reports that when he was younger, he was diagnosed with Osgood-Schlatter's and SLJS. What condition does this patient present?
Stage II Patellar Tendonitis responds conservative treatment
What stage of patellar tendonitis presents with more constant pain during and after activity and with pain limiting performance?
Stage III
What stage of CRPS presents with fibrosis and joint ankylosis in the hand which makes it appear atrophied and clawed?
Stage III (atrophic) CRPS 6-10th month (occurs after one year)
What stage of patellar tendonitis presents with complete tendon rupture?
Stage IV
T or F: regaining physiological and non-physiological motion as fast as possible is typically indicated for stiff elbow
True
T or F: rotator cuff tears can be either a structural or functional factor of subacromial space narrowing
True
T or F: SLJS and Osgood-Schlatter's frequently develop concurrently with SLJS occuring first
True
T or F: Shoulder may progress to adhesive capsulitis in shoulder-hand syndrom
True
T or F: The presence of scapular dyskinesis may possibly but not necessarily increase the risk of future shoulder pain and dysfunction in asymptomatic individuals
True
T or F: a voluntary dislocator without psychiatric disorder will typically respond to conservative treatment
True
T or F: imaging does NOT predict prognosis of tendinopathies, however it does increase likelihood of a diagnosis
True
What is the relatively avascular fibro-cartilage or menisci located between the distal articular surface of the ulna and proximal carpal row (triquetrum) that acts as a shock absorber between ulna and proximal carpal row?
Triangular Fibro-Cartilaginous Complex
T or F: ACL injuries are more likely to occur in synthetic turf/grass and synthetic indoor floors
True
T or F: Bursitis can be recurrent if underlying cause is not corrected
True
T or F: EMG is a diagnostic test for radial tunnel syndrome since PIN is a motor nerve
True
T or F: In shoulder-hand syndrome, the shoulder is typically involved first where it may be stiff for several months before the hand becomes involved or they occur simultaneously
True
T or F: LCL injuries are less common than MCL injuries because it is less attached to the joint
True
T or F: Primary impingement is usually more prominent in those 40 years or older since structural changes associated with this takes decades to develop
True
T or F: SLAP lesions are diagnostically challenging and are typically diagnosed via imaging
True
Based on the *Kay* classification scheme for stiff elbows, which type of elbow stiffness presents *only with soft tissue contracture*?
Type 1
What type of scapular dyskinesis is described by prominent inferior medial scapular angle usually due to excessive anterior tilting of the scapula?
Type 1
What type of TFCC disorder is a traumatic horizontal tear adjacent to radius?
Type 1A
What type of TFCC disorder is a traumatic peripheral detachment from the ulna?
Type 1B
What type of TFCC disorder is a traumatic tear of ulnarcarpal ligaments?
Type 1C
What type of TFCC disorder is a traumatic avulsion from sigmoid notch?
Type 1D
Based on the *Kay* classification scheme for stiff elbows, which type of elbow stiffness presents with *soft tissue contracture with ossification without apparent bony elbow trauma*?
Type 2
What type of scapular dyskinesis is described by prominent medial scapular border associated with excessive scapular IR?
Type 2
What type of TFCC disorder is a degenerative partial thickness thinning of articular disc?
Type 2A
What type of TFCC disorder is a degenerative partial thickness thinning of articular disc in addition of: chondromalacia of lunate/ulnar head
Type 2B
What type of TFCC disorder is a degenerative partial thickness thinning of articular disc in addition of: - chondromalacia of lunate/ulnar head - full thickness tear of articular disc
Type 2C
What type of TFCC disorder is a degenerative partial thickness thinning of articular disc in addition of: - chondromalacia of lunate/ulnar head - full thickness tear of articular disc - partial tear of lunotriquetral ligament
Type 2D
What type of TFCC disorder is a degenerative partial thickness thinning of articular disc in addition of: - chondromalacia of lunate/ulnar head - full thickness tear of articular disc - partial tear of lunotriquetral ligament - full tear of the lunotriquetral ligament and arthrosis
Type 2E
Based on the *Kay* classification scheme for stiff elbows, which type of elbow stiffness presents with *minor articular fracture with resulting soft tissue contracture*?
Type 3
What type of scapular dyskinesis is described by prominent superior scapular border associated with excessive upward translation of scapula?
Type 3
Based on the *Kay* classification scheme for stiff elbows, which type of elbow stiffness presents with *displaced intra-articular fractures with soft tissue contracture and ectopic ossification*?
Type 4
Based on the *Kay* classification scheme for stiff elbows, which type of elbow stiffness presents with posttraumatic bony bars (ankylosis) and significant disability?
Type 5
What type of rotational ankle fractures presents with the following: - avulsion fracture of lateral malleolus - shear fracture of medial malleolus caused by medial rotation of talus - intact tibfib ligaments
Type A
What type of scaphoid fracture is described by the following: acute, stable tubercle
Type A1
What type of scaphoid fracture is described by the following: acute, stable, nondisplaced crack in the waist
Type A2
What type of rotational ankle fractures presents with the following: - shear fracture of lateral malleolus - small avulsion of medial malleolus caused by lateral rotation of talus - intact tibfib ligaments/partially torn
Type B
What type of scaphoid fracture is described by the following: acute, unstable, oblique distal third
Type B1
What type of rotational ankle fractures presents with the following: - disruption of tibfib ligaments - diastasis of syndesmosis caused by ER of talus - force transmitted through fibula results in oblique fracture at higher level - avulsion of medial malleolus
Type C
What type of scaphoid fracture is described by the following: delayed union
Type C
What type of scaphoid fracture is described by the following: established nonunion, fibrous
Type D1
What type of scaphoid fracture is described by the following: established nonunion, sclerotic
Type D2
According to Pipkin, what type of *type V posterior hip dislocation* presents with fracture of femoral head inferior to fovea centralis?
Type I
According to Thomposon and Epstein, what type of *posterior hip dislocation* presents without significant fracture of the acetabulum?
Type I
What type is a non displaced radial head fracture?
Type I
What type of Bennett's fracture is described by the following: large single ulnar fragment and subluxation of the metacarpal base
Type I
What type of CRPS is associated with an initiating noxious event like a fracture, crush injury, immobilization, adhesive capsulitis, and soft tissue injury?
Type I
What type of labral tear is described as degenerative fraying of the labrum?
Type I
According to Epstein, what type of *anterior hip dislocation* presents with a simple superior dislocation with no associated fracture?
Type IA
According to Russel-Taylor, what type of subtrochanteric fracture extends from below the lesser trochanter to the femoral isthmus?
Type IA
According to Epstein, what type of *anterior hip dislocation* presents with a superior dislocation with concurrent fracture of head of femur?
Type IB
According to Russel-Taylor, what type of subtrochanteric fracture involves the areas of the lesser trochanter to the isthmus?
Type IB
According to Epstein, what type of *anterior hip dislocation* presents with a superior dislocation with concurrent fracture of the acetabulum?
Type IC
According to Pipkin, what type of *type V posterior hip dislocation* presents with fracture of femoral head superior to fovea centralis?
Type II
According to Thomposon and Epstein, what type of *posterior hip dislocation* presents with a large single fracture of posterior rim of the acetabulum?
Type II
What type is a marginal radial head fracture with displacement?
Type II
What type of Bennett's fracture is described by the following: impaction fracture without subluxation of the thumb metacarpal
Type II
What type of CRPS is associted with a defined nerve injury?
Type II
What type of labral tear is described as avulsion of the superior labrum and biceps?
Type II
According to Epstein, what type of *anterior hip dislocation* presents with a simple inferior dislocation with no associated fracture?
Type IIA
According to Russel-Taylor, what type of subtrochanteric fracture does not have significant comminution or fracture or all of the lesser trochanter?
Type IIA
According to Epstein, what type of *anterior hip dislocation* presents with a inferior dislocation with concurrent fracture of head of femur?
Type IIB
According to Russel-Taylor, what type of subtrochanteric fracture has significant comminution of the medial femoral cortex and loss of continuity of the lesser trochanter?
Type IIB
According to Epstein, what type of *anterior hip dislocation* presents with a inferior dislocation with concurrent fracture of the acetabulum?
Type IIC
According to Pipkin, what type of *type V posterior hip dislocation* presents with Type I or II fracture dislocation associated with a concurrent fracture of femoral neck?
Type III
According to Thomposon and Epstein, what type of *posterior hip dislocation* presents with comminution of the posterior acetabular rim, with or without a major fragment?
Type III
What type is a comminuted radial head fracture involving the entire radial head?
Type III
What type of Bennett's fracture is described by the following: ulnar avulsion fragment with metacarpal dislocation
Type III
What type of labral tear is described as bucket handle tear of the superior labrum with an intact biceps?
Type III
According to Pipkin, what type of *type V posterior hip dislocation* presents with Type I, II, and III fracture dislocation associated with concurrent fracture of acetabulum?
Type IV
According to Thomposon and Epstein, what type of *posterior hip dislocation* presents with fracture of acetabular floor?
Type IV
What type is a radial head fracture with simultaneous elbow dislocation?
Type IV
What type of labral tear is described as bucket handle tear of the superior labrum with extension into the biceps?
Type IV
In a patellar instability patient, EMG testing of the __________ muscle may reveal disuse atrophy.
VMO
What is the most important dynamic stabilizer of the patella to resist lateral displacement?
VMO
21-year old college student reports paresthesia into the 4th and 5th digits. She presents with a claw-hand deformity and wasting of ulnar border of forearm (FDP/FCU). When the PT asked her to adduct all her fingers, her little finger fails to do so. What is this special test and what does a positive finding indicate?
Wartenberg's sign indicates possible cubital tunnel syndrome
Why does the hip presents to be rotated in SCFE patients?
When the patient attempts to flex the hip, the edge of femoral neck impinges on the anterior lip of the acetabulum so by ER rotating the thigh, the impingement is relieved and further flexion is possible
What would a histological assessment present in a Dupuytren's contracture?
a low-grade inflammatory fibrosis over palmar fascia and digital flexor tendon sheaths
What does a positive SLR test indicate in someone with a suspected patellar tendonitis?
a problem with deep fibers consistent with jumper's knee lower patella tenderness is *relieved* because the painful area is protected by the tensed superficial fibers of the patellar tendon
Unlike primary impingement, secondary impingement can occur in younger ages (between 15-30 yo) since it is associated with failure of ___________ and ___________ constraints that may develop in childhood or adolescence.
active and passive
Vascular filling of supraspinatus tendon occurs during ______________ of the arm when the compression of the tendon across the humeral head is decreased in this position.
abducted
Radial head fractures usually occur during a fall involving severe _______________ force applied to an _____________ to partially _____________ elbow.
abduction; extended; flexed
DeQuervain's tenosynovitis is a tenosynovitis of __________ and __________ tendons at wrist.
abductor pollicis longus and extensor pollicis
What bony presentation do pincer impingements have?
abnormal and excessive localized or generalized bone extends out and over the normal rim or border of the acetabulum resulting in excessive coverage of femoral head by the acetabulum
_______________ are prescription foot orthoses designed to alter loading patterns, and to relieve pressure from painful, injured, and/pr plantar structures/tissue susceptible to injury during WB activities.
accommodative foot orthoses
___________ is the greatest perpendicular distance from the acetabular roof to a line joining the lateral margin of the acetabular roof and the upper corner of the symphysis pubis on the same side.
acetabular depth
Acetabular depth less than *9 mm* is associated with __________________.
acetabular dysplasia
Acute ______________ results from acute eccentric overload placed on a DF ankle combined with chronic tendinosis.
achilles tendon rupture
______________ is a surgery where the anteroinferior portion of acromion is resected in cases where anterior portion of the undersurface of acromion is the site of impingement.
acromioplasty
PII is most frequently described as occuring secondary to ___________ instability and laxity.
anterior
Normal aging of the cuff tissues as characterized by continuous repetitive microtrauma over time along with faulty healing and diminished healing environment are primary predisposing factors for _________ ruptures.
acute it is a chronic process with an acute rupture
According to Neviaser, Stage 2 adhesive capsulitis present with?
acute synovitis with adhesions of the dependent folds of the synovial lining
What type of slipped capital femoral epiphysis presents with aching of hip, thigh, or knee for weeks to months and then experiences a significant trauma?
acute-on-chronic
Vascular filling of supraspinatus tendon is limited when the arm is _____________ and is compressed over the humeral head.
adducted
Those who have anterior instability should begin exercise in a _________________ shoulder position and then progress to abduction in the scapular plane to reduce stress in GH joint.
adducted, forward-flexed
When can conservative strengthening focusing in ROM, ADL, flexibility, and restoring normal grade II joint play begin in those with Colles/Smith injury?
after the fracture has healed
Which of the following is NOT correct regarding anterior instability? - It accounts for ~90% of all instabilities - It is characterized by loss of GH centering ability associated in one or more locations with symptoms - Can be traumatic or atraumatic - Can be chronic or congenital
all are correct
The _____________ angle is the angle between a line from the center of the femoral head through the middle of the femoral neck and a line through a point where the contour of the femoral head-neck junction exceeds the radius of the femoral head.
alpha
Osgood-Schlatter is associated with patella ____________.
alta
What is surgical trauma?
an incision that weakens the medial capsule and predispose the patella to lateral migration
Why is a larger Q angle a risk factor for ACL injuries?
an increased Q angle increases the lateral pull on the quadriceps muscle that is connected to the patella, adding medial stress to the knee
What is crucial after an ACL injury?
an intense neuromuscular training program
18-year old college baseball player presents to the clinic with significant pain and muscle spasms in the shoulder. He reports that he feels excessive looseness in his shoulder joint which causes him to feel apprehensive to return to playing baseball. He also finds himself limiting his ADL functions to prevent provocation of symptoms. He reports that he has difficulty sleeping and is uncomfortable putting his hands behind his head. During examination, his humeral head is more palpable anteriorly and as a result has a depression noted over posterior shoulder just above the acromion. Apprehension test, load and shift test, crank, and relocation test were all positive. What condition is most likely present?
anterior instability
A 50-year old butcher complains of an aching pain and weakness in the anterior forearm during functional tasks at his job and reports that it would last for hours to days. His job requires forearm pronation and elbow flexion as he butchers and heavy lifting to carry in products. Symptoms are provoked during these activities. What nerve is possibly irritated during these activities?
anterior interosseous of median n.
A 55-year old carpenter reports spontaneous and vague anterior forearm pain that is exacerbated when lifting heavy objects during work. These symptoms would sometimes last hours to days and would sometimes wake him at night. He was asked to do the pinch grip test with the affected side, however, instead of doing a tip-to-tip pinch like he was asked, he could only do a pulp-to-pulp pinch. What does this indicate?
anterior interosseous syndrome (i.e. Kiloh-Nevin Syndrome)
What is the most important soft-tissue constraint to valgus instability?
anterior oblique fibers of UCL this is why damaged to this tissue is an indication for the highest stage of elbow instability
What bundle of the ACL is tight in flexion and resists anterior drawer between 60-90° of flexion?
anterior-medial bundle of ACL attaches to anterior-medial tibia
Smith fracture is also know as the reverse Colles fracture due to the distal fragment of the fractured end of the radius being displaced _____________.
anteriorly towards the flexor surface of the forearm
______________ is a pathologic increase in angle of torsion.
anteversion or IR femoral torsion
What is the focus of conservative therapy for *tendinitis*
anti-inflammatory modalities and drugs
What must be ruled out in a suspected Legg-Calvè-Perthes disease?
arthritis
_____________ Bankart repair is when avulsed capsular labrum and ligaments are reattached directly to bony rim without duplication of subscapularis tendon. This is an appropriate surgical technique for unidirectional anterior instability.
arthroscopic open repair may be more effective
___________ fracture is fracture of the capitulum and/or trochlea joint surface and is often classified by the boney landmark affected.
articular
What is the more common tear that responds well to conservative treatment and is characterized by only being on the joint side of the tendon?
articular side tears
What is deceleration injury?
as the foot is planted, the femur IR on a ER and fixed tibia pivoting on planted foot results in a sudden valgus force at the knee
_______________ instability is characterized by instability without significant or notable injury and is usually anterior, inferior, or MDI.
atraumatic possible causes: - loss of negative intraarticular pressure - failure of ligaments - failure of dynamic stabilizers - altered neuromuscular control - anatomical variations - disuse atrophy - familial
How would an retroverted femur present if it is compensated?
available IR will be toed out if NOT compensated
How would an anteverted femur present if it is compensated?
available hip ER will be toed in if NOT compensated
What complications arise with Pavlik harness?
avascular necrosis
With extreme slipped capital femoral epiphysis, there is a danger of ___________, especially if a forceful surgical reduction is performed.
avascular necrosis
A26-year old male complains of thigh and groin pain especially with hip IR. He presents with overall decreased hip ROM. He also suffers from alcoholism. What condition does he most likely present with?
avascular necrosis of the head of femur
LCL injuries are uncommon, however, when it occurs, the ligament is more likely to _________ from its origin or insertion compared to MCL.
avulse
Medial epicondyle fractures usually occur in children as an ___________ injury.
avulsion
What is a type II SLAP tear?
avulsion of the superior labrum and biceps
What is the mechanism of injury for Bennett's fracture?
axial loading on a partially flexed metacarpal
What nerve has the greatest risk of injury after an anterior dislocation?
axillary n. however cutaneous innervation on lateral shoulder is frequently normal
______________ lasted shoes are constructed on a firm board, which is typically plastic, cardboard, and/or synthetic material.
board
In a stiff elbow, a ___________ end feel indicates a bony block.
bony
If the humerus is displaced forward during an elbow dislocation, what structures can be damaged?
brachial artery and median nerve
The ___________ muscle is either significantly stretched and/or torn at the coronoid process with a posterior dislocation of the elbow.
brachialis
What is the mechanism of injury for Smith fracture?
backwards fall onto a flexed wrist
Supinators have ____________ shock absorption.
bad
Quadriceps tendonitis may be related to patella _________.
baja
Why is avascular necrosis common in femoral neck fractures?
because most vessels cross the femoral neck
Why are extensor tendons of the distal phalanx susceptible to injury and re-injury?
because they are thin and broad
What is the indicated intervention after initial healing and removal of external fixation in a Colles/Smith injury?
begin PROM, AAROM, AROM, focusing on supination and pronation
Where does the tibialis posterior tendon pass through?
behind the medial malleolus that inserts on the navicular
Distal ___________ tendon ruptures are often a result of eccentric loading.
bicep
_____________ rupture occurs secondary to impingement tendinitis and RTC cuff tears and is characterized by "Popeye arm".
biceps rupture
Symptoms of stress fractures of the metatarsal shafts are often __________.
bilateral resolve by 2 weeks following elimination of exacerbating activity
What causes the avascular necrosis proximal to the scaphoid fracture site and a nonunion fracture?
blood flow moves from distal to proximal - fracture of center scaphoid = disruption of blood flow to proximal scaphoid - fracture of distal scaphoid = disruption of blood flow to center and proximal scaphoid
Why does pain vary in location in those with osteochondritis dissecans?
due to the location of mobile fragments floating within the knee
____________ is the result of tendon degeneration caused by chronic fibrosis and necrosis and can be a function of repetitive microtrauma and aging.
calcific tendinitis
_________ impingement results from morphologic changes of the proximal femur.
cam
What capsular pathology is described by the following: - accounts for approximately 30-40% of all dislocations - detachments of the labrum or capsule as a result of either direct or indirect loading over the humerus
capsular detachments
___________ is a procedure used to tighten a joint.
capsular shift
What capsular pathology is described by the following: - accounts for approximately 60-70% of all dislocations - tearing of the capsule occurs as a result of either direct or indirect loading over the humerus
capsular tear
What is the most common nerve entrapment syndrome in the wrist?
carpal tunnel syndrome
Why are fractures in the mid portions of radius and ulna more common?
due to the relatively smaller cross sectional areas
The ______________ angle is the angle created with the line connecting the lateral rim of the acetabulum and the center of the femoral head and the vertical.
center-edge
History of early _______________ or early OA concurrent with other symptoms can indicate chronic ACL instability.
chondromalacia patallae
A 24-year old patient presents to the clinic with dull aching anterior knee pain exacerbated with squatting, prolonged sitting, and ascending/descending stairs. You discover generalized anterior knee tenderness and swelling and crepitus during knee extension. Patient reports that he fracture his patella a couple years ago. Radiographs reveal arthritic changes in the knee. What condition does this patient present?
chondromalacia patellae
____________ is softening and degeneration of the cartilage between the patellae secondary to hyaline cartilage trauma and/or abnormal loading.
chondromalacia patellae osteoarthritis of the patella in older individuals
What type of slipped capital femoral epiphysis presents with history of pain and limp for weeks to months with loss of hip motion?
chronic
According to Neviaser, Stage 4 adhesive capsulitis present with?
chronic adhesions
Radial head excision in radial head fractures with associated ligamentous injury may lead to __________________.
chronic lateral elbow instability
__________ is a deformity of the toes characterized by HE of MTP joints and flexion of IP joints.
claw toe associated with pes cavus or over pronators
A degenerative knee aspirate will appear _________.
clear
A normal knee aspirate will appear _________.
clear
What is the mechanism of injury for inversion ankle sprains?
excessive inversion and PF like stepping off a curb and inverting
A RA knee aspirate will apear __________.
cloudy
____________ is a complex congenital deformity consisting of hindfoot equinus, hindfoot varus, and forefoot varus.
clufoot/talipes equinovarus
________________ lasted shoes are typically board lasted in the rearfoot and slip lasted in the forefoot.
combination
What is a common elbow fracture that is often associated with medial and lateral ligamentous injury/disruption?
combined radial head and coronoid process fracture
_______________ is a condition in which pressure in one or more compartments is increased.
compartment syndrome
What compartments are more prone to compartment syndrome?
compartments of lower leg and ventral forearm
Which type of elbow stiffness is described below: - multiple prior surgeries - ulnar nerve transposition or dysfunction - prior internal fixation - significan enterotropic ossification - distorted bony anatomy
complex
Rotator cuff impingement syndrome is a common form of rotator cuff disease resulting from ______________ and ______________ of the rotator cuff tendons and subacromial structures.
compression and inflammation
Radial head fractures occur when the _________ surface of radial head becomes crushed against the __________ surface of capitulum.
concave, convex
What is a distal humerus fracture that is classified as medial or lateral and can only be diagnosed through CT?
condylar lateral = most common
How are stable and non displaced radial head fractures (Type I) managed?
conservatively with limited immobilization and early ROM
What type of ACL injury entail a force variable acting on the knee into valgus/varus load at or near full knee extension?
contact
What is phase 3 of meniscal post-operative management?
continuation of strength training with progression into sports-related activities
According to Neviaser, Stage 3 adhesive capsulitis present with?
continued maturation of the adhesions
Osteochondritis dissecans is common in ______________ WB bones.
convex
With a mid portion fracture of radius and ulna, what might be a reason why healing is delayed?
cortical shafts are less vascular than other regions
An increase in the angulation between the neck and shaft or _____________ is associated with hip dysplasia.
coxa valga
____________ is a pathologic increase in the angulation between the neck and shaft of the femur.
coxa valga
_____________ is a pathologic decrease in the angulation between the neck and shaft of the femur.
coxa vara
21-year old college student reports paresthesia into the 4th and 5th digits and hypothenar and interossei atrophy. She said symptoms worsen when she is studying when she leans on her elbow with her face on her hand. What is the most likely reason for her symptoms?
cubital tunnel syndrome caused by repeated trauma in the ulnar n. (i.e. leaning on elbow)
______________ is a deformity characterized by HE of the MTP joints and DIPs with flexion of PIPs.
hammer toe
Femoral retroversion causes a ___________ Q angle.
decrease
Internal tibial torsion _______________ Q angle.
decrease
Patella alta _________ static stability between the patella and the larger lateral femoral condyle.
decrease
Which of the following is NOT an advantage of doing a patellar tendon graft for ACL repair: - bone to bone healing - decreased development of knee syndromes - less knee laxity - lower graft failure - stable fixation as soon as 6 weeks to 4 months
decreased development of knee syndromes patellar tendon graft has high occurrence of the development of the following: - PF dysfunction - chondromalacia - kneeling pain - anterior knee pain - infrapatellar fibrosis - patella fracture
Cam impingement exhibit a _____________ femoral head-neck offset anterior at the femoral head-neck junction and/or an alpha angle ______________ than 55°.
decreased; greater
What is the preferred intervention for a young, active patient with trochanteric fracture?
defer weight bearing until the fracture has united
Most rotator cuff tears are _______________ in nature.
degenerative
What is a type I SLAP tear?
degenerative fraying of the labrum
Capsular/labrum __________ accounts for ~30-40% of all dislocations and is a result of either direct or indirect loading over the humerus. This type of injury is less common than tears.
detachment
Why might traumatic cuff lesions be missed on the first clinical examination?
due limited physical findings that are masked by pain clinicians tend to misdiagnose unless imaging methods help to evaluate patient
A 2-month old infant presents with limited ROM on R hip, especially with abduction *(<60° in 90° hip flexion)*. The R limb appears to be turned out and is shorter with a higher greater trochanter. The patient appears to have asymmetrical gluteal and thigh folds. What condition does this patient present with?
developmental dysplasia of the hip
A force the is applied directly to the joint is called _________ force.
direct
What is the mechanism of injury of mallet finger?
direct blow that forcibly flexes or hyper extends an extended finger
___________ is described as the femoral head being in place but can be dislocated.
dislocatable
Patellar ___________ refers to complete loss of contact between articular surfaces and may be accompanied with tear of medial capsule/retinacula.
dislocation
What is CT scan for proximal humeral fracture indicated for?
displaced and severely comminuted fractures
Patient presents with symptoms indicating ulnar nerve compression. However, she only presents with sensory loss only (superficial branch only). Where is the possible location of the compression?
distal portion of Guyon's canal
A nursemaid's elbow is a ___________ displaced radial head.
distally
Colles fracture presents with a dinner-fork deformity which is due to the distal fragment of the fractured distal radius displacing ________________.
dorsally towards the extensor surface of the forearm the degree of displacement = the degree of wrist extension during injury
First ray __________ is limited in hallux rigidus.
dorsiflexion
After anterior dislocation, progressive isometric exercises are performed __________ immobilization and progressive resisted exercises are added ________ immobilization.
during; after
What degree of carpal tunnel syndrome presents with the following: - symptoms are activity induced - otherwise asymptomatic - no detectable physical findings
dynamic
What are the surgical management for intertrochanteric fractures?
dynamic hip screw or intramedullary fixation
Secondary impingement, otherwise known as _____________, is associated with a decrease in subacromial space, cuff weakness, and involvement of adjoining structures.
dynamic instability impingement occurs secondary to instability
What happens if FAI is left untreated?
early onset of hip OA
What condition will a scaphoid fracture often contribute to?
early radiocarpal joint arthrosis
How are radial head fracture with dislocation (Type IV) managed?
elbow reduction and radial head resection
What is the focus of conservative therapy for *tendinosis*?
encouragement of collagen-synthesis maturation and strength
What are the radiograph presentations of little leaguer's elbow?
enlarged, sclerotic epicondyle with fragmentation, and/or widening of epiphyseal plate
The 43-year old receptionist at your PT clinic c/o numbness and tingling in the radial-palmar aspect of the hand, thumb, index finger, and 1/2 of ring finger. She also states she experiences aching pain and cramps in her hand. She states that these symptoms worsens when she is typing on the computer and would sometimes wake her up at night. She also states she has been so clumsy lately because she drops everything she holds. Explain the pathology of the possible condition that is described above.
entrapment/compression of median n. at the wrist between tendons of longitudinal finger flexors and transverse superficial carpal ligament
Little leaguer's elbow can be associated with a slight stress fracture through the __________ of the medial epicondyle.
epiphyseal plate
TIbialis posterior tendon stabilizes the rearfoot against _____________ forces and maintain the navicular bone in its normal position.
eversion/valgus
What is a compensation seen in someone with rearfoot varus?
excessive STJ pronation to allow heel to touch ground during heel strike followed by rapid pronation until heel rise, and delayed supination
What is the mechanism of injury for Colles fracture?
fall on an outstretched arm with a forceful wrist DF (extension)
What is the mechanism of injury for a scaphoid fracture?
falling on an outstretched and supinated arm with a hyperextended and radial deviated wrist
What is the most common cause of hip fractures?
falls in individuals 65+ years old
__________ is defined as the abutment of the proximal femoral head-neck junction against the acetabular rim.
femoral acetabular impingement
What is the cause of in-toeing after 3 years old?
femoral anteversion
In a cam impingement, there is an abnormal/excessive bone that forms on the __________ resulting in an abnormally shaped femoral head that cannot glide and rotate smoothly inside the acetabulum.
femoral had called the cam bump
_______________ fractures maybe associated with underlying organ system dysfunctions in adults between 40-60 years of age.
femoral neck
50-year old female patient presents to the clinic with c/o pain in R buttock, groin, and thighs. She reports that she suddenly is unable to weight bear on the R side without these symptoms. You find that she has significantly decreased ROM on her R compared to her L and appears to have Trendelenburg gait. Bone scan detect stress fracture on proximal femur. What condition does this patient presents with?
femoral neck fracture
In a stiff elbow, a __________ end feel indicates soft tissue contracture.
firm
Dysfunction of the tibialis posterior may result in an acquired __________ deformity.
flatfoot progresses to - collapsed heel into valgus - pronated midfoot -decreased height of longitudinal arch - abducted forefoot
___________ PF first ray is plantar flexed but has normal mobility.
flexible
Cam impingement typically results in inside-to-outside damage to the anterosuperior portion of the acetabulum with repetitive hip ___________ and ____________ activities and movements.
flexion and IR
Pavlik harness for hip dysplasia places the hips in ________.
flexion and abduction
The most common location of the root of a volar carpal ganglion cyst is the _________ tendon sheath or from between R-S, S-Trapezium, S-L.
flexor
Elbow posterolateral rotatory instability is described as the distal end of the humerus displaced ______________ into or through the _____________ capsule as the radius and ulna are subluxed or dislocated posteriorly into or through _______________ capsule.
forward; anterior; posterior
What is a common elbow fracture that typically occurs secondary to high-energy forces and can be classified into six categories?
fracture of the distal humerus
What radiograph view should be obtained to catch early slips of small magnitude?
frog-leg lateral view
The angle of inclination occurs in the _________ plane between the axis of femoral neck and the axis of femoral shaft and represents teh superior WB surface of acetabulum.
frontal
_____________ is a type of foot orthosis that extends beyond the tips of the toes.
full length
Plain film imaging may show superior migration of the humeral head and reduced acromiohumeral distance with ______________ tears.
full thickness
During an arthrography, the escape of dye into the subacromial or sub-deltoid space after injection indicates a ___________.
full thickness RTC
______________ are orthopedic devices designed to maintain and preserve structural integrity of the foot and lower joints and soft tissues by resisting ground reaction forces that would be expected to lead to abnormal/undesirable motion during WB activities.
functional foot orthoses
_______________ maintain and preserve structural integrity of foot while altering loading patterns.
functional/accommodative foot orthoses aka combination
Overpronators have ____________ shock absorption.
good
Prognosis of Legg-Calvè-Perthes disease is _____ if the onset is under 5 yo.
good
Type 2 subtrochanteric fractures extend proximally into the the ________________ and involves the piriformis fossa.
greater trochanter
____________ is a degenerative joint disease of the MTP of great toe. The bony proliferation is noted in dorsal aspect of the joint.
hallux rigidus lateral weight bearing i.e. shifting away from the deformity is common
____________ is a deformity in which there is a lateral deviation of the great toe at MTP joint.
hallux valgus results of abnormal stresses and is typically found with pes planus type deformities
A 27-year old runner presents to the clinic with swelling and ecchymosis in his posterior thigh. Patient reports at the time of injury he felt a pulling sensation in the posterior aspect of the thigh during his sprint. Patient has pain with resisted knee flexion and appears to have no knee extension during terminal swing phase of gait. Ischial tuberosity is tender. What condition is most likely present?
hamstring strain with avulsion fracture suspected indicated by ttp ischial tuberosity surgery is indicated if there is a bony avulsion displacement of 2 cm or more
What helps the ACL resist forward displacement of the tibia and act to prevent anterior translation and dislocation of the tibia relative to the femur?
hamstrings ACL does about 60-85% of the work
An untreated hip dysplasia will likely lead to _____________, which may be severely debilitating.
hip arthritis
Older persons tend to present with ___________ meniscal tears due to the chronic degenerative changes in the fibrocartilage.
horizontal
What is the inferior border of subacromial space?
humeral head
Biceps tendinitis is a degenerative condition that usually involves sports that require __________________.
humeral rotation at or above the level of the horizontal
A ________________ mechanism of injury would likely damage the anterior oblique fibers of the UCL.
hyperextension
When is surgery indicated for a patellar fracture?
if fracture is displaced, comminuted, and/or if there is an injured extensor mechanism
Because most partial thickness tears occur on the articular side of the cuff, differential diagnosis between articular side partial-thickness tears and _________________ can be difficult by means of traditional physical examination.
impingement lesions
What is the possible mechanism of patellar tendonitis?
impingement of the deep fibers of the patellar tendon against the lower pole of the patella occurring during flexion
Secondary impingement is described as __________.
impingement tendinosis
Tibial valga leads to more _____________ orientation of the femur and thus the tibias are forced into valgus.
medial
External tibial torsion _______________ Q angle.
increase
Femoral anteversion causes an _________ Q angle.
increase
Which of the following is NOT a disadvantage of doing a hamstring tendon graft for ACL repair: - anterior knee pain - kneeling knee pain - harvesting tendon - increased knee stiffness - harvested tendon may be too short for ACL repair
increased knee stiffness hamstring tendon graft results in less residual knee stiffness compared to patellar tendon graft
A force applied at a lower load via a lever arm is called ___________ force.
indirect most common mechanism
What is the mechanism of injury for intercondylar fractures?
indirect trauma forces delivered via olecranon impacting on the humerus, causing the end to split via a wedge effect
The center-edge reflects the amount of ________ tilt of the acetabulum and is used to evaluate the relationship of femoral head to acetabulum.
inferior
___________ instability is often described as subluxation rather than an instability and it often occurs with lifting activities. Patients with this shoulder condition will present with a sulcus sign.
inferior
____________ bursitis is due to kneeling along the skin surface overlaying the tibial tuberosity.
infra-patellar clergyman's
What is the first and most important step in management of Legg-Calvè-Perthes disease?
initial containment of the involved portion of the femoral head within the acetabulum by either surgical or non-surgical means as well as maintenance of hip motion and relief of symptoms
Patellar ___________ refers to symptoms secondary to episodic lateral subluxation or dislocation of the patella.
instability
A _______________ fracture is classified as T or Y shaped fractures between the condyles of the humerus.
intercondylar fracture
55-year old female presents with mild ache and discomfort in the area of the 4th metatarsal head. She also has a burning sensation and tingling that radiates to the tip of the toes. She reports that symptoms are more apparent when wearing pointy dress shoes vs tennis shoes. She also reports the feeling of a pebble inside of her shoe under the ball of her foot. During palpation, pain was provoked with 3rd and 4th metatarsals. What condition is likely present?
interdigital neuroma
_____________ is the irritation of the interdigital nerves of the foot as the travel beneath and between the metatarsals.
interdigital neuroma often over 3rd plantar interdigital nerve
What is the hallmark symptom of meniscal pathology?
intermittent pain localized to the joint line
Essex-Lopresti usually involves disruption of the ________________ and ______________ of the distal radioulnar joint, which usually occurs with radial head fracture.
interosseous membrane and ligamentous support
What is an extracapsular hip fracture that runs along the base of the femoral neck between the trochanters?
intertrochanteric
What are the surgical management for subtrochanteric fractures?
intramedullary fixation or fixed angle plating
What is the a RTC tear that has no communication with either joint or subacromial bursa?
intratendinous tear
Based on the *Morrey* anatomical classification scheme for stiff elbows, which type of elbow stiffness involves the articular malunion/non-union, adhesions, and loose bodies?
intrinsic
___________ factors are abnormalities or variations involving the knee.
intrinsic
In a rearfoot varus, an __________ deformity of calcaneus is noted when the STJ is held in a neutral position and the MTJ is locked.
inversion
__________ ankle sprains occur with stress on the lateral collateral ligament complex of the ankle.
inversion
How does a degeneration or injury in TFCC affect force transmission through the forearm?
it degrades normal transmission of axial forces from the carpus to ulnar pole and stability of distal radio-ulnar joint
What anatomical arrangement places the scaphoid at potential risk of injury as a result of shearing forces through the wrist?
its location in the proximal row of carpal bones but its distal row spanning to midcarpal joint
Patient describes a lateral elbow pain that is aching, sharp, and sometimes burning with movement. TTP over origin of wrist extensor muscles. Patient is a 45 year-old male who like smoking cigars at the country club where he plays tennis. What is likely his diagnosis?
lateral epicondylitis
What is the typical shoe wear of a supinated foot?
lateral part outside the shoe
_____________ test is a static measurement of the side-to-side difference of the distance from the inferior angle of the scapula to the adjacent spinous process.
lateral scapula slide test not valid because does not look at dynamic 3D motion
What part of the knee does osteochondritis dissecans often occur at?
lateral trochlear margin of the femur and the proximal one half of the patella
A center-edge angle ________ than 25° is associated with hip dysplasia.
less if it is less than 20°, it is severe
Unstable type III radial head fracture patterns with greater _______________ injury have a more guarded.
ligamentous
Knee buckling is a clinical presentation of meniscal injuries, however, it might be due to _____________ rather than directly from meniscal injuries.
ligamentous injuries and/or strength deficits
Reoccurrence of elbow dislocations are rare and are usually associated with _____________.
ligamentous injury
Explain the vascularity of the menisci
limited along the outer margins/horns and the central portions are avascular medial meniscus = 10-30% of width before avascular lateral meniscus = 10-25% before avascular
10-year old baseball player presents with localized swelling of the anterior shoulder and tenderness over the GH joint. He also presents with limited ROM. AP radiographs present a widening and irregularity of the proximal humeral epiphyseal plate with metaphyseal separation. What interventions are appropriate for this patient?
little leaguer's elbow will benefit from - rest *without* immobilization - stretching - neuromuscular re-education - elimination of muscle imbalances - proper pitching mechanics
_____________ is a result of repetitive stress on shoulder causing an epiphysiolysis of proximal humerus.
little leaguer's shoulder more than half of little leaguer's shoulder can be prevented
What is a risk for displaced femoral neck fractures?
loss of blood supply to femoral head which can result in avascular necrosis
What is the glucose level in a RA knee aspirate?
low
What histological finding may be present in CRPS patients?
low-grade inflammatory fibrosis noted in the palmar fascia and surrounding the adjacent digital flexor tendon sheaths
In a normal scapula, it is common for the dominant side to be slightly __________ than the non-dominant side.
lower
___________ is the detachment of extensor tendon from the base of the distal phalanx directly or in association with an avulsion fracture at insertion of extensor tendon.
mallet finger
___________ is a flexion deformity of one or more of the four lateral DIPs.
mallet toe common in the second toe
A tear measuring greater than or equal to 5 cm is considered _________________ sized.
massive
What type of impingement is primary impingement?
mechanical soft tissue structures being compressed at the anterior aspect of the humerus between the head and the coracoid process, and under the acromion process
What is the result of soft tissue structures being compressed at the anterior aspect of the humerus between the head and the coracoid process, and under the acromion process?
mechanical impingement
What is the hallmark of osteochondritis dissecans?
mechanical obstruction such as locking or catching of the knee in extension
A 46-year old pastient presents to the clinic with anterior-medial knee pain that is typically intermittent. Symptoms are aggravated with prolonged standing, squatting, and stair climbing. Patient also c/o clicking, catching, and crepitus during activities. Patient is positive during Stutter test, O'Conner's sign, impingement test, and Hughston test. MRI shows plica in the medial knee. What is the likely cause of this disorder?
medial plica syndrome may be caused by repetitive stress, acute blund trauma, knee internal derangement, loose bodies, and symptomatic knee pathologies like chondromalacia
What is the cause of in-toeing at 2 years old?
medial tibial torson
Squinting patella occurs when the anterior surface of the patella faces __________ and is positioned slightly ____________.
medially; inferior
Anterior interosseous syndrome is entrapment or compression of the anterior interosseous nerve of the ___________ nerve in the forearm.
median
The following conditions affect the ________ nerve: - pronator teres syndrome - anterior interosseous syndrome - carpal tunnel syndrome
median
PTs should treat suspected acute compartment syndrome as a ______________ requiring immediate follow-up and referral.
medical emergency
A tear measuring between 1-3 cm is considered _________________ sized.
medium
The femoral head receives majority of its blood supply from the ___________ rather than the periosteum or surrounding tissue.
medullary cavity
_____________ is a type of foot orthosis that ends proximal to the metatarsal heads.
metatarsal length
The ________ pole of the scaphoid is the most common fractured part of the wrist bones.
middle
What degree of carpal tunnel syndrome presents with the following: - intermittent symptoms - decreased light-touch sensibility - digital compression test positive - Tine sign and Phalen maneuver may or may not be present
mild
The following are presentations of __________ halux valgus: - MTP joint is congruent - little valgus deformity - MTP angle less than 20 degrees - painful medial prominence of the metatarsal head - sesamoid bones are in their anatomical position
mild non-surgical management
According to Neviaser, Stage 1 adhesive capsulitis present with?
mild synovitis in the inferior recesses of the joint capsule
Based on the *Morrey* anatomical classification scheme for stiff elbows, which type of elbow stiffness involves both extrinsic and intrinsic factors?
mixed
What is the most common type of FAI?
mixed (both cam and pincer)
What degree of carpal tunnel syndrome presents with the following: - frequent symptoms - decreased vibratory perception in median n. distribution - positive Phalen maneuver and digital compression test - increased 2-point discrimination - weakness of thenar mm.
moderate
The following are presentations of __________ halux valgus: - MTP joint is not congruent - moderate valgus deformity - MTP angle of 20-40 degrees - painful medial prominence of met head - lateral sesamoid nones are partially completely displaced beneath the met head - hallux is pronated
moderate non-surgical to surgical
____________ is a capsular shift with reattachment of the labrum.
modified Bankart
______________ instability often involves anterior, inferior, and sometimes posterior instability and is related to failure of passive and active factors to maintain stability.
multidirectional congenital instability is usually MDI
What does an excessive coverage in pincer impingement result in?
neck of femur prematurely impacting against the acetabulum rim during hip flexion and IR activities which can lead to - labrum damage/tears - ossification of labrum - cartilage damage over rim of acetabulum
What type of ACL injury are the most common types, especially in athletes, and entails a sudden cut or sudden deceleration/acceleration motions with varus/valgus load at or near full knee extension?
non-contact
Non-displaced patellar fractures with an intact extensor mechanism are treated ___________.
non-surgically
What is the glucose level in a degenerative knee aspirate?
normal
What is a typical patient of SCFE?
obese black male with low testosterone
____________ is an osseous lesion characterized by complete or incomplete separation of a portion of joint cartilage and underlying bone secondary to the loss of blood supply to an area of bone that is adjacent to joint surface; associated with epiphyseal aseptic necrosis.
osteochondritis dissecans may be described as a stress fracture of the subchondral bone of the WB surface of the femoral chondyle
Transcondylar fractures are more common in elderly populations secondary to _____________.
osteoporosis
What is considered late detection of hip dysplasia and is a failure to diagnose one early screening?
over 3 mos a small number of hip might appear stable upon physical examination at birth but can become dislocated after birth
Posterior internal impingement, or *secondary* internal impingement, is frequently seen in ____________.
overhead athletes
What provides stabilization of distal radio-ulnar joint during pronation and supination?
palmar and dorsal radioulnar ligaments developing tension
____________ tears show no communication between the subacromial bursa and the GH joint.
partial thickness
What meniscal tear show the best results with conservative care?
partial thickness tears oriented along longitudinal meniscal axis
Quadriceps rupture often occur during rapid eccentric contraction of quads with planted foot and __________ knee.
partially flexed
_________________ syndrome is pain in the patellofemoral joint without instability and without cartilage damage which occurs when either the VMO is weak or the lateral retinaculum is tight.
patellar compression aka excessive lateral pressure syndrome (ELPS)
A 34-year old patient reports dull aching pain in the anterior knee worsen by squatting and descending stairs. Point tenderness is present over lateral facet of the patella with intense pain and crepitus elicited when the patella is manually compressed into patella groove. Synovial inflammation is also present. Patient does not present with instability or cartilage damage. What condition is most likely present?
patellar compression syndrome
_______________ is described as traction apophysitis of the distal pole of the patella (i.e. tendon-bone interface) secondary to repetitive stress and a progressive overuse disease of the patellar tendon.
patellar tendonitis jumper's knee
_________________ is a disease in which articular cartilage of the patella is lost, leading to joint pain and stiffness.
patellofemoral OA
Patient presents to the emergency room after a MVA with pain and effusion in the knee. Patient states that she had hit her knee on the dashboard upon collision. You have found about 8 mm of joint space opening in the knee as well as a solid end-feel. Posterolateral drawer test and posterior sag sign are both positive. Radiographs are insignificant. With no other injuries sustained, what is the recommended intervention for this patient?
patient experienced a Grade 2 PCL injury common recommendation is non-operative minimal immobilization, early strengthening and return to activity as early as 3-4 weeks
How can a triggering be elicited in a trigger finger?
patient make a tight fist then extend digits this is the most simplistic diagnosis but radiographs are allowed to r/o other conditions
A 13-year old dancer presents to the clinic with pain, swelling, tenderness over the tibial tubercle at the patellar tendon insertion. She appears to have a prominent tibial tubercle. Her mom recalls that the teen has had low grade discomfort over a period of months and experiences pain and swelling after dance classes. Now, she appears to have severe pain and antalgic gait. What is the proper intervention for this patient?
patient presents with Osgood-Schlatter syndrome with a repeated microavulsion injury and incomplete fibroosseous repair on tibial tubercle (indicated by prominent tubercle) interventions include: - reduce activity level where symptoms are minimized and - possibly bracing, immobilization, injection, and surgery
21-year old female athlete presents to the clinic for her R knee. She c/o something in her knee "jumping up" and giving away during straight ahead activities and stair climbing. During palpation, you discover an enlarged fat pad and tenderness along medial knee. You had patient perform a terminal knee extension and discover an abrupt lateral movement of the patella. There is no bloody effusion present. What special test can be performed next to help your diagnosis?
patient presents with patellar instability and subluxation with no dislocation special tests to perform will be - lateral apprehension sign - lateral glide test
54-year old electrician presents to the clinic with his arm held in adduction and IR. He says he was electrocuted badly during a project. He only has 90° of AROM elevation and tested positive with clunk test during IR and horizontal adduction. A prominence or rounding over posterior shoulder below the acromion and flattening of the anterior aspect of shoulder below the acromion is noted. The coracoid process also appears more prominent in the involved side. Radiographs show a hatchet shaped anterior humeral head fracture and a lesion at the posterior glenoid rim and lesser tuberosity. Explain the pathology of the condition.
patient presents with posterior dislocation as a result of the electrocution--violent contraction of the muscles around the shoulder that caused his stronger IR to overwhelm weaker ER radiographs also show a reverse Hill-Sachs and reverse Bankart lesion which is apparent in posterior dislocation
A 41-year old patient presents with acute onset of knee pain, swelling, and functional loss. Patient is unable to perform knee extension against gravity. During gait, patient presents with decreased knee AROM, compensation from hip joint, and c/o knee buckling. What must be ruled out during examination of the patient?
patient presents with quad tendon rupture r/o systemic diseases like - DM - steroid use - hyperparthyroidism - renal failure - SLE - gout - leukemia
You are working at a soccer game and witnessed a player collapse to the ground after suddenly stopping while running. Player reports immediate severe pain and a sound of popping after injury. Lachman, pivot shift, and anterior drawer tests are all positive. You see the patient the next day but cannot you cannot get a positive when the same tests are performed. What could be the reason for this phenomenon?
patient suffered from an ACL injury the next day, they are guarding and therefore strong, fast motions cannot elicit the positive signs for an ACL injury
What is the worst case scenario in meniscal injuries?
patient will describe inability to completely extend the knee and/or a mechanical locking during ROM
Bankart and Hill-Sachs lesions are often indication of surgical interventions because they are good predictors of ___________.
persistent instability
__________ impingement results from morphologic changes of the acetabulum.
pincer
A greater center-edge angle greater than 28° of acetabular coverage and a retroverted acetabulum is associated with ________ type femoral acetabular impingement.
pincer (anterior impingement)
Type 1 subtrochanteric fractures do not extend into the _____________.
piriformis fossa
Guyon's canal syndrome is the entrapment of ulnar n. at the wrist in the tunnel formed by __________, ________, and associated ___________________.
pisiform, hamate, and ligaments/flexor retinaculum
A ____________ deformity is typically observed in cam impingement.
pistol grip
25-year old male with a excessive pronated foot, presents to the clinic with pain over the medial plantar aspect of foot. He states that the pain is typically greatest in the morning after rising, particularly with the first few steps, during midstance, after heel raises, and during stair climbing. After sitting down on a short break, the patient will often have a recurrence of symptoms upon rising and for the first few steps. What condition does this patient present with?
plantar fascitis
____________ is an inflammatory condition affecting the fascia on the bottom of the foot characterized by burning heel and arch pain.
plantar fascitis a biomechanica imbalance (abnormal pronation) results in abnormal tension along plantar fascia
Prognosis of Legg-Calvè-Perthes disease is _____ if the onset is greater than 9 yo especially if the presence of complicating factors.
poor
_________________ is an enlarged cyst on the posteromedial aspect of the knee between the medial head of gastroc and semimembranosus tendon formed by the trapping of fluid in a bursa.
popliteal or Baker's cyst often associated with intra-articular pathology
Your CI suspects a 2-month old infant to have developmental hip dysplasia. He performs a special test where he adducts the hip while he pushes the thigh in a dorsal direction. A dislocation was produced. What does this indicate?
positive Barlow maneuver
A 21-year old college athlete presents to the clinic with groin and anterior thigh pain and hip stiffness with an insidious onset. He reports that he has pain at night and while walking on flat surfaces. He has excruciating pain during sports activities and has noticed significant decrease in hip ROM. He reports that he even has trouble putting on/taking off socks. Patient also complains of a catching sensation recently. Physical therapist observes unavoidable passive ER of the hip while performing a hip flexion and pain with passive hip flexion, adduction, and IR. What does this indicate?
positive Drehmann's sign and positive FADIR advanced cartilage damage and OA due to anterior FAI
A 44-year old avid rock climber who reports paresthesia in the lateral 3 1/2 fingers and palm of the hand that worsens after a day of climbing experiences the same symptom as the physical therapist test MMT for middle finger flexion. What does this indicate?
positive FDS MMT entrapment of median n. in the arch of FDS
Your CI suspects a 3-month old infant to have developmental hip dysplasia. He places the child in supine with both hips and knees flexed. There is a dissimilarity in the height of the knees. What does this indicate?
positive Galeazzi sign
Your CI suspects a 3-month old infant to have developmental hip dysplasia. He performs a special test where he abducts and gently pulled ventral while the contralateral hip is stabilized. A sensation of instability was produced. What does this indicate?
positive Ortolani maneuver
A 60-year old tennis player who reports insidious onset of symptoms, pain, and tenderness in the proximal anterior aspect of the forearm experiences the same symptoms as the physical therapist resists supination while elbow is positioned in flexion. What does this indicate?
positive lacertus fibrosus test entrapment of median n. in the aponeurosis of biceps
What are the main stabilizers against valgus stress?
primary: anterior oblique medial collateral ligament secondary: radio-capitular articulation
A 35-year old office worker presents to the clinic with groin and anterior thigh pain and hip stiffness with an insidious onset. He reports that pain only arises during end hip ROM and prolonged sitting. Pain also arises during his morning runs, especially up the hill. During examination, patient had reproduction of symptoms during hyper extension and ER of the hip. What does this indicate?
positive posterior impingement test with initial symptom posterior FAI
A 55-year old carpenter who reports paresthesia in the lateral 3 1/2 fingers and palm of hand experiences the same symptoms as the physical therapist resists pronation while gradually straightening out his elbow. What does this indicate?
positive pronator teres test entrapment of median n. between two heads of pronator teres
What is the most common type of hip dislocation?
posterior dislocation most commonly caused by motor vehicle accidents
What is a mechanism for medial epicondyle fractures?
posterior elbow dislocation/direct blow
Commonly, radial tunnel syndrome is described as compression or entrapment of the ___________________ in the radial tunnel.
posterior interosseous nerve however in the literature, radial tunnel syndrome (sensory) and posterior interosseous nerve entrapment (motor) are different
44-year old female presents to the clinic with pain posterior to the medial malleolus and along the posterior tibial tendon. Deltoid ligament and medial arch is painful to palpation. When looking from behind, you notice more toes on the affected side than are observed on the other limb. SL heel raise is painful. What condition does this patient present with?
posterior tibial insufficiency
_____________ is a loss of function of the tibialis posterior of multifactorial origin.
posterior tibial insufficiency
34-year old female patient presents to the clinic with pain that is burning and tingling in nature, in and around the ankle and to the toes. The pain is worse during walking and is relieved by rest. Tinel sign is positive over the tarsal tunnel. What condition is likely present?
posterior tibial nerve neuralgia
____________________ is the compression of the nerve within this canal as the nerve passes underneath the flexor retinaculum at the level of the ankle joint.
posterior tibial nerve neuralgia (tarsal tunnel syndrome)
What bundle of the ACL is tight is extension and resists anterior subluxation near full extension?
posterior-lateral bundle of ACL attaches to posterior-lateral tibia
According to O'Driscoll's classification, what are the special tests for *posterolateral rotatory instability*?
posterolateral rotatory instability test (*pivot shift*)
_____________ bursitis is due to repetitive shearing to the anterior aspect of the knee.
pre-patellar house-maid's
What causes a delayed diagnosis of SCFE?
presentation of knee pain can have serious consequences like slippage, increased risks of arthritis, and osteonecrosis
What are treatment goals for SCFE?
prevention of further slipping and avoidance of complications
During Neer's impingement test, pain at 90° abduction or elevation is a positive sign for ______________.
primary impingement
Grade IV in Magee's classification of system for shoulder impingement
primary instability with no impingement
Tibial vara is a bowleg deformity of the tibia that places the lateral border of the foot in contact with the ground at the time of contact and this encourages excessive ___________.
pronation
_____________ is the entrapment of the median n. in the proximal forearm, typically has an insidious onset and is due to repetitive pronation/supination movements or grasping, carpentry, and tennis.
pronator teres syndrome
21-year old swimmer presents to the clinic with pain in the anterior shoulder and arm that is diffused and difficult to localize. Patient presents with a painful arc between 60-120° of elevation and is TTP over bicipital groove. Resisted elbow flexion and MMS for biceps is painful. Neer and Hawkins-Kennedy tests were inconclusive but Speeds, Yergason, Deaquin, and Ludington tests were positive. What condition is most likely present?
proximal biceps tendinosis
Patient presents with symptoms indicating ulnar nerve compression. She presents motor weakness in all ulnar innervated hand intrinsics and ulnar distribution paresthesia at the dorsal aspect of the hand. Where is the possible location of the compression?
proximal portion of Guyon's canal
Severe ligamentous disruption accompanied by radial head excision in Essex-Lopresti injury will result in increased ___________________ migration.
proximal radial this often results in subluxation of the distal radioulnar joint and increasingly painful ulnar abutment at the wrist
Grade I in Magee's classification of system for shoulder impingement
pure impingement with no instability; often seen in older patients
A 34-year old patient c/o "pulled thigh" and pain and tenderness in the anterior thigh muscle belly. Extension of the hip with knee flexion causes extreme discomfort. Patient seems to be in the acute phase of the injury. What interventions is appropriate at this time?
quadriceps strain - RICE - NSAIDs - PWB on injured side - no athletic participation
49-year old patient presents to the clinic with a dull aching pain in the suprapatellar region at the beginning of activity warm-up but decreases after warm-up. He reports the pain reappears after activity. Patient reports weakness and giving away of the knee. Patient presents with ttp of the quadriceps tendon. Patella baja is observed. Radiographs are negative What condition is most likely present?
quadriceps tendonitis
____________ is a traction overuse injury secondary to intrinsic overload on the extensor mechanism of the knee.
quadriceps tendonitis
The following conditions affect the ________ nerve: - posterior interosseous nerve compression - Wartenburg's syndrome - Supinator syndrome
radial
According to O'Driscoll's classification, what are the damaged structures with *posterolateral rotatory instability*?
radial collateral ligament (*ulnar*)
38-year old male construction worker comes in to the clinic with c/o aching and deep burning pain in the dorsal forearm. He was TTP 4-5 cm distal to the lateral epicondyle around the supinator muscle. He reports that his symptoms usually worsens at the end of the work day and is aggravated during wrist extension and pronation activities. His symptoms are not alleviated at rest and wakes him at night. What condition does this patient have?
radial tunnel syndrome
What are the diagnostic tests for mallet finger?
radiographs (AP, lateral, oblique) to rule out avulsion
What is the initial treatment goal for Legg-Calvè-Perthes disease?
re-establish hip ROM *with special attention given to hip abduction*
_______________ is an excessive subtalar pronation.
rearfoot valgus observed following a calcaneal fracture
____________ is a fixed, osseous congenital deformity originating from the tibia and/or subtalar joint.
rearfoot varus can be due to - tibia varum (bowleg) - subtalar varus (supination) secondary to incomplete de-rotation of posterior calcaneus - both
What should rehabilitation for elbow dislocations focus on?
restoring early ROM and basic ADL function
What is the primary goal of PT for patients who fracture the mid portion of radius and ulna?
restoring supination and pronation
What are general principles for Phase IV (over 6 months) of hip fracture rehabilitation?
return to pre-morbid functional level
____________ PF first ray cannot correct or DF.
rigid
The most common location of the root of a dorsal carpal ganglion cyst is the dorsal __________ capsule and ligament.
scaphoid-lunate
During Neer's impingement test, pain during abduction and IR is a positive sign for ______________.
secondary impingement
Grade II in Magee's classification of system for shoulder impingement
secondary impingement and instability caused by chronic capsular and labral microtrauma
Grade III in Magee's classification of system for shoulder impingement
secondary impingement and instability caused by generalized hypermobility or laxity
____________ PF first ray is correctable to the level of second metatarsal.
semi-rigid
What degree of carpal tunnel syndrome presents with the following: - persistent symptoms - marked increase in or absence of 2-point discrimination - thenar mm. atrophy
severe
The following are presentations of __________ halux valgus: - significant joint incongruence - total dislocation of lateral sesamoid into intermetatarsal space - MTP angle greater than 40 degrees - marked lateral deviation of the great toe with noted pronation of hallux - management is surgical
severe surgical
What is the progression of intervention for a non-displaced Bennett's fracture?
short arm cast for 6-8 weeks > SPICA splint > PROM/AAROM/AROM > RROM
Patella baja occurs secondary to ______________.
short patellar tendon results in an early and excessive compressive forces/contract forces between patella and femur
What is the initial treatment for achilles tendon rupture?
short-leg splint or cast with ankle joint positioned in PF, ice, elevation, and assistive ambulatory device
59-year old female presents to the clinic with diffuse somatic pain at rest and worsens with increased activity. She also c/o painful crepitus and loss of function in shoulder joint. PT palpates grinding in GH joint and observes loss of GH AROM/PROM. PT also indicates that patient has decreased joint play and abnormal end-feel. Plain film radiographs show joint space narrowing, spurring of the humeral neck, and sclerotic and cystic changes. What condition is likely to be present?
shoulder OA
Pain present during scapular dyskinesis correspond to underlying _____________________ and may include scapular pain, coracoid pain, pain over anterior, superior, ventral and/or lateral aspects of the shoulder, AC joint pain and/or clavicular pain.
shoulder pathology
Which type of elbow stiffness is described below: - less than 80° of elbow ROM - no or minimal prior surgery - no prior nerve transposition - no internal fixation - minimal heterotopic ossification - well-preserved bony anatomy
simple
Resolution of ainterior interosseous syndrome may take up to ______ months of therapy that includes ___________ of all movements and/or occupation that exacerbates symptoms.
six; avoidance
A 13-year old obese black male presents with a limp and hip rotation during gait. He c/o hip stiffness and pain with his R hip. He states that stiffness is relieved by rest. Pain is often localized in the groin area and radiates down to anteromedial thigh and knee. Upon examination, you notice atrophy of the R thigh and the R limb being shortened 1-2 cm. Patient present with abd, IR, and flex ROM deficits and an ER R leg. Radiographs show asymmetric physial widening. What condition is most likely present?
slipped capital femoral epiphysis
__________ is epiphysiolysis loosening or separation, either partial or complete, of an epiphysis from the shaft of the bone and results in the growth plate of the proximal femur to become weak and displaced.
slipped capital femoral epiphysis
A tear measuring greater than or equal to 1 cm is considered _________________ sized.
small
What could be the cause of someone with Osgood-Schlatter being symptomatic into adulthood?
small portion of calcified material in tendon adjacent to the tubercle and/or bursal involvement is frequently present management is surgical
According to O'Driscoll's classification, what are the symptoms for *posterolateral rotatory instability*?
snapping and/or feeling of instability
According to O'Driscoll's classification, what are the symptoms for *posterior dislocation of elbow*?
snapping and/or feeling of instability and recurrent *dislocation*
According to O'Driscoll's classification, what are the symptoms for *perched (subluxed) elbow*?
snapping and/or feeling of instability and recurrent *subluxation*
Forefoot supinatus is an acquired _____________ deformity in which the forefoot is inverted on the rearfoot.
soft tissue
____________ is a deformity involving widening of forefoot.
splaying associated with weakness of intrinsic foot muscles and laxity of intermetatarsal ligaments
What stage of adhesive capsulitis present with the following capsular changes: *hypertrophic and hypervascular synovitis with an otherwise normal capsule*
stage 1
What stage of adhesive capsulitis present with the following signs and symptoms: - pain referred to deltoid insertion - pain at night - capsular pain on deep palpation - empty end feel at extremes of motion - full motion under anesthesia
stage 1
What stage of adhesive capsulitis presents with a arthroscopic examination finding of diffuse glenohumeral synovitis more pronounced in the anterosuperior and inferior capsule?
stage 1
What stage of Legg-Calvè-Perthes disease presents with the following: - femoral head stops growing because of lack of blood supply - involved head and medial joint space appear smaller than uninvolved side
stage 1: initial (avascular)
What stage of adhesive capsulitis present with the following capsular changes: *progressive hypertrophic and hypervascular synovitis with progressive fibroplastic scar formation in underlying capsule*
stage 2
What stage of adhesive capsulitis present with the following signs and symptoms: - severe night pain - stiffness - motion restricted in forward flexion, abduction, IR, and ER - some motion loss under anesthesia
stage 2
What stage of adhesive capsulitis presents with a arthroscopic examination finding of diffuse pedunculated synovitis?
stage 2
What stage of Legg-Calvè-Perthes disease presents with the following: - epiphysis appears fragmented - new bone formation is noted - revascularization of the femoral head noted
stage 2: fragmentation
What stage of adhesive capsulitis present with the following capsular changes: *end stages of synovitis without significant hypervascularity and dense scar tissue in the capsule*
stage 3
What stage of adhesive capsulitis present with the following signs and symptoms: - profound stiffness - pain only at end of ROM - significant loss of motion - tethering at ends of motion - no improvement under anesthesia
stage 3
What stage of adhesive capsulitis presents with a arthroscopic examination finding of remnants of fibrotic synovitis?
stage 3
What stage of Legg-Calvè-Perthes disease presents with the following: - bone density returns to normal - femoral head and neck may show changes in shape and structure
stage 3: re-ossification (regrowth, regeneration)
___________ occurs when normal bone becomes exposed to excessive forces caused by repeated loading.
stress fractures of metatarsal shafts (usually 2nd, 3rd, and 4th) symptoms result secondary to active remodeling of bone as a function of applied stresses
___________________ refers to inflammation of a tendon and is treated by RICE, PRICE, NSAIDs, and SAIDs.
tendinitis
________________ lasted shoes have the upper stitched to a thin piece of material that is glued to the midsole.
strobel most performance running shoes are Strobel lasted
Primary impingement, or ___________________, is characterized by impingement of the __________ beneath the coracoacromial arch and is mechanical in nature.
structural narrowing; RTC
What is the most commonly compressed and inflamed subacromial structure?
subacromial bursa
_______________ may act as a pro-inflammatory membrane that is in-part responsible for shoulder pain and cuff disease, hence an extrinsic factor of tendinosis and RTC disease.
subacromial bursa
54-year old carpenter presents with sudden onset of shoulder pain. Anterolateral shoulder is TTP. He presents pain during abduction at about 60° but decreases between 100-120°. Patient presents no limitation in rotation and resisted testing with arm by the side is normal with no discomfort. However, resisted testing during elevation is painful. Radiographs show calcified material in the bursa. What condition is most likely present?
subacromial bursitis
____________________ occurs secondary to repetitive activities linked to impingement tendinitis and RTC tears.
subacromial bursitis repetitive shoulder movements cause a reactive accumulation of fluid in the bursa in the attempt to attenuate friction
Which of the following is *NOT a functional factor* that may cause narrowing of subacromial space: - parascapular weakness - suprascapular nerve palsy - posterior or inferior capsular tightness - faulty neuromuscular control of scapular muscles - subacromial fibrosis
subacromial fibrosis *this is a structural factor*
What is an intracapsular hip fracture across the neck of the femur immediately below the head?
subcapital
___________ is described as the femoral head can be moved significantly but does not dislocate.
subluxable
Patellar ___________ refers to partial loss of contact between the articular surfaces of the patella and femur.
subluxation
Total shoulder arthroplasty typically entails ___________ repair so extreme caution needs to be taken to avoid rupture during early rehab as this will result in weakness and instability.
subscapularis
What is an extracapsular hip fracture of the proximal femur below the lesser trochanter?
subtrochanteric
________________ fractures are often difficult to reduce and is associated with a greater occurrence of implant failure.
subtrochanteric
_____________ is a type of foot orthosis that extends to the web spaces of toes.
sulcus length
_____________ instability is a rare instability that result from loading of humerus in an anterior and superior direction with the arm adducted. It is typically associated with fractures, cuff disruption, and neurological/vascular injuries.
superior
Immobilization of the forearm in partial ________ to relieve pressure on the __________ is an intervention for anterior interosseous syndrome.
supination; pronator teres
A ______________ fracture is a fracture of the distal humerus which usually results from a mechanism of elbow hyper extension.
supracondylar fracture
If painful arc is present in a suspected impingement patient, _________ soft tissue irritation is suspected.
suprahumeral
Ultrasound is sensitive to full and partial-thickness tears of ________________, if read properly.
supraspinatus
What is the most commonly compressed and inflamed RTC tendon?
supraspinatus
Late cocking phase of pitching and tennis serve (extreme ER) causes contact or impingement of the articular sides of the ______________ tendons and the posterior/superior aspect of GH ________________.
supraspinatus/infraspinatus; glenoid rim and labrum
During Hawkins-Kennedy impingement test, pain during IR indicates positive test because the movement pushes _____________ against the anterior surface of ______________ ligament and coracoid process.
supraspinatus; coracoacromial ligament
What are surgical interventions for infants with hip dysplasia and are older than 5-6 months?
surgical release of hip adductor and illiopsoas mm.
What provides stability when loads are placed across the GH joint?
surrounding musculature
What deformity presents with hyperextension of proximal interphalangeal joint and flexion of the distal interphalangeal joint?
swan-neck deformity due to contractures of intrinsic muscles and/or tearing of the volar plate
Hamstring strain injury can occur during the last half of the _________ in which the hamstrings work eccentrically, or during early ________ during a forceful concentric contraction.
swing phase; stance phase
Capsular _______ accounts for ~60-70% of all dislocations and is a result of either direct or indirect loading of the humerus. This type of injury heals better than detachments.
tears
Since surgical interventions are often not done in older patients with bicep tendon rupture, what should be included in the interventions?
techniques that will help recruit other muscles surrounding elbow
Hoffa's disease is caused by _________________ of the infrapatellar fat pads due to repetitive trauma and possibly due to impingement between patella and femur.
thickening and fibrosis
What must be ruled out when Baker's cyst is suspected?
thrombophlebitis because if the cyst ruptures, it can cause the same symptoms as thrombophlebitis
_____________ is coupled with supination of the subtalar joint.
tibial ER
______________ is coupled with pronation of the subtalar joint.
tibial IR
What is the mechanism of injury for transverse meniscal injuries?
tibial IR in flexion followed by sudden extension
_______________ deformity typically results in lateral tracking of the patella.
tibial valga
What is the purpose of cock-up splints or splinting the wrist in a neutral position for carpal tunnel syndrome?
to avoid prolonged flexion and/or extension of the wrists during activities and sleep
Why is MRI indicated for proximal humeral fracture?
to determine patency of RTC and other soft tissue structures
What complications can present with LCL injuries?
traction injury to the lateral popliteal nerve
The angle of torsion occurs in the ___________ plane between the axis of the femoral neck and axis of femoral condyles and reflects the degree of IR of the femoral condyles that occurred during fetal development.
transverse
What is the worst case scenario in an rotatory instability injury?
traumatic dislocation with injury to popliteal nerves and vessels leading to amputation uncommon usually MVA related
What is a possible predisposing factor for Kienböck's disease?
ulna is shorter than radius or when fewer than normal vessels supply the lunate
The following conditions affect the ________ nerve: - cubital tunnel syndrome - bowler's thumb - entrapment in the Guyon's canal
ulnar
With elbow stiffness, it is important to rule out neurovascular involvement, especially involvement of ___________ nerve.
ulnar
______ nerve findings are often noted with little leaguer's elbow.
ulnar
Bowler's thumb is the compression neuropathy and perineural fibrosis of the _________ digital n.
ulnar *do not think radial since it is the thumb--this nerve snakes around from ulnar side to radial side*
Cubital tunnel syndrome is the compression of __________ nerve in the cubital tunnel at the elbow. It results from repeated trauma of this nerve in the ________ of the elbow or along different sites along the nerve path.
ulnar n.; ulnar groove ("hitting your funny bone")
EMG in a stiff elbow helps rule out ____________.
ulnar nerve involvement
What diagnostic testing is indicated with abnormal physical examination or to rule out other conditions in someone with suspected developmental hip dysplasia?
ultransoundnography
A plantarflexed first ray may erroneusly give the appearance of a forefoot ____________ if the angulation of metatarsal heads 2-4 is not properly identified.
valgus
In general, intact ligamentous and osseous structures will allow for early mobility with elbow dislocation patients, granted that _________ forces are avoided.
valgus
What indicates a severe MCL injury with probable concurrent injury to the posteromedial capsule and one or both of the cruciate ligaments?
valgus stress testing with laxity in full extension
Little leaguer's elbow occurs secondary to repetitive ________ stresses as well as the strong pull of the ______ muscles that are attached to the medial epicondyle.
valgus; flexor
Forefoot supinatus mimics forefoot _________.
varus develops with adult acquired flat foot
What is the glucose level in a septic arthritic knee aspirate?
very low
In a Bennett's fracture, the ____________ aspect of the metacarpal base is separated from the remaining metacarpal.
volar-ulnar
Patient diagnosed with SCFE should not ____________ on the affected extremity.
weight-bear
When can radiograph detect developmental hip dysplasia?
when infants reach 3-5 months (late diagnosis if > 3 months)
After anterior dislocation, when can patient go back to play and overhead ADLs?
when the following are restored - normal cuff strength - full forward elevation - ability to perform stable and adaptable movements
When are CT indicated to diagnose fractures?
when there are more fragments
When is anterior-medial bundle of ACL most likely to be injured?
with an anterior force when the knee is in greater flexion
How do patients with anterior dislocation present after the injury?
with arm abd and ER will unlikely show to PT like this
How would someone with proximal humeral fracture present in a clinic?
with ecchymosis and swelling due to fall in outstretched arm OR direct fall on the shoulder
How might a patient with osteochondritis dissecans walk to avoid pain?
with the foot in ER
What is the glucose level in a normal knee aspirate?
within 60% more of serum glucose
Patient presents with symptoms indicating ulnar nerve compression. However, she still has sensation to the dorsal hand and muscles of the proximal hand/palm. Where is the possible location of the compression?
within Guyon's canal at the level of the lower wrist
