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“Don’t Miss” Musculoskeletal Quiz - Uniformed Services …
The 6-step msk exam steps are… Inspection Palpation Range of motion Strength Neurovascular Special Tests SITS in the rotator cuff muscles stands for… Supraspinatus Infraspinatus Teres minor Subscapularis A 35 yo male falls off a 4-foot ladder onto his elbow 1 week ago and c/o shoulder pain Poor motion Poor strength Pain worse while lying on side ADLs affected Normal appearance NTTP ROM: poor active abduction, better passive Strength: poor abduction N-V: normal Tests: + Hawkins Neers + empty can + drop-arm What’s your diagnosis? AC sprain Humeral head fracture Impingement syndrome Rotator cuff tear Treatment Analgesics Physical therapy referral Improve ROM, strength Orthopedics consult if poor improvement ? repair Should you get an xray? Yes No Don’t know In inversion ankle sprains, which feature is not an indicator for an xray? Tenderness over the ATFL TTP over the navicular bone TTP over the 5th MT base Inability to bear weight Ottawa Ankle Rules When to x-ray acute ankle sprains Unable to bear weight Tender over posterior lateral malleolus Tender over posterior medial malleolus Tender on navicular bone Tender on 5th MT base Which finding might prompt an xray per Ottawa knee rules? Age of 20 Inability to bend knee 90d Hx of trauma Effusion Physical Examination Effusion, no deformity TTP over ant-med joint line ROM: slight restriction of flexion Strength: can’t test N-V: normal Special tests: Positive Thessaly Positive McMurray Negative Lachman, posterior drawer, varus valgus stress, patellar apprehension, etc. What’s your diagnosis? Tibial plateau fracture ACL tear Patellofemoral syndrome Meniscal tear A 35 yo runner training for a 10k c/o anterolateral knee pain, worse w/ running or prolonged sitting, no h/o trauma. Exam: + patellar grind, neg apprehension. Diagnosis? Plica syndrome ITB syndrome MCL sprain Patellofemoral syndrome PFS Treatments Reduce painful activities Non-painful aerobics Patellar retinaculum stretching Hamstring stretching Quad streng
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