MSK 4 Study Material with Latest Questions and Verified Answers 2024

MSK 4 Study Material with Latest Questions and Verified Answers 2024 Most common elbow diagnosis? - Correct Answer Lateral epicondylitis Elbow fractures - Correct Answer MVA and falls, common in children, immediate referral, possible involvement of other structures Elbow fracture management - Correct Answer ORIF if displaced, yields the best results Elbow avulsion fracture - Correct Answer Ligament pulls bone away, may report a pop and may be painful, more common in children and throwers Elbow avulsion fracture management - Correct Answer Splint for 6 weeks, gentle ROM at 2 weeks Apophysitis - Correct Answer Disruption of the growth plate in adolescents Common peds elbow fractures - Correct Answer Supracondylar fracture, salter-harris fracture Special tests for fractures - Correct Answer Full elbow extension, bump, leverage test, alignment Elbow dislocation - Correct Answer Nursemaid's elbow, displaced ulna requires surgery and may lead to fracture Radial head dislocation - Correct Answer Traction injury of humero-radial joint, most common in pediatrics due to increased laxity, pain and apprehension with palpation, decreased grip strength, reduced use of UE Neural screen for elbow - Correct Answer It's cervical until it isn't, UQS needed, pain may be referred from shoulder Cubital tunnel syndrome - Correct Answer Sensory deficits, + Tinel's, Wartenberg sign, elbow flexion test, throwers at risk, use conservative treatment Cubital tunnel management - Correct Answer 1/2 improved with conservative management, modify provocation activity and correct throwing mechanics, surgical may be decompression and transposition Cubital tunnel treatment - Correct Answer Phase I: Active rest, neural glides, protection Phase II: Stretching/strengthening Phase III: Advance strength/stretching and progress stability of elbow and shoulder complex Phase IV: Functional strengthening, preventative taping Supracondylar process syndrome - Correct Answer Ligament of strutters compression (median n) Pronator syndrome - Correct Answer Compression of median between 2 heads of pronator teres, provocation of symptoms with no weakness, resist pronation and elbow flexion to test Anterior interosseous syndrome - Correct Answer Pinch grip test (median n) Spiral groove syndrome - Correct Answer Spiral groove (radial n), wrist drop, radial nerve sensory deficits Radial tunnel syndrome - Correct Answer Posterior interosseous nerve compressed close to radial head, mimics lateral epicondylitis Supinator syndrome - Correct Answer Arcade of froshe, thumb and finger extensor weakness without wrist drop, no sensory deficits (posterior interosseous nerve) Lateral epicondylalgia presentation - Correct Answer 40s-50s, 1-3% of the population, lateral elbow pain with gripping and activity, systemic risk factors LE differential dx - Correct Answer Cervical radiculopathy, radial tunnel syndrome, supinator syndrome, LE tendionpathy - only LE will have - cervical compression, weak and painful wrist extension, and + special tests Lateral tendinosis - Correct Answer Microtrauma at the musculotendinous junction, fibroblasts and vascular hyperplasia, malformed and weak collagen tissue LE special tests - Correct Answer Pain free grip, resisted wrist extension (Cozen's), passive stretch (Mill's), resistance of 3rd digit Bracing for LE - Correct Answer No outcomes difference, may increase fatigue, short term may be helpful Medical management LE - Correct Answer Corticosteroid injections (limited evidence), PRP (more evidence but expensive), Extracorporeal shockwave therapy, surgery PT for LE - Correct Answer HSR, manual therapy, activity modification Education for LE - Correct Answer Avoid provocative activity, use larger handles, promote good posture, work modifications, avoid palm down driving Manual therapy for LE - Correct Answer Cervical mobilization (?), local mobes Medial epicondylalgia - Correct Answer Golfer's elbow, pain with resisted flexion and passive wrist extension, + varus test ME causes - Correct Answer Traumatic, overuse from improper throwing mechanics and high pitch counts Impairments from ME - Correct Answer Tendinopathy, UCL instability, ulnar neuritis/subluxation, leads to decreased velocity and endurance Treatment of ME - Correct Answer Acute: PRICE, Chronic: relative rest, manual therapy, ther ex, activity modification Therapeutic exercise for ME - Correct Answer Emphasis on eccentric training, postural/shoulder complex strengthening, throwing mechanics UCL instability incidence - Correct Answer 2nd most common injury in baseball, increased risk in younger throwers UCL instability risk factors - Correct Answer Year round throwing, overuse, throwing velocity 80 mph, breaking balls before age 14, inadequate warm up UCL special tests - Correct Answer Moving valgus stress test, valgus stress test, milking maneuver, stand up test LCL special test - Correct Answer Varus stress test UCL non-operative management - Correct Answer Brace, restore pain-free ROM, activate scapular stabilizers - Improve strength/stability, increased to high speed training - Increase strength, maintain thoracic mobility, plyometrics, begin throwing progression (6-10 weeks) UCL reconstruction outcomes - Correct Answer 83% excellent results, performance drops, many players return to injured list UCL reconstruction management - Correct Answer Brace, isometrics, scap activation - Progress brace, dynamic shoulder strengthening - Increase stability in elbow and core, progress to 90/90 positions - Work on strength and power, throwing program at 4 months Total elbow arthroplasty indications - Correct Answer Severe pain (end stage RA), gross instability, comminuted fractures, failed radial head resection, joint incompetence TEA management - Correct Answer Immobilization - Mod protective ROM and strengthening, no triceps for 10-12 weeks - ROM in WB and NWB - Functional training Bicipital tendon rupture locations - Correct Answer 90% proximal long head, 3% distal, 1% proximal short head Distal biceps tendon rupture - Correct Answer MOI: Forceful elbow flexion and supination S/S: Swelling and ecchymosis, tenderness over radial tubercle, popeye deformity Distal biceps tendon rupture management - Correct Answer Conservative: results in weak supination Surgical: Braced in shortened position, PROM and AAROM for 6 weeks, focus on shoulder ROM and isometrics, elbow isometrics at 6 weeks, return to throwing 20 weeks Myositis ossificans - Correct Answer Atypical bone formation, managed by STM, stretching, some strengthening, may need surgery Olecranon bursitis - Correct Answer Subdermal bursa, chronic or traumatic, manage with ice and reduction in pressure, may require aspiration Elbow outcome measures - Correct Answer Special tests, grip strength, DASH, SPADI, ASES, PRTEE, KJOC, closed-kinetic chain upper extremity test, one arm hop test Anatomical snuff box - Correct Answer abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus Wrist observation - Correct Answer Posture, proximal structures, effusion (radial/dorsal aspect, ganglion cyst) Wrist functional assessments - Correct Answer PRWE, DASH, Carpal tunnel scales, henson-taylor hand function, minnesota rate of manipulation, grip strength Scaphoid fractures - Correct Answer don't heal well, most common carpal fracture, poor blood supply, pain with overpressure in extension, typically younger patients, MOI is FOOSH Scaphoid immobilization - Correct Answer needs to include the thumb Distal radius fracture - Correct Answer Colles: Radius displaced dorsally Smith's Radius displaced anteriorly Distal radius fracture outcomes - Correct Answer ORIF more stable, better outcomes, reduced infection, PT sees them beyond 8 weeks if home exercise is not effective Wrist instability presentation - Correct Answer May be traumatic or atraumatic, pain with activity and loading Wrist instability conditions - Correct Answer VISI, DISI, TFCC tear Wrist instability special tests - Correct Answer Finger extension, shear testing, murphy's sign, TFCC testing Wrist instability management guidelines - Correct Answer Refer if needed, modify activity, protect (splint/brace), correct neuromuscular deficits TFCC injuries - Correct Answer May be traumatic or atraumatic, lose stability in ulnar side of wrist TFCC special tests - Correct Answer Piano keys test, supination lift test TFCC management - Correct Answer Conservative: immobilization 8-12 weeks Surgical: good outcomes after conservative fails Wrist OA - Correct Answer May be traumatic or atraumatic, scapholunate most common, conservative management not well studied Surgery for wrist OA - Correct Answer TWA: 80% ROM, decreased QoL but patients are satisfied TWF: Pain relief, increased grip strength, no ROM Wrist arthroplasty management - Correct Answer Splint, tendon gliding - Decrease splint, begin exercise - No splint, functional strength/mobility - Monitor for hardware loosening, return to regular activity Tendon gliding - Correct Answer To maintain or develop free gliding between FDP, FDS, and underlying structures Precautions after wrist arthroplasty - Correct Answer Avoid WB, modify assistive devices, avoid functional activities, wear splint, permanently refrain from high impact work or sports, fall prevention! Repetitive overuse guidelines wrist - Correct Answer Resolve irritation - Restore stability and mobility impairments - Train posture for endurance DeQuervain's Syndrome - Correct Answer tenosynovitis of dorsal wrist, movements of ulnar deviation with the thumb stabilized in a grip DeQuervain's Syndrome symptoms - Correct Answer Pain at radial styloid process, pain with thumb opposition, positive finkelstein test DeQuervain's Syndrome interventions - Correct Answer Education for activity modification, assess ergonomics, joint restriction, some exercises for strength impairments Carpal tunnel syndrome risk factors - Correct Answer Advancing age, females, diabetes, cumulative or repetitive motions, pregnancy, autoimmune disorders, family history Carpal tunnel syndrome - Correct Answer Median n compression under transverse carpal ligament; possible weakness and atrophy of thenar eminence muscles; sensory deficits in palm and first three fingers CTS presentation - Correct Answer Pain at night and with activity, numbness along median nerve distribution, atrophy and weakness of thenar eminence muscles, elbow and shoulder pain possible CTS treatment - Correct Answer Bracing! Exercises to treat impairments (posture)m minimize grip squeezing, ergonomic assessment CTS stages - Correct Answer 1 - preclinical, activity progression to minimize progression 2 - mild, reduction of dexterity but still good prognosis 3 - moderate, need major changes to see pain relief 4 - severe, constant pain, surgery indicated CTS DX - Correct Answer Semmes-Wienstein monofilament sensory exam, thenar muscle weakness, thenar muscle atrophy, Tinel's, direct compression test, phalen's test Outcome measures for CTS - Correct Answer Boston carpal tunnel questionnaire, hand and shoulder carpal tunnel questionnaire, DASH Performance tests for CTS - Correct Answer Purdue pegboard test, dellon-modified moberg pick up test Wartenburg's syndrome - Correct Answer Compression of superficial radial nerve under brachioradialis/ECR/first dorsal compartment Causes of Wartenburg's syndrome - Correct Answer Overuse, trauma, chronic pressure Presentation of Wartenburg's syndrome - Correct Answer Pain/parethesia over radial dorsal wrist, exacerbation with grip Wartenburg's syndrome treatment - Correct Answer NSAIDs, PT, surgical release Guyon tunnel syndrome - Correct Answer Ulnar nerve entrapment at pisohamate, affects sensory branches to palmar and dorsal aspects of hand, weakness of hypothenar eminence, common in cyclists and long term crutch users Hand function - Correct Answer 40-50% thumb, 20% 1st and 2nd, 10% 4th and 5th; hand is 90% of UE function Nail pathologies - Correct Answer Changes in nail shape can occur with chronic cardiovascular disease Swan neck - Correct Answer MCP flex, PIP hyperext, DIP flex, caused by laxity and intrinsic muscle contracture with RA or trauma to volar plate Boutonniere - Correct Answer MCP ext, PIP flex, DIP ext, caused by rupture of central tendon from trauma or laxity from RA Zigzag deformity of the thumb - Correct Answer Flexed CMC, extended MCP, caused by hyper mobility and laxity with RA Ulnar drift - Correct Answer Ulnar deviation of the digits, caused by laxity and joint erosion of the MCPs with RA Ape hand - Correct Answer Thenar eminence wasting caused by median nerve damages Claw finger - Correct Answer Intrinsic muscle wasting putting you in the extrinsic plus position, caused by ulnar and median nerve palsy Bishops hand - Correct Answer Hypothenar eminence wasting and 4th/5th digit flexion, caused by ulnar nerve palsy Depuytren contracture - Correct Answer Fixed finger flexion caused by palmar fascia contracture Mallet finger - Correct Answer Flexed DIP caused by avulsion of extensor tendon Trigger finger - Correct Answer Flexed PIP caused by sticking of tendon under sheath with RA or overuse Sweater finger - Correct Answer Extended DIP caused by flexor profundus rupture rheumatoid arthritis presentation - Correct Answer Multi-joint pain, swelling, capsule weakening and deformities, limited motion, muscle weakness rheumatoid arthritis deformities - Correct Answer Radial deviation of wrist, volar subluxation, ulnar deviation of MCP joints, swan neck and boutonniere deformities RA principles of joint protection - Correct Answer Maintain joint ROM and strength, avoid deforming positions, adapt tasks, avoid prolonged positions, respect pain RA management - Correct Answer Exercise, protective splinting, education, grip strength, medication RA PT management - Correct Answer Joint protection, energy conservation, ROM and gentle stretching, motor control, muscle performance Outcome measures for the hand - Correct Answer Subjective: Michigan hand related outcomes questionnaire, pt-related wrist evaluation Dynamic: Minnesota rate of manipulation test, purdue peg board Hand function grips - Correct Answer Power grip, pinch grip, power pinch, precision pinch, hook grip MMTs in the hand - Correct Answer 5-10% difference between dominant and non-dominant hand, can assess grip and pinch strength Sensory testing in the hand - Correct Answer Test sensation away from borders, two point discrimination, pressure Circulatory testing in the hand - Correct Answer Vascular occlusion, Allen test, capillary refill Bunnel-Littler test - Correct Answer PIP hypo mobility in MCP extension tight capsule = tight in both tight intrinsic = tight only in MCP extension Ulnar nerve dysfunction tests - Correct Answer Fromet's sign, jeanne's sign Game keepers thumb - Correct Answer Speain of the UCL at the MCP joint, valgus stress test, surgery for a total rupture Gamekeepers thumb conservative management - Correct Answer Thumb spica x 4-12 weeks, pain free PROM/AROM, work on grip and pinch strength, avoid valgus stress Hand fractures - Correct Answer Boxer's fracture: 5th MC Bennett's fracture: base of 1st MC Mallet finger treatment - Correct Answer Immobilize DIP in extension for 6-10 weeks Tendon lacerations - Correct Answer Extensor lacerations more common, balance between movement to prevent adhesions and immobilizing to allow for healing, partial tear in non-operative When to do a tendon laceration repair? - Correct Answer Within two weeks of damage Zone 2 in the hand - Correct Answer Poor vascular supply and prone to adhesions Zones in the thumb - Correct Answer Three zones, distinct from hand zones Tendon repair guidelines - Correct Answer Early mobilization, within 3 days Flexor tendon repair brace - Correct Answer Static dorsal blocking splint (5 weeks) - Dynamic extension splint with dorsal block (8 weeks) • Extensor tendon repair brace - Correct Answer Static volar blocking splint (7 days) - Daytime dynamic volar splint (3-6 weeks)