Name the 3 hip ROM tests the in order in which they are performed here:
Image Challenge: Hip, Foot and Ankle
UCSF Primary Care Sports Medicine Conference 2018
Carlin Senter, MD Anthony Luke, MD, MPH Associate Professor Professor
UCSF Primary Care Sports Medicine
12/13/2018
The 3 hip ROM tests in order are: Hip passive range of motion
A. Extension, flexion, adduction
B. Extension, flexion, abduction 71% C. Flexion, abduction, adduction
D. Flexion, adduction, abduction E. Flexion, external rotation, internal rotation 19% F. Flexion, internal rotation, external rotation 6% 3% Flexion External Internal 1% 0% normal rotation rotation
...... c. c. . ,. ,. u u u n n 120° normal 40-60° normal 30- d io o dd bd b t i a a , a a at , , n t t n n o ro o o o ti l l r 40° xi xi c a a le le u rn n f f d e er , , ad xt t n n , e in io io n , , s s io n n n n x io io te te e x x x x Flexion, abduction,Fl addu...e e E E Fl Fl http://www.youtube.com/watch?v=5LNYdJIrWYo
1 Hip passive range of motion: 21 y/o soccer player has groin pain with this internal and external rotation maneuver. What is the most likely diagnosis?
What is the most likely diagnosis? FADIR
A. Trochanteric bursitis 82% . Flexion B. Iliotibial band tendinitis . Adduction C. Hip flexor tendinitis . Internal D. Femoroacetabular impingement . Rotation E. Sacroiliac joint dysfunction 9% 2% 2% 4%
is is is . it it it .. rs n in p u di d m b n n i c e te r ri t la e d or u t n x b n a e ta a b fl e ch l c o ia ip a r ib H ro T t o io Il m Fe Sacroiliac joint dysfunction http://www.aafp.org/afp/2009/1215/p1429.html
2 Please focus on L hip. What x-ray findings do you NOT see? What x-ray findings of the L hip are seen?
87% A. Joint space narrowing
B. Subchondral sclerosis
C. Subchondral cysts
D. Osteophytes
E. Femoral neck fracture 7% 6% 0% 0%
g s s e n si t r i o s u w r cy t o e l ac r cl a r ar s r f n l d k ra n c e d o Osteophytes e ac n ch l n p o b ra s ch u o t b S in u m Jo S Fe
4 radiographic hallmarks of osteoarthritis Which muscle is weak in this runner?
1. Joint space narrowing 2. Subchondral sclerosis 3. Subchondral cysts 4. Osteophytes
3 Which Muscle is weak in this runner? Case: What will this patient have difficulty doing ?
78% A. Gluteus Minimus
B. Gluteus Medius
C. Piriformis
D. Quadratus Lumborum E. Hamstring 8% 4% 6% 4% F. Rectus abdominis 1%
s s g s u iu m in i m d u r in i e r st m in o o M b m M s m a bd s u Piriformis u H a u te L s te u s u u l tu ct l G a e G r R ad u Q
What will this patient have difficulty doing? PT Dysfunction
A. Wearing running shoes Presentation B. Swimming . Usually women > 40 y.o. C. Going on her toes . Weakness with inversion D. Curling her toes 77% . “Too many toes sign” E. Taking her shoes off . Unable to plantarflex – Single limb heel rise test F. Feeling her little toe
15%
4% 3% 0% 0%
s g s ff e e in e o o o to s t h m r e le s im e o t g h h it in w s l n S n r r n o e e u g h h r in g g g o Curling herin toes lin in G k e ar a e e T F W
4 Looseness on this Exam is Consistent with Injury to ? Ankle Ligaments
A. High tibial fibular ligament Lateral Collateral Complex B. Anterior Talofibular ligament . Anterior talofibular lig. C. Calcaneal Fibular ligament . Calcaneofibular lig. D. Posterior Talofibular ligament . Posterior talofibular lig. Medial Ligament Complex E. Spring Ligament 80% . Deltoid ligament . Superficial and deep ligaments
11% 7% 2% 1%
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What is the difference between these two R The difference between the 2 radiographs: knee x-rays taken days apart on the same patient? A. Non weight-bearing versus weight-bearing
1. 2. B. Extended versus flexed
C. AP versus lateral
D. AP versus sunrise view
0% 0% 0% 0%
d . e w s. x ie r e v e fl v s se g u ri in rs n ar e u v s e d s -b e u t d AP versus lateralrs h n e ig e v e xt P w E A n o N 10
5 Weight-bearing radiographs increase sensitivity for joint space narrowing What is the diagnosis?
3 views for knee pain . 66 y/o woman - Weight bearing . Presented to urgent care with sudden severe R shoulder pain that developed a few days after doing extensive yard work flexed PA (aka notch view) . ROM limited to 10 degrees forward flexion, 10 degrees FW abduction. - Lateral of affected . Unable to tolerate strength testing of shoulder due to side B excruciting pain - Sunrise or merchant XR view
What is the diagnosis? A. Glenohumeral joint osteoarthritis Calcific tendinitis of the shoulder
B. Frozen shoulder . Calcium deposit in rotator cuff tendon, most commonly C. Calcific tendinitis supraspinatus at its insertion on greater tuberosity of humerus D. Gout . Can cause severe shoulder pain, causing patient to go to E. Polymyalgia rheumatic emergency room F. Fibromyalgia . Can be asymptomatic, incidentally found on radiographs . Diagnosed by radiograph or ultrasound . Tx (not a lot of evidence for any of following) - Rest, ice, NSAIDs, Physical therapy - Subacromial corticosteroid injection can dissolve calcium deposition 0% 0% 0% 0% 0% 0% - Extracorporeal shock-wave therapy (Bannuru RR et al. Annals
. r is ic a Internal Medicine, 2014) .. e it t gi e ld n a l t u i Gout m a s o d u y o h n e m t s te h o in n r r o e ic a ib - Arthroscopic debridement if above does not resolve symptoms j z if i F l o lc lg ra Fr a a e C y m m u ly h o 10 o P n le G
6 Case: What nerve is involved here? What nerve is involved here?
A. Superficial branch of the radial nerve
B. Axillary nerve
C. Suprascapular nerve
D. Long thoracic nerve E. Musculocutaneous nerve
F. Ulnar nerve 0% 0% 0% 0% 0% 0%
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Winged scapula
. Long thoracic nerve = pure motor nerve . Injury paralysis of serratus anterior muscle winged scapula most obvious on a wall pushup . Causes - Brachial neuritis (Parsonage turner) - Trauma or compression - Stretch or traction . Usually resolves over 1-3 years Have a great evening! . Physical therapy to maintain range of See you tomorrow motion, strengthen around the injury
UpToDate “Overview of upper extremity peripheral nerve syndromes” accessed 7/15/17. 29
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