Study Guide

General

• Describe “bone remodeling” and its role in health and disease.

• What is fibromyalgia and why is it (still) controversial?   

• What is the Female Athletic Triad and what are its implications for musculoskeletal medicine?  

• What are the adverse effects of NSAIDs?   

• What are the important differences that distinguish the management of a cancer-related pathologic fracture from the treatment of ordinary fractures? 

• What are the causes and consequences of adult septic arthritis? 

• What are the temporal limitations regarding our ability to diagnose septic arthritis definitively? (And how do we get around that?) 

• Although bone is part of the vascular system (and therefore fractures can cause hemorrhage and metastatic cells can lodge in the skeleton), why might antibiotics have trouble reaching areas of infected bone in osteomyelitis?  

• Describe the relationship between menopause and hip fracture risk. Describe the relationship between body mass and hip fracture risk. 

• What is a Charcot joint? 

• What are the three fractures typically associated with osteoporosis? Which of these might be considered “worst”?   
  

• What else, besides intrinsic bone conditions, might lead to fragility fractures of the hip?  

Trauma

• Why is a traumatic hip dislocation typically associated with more clinical morbidity than a shoulder dislocation?  

• Define the parameters that allow you to describe a long bone fracture pattern over the phone. 

• Tibia fractures, among others, might be complicated by a so-called compartment syndrome. What is compartment syndrome and how is it diagnosed, and treated? 

• What are the advantages of treating a mid-shaft femoral shaft fracture with an intramedullary nail as compared to casting or traction? (Also: what complications/patient morbidity may be seen despite this treatment?) 

• It is well known that if more tissue is resected in a lower extremity amputation, the metabolic cost of walking is greater. For example, the energy requirements for walking with a transfemoral prosthesis are significantly higher than walking with a transtibial prosthesis. Nonetheless, a surgeon addressing an irreparable distal tibia fracture (an injury close to the ankle) might nonetheless perform a below-the-knee amputation (at the proximal tibia). Why is it reasonable to remove more bone?  

• Describe the 2 main types of bone healing. 
  

• Plating a fracture clearly disrupts the soft tissue envelope around a fracture. Why, then, is surgical plating ever used? 

Hand

• Carpal Tunnel Syndrome might be diagnosed (in part) by the presence of a so-called Tinel’s Sign. What is that and why is it not a true sign?   

• Both compression of the 6th cervical nerve root (C6 radiculopathy) and compression of the median nerve at the wrist (carpal tunnel syndrome) can cause painful dysesthesias in the thumb. How can these two conditions be differentiated? 

• Why should a patient with negative x-rays but snuff box tenderness be immobilized in a splint or cast?  

• What’s the significance of blood on the skin with a fifth metacarpal fracture?

Pediatrics

• What features of a musculoskeletal injury should prompt an examining physician to suspect child abuse? 

• Why might successfully treated developmental dysplasia of the hip have a better prognosis than SCFE and Perthes?  

• Early Onset Scoliosis can be classified as congenital, syndromic, neuromuscular or idiopathic. How are these types defined, and what are the clinical distinctions?  

• What is Clubfoot and how is it diagnosed and treated? 

Sports (knee, shoulder, ankle)

• What are the options for treating a chondral defect of the knee caused by sports trauma? 

• Why is it reasonable to treat tennis elbow with a wrist brace?  

• Is arthroscopic surgery more or less expensive than a comparable open procedure?  

• Why is the prototypical patient with a ruptured Achilles tendon about 40 years old? What are the biological and mechanical steps leading to tissue failure? 

• What are the specific aims of supervised physical therapy for rotator cuff tendinopathy? 

• A meniscal tear might be removed, repaired, or not treated at all. What might dictate the choice of treatment?  

• What is a stress fracture? How does a stress fracture present, how is it diagnosed, and how is it treated? What are the consequences of ignoring and not treating a stress fracture?   

• What is rotator cuff tendinosis (tendinopathy)? What are the consequences of labeling it as “tendinitis"? What are the consequences of labeling rotator cuff tendinopathy as a “partial rotator cuff tear”? What are the consequences of labeling rotator cuff tendinopathy as “impingement syndrome”?
  

• What is the function of the ACL? How do ACL tears occur - and why might it be the case (as we suspect) that skiing-related tears of the ACL in the knee occur disproportionately after 2pm? 

• How are tears of the cruciate ligaments of the knee detected by history and physical examination? 

• The phrase “just a sprain” may understate the impairment such an injury imparts. Why might a Grade I ankle sprain cause impairment? 
  

• What is an ankle sprain? 
  

Spine

• Back pain is a common, self-limited condition in many people, often without identified cause. Cauda equina syndrome, discitis and cancer are also causes of back pain which are not so innocent and self-limiting. Describe these conditions and suggest some questions a physician might ask to help detect the diagnoses.  

• An MRI report might list a disc herniation, but the report often adds “clinical correlation suggested.” What are the clinical correlations of a herniated disc said to compress the L4, L5 or S1 nerve roots? 
  

• In what way are neurogenic claudication and vascular claudication similar? In what ways do they differ?