Upgrade to remove ads
Only $35.99/year

Neuro-Ortho Cases

Terms in this set (92)

A racquet player presents to your clinic after an indirect injury in which the forearm was suddenly and forcefully turned into pronation or supination. The patient complains of pain over the distal end of the ulna, associated with a painful clicking and a sensation of weakness or instability of the wrist. Pain and clicking may be reproduced on circumduction, ulnar or radial deviation of the wrist or by passive movement of the ulnar head. Examination reveals tenderness and swelling over the dorsal ulnar aspect of the wrist, pain on resisted wrist dorsiflexion and ulnar deviation, a clicking sensation on wrist movement and reduced grip strength. The press test in which the patient creates an axial ulnar load by attempting to lift their weight up off a chair using the affected wrist replicates the symptoms when positive.
Ligament sprains of the wrist and hand - Inferior radioulnar joint
A carpenter presents with pain and tenderness that are well localised to the acromioclavicular joint. The pain came on after his weekly rowing session. On examination: the acromioclavicular joint is prominent. Pain exists on full abduction or horizontal adduction and is also reproduced with adduction of the extended arm. Crepitus is localised to the joint.
Acromioclavicular osteoarthritis
Patient presents with pain in the lower cervical segments between C4-C7. The patient is a sportsman and reports a recent injury that occurred with axial loading of the neck in flexion. On examination, the percussion/vibration test is positive.
Fractures
Patient comes to your clinic complaining of point tenderness over the dorsal aspect of the scapholunate region of the wrist after a mild injury to the scapholunate ligament. On examination : there is the presence of an occult dorsal wrist ganglion and pain with passive extension.
Dorsal wrist syndrome
A 40 years old+ female complains of gradual onset of unilateral shoulder pain of an inflammatory nature characterised by increasing pain and stiffness. The patient said she suffered from the same thing few years ago in her other shoulder. On examination: there is a painful global restriction of glenohumeral AROM and PROM.
Adhesive capsulitis
Patient presents with pain in the intercostal muscles and the serratus anterior that came on after attacks of violent sneezing or coughing.
Muscle injury (Strains)
Patient comes to your clinic after they fell on their dorsiflexed hand. On examination : there is tenderness 2cm distal to Lister's tubercle on the radial side of the lunate and little swelling. When the examiner's thumb is placed on the scaphoid tuberosity with the wrist in ulnar deviation and that the wrist is deviated radially with the examiner placing pressure on the scaphoid, the patient feels pain dorsally and the examiner feels the scaphoid move dorsally (positive Watson's test).
Scapholunate dissociation
A young patient presents complaining of a painful shoulder with all the signs and features of a rotator cuff or bicipital tendinitis. On examination : the humeral head is gripped firmly and moved backwards and forwards in the glenoid fossa to assess the stability of the shoulder in the anterior and posterior directions (Drawer test). As the scapula is stabilized the patient's arm is pulled down and an indentation develops between the acromion and the humeral head (Positive sulcus sign).
Glenohumeral instability
Patient presents with a circumscribed local tenderness that refer pain elsewhere when subjected to firm pressure. On examination you note a local twitch response with stimulation of associated muscle.
Myofascial trigger points
Patient comes to your clinic after a direct blow to the end of their finger while the terminal joint was held extended. They present with flexion deformity of the terminal joint of the involved finger. On examination: active extension of the flexed terminal interphalangeal joint is impossible and is associated with a painless weakness of resisted terminal joint extension. Passive movement of the joint can straighten the terminal phalanx. On X-ray : you can see an avulsed fragment of bone.
Tendon rupture (Mallet finger)
Patient comes to the clinic complaining of severe pain and holding their arm tightly against their body. The shoulder appears flattened laterally and prominent anteriorly. The acromion process is prominent and the shoulder appears to be ‟squared off.‟ On X-ray: (AP and lateral scapula or axillary views) there is no sign of fracture.
Glenohumeral dislocations
Patient complains of a history of widespread pain in the low back with/without radiation to buttocks and legs and pain in neck and across shoulders. The pain involves both sides of the body, above and below the waist as well as the axial skeletal system and has been present for at least three months.Patient complains of fatigue, sleep disturbance, morning stiffness, paraesthesiae, feeling of swollen joints but with no objective swelling. Patient also complaints of memory disturbance, difficulty word finding, headaches, light-headedness and dizziness. They report fluctuations in weight, anxiety and depression. Patient reports the symptoms to be worse in cold, humid weather and under times of stress.On examination, digital palpation using the thumb causes pain.Hypothyroidism and the inflammatory arthritides have been ruled out by GP.
Fibromyalgia
A 65 years old (white) male comes to your clinic with a flexion deformity of the MCP and PIP joints of their 4th digits bilaterally. Patient suffers from diabetes and reports their father had the same flexion deformity of joints.
Dupuytren's contracture
Patient presents to your clinic after a fracture. On examination : there is weakness of pronation and wrist/finger flexion. They report sensory changes in the distal median nerve distribution (palm).
Median nerve entrapment at the shoulder
Patient presents with tightness in the neck and stiffness in the cervical joints. They complain of head and face pain as well as vertigo. Neck pain is well localised and situated to one side of the upper neck. On examination: there is a painful restriction of active and passive range of movement in certain directions only. Passive intervertebral joint movements are restricted in range and reproduce the patient's pain. Tenderness and a sensation of thickening is found over the interspinous ligaments in the midline and over the apophyseal joints and tender painful areas with palpable spasm are found around the scapula on the affected side.
Cervical manipulable lesions
65+ year old female complaints of ill-defined back ache. It's a sudden sharp pain that occurs when she is bending forward or lifting something. She also reports local muscle tenderness/hypertonicity. On examination : she has an increased kyphosis (that her Dr called « Dowager's hump »). She is taking steroid medication for years and admits being aware of suffering from dietary deficiencies.
Senile Osteoporosis
Patient presents with definite neurological deficits. They have lower limb sensorimotor neuro deficits, saddle distribution sensory loss. They also report bowel incontinence, urinary retention, overflow urinary incontinence and impotence.
Epidural compression syndrome
A student comes to your clinic complaining of pain around the olecranon. They say they have been studying a lot and have rested their elbow on their desk for long periods of time. On examination : there is swelling around the olecranon of the elbow.
Olecranon bursitis
A 25 years old man reports pain in their wrist. They say that a wrist injury caused the symptoms but say the trauma was not severe. They perform manual labour involving the upper extremities. The pain progresses in severity. On examination : there is disruption of the wrist's articulation, pain and loss of motion. There is a moderately swollen wrist with limitation of extension and flexion as well as reduction in grip strength of at least 50%. Pronation and supination are not affected. On X-rays you can see a collapsed lunate.
Kienbock's disease
Patient presents to your clinic saying that their shoulder feels stiff or that the joint feels dry or needs to be lubricated. They are unable to abduct the shoulder without forward flexion and are unable to have shoulder contact with the table, in the prone position with the involved arm above the head.
Glenohumeral joint dysfunction
A elderly patient presents to your clinic with little pain in the neck and some limitation of active and passive movement associated with crepitus. Patient says they have difficulty walking over uneven ground and complain of loss of balance. They also report stiffness in legs with a broad-based gait. On examination : there is impairment of appreciation of light touch and tactile discrimination and pin prick over some of the digits, with loss of postural sensibility, which is also present in the lower limbs. The tendon reflexes in the upper limbs are diminished.
Cervical myelopathy
Patient complains of pain that is localised around the 1st carpometacarpal joint.The pain is constant and aching and sometimes interfere with sleep. Activity makes the pain worse. Rest and heat provide some relief. Patient complains of a grating or grinding sensation with use of the joint. In addition to this pain, patient experiences a gradual decrease in functional ability with decreasing range of motion of the involved joint, making everyday tasks such as using a computer keyboard, holding a coffee cup or turning a door knob quite difficult. On examination : crepitus is present.
Osteoarthritis of the 1st carpometacarpal joint
Patient has pain and tenderness above the elbow and reports clumsiness and sensory changes in palm. On examination : there is weakness of pronation and wrist/finger flexors. On X-ray : there is a bone spur on the anterior humerus
Median nerve entrapment at the elbow
A 22 years old patient presents to your clinic with unilateral neck pain and deformity. They felt their neck becoming « stuck » during a sudden movement during the day. They said they felt sudden pain and immediate inability to return the head to its original position. The pain is felt unilaterally in the neck and radiates either up to the head or down into the interscapular region. There are no neurological symptoms. Examination reveals that the patient's head is held in lateral flexion away from the painful side. Both active and passive movements are painfully limited and there is a restriction of lateral flexion and rotation towards the painful side as well as a loss of extension.
(Acute) Torticollis
A patient presents to your clinic after a trauma to the anterior aspect of the upper arm. They report pain around their elbow. On examination : you can observe and palpate contusion and when assessing the extension end feel, a muscular limitation is present. There is a permanent contraction of the elbow flexors which limits extension at the elbow.
Myositis ossificans of the brachialis
13 year old girl, presents with increasing curve noted in the contour of the back with an associated rib hump best shown on forward flexion. Bunching of paraspinal. The non-structural curve retains flexibility and improves or remits on trunk flexion (Adam's test) or lateral flexion away from the concavity. (NB: A structural curve does not change with these tests). On X-ray, the Cobb angle is measured.
Scoliosis
Patient presents with pain in the shoulder, which is well localised anteriorly and radiates down the anterior aspect of the upper arm. They say it is chronic and recurrent. On examination: Speed's test (specific testing of the biceps) is painful. Tenderness is present in the bicipital groove.
Bicipital tendinitis/tendinopathy
Patient presents with back pain around T11-T12 and radicular pain, which follows the dermatome. The back pain is vague and may refer anteriorly to chest wall or abdomen unilaterally or bilaterally. The pain is aggravated by forward bending, coughing, sneezing, straining. On examination, Beevor's sign and absent abdominal cutaneous reflexes help to establish the diagnosis.
Thoracic disc protrusion
14 year old boy presenting with poor posture, is unable to flex properly and touch his toes. He has a hunchback and cannot straighten his spine (rigid kyphosis sign). Pain, when present, occurs more typically towards the end of the day. On palpation: he has hypertonic pectorals and hamstrings. On X-ray : Wedging of the vertebrae and Schmorl's nodes are visible in at least 4 segments.
Scheuermann's disease
An elderly person with known osteoporosis came to you after they felt pain when lifting their grocery bag. They report pain around the thoracolumbar junction when doing the percussion/vibration test. On examination you can see local spasm and swelling. On X-ray, there are visible bony metastasis.
Compression fracture
A 65 yeard old+ patient complains of night pain when lying on his side and reports a history of trauma. They have pain on abduction and flexion with varying degrees of loss of active movement. They say the night pain is often severe. On examination : there is an inability to maintain the arm in abduction when lowering from the elevated position, (Positive drop-arm test). Subacromial crepitus and pain on impingement testing are present. There is also wasting of the infraspinatus muscle and to a lesser degree the supraspinatus, with weakness of abduction, flexion and internal or external rotation.
Rupture of supraspinatus
A 50 years old patient complains of not well localised pain and tenderness to their medial epicondyle that is felt a little distal to the flexor origin. It apparently arose slowly and spontaneously (patient does not remember any blow or acute traumatic episode). On examination : there is pain on resisted wrist flexion with the elbow in extension.
Medial epicondylitis (flexor/pronator tendinopathy) (Golfer's elbow)
A young patient presents with pain along the medial scapular border that is associated with a loud cracking or snapping sound as the scapula is abducted. Pain is felt as a dull ache, usually constantly present along the medial border of the scapula and the patient does not associate the pain with the disturbance of scapular movement. On X-ray (lateral view of the scapula) we can see an underlying bony abnormality such as an osteoma or a bony spur on the scapular border.
Snapping Scapula
An elderly patient comes to your clinic complaining of pain on respiratory movements that came on after coughing. On examination, there is local spasm, tenderness and swelling. The percussion/vibration test reproduces the patient's pain.
Rib fracture
Patient comes to your clinic after repetitive strain injury of the hand. They developed a tendon nodule at site of stenosis that interferes with normal tendon gliding resulting in pain over the area of the pulley and snapping, triggering or catching movement of the finger or thumb.
Trigger finger/thumb (Stenosing digital tenosynovitis or snapping finger/thumb)
Patient presents with poorly localised pain deep in the shoulder, exacerbated by overhead and behind-the-back motions, popping, catching or grinding. On examination: the active compression test and Hawkins test are positive.
Labral tear
Patient complains of pain and stiffness in the thoracolumbar junction as well as the SI joints that follow a pattern of exacerbation and remission. It is worse in the morning and improves throughout the day. On examination, there is a marked limitation of chest expansion. On X-ray, you can see a « bamboo spine ».
Ankylosing spondylitis
Patient presents with pain that is felt deep in the elbow joint. They report their elbow to feel stiff and say it needs to be popped or cracked.
Manipulable lesion of the elbow
A young adult presents to your clinic complaining of intense pain in the shoulder, often radiating down the upper arm, which started suddenly and rapidly became worse. Pain is made worse by any shoulder movement and disturbs sleep. The patient is unable to use their arm and it needs to be supported in a sling. On examination: there is a painful limitation of shoulder movements in all directions. On X-ray: you can see of soft tissue calcifications.
Calcific tendinitis of supraspinatus (HADD)
Patient presents with vague pain in the upper limbs and diffuse vague head and posterior neck pain. The patient cannot really define where the pain is in the thoracic spine but claims it is in the « middle » and that one or more levels are affected. On examination you discover that T4 is involved.
T4 syndrome
Patient presents with shoulder pain on both active and passive ROM. On examination : there is visible focal warmth, swelling. Patient shrugs shoulder to initiate abduction.
Subacromial bursitis
A rower comes to your clinic complaining of distal forearm pain. They say the pain started after they did a lot of repetitive extensions when they were rowing. On examination: the area of inflammation is approximately 6 to 8 cm proximal to the radial styloid (about 4 fingerbreadths proximal to the wrist). There is associated swelling and point tenderness and some crepitus with active extension of the wrist. Digital pressure at this site reproduces/exacerbates the patient's pain.
Intersection syndrome
Patient presents with mild to moderate anterior chest pain that may occur unilaterally or bilaterally and radiates to the chest, back or abdomen. The patient says the pain has been bothering them for several months. It is usually unilateral, sharp in nature and exacerbated by breathing, coughing/sneezing, physical activity or a specific position. On palpation there is tender nodular swelling over 2nd and 3rd costal cartilages and an associated trigger point. The patient reports a history of upper respiratory tract infection (URTI).
Costochondritis
A 35 years old woman presents with symetrical fusiform swelling and synovial, boggy thickening around the MCP and PIP joints that seem to have developed suddenly, within a few weeks. On examination: there is redness, warmth and swelling. The patient reports prolonged morning stiffness of the joints often lasting for hours. She also complains of general feeling of sickness and fatigue, diffuse arthralgias, small joint stiffness and weight loss.
Rheumatoid arthritis
Patient present with « muscle ache » in the proximal forearm precipitated by repetitive, strenuous use of the elbow/forearm in pronation. They say the pain may last several hours after the activity/exercise. They describe a feeling of weakness and arm tiredness. The specifically complain of weak thumb movements and impaired index and middle finger flexion. They say the aching pain in the proximal forearm began insidiously. They have paraesthesia that follows the median nerve distribution into the hand. On examination : direct compression of nerve produces a deep, dull ache, there is pain on resistance of pronation and flexion of wrist and a positive Tinel's sign at the proximal forearm.
Pronator teres syndrome
Parents present with a newborn baby who has a deformity that became apparent soon after birth and consists of a lateral flexion of the neck apparently due to an SCM contracture. On examination : a hard lump is visible.
Congenital torticollis
Patient presents with dramatic back pain. They report a history of incontinence of urine or stool and say that toilet paper feels different when wiping (saddle paraesthesia). They explain bladder dysfunction as being difficulty starting or stopping a stream of urine. Walking nearly causes urination. They report numbness in both legs and in the soles of both feet. They say numbness/burning sensation arises around the buttocks. Numbness is present, but pain is absent. On examination: there is hyporeflexia and flexor plantar response + weakness of quads, foot evertors and dorsi- and plantar flexors.
Cauda equina syndrome (Lower motor neuron sensorimotor deficits)
A bowling player complains of local pain and tenderness in the region of the bicipital tuberosity of the radius, with pain on resisted flexion and supination.
Biceps tendinitis/tendinopathy
A 40 years old+ patient presents with a history of pain around the deltoid insertion area particularly with the arm at or above shoulder level. The pain progresses to shoulder pain whenever the arm is used above shoulder level. The patient reports prolonged rest sometimes produce secondary stiffness and adds that pain may be significant at night and disturbing their sleep. On examination: there is muscle atrophy of infraspinatus and supraspinatus and some subacromial crepitus. The "Drop arm test" is positive and the impingement tests (Hawkin's test, Emptying the can test, Neer's test) reproduce the pain.
Impingement syndrome and rotator cuff tear
A 79-year-old man complains of low back and upper thigh pain and a feeling of leg heaviness when he walks with his wife in the grocery store. The pain seems more intense if he straightens his back and he has noticed that the pain is reduced when he pushes the shopping cart. The pain resolves slowly with sitting.
Spinal stenosis
A mother comes to your clinic with her 4 years old child crying and refusing to use his arm. The mother tells you she applied a sudden traction to her son's arm when he tried to cross the road. The arm is either limp by the side or supported on the child's lap. The elbow is slightly flexed and the forearm is pronated or held in mid-position. The arm is tender around the elbow without bruising or deformity.
Pulled elbow
Old patient presents with bilateral pain and stiffness in the shoulder girdle sometimes associated with hip girdle pain. The patient complains bitterly about their pain and seems flat and miserable. The pain is described as a deep intense ache that is constant but easier in the afternoon and evening. Patient will wake with pain at its greatest intensity. There is severe morning stiffness lasting longer than 30 minutes with malaise. Looking at the blood test : there is a greatly elevated ESR.
Polymyalgia rheumatica
Patient presents with LBP, buttock and leg pain that may radiate as far as the calf and foot. Patient says the pain is sharp and severe in nature and that the leg pain exceeds back pain. They report a history of flexion/rotation at onset and a history of chronic/repetitive LBP.They report lower limb numbness, pins and needles, weakness as associated symptoms. Aggravating factors are trunk flexion, coughing, sneezing, sitting. Being supine with supported hip/knee flexion relieves the pain. On examination: there is antalgia away from leg pain side (posterolateral herniation). Lumbar flexion is usually decreased and painful increasing leg pain, extension less painful and restricted. SLR (L5, S1 roots) is positive for leg pain and the Valsalva's test is positive.
Herniated Disc
Patient complains of paraesthesia in the hand and lateral forearm as well as pain over the forearm extensor mass, wrist aching and pain in the middle/upper third of the humerus. They say maximal tenderness is over the supinator muscle, four finger breadths below the lateral epicondyle. On examination patient reports marked pain on resisted supination of the forearm with the elbow flexed to 90 degrees and the forearm fully pronated. Pain may also occur with resisted extension of the middle finger with the elbow extended. The radial nerve tension test reproduces the patient's symptoms.
Posterior interosseous nerve entrapment (PIN)
Patient 50+ years old, complains of sharp aching pain in neck radiating into an arm. The discomfort can range from a dull ache to severe burning pain. Onset of radicular pain occurred acutely without a specific trigger. On examination : flexion of neck decreases arm pain.
IVF encroachment in DJD
A young person comes to your clinic complaining of pain in the rib angle in the mid axillary line that seems to affect several levels. It is apparently usually due to compression injury and the patient reports pain on respiratory movements. They have local spasm, tenderness, swelling and rib cage compression reproduces their pain.
Rib fracture
Patient complains of pain and stiffness in the thoracolumbar junction as well as the SI joints that follow a pattern of exacerbation and remission. It is worse in the morning and improves throughout the day. They report morning stiffness of more than 30 minutes duration and alternating buttock pain. The say they are waking because of back pain but during the second half of the night only. They report improvement in back pain with exercise but not with rest. On examination : measurement of forward lumbar forward flexion (Schober's test) is less than 5 cm, lateral lumbar flexion and chest expansion are decreased and patient reports pain when examiner palpates and stresses the sacroiliac joints. On X-ray, you can see a « bamboo spine ».
Ankylosing spondylitis
A racquet player presents to your clinic with paraesthesias and pain in ulnar distribution (in the ring and little finger) and local discomfort at the elbow. They report gradual progressive onset, intermittent and related to repetitive/sustained elbow flexion especially when they play tennis. The pain is relieved by rest and by prolonged extension (that opens tunnel). They also complain of night pain.On examination : they have weakness of grip, hand clumsiness, atrophy of hand muscles, and complain of impaired pinch grip strength between thumb and index finger. The Tinel's sign and the elbow flexion-pressure provocative test are positive. Patient reports tenderness to palpation along the cubital tunnel.
Cubital tunnel syndrome
Patient presents with diffuse pain in the middle and lower portion of the posterior neck. Physical examination reveals local tenderness in the paracervical muscles, decreased ROM and loss of the cervical lordosis. No abnormalities are found with neurologic or shoulder examinations.
Strain
A 40 years old patient complains of local pain relieved by rest and aggravated by activity around L4/5 and L5/S1. They say pain may refer to buttock or hip/thigh and they have a sensation of « weakness » in their back. On examination : there is muscle hypertonicity locally, reduced ROM unilaterally and patient reports tenderness over involved segment.
Degenerative joint disease
Patient complains of pain and local tenderness that radiate proximally. On examination : there is weakness of the intrinsics (interossei, adductor pollicis, opponens digiti minimi, flexor digiti minimi, abductor digiti minimi, medial two lumbrical) (Noted: the lateral two lumbicals are spared). There is also atrophy of intrinsics and hypothenar muscles and isolated sensory loss. Patient reports a cold intolerance of hand and says the symptoms are aggravated by wrist movements.
Ulnar nerve entrapment at the wrist
Patient comes to your clinic after they have had a rear-impact RTA that happened last night (about 18h ago). They experience stiffness and pain with motion; they also have difficulty in swallowing or chewing. Physical examination reveals : soreness, paracervical muscle contraction and decreased ROM. Neurologic examination is unremarkable, but radiographs reveal loss of cervical lordosis.
Whiplash
A 40 years old woman presents to your clinic complaining of wrist and hand pain due to repetitive strain injury. On examination : Pain is reproduced when patient makes a fist with thumb Inside and performs ulnar deviation at the wrist (Finkelstein's test is positive) and tendon crepitus palpable.
DeQuervain's tenosynovitis
A rugbyman comes to your clinic after a violent rugby tackle where sudden extension and abduction of his arm occurred. On examination : the long head of the biceps tendon is felt to sublux out of its groove.
Rupture of the transverse humeral ligament
Patient presents with unilateral pain radiation along line of ribs. Patient recalls onset being related to a cough/sneeze. The pain is increased by deep respiratory movements or cough/sneeze. On palpation, there is tender rib dysfunction and adjacent muscle splinting.
Costovertebral and costotransverse manipulable lesions
Older person complaining of chronic back pain and stiffness as well as acute episodes following over-activity. On X-ray you can see dystrophic calcification of disc T9/T10.
DJD in Tx Spine
Patient presented to the clinic with unilateral pain, radicular in distribution and related to activity which sometimes referred pain to the abdomen and could be mistaken for intra-abdominal problems. After an intensive course of manipulation/mobilisation, the pain responded dramatically to spinal manipulation.
Manipulable lesions of the thoracic spine
Patient presented to clinic complaining of back pain that appeared to be mechanical (Ex: from facets). X-rays were taken and presence of spondylolisthesis was discovered. On examination : patient has a hyperlordotic posture, prominent buttocks and a waddling gait (stiff, short stride) due to tight hamstrings and increased lordosis.
Spondylolysis and spondylolisthesis
Patient presents with chronic LBP with radiation to buttock and leg that may radiate as far as the foot. Distal leg pain is the main complaint. The pain is burning in nature accompanied by tingling and/or numbness. On examination: SMR changes are demonstrable on neurological exam and nerve tension tests are moderately positive for leg symptoms. Flexion/extension movements increase pain. Rotation, especially sustained peripheralises pain.
Lateral entrapment:
Patient presents to your clinic complaining of weakness of shoulder activities requiring flexion/abduction. They say they have been carrying a really heavy backpack on a long distance when they went hiking 2/3 weeks ago. On examination : there is paralysis of the serratus anterior, which leads to winging of the scapula.
Long thoracic nerve (C5-8)
A rugbyman comes to your clinic complaining of radiating pain, numbness, weakness and tingling down one arm. He says he injured his shoulder few days ago while playing rugby. He says he felt a downward displacement of his right shoulder while he was laterally flexing his neck towards his left shoulder.
The burner or stinger syndrome
A patient comes to you clinic complaining of elbow pain that they think is the result of chronic excessive valgus stress due to throwing. On examination : there is localised tenderness over the ligament and mild instability on valgus stress.
Medial collateral ligament sprain
Patient presents with pain in the shoulder and decreased ROM. Tenderness is maximal around the point of insertion, behind and below the tip of the greater tuberosity, with the pain provoked by external rotation. They say stretching with the arm behind the back may also bring on the pain.
Infraspinatus tendinitis/tendinopathy
Patient presents with localised pain and tenderness, sometimes severe along the upper part of the medial scapular border. Pain usually gets worse as the day goes on or after use of the shoulders. The pain may be associated with postural faults or sagging shoulders and can be reproduce on resisted scapular movements.
Scapulocostal tendinitis
Patient presents to your clinic after a trauma to the forearm. They report a dull, aching pain in the volar aspect of the proximal forearm.On examination : the patient has no sensory complaints and experiences only motor weakness. They have loss of distal flexion of the thumb and index finger (Pinch sign) and there is decreased resistance to forced supination of the forearm when testing pronator quadratus.
Anterior interosseous nerve syndrome
A young person comes to your practice after having had an axial compression with forced flexion. He complaints of pain around the thoracolumbar junction witch is associated with tenderness, local spasm and swelling. On examination you can see a little local flexion deformity. The percussion/vibration test is positive.
Compression fracture
Patient comes to your clinic complaining of pain in their Metacarpophalangeal joints. They report a ski injury which follows a fall onto the hand with the stock held firmly clenched by their thumb. On examination : the rupture is diagnosed by keeping the patient's thumb fully extended and applying an abduction strain to the MCP joint to demonstrate any lateral instability. There is also weakness of thumb pinch.
Ligament sprains of the wrist and hand - Metacarpophalangeal joints
Patient presents to your clinic after a fall onto their acromion. The pain is aggravated on abduction, especially above 90 degrees and at the end range of adduction of the arm at 90 degrees (across the chest).
Acromioclavicular joint sprains
A 40+ year old patient presents with neck pain associated with stiffness. This is a dull, aching but not severe pain, which is constantly present and made worse by sudden movements or most physical activities involving the neck. Pain is felt diffusely in the neck or in the interscapular region or shoulders. Pain may also be referred distally into the arms. Pain may be aggravated by cold, damp and changes in barometric pressure. Pain may be relieved by heat, movement and NSAIDs. On ROM, flexion produces relief, extension aggravates and rotation and lateral flexion are usually significantly reduced.
Cervical Spondylosis
A 40 years old patient suffers recurrent attacks of repeated, painless rotation or lateral flexion of the head. The onset is gradual and the head movement is a rotation towards the left side. On examination : the patient or the examiner can manually overcome the spasms.
Spasmodic torticollis (dystonia)
A young adult presents to you clinic with cystic swelling on the dorsum of their hand in the carpal area that apparently appeared after trauma. On examination, there is a characteristic nodular lump in the region that feels hard, even bony and is mildly tender.
Ganglion (in wrist)
A patient comes to your clinic complaining of pain after they overused their wrist. The pain is is just proximal to their insertion. On examination : there is loss of normal accessory movements of the intercarpal joints and pain is reproduced by isometric contraction of the muscle.
Tendinitis/tendinosis
A middle aged male who has a history of bicipital tendinitis presents to your clinic after they felt a sudden snap at their anterior shoulder while they were lifting a heavy box. On examination : you can see some bleeding into the soft tissues and the appearance of the contracted muscle belly distally (Popeye sign).
Rupture of the long head of the biceps tendon
Patient complains of unilateral or bilateral pain over iliac crest area and groin pain/thoracolumbar pain. Patient also reports hypersensitivity of skin overlying iliac crest (positive « Skin roll test ») On palpation, you find a thoracolumbar manipulable lesion and local muscle splinting.
Maigne's syndrome
Patient complains of burning, pins-and-needles sensations, numbness and tingling in the fingers. They report being awakened at night by abnormal sensations and having to shake the hand in an attempt to relieve the numbness. They think position of the hands during sleep may contribute to nocturnal distress. They say that activities requiring wrist flexion or extension aggravate symptoms. On examination : there is sensory loss to radial 3 fingers and half of ring finger as well as thenar atrophy. Tinel's, Phalen's and Compression tests are positive.
Carpal tunnel syndrome
Patient presents with a circumscribed local tenderness that refer pain elsewhere when subjected to firm pressure. On examination you note a local twitch response with stimulation of associated muscle.Q1) Patient complains of neck pain with the head tilted to the side of pain. They will have an ache at the base of the neck and will push on the muscle.Q2) Patient says they suffer from a « stiff neck » with markedly limited rotation.Q3) Patient reports pain on extending or flexing the neck. A1) Trigger point in the upper trapezius muscle A2) Trigger points in the levator scapulae and upper trapezius muscles A3) Presence of one or more Trigger points in the ligamentum nuchae.
Trigger points
A teenager who is training 3x a week for a swimming contest comes to your clinic complaining of shoulder pain that keeps him from training. He says the pain is getting worse and now affects his performance. He used to feel pain only at the beginning and after the training session but now reports pain during and after swimming. Because of this had to stop training.
Swimmer's shoulder
A right-handed 50 years old patient complains of pain localised to their right lateral epicondyle that spreads up and down the upper limb. It apparently arose slowly and spontaneously (patient does not remember any blow or acute traumatic episode). Grip is impaired due to pain and this result in restricted daily activities. There is tenderness over the epicondyle. On examination : there is an increase in pain on resisting wrist dorsiflexion with the elbow in extension. Symptoms may also be precipitated by extending the elbow with the wrist flexed and by resisted middle finger extension. Resisted supination is also painful. The range of movement of the elbow is normal.
Lateral epicondylitis/extensor tendinopathy (Tennis elbow)
An 80-year-old woman limps into your office with left lower back pain that shoots to her left buttock and posterior lateral thigh. There is occasional radiation of discomfort over the anterior shin to her foot.
Sciatica
Patient complains of deep pain in the posterior part of the forearm. The onset was insidious and they experience gradual finger weakness and some mild wrist weakness.They report local discomfort at elbow about 4 fingerbreadths below lateral epicondyle.On examination : they feel pain on active supination and have positive middle finger test, Tinel's test and wrist drop.
Radial nerve entrapment
Patient presents with pain precipitated by a sudden neck movement on awakening. It is a sharp aching pain in neck radiating into an arm. The discomfort can range from a dull ache to severe burning pain. The pain radiates to the scapula initially and then along the upper or lower arm and into the hand. There is stiffness of neck with limitation of movement and the pain wakes the patient at night. Coughing, sneezing, or straining usually aggravates the pain and causes it to radiate throughout the involved dermatome.Patient reports a reduction in their radicular symptoms by abducting the shoulder and placing their hand on the head (Bakody' sign). Patient complains of sensory changes along the involved nerve root dermatome, which can include tingling, numbness or loss of sensation. Spurling's test, Distraction, Lhermitte sign
Cervical disc herniation
A patient comes to your clinic complaining of pain over the lateral shoulder, that sometimes radiates distally and disturb their sleep. They say the course of symptoms followed a pattern of exacerbation and remission over several years.On examination : there is pain on active abduction, especially 60-120 degrees (« The painful arc ») and painful resisted abduction and external rotation. The "Drop arm test" is positive and the impingement tests (Hawkin's test, Emptying the can test, Neer's test) reproduce the pain. There is pain and weakness on supraspinatus muscle tests and tenderness at the insertion of the tendon at the greater tuberosity.
Supraspinatus tendinitis/tendinopathy
Other sets by this creator