A 45-year-old patient reports a recent onset of unilateral shoulder pain which is described as diffuse and is associated with weakness of the shoulder but
... [Show More] no loss of passive range of motion. What does the provider suspect as the cause of these symptoms?
a. Acromioclavicular joint disease
b. Cervical radicular pain
c. Glenohumeral arthritis
d. Rotator cuff injury - ANS: D
Rotator cuff injury is usually characterized by diffuse pain, weakness of the joint, but no change in range of motion. Acromioclavicular joint disease is associated with anterior-superior shoulder pain. Glenohumeral arthritis has similar symptoms, but with loss of range of motion. Cervical radicular pain is characterized by pain distal to the elbow.
An examiner is evaluating a patient who reports unilateral shoulder pain and notes limited active and passive range of motion in the affected shoulder along with erythema and bulging on the anterior shoulder. What diagnosis is likely with this presentation?
a. Acromioclavicular joint disease
b. Adhesive capsulitis
c. Inflammatory bursitis
d. Rotator cuff tear - ANS: C
Both bursitis and adhesive capsulitis will present with decreased active and passive range of motion, but patients with inflammatory bursitis will exhibit erythema and bulging of the anterior shoulder. Acromioclavicular joint disease does not cause erythema or bulging of the joint.
A patient reports a deep ache in one shoulder and the provider suspects tendonitis secondary to repetitive activity. To determine whether the pain is caused by impingement on the acromion, the provider will ask the patient to
a. abduct the arm.
b. adduct the arm.
c. internally rotate the shoulder.
d. shrug the shoulders. - ANS: A
If pain is caused by impingement on the acromion, the patient will reflexively shrug when asked to abduct the arm to reduce the pain. Adduction of the arm does not elicit this response. The shrug elicited is reflexive and not intentional. Internal rotation may be performed to
evaluate generalized muscle weakness.
A soccer player is brought to the emergency department after twisting an ankle during a game. An examination of the affected joint reveals ecchymosis and edema of the ankle and limited
joint laxity along with pain on weight-bearing, although movement with pain is intact. Which grade sprain is likely?
a. Grade I
b. Grade II
c. Grade III
d. Grade IV - ANS: B
This patient probably has a grade II sprain, which involves incomplete tear of a ligament with some functional impairment, ecchymosis, and pain with weight-bearing. A grade I sprain causes only pain and edema. A grade III sprain is a full or complete tear of the ligament with loss of ligament integrity. A grade IV sprain results in severe weakness with loss of function.
A school-age child falls off a swing and fractures the humerus close to the elbow joint. What is the most important assessment for this patient to evaluate possible complications of this injury?
a. Evaluation of pain with extension
b. Palpation for joint laxity
c. Salter-Harris classification
d. The presence of a spiral fracture - ANS: C
Salter-Harris classification identifies the degree of epiphyseal, or growth plate involvement and is important to evaluate in children and adolescents, since damage to the growth plate can result in shortening of the long bone. The other assessments are part of the exam but have less importance than assessment of growth plate involvement.
An emergency department provider is giving instructions for rest, ice, compression, and elevation (RICE) treatment in a patient with a sprain. What is included in teaching about this home care? (Select all that apply.)
a. An elastic bandage is enough for compression.
b. Apply ice packs for 20 minutes three times daily.
c. Proximal joints should be elevated higher than distal joints.
d. The injured extremity should be raised above the level of the heart.
e. Place a cloth between the ice pack and the skin. - ANS: A, D, E
There is good evidence supporting use of an economical elastic bandage for support and
compression. Elevation of the extremity above the level of the heart after the injury helps to reduce the edema and thereby decrease initial pain. If using an ice pack, a cloth should be placed between the ice pack and the skin to prevent cold burn. Ice packs should be applied at 20-minute intervals, allowing the skin to return to normal temperature before each application.
Distal joints should be higher than proximal joints.
A patient reports elbow pain and the examiner elicits pain with resisted wrist flexion, forearm pronation, and passive wrist extension on the affected side. What is a likely cause of this pain?
a. Lateral epicondylitis
b. Medial collateral ligament instability
c. Medial epicondylitis
d. Ulnar neuritis - ANS: C
Medial epicondylitis will produce pain as described above. Lateral epicondylitis may result in pain with passive wrist flexion and active wrist extension.
A patient has chronic elbow pain associated with arthritis. What is included in management of this condition? (Select all that apply.)
a. Avoidance of certain activities
b. Balanced rest and exercise
c. Long-term NSAIDs
d. Occupational therapy
e. Splinting of the elbow - ANS: A, B, D
Patients with arthritis may be managed by avoiding pain-causing activities, a program of balanced rest and exercise, and occupational therapy to improve function. NSAIDs are used for short periods. Splinting is not recommended.
A 40-year-old woman reports pain at the thumb base in one hand radiating to the distal radius. The provider learns that the woman knits for a hobby and is able to elicit the pain by asking the patient to pour water from a pitcher. Which condition is suspected in this patient?
a. Carpal tunnel syndrome
b. Palmar fibrosis
c. De Quervain's Tenosynovitis
d. Trigger finger - ANS: C
De Quervain's tenosynovitis causes pain as described and occurs more in women between 30 and 59 years who engage in activities requiring excessive repetitive motions, such as knitting. Carpal tunnel syndrome presents with intermittent wrist pain, numbness, and tingling radiating from the palm to the thumb, index finger, middle finger, and medial aspect of the ring finger. Palmar fibrosis causes contractures, usually of the ring finger. Trigger finger causes nodules in tendons that catch on the finger pulley and impede movement. [Show Less]