MSK- Block 6

While pursuing a course of watchful waiting, your patient with subacute sciatica telephones asking for treatment for pain. She has heard about an injection that might help. Which one of the following should you tell her about epidural steroid injection?

A 65 year old woman reports pain, swelling, and warmth in her right knee 1 day after steroid injection to manage chronic OA in that knee. The symptoms began about 6 hrs after the injection. She is otherwise healthy and denies any symptoms including fevers or chills. Her vitals are stable and afebrile. She has tenderness to palpation over the medial and lateral joint lines more so than before the injection, and a modest increase in knee effusion, but rest of exam is stable. Her range of motion is limited in both flexion/extension and passive assistance causes pain. There is no joint laxity. Joint aspirate yields 25ml non-bloody cloudy yellow fluid with 12,000WBC with 95% PMN. Gram stain is negative. Crystal analaysis shows abdundant intra and extracellular crystals with polymorphic appearance and both positive and negative birefringence.

Which one of the following approaches is most appropriate for initial management of a 19-year-old female military recruit who has progressively worsening unilateral pain and tenderness along the tibial surface that is exacerbated by activity - and whose tibial radiographs are unremarkable?

A 35-year-old male with a 4-month history of pain in the medial aspect of his right knee sees you for follow-up. He has been doing physical therapy for the past month with minimal benefit. A plain radiograph is negative and MRI shows a tear in the medial meniscus. Which one of the following is most likely to yield the best long-term result?

A 30-year-old female stepped off a curb earlier today and twisted her left ankle. She was able to bear weight immediately following the injury and tried to continue her normal routine, but the pain in her ankle and foot increased over the next few hours. She comes to your office and your examination reveals swelling of the ankle and bruising of the lateral foot. Tenderness to palpation is present over the distal aspect of the fibula and lateral malleolus and to a lesser degree over the proximal fifth metatarsal. No bony tenderness is present along the medial aspect of the ankle or foot. According to the Ottawa Ankle Rules, which one of the following would be most appropriate at this point?

A 67-year-old male presents with a 10-day history of bilateral shoulder pain and stiffness accompanied by upper arm tenderness. On examination there is soreness about both shoulders and the patient has great difficulty raising his arms above his shoulders. There is no visual disturbance, and no tenderness over the temporal arteries. C-reactive protein is elevated and the erythrocyte sedimentation rate is 65 mm/hr (N 0–17). Which one of the following would help to confirm the most likely diagnosis?

A 70-year-old white female asks you to evaluate her right shoulder because of pain and limited range of motion. Further history reveals that 2 months ago she slipped in her kitchen and caught onto the refrigerator door handle to avoid falling to the floor. On examination she has pain and weakness at 45° of abduction and weakness on external rotation. She should be treated for

A 50-year-old man who works for the railroad presents with three months of shoulder pain. Which finding described below indicates subacromial impingement?

A 26-year-old man presents complaining of right shoulder pain after a fall from an all-terrain vehicle onto his shoulder. Radiographs are completed and show a Hill-Sachs lesion. Which of the following best describes this finding?

A 42-year-old female presents with a 2-month history of right-sided shoulder pain. A history reveals that her job requires repetitive motion, including abduction of the shoulder. Ibuprofen has not been helpful and the pain interferes with her sleep. The physical examination suggests rotator cuff tendinitis. A radiograph of the shoulder is normal. You discuss treatment options and the patient decides to proceed with a corticosteroid injection. Which one of the following is the appropriate anatomic location for the injection?