2023 MSK Primer PDF

Musculoskeletal (MSK) Course Primer Course Directors: Dr. Kamalpreet Buttar, MD Dr. Farzana Nuruzzaman, MD Created by: Jack Scheutzow, Kevin Kashanchi Table of Contents (click below to go directly...

Musculoskeletal (MSK) Course Primer Course Directors: Dr. Kamalpreet Buttar, MD Dr. Farzana Nuruzzaman, MD Created by: Jack Scheutzow, Kevin Kashanchi Table of Contents (click below to go directly to that section) 1. Spine……………...……………………………………………….2 2. Hand / Wrist………..……………………………………………...9 3. Elbow………………..…………………………………………...17 4. Shoulder………………..………………………………………...22 5. Knee……………………..……………………………………….30 6. Hip………………………...……………………………………...39 7. Ankle / Foot……………………..……………………………….46 8. Bone Biology & Bone Tumors……………………….…………52 9. Additional Videos………………..………………………………58 10. Abbreviations…………………………………………………….59 1  1. Spine Learning Objectives Know the basic components of the physical examination of the cervical spine and lumbar spine Understand the implications of the Spurling’s Test, Lhermitte Sign, and Straight Leg Raise Identify the clinical presentation, PE findings, and basic management of the following spinal disorders: ○ Thoracic kyphosis ○ Vertebral fractures (pathologic) ○ Disc herniation Lumbar disc (L4-L5) Cervical disc (Posterolateral annulus fibrosus) ○ Paget’s disease (Osteitis deformans) ○ Spondylolisthesis (Risk factors) ○ Ankylosis / Spondyloarthropathies ○ Cervical nerve radiculopathy ○ Enthesopathy of the Spine 2 Basic Anatomy of the Spine 3 4 5 Normal Physical Exam Components of the Cervical Spine & Lumbar Spine Key Physical Exam Maneuvers Spurling’s Test o Extend the neck to the side of the pain and apply downward pressure from the top of the head o Limb pain → cervical radiculopathy Lhermitte Sign o “Barber chair phenomenon” o Electrical shock sensation running down spine and radiating into the upper or lower extremities upon flexion of the neck o Interpretation: compression of upper cervical spine or brainstem 6  Straight Leg Raise o Lie in supine position, lift leg 30-70˚ while knee is extended o Pain radiating below the knee → lumbar nerve root impingement Clinical Presentations of Spinal Disorders Thoracic kyphosis o Exaggerated, forward rounding of the back o Normal thoracic kyphosis: 20-40˚ o Abnormal thoracic kyphosis: > 40˚ Pathologic Vertebral Fractures o Spontaneous fracture following mild physical exertion or minor trauma due to abnormal weakness of the bone from an underlying condition Disc herniation o Complete extrusion of the nucleus pulposus (core) through a tear in the annulus fibrosus (outer ring) Paget’s disease (Osteitis deformans) o Pathophysiology: increased osteoclast activity o Clinical Features: bone pain, pathologic fractures Spondylolisthesis o Vertebral body slips anteriorly over adjacent vertebra o Risk factors ▪ Congenital malformation of lumbosacral joints ▪ Repetitive hyperextension & rotation (gymnastics, swim, weightlifting) ▪ Spondylolysis = stress fracture through pars interarticularis ▪ Trauma ▪ Degenerative disease Ankylosing Spondylitis o Partial or complete fusion and rigidity of the spine o Risk factor: HLA-B27 + o Clinical features: morning stiffness that improves with exercise 7  Cervical nerve radiculopathy o Affected nerve root is the one below the level of disk herniation Radiological Findings Spondylolisthesis 8  2. Hand & Wrist Learning Objectives Know the basic components of the physical examination of the hand and wrist Understand the implications of the Finkelstein’s test, Watson’s test, Snuff Box Tenderness, Gamekeeper’s thumb, Tinel’s sign, Phalen’s sign, Froment’s sign, and Wartenberg’s sign Identify the clinical presentation, PE findings, and basic management of the following hand and wrist disorders: ○ Dupuytren contractures ○ Anatomic snuff box fractures (Scaphoid fracture) ○ De Quervain disease ○ Carpal tunnel syndrome Acute (lunate dislocation) Chronic (associated with pregnancy, RA, hypothyroidism, DM, dialysis- related amyloidosis, repetitive use) ○ Guyon canal syndrome ○ “Fall on outstretched hand” injury 9 Basic Anatomy of the Hand & Wrist 10 11 Normal Physical Exam Components of the Wrist 12 Normal Physical Exam Components of the Hand 13 Key Physical Exam Maneuvers Finkelstein’s test ○ Flex thumb into palm, ulnarly deviate the wrist ○ Pain in 1st dorsal compartment (APL/EPB tendons) → de Quervain’s tenosynovitis Watson’s test (Scaphoid shift) ○ Push dorsally on distal pole of scaphoid, bring wrist from ulnar to radial deviation ○ Clink or clunk (scaphoid subluxating dorsally over rim of distal radius) → positive for carpal instability Snuff Box Tenderness ○ Pain in the anatomic snuffbox ○ Suggestive of scaphoid fracture Gamekeeper’s thumb ○ Injury to the ulnar collateral ligament of the thumb ○ Results from a radially deviated force → hyper abduction type injury to the thumb ○ Physical exam shows radial instability at the thumb MCP Tinel’s sign ○ Tap volar wrist (TCL) ○ Reproduction of symptoms (ie. tingling) → median nerve compression (CTS) 14  Phalen’s sign ○ Flex both wrists for 1 minute ○ Reproduction of symptoms (ie. tingling) → median nerve compression (CTS) Froment’s sign ○ Hold paper with thumb and index finger, pull paper ○ Thumb IP flexion → adductor pollicis weakness or ulnar neuropathy Wartenberg’s sign ○ Small finger abduction during attempted adduction ○ Seen in cubital tunnel syndrome (ulnar neuropathy) 15 Clinical Presentations of Hand & Wrist Disorders Dupuytren contractures ○ Fibroproliferative disorder of the palmar fascia ○ 4th and 5th fingers are most commonly involved ○ Risk factors: trauma, cigarette smoking, liver cirrhosis Scaphoid fracture ○ Most commonly fractured carpal bone ○ Etiology: history of falling onto outstretched hand (FOOSH) ○ Clinical features: pain when applying pressure to the anatomical snuffbox De Quervain disease ○ Etiology: repetitive abduction and extension of the thumb ○ PE findings: + Finkelstein test Carpal tunnel syndrome ○ Peripheral neuropathy caused by chronic or acute compression of the median nerve by the transverse carpal ligament ○ Types Acute Lunate dislocation Chronic Associated with pregnancy, RA, hypothyroidism, DM, dialysis- related amyloidosis, repetitive use Guyon canal syndrome ○ Compression of the ulnar nerve ○ Associated with cycling and blunt trauma (hook of hamate fracture) ○ Clinical features: atrophy of hypothenar muscles ○ PE findings: + Wartenberg’s sign, + Froment’s sign 16  3. Elbow Learning Objectives Know the basic components of the physical examination of the elbow Know the tests used for medial epicondylitis (Golfer’s Elbow) and lateral epicondylitis (Tennis Elbow) Identify the clinical presentation, PE findings, and basic management of the following elbow disorders: ○ Olecranon bursitis ○ Radial Head Subluxation Fracture ○ Distal biceps tendon rupture ○ Lateral Epicondylitis (Tennis Elbow) ○ Medial Epicondylitis (Golfer’s Elbow) ○ Enthesopathy of the elbow 17 Basic Anatomy of the Elbow 18 19 Normal Physical Exam Components of the Elbow Key Physical Exam Maneuvers Medial Epicondylitis Test ○ “Golfer’s elbow” ○ Supinate arm, extend wrist and elbow ○ Pain at medial epicondyle → medial epicondylitis Lateral Epicondylitis Test ○ “Tennis elbow” ○ Make fist, pronate, extend wrist and fingers against resistance ○ Pain at lateral epicondyle → lateral epicondylitis 20 Clinical Presentation of Elbow Disorders Olecranon bursitis o Pathophysiology: inflammation of the olecranon bursa, non-septic (overuse/repeated trauma) vs septic (infected) o Physical exam: erythema about the elbow with associated localized swelling which is tender to palpation Radial Head o Subluxation (Nursemaid’s Elbow) ▪ Partial dislocation of the head of the radius ▪ Etiology: axial traction of the pronated and extended forearm ▪ Clinical features: child holds arm, with elbow slightly flexed and pronated ▪ Tx: hyperpronation maneuver, supination-flexion maneuver o Fracture ▪ Etiology: fall on outstretched hand (FOOSH) with elbow partially flexed and pronated ▪ Clinical features: radial head tenderness, hemarthrosis of elbow joint Distal biceps tendon rupture o Clinical features: pt. feels a sudden pop when lifting something heavy o Physical exam: reverse Popeye deformity Medial Epicondylitis (Golfer’s Elbow) o Etiology: repeated wrist flexion and forearm pronation o Clinical features: often associated with activities involving repeated wrist flexion o Physical exam: TTP about medial epicondyle Lateral Epicondylitis (Tennis Elbow) o Etiology: repeated wrist extension and forearm pronation / supination o Clinical features: often associated with activities involving repeated wrist extension o Physical exam: TTP about lateral epicondyle, pain with resisted wrist extension 21  4. Shoulder Learning Objectives Know the basic components of the physical examination of the shoulder Understand the implications of Neer’s Test, Hawkins-Kennedy Test, Yergason’s Test, and Speed’s Test Identify and understand the tests used for assessing labral tears ○ O’Brien’s Test ○ Crank Test Identify and understand the test used for assessing the integrity of the AC joint ○ Scarf Test (cross-body adduction) Identify and understand the tests used for assessing shoulder instability ○ Sulcus Sign ○ Anterior Drawer Test ○ Posterior Drawer Test Identify the clinical presentation, PE findings, and basic management of the following shoulder disorders: ○ Bicipital tendonitis ○ Adhesive capsulitis “frozen shoulder syndrome” ○ Shoulder impingement syndromes – supraspinatus syndrome ○ Shoulder separation – injury to coracoclavicular ligament ○ Shoulder dislocation – posterior shoulder dislocation ○ Injury to the supraspinatus ○ Injury to the subscapularis ○ Injury to the infraspinatus ○ Injury to the teres minor 22 Basic Anatomy of the Shoulder 23 24 Normal Physical Exam Components of the Shoulder 25 Key Physical Exam Maneuvers Rotator Cuff Strength Testing o Supraspinatus (Jobe Empty Can Test) ▪ Pronate arm, resisted forward flexion in scapular plane ▪ Pain or weakness → supraspinatus tear o Infraspinatus (ER Lag Sign) ▪ External rotation of shoulder, patient holds this position ▪ Inability to maintain ER → infraspinatus tear o Teres Minor (Hornblower’s sign) ▪ Resisted external rotation in slight abduction ▪ Weakness → teres minor tear o Subscapularis ▪ Lift Off Test Hand behind back, push backward Weakness → subscapularis tear ▪ Belly Press Test Hand on belly, push toward belly Weakness → subscapularis tear Special Testing o Impingement (Neer’s Test) ▪ Forward flexion > 90˚ ▪ Pain → impingement syndrome o Subacromial bursitis (Hawkin’s Test) ▪ Forward flexion of 90˚, then internal rotation ▪ Pain → impingement syndrome 26  o Biceps ▪ Yergason’s Test Elbow at 90˚, resisted supination Pain → biceps tendon injury ▪ Speed’s Test Resisted flexion in scapular plane Pain → biceps tendinitis Labral Tears o O’Brien’s Test ▪ Forced flexion at 90˚, adduct 10˚, resisted flexion (pronation, then supination) ▪ Pain w/ resisted flexion and greater in pronation → SLAP tear or AC joint pathology o Crank Test ▪ Abduct 90˚, axial load, rotate internally & externally ▪ Pain → SLAP tear AC joint o Cross-body adduction ▪ Adduct arm across the body ▪ Pain at AC joint → AC joint pathology (arthrosis) Instability o Sulcus sign ▪ Pull down on adducted arm ▪ Sulcus under lateral acromion → inferior instability o Posterior drawer ▪ Increased posterior translation of the humeral head relative to the glenoid ▪ Suggestive of posterior shoulder instability o Anterior drawer ▪ Increased anterior translation of the humeral head relative to the glenoid ▪ Suggestive of anterior shoulder instability 27 Clinical Presentation of Shoulder Disorders Biceps tendonitis o Clinical features: anterior shoulder pain +/- snapping o Physical exam: tenderness to palpation over bicipital groove, + Yergason Test, + Speed test Adhesive capsulitis “frozen shoulder syndrome” o Pathophysiology: Inflammation and fibrosis of shoulder joint capsule o Risk factors: hypothyroidism, diabetes mellitus, long periods of immobilization o Clinical features: pain, stiffness o Physical exam: loss of both active and passive ROM Shoulder impingement syndromes (supraspinatus syndrome) o Pathophysiology: impingement of supraspinatus tendon under the acromion o Clinical features: pain with overhead activities o Physical exam: + Neer Test, + Hawkins Test Rotator cuff tear o Epidemiology: chronic degenerative tears in the elderly or acute injury in younger patients, most commonly involves the supraspinatus o Clinical features: shoulder pain exacerbated by overhead activities, night pain o Physical exam: loss of active ROM with preserved passive ROM Shoulder separation o Injury to acromioclavicular and/or coracoclavicular ligaments o Clinical features: often occurs after fall onto shoulder o Physical exam: gross deformity about the shoulder 28  Shoulder dislocation o Anterior shoulder dislocation: ▪ Clinical features: often occurs after trauma ▪ Physical exam: arm is abducted and externally rotated ▪ Note: axillary nerve at risk o Posterior shoulder dislocation: ▪ Clinical features: often occurs after seizures or electrocution ▪ Physical exam: arm is adducted and internally rotated Injury to the supraspinatus o Function: abduction of arm from 0-15 deg. o Physical exam: + Jobe test, +Drop sign Injury to the infraspinatus o Function: external rotation of shoulder o Physical exam: Weakened shoulder ER strength Injury to the teres minor o Function: adduction of arm, external rotation of shoulder o Physical exam: + Hornblower’s sign Injury to the subscapularis o Function: internal rotation of shoulder o Physical exam: + Lift off, + Belly press 29  5. Knee Learning Objectives Know the basic components of the physical examination of the knee Identify tests used for assessing injuries to: ACL, MCL, LCL, PCL, meniscus, patella Understand the implications of the Anterior Drawer Test, Posterior Drawer Test, Bulge Sign, Abnormal Passive Abduction, Abnormal Passive Adduction, Lachman Test, and McMurray Test Identify the clinical presentation, PE findings, and basic management of the following knee disorders: ○ Osteochondritis dissecans ○ Knee dislocation (ankle brachial indices) ○ Lateral collateral ligament (LCL) injury ○ Medial collateral ligament (MCL) injury ○ Anterior cruciate ligament (ACL) injury ○ Posterior cruciate ligament (PCL) injury ○ Osgood-Schlatter disease ○ Chondromalacia patella ○ Genu valgum or varum ○ Prepatellar bursitis ○ Baker cyst ○ “Unhappy triad” injury (lateral force applied to planted leg injury) 30 Basic Anatomy of the Knee 31 32 Normal Physical Exam Components of the Knee 33 Key Physical Exam Maneuvers Anterior Drawer Test o Knee at 90˚ flexion, fix foot on the table, pull proximal tibia forward o Increased tibial anterior gliding → ACL tear Posterior Drawer Test o Knee at 90˚ flexion, fix the foot on the table, push the proximal tibia backward o Increased tibial posterior gliding → PCL tear 34  Bulge Sign in Knee o Effusion in the suprapatellar bursa Lachman Test o Knee at 20-30˚ flexion, stabilize the femur and pull tibia anteriorly o Increased tibial anterior gliding → ACL tear Valgus Stress Test o Knee extended or 20-30˚ flexed, abduct the tibia by pushing on the knee from the lateral side (valgus force) o Widening of the medial joint space → MCL injury Varus Stress Test o Knee extended or 20-30˚ flexed, adduct the tibia by pushing on the knee from the medial side (varus force) o Widening of the lateral joint space → LCL injury 35  McMurray Test (Meniscus Pathology) o Hold knee in one hand and palpate joint spaces while holding ankle in other hand o Bring the knee to maximal flexion o External rotation of tibia and valgus stress while extending the knee ▪ Pain → medial meniscus tear o Internal rotation of tibia and varus stress while extending the knee ▪ Pain → lateral meniscus tear Ligamentous Testing o ACL → Lachman test, anterior drawer test, pivot shift test o MCL → Valgus Stress Test (test at 30˚ for isolated, 0˚ for combined MCL / ACL) o LCL → Varus Stress Test (test at 30˚ for isolated, 0˚ for combined LCL / PCL) o PCL → Posterior Drawer Test, Posterior Sag sign Meniscus injury o Joint line tenderness (medial or lateral respectively), McMurray’s test 36 Clinical Presentation of Knee Disorders Osteochondritis dissecans o Pathogenesis: localized necrosis of subchondral bone caused by repetitive trauma or stress. Often associated with loose, intra articular cartilage fragments o Clinical features: pain, mechanical joint symptoms (locking/catching secondary to loose intra-articular fragments) Knee dislocation o Management ▪ Closed reduction (anterior / posterior dislocation) ▪ Open reduction (posterolateral dislocation) o Ankle brachial indices (ABI) ▪ Ratio of systolic ankle blood pressure to systolic brachial blood pressure ▪ Abnormal value → peripheral artery disease (PAD) Medial collateral ligament (MCL) injury o Physical exam: widening of medial joint space with valgus stress Anterior cruciate ligament (ACL) injury o Clinical features: non-contact pivoting injury, immediate hemarthrosis o Physical exam: + anterior drawer, + Lachman Posterior cruciate ligament (PCL) injury o Clinical features: Dashboard injury o Physical exam: + posterior drawer Osgood-Schlatter disease o Pathogenesis: traction apophysitis of patellar tendon in active adolescents o Clinical features: anterior knee pain worse with activity o Physical exam: enlarged, tender tibial tubercle with pain on resisted knee extension Genu valgum o Valgus (lateral) misalignment of knee, results in knocked-knee deformity Genu varum o Varus (medial) misalignment of knee, results in bowleg deformity Baker’s cyst o Clinical features: synovial cyst in the popliteal fossa between the semimembranosus and medial head of the gastrocnemius muscles 37  Prepatellar bursitis (“housemaid’s knee”) o Pathogenesis: repeated kneeling → inflammation of prepatellar bursa o Clinical features: localized anterior knee swelling and pain “Unhappy triad” injury (lateral force applied to planted leg injury) o ACL tear, MCL tear, and medial meniscus tear (medial meniscus is attached to MCL) o Acute ACL tears is most commonly associated with lateral meniscus pathology 38  6. Hip Learning Objectives Identify the basic components of the physical examination of the hip Understand the implications of the FABER Test, FADIR Test, Log Roll Test, Stinchfield Test, Thomas Test, and Ober’s Test Recognize and understand the pathophysiology of the Trendelenburg gait Identify the clinical presentation, PE findings, and basic management of the following hip disorders: ○ Trochanteric bursitis ○ Slipped capital femoral epiphysis ○ Legg-Calve Perthes ○ Developmental dysplasia of hip ○ Fracture of femoral neck ○ Fractures of femur 39 Basic Anatomy of the Hip 40 Normal Physical Exam Components of the Hip 41 Key Physical Exam Maneuvers Trendelenburg Sign o Standing: lift one leg (flex hip) o Flexed side: pelvis should elevate o If pelvis falls → gluteus medius weakness (superior gluteal n. dysfunction) FABER (Patrick's Test) o Flex, ABduct, External Rotation of the hip, then abduct more o Pain in hip → sacroiliac (SI) joint pathology FADIR o Flex ADduct, Internal Rotation of the hip, then adduct more o Pain in the groin → hip impingement Log Roll o Supine, hip extended: internal rotation / external rotation o Pain in hip → arthritis 42  Stinchfield Test o Resisted straight leg raise o Pain → hip pathology Thomas Test o Supine, one knee to chest o Opposite thigh elevates off table → flexion contracture Ober’s Test o On side: flex and abduct hip o Extend and adduct hip, unable to adduct→ IT band tightness 43 Clinical Presentation of Hip Disorders Trochanteric bursitis o Pathophysiology: irritation of trochanteric bursa from repeated tracking of iliotibial band over greater trochanter o Clinical features: lateral hip pain o Physical exam: TTP over greater trochanter Slipped capital femoral epiphysis (SCFE) o Pathophysiology: Slipping of femoral metaphysis relative to the epiphysis o Risk factors: obesity, male sex, periods of rapid growth, hypothyroidism o Clinical features: groin/thigh pain (may be referred to knee), antalgic limp in teenage years Legg-Calve Perthes o Pathophysiology: idiopathic avascular necrosis of the femoral head o Clinical features: antalgic gait, hip pain (may be referred to knee) in a young child (ages 4-10; earlier onset than SCFE) Developmental dysplasia of hip (DDH) o Hip instability, hip subluxation, or hip dislocation → abnormally developed, shallow acetabulum o Clinical features: clunk on hip examination, limited hip abduction o Most common congenital abnormality of skeletal development 44 Radiological Findings Fracture of Femoral Neck Fractures of Femur 45  7. Ankle & Foot Learning Objectives Know the basic anatomy of an ankle deltoid ligament injury Know the basic components of the physical examination of the foot and ankle Understand the implications of the Anterior Drawer Test, Inversion Stress Test, and Thompson Squeeze Test Identify the clinical presentation, PE findings, and basic management of the following knee disorders: ○ Ankle Fracture (injury to deltoid ligament) ○ Achilles’ tendon rupture ○ Sprains Anterior talofibular ligament Lateral ligament Tibial collateral ligament ○ Enthesopathy of the ankle ○ Plantar fasciitis ○ Charcot joints ○ Pes planus ○ Varus and valgus deformities of foot 46 Basic Anatomy of the Ankle & Foot 47 48 Normal Physical Exam Components of the Ankle & Foot 49 Key Physical Exam Maneuvers Anterior Drawer Test o Stabilize the tibia, plantarflex the foot, apply anterior force on the heel o Increased laxity → anterior talofibular ligament (ATFL) ligament injury Inversion Stress Test o Stabilize the tibia, dorsiflex the foot, invert the foot o Increased laxity → calcaneofibular (CFL) ligament injury Thompson Squeeze Test o While prone, squeeze the calf o Absent foot plantarflexion → Achilles tendon rupture Clinical Presentation of Ankle & Foot Disorders Achilles’ tendon rupture o Risk factors: fluoroquinolone use, steroid injections o Clinical features: patient reports a “pop” usually during sporting activity o Physical exam: + Thompson test “Low” ankle sprains (more common than “high” ankle sprain) o Anterior talofibular ligament (most common) ▪ Injury with ankle plantarflexion and inversion ▪ Tenderness along ATFL 50  o Calcaneofibular ligament ▪ Injury with ankle dorsiflexion and inversion ▪ Tenderness along CFL Plantar Fasciitis o Pathogenesis: Inflammation of plantar fascia o Risk factors: obesity, abrupt increases in physical activity levels, foot deformity, standing/bearing weight on feet for long periods of time o Clinical features: sharp pain at heel that is worse after prolonged weight-bearing or after periods of inactivity (upon waking up and taking first few steps); bilateral is common o Physical exam: point tenderness at medial tuberosity of calcaneus Charcot Neuropathy o Risk factors: diabetic neuropathy, leprosy, tabes dorsalis, alcoholism o Pathogenesis: loss of joint sensation and proprioception → repetitive microtrauma → joint destruction Acquired Pes Planus (“flat foot”) o Pathogenesis: tibialis posterior tendon dysfunction 51  8. Bone Biology & Bone Tumors Learning Objectives Explain how disruptions of ossification, growth, remodeling and repair can lead to selected neoplasms of bone (eg.osteosarcoma, Ewing sarcoma, chondrosarcoma, osteochondroma, osteoid osteoma, osteomalacia, osteoblastoma, giant cell tumor) Recognize that unregulated growth and stimulation of chondroblasts can result in chondroblastomas (benign tumor) or a chondrosarcoma (malignant tumor) Differentiate between histology findings of osteosarcoma, Ewing sarcoma, chondrosarcoma, osteochondroma, osteoid osteoma, osteomalacia, osteoblastoma, giant cell tumor Distinguish between clinical features of benign neoplasms of bone (eg. osteochondroma, osteoma, osteoid osteoma, osteoblastoma, chondroma, giant cell tumor) Recognize and distinguish between malignant neoplasms of bone & cartilage (eg, osteosarcoma, chondrosarcoma, Ewing sarcoma) and metastases to bone/secondary malignant neoplasm of bone by primary localization, typical patient age demographics, and radiographic findings in the context of clinical cases 52 Basic Bone Biology 53 54 55 56 Clinical Presentation of Bone Tumors Ewing sarcoma o Malignant bone tumor arising from neuroectodermal cells o Associated with chromosomal translocations of EWSR1 gene (chr. 22) o Location: diaphysis of long bones (femur, fibula, tibia, humerus) Osteoid Osteoma o Small benign bone tumor (< 2 cm) o Location: cortex of long bones o Responsive to NSAID therapy Osteoblastoma o Large benign bone tumor (> 2 cm) o Location: cortex of long bones o NOT responsive to NSAID therapy Osteosarcoma o Most common primary malignant bone tumor in adolescents o Arises from mesenchymal stem cells (osteoblasts) o Location: metaphysis of long bones (distal femur, proximal tibia) Osteochondroma o Most common primary benign bone tumor o Bony outgrowth (exostosis) with a cartilaginous cap on surface of long bones, next to growth plates o Location: metaphysis of long bones Giant Cell Tumor (Osteoclastoma) o Benign bone tumor composed of giant cells from the bone marrow o Location: epiphysis or metaphysis of long bones (especially the knee) Osteomalacia o Defective bone matrix mineralization o Common etiology: Vitamin D deficiency o Symptoms: bone pain & tenderness Chondroblastoma o Benign cartilage tumor o Location: epiphysis of long bones Chondrosarcoma o Most common bone tumor in adults o Malignant bone tumor arising from mesenchymal stem cells (chondroblasts) o Location: medullary cavity of pelvis, ribs, proximal femur, proximal humerus 57 9. Additional Videos Upper Extremities: https://www.youtube.com/watch?v=4kYX8GHnbVU Lower Extremities: https://www.youtube.com/watch?v=nQg5xQEF6Os Spine & Back: https://www.youtube.com/watch?v=Ahn69klysEA 58  10. Abbreviations AC joint = acromioclavicular joint ACL = anterior cruciate ligament APL tendon = abductor pollicis longus tendon AROM = active range of motion ASIS = anterior superior iliac spine ATFL = anterior talofibular ligament CFL = calcaneofibular ligament CMC joint = carpometacarpal joint CTS = carpal tunnel syndrome DDH = developmental dysplasia of the hip DIP joint = distal interphalangeal joint DJD = degenerative joint disease EPB tendon = extensor pollicis brevis tendon ER = external rotation FCU tendinitis = flexor carpi ulnaris tendinitis Fx = fracture GT = greater trochanter IP = interphalangeal IR = internal rotation IT band = iliotibial band LCL = lateral collateral ligament LM = lateral malleolus LT = lesser trochanter MCL = medial collateral ligament MCP joint = metacarpophalangeal joint MP joint = metacarpophalangeal joint MT adductus = metatarsus adductus MT head = metatarsal head MTP joint = metatarsophalangeal joint OA = osteoarthritis ORIF = open reduction and internal fixation PCL = posterior cruciate ligament PIP joint = proximal interphalangeal joint PROM = passive range of motion PSIS = posterior superior iliac spine PTFL = posterior talofibular ligament RA = rheumatoid arthritis RC tear = rotator cuff tear ROM = range of motion SCFE = slipped capital femoral epiphysis SI joint = sacroiliac joint SLAP tear = superior labrum from anterior to posterior TCL = transverse carpal ligament TFCC = triangular fibrocartilage complex TTP = tenderness to palpation VMO = vastus medialis obliquus WB = weight-bearing 59 References Thompson JC Netter FH. Netter's Concise Orthopaedic Anatomy. 2nd ed. Philadelphia PA: Saunders Elsevier; 2010. 60