Anatomy of the lower leg

1. What are the anterior muscles of the lower leg?
2. What are the lateral muscles of the lower leg?
3. What are the posterior muscles of the lower leg?
4. What are the four compartments of the lower leg?

Answers:
1. Dorsiflexors and extensors: tibialis anterior, EHL, EDL, and peroneus tertius.
2. Peroneus brevis and longus.
3. Gastronemius, plantaris, soleus, FDL, tibialis posterior, FHL, popliteus.
4. Anterior, lateral, deep posterior, and superficial posterior.

Osteochondritis dissecans

1. What is osteochondritis dissecans?
2. How does OD present?
3. How is it diagnosed?
4. What is the treatment?

Answers:
1. Localized area of avascular necrosis of end of long bone with degeneration of overlying cartilage, which may detach and enter joint space. Medial femoral condyle is most often affected.
2. Primarily seen in adolescents. Joint pain and irritation, synovial effusion, buckling, locking.
3. Radiographs, CT.
4. Rest, NWB on knee. If no healing or if fragment detaches, surgical excision may be required.

Jumper's knee

1. What is jumper's knee?
2. How does jumper's knee present?
3. How is jumper's knee treated?

Answers:
1. Patellar tendinitis associated with micro-tears of the tendon, associated with jumping, squatting and kneeling.
2. Pain on activity, worse after activity. Tenderness at inferior or superior pole of patella.
3. Same treatment of patellofemoral syndrome.

Plica

1. What is plica of the knee?
2. What is the presentation of plica?
3. How is plica diagnosed?
4. What is the treatment of plica?

Answers:
1. Plica is a redundant fold in the synovial lining of the knee, which is susceptible to tearing.
2. Insidious onset of anterior knee pain, especially with prolonged knee flexion or sitting. The plica can also become inflamed after knee trauma.
3. MRI, arthrogram, and arthroscopy.
4. Treatment same as for patellofemoral syndrome. Consider surgery if conservative measures fail.

Patellar chondromalacia

1. What is chondromalacia of the patella?
2. What predisposes to patellar chondromalacia?
3. What imaging should be ordered?
4. What is the treatment?

Answers:
1. Softening of the patellar articular cartilage, which is the culmination of cartilage degeneration.
2. Chronic patellofemoral overload and tracking dysfunction, infection, trauma, autoimmune processes.
3. CT or MRI may detect defects in articular cartilage of patella.
4. Correct abnormal patellar mechanics.

Patellofemoral pain

1. What is patellofemoral pain?
2. What is the presentation of patellofemoral syndrome?
3. What conditions predispose to PF syndrome?
4. What imaging is required for PF syndrome?
5. What is the nonsurgical treatment of PF syndrome?
6. What are surgical options for PF syndrome?

Answers:
1. Overuse injury caused by repeated microtrauma leading to peripatellar synovitis.
2. Presentation is as anterior knee pain w/wo effusion or crepitus, worse with stairs.
3. High riding, laterally shifted patella, which may be due to VL tightness and relative medial weakness, tight lateral retinaculum, rotation of patella, tight hip flexors or abductors or hamstrings, increased Q angle.
4. X-ray to assess patella position. MRI not useful, CT used if growth plate involvement or tumor is suspect.
5. Use ice and NSAIDs in acute phase, patellar taping and bracing, therapy including strengthening of VMO, stretching of hamstrings, IT band, adductors, and VL, proprioceptive exercises.
6. Surgical options are lateral release of retinaculum, patellar realignment, patellar tendon transfer, patellectomy. Consider surgery if no improvement after 4-6 mo.
7.

Recurrent patellar subluxation

1. What are factors that may predispose to patellar subluxation?
2. What are the signs and symptoms of patellar subluxation?
3. What imaging should be done to assess for subluxation?

Answers:
1. Less prominent lateral lip or more prominent medial lip, increased genu valgum/varus, excessive genu recurvatum, vastus medialis weakness, tibial external torsion, shallow lateral femoral condyle, laterally attached infrapatellar tendon.
2. Knee buckling, pain and tenderness in the peripatellar region, effusion, wasting of vastus medialis, impaired extension.
3. Lateral view in 45 degrees knee flexion and in full extension, sunrise view.

Hypermobility

Beighton criteria:

--1 pt: if you can bend place hands flat on floor without bending knees
--1 pt: for each knee that bends backwards
--1 pt: for each elbow that bends backwards
--1 pt: for each thumb that bends to touch the forearm
--1 pt: for each hand where you can bend the little finger back beyond 90 degrees

A score of 4 or greater indicates hypermobility.

Iliotibial band syndrome

1. Where does the ITB insert?
2. What is the presentation of ITB syndrome?
3. What is the treatment of ITB syndrome?

Answers:
1. On Gerdy's tubercle on the lateral tibia.
2. Pain over lateral femoral condyle, worse with running and walking.
3. Stretching of ITB, hip flexors, gluteus maximus, strengthening of hip abductors, gluetus maximus, and TFL. Injection for resistant cases.

MCL/LCL injuries

1. What is a common cause of MCL injury?
2. What are the exam findings of MCL injury?
3. What imaging is indicated for MCL injury?
4. What is the treatment of MCL injury?
5. How do LCL tears usually occur? How are they evaluated?

Answers:
1. MCL tears occur in football and skiing and are from force to the lateral knee.
2. Exam shows medial swelling and tenderness, minimal effusion, and medial instability.
3. Radiographs may show epiphyseal fracture. MRI delineates the MCL tear and evaluates the ACL and medial meniscus (O'Donaghue's triad).
4. Treat conservatively with knee bracing and strengthening.
5. LCL tears usually occur with knee dislocation. Patient with LCL tear should also be evaluated for associated vascular injury and cruciate and peroneal nerve injuries.

PCL injuries

1. How do PCL injuries often occur?
2. What is the history and physical exam findings for PCL injury?
3. What imaging is used to diagnose PCL injury?
4. What is the treatment of PCL tear?

Answers:
1. Most frequent cause is hitting the front of the tibia with the knee flexed (dashboard injury) or hyperflexion in athletes. Less common than ACL.
2. May be a pop, minimal swelling that increases over 24 hours. Exam shows popliteal tenderness, an effusion, positive posterior drawer and sag tests.
3. MRI less accurate than for ACL, arthroscopy more accurate than MRI.
4. Surgical repair if ligament is avulsed, quadriceps strengthening.

ACL injuries

1. What is the typical mechanism of ACL injury?
2. What is O'Donoghue's triad?
3. What are the symptoms of ACL injury? What are the physical exam findings?
4. What imaging is done for ACL injury?
5. What is the treatment of ACL injury?


Answers:
1. Cutting, deceleration, and hyperextension of the knee, often noncontact injury (football, soccer, downhill skiing). 50% occur with meniscal tears.
2. ACL injury, MCL injury, and medial meniscus injury (since MCL is attached to medial meniscus).
3. Sudden pop with anterior knee pain and posterolateral joint line pain, instability, early swelling. PE shows effusion, tenderness, anterior drawer and Lachman's may be positive.
4. MRI or arthroscopy.
5. If reconstruction is done, partially WB with ROM over first two weeks, then progress to closed chain kinetics. Sports-specific exercises in 6-12 wks.

Meniscal injuries to the knee

1. How do medial and lateral meniscus injuries usually occur?
2. What are the symptoms of acute and degenerative meniscus injury?
3. What is seen on physical exam?
4. What is the imaging gold standard for meniscus injury diagnosis?
5. What is the treatment?

Answers:
1. Medial meniscus: injured with tibial rotation while knee partially flexed (football, soccer). Lateral meniscus: injured during squatting in full flexion with rotation (wrestling).
2. An acute tear is associated with a pop with true locking, effusion, and knee stiffness. Degenerative tears involve minimal trauma in >40 yrs.
3. Decreased ROM, flexion limited by effusion, tenderness at jt line, positive Apley and McMurray tests.
4. MRI.
5. Injury to inner 2/3 of meniscus needs surgery due to poor vascularization. NWB for 4-6 wks after surgery if meniscus repaired, WBAT in 1-2 days if meniscus is removed.

Test of the knee ligaments

1. What may cause an anterior drawer test to be falsely negative?
2. What is the sag test?
3. How does Lachman's test compare to anterior drawer in sensitivity?

Answers:
1. Hemarthrosis, hamstring spasm, meniscal tear, and other structures (posterior capsule) can limit forward movement of tibia.
2. Test for PCL patency. Place patient supine with knee flexed 90 degrees, test is positive if tibia is displaced posteriorly.
3. Lachman's test, in which knee is flexed 15-30 degrees and anterior force is applied to tibia, is more sensitive than anterior drawer.

Physical exam of the knee

1. What is the McMurray test best used for?
2. What is Apley's Grind Test?
3. What is Apley's Distraction Test?
4. What is the Patella Femoral Grind Test?

Answers:
1. Diagnosis of posterior meniscal tears.
2. Test for diagnosis of torn meniscus. Patient lies prone with knee flexed 90 deg while examiner places downward force on heel while rotating tibia. A positive test elicits pain.
3. Test for ligamentous damage. Same as Grind Test, but a traction is applied rather than a downward force, reducing stress on meniscus. Positive test elicits pain.
4. Test to evaluate quality of patella articulating surfaces. Patient is supine with legs in neutral, while examiner pushes on patella distally while patient contracts quads. Patella should glide smoothly up. Positive test is pain and crepitation.

Bursae of the knee

1. What are the anterior bursa of the knee?
2. How is the prepatellar bursa inflamed?
3. How is the superficial infrapatellar bursa inflamed?
4. How many lateral bursae are there?
5. Where is the pes anserinus bursa located?
6. What is a Baker's cyst?

Answers:
1. Prepatellar bursa, suprapatellar bursa, deep infrapatellar bursa, and superficial infrapatellar bursa.
2. The prepatellar bursa is the most commonly damaged, caused by prolonged kneeling: housemaid's knee.
3. Associated with kneeling in an upright position: vicar's knee.
4. Three.
5. Located between the pes anserinus tendons and the MCL.
6. Distension of the bursa between the medial head of the gastrocnemius and the capsule, which is an outpocketing of the synovial membrane.

Other ligaments of the knee

1. Where does the medial collateral ligament attach?
2. Where does the lateral collateral ligament attach?
3. What are the capsular ligaments? What is the function of the capsular ligaments?
4. What is the function of the oblique popliteal ligament? Where does it attach?
5. What is the function and attachment of the arcuate popliteal ligament complex?
6. What can the APLC be mistaken for on MRI?

Answers:
1. The MCL attaches to the medial femoral condyle, to the medial upper end of the tibia, and it has an attachment to the medial meniscus.
2. The LCL attaches to the lateral femoral condyle, to the upper end of the lateral fibula.
3. Tibial collateral ligament, oblique popliteal ligament, arcuate ligament, and fibular collateral ligament.
4. The OPL, which resists knee extension, arises from the semimembranosus tendon and is attached to the posterior capsule and lateral meniscus.
5. The APLC provides attachment for the posterior horn of the lateral meniscus. Its function is to reinforce the lateral knee and prevent posterior tibial subluxation.
6. A tear of the posterior horn of the lateral meniscus.

Ligaments of the knee: ACL and PCL

1. Where does the ACL attach?
2. What is the function of the ACL?
3. If the ACL is deficient, where is extra pressure placed?
4. Where does the PCL attach?
5. What is the function of the PCL?
6. If the PCL is deficient, where is extra pressure placed?

Answers:
1. The ACL attaches to the lateral intercondylar notch (of the femur) and to a point lateral to the medial tibial eminence.
2. Prevents anterior tibial subluxation, prevents backward sliding of femur and hyperextension of knee. In flexion, it draws the femoral condyles anteriorly.
3. Posterior menisci.
4. The PCL attaches to the medial intercondylar notch and to a point lateral to the posterior tibial plateau.
5. Restrain posterior tibial subluxation.
6. Patellofemoral joint.

Menisci of the knee

1. What is the function of the menisci of the knee?
2. What is the vascular supply of the menisci?
3. What are the shapes of the two menisci?

Answers:
1. The menisci are fibrocartilage of crescent shape, which deepen the articular surface of the tibia for stability.
2. The peripheral 1/3 of the menisci are well vascularized and the inner 2/3 of the menisci are not well vascularized and can't usually be surgically repaired.
3. The medial meniscus is C-shaped and adheres to the MCL. The lateral meniscus is circular.

Knee functional anatomy

1. What are the knee extensors?
2. What are the knee flexors?
3. What are the knee medial rotators?
4. What are the knee lateral rotators?
5. What is the function and innervation of the popliteus?

Answers:
1. Quadriceps.
2. Lateral and medial hamstrings, sartorius, gracilis, gastrocnemius.
3. Medial hamstrings, sartorius, gracilis.
4. Biceps femoris.
5. The popliteus locks and unlocks the knee. It is innervated by the tibial nerve (L4, L5, S1).

Osteitis pubis

1. What is the cause of osteitis pubis?
2. How does osteitis pubis present?
3. What is seen on CT/X-rays?
4. What is the treatment of osteitis pubis?

Answers:
1. This is an inflammatory condition of the pubic rami, caused by adductor overuse.
2. Pubic symphysis or groin pain radiating into the thigh, causing popping with ambulation and pain with resisted adduction.
3. Periosteal thickening.
4. Rest, NSAIDs, steroid injection, physical therapy. Surgery for severe cases.

Avulsion fractures in the hip

1. How do ischial tuberosity avulsion fractures usually occur? What is the presentation? How is it distinguished from ischial tuberosity bursitis?
2. How are ischial tuberosity avulsion fractures treated?
3. How are ASIS avulsion fractures caused? What is the presentation?
4. What is the treatment of ASIS avulsion fractures?
5. What is the cause of AIIS avulsion fractures? What is the presentation?
6. What is the treatment of AIIS avulsion fractures?

Answers:
1. They are caused by forceful hamstring contracture with knee in extension and hip in flexion. The presentation is of sudden pain and tenderness over the ischial tuberosity, whereas ischial is of insidious onset.
2. Rest, ice, weight bearing as tolerated. Resistance exercises can be started after achieving a full ROM.
3. ASIS avulsion is caused by forceful contraction with hip extended and knee flexed. The lateral femoral cutaneous nerve may be involved and there is acute pain and tenderness over the ASIS, with hip flexion pain.
4. Rest, ice, weight bearing as tol. May require knee splinting in flexion.
5. AIIS avulsion is caused by forceful kicking and quad contraction. Presentation is as pain over AIIS or acute groin pain.
6. Treatment is with rest and ice, weightbearing as tolerated.

Slipped capital femoral epiphysis (SCFE)

1. What is SCFE?
2. What is the most common age for SCFE?
3. What is the presentation of SCFE?
4. What will radiographs show?
5. What is the treatment of SCFE?

Answers:
1. Injury to epiphyseal growth plate at the head of the femur --> displacement of plate.
2. 11-16 yrs.
3. Usually presents as groin pain, but may present as thigh or knee pain. Antalgic gait, with limited int hip rotation.
4. Medial and posterior displacement of epiphysis.
5. NWB, surgery. Endocrine testing for growth hormone, thyroid, panhypopituitarism, MEN.

Femoral neck stress fractures

1. What are the two types of femoral stress fractures? Which is more stable?
2. What is the presentation of a femoral stress fracture?
3. How long does it take for bone scan to turn positive after onset of symptoms?
4. What is the treatment for the two types of fracture?

Answers:
1. Compression and transverse fractures. Compression fx are more stable and occur at the inferior neck of the femur. Transverse fx is unstable and occurs in superior femur.
2. Groin pain worse with ADLs, pain with int/ext rotation.
3. 2-8 days.
4. Compression-type fracture should be treated with bed rest, then weightbearing with pain free. Transverse fractures should be treated with internal fixation.

Intertrochanteric and subtrochanteric hip fractures

1. What is the most common type of hip fracture?
2. What is the general presentation of hip fracture?
3. What type of hip fracture is the most difficult to stabilize surgically? Why?
4. When does rehab start after subtrochanteric hip fracture?

Answers:
1. Intertrochanteric.
2. Hip pain, externally rotated and shortened limb.
3. Subtrochanteric is most difficult to stabilize due to high mechanical stresses.
4. Start rehab after healing is evident.

Femoral neck fractures

1. What are modifiable risk factors for hip fracture?
2. What are complications of a femoral neck fracture? What are complications of surgery for femoral neck fx?
3. What is the presentation for hip fracture?
4. What are the four stages of femoral neck fx?
5. What are the treatments of femoral neck fx?

Answers:
1. Alcohol, caffeine, smoking, antipsychotics, benzos, malnutrition, low body weight.
2. Morbidity from disruption of blood vessels to femoral head, causing necrosis. Postop, can have nonunion or osteonecrosis.
3. Hip pain, limb ext rotation, and apparent shortened limb.
4. Garden stages: I is incomplete, nondisplaced. II is complete, nondisplaced. III is displaced with hip joint capsule partially intact. IV is displaced with hip joint capsule completely disrupted.
5. For stages I and II, pins across fx site, early rehab. For stages III and IV, replacement of femoral head, followed by rehab with hip precautions (no flexion >90, no adduction or internal rotation).

Avascular necrosis of the femoral head

1. What is the definition of avascular necrosis? What are the most common causes?
2. What is avascular necrosis of the hip called in children aged 2-12?
3. What are the symptoms of avascular necrosis of the hip?
4. What is seen on MRI in avascular necrosis?
5. What is the treatment?

Answers:
1. Death of femoral head without sepsis, commonly caused by steroid use or alcohol abuse.
2. Legg-Calve-Perthes disease.
3. Insidious onset of groin, anterior thigh, or knee pain, with short swing and stance phase, and loss of hip rotation.
4. MRI shows irregular or mottled femoral head.
5. Bracing or casting in peds population. In adults, osteotomy of femoral head if disease not advance, but may require THA.

Posterior hip dislocation

1. What is the most common type of hip dislocation?
2. How does posterior hip dislocation often occur?
3. What nerve is often damaged in posterior hip dislocation?
4. What is the appearance of a posterior hip dislocation?
5. How is posterior hip dislocation treated?

Answers:
1. Posterior (90%).
2. MVA in which knee strikes dashboard.
3. Sciatic nerve.
4. Flexed, adducted, and internally rotated. It may appear shorter.
5. Surgery (emergent).

Greater trochanteric bursitis

1. Where is the trochanteric bursa located?
2. What conditions is trochanteric bursitis associated with?
3. What are the symptoms?
4. What is the provocative test?
5. What is the treatment?

Answers:
1. Located over greater trochanter and deep to gluteus medius, gluteus minimus, and TFL.
2. Hip OA, obesity, leg length discrepancy, direct trauma, overuse, herniated lumbar disc, and hemiparesis.
3. Night pain, inability to like on affected side, hip snapping.
4. Pain over greater troch during movement from full extension to flexion.
5. IT band stretching, NSAIDs, hip adductor strengthening, local cortisone injection.

Groin strain

1. How does groin strain (hip adductor strain) usually occur?
2. What are the symptoms of groin strain?
3. What is the provocative test?
4. What imaging should be ordered?
5. What is the treatment?

Answers:
1. Resisted forced abduction of the hip.
2. Pain in the adductors distal to their origin.
3. Pain with resisted hip adduction.
4. X-rays of hip including adductor tubercle to rule out avulsion.
5. Rest, ice, NSAIDs, advance to stretching and strengthening.

Iliopsoas bursitis and tendonitis

1. What are the symptoms of iliopsoas tendonitis or bursitis?
2. What is the provocative test?
3. What is the treatment?

Answers:
1. Hip snapping with flexion due to IT band snapping over greater trochanter or iliopsoas tendon subluxing, tenderness over iliopsoas muscle.
2. Pain on hip flexion.
3. Ice, NSAIDs, stretching and strengthening, cortisone injections.

Piriformis syndrome

1. How is the piriformis usually injured?
2. What are the clinical symptoms of piriformis syndrome?
3. What is the provocative test for piriformis syndrome?
4. What is the treatment?

Answers:
1. Poor body mechanics, forceful hip internal rotation. (Sciatic nerve may be involved.)
2. Pain in lateral buttock, posterior hip and prox posterior thigh, SI joint, with tenderness over the muscle belly going from the sacrum to the greater trochanter. It is exacerbated by walking up stairs.
3. Pain with internal hip rotation, adduction, and flexion.
4. Stretching, NSAIDs, US, local cortisone injection.

Hamstring strain

1. What are predisposing factors to hamstring strain?
2. What is the strength ratio of hamstrings to quads?
3. What are the grades of hamstring strain?
4. What is the provocative test for hamstring strain?
5. what is the treatment of hamstring strain?

Answers:
1. Inadequate warmup, poor flexibility, exercise fatigue, poor conditioning, and muscle imbalance.
2. 3:5.
3. Grades I (strain) to III (complete tear).
4. Pain in ischial region with knee flexion.
5. Ice, compression, weight bearing reduction, NSAIDs, gentle stretch.

Leg length discrepancy

1. How is a true leg length discrepancy assessed?
2. How do you measure for discrepancy in the femur?
3. How do you measure an apparent leg length discrepancy?
4. What are the causes of an apparent leg length discrepancy?

Answers:
1. Measure from ASIS to the medial malleoli.
2. Patient lies supine and flexes knees to 90 degrees, assess if one knee is higher than the other.
3. Measure from umbilicus to medial malleoli.
4. Pelvic obliquities or flexion/adduction deformities of the hip.

Tests of the hip joint

1. What is FABER (Patrick) test used to assess?
2. What is Thomas test used to assess?
3. What is Ober's test used to assess?
4. What conditions are associated with a positive Trendelenberg?

Answers:
1. Inguinal pain in flexion, abduction, and external rotation is an indication of hip joint pathology.
2. Hip flexion contractures.
3. Iliotibial band and TFL contractures.
4. Trendelenberg indicates gluteus medius weakness, associated with radiculopathy, polio, meningomyelocele, fractures of greater trochanter, SCFE, congenital hip dislocation.
6.

Ligaments of the hip

1. What is the purpose of the acetabular labrum?
2. What is the iliofemoral ligament?
3. What ligament checks medial rotation? Abduction?
4. What is the first ROM to be limited in OA?

Answers:
1. Deepens acetabulum and holds femoral head in place.
2. The iliofemoral ligament (Y-ligament of Bigelow) is the strongest ligament in the body, going from the AIIS to the intertrochanteric line.
3. The ischiofemoral ligament checks medial rotation. The pubofemoral ligament checks abduction.
4. Internal rotation.

Hip muscles

1. What are the hip flexors?
2. What are the hip adductors?
3. What are the hip abductors?
4. What are the hip extensors?
5. What are the lateral rotators of the hip?
6. What are the medial rotators of the hip?

Answers:
1. Flexors: iliopsoas, sartorius, rectus femoris, gracilis, adductor longus, adductor brevis, adductor magnus, pectineus, TFL.
2. Anterior: gracilis, adductor magnus, adductor brevis, adductor longus, pectineus. Posterior: gluteus maximus, obturator externus, gracilils, biceps long head, medial hamstrings.
3. Gluteus medius, gluteus minimus, TFL, sartorius, piriformis, gluteus maximus.
4. Gluteus maximus, gluteus minimus, gluteus medius, piriformis, adductor magnus, hamstrings.
5. Piriformis, obturator internus, gemelli, obturator externus, quadratus femoris, gluteus muscles.
6. TAGGGSS: tFL, adductors (magnus, longus, brevis), gluteus medius, gluteus minimus, gracilis, semitendinosus, semimembranosus.

Proximal humerus fractures

1. How much must a portion of the humerus be displaced to call it a fragment?
2. What is the most common location of humerus fractures? What are other locations?
3. What are the symptoms of proximal humerus fracture?
4. What are the surgical and non-surgical treatments?
5. What are complications of proximal humerus fracture? What nerve is often involved in surgical neck fractures?

Answers:
1. Angulated by 45 degrees or displaced >1cm.
2. Most common is the surgical neck, followed by the greater tuberosity, lesser tuberosity, and anatomical neck.
3. This fracture is common in osteoporotic elderly women after a fall and involves pain, swelling, and ecchymosis. Loss of sensation or diminished radial pulse may occur. If there's a fracture of the surgical neck, the supraspinatus causes abudction of the proximal fragment of the humerus.
4. Conservative treatment is early ROM, sling immobilization, rehab, pendulum exercises. If displaced, need ORIF.
5. Complications include brachial plexus injury, axillary artery compromise, and avascular necrosis of the humeral head. The axillary nerve is involved in surgical neck fractures.

Scapula and Clavicular fractures

1. What other significant injuries may be associated with a scapula fracture? How is it diagnosed?
2. What is the treatment for a scapula fx?
3. How are clavicular fractures classified?
4. What is the treatment of clavicular fx?

Answers:
1. Rib fx, pulmonary pathology (contusion, ptx) is associated with scapula fx. It is diagnosed by plain films (AP, lateral (scapular Y), and axillary) or CT.
2. Closed treatment for nondisplaced fx (sling, early ROM within 1-2 wks). ORIF for large displaced fragments.
3. By location: proximal, middle, or distal thirds.
4. Conservative treatment for most fxs. If >1cm displacement of lateral clavicle at AC jt, do closed reduction and figure 8 sling immobilization 3-6wks.

Adhesive capsulitis

1. What are the stages of adhesive capsulitis?
2. What conditions is adhesive capsulitis associated with?
3. What imaging is done for adhesive capsulitis?
4. What is the conservative treatment?
5. What is the surgical treatment?

Answers:
1. The first, painful stage is a progressive vague pain lasting 8 months, the second stiffening stage lasts about 8 months with decreasing ROM, and the third thawing stage results in increasing ROM with decreased pain.
2. CVA, hemorrhage, brain tumor, clinical depression, shoulder-hand syndrome, Parkinson's disease, iatrogenic disorder, cervical disc disease, IDDM, hypothyroidism.
3. Do plain films to rule out underlying tumor or calcium deposit or if there is not improvement with 3 months of treatment, arthroscopy shows decreased joint volume.
4. Restoring ROM, decrease pain, corticosteroid injection, home program, modalities.
5. Manipulation under anesthesia or arthroscopic lysis of adhesions.