NMS Q&A Family Medicine

Musculoskeletal Problems of the Upper Extremities 1458 A 35-year-old house painter who was a catcher inbaseball on his high school and industrial leagueteams complains of right shoulder pain that hasbecome increasingly annoying over the past 3 weeks.His pain interferes with his work because it is engenderedby the motion of abduction and by forwardplacement of his dominant right arm. Which of thefollowing maneuver would be useful in determiningwhether this man has the impingement syndrome?(A) Testing the proximal biceps insertion for tenderness(B) Patient actively supinating the forearm againstresistance(C) Passive inversion of the shoulder while the armis forward, held in the horizontal(D) Testing for pain with active extension of theelbow against resistance(E) Observe patient’s performance of digit tothumb apposition9 A 35-year-old man, while playing touch football at afamily reunion, fell on his abducted right shoulderwith his right arm in abduction behind his back. Heheard a “pop.” The patient is fully alert but in pain,holding his right arm with his left; the arm is held inslight abduction and external rotation. On examinationhis right acromion is prominent, a depression isnoted in the superior portion of the deltoid, and hisright humeral head is palpated anterior to the acromion.Which of the following fractures is commonlyassociated with this dislocation?(A) Fracture of distal third of clavicle(B) Posterolateral humeral head(C) Posterior rim of glenoid(D) Transverse fracture of upper third of humerus(E) Coracoid process fracture10 A 21-year-old wide receiver on a prominent collegefootball team, in catching a pass, makes a twistingleap and lands directly on his right shoulder. Immediatelyhe is in pain, holding his right arm with hisleft hand. There is no glenohumeral tenderness, andthere is full range of motion. The right acromionmanifests prominence that is reduced by downwardpressure on the clavicle. There is tenderness andecchymosis around the acromioclavicular (AC) joint.Distal motion, pulses, and sensory examinations arenormal. Which of the following examinations orancillary studies would you obtain?(A) Anteroposterior (AP) and lateral and modifiedaxillary view of left shoulder(B) Magnetic resonance image (MRI) of the leftshoulder(C) AP views of both AC joints with the patientholding 10-lb (4.5-kg) weights in each hand(D) Right clavicle x-ray(E) Arthrogram of left AC joint11 A 35-year-old male mechanic sustained a small puncturewound on the volar surface of his left index fingerwhile working on an engine. Three days later hecomplains of increasing pain in the digit. You find thefinger to be swollen to about half above its normaldiameter and being held in a semi-flexed position.There is pain with passive extension of the finger, andthe hand otherwise presents no remarkable change.Active flexion and extension are intact thoughpainful. Which of the following is the most likelydiagnosis?(A) Cellulitis of the hand(B) Palmar space infection(C) Flexor tendon rupture of the index finger(D) Tenosynovitis of the flexor tendon(E) Stoving injury involving the joint capsule of theproximal interphalangeal (PIP) joint12 A 32-year-old former competitive athlete complainsof 3 weeks of right elbow pain, coming on 2 weeksafter he had decided to take up tennis. There has beenno trauma to the elbow. He first noted his pain whenperforming his backhand stroke on the tennis court.Later he began to complain of pain upon shakinghands, turning a screwdriver, and now even when heturns a doorknob. He denies any other musculoskeletalsymptoms. He is afebrile, and there is no elbowjoint swelling or discoloration. There is tendernessover the lateral epicondyle of the proximal forearm.Which of the following therapeutic approacheswould be inappropriate?(A) Addressing the ball with increased wrist andelbow extension during the backhand stroke(B) Hand grip exercises with a rubber ball(C) Forearm splinting(D) Paralesional injection of a glucocorticoid solution(E) Cold applications to the elbow13 A 35-year-old woman has an accident in the kitchenwith a paring knife. As she is brought to your office,you note a laceration of the skin across the dorsum ofthe PIP joint of the middle finger of the left hand.You note also that the PIP joint is in partial flexionwhile the distal interphalangeal (DIP) joint is inextension. Which of the following injuries causes thisresult?(A) Collateral ligament injury(B) Transection of the flexor tendon of the middlefinger(C) Laceration of the central slip of the extensortendon