daily question
Scott Rand
A 21 year old type 1 diabetic athlete begins training for a 50 mile bike ride with a partner. She uses an insulin pump and is experienced with running cross country in high school. During her first 30 mile ride she experiences symptoms of hypoglycemia at 25 miles and almost falls before stopping. She is confused and her BS is 40.
What is the most appropriate immediate action?
A. Eat a banana or sports bar
B. Administration of glucagon by her partner
C. Drink a carbohydrate sports drink then quickly resume riding to reach a safe destination
D. Drink 8 ounces of water to improve volume status
Scott E Rand, MD FAAFP CAQSM
Director, Primary Care Sports Medicine Fellowship
Co Director of Sports Medicine, Houston Methodist Orthopedics and Sports Medicine Willowbrook
Assistant Professor of Clinical Family Medicine Houston Methodist Academic Institute
Adjunct Assistant Professor of Family and Community Medicine, Texas A&M University
Assistant Professor of Family Medicine in Clinical Medicine Weill Cornell Medical College.
13802 Centerfield Dr Suite 300
Houston, TX 77070
Scott Rand
Which of the following is
a contraindication for the use of cryotherapy in acute musculoskeletal
injuries?
A. Muscle soreness after exercise
B. Raynaud’s phenomenon
C. Local inflammation
D. Joint effusion
Scott Rand
What is the boutonniere deformity of the finger and
how is it different from the pseudoboutonniere deformity?
Scott Rand
1. A 15 year old rugby player presents with a left 4th finger injury. She is unable to flex the DIP and there is fullness along the flexor tendon. What is the appropriate course of treatment?
A. Ice and NSAIDs
B. Early surgical intervention
C. Custom splint during games
D. Buddy taping to left third finger
Scott Rand
A 25 year old male presents with thumb pain after a fall while skiing. On exam, his MCP joint is grossly unstable and MRI reveals a Stener lesion. Optimal management of this injury requires
A. Thumb splinted in extension for 4 weeks
B. Thumb spica splint x 6 weeks
C. Short arm cast for 6 weeks
D. Surgical repair
Scott Rand
: Wrestlers with herpes gladitorum must have no lesions and have been treated with antiviral medications for ___ days before being allowed to participate
Scott Rand
Which of the following statements is true regarding skin infection in athletes?
A. Rifampin is the first line treatment for MRSA infections
B. Any skin wound that is suspicious for Staphylococcus infection should be cultured
C. The gold standard treatment of MRSA is appropriate oral antibiotics
D. First line treatment of MRSA should be topical antibiotics
E. Special cleaning of locker room, equipment and playing area is needed if MRSA is diagnosed in
Scott Rand
How do you advise your patient to avoid being this guy in the marathon
Scott Rand
A 17 year old male high school baseball pitcher presents to your sports medicine clinic for review of a MRI ordered by another physician. The pitcher has pain in his throwing shoulder. The MRI demonstrates bone marrow edema and cortical flattening suggestive of a Hill-Sachs lesion in the proximal humerus with subchondral sclerosis in the posterosuperior aspect of the glenoid. You would anticipate which of the following physical exam findings based on the imaging study?
A. Visible atrophy of the supraspinatus and infraspinatus with muscular weakness on testing
B. Posterior shoulder pain with passive abduction and external rotation of the affected shoulder
C. Marked weakness of shoulder internal rotators
D. Enlarged cervical and peri-clavicular lymph nodes
Scott Rand
A 23 y/o mountain bike racer flips over his handlebars and lands on the posterior superior portion of his right shoulder. Evaluation in the medical tent demonstrates significant weakness with resisted extension of the shoulder when tested at 90 degrees flexion, 30 degrees lateral to the coronal plane, and with hand pronated (empty can test) as well as an inability to initiate abduction of the involved arm. The patient also has weakness with resisted external rotation. There are no sensory deficits to light touch or pin prick over the shoulder, arm, thorax or back. Which nerve has most likely been injured?
A. Axillary nerve
B. Subscapular nerve
C. Suprascapular nerve
D. Dorsal scapular nerve
Scott Rand
The “clunk test” evaluates shoulder pathology caused by the following:
A. Impingement
B. Tendinopathy
C. Labral tears
D. Sliding Biceps tendon
E. Instability
Correct: C
Snapping shoulder syndrome may be related to an intraarticular or extraarticular pathological condition. The initial evaluation of a patient with snapping shoulder should include thorough examination for mild glenohumeral instability and labral defects, which can be evaluated by the “clunk” test. This test, as described by Andrews and Gillogly, is performed with the patient supine and the arm in full overhead abduction. One of the examiner”s hands is placed posterior to the humeral head to apply anterior pressure while the other hand is placed at the level of the humeral condyles to provide rotation and axial loading. A “clunk” or grinding may indicate a Bankart lesion or a labral tear caused by instability.
1. Canale: Campbell”s Operative Orthopaedics, 10th ed. 2003
Scott Rand
What is felt to be the function of Lister’s tubercle?
Scott Rand
A 27 year old white male complains of pain and numbness in his palm and 4th and 5th fingers after his recent karate tournament. There is a tender mass in his hypothenar area and an abnormal Allen’s test. You suspect damage to which of the following structures?
A. Thrombosis of ulnar artery
B. Thrombosis of radial artery
C. Thrombosis of median artery
D. Thrombosis of common palmar digital artery
Scott Rand
A 22 year old male wrestler presents to your clinic after falling awkwardly in a match approximately 4 hours earlier in the day injuring his left wrist. The patient appears uncomfortable and states the pain has been getting worse since the time of the injury despite ice and immobilization. On exam, he has swelling and is tender over the distal radius. His neurovascular exam is intact but he is unwilling to allow extension of his wrist or fingers because of pain. An x-ray is done and shows a minimally displaced extraarticular fracture of the distal radius. Which of the following complications of this injury is most likely at this time?
A. Stretch injury of the median nerve
B. Compartment syndrome
C. Malunion
D. Complex regional pain syndrome
Scott Rand
A 22 year old male American football player suffers a hyperpronation injury of the right forearm and this results in a first-time dorsal-ulnar dislocation of the distal radioulnar joint (DRUJ). Fracture is ruled out by radiographs and adequate closed reduction is achieved. How should this injury be managed?
A. Thumb spica splint for 2 weeks
B. Short arm cast for 4 weeks
C. Long arm cast for 6 weeks
D. Orthopedic referral for arthrodesis
Scott Rand
While completing the PPE paperwork on a Down syndrome athlete, you review the report of the lateral c-spine x-rays to screen for atlanto-axial instability. You recall that a normal atlantodens interval (ADI) is
A.
0 mm
B. <2.5 mm
C. >4.5 mm
D. >6.0 mm
Scott Rand
The femoral nerve arises from the __________ nerve root and supplies motor function to the (list at least 4) muscles.
Scott Rand
The "stinger" injury is (pick one):
A. traction or compression of the
brachial plexus
B. results in bilateral arm weakness and paresthesia
C. generally resolves in 6-8 hours
D. precludes return to participation in the same contest