Here is your complete, exam-ready study package based directly on all 9 PDFs:
🦴 ORTHOPAEDIC EXAM MASTER STUDY GUIDE
Based on your 9 lecture PDFs — Dr. Nguyen Ngoc Thach
PART 1: HIGH-YIELD FACT SHEETS BY TOPIC
📌 MUSCULOSKELETAL EXAMINATION PRINCIPLES (PDF 1)
| Concept | Key Fact |
|---|
| Correct exam sequence | History → Physical Exam → Investigations |
| Most valuable diagnostic step | History taking |
| Physical exam order | Look → Feel → Move → Special Tests |
| First step in joint exam | Inspection (Look) |
| Pain suggesting inflammatory pathology | Night pain + morning stiffness |
| Red flag symptoms | Night pain, unexplained weight loss, neurological deficit |
| Active ROM decreased, passive normal | Muscle/tendon problem |
| Both active AND passive decreased | Joint/bone pathology |
| MRC Grade 0 | No contraction |
| MRC Grade 5 | Normal power against full resistance |
Imaging Principles:
- X-ray: First-line for all fractures/dislocations
- CT: Complex/comminuted fractures, bone detail
- MRI: Soft tissue (ligaments, tendons, cartilage, occult fractures)
- FAST ultrasound: Rapid screening for intra-abdominal/pericardial bleeding
📌 SHOULDER & ARM (PDF 2)
Rotator Cuff - SITS:
- Supraspinatus - initiates abduction, dynamic stabilizer
- Infraspinatus - external rotation
- Teres minor - external rotation
- Subscapularis - internal rotation
Scapulohumeral Rhythm: 2:1 ratio (120° GH + 60° scapulothoracic = 180° total abduction)
| Condition | Key Feature |
|---|
| Rotator cuff disease | Lateral shoulder/deltoid pain |
| Infraspinatus injury | Weakness of external rotation |
| Adhesive capsulitis (frozen shoulder) | Global pain + restriction of BOTH active & passive ROM; capsular pattern: ER > ABD > IR |
| Subacromial impingement | Painful arc 60-120° of abduction |
| AC joint injury | Step deformity at AC joint |
Special Tests:
| Test | Technique | Positive = |
|---|
| Neer's sign | Passively flex internally rotated arm overhead | Pain = impingement |
| Hawkins-Kennedy | Flex shoulder 90°, flex elbow 90°, internally rotate | Pain = impingement |
| Apprehension test | Abduct 90°, externally rotate, apply anterior force | Apprehension = anterior GH instability |
📌 ELBOW & FOREARM (PDF 3)
3 Articulations:
- Humeroulnar - flexion/extension
- Humeroradial - flexion + rotation
- Proximal radioulnar - pronation/supination
Normal ROM: Flexion ~145°, Extension 0°, Pronation ~80°, Supination ~80°
| Condition | Location | Key Fact |
|---|
| Lateral epicondylitis (Tennis elbow) | Lateral elbow pain | ECRB overuse |
| Medial epicondylitis (Golfer's elbow) | Medial elbow pain | Common flexor origin overuse |
| Cubital tunnel syndrome | Ulnar nerve | Tingling in ring & little fingers |
| Radial head fracture | Just distal to lateral epicondyle | Pain with pronation/supination |
Radial head location: Immediately distal to the lateral epicondyle - palpable during pronation/supination
Special Tests:
| Test | Tests For | Positive Sign |
|---|
| Cozen's test | Lateral epicondylitis | Lateral elbow pain on resisted wrist extension |
| Reverse Cozen's (Golfer's test) | Medial epicondylitis | Medial elbow pain on resisted wrist flexion |
| Tinel's at elbow | Cubital tunnel (ulnar nerve) | Tingling in ring/little fingers |
Forearm Fracture Patterns (HIGH-YIELD):
| Pattern | Mnemonic |
|---|
| Monteggia = Ulna fracture + proximal radial head dislocation | Monteggia-Ulna |
| Galeazzi = Radius fracture + DRUJ disruption | Galeazzi-Radius-Distal |
First-line imaging: X-ray (AP + Lateral; must include wrist AND shoulder)
For soft tissue elbow: MRI
📌 WRIST & HAND (PDF 7)
| Condition | Key Facts |
|---|
| Scaphoid fracture | FOOSH mechanism; anatomical snuffbox tenderness; X-ray may be NORMAL initially; risk of AVN |
| Carpal tunnel syndrome | Median nerve compression; thenar wasting; positive Phalen's + Tinel's |
| Flexor tendon injury | Cannot flex affected fingers |
| Ulnar nerve injury | Claw hand (ring + little fingers); positive Froment's sign |
| Wrist drop | Radial nerve injury |
Scaphoid Fracture Protocol:
- X-ray negative + clinical suspicion → Treat as fracture + repeat X-ray in 10-14 days OR proceed to MRI
- Danger: Proximal pole at risk of AVN (retrograde blood supply)
Special Tests:
| Test | Condition | Positive Sign |
|---|
| Phalen's test | Carpal tunnel syndrome | Tingling in median distribution after 60 sec wrist flexion |
| Tinel's at wrist | Carpal tunnel syndrome | Tingling on tapping carpal tunnel |
| Froment's sign | Ulnar nerve palsy | Thumb IP flexion when pinching paper |
📌 ANKLE & FOOT (PDF 5)
| Structure | Key Fact |
|---|
| ATFL | Most commonly sprained ligament (inversion injury) |
| Achilles tendon | Gastrocnemius + soleus; Thompson test diagnoses rupture |
| Dorsalis pedis pulse | Between 1st and 2nd metatarsals on dorsum of foot |
| Posterior tibial pulse | Posterior to medial malleolus |
| Ottawa Ankle Rules | Unable to bear weight → X-ray required |
Thompson Test: Squeeze the calf - no plantarflexion = positive = Achilles tendon rupture
Anterior Drawer Test (ankle): Tests ATFL - positive if >5mm anterior translation
Normal ankle ROM: Dorsiflexion ~20°, Plantarflexion ~50°
Imaging views: AP, Lateral, Mortise view (15-20° internal rotation) for ankle fractures
📌 KNEE & THIGH (PDF 6)
| Structure | Key Fact |
|---|
| ACL | Best test: Lachman test; twisting injury mechanism; causes hemarthrosis |
| Meniscus | McMurray test; locking = meniscal tear |
| Popliteal artery | At risk in posterior knee dislocation - MANDATORY CTA even with normal distal pulses |
| Common peroneal nerve | Injury causes foot drop |
| MCL | Valgus stress injury; medial knee pain |
Hemarthrosis (rapid knee swelling after twisting) = ACL tear / fracture / patellar dislocation until proven otherwise
Special Tests:
| Test | Tests For | Positive Sign |
|---|
| Lachman test | ACL (best test) | Increased anterior translation, soft endpoint |
| Anterior drawer (knee) | ACL | >5mm anterior tibial translation |
| McMurray test | Meniscal tear | Pain/click on rotation during flexion |
Neurovascular injury at knee: Doppler → CTA (gold standard for vascular injury)
EMG only after 14 days (nerve degeneration needs time)
📌 PELVIS & HIP (PDF 8)
| Feature | Key Fact |
|---|
| Pelvic fracture cause | High-energy trauma (MVA, fall from height) |
| Pelvic fracture danger | Massive hemorrhage and shock |
| Associated injury | Bladder injury - detected by hematuria |
| Pelvic compression test | Performed ONCE ONLY - never repeat (risk of worsening hemorrhage) |
| FAST ultrasound | Detects intra-abdominal bleeding |
| Imaging sequence | X-ray pelvis AP first → CT (gold standard) |
Hip Special Tests:
| Test | Tests For | Positive Sign |
|---|
| Trendelenburg test | Gluteus medius weakness | Contralateral pelvis drops |
| Thomas test | Hip flexion contracture | Hip cannot fully extend on bed |
Referred pain: Hip pathology can refer pain to the KNEE - always examine the hip in children with knee pain
📌 ORTHOPAEDIC TRAUMA MANAGEMENT (PDF 9)
Primary Survey - ABCDE ("Life Before Limb"):
- A - Airway
- B - Breathing & Circulation
- D - Disability (GCS)
- E - Exposure
Conservative treatment: Stable/non-displaced fractures → Cast or Splint
Surgical treatment: Displaced/unstable → ORIF (plates/screws), IM Nail, External Fixation
Indications for Surgery:
- Displacement
- Instability
- Open fracture
- Neurovascular injury
Open Fracture Management (EMERGENCY):
- IV Antibiotics immediately
- Surgical debridement
- Tetanus prophylaxis
- External fixation or staged treatment
RICE: Rest, Ice, Compression, Elevation (for sprains/strains)
Fracture Complications: Non-union, Malunion, Infection (osteomyelitis), Stiffness
📌 CAST & FIXATION CARE (PDF 4)
Purpose of cast: Immobilize + maintain bone alignment
Immediate post-cast care:
- Elevate the limb above heart level (reduces edema)
- Check circulation
- Pain control
The 5 P's (Neurovascular Monitoring):
- Pain (out of proportion - earliest sign)
- Pallor
- Pulse
- Paresthesia
- Paralysis
Compartment Syndrome:
- Cardinal sign: Severe pain out of proportion to injury
- Pathognomonic sign: Pain on passive stretch
- Emergency treatment: Fasciotomy
- Other signs: weak/absent pulse, numbness, cold limb, pallor, paralysis (LATE signs)
Cast types:
- Plaster of Paris: Heavier, mouldable, cheaper
- Fiberglass: Lighter, stronger, water-resistant
External fixation: Open fractures, polytrauma, damage control
- Most common complication: Pin infection
PART 2: NEW MCQs FROM THE PDFs
🩺 MUSCULOSKELETAL EXAMINATION
Q1. During shoulder examination, a patient has full passive range of motion but reduced active abduction. The most likely diagnosis is:
A. Adhesive capsulitis
B. Glenohumeral arthritis
C. Rotator cuff tear
D. Acromioclavicular joint injury
✅ Answer: C - Active ROM reduced (tendon/muscle problem); passive preserved means the joint itself is intact.
Q2. The Hawkins-Kennedy test is performed by:
A. Passive overhead arm elevation with internal rotation
B. Shoulder abduction 90° + external rotation + anterior force
C. Shoulder flexion 90°, elbow flexion 90°, then internal rotation of shoulder
D. Palpation of the bicipital groove
✅ Answer: C - Flex shoulder 90°, flex elbow 90°, stabilize shoulder, internally rotate → pain = impingement.
Q3. A patient complains of lateral shoulder pain worsening at 60-120° of abduction. What does this "painful arc" indicate?
A. Adhesive capsulitis
B. Glenohumeral instability
C. Subacromial impingement / rotator cuff pathology
D. AC joint injury
✅ Answer: C
Q4. Scapulohumeral rhythm during shoulder abduction is:
A. 1:1 (equal glenohumeral and scapulothoracic)
B. 2:1 (2° glenohumeral for every 1° scapulothoracic)
C. 3:1 (3° glenohumeral for every 1° scapulothoracic)
D. The scapula does not contribute to abduction
✅ Answer: B - 120° GH + 60° scapulothoracic = 180° total.
🦴 ELBOW & FOREARM
Q5. A 35-year-old carpenter presents with lateral elbow pain that worsens when gripping tools. Cozen's test is positive. The most likely diagnosis is:
A. Medial epicondylitis
B. Cubital tunnel syndrome
C. Lateral epicondylitis
D. Olecranon bursitis
✅ Answer: C - Cozen's test = lateral epicondylitis (Tennis elbow).
Q6. A patient falls and sustains an isolated ulnar shaft fracture. X-ray reveals the radial head is dislocated proximally. This is called:
A. Galeazzi fracture
B. Colles fracture
C. Monteggia fracture
D. Both-bone forearm fracture
✅ Answer: C - Monteggia = Ulna fracture + proximal radial head dislocation.
Q7. Tapping posterior to the medial epicondyle produces tingling in the ring and little fingers. This indicates injury to the:
A. Median nerve
B. Radial nerve
C. Anterior interosseous nerve
D. Ulnar nerve
✅ Answer: D - Tinel's sign at the cubital tunnel = ulnar nerve injury.
🤲 WRIST & HAND
Q8. A 22-year-old falls on an outstretched hand. X-ray is reported as normal but there is anatomical snuffbox tenderness. The next best step is:
A. Discharge with analgesia - X-ray is normal
B. Order an EMG
C. Treat as a scaphoid fracture; apply a cast and repeat X-ray in 10-14 days (or MRI)
D. Order an ultrasound
✅ Answer: C - Scaphoid fractures may be X-ray negative initially. Clinical suspicion dictates treatment to avoid AVN.
Q9. A patient cannot flex the index and middle fingers after a laceration to the palm. This finding indicates:
A. Ulnar nerve injury
B. Flexor tendon injury
C. Extensor tendon injury
D. Median nerve injury only
✅ Answer: B - Inability to flex fingers = flexor tendon injury.
Q10. Froment's sign tests the integrity of which nerve?
A. Median nerve
B. Radial nerve
C. Ulnar nerve
D. Musculocutaneous nerve
✅ Answer: C - Froment's sign: Patient flexes thumb IP joint when pinching paper = weak adductor pollicis = ulnar nerve palsy.
🦵 KNEE & THIGH
Q11. Which test is considered the BEST for diagnosing an ACL tear?
A. Anterior drawer test
B. McMurray test
C. Lachman test
D. Valgus stress test
✅ Answer: C - Lachman test is the most sensitive test for ACL integrity.
Q12. A patient with a knee dislocation has normal distal pulses in the foot. What is the most appropriate next step?
A. Discharge with physiotherapy
B. X-ray only is sufficient
C. CT angiography is still mandatory
D. Doppler ultrasound is sufficient confirmation
✅ Answer: C - Popliteal artery injury can be present even with normal distal pulses due to collateral flow. CTA is mandatory.
Q13. A clicking sensation and medial knee pain during rotation in a flexed knee. Which test is this and what does it indicate?
A. Lachman test - ACL tear
B. McMurray test - Meniscal tear
C. Anterior drawer test - PCL injury
D. Varus stress test - LCL injury
✅ Answer: B
🦶 ANKLE & FOOT
Q14. The Thompson test is performed by:
A. Tapping the Achilles tendon and checking reflexes
B. Asking the patient to stand on tiptoe
C. Squeezing the calf muscle while the patient is prone; absence of plantarflexion = positive
D. Anterior talar translation test
✅ Answer: C - No plantarflexion on calf squeeze = Achilles tendon rupture.
Q15. Which ligament is MOST commonly sprained in an inversion ankle injury?
A. Deltoid ligament
B. Posterior talofibular ligament
C. Calcaneofibular ligament
D. Anterior talofibular ligament (ATFL)
✅ Answer: D - ATFL is the weakest and most commonly injured lateral ankle ligament.
Q16. According to Ottawa Ankle Rules, which criterion mandates an X-ray?
A. Ankle swelling
B. Bruising over the lateral malleolus
C. Inability to bear weight
D. Pain on palpation of the Achilles tendon
✅ Answer: C
🦴 PELVIS & HIP
Q17. A patient involved in a high-speed motor vehicle accident presents with pelvic pain, hypotension, and blood in the urine. Which associated injury is most likely responsible for the hematuria?
A. Liver laceration
B. Bladder injury
C. Splenic rupture
D. Femoral artery injury
✅ Answer: B - Pelvic fractures are strongly associated with bladder injury, detected by hematuria.
Q18. When examining the pelvis for fracture, the spring (compression) test should be:
A. Repeated multiple times to confirm
B. Performed bilaterally and compared
C. Performed ONCE ONLY to avoid worsening hemorrhage
D. Avoided completely and replaced with CT immediately
✅ Answer: C
Q19. A Trendelenburg test is positive when:
A. The patient cannot extend the hip fully when lying flat
B. The contralateral pelvis drops when the patient stands on the affected leg
C. The patient has pain in the groin during passive hip rotation
D. Hip extension is more than 10° beyond neutral
✅ Answer: B - Indicates gluteus medius weakness / hip abductor insufficiency.
🚨 CAST CARE & COMPARTMENT SYNDROME
Q20. A patient with a forearm cast complains of severe pain that worsens when the fingers are passively extended. This is MOST consistent with:
A. Normal post-fracture pain
B. Cast pressure sore
C. Compartment syndrome
D. Deep vein thrombosis
✅ Answer: C - Pain on passive stretch is the pathognomonic sign of compartment syndrome.
Q21. The EARLIEST warning sign of compartment syndrome is:
A. Absent peripheral pulse
B. Pallor of the limb
C. Paralysis
D. Severe pain out of proportion to the injury
✅ Answer: D - Pain out of proportion is the EARLIEST sign; absent pulse and paralysis are LATE signs.
Q22. Which of the following is the definitive emergency treatment for compartment syndrome?
A. Elevation of the limb
B. IV analgesia and observation
C. Fasciotomy
D. Cast splitting only
✅ Answer: C
🏥 TRAUMA MANAGEMENT
Q23. In a patient who arrives after a high-energy road traffic accident with an open femur fracture and a suspected pelvic fracture with hypotension, what takes FIRST priority?
A. X-ray of the femur
B. Splint the fracture immediately
C. Primary survey - Airway, Breathing, Circulation (ABCDE)
D. Urgent fracture fixation
✅ Answer: C - "Life before limb" - ABCDE primary survey always first.
Q24. For an open (compound) fracture, which intervention must be initiated FIRST?
A. Surgical debridement
B. Internal fixation
C. IV antibiotics immediately
D. Cast application
✅ Answer: C - Immediate IV antibiotics to prevent infection/osteomyelitis are the first step.
Q25. Common peroneal nerve injury at the knee results in:
A. Loss of ankle plantarflexion
B. Loss of knee extension
C. Foot drop (weakness of dorsiflexion and eversion)
D. Hamstring paralysis
✅ Answer: C
PART 3: CLINICAL CASES
🏥 CLINICAL CASE 1 — Shoulder
A 55-year-old office worker presents with a 6-month history of progressive right shoulder pain and stiffness. She reports difficulty combing her hair, reaching behind her back, and putting on her coat. Physical examination reveals reduced active AND passive range of motion in all planes, most notably external rotation. There is no history of trauma.
Q1. What is the most likely diagnosis?
A. ✅ Adhesive capsulitis (Frozen shoulder) - both active and passive ROM restricted, capsular pattern (ER > ABD > IR).
Q2. What pain pattern is typical of this condition?
A. Global/diffuse shoulder pain (not localized), worse at night, limiting sleep.
Q3. Which imaging modality is first-line?
A. X-ray (to exclude bony pathology). MRI if soft tissue detail needed. Clinical diagnosis in most cases.
🏥 CLINICAL CASE 2 — Elbow
A 42-year-old accountant complains of lateral elbow pain for 3 months that started after spending long hours typing. Examination reveals point tenderness over the lateral epicondyle. Cozen's test is positive. There is no swelling or deformity.
Q1. Diagnosis?
A. ✅ Lateral epicondylitis (Tennis elbow) - ECRB overuse, common extensor origin.
Q2. What structure is affected?
A. Extensor Carpi Radialis Brevis (ECRB) at its origin on the lateral epicondyle.
Q3. First-line imaging?
A. X-ray (to exclude bony pathology); clinical diagnosis. MRI if refractory.
Q4. Conservative management?
A. Rest, NSAIDs, physiotherapy, activity modification. Corticosteroid injection for persistent cases.
🏥 CLINICAL CASE 3 — Wrist (FOOSH)
A 19-year-old student falls while skateboarding, landing on an outstretched right hand. He presents with wrist pain and mild swelling. X-ray of the wrist is reported as normal. On examination, there is exquisite tenderness in the anatomical snuffbox.
Q1. What fracture must be suspected?
A. ✅ Scaphoid fracture - anatomical snuffbox tenderness after FOOSH is scaphoid fracture until proven otherwise.
Q2. Why is this fracture serious if missed?
A. Risk of Avascular Necrosis (AVN) of the proximal pole due to retrograde blood supply.
Q3. Management despite normal X-ray?
A. Apply thumb spica cast; repeat X-ray in 10-14 days OR proceed directly to MRI (most sensitive for occult fracture).
Q4. What imaging is best for occult scaphoid fractures?
A. MRI - gold standard for occult fractures.
🏥 CLINICAL CASE 4 — Knee (Sports Injury)
A 25-year-old football player twists his right knee during a tackle. He hears a "pop" and the knee swells rapidly within 1 hour. He is unable to bear full weight. Lachman test reveals increased anterior tibial translation with a soft endpoint.
Q1. What is the most likely diagnosis?
A. ✅ ACL tear - rapid hemarthrosis + "pop" + positive Lachman test.
Q2. What does rapid swelling (within 1-2 hours) indicate?
A. Hemarthrosis - blood in the joint = ACL tear, fracture, or patellar dislocation.
Q3. What imaging should be ordered first?
A. X-ray first (to exclude fracture), followed by MRI (to confirm ACL and assess menisci).
Q4. Which nerve/vessel must be assessed?
A. Common peroneal nerve (foot drop) and popliteal artery (vascular injury).
🏥 CLINICAL CASE 5 — Ankle
A 30-year-old woman rolls her ankle while descending stairs (inversion mechanism). She has lateral ankle pain and swelling. She cannot bear weight. Palpation reveals bony tenderness over the lateral malleolus.
Q1. What do Ottawa Ankle Rules indicate?
A. ✅ Inability to bear weight = X-ray is mandatory.
Q2. Which ligament is most likely injured?
A. ATFL (Anterior TaloFibular Ligament) - most commonly sprained in inversion injury.
Q3. How do you assess vascular status of the foot?
A. Palpate the dorsalis pedis pulse (dorsum of foot, between 1st and 2nd metatarsals) and posterior tibial pulse (posterior to medial malleolus).
Q4. What test confirms Achilles tendon rupture?
A. Thompson test - no plantarflexion on calf squeeze = positive.
🏥 CLINICAL CASE 6 — Pelvic Fracture (Trauma)
A 28-year-old male motorcyclist is brought to the emergency department after a high-speed collision. He is hypotensive (BP 85/60 mmHg, HR 130 bpm). He complains of severe pelvic pain. Blood is noted at the urethral meatus. The abdomen is tender on palpation.
Q1. What is the primary concern?
A. ✅ Pelvic fracture with massive hemorrhage causing hemorrhagic shock. Life-threatening emergency.
Q2. What does blood at the meatus suggest?
A. Urethral or bladder injury associated with pelvic fracture (hematuria is the key sign).
Q3. How many times should you perform pelvic compression?
A. ONCE ONLY - repeat compression risks dislodging clots and worsening hemorrhage.
Q4. What bedside investigation quickly assesses for intra-abdominal bleeding?
A. FAST ultrasound (Focused Assessment with Sonography in Trauma).
Q5. What is the definitive imaging?
A. CT scan - gold standard for pelvic fracture characterization.
Q6. What is the FIRST priority in management?
A. ABCDE primary survey - Airway, Breathing, Circulation (hemorrhage control). Life before limb.
🏥 CLINICAL CASE 7 — Compartment Syndrome (Cast)
A 16-year-old boy has a below-elbow cast applied after a radius fracture. 8 hours later, he presents with severe, escalating forearm pain rated 9/10. His pain significantly worsens when the nurse passively extends his fingers. The cast feels very tight. Sensation in his fingers is reduced.
Q1. What is the diagnosis?
A. ✅ Acute compartment syndrome - pain out of proportion + pain on passive stretch + paresthesia.
Q2. What is the pathognomonic sign?
A. Pain on passive stretch of muscles within the compartment.
Q3. Which of the 5 P's are present?
A. Pain (out of proportion), Paresthesia (reduced sensation), and signs of Pulse/Perfusion compromise.
Q4. What is the IMMEDIATE first step?
A. Split and remove the cast urgently.
Q5. What is the definitive emergency treatment?
A. Fasciotomy - surgical release of the compartment.
Q6. What happens if untreated?
A. Permanent muscle and nerve ischemia, contracture (Volkmann's contracture in the forearm), paralysis.
🏥 CLINICAL CASE 8 — Knee Dislocation (Emergency)
A 35-year-old male is involved in a high-velocity motor vehicle collision. On examination, his right knee is grossly deformed. After reduction, the knee appears aligned and distal pulses in the foot are palpable.
Q1. Despite normal pulses, what must still be done?
A. ✅ CT Angiography (CTA) is mandatory - popliteal artery injury can exist with normal distal pulses due to collateral flow. A missed vascular injury leads to limb loss.
Q2. Which vessel is most at risk in knee dislocation?
A. Popliteal artery - tethered proximally and distally, highly vulnerable to stretch/tear.
Q3. Which nerve must be checked?
A. Common peroneal nerve - check for foot drop (dorsiflexion weakness + eversion weakness).
Q4. What should always be done after reducing a dislocated joint?
A. Always check neurovascular status immediately post-reduction.
PART 4: RAPID REVIEW TABLES
⚡ SPECIAL TESTS QUICK REFERENCE
| Test | Region | Tests | Positive Sign |
|---|
| Neer's sign | Shoulder | Subacromial impingement | Anterior/lateral pain on overhead IR |
| Hawkins-Kennedy | Shoulder | Subacromial impingement | Pain on IR at 90/90 position |
| Apprehension test | Shoulder | Anterior GH instability | Apprehension on ER at 90° ABD |
| Cozen's test | Elbow | Lateral epicondylitis | Lateral pain on resisted wrist extension |
| Tinel's (elbow) | Elbow | Cubital tunnel (ulnar n.) | Tingling ring/little fingers |
| Phalen's test | Wrist | Carpal tunnel (median n.) | Median tingling in 60 sec |
| Tinel's (wrist) | Wrist | Carpal tunnel (median n.) | Tingling on tapping |
| Froment's sign | Hand | Ulnar nerve palsy | IP flexion when pinching paper |
| Lachman test | Knee | ACL (BEST test) | Soft endpoint, increased translation |
| Anterior drawer | Knee/Ankle | ACL / ATFL | Increased translation |
| McMurray test | Knee | Meniscal tear | Click/pain on rotation |
| Thompson test | Ankle | Achilles rupture | No plantarflexion on calf squeeze |
| Trendelenburg test | Hip | Gluteus medius weakness | Contralateral pelvis drops |
| Thomas test | Hip | Hip flexion contracture | Hip cannot fully extend |
⚡ IMAGING DECISION GUIDE
| Scenario | First Choice | If Inconclusive/Complex |
|---|
| Any acute fracture | X-ray | CT (complex), MRI (occult) |
| Scaphoid fracture (X-ray negative) | X-ray | MRI (best for occult scaphoid) |
| ACL / meniscal tear | X-ray (exclude fracture) | MRI |
| Pelvic fracture | X-ray AP pelvis | CT (gold standard) |
| Soft tissue (ligaments, tendons) | MRI | - |
| Complex/comminuted fracture | X-ray | CT |
| Intra-abdominal bleeding (trauma) | FAST ultrasound | CT |
| Vascular injury (knee dislocation) | Doppler | CTA (mandatory) |
| Nerve injury (EMG) | Only after 14 days | - |
⚡ EMERGENCIES SUMMARY
| Emergency | Cardinal Sign | Treatment |
|---|
| Compartment syndrome | Pain on passive stretch | Fasciotomy |
| Open fracture | Bone through skin | IV Antibiotics + Debridement |
| Pelvic fracture + shock | Hypotension + pelvic pain | ABCDE + ONCE compression + CT + hemorrhage control |
| Popliteal artery injury | Knee dislocation | CTA mandatory even with normal pulses |
| Scaphoid AVN risk | FOOSH + snuffbox tenderness | Treat despite normal X-ray; MRI |
⚡ THE 5 P's OF NEUROVASCULAR COMPROMISE
| P | What to Check |
|---|
| Pain | Out of proportion - EARLIEST sign |
| Pallor | Skin color - pale/white |
| Pulse | Peripheral pulse quality |
| Paresthesia | Tingling/numbness |
| Paralysis | Motor weakness - LATEST sign |
⚡ FRACTURE MANAGEMENT ALGORITHM
FRACTURE
|
├── Stable / Non-displaced → CONSERVATIVE (Cast / Splint)
|
└── Unstable / Displaced / Open / Neurovascular injury
|
└── SURGICAL
├── ORIF (Plates + Screws) - articular/displaced fractures
├── IM Nail - diaphyseal long bone (femur, tibia, humerus)
└── External Fixation - open fractures, polytrauma, damage control
This covers every high-yield topic from all 9 of your PDFs. The MCQs and clinical cases mirror the exact exam style your lecturer uses, built directly from the lecture content. Focus especially on: special tests and their positive findings, the 5 P's, compartment syndrome signs, scaphoid fracture protocol, Ottawa rules, Thompson test, and the ABCDE primary survey hierarchy.
