MSK CASE STUDIES | COMPLETE STUDY GUIDE, CLINICAL CASES & PRACTICE QUESTIONS
2026/2027
Greater Trochanteric Bursitis - ANS ✔✔A 26 you. Female present to the clinic with right lateral
hip pain that radiates downward. She states that it began last week after completing her 5th
marathon this year. The pain gets worse with prolonged sitting then rising and walking up stairs.
Family history include mother with osteoarthritis. On physical examination, there is mild edema
around the right hip. Pt also grimaces with active ROM of the hip. Greater trochanter and
bursae are TTP.
Labs: X-rays only to R/O boney pathology (OA, osteophytes, AVN)
Treatment: Relative rest, RICE, Physical Therapy - inonto/phono, ice friction massage, NSAIDs,
Corticosteroid injections ***,
Self-limiting with management and patient compliance
Avascular Necrosis of the Hip (AVN) - ANS ✔✔A 65 y.o. Male comes to the clinic with unilateral
hip pain in the left hip that began last week. He states that it began slowly as a dull
ache/throbbing pain that kind of radiates to the groin area and buttocks. Pt also complains that
the pain is there even when he's just sitting watching TV at night. Pt has a history of
osteoarthritis. On physical examination, pt experiences pain standing up. AROM is limiting in the
affected hip. Pain is exacerbated with internal rotation.
Labs: X-rays are good (Flattened Femoral Head)
MRI is definitive for diagnosis (Flattened Femoral Head)
Treatment: Bed rest, weight bearing as tolerated
Bisphosphonates (maybe)
Referral to orthopedic surgery sooner better than later
,Revascularization procedures available
Replacement arthoplasty most common treatment
Osteoarthritis of the Hips - ANS ✔✔A 65 y.o. Female comes to the clinic complaining of achy hip
pain for the past 2 months. The pain initially would come on after walking one loop around the
park, but is now present even when she is laying in bed. She complains that the pain kind of
radiates to the groin and the inside of her thigh. Physical exam reveals a slight gait abnormality
and mild pain with AROM, worse with internal rotation.
Labs: X-Rays (Narrowed joint space from loss of cartilage, Bone spurs)
Treatment:
Step 1: conservative treatment, motion (non-weight bearing like swimming), modify activity,
cycle, NSAIDs, Tylenol
Step 2: Steroids injections
Step 3: Hip replacement for pain management
Piriformis Syndrome - ANS ✔✔A 40 y.o. Male truck driver comes to the clinic with significant
right gluteal pain for the past 6 months. It gets worse with sitting or climbing stairs. On physical
examination there is pain with AROM and exacerbated with hip flexion and internal rotation.
Patient is TTP with deep palpation of the glute.
Labs: Piriformis test (knee bent, internal rotation)
Treatment: Modify activity, relative rest, physical therapy, NSAIDs, Ice or heat, evaluate the SI for
alignment issues
Osteoarthritis of the Knee - ANS ✔✔A 55 y.o. Female comes to clinic with a history of chronic
knee pain. Pain and stiffness is prominent in the morning. The pain gets worse with activity and
, better with rest. Physical exam reveals crepitus with knee flexion. Hands also reveal Heberden's
nodes and Bouchard's Nodes.
Labs: X-ray (narrowing of joint space)
Treatment: Conservative, Tylenol for aches and pains, +/- NSAIDs, warm climate locations, non-
weight bearing activity, steroid injections, Synvisc injections, joint replacement
Pre-petellar Bursitits (house maid's knees, Electrician's Knees) - ANS ✔✔A 36 y.o. Male
complains of swelling of the left knee. He complains that he has trouble walking occasionally
but it gets better at rest. He denies any trauma in the past. Pt owns a carpet company and has
had to delay a few jobs because of the pain. Physical exam shows fluctuante edema over the
inferior pole of the patella, mild erythema, decreased knee flexion, and TTP of the patella.
Clinical Diagnosis
Labs: X-ray to R/O fractures,
If infectious, needle aspiration to relieve pressure and culture
Treatment: Get off the knees, compression and padding, Rest, ice, NSAIDs
Abx if infection. If symptoms do not resolve after 2 weeks, consider aspiration
Iliotibial Band Syndrome - ANS ✔✔A 20 y.o. Male complains of lateral left knee pain for the past
4 days. Active stretching only helps a little bit and it gets worse with activity. Pt is a avid runner
and has a meet coming up in 2 weeks and does not want to miss it. Physical exam reveals pain
over lateral Femoral Condyle and decreased range of motion.
Special tests: + Ober's, + Nobel's
Labs: X-rays to R/O fracture, otherwise unnecessary
2026/2027
Greater Trochanteric Bursitis - ANS ✔✔A 26 you. Female present to the clinic with right lateral
hip pain that radiates downward. She states that it began last week after completing her 5th
marathon this year. The pain gets worse with prolonged sitting then rising and walking up stairs.
Family history include mother with osteoarthritis. On physical examination, there is mild edema
around the right hip. Pt also grimaces with active ROM of the hip. Greater trochanter and
bursae are TTP.
Labs: X-rays only to R/O boney pathology (OA, osteophytes, AVN)
Treatment: Relative rest, RICE, Physical Therapy - inonto/phono, ice friction massage, NSAIDs,
Corticosteroid injections ***,
Self-limiting with management and patient compliance
Avascular Necrosis of the Hip (AVN) - ANS ✔✔A 65 y.o. Male comes to the clinic with unilateral
hip pain in the left hip that began last week. He states that it began slowly as a dull
ache/throbbing pain that kind of radiates to the groin area and buttocks. Pt also complains that
the pain is there even when he's just sitting watching TV at night. Pt has a history of
osteoarthritis. On physical examination, pt experiences pain standing up. AROM is limiting in the
affected hip. Pain is exacerbated with internal rotation.
Labs: X-rays are good (Flattened Femoral Head)
MRI is definitive for diagnosis (Flattened Femoral Head)
Treatment: Bed rest, weight bearing as tolerated
Bisphosphonates (maybe)
Referral to orthopedic surgery sooner better than later
,Revascularization procedures available
Replacement arthoplasty most common treatment
Osteoarthritis of the Hips - ANS ✔✔A 65 y.o. Female comes to the clinic complaining of achy hip
pain for the past 2 months. The pain initially would come on after walking one loop around the
park, but is now present even when she is laying in bed. She complains that the pain kind of
radiates to the groin and the inside of her thigh. Physical exam reveals a slight gait abnormality
and mild pain with AROM, worse with internal rotation.
Labs: X-Rays (Narrowed joint space from loss of cartilage, Bone spurs)
Treatment:
Step 1: conservative treatment, motion (non-weight bearing like swimming), modify activity,
cycle, NSAIDs, Tylenol
Step 2: Steroids injections
Step 3: Hip replacement for pain management
Piriformis Syndrome - ANS ✔✔A 40 y.o. Male truck driver comes to the clinic with significant
right gluteal pain for the past 6 months. It gets worse with sitting or climbing stairs. On physical
examination there is pain with AROM and exacerbated with hip flexion and internal rotation.
Patient is TTP with deep palpation of the glute.
Labs: Piriformis test (knee bent, internal rotation)
Treatment: Modify activity, relative rest, physical therapy, NSAIDs, Ice or heat, evaluate the SI for
alignment issues
Osteoarthritis of the Knee - ANS ✔✔A 55 y.o. Female comes to clinic with a history of chronic
knee pain. Pain and stiffness is prominent in the morning. The pain gets worse with activity and
, better with rest. Physical exam reveals crepitus with knee flexion. Hands also reveal Heberden's
nodes and Bouchard's Nodes.
Labs: X-ray (narrowing of joint space)
Treatment: Conservative, Tylenol for aches and pains, +/- NSAIDs, warm climate locations, non-
weight bearing activity, steroid injections, Synvisc injections, joint replacement
Pre-petellar Bursitits (house maid's knees, Electrician's Knees) - ANS ✔✔A 36 y.o. Male
complains of swelling of the left knee. He complains that he has trouble walking occasionally
but it gets better at rest. He denies any trauma in the past. Pt owns a carpet company and has
had to delay a few jobs because of the pain. Physical exam shows fluctuante edema over the
inferior pole of the patella, mild erythema, decreased knee flexion, and TTP of the patella.
Clinical Diagnosis
Labs: X-ray to R/O fractures,
If infectious, needle aspiration to relieve pressure and culture
Treatment: Get off the knees, compression and padding, Rest, ice, NSAIDs
Abx if infection. If symptoms do not resolve after 2 weeks, consider aspiration
Iliotibial Band Syndrome - ANS ✔✔A 20 y.o. Male complains of lateral left knee pain for the past
4 days. Active stretching only helps a little bit and it gets worse with activity. Pt is a avid runner
and has a meet coming up in 2 weeks and does not want to miss it. Physical exam reveals pain
over lateral Femoral Condyle and decreased range of motion.
Special tests: + Ober's, + Nobel's
Labs: X-rays to R/O fracture, otherwise unnecessary
