[Intro: 84 B.P.M. Four bars bass limp alone. Piano fourths enter bar three. Trumpet mutes a falling minor third under bar four. Voice already singing.] [Chorus] [Lead Vocalist — first starred block as hook. “R.O.M.” tapped, not stretched. “I.V.” two short notes.] Bursitis; focal tenderness and swelling; less likely to affect R.O.M. No imaging. Aspirate (analyze) if acute swelling and redness or fever. I.V. antibiotics if septic [Verse 1] [Lead Vocalist — same melody, narrower on the place-names.] Pes anserine bursitis; medial knee pain Ruptured Baker cyst; rest, leg elevation ± triamcinolone injection. [Verse 2] [Lead Vocalist — colder, limb-position sung as one locked phrase.] Hip Fractures; shortened and externally rotated limb. Provocative internal rotation test. Surgery [Verse 3] [Lead Vocalist — position list kept in time; “sciatic” slightly held.] Posterior hip dislocation (most common); hip in flexion, internal rotation and adduction position; sciatic nerve injury. Anterior dislocations; abduction, external rotation [Verse 4] [Lead Vocalist — warmer on “groin,” then cut dry on the last clause.] Hip Osteoarthritis; deep in the groin, loss of active and passive R.O.M. in severe O.A.; normal passive hip adduction makes O.A. unlikely. [Verse 5] [Lead Vocalist — audible “pop” is still sung, not spoken. Instability line leans forward.] A.C.L. injury; injury involving an audible pop, swelling immediately or within 2 hours. Instability with lateral movement activities and going down stairs. Surgery. P.C.L.; high suspicion for neurovascular injuries, thorough neurovascular examination L.C.L. injury, less common, associated with other injuries (A.C.L. and P.C.L.). Require urgent surgery. M.C.L. if mild; protected weight bearing and physical therapy [Verse 6] [Lead Vocalist — catching/locking given a tiny catch in the phrase, then released.] Meniscus Injuries; patient may or may not report an injury. Joint line pain, antalgic gait and difficulty with squatting. Catching or locking of the meniscal fragment. Swelling (mostly) within 24 hours. Conservative treatment can be used for degenerative tears in older patients [Verse 7] [Lead Vocalist — almost kind until “No swelling/redness.” “Inspect footwear” named clearly.] Patellofemoral pain (anterior knee pain/chondromalacia/runner’s knee); pain with bending/squatting, patellar instability (due to decreased quadriceps strength). Inspect footwear. After trauma or repetitive physical activity. No swelling/redness. Imaging has limited use. Conservative Treatment. [Verse 8] [Lead Vocalist — one long falling line, quieter.] As the knee joint degeneration becomes more advanced, the patient loses active R.O.M. and may lose passive R.O.M. as well. [Verse 9] [Lead Vocalist — list sung as law. “Ottowa” kept as written. Weight-bearing clause is the fall.] Ottowa Rules; Ankle X-ray is required if tenderness along the distal 6 cm of the posterior edge of the tibia/fibula or tip of the medial/lateral malleolus or inability to bear weight (immediately or for four steps) [Verse 10] [Lead Vocalist — nerve names punched, then sling sung soft.] Humerus fracture proximally-axillary, mid-shaft-radial, or distally-median/ulnar injury Clavicle fracture sling if uncomplicated (closed, no neurovascular). [Verse 11] [Lead Vocalist — two names as twin blows; “O.R.I.F.” three even syllables.] Monteggia; proximal ulna fx with radial head subluxation. Galeazzi; radius fx with distal radioulnar joint dislocation. Treat with O.R.I.F. [Verse 12] [Lead Vocalist — pain line hotter; drugs listed without drama.] Complex regional pain syndrome; after trauma; severe pain, swelling, changes in skin color and temperature. Physical therapy, N.S.A.I.D.s, gabapentin, bisphosphonates [Verse 13] [Lead Vocalist — younger tone on the age range, then radiographic and cold again.] Osteochondritis Dissecans; active 10 to 20 years, subchondral bone detaches; knee, elbow, and ankle. Dull, joint pain that worsens with activity ± swelling, stiffness, crepitus. Radiographs and M.R. Conservative or surgery. [Verse 14] [Lead Vocalist — squeeze the metatarsals on the line “worsen when metatarsals are squeezed.”] Morton neuroma; Neuropathic degeneration mostly between the third and fourth toes (numbness, pain, and paresthesia). Repetitive irritation (Runners=), worsen when metatarsals are squeezed. Treatment requires padded shoe inserts or surgery. [Verse 15] [Lead Vocalist — last couplet as a quiet spine hymn. “L.B.P.” three short notes. “L.5–S.1” spoken-sung on pitch.] Spondylosis; degeneration, most common pediatric low back pain. Cervical in older people Spondylolisthesis; anterior displacement of vertebrae mostly L.5–S.1. L.B.P., radicular pain. Conservative (N.S.A.I.D.s, physical therapy, bracing), surgery. [Chorus] [End]
