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2) Patho 2 > 3) Hip & Knee Pathologies > Flashcards

3) Hip & Knee Pathologies Flashcards

1
Q

Bursitis

A

Inflammation of bursa

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2
Q

What is the MOI for bursitis?

A

Direct blow or Friction

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3
Q

What are bursae?

A

Fluid-filled sacs near synovial jt’s that are filled w/synovial fluid to create frictionless movement between muscles, tendons, bones, ligaments, & skin

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4
Q

What are the types of hip bursitis?

A
  • Trochanteric
  • Iliopsoas
  • Ischial
  • Gluteal
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5
Q

What are the least common types of hip bursitis?

A

Ischial &amp Gluteal

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6
Q

What patho can’t trochanteric bursitis be differentiated from based on sx’s alone?

A

Gluteal Tendinitis

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7
Q

How will a pt w/trochanteric bursitis present?

A
  • Painful palp of troch’s
  • Painful ITB stretch
  • Painful resisted abd, ext, or ER
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8
Q

How will a pt w/iliopsoas bursitis present?

A
  • Tender palp
  • Painful passive ext, abd, flexion & ER
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9
Q

Tendinopathy

A

Any abn condition of the tendon

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10
Q

What is the MOI for tendinopathy?

A

Sudden overload or Repetitive loading/unloading

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11
Q

Which tendons are at the highest risk for injury?

A

Tendons that transmit large eccentric loads

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12
Q

What is the clinical presentation for tendinopathy?

A
  • Tender palp
  • Strong & painful resisted isometrics
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13
Q

Describe the stages of healing for tendinopathy

A

1) Inflammation–>Hematoma formation

  • Infiltration of inflammatory cells
  • Fibroblasts initiate collagen synthesis

2) Repair–>Laying down of collagen &amp tendon matrix
3) Remodeling–>Collagen becomes structured &amp organized

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14
Q

Should tx for tendinopathy be conservative or aggressive?

A

Conservative

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15
Q

What should be addressed when tx’ing a pt w/tendinitis?

A

Inflammation

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16
Q

What should a POC for tendinopathy include?

A

Loading-based TherEx

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17
Q

What should tx of tendinopathy include?

A
  • Progressive loading program w/eccentrics
  • Stretching (if cause was adaptive shortening)
  • Cross-friction massage
  • NSAIDs
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18
Q

Tendinitis

A

Acute inflammatory rxn of the tendon (characterized by microscopic tearing & tendon inflammation)

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19
Q

Paratendinitis

A

Superficial patho w/inflammation of the outer layers of a tendon; Can be accompanied by synovitis of tendonous sheath

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20
Q

Tendinosis

A

Intratendon degenerative lesion

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21
Q

Is it possible for a pt to have acute flare-ups of tendinosis?

A

Yes

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22
Q

What are the most common sports injuries?

A

Sprains & strains

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23
Q

What is the MOI for sprains & strains?

A
  • Excessive strain/tension
  • Contusion
  • Lacerations
  • Burns
  • Myotoxic Agents
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24
Q

What are risk factors for experiencing a sprain or strain?

A
  • Decr strength, flexibility, or endurance
  • Insufficient warm-up
  • Dyssynergistic muscle contraction
  • Not fully rehabbed prior injury
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25
Q

What are the common locations for hip strains?

A
  • Glutes
  • Hams
  • Quads
  • Iliopsoas
  • Adductors
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26
Q

Describe the stages of healing of sprains & strains

A

1) Destruction–>Gap forms between ruptured fiber ends, necrosis, & degenerated muscle tissue
2) Repair–>Hematoma fills the gaps, matrices form, & collagen gets laid down
3) Remodeling–> Regenerated muscle matures & contracts w/pattern of scar tissue

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27
Q

When are muscles the weakest following injury?

A

1st week

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28
Q

What should be used to guide tx of sprains & strains?

A

Pain & Stage of healing

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29
Q

In reference to tx’ing sprains & strains, why is controlled mobility & stress important?

A

Bc it allows for:

  • Scar formation
  • Correct orientation of new muscle fibers
  • Muscle regeneration
  • Normalization of tensile properties
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30
Q

What is the MOI for anterior hip dislocation?

A

Impact while hip is in extension & ER

*Also occurs post-anterior THR

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31
Q

Anterior hip dislocation accounts for what percent of all dislocations?

A

15%

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32
Q

What is the MOI for posterior hip dislocation?

A

Impact while hip is in flexion

*Also occurs post-posterior THR

*Concomitant w/acetabular fx’s

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33
Q

What does a hip dislocation imply?

A

Pt experienced large force trauma

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34
Q

What happens if a pt does not get immediate medical attention for a hip dislocation?

A

Femoral nerve injury

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35
Q

A pt w/hip dislocation has a risk of what?

A

Subsequent dislocations

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36
Q

What does tx for hip dislocation depend on?

A

If the reduction was closed or open

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37
Q

What should POC for hip dislocations include?

A
  • Modified/delayed WB
  • Abduction brace
  • Stabilization exercises
  • Pt ed
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38
Q

What is the MOI for acetabular labral tears?

A

Repetitive twisting or pivoting

  • Young pt w/twisting or trauma to hip
  • Older pt w/hx of dysplasia
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39
Q

What are the types of acetabular labral tears

A
  • Degenerative
  • Dysplastic
  • Traumatic
  • Idiopathic (Impingement)
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40
Q

What is the clinical presentation of acetabular labral tear?

A
  • Buckling
  • Locking
  • Instability
  • Twinges
  • Painful clicking
  • Anterior groin pain
    • Can also see pain in butt, thigh, troch, & medial knee
  • (+) Impingement Test
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41
Q

What is needed to confirm acetabular labral tear?

A

MRI

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42
Q

What is femoral acetabular impingement syndrome?

A

Anterior or anterosuperior labrum gets pinched between the acetabulum & femoral neck

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43
Q

What are the types of femoral acetabular impingement?

A

Cam & Pincer

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44
Q

Cam Femoral Acetabular Impingement

A

Abn shape of femoral head/neck that impinges on the acetabulum during movement

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45
Q

Pincer Femoral Acetabular Impingement

A

Acetabular retroversion resulting in over-coverage of the femoral head

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46
Q

What should POC for femoral acetabular impingement include?

A
  • Hip ROM
  • Strengthening of glutes, hips, & core
  • Pt ed
  • NSAIDs
  • Corticosteroids
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47
Q

What is done to tx non-traumatic impingement syndrome?

A

Athroscopy

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48
Q

What is the surgical tx for hip dysplasia?

A

Bony Osteotomy

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49
Q

What is the surgical tx for capsular/ligament instability?

A

Suture plication

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50
Q

What is the surgical tx for femoroacetabular decompression?

A

Trim the mechanical abns, acetabulum, or femoral head

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51
Q

How should initial tx for knee OA be?

A

Conservative

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52
Q

What are the indications for surgical tx of knee OA?

A
  • Young active pt
  • Adequate ROM
  • Unicompartmental degeneration
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53
Q

When is a high tibial osteotomy done & what does it do?

A

For medial knee OA 2° to varus–>Corrects the malalignment to transfer loads to uninvolved areas

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54
Q

Describe the post-op rehab for knee OA

A
  • Follow post-op protocols
  • Modified WB, possibly w/brace
  • Stretching & strengthening should be impairment-based
  • Flexion will be limited for 4-6wks
  • No CKC until 6th wk
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55
Q

What is the MOI for patellar fx’s?

A

Direct blow to the knee

56
Q

What are the types of patellar fx’s?

A
  • Undisplaced
  • Transverse
  • Upper/Lower Pole
  • (Un)Displaced Communited
  • Osteochondral
  • Vertical
57
Q

What is the clinical presentation of patellar fx’s?

A
  • Unable to stand
  • Unable to extend knee
  • Bruising
  • X-ray findings
58
Q

What is the conservative & surgical tx’s for patellar fx’s?

A

Conservative=Modified WB, Bracing, Immobilization

Surgical=ORIF w/tension bands or k-wires

59
Q

What is the MOI for tibial plateau fx’s?

A

Lateral=Combined valgus & axial loading

Medial=Combined varus w/axial loading

60
Q

What is the clinical presentation for tibial plateau fx’s?

A
  • Unable to WB on affected leg
  • Unable to flex/extend knee
  • Edema
  • X-ray to confirm
  • MRI to r/o ST injuries
61
Q

What are the conservative & surgical tx’s for tibial plateau fx’s?

A

Conservative=Bracing, Restricted ROM, Modified WB until X-ray shows healing

Surgical=ORIF

62
Q

How are tibial plateau fx’s usually tx’ed?

63
Q

Osteochondritis Dessicans

A

Loosening of subchondral bone resulting in cartilage fragmentation

64
Q

What is osteochondritis dessicans associated w/?

A

Other injuries

  • Stress fx
  • Subchondral bone loss
  • AVN
65
Q

Who is osteochondritis dessicans most common in & in what jt?

A

Male knees

66
Q

What is the clinical presentation of osteochondritis dessicans?

A
  • Vague, non-localized knee pain
  • Jt effusion
  • Crepitus
  • Pain
  • X-ray/MRI to confirm for localizing lesion
67
Q

What is the conservative tx for osteochondritis dessicans?

A
  • Immobilization
  • WB modifications
  • Activity modifications
  • Full PT once pt is painfree
68
Q

When is surgery indicated for osteochondritis dessicans?

A

When there’s loose bodies, unstable lesions, & persistant sx’s

69
Q

What does surgical management of osteochondritis dessicans consist of?

A
  • Drilling to incr vascularization
  • Bone graft
  • ORIF
70
Q

After surgery for osteochondritis dessicans, how long will a pt have WB modifications for?

71
Q

Articular Cartilage Defect

A

Loose body of cartilage in jt

72
Q

What is the clinical presentation of articular cartilage defects?

A
  • Vague, diffuse knee pain
  • Knee swelling
  • Locking/catching if loose body is present
  • MRI to confirm
73
Q

When will conservative tx for articular cartilage defect be done?

A

If defect is small & pt is asymptomatic

74
Q

What are the 3 types of surgical procedures done for articular cartilage defect?

A
  • Micro Fx
  • OATS Mosaicplasty
  • DeNovo Procedure
75
Q

Describe the micro fx procedure

A

Athroscopy where small holes are poked in the bone near the defect to stim healing

76
Q

Describe the OATS mosaicplasty

A

Healthy cartilage is harvested from NWB areas of the knee & plugged into areas w/damaged cartilage

77
Q

Describe the DeNovo procedure

A

Cartilage transplant from organ donors <13y/o

78
Q

What is the most common cause of mechanical sx’s in the knee?

A

Meniscal Tears

79
Q

Meniscal tears are the most common cause of what?

A

Mechanical sx’s of the knee

80
Q

What can meniscal tears alter &amp; what can this go on to cause?

A

Contact pressure between the femoral condyle & tibial plateau–>Leads to early OA

81
Q

What part of the meniscus is the most susceptible to injury?

82
Q

What are the types of meniscal tears?

A

Acute & Degenerative

83
Q

Acute Meniscal Tear

A

Result of trauma (generally axial loading w/rotation)

84
Q

Degenerative Meniscal Tear

A

Normal forces to meniscus cause degeneration (wear & tear)

85
Q

How are meniscal tears classified?

A
  • Size (Small-Large)
  • Location &amp; Associated Vascularization
  • Orientation (Longitudinal, Oblique, Radial, &amp; Complex)
86
Q

What is the clinical presentation of meniscal tears?

A
  • Pain
  • Stiffness
  • Jt Line Tenderness
  • Clicking, Catching, Locking
  • Jt Effusion
  • (+) Special Tests
  • MRI to confirm
87
Q

When tx’ing a pt for a meniscal tear, what should PT focus on?

A

Strength & stability at the hip, knee, & ankle

88
Q

When is conservative tx for meniscal tears done?

A

For small stable tears in red/red zone

89
Q

What is the most common choice of tx for meniscal tear?

90
Q

Partial Meniscectomy

A

Damaged white-white zone meniscal tissue gets removed

91
Q

Which ligaments of the knee heal best?

A

Extra-articular Ligaments (MCL & LCL)

92
Q

What are the 4 stages of healing of extra-articular knee ligaments?

A

1) Hemorrhage
2) Inflammation
3) Proliferation
4) Remodeling/Maturation

93
Q

Why should immobilization following extra-articular ligament injury be minimized?

A

Bc immobilization & disuse decr a ligament’s ability to resist strain & absorb force

94
Q

To minimize immobilization after extra-articular ligament injury, how should a PT proceed w/tx?

A

Do cautious progressive stressing of ligaments

95
Q

What is the MOI for extra-articular ligament injury?

A

Valgus/varus stress to the knee or non-contact rotation

96
Q

What is the clinical presentation of LCL injury?

A
  • Lateral knee pain
  • Lateral knee instability–>Worse in pt’s w/varus alignment
  • (+) Varus Test
97
Q

What is a varus thrust?

A

Lateral knee pain &amp; instability

98
Q

What is the clinical presentation of MCL injury?

A
  • Medial knee pain &amp; instability at 30° of flexion
  • Medial Jt line tenderness
  • (+) Valgus Test
99
Q

If a valgus test is (+) at 0°, what should you suspect?

A

ACL/PCL Injury

100
Q

For what grade injuries to extra-articular ligaments is conservative tx done for?

A

Isolated Grade 1 & 2 injuries

101
Q

Describe PT for grade 1 & 2 extra-capsular ligament injuries

A

Immobilization followed by progressive fxnl activties w/focus on quad strengthening

102
Q

What is the approximate RTP time following grade 1 & 2 extra-capsular ligament injuries?

103
Q

Describe the surgical tx for LCL tear

A

Reconstruction:

  • W/popliteofibular ligament
  • W/semitend or achilles graft
104
Q

Describe the surgical tx’s for MCL tear

A
  • Primary repair
  • Repair w/shortening
  • Repair w/graft (allo- or auto-)
105
Q

What is the MOI of ACL tear?

A

Valgus hyperextension or deceleration w/rotation

106
Q

Who are ACL tears most common in?

107
Q

In the 1st 12mo post-ACL repair, how much higher is the risk of re-tear or contralateral injury?

108
Q

What is the clinical presentation of ACL tears?

A
  • Report of audible pop &amp; immediate swelling
  • Pain
  • Instability
  • Edema
  • Decr ROM &amp; strength
  • (+) Special Tests
  • MRI to confirm; X-ray to r/o fx
109
Q

What are the goals of prehab for ACL tears?

A
  • Edema control
  • ROM restoration
  • Strengthening of quads &amp; glutes
110
Q

For complete ACL tears, is conservative tx successful?

A

Typically no

111
Q

What should conservative tx for partial ACL tears focus on?

A
  • Restoration of full ROM
  • Progressive fxnl strengthening
  • Proprioceptive strengthening
112
Q

What are the types of autografts for ACL reconstruction?

A
  • Patellar Tendon (BTB)
  • Hams Tendon (Semiten or Gracilis)
  • Single or Double Bundle
113
Q

Post-ACL reconstruction w/an autograft, how can you protect the donor site?

A

No resisted hams exercises for 12wks

114
Q

Post-ACL reconstruction, how can you protect the graft?

A

No OKC extension between O-45°–>Do quad sets &amp; SLR instead

115
Q

What is common following ACL reconstruction?

A

Loss of knee extension &amp; Quad Lag

116
Q

Following ACL reconstruction, what is pt progress based on?

A

Meeting milestones. NOT TIME!

117
Q

What is the MOI of PCL tears?

A

Direct blow to tibia w/flexed knee

118
Q

What is the clinical presentation for PCL tears?

A
  • Pain
  • Swelling
  • Stiffness
  • Unlikely to hear a pop
  • Less likely to complain of instability
  • (+) Special Tests MRI & X-ray to r/o other injuries
119
Q

What things are done in PT to tx PCL tears?

A
  • Maintenance/Restoration of ROM & Strength–>Focus on quads
  • Gait retraining
  • Progress to fxnl strengthening
120
Q

Post-PCL repair, what is the typical RTP timeframe?

A

5-9mo post-op

121
Q

What kinds of post-op pxn’s might a PCL reconstruction pt have?

A

Knee Flexion & Squats

122
Q

What is the MOI of patellar tendinitis?

123
Q

What is the clinical presentation of patellar tendinitis?

A
  • Painful palp
  • Painful resisted extension
  • Painful CKC activities
124
Q

What is the MOI of patellar tendon rupture?

A

Strong eccentric contraction such as jump landing or slipping on stairs

*Often occurs 2° to chronic tendinopathy

125
Q

What is the clinical presentation of patellar tendon rupture

A
  • Difficulty w/extension
  • Buckling/Instability
  • Bruising
  • Pain
  • Quad retraction
  • Patella alta
126
Q

For what types of patellar tendon ruptures is conservative tx effective?

A

Small tears w/intact extensor mechanism

127
Q

For a pt w/patellar tendon rupture trying conservative tx, how long will they be immobilized or PWB for?

128
Q

What is the tx of choice for most pt’s w/patellar tendon rupture?

129
Q

Describe the surgery for patellar tendon rupture

A

Patellar tendon gets sutured/anchored to the patella

130
Q

Who is PFPS most prevalent in?

A

Female athletes age 12-17

131
Q

What is the clinical presentation of PFPS?

A
  • Pain around/behind patella
  • Pain aggravated by loading PFJ on a flexed knee
  • Biomechanical alterations in hip adduction, IR, & tibial IR
  • (+) Clarke’s Test
132
Q

What is the MOI for patellar dislocation?

A

Valgus force when knee is slightly flexed

133
Q

What can lateral patellar dislocation cause?

A

MPFL & medial retinaculum tear

134
Q

Who are patellar dislocations most common in?

A

Female adolescents

135
Q

What is the clinical presentation for patellar dislocations?

A
  • Medial patellar pain
  • Swelling
  • Tenderness
  • (+) Apprehension Test
136
Q

What are the risk factors for patellar dislocations?

A
  • Patellar Hypermobility
  • Patella Alta
  • Genu Recurvatum
  • Trochlear Dysplasia
  • Large Q Angle
137
Q

Describe the surgical tx’s for patellar dislocation

A
  • Proximal patellar realignment w/MPFL reconstruction
  • Advancement w/lateral release
  • Distal tibial tubercle relocation to make Q-angle >20°

2) Patho 2 (20 decks)

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