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Musculoskeletal System > 3 - Ortho: Hip/Knee/Ankle/Foot > Flashcards

3 - Ortho: Hip/Knee/Ankle/Foot Flashcards

1
Q

Describe the Trendelenberg sign?

A

Shows gluteal weakness

Stand on one leg and opposite hip falls

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2
Q

Describe the galeazzi test

A

The bent knee supine test to delineate a leg length deformity

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3
Q

Describe the thomas test. With a positive result what must you rule out before dx of the target pathology

A

Detects hip flexion contracture
Supine, Hold knee of one leg and drop other leg, tests
Must rule out pelvic tilt and lumbar lordosis

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4
Q

Where can referred pain from the hip go? what nerves are responsible for the regions affected.

A 
Suprapatellar Region (femoral nerve) 
Medial Thigh (obturator nerve)
Buttock (sciatic nerve)
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5
Q

What are the treatment options for DJD or OA at the hip joint?

A

Activitiy Modification
Weight Control
Surgery (total hip, osteotomy of acetabulum, hip resurfacing, last option arthrodesis)

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6
Q

What is a possible complication of total hip replacements?

A

Metallosis - fragments of the metal on metal hip replacements enter the blood stream (increased serum nickel)

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7
Q

What are the possible complications of total hip replacements?

A

Periprosthetic fracture
Periprosthetic infection
Periprosthetic dislocation
Osteolysis - could be from infection, loss of bone around implant (likely related to motion of stem)
Component loosening -
Component wear
post-op parameters are aimed at preventing it

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8
Q

What is acetabular protrusio?

A

Head of the femur or surgical implant pushing through the acetabulum

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9
Q

What is the most important avoidable complication of hip replacement

A

DVT!!!

Must use prophylactic anti-coagulents, coumadin, warfarin etc.

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10
Q

What is the common presentation of hip fractures?

A

Groin pain after fall
Deformity may reveal itself
Passive/Active motion is painful

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11
Q

What is the log roll test?

A

Rolling the whole leg manually, gently to look for hip pathology pain

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12
Q

What is the best radiographic examination for suspected occult hip fracture?

A

MRI - shows edema which indicates fracture

Also order AP: Llateral Pelvis and Hip Fractures

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13
Q

What should you suspect if you hear crescent sign?

A

AVN - TYPE III osteonecrosis

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14
Q

What is Coxa Saltan’s? Be able to differentiate between internal and external forms

A

Snapping of the hip, can be caused by internal or external factors

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15
Q

Describe the common causes of external coxa saltan’s (snapping hip)

A 
Most Common
Females on banked surfaces (IT Band) - classic
Pain and snapping on passive flexion 
Snapping may occur with: 
- climbing stairs
- rising from seated position
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16
Q

Describe the common causes of internal coxa saltans (snapping hip)

A

Illiopsoas tendon subluxing over the iliopectineal eminence
Labral tear
Occurs with hip moving from flexion to extension
Groin pain
Much less common than external

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17
Q

Describe meralgia paresthetica

A

Entrapment of the femoral cutaneous nerve between the sartorious and the inguinal ligament at the level of the ASIS

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18
Q

Describe symptoms of Meralgia Paresthetica

A

Pain and dysesthesia that radiate to the lateral thigh
Decreased sensation in the distribution of the lateral femoral cutaneous nerve
Positive Tinel sign medial to the ASIS

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19
Q

Describe treatment of Meralgia Paresthetica?

A

Avoidance of clothes or activities that compress teh nerve
Weight reduction
Steroid injections can be diagnostic and therapeutic?
Surgery for persistent/severe symptoms

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20
Q

What are the ligaments of the joint capsule?

A

Review in BRS…/

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21
Q

what is the most likely type of fracture to occur in the proximal femur?

A

Type 2 (garden classification)

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22
Q

What is the preferred method of treatment for a type 2 garden classification fracture of the hip?

A

Percutaneous screws

Type 3&4 always require arthroplasty

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23
Q

Describe the treatment options for intracapsular hip fractures depending on the class of fracture.

A

Conservative treatment is rarely indicated
Garden;
1+2 - percutaneous screws
3+4 w/o DJD - Hemiarthroplasty
3+4 w/ evident DJD - Total Hip Arthroplasty
Possibly resection arthroplasty if there is no hope for arthroplasty to work

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24
Q

What direction of hip dislocation is the most common by far?

A

Posterior - axial force in line with femur, adducted hip

Commonly associated with posterior wall acetabular fracture

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25
Q

How will a patient present with a posteriorly dislocated hip?

Anterior?

A

Will be flexed at the hip, adducte, and internally rotated

Will be externally rotated with varying degrees of flexion and abduction

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26
Q

What is the proper course of treatment for a hip dislocation?

A

Emergent Reduction (immediately) - often done closed right in the ER, can be also done in the OR

OR is indicated if there is an associated hip or femoral neck fracture of the ipsilateral side

Some form of sedation or nerve block should be done prior to reduction attempt

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27
Q

What are some of the common risk factors for AVN of the hip?

A 
Alcoholism
The bends
Marrow-replacing diseases (gaucher's)
Sickle Cell 
Hypercoagulable states
Steroids
SLE 
Inflammatory Bowel Disease
Viruses
Transplant Patients
Trauma
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28
Q

What is the common presentation of Hip ON/AVN?

A

Dull, activity-related pain in the groin/buttock
Decreased internal rotation and abduction (ROM)
Progressive in nature

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29
Q

What are the common radiographic findings for AVN?

A

Sclerosis early on
May look normal
CRESCENT SIGN**

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30
Q

What modality is used to define the extent of ON/AVN of the hip

A

MRI, can also be a source of early detection

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31
Q

What is the course of treatment for Hip ON/AVN

A

Precollapse: Bisphosphates
Surgery: Controversial - wont be asked
- vascularized fibular graft possible

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32
Q

What is the most common type of bursitis in the hip?

A

Greater Trochanteric - underneath the IT band

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33
Q

What are the common symptoms of Greater trochanteric bursitis?

A

Pain/Tenderness over the greater trochanter
May radiate over lateral thigh
Discomfort when lying on that side
Pain can be elicited with extremes of adduction and internal rotation

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34
Q

What is the proper course of treatment for greater trochanteric bursitis?

A

Activity Modification
NSAIDs
Injection of the bursa with corticosteroids

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35
Q

What are the extracapsular ligaments in the hip?

A

Anterior - Iliofemoral ligament

Posterior - ischiofemoral ligament

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36
Q

Review Young-Burgess Classifications Somehow

A

High Energy Injuries usually
LC - Lateral Compression
APC - Anterior Posterior Compression
VS - Vertical Shear

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37
Q

If you hear crescent sign in a vignette, what should you suspect?

A

AVN

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38
Q

What is the first thing you always do when examining a patient with pain complaints/

A

Compare the injured side to the non-injured side, to gain an understanding of normal for that patient

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39
Q

Describe the tests that can be used in diagnosis of the meniscus via palpation?

A

McMurray - External Rotation and Extension

Apley’s Compression/Distraction -

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40
Q

Describe the tests that can be used in diagnosis of the knee ligaments via palpation?

A

Lachman’s
Drawer Dests
Pivot Shift
Varus/Valgus

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41
Q

Describe the tests that can be used in diagnosis of patella pathology via palpation?

A

Crepitus
Apprehension
Clark Test
Height

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42
Q

Describe thessaly’s test and what it is used for.

A

Used to test for meniscal injuries
Patient Stands Flat Footed, provider assists with hands to help with balance. The patient then flexes the knee to 20deg then rotates the femur on the tibia

Test is positive if the patient experiences medial or lateral line pain with the movements

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43
Q

Describe the functioning of synovium cell types A, B, C and fluid portion.

A

Type A - phagocytosis

Type B - production and secretion, likely the source of glycoprotein and hyaluronic acid and synovial fluid

Type C - undifferentiated

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44
Q

What is the function/composition of synovial fluid?

A

Major Functions: Lubrication, Nourishment

Lubricin - Hyaluronic Acid, Proteinase, Collagenase, Prostaglandins (inflammation)

DOES NOT CONTAIN: RBCs, Clotting Factors, Hemoglobin

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45
Q

Describe the function of Hyaluronic Acid?

A

Increases the viscosity and elasticity of articular cartilages, lubricates teh joint space

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46
Q

Describe the function of Lubricin in synovial joints?

A

Glycoprotein that is key in lubrication

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47
Q

Describe the different types of knee effusion and the possible indications of these appearances.

A

Knee Swelling within 4-6 hours indicates hemarthrosis (bleeding into the joint caused by a variety of pathologies)

Fat Globules: fractures
Cloudy Aspiration: infection
Viscosity: infection (string sign)

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48
Q

Describe the condition using the following synovial fluid analysis:

Yellow, opaque, Variable viscosity, 15,000 - 200,000 WBCs per mm, >75% PMNs, Poor mucin clotting

A

Septic

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49
Q

Describe the condition using the following synovial fluid analysis:

Yellow to Green, opaque, Low Viscosity, 2,000 - 15,000 WBCs per mm, >50% PMNs, Good to poor mucin clotting

A

Inflammatory

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50
Q

Describe the condition using the following synovial fluid analysis:

Yellow, transparent, high viscosity, 200 - 2,000 WBCs per mm, <25% PMNs, Good mucin clotting

A

Non-Inflammatory

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51
Q

Describe the condition using the following synovial fluid analysis:

Clear, Transparent, High viscosity, <25% PMNs, Good mucin clotting

A

Normal Knee

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52
Q

Describe two discussed synovial tissue pathologies seen in children and adolescents.

A

Toxic Synovitis: low grade temp, pain, negative cultures, 7-10 d duration, usually in the hip and knee. (unknown etiology - possible viral infection as cause)

Synovial Cell Carcinoma: Rare, adolescents and young adults, very malignant, spindle sarcomatous cells or epithelial cells. Radical surgery and cancer treatment therapy needed immediately

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53
Q

Describe Synovial Chondromatosis aka Reichel Syndrome)

A 
Osteochondromatosis (3 stages)
Rare,
Causes unknown 
Benign 
Looks like a bunch of goat cheese in the joint on radiographs
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54
Q

Describe the cc of a torn meniscus

A

Pain, Snapping, Swelling, Stiffness, Decereased ROM, Instability, Locking

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55
Q

Describe the common history seen in pt. with torn meniscus

A

Acute: Twisting injury of the knee with foot planted

Chronic: Older patient with minimal or no trauma, pt can usually continue to ambulate, work or even participate in sports (with the exception of locked knee caused by a floater getting wedged)

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56
Q

Describe the P.E. findings in a meniscal tear at the knee joint.

A

Pain at the joint line, swelling/stiffness 24-72 hrs post injury, Popping/catching/locking, McMurrays Positive

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57
Q

Describe the objective tests done for dx of a torn meniscus

A

X-Ray: AP/Lat/Oblique, Sunrise Patella
MRI
Arthrogram
CT Scan to rule out inra-articular fractures

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58
Q

Discuss the possible other etiologies in a meniscus tear differential?

A 
Loose Bodies (Floaters)
ACL Tear
MCL Tear
Osteochondritis Desicans OCD
Discoid Meniscus
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59
Q

Discuss the courses of treatment for a torn meniscus

A

Arthroscopy (repair or partial meniscectomy) - Repair generally unsuccessful

PT
Meds

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60
Q

What pathology is commonly seen with a double PCL sign on MRI?

A

In 80% of cases it is associated with a medial meniscus tear

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61
Q

Describe the common CC with an ACL Rupture?

A

Post-Traumatic pain and swelling
Instability
Immediate effusion >70% are ACL Rupture

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62
Q

Describe the common histories associated with an ACL tear.

A

Hyperextension/Twisting injury
Deceleration Injury
Audible Pop
Immediate pain and effusion
May be present with chronic instability which would be old injury
Think ACL with posterior medial meniscal horn tear

63
Q

How many bundles of ACL are present?

A

2
Anteromedial - tight in flexion
Posterolateral - tight in extension

64
Q

Describe the common P.E. findings in an ACL Rupture.

A 
Lachmans test (most sensitive) 
Anterior Drawer
Pivot Shift 
Effusion 
COMPARE BOTH KNEES!!!!!!!!!!!!
65
Q

Describe the common objective tests used in dx of an ACL rupture

A

X-Ray (Segond Fracture: avulsion of the lateral portion of the tibial plataeu)
MRI
Aspiration

66
Q

List the other possible etiologies involved with an ACL differential.

A

Torn Meniscus - Acute = Lateral, Chronic = Posterior horn of medial meniscus

Torn PCL
Torn MCL
Combo of alll!!!!!!!! (refrer to history and mechanism of injury)

67
Q

Describe the course of treatment for an ACL rupture?

A

Age dependent
Surgery very common
Conservative (generally in older population)
- Bracing or PT

68
Q

What are the possible treatments for repair of an ACL?

A

Graft Procedures: Auto/Allograft, Hamstrings/Bone-tendon-bone

Radiofrequency heat - to shrink a stretched ACL

Simple Debridement - to clear the damaged tissue and prevent locking/popping

69
Q

Describe the general information about PCL tears.

A 
Rare
Usually due to high energy trauma
Knee Dislocations commonly associated
Dashboard Injuries
Can display as recurvatum when standing with legs fully extended
70
Q

Describe some of the objective testing available for dx of a torn PCL.

A

Posterior Drawer Test

Posterior Sag Sign

71
Q

Describe the bundles of the PCL and their characteristics.

A

Runs from the lateral aspect of the medial femoral condyle to the posterior portion of the tibial plataeu
2 Bundles:
Anterolateral: tight in flexion
Posteromedial: tight in extension

72
Q

Describe what is involved with a CC of a dislocated patella.

A

Over 90% occur with a lateral dislocation of the patella
Spontaneous or traumatic, injury with palpable deformity of the knee
Knee is usually in the flexed position

73
Q

What types of objective assessments can be done in dx of the patella/ patellar dislocation?

A

Apprehension Test (displace patella laterally, and patient flexes quad as a guarding mechanism)

Assess Q angle: large Q angle predisposes pt. for patellar subluxation or dislocation

74
Q

What are some anatomical considerations involved with assessing the stability of the patella?

A 
Lateral Positioning (naturally)
Recurvatum
Patellar Facet Deformity 
Shallow Patello-Femoral Groove
Tight lateral retinaculum
75
Q

Discuss treatment options for a subluxed/dislocated patella.

A 
Reduction
Immobilization
Braces 
Arthroscopic procedures
Open procedures (reallignment)
76
Q

Describe the common characteristics associated with a CC of chondromalacia aka petellofemoral syndrome.

A

Pain around the knee cap
Crepitance
Pain when doing the stairs

77
Q

Discuss the grading system for chondromalacia.

A

Grade I
focal areas of hyperintensity with normal contour
arthroscopically : softening or swelling of cartilage

Grade II
blister-like swelling/ fraying of articular cartilage extending to surface
arthroscopically : fragmentation and fissuring within soft areas of articular cartilage

Grade III
partial thickness cartilage loss with focal ulceration
arthroscopically : partial thickness cartilage loss with fibrillation (crab-meat appearance)

Grade IV
full thickness cartilage loss with underlying bone reactive changes
arthroscopically : cartilage destruction with exposed subchondral bone

78
Q

What P.E. testing can be done in dx of chonromalacia/

A

Pain around patella
Patello-femoral grind
Clark’s Sign
Lateral J sign - lateral movement of the patella in extension above the tochlear groove

79
Q

What objective tests can be done in dx of chondromalacia?

A

Sunrise Radiograph
MRI
Bone Scan
Arthroscopy

80
Q

What common injuries are part of the differential of chondromalacia?

A

Patellar Malalignment
Osteoarthritis
Osteochondritis Desicans
Plica Syndrome

81
Q

Describe the treatment options for a patient diagnosed with chondromalacia.

A

Conservative: Meds, Braces, PT

Surgical: Chondroplasty, Lateral Release, Open realignment, Patellectomy

82
Q

Describe the symptoms associated with a CC of prepatellar bursitis.

A 
CC - painful swollen prepatellar bursa
Increased temp of skin over knee
Pain in flexion 
Usually a direct blow or overuse injury 
May be spontaneous
83
Q

Describe the various etiologies of prepatellar bursitis.

A

Sepsis, Trauma, Arthritic

84
Q

What is the common course of treatment for prepatellar bursitis?

A

Conservative: aspiration, cortisone, antibiotics

Surgical: Excision

85
Q

Differentiate between osgood schlatters/jumpers knee and Sindig-Larsen Johansen Disease.

A

Both seen in boys>girls ages 10-15

Osgood: partial avuslion of the tibial tuberosity - often seen in early teens near the end of the growth phase.

Sindig: Calcification and abnormal formation of the inferior pole of the patella (causing pain similar to osgoods)

86
Q

What is the most common etiology associated with a bakers cyst?

A

usually secondary to internal derangement in the knee (arthritis (rheu/osteo), synovitis, etc..)

87
Q

What should be ruled out in a differential of a bakers cyst?

A

Synovial cell sarcoma - aspiration can help with ruling

88
Q

Describe the grading of knee ligament (collateral) sprains.

A

First Degree - Pain/Tenderness associated with trauma, but no joint laxity

Second - Detectable joint laxity with localized pain and tenderness

Third - Ligaments completely torn and joint grossly unstable

89
Q

What is thje strongest portion of the MCL?

A

The superficial portion is the strongest, the deep portion attaches to the medial meniscus for stabilization

90
Q

What types of objective testing can be done for dx of an MCL sprain?

A 
X-ray + Stress xray
MRI
Arthrogram
Arthroscopic Exploration
Segond Fracture
Pellegrini Stieda Disease
91
Q

What is pellegrini stieda disease?

A

(PS) lesions are ossified post-traumatic lesions at (or near) the medial femoral collateral ligament adjacent to the margin of the medial femoral condyle. One presumed mechanism of injury is a Stieda fracture (avulsion injury of the medial collateral ligament at the medial femoral condyle).

92
Q

What is involved with the differential of a collateral ligament tear?

A

Torn Meniscus
Tibial Plateau Fractures
ACL Rupture

93
Q

Discuss treatment options for a collateral ligament tear?

A

Bracing
Casting
Surgery is rare

94
Q

What is osteochondritis desicans?

A

Necrosis of subchondral bone
CC - pain, swelling, popping, locking
History - Repetitive use or trauma, acute injury history, idiopathic, incidental finding on unrelated radiograph

95
Q

What types of physical findings are associated with osteochondritis desicans?

A

Painful ROM
Effusions
Poppin/Locking
Painful weight bearing

96
Q

What types of objective testing can be done in dx of osteochondritis desicans/

A

Xray Tunnel View - usually involves the lateral aspect of the medial femoral condyle

MRI - open or closed lesion will be seen

97
Q

What else may be part of the differential for osteochondritis desicans.

A

Torn Meniscus

Torn ACL

98
Q

What is the most common cause of loose bodies int he knee joint?

A

Osteochondritis Desicans

99
Q

What are the possible treatments for osteochondritis desicans?

A

Conservative - long leg cast

Surgical - debridement, pinning, in situ pinning, OATES, drilling/microfracture, removal of free fragment, autologous cartilage transfer

100
Q

Describe knee arthritis

A

Pain with weight bearing ,Swelling, Decreased ROM, varus/valgus deformity, Crepitance and catching

Progressive development of symptoms, may be compartmentalized on physical exam

Varus Deformity with OA in the medial compartment

101
Q

Which objective testing can be done in dx of OA at the knee joint?

A

Weight-bearing Radiograph
Bone Scan
Blood work

102
Q

What could be part of the differential for OA of the knee joint?

A

Torn Meniscus
Chondromalacia
Hip Pathology
Chondrocalcinosis

103
Q

What nerve is involved with referred pain from the hip to the medial border of the knee joint?

A

Obturator N.

Anterior Branch - supplies adductors, pectineus, gracillus, and cutaneous branches to medial thigh

Posterior Branch - supplies obturator externus and adductors

104
Q

What types of treatment can be offered for OA of the knee joint?

A

Conservative: Oral meds, PT, Injection, Assistive devices.

Surgical: High tibial osteotomy, unicompartmental knee replacement, total knee replacement

105
Q

What are some risk factors associated with increased ankle sprain incidence?

A

Individuals with varus mal-alignment
Tight Calf Muscles
Incompletely healed previous injuries to the ankle

106
Q

Describe the ligaments involved with an inversion ankle sprain.

A

ATFL is the most commonly injured with this mechanism
CFL is next
Followed by PTFL

107
Q

Describe objective tests used in dx of ankle sprains.

A

Hx and PE
Stress Radiographs
Anterior drawer test
MRi

108
Q

Discuss the grading system for ankle sprains.

A

Grade 1 - ATFL only injured, minimal change on inversion stress, normal anterior drawer test

Grade 2 - Torn ATFL and stretched CFL, laxity with inversion stress, positive anterior drawer.

Grade 3 - Torn ATFL/CFL, possibl PTFL involvement, uncommon, can be associated with fractures

109
Q

Describe the common treatment for mild/moderate ankle sprains?

A 
RICE
NSAIDS
Crutches for a few days
Functional splint (air cast or swede-o-brace)
Early weight-bearing and ROM
110
Q

Describe treatment for severe ankle sprains

A

Walking boot or cast
Non-weight bearing, followed by and as-tolerated basis
ROM as pain allows
PT

111
Q

What is the common recovery time for a severe ankle sprain?

A

6 weeks or more

Surgery may be necessary

112
Q

What exercise has mounting evidence for greatly improving the prognosis of ankle sprains, and reducing the incidence of re-injury.

A

Proprioceptive Balance Training

113
Q

Describe “high ankle” sprains and the mechanism of injury involved.

How is it commonly diagnosed?

A

Syndesmosis sprain (more significant than regular inversion)

Eversion stress radiograph

114
Q

Describe the weber classifications of ankle fractures.

A

A: transverse fibular avulsion, occasionally with an oblique medial malleolus fracture (internal rotation and adduction/inversion)

B: oblique fracture of the lateral mallelous w/ or w/o rupture of the tib/fib syndesmosis and medial injury (external rotation/eversion)

C: high fibular fracture with rupture of the tib/fib ligament and transverse avulsion fracture of the medial malleolus. Syndesmotic injury is more extensive than in type B (eversion)

115
Q

Describe teh Maisoneuve Fracture

A

Eversion fracture that typically involves medial malleolus and disruption of the tib/fib syndesmoses, resulting in fx of the proximal fibula**, and torn deltoid ligament

Can be missed with ankle exam

Proximal Fibular fx is key in this dx

116
Q

Describe common treatment for bimalleolar fractures?

A

Likely requires surgery,

117
Q

Describe the symptoms of achilles tendonitis

A

Usually associated with sig. increase in activity or change in activity type
Pain with push-off of gait
Tender upon palpation
Marked increase in size of posterior anatomy

118
Q

Describe treatment options for achilles tendonitis

A 
Heel Lift/Boot/Cast
Pt
Soaks
NSAIDs
Can be precursor to rupture, takes weeks/months to resolve
119
Q

Why are steroid injections contraindicated for achilles tendonitis?

A

corticosteroids have been shown to resolve inflammation, however they are also known to weaken the achilles tendon and greatly increase the incidence of rupture

120
Q

Describe achilles tendon ruptures

A

Common in young/middle-aged adults
Commonly see history of chronic disease
Contributing biomechanical factors of the foot (spurs, increased pronation, pes cavus (high arch), tight calves)

121
Q

Describe the dx process for an achilles tendon rupture.

A

Local tenderness/swelling, Palpable defects, Ultrasound/MRI, Inability to plantar flex

122
Q

What physical testing can be done in the dx of achilles tendon rupture?

A

Thompson Test - squeeze calf and foot should plantar flex (positive if no flexion observed)

123
Q

Where is the most common site of achilles tendon rupture/

A

4-6cm proximal to insertion on the calcaneous, due to decreased blood supply to the area “known as the “watershed area” of the tendon.

124
Q

Describe treatment of an achilles rupture?

A

Surgical - repair end-to-end or use a fascial graft

Non-surgical - less strength, high rate of re-rupture, less complications obviously…

125
Q

Describe the signs and symptoms of a calcaneus fracture.

A

Severe heel pain, toe gait, localized tenderness, low back pain, swelling

Can involve an avulsion of achilles insertion
Treament - may need arthrodesis, very difficult to get to heal

126
Q

Describe Calcaneal Apophysitis aka Sever Disease

A

M>F, usually around 10-14 yrs old
Repetitive heel strike during running or jumping, repetitive traction through achilles tendon
Can be with or without fragmentation of the apophysis

Will exhibit walking/running pain, swelling, tight ROM

Open calcaneal growth plate on radiograph

127
Q

Describe treatment options for sever’s disease.

A 
Activity modification
ICE
Shoes support/orthotics
Stretching
NSAIDS
Non-weight-bearing cast if severe
*this disease is self-limiting, growth plate will fuse eventually
128
Q

Describe retrocalcaneal bursitis

A

Caused by repetitive dorsi/plantar flexion with friction/traction exerted on achilles (eg. shoe rubbing)

May include “pump bump” aka haglund’s deformity callous formation

Treated with NSAIDs, RICE, Ultrasound, PT, Injections, Surgical bursectomy is rarely indicated

129
Q

What is the tendon involved with acquired flatfoot?

A

Posterior Tibial Tendon is insufficient

Treated with orthotics or possibly casting for 6-8 weeks

Severe cases treated with surgery

130
Q

Describe tarsal tunnel syndrome.

A

Caused by indirect trauma, repetitive heel strike during running on hard surfaces, and poor fitting shoes

Compression of the posterior tibial nerve in the posteromedial compartment of the ankle

131
Q

Describe the symptoms of tarsal tunnel syndrome.

Treatments?

A

Localized swelling, pain(tingling/burning) medial ankle and heel, May have EMG/NCV deficits

NSAIDs/Corticosteroid Injections
Ultrasound
Activity modifications
Orthotics
Decompression surgery if indicated
132
Q

Describe osteochondritis dissecans

A

Distinct lesion +/- detachment of articular cartilage from subchondral bone forming a loose body
Secondary to trauma
Average age: 20-35 yrs
Male 70% : Female 30%
6% of patients with any hx of ankle sprains, have OCD of ankle

133
Q

What are the signs and symptoms of OCD in the ankle.

A 
Pain
Acute inversion injury
Chronic ankle pain 
Catching/Grinding
Feelings of instability or give-way episodes

DX/ radiograph, MRI, CT scan is modailty of choice if lesions are known

Treated conservatively and can do surgery if conservative fails

134
Q

Describe the hawkins classifications for Talar Neck Fractures.

A

Type 1 - nondisplaced
Type 2 - displaced, subluxed subtalar joint
Type 3 - displaced, dislocated subtalar and tibiotalar joints
Type 4 - displaced, dislocated talonavicular joint (high risk of AVN)

135
Q

Describe the significance of hawkins sign in a healing talar neck fracture.

A

Sign of revascularization
Osteopenia seen beneath the subchondral surface of the talar dome
Occurs 6-8 weeks after the fracture

136
Q

Describe the courses of treatment of a talar neck fracture (depending on the hawkins grade)

A

Hawkins 1 - nonoperative: NWB cast for at least 8 weeks

Hawkins 2/3/4 - usually require surgery.

137
Q

Describe a lateral process fracture of the Talus.

A

aka snowboarders fracture
seen with forced dorsiflexion and external rotation of the foot
can be seen on plain xrays
treated with casting usually dont need surgery

138
Q

Describe Plantar fasciits.

A

Repetitive stress during weight bearing or push off
Predisposing factors - pes cavus, shortened achilles tendon, activity level, weight
Morning pain/stiffness
Walking “toe out”
Point tender at calcaneal insertion
Tightness of achilles tendon on affected side

139
Q

Describe the common course of treatment for plantar fasciiitis

A

NSAIDs, Stretching, Night splints, Ultrasound therapy, Orthotics, Activity modification (tolerance), Injection and/or surgical in severe cases

140
Q

Describe a march fracture injury

A

Stress fracture of the neck or shaft of the metatarsals (usually 2nd, 3rd, or 4th)

Gradual Onset, Sharp Point Tenderness, Diffuse Swelling

Treat with RICE, alter activity, stiff soled shoe, non-weight bearing, may require casting

141
Q

What do you call a fracture located w/in 1.5 cm distal to tuberosity of 5th metatarsal?

A

Jones fracture - high incidence of AVN and non-union

Treat w/ NWB cast for 6-8 weeks is necessary for healing

Surgical intervention in the case of non-union

142
Q

Describe the Lisfranc Injury

A

Fracture-Dislocation injury of the tarsal/metatarsal joint
Complex injury that is often missed
(initial xrays show minimal displacement, but severe ligamentous injury may exist)

143
Q

What are the mechanisms of lisfranc injury.

A

Direct: results from dorsally applied force (i.e. crush, drop tool box, etc..)

Indirect; axial load and twist on a plantar flexed foot

144
Q

What will be evident on a radiograph of a patient with a lisfranc injury?

A

“Fleck Sign” - avulsion of the ligament off the 2nd metatarsal base

Gold standard test is the CT scan

145
Q

Discuss treatment of a lisfranc injury.

A

Non-operative (conservative

Operative - reduction of metatarsal is key

ORIF required for >2mm gap

146
Q

Describe Morton’s neuroma

A

Fibrous enlargement of the plantar interdigital nerve with entrapment between metatarsal heads (usually 3rd and 4th)

Can result from direct trauma (stretching of plantar structures during hyperextension of the MP joint) e.g. sprint starts or recovery from a jump

Tight Shoes can also cause it

147
Q

Describe treatment for Morton’s Neuroma

A 
Relieve PRessure (orthotics, metatarsal neck pad) 
Local Injections
Surgery for refractory cases
148
Q

Describe Hallux Valgus (Bunion)

A

Big Toe deviates toward the direction of the little toe
As big toe drifts into valgus, a bump starts to develop on the medial side of the toe over the metatarsal

Can be treated by simply changing shoes or via surgical change of the foot (cosmesis)

149
Q

Describe Hammer Toe

A

plantar flexed PIP joint
pain over taht portion
6-12 months of non-operative treatment, if unsuccessful then a surgery can be done to fix it.

Flexible deformity = soft tissue procedure
Rigid deformity = bone and soft tissue procedure

150
Q

Describe Mallet Toe

A

Pain/Deformity including plantar flexted DIP joint

2nd and 3rd toes most common

151
Q

Describe corns

A

Callosity overlying a bony prominence - common in dorsolateral aspect of the 5th toe and interdigital space between 4th and 5th toe

Conservative: relieve pressure on toe, modalities (gauze, cut-out pads, toe crest)

Surgery - excision if pain continues despite conservative tx

152
Q

Describe the Freiberg infraction

A 
AVN of the lesser metatarsal heads
More common in females
ages 11-17 = peak incidence
Decreased ROM at MTP
Initial radiographs could be unremarkable 
Bone Scan helpful in dx 
CT scan late
153
Q

Describe the management of a freiberg infraction

A

Rest
NWB cast in acute phase
Shoe Modifications: MT bars, Rigid shanks, Rocker Bottom, Avoid Heels,
Acitivity modification
Surgery reserved for failed conservative treatment options

Musculoskeletal System (21 decks)

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