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MSS Conditions > Acute Knee & Hip Pain > Flashcards

Acute Knee & Hip Pain Flashcards

1
Q

What is the hx of ACL injury?

A
  • Cutting/pivoting, knee shifted, pop, quick effusion in first few hours (key!)
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2
Q

What will be found on PE of ACL injury?

A
  • Large tight effusion
  • Lachman’s is most sensitive test
  • Blocked extension consider large bucket handle meniscal tear
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3
Q

Imgaging for ACL injury

A
  • MRI is best imaging
  • Segond fracture on X-ray (pathognomonic)
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4
Q

Tx/management for ACL injury

A

Surgery for young and active or older with daily instability or fail conservative management
Must have full ROM and swelling decreased before surgery

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5
Q

What does the PCL do?

A

Resist posterior stress on knee

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6
Q

How is PCL usually torn?

A

Dashboard injury or direct blow to flexed knee

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7
Q

What is the best test to evaluate a PCL tear?

A

Posterior drawer

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8
Q

How does a pt present w/ PCL tear?

A

More subtle symptoms & usually patient doesn’t c/o of instability

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9
Q

How is a PCL tear tx?

A

Nonoperatively

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10
Q

How is LCL injured?

A
  • Mech is us getting hit on lower lateral tibia
  • Opening to varus stress at 30 degrees of flexion
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11
Q

What nerve should be tested in a LCL injury?

A

Peroneal (fibular)–dorsiflexion of foot & sensation laterally

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12
Q

What is the tx for LCL tear?

A

Subacute surgical repair or chronic reconstruction

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13
Q

What is the hx of MCL tear?

A
  • Medial sided pain
  • Less swelling than ACL tears
  • Opening to valgus stress at 30 degrees F
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14
Q

What is the Pellegrini Stieda lesion?

A

Post traumatic ossification near avulsion fracture of MCL near medial femoral condyle. See on X-ray

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15
Q

What is the tx for MCL tear?

A

Hinge knee brace w/ early ROM

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16
Q

What is the hx of a Meniscal tear?

A
  • Usually rotation & axial load
  • Clicking, catching or may have locked knee if large acute bucket handle tear
  • May be insidious onset in those over 40 yo
  • Best test is joint line tenderness****
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17
Q

What test used to dx a Meniscal tear?

A

Apley & McMurray

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18
Q

What is the tx of a meniscal tear?

A
  • Usually treat chronic first with nonop
  • Surgery for acute tears in young pt w/ possible repair esp w/ concomitant ACL surgery
  • Watch out for the locked meniscus w/ inability to fully extend
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19
Q

What is the hx of a Patellar Tendon rupture?

A
  • Pts <40yo
  • Felt pop
  • Missing step of stairs
  • Playing basketball/jumping
  • Can’t extend knee
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20
Q

What will be found on PE w/ a Patellar Tendon rupture?

A
  • Unable to extend knee
  • Unable to hold leg in air (straight leg raise)
  • High riding patella
  • Defect below patella
  • Hemarthrosis
  • Possible bruising anterior knee
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21
Q

What are the dx tests for patella tendon rupture?

A
  • X-ray: high riding patella; r/o patella frature
  • MRI: not necessary unless confimatory necessary
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22
Q

What is the tx for a patellar tendon rupture?

A

Operative repair

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23
Q

What is the hx of a patellar dislocation?

A
  • Valgus force & external R of tibia to a F knee
  • Females in 2nd decade MC
  • Knee shifted medially or patella out laterally
  • Most are lateral
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24
Q

What will be found on PE w/ Patellar dislocation?

A
  • Pain along medial retinaculum & adductor tubercle
  • Apprehension sign to lateral pressure of patella
  • J sign
25
Q

What is J sign?

A

Inverted J path the patella takes in early F as the patella begins laterally subluxated & shifts medially to engage femoral groove

26
Q

What are the dx tests for patellar dislocation?

A
  • X-ray: osteochondral loose pieces/fractures
  • MRI: distinguish from ACL tear
27
Q

What is the tx for a patella dislocation?

A
  • Reduction maneuver: extend knee & push patella over**
  • Nonop initially
  • Knee brace or cast w/ knee in extension or early ROM w/ brace
  • Sugrical if fails
28
Q

Important points of Patella Sleeve Fracture

A
  • 8-12 yo
  • Usually fall at playground, sports or bicycle
  • Distal pole of patella plus a large sleeve of articular cartilage
  • Often misdx esp w/. small piece
  • Key is extensor lag & inability to do straight leg raise
  • Urgent referral to orthopedic surgeon for open tx
29
Q

Important points of Bipartite Patella

A
  • Synchondrosis
  • Failure of complete fusion of the patella in childhood
  • Not a fracture
  • No Hx of trauma
  • Commonly seen on x-ray
30
Q

What should you also examine in a pt w/ knee pain?

A

The hip! Hip pain often radiate to the knee esp in children! Always examine the hip!

31
Q

What is a SCFE?

A
  • Slipped capital femoral epiphysis
  • MC hip disorder in adolescence
32
Q

What is the hx of a SCFE?

A
  • Obese child 11-13yo
  • Painless limp
  • Acute or subacute pain 1+ month
  • Thigh, knee or hip pain
33
Q

What will be found on PE of a SCFE?

A
  • Loss of ABDuction & internal R
  • Acute–inability to bear wt
34
Q

What are the dx test for a SCFE?

A

AP & Frog Leg Lateral

35
Q

What is the tx of a SCFE?

A

Requires prompt surgical tx**

36
Q

Important points of Perthes dz

A
  • 4-11 years old
  • Normal size
  • Aching thigh or knee pain
  • Loss of ABDuction & internal R
  • Avascular Necrosis
  • Usually self limiting
37
Q

Important points of Hip Stress Fracture

A
  • Female long distance runner
  • Pain worse w/ activity
  • Groin pain
  • High index–get MRI
  • If superior fracture must be non-wt bearing & go to surgery immediately
38
Q

How will a pt w/ a Posterior Hip dislocation present?

A

Leg short, ADDucted & internally R

39
Q

How will a pt present w/ an Anterior Hip dislocation?

A

Leg flexed, ABDucted & externally rotated

40
Q

What is the tx for a hip dislocation?

A

Emergent reduction under conscious sedation in ER or general anesthia in OR

41
Q

What is the biggest risk of waiting to reduce a hip dislocation?

A

Avascular necrosis

42
Q

Tx for Intertrochanteric Hip Fracture

A

Open reduction internal fixation

43
Q

What attaches to the iliac crest?

A

Abdominal muscles

44
Q

What attaches to the ASIS?

A

Sartorius

45
Q

What attaches to the AIIS?

A

Rectus femoris

46
Q

What attaches to the pubic symphysis?

A

Adductor muscles

47
Q

What attaches to the Greater Trochanter?

A

Gluteal muscles

48
Q

What attaches to the Lesser trochanter?

A

Iliopsoas

49
Q

What attaches to the Ischial Tuberosity?

A

Hamstrings

50
Q

How do you tx a quad contusion?

A
  • Place knee in mild F to dec bleeing
  • Use ace wrap around knee to hold it on sideline
  • Heat should be avoided that will open up BV & continue bleeding & inc risk of hematoma
51
Q

What complication can occur from quad contusion?

A

Myositis ossifcans

52
Q

Hx of Qaudriceps tendon rupture

A
  • >40yo**
  • Felt pop
  • Can’t extend knee
  • Miss a step of stairs
  • If bilateral think: gout, DM, steroid use**
53
Q

PE of Quadriceps tendon rupture

A
  • Unable to extend knee
  • Unable to hold leg in air (straight leg test)*
  • LOW riding patella
  • Defect ABOVE patella
  • Hemarthrosis
  • Possible anterior knee bruising
54
Q

Imaging for quadriceps tendon rupture?

A

X-ray: low riding patella, r/o patella fx

55
Q

Tx of quadriceps tendon rupture?

A

Surgical repair

56
Q

What ligament is surgically reconstructed in a Patellar dislocation?

A

Medial petellofermoral ligament

Holds patella from going out laterally & injured in a patella dislocation

57
Q

Why do hip fx have a high risk of nonunion or avascular necrosis to the femoral head?

A

Injury to BS (median circumflex artery)

58
Q

What can SCFE be a cause of?

A

Premature OA in young adults

MSS Conditions (7 decks)

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