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OSCE > BIOMECHANICS > Flashcards

BIOMECHANICS Flashcards

1
Q

NOLDCAT

A

NATURE-what type of pain, shooting, sharp, burning
Onset-when does it hurt, triggers?
Location- where does it hurt?
Duration- how long has it been hurting for? when did you first notice?
Cause- acute event,. insidious
Aggravating/ alleviating: what makes it worse? what makes it better?
Treatment- have you seen/ had any other rx by health professionals

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2
Q

Metatarsal stress fracture

A
  • Forefoot pain aggravated by WB activity/ sport
  • Hx of inc training load
  • Palpation- focal tenderness
  • Radiology
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3
Q

Turf toe sprain 1st MTPJ joint sprain.

A 
-	Forced hyperextension injury (acute)
o	Axial load to a foot in fixed equinas
o	Drives hallux into hyperextension
o	Attenuating or disrupting plantar joint complex
-	Range in severity
o	sprain or tear of joint capsule
o	Dislocation
-	Hx related to footballers playing on hard surfaces in. cleats
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4
Q

Plantar plate injury

A

Plantar plate anatomy
- Fibrocartilaginous
- Trade off perfusion for strength
o Does not repair well if torn
Plantar plate serves to:
- Stabilise MTPJ and resist hyperextension
- Assist windlass mech through attachment to plantar fascia
- Absorb compressive loads
- Allows large forces to be transmitted through MTPJs during propulsion

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5
Q

plantar plate MOI

A 
-	Typically repetitive trauma/ overload
o	Abnormal loading patterns
o	Lesser MTPJ instability
	Plantar plate, synovitis, hammertoe or cross over def
o	Can be acute (traumatic)
o	2nd most frequent
-	Clinically-palpation
-	V- sign
o	Med deviation of involved toe
-	Digit elevated (DF)
o	Floating toe
-	Radiolog: X-ray,US, MRI
-	Laxity> drawer test (Lachman test) 
o	Prox phalanx dorsally translocated with met head stabilised
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6
Q
  1. Sesamoidopathy
A 
-	Acute injury (traumatic) > fracture
o	Hyperextenison or direct impact
-	Stress injury (overuse) > stress fracture
o	Runners with repetitive impact through forefoot
-	Medial sesamoid most frequent 
Clinical hx
-	MOI (repetitive stress or trauma?)
-	Careful palpation- compression
-	ROM
-	Radiology
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7
Q
  1. Morton’s neuroma
A
  • Not a true neuroma
  • Due to adaptive changes not tumor
  • Non neo plastic- originates through adaptive changes
  • Commonly in 3rd met spaces
  • Middle aged womens
  • Ache burning pain
  • Tight compressed shoes
  • Altered sensation- profound paraesthesia- sharp/ shooting
  • Pain when walking
  • Massage helps
    Histopathology
    Macrospoic- thickened
  • Not just cellular changes- vascular aswell
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8
Q

Mortons neuroma patho

A
  1. Chronic trauma theory- repetitive trauma from ambulation causes digit DF and flexor digitroum action,stretching the common
  2. Ischaemic theory: possible degermation of plantar digital arterial supply of hypertropgy of neural tissue
  3. Intermetarsal bursists-creates a compressive neuropathy fibrosis
  4. Entrapement theory- conintued irration- fibrosis, inc diameter or nerve,chronic compression
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9
Q

Mortons physical examination

A
  • Transverse compression forefoot Squeeze test
  • Direct compression b/w finger and thumb intermetasral 4/4
  • Mulders click
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10
Q

population and investigation mortons neuroma

A 
Common in
-	Sedentary women aged 50-70yrs
o	High heeled shoes
o	Overlaod of met heads
-	Athletics men aged 25-64
o	Found to have long 2nd met
o	Repet activity

Investigation
- WB views: AP, MO and lateral
- Check for bone patho: #, arthritis, tumour
- Biomech features such as digital alignment +. Me length
AP view
- Transverse plane deformity
- Compare met lengths
Lateral view
- Rectus, contracted, subluxed or dislocated joint
- Assess: arthritis, long standing conditions demonstrate bony erosin of dosarl aspect of met head/ and or phalangeal base

  • Provides baseline for future comparison of progression of deformity + assessing post op healing
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11
Q
  1. Lisfranc joint complex
A

MOI:
- Typically forced PF + ABD while the foot is in a fixed eqiunas position
- Range in severity
o Mild sprain> #/dislocation

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12
Q

lisfranc clinical ax

A 
-	Palpation and swelling
o	Tenderness to dorsal midfoot (TMTJ) region
-	Pain with stress testing
o	‘Piano key’ testing
-	Stability?
-	WB (Ffoot loading)
o	Single limb heel raise
o	Propulsion in gait
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13
Q

lisfranc radiology

A 
-	X-ray (WB)
o	Widening (Diastasis)
o	Compare uninjured side- normal
o	‘Fleck’ sign (avulsion)
-	MRI
o	Sensitivity
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14
Q

Achilles Tendinopathy

A 
( implies inflammatory)
-	Tendinosis (im plies degenerative)
-	Rupture
Stages:
-	Reactive
-	Tendon disrepair
-	Degenerative
Insertional tendinopathy- Enthesis
Non-interstional tendinopathy- mid- portion
Clinical ax
Hx
-	Load
-	AM stiffness and pain
Palpation
-	Pain
-	Insertion v mid portion
-	Thickening
-	Swelling
-	Crepitus
Passive range
-	PF (ddx posterior impingment)
Thompson’s test (calf squeeze test)
>rupture
Function
-	Calf raise (double and single leg)
-	Hop
-	Hop forward
-	Eccentric drops
-	Lunge
Imaging
-	X-ray MR
-	Pathology poorly correlated with pain and function
-	DDx or mis- diagnosis
o	PAI
o	Plantaris
o	Neural irritation
-	Systemic disease
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15
Q

ANKLE INJURY

A
  • Articulation of the distal tibia and fibula with the trochlear surface of the talus
  • Mainly SP- PF and DF
    o Abd with DF& Add with PF
  • PF limited by ATFL& osseous block of the posterior talus on the tibia
  • DF limited by trochlea shape of talus, triceps surae, posterior deltoid and PTFL
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16
Q

Ankle anatomy- ligamentous support

A
  1. Lateral ankle ligaments
    a. Anterior talofibular ligaments (2 bands)
    b. Calcaneofibular ligament
    c. Posterior talofibular ligament
  2. Medial (deltoid ligaments)
    a. Insertions into talus, calcaneus and navicular
    Superficial
    - Tibiospring lig
    - Tibionavicularlig
    - Superior tibiotalar lig
    - Tibiocalcaneal lig
    Deep
    - Deep posterior tibiotalar lig
    - Anterior deep tibotalar lig
  3. Syndesmosis
    a. Anteriorinferior tibiofibular ligament (AITFL)
    b. Posteriorinferior tibiofibular ligament (PITFL)
    i. Superfical and deep components
  4. Interosseous tibiofibular ligament
    a. Continuation of interosseous membrane
17
Q

Ankle sprain

A
  • MOI
  • Inversion> lateral lig damage
  • Eversion> medial lig damage
  • Compressive forces > consider osteochondral injury
  • Df/ EXT rotation > syndesmosis
  • Onset of pain
  • Ability to WB
  • Location and degree of pain and swelling
    o Usually indicative of injury and severity
  • Initial management
  • Previous hx
    o Management/rehab
    o Use of bracing or taping post injury
    Observation
  • Swelling/ bruising
    Palpation
  • Consider assoc injury
  • Active movements (PF, DF, INV/ EV)
  • Passive movements
  • Resisted movements
  • Functional movements (hop, lunge, SL balance)
    Specifc tests- anterior draw test
Clinical examination
Specific test: Syndesmosis
-	Squeeze test
-	Ext roation test
-	Crossed leg test
18
Q

Syndesmosis injury (High ankle sprain)

A
  • Df/ ext on a planted foot
  • Range in severity
  • Typically assoc with longer recovery/ healing
  • Surgical consideration
    Ankle sprain: Radiology
    X-ray
  • Include base of 5th met (alvusion #)
  • Ankle mortise or syndesmotic views if injury suspected
19
Q
  1. Medial tibial stress syndrome (MTSS)
A
  • Common in runners/ running based sports
    Palpation
  • Diffuse pain along 1/3 posteromedial tibial border >5cm
    Aetiology
  • Tibial bending
  • Fascial tension
    Running limb varus
20
Q
  1. Medial tibial stress fracture
A

Palpation

  • Localised pain (not diffuse)
  • > intensity
21
Q
  1. Chronic exertional compartment syndrome
A
  • Inc in intracompartmental muscle pressure
    o Tissue hypoxia and ischemia pain due to dec blood flow
  • Anterior compartment most common
  • Symptoms ‘tightness’ or constricting’ pain, cramping, parathesia- relived on rest
  • Acute compartment syndrome (surgical emergency)
  • Biomechanical overload syndrome (BOS)
22
Q
  1. Anterior tibial cortex stress fracture
A

Dread black line’

  • Aiteology- tibial bending (SP)
  • Signifcantly longer recovery

OSCE (8 decks)

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