Brown Lecture Flashcards
What is the most common form of arthritis? Those with arthritis are more susceptible to what?
Osteoarthritis
2.5x more prone to falls/injury than those without arthritis
What are 2 indicators that increase risk of developing OA?
- Estrogen deficiency
2. High C-reactive Protein (CRP): indicative of generalized inflammation
What 2 ways can OA be detected by and diagnosed?
Gold standard: x-ray
Symptoms: direct complaint from patient
What medications are used to treat OA? What are the risks associated with each?
Acetaminophen: can affect kidney and liver
SMALLEST DOSAGE FOR SMALLEST AMOUNT OF TIME
NSAIDs: GI bleed, kidney/liver damage, CV disease
Corticosteroids: destructive to cartilage and bone
Opioids: addiction, GI bleed, fracture
What are the signs and symptoms of hip OA?
Pain in groin, thigh, buttock or referred to knee
AM STIFFNESS
Decreased ROM and functional limitations
What is avascular necrosis? What are the symptoms?
Death of bone tissue due to poor blood supply
Pain in groin/hip/thigh with WB that eventually progresses to pain at rest
What is the incidence of avascular necrosis? How is it diagnosed?
Affects more males > females
40-65 y/o most commonly affected
Unilateral/bilateral
MRI, X-ray, bone scan
What are the risk factors for avascular necrosis?
- Trauma
- Alcoholism
- Long term corticosteroid use
- Fracture/disloaction
What does the conservative treatment for avascular necrosis consist of?
Rest, minimal WB, use of AD, gentle ROM
Electrical stimulation: stimulation bony regrowth
What is the surgical treatment for avascular necrosis?
Core decompression: removal of necrotic bone to stimulate regrowth
THA: when femoral head collapses
What is the most common cause of pelvic fractures?
MVA, crush injury, fall from high surface
Can also be caused by: stress, avulsion, osteoporotic bone
How are pelvic fractures treated? (Stable vs. unstable)
Stable: conservative/bedrest
NSAIDs, weight loss, isometric exercise, gentle motion
Unstable: ORIF/IRIF/Traction
What are the risk factors for a pelvic fracture?
- Age (55+)
- Obesity
- Trauma
- Female gender
- Repetitive squatting/kneeling
What are the symptoms associated with a pelvic fracture?
Worse pain in AM (exacerbated by activity)
Swelling
Pain
Loss of strength
What is bursitis? What is the MOI?
Inflammation of the bursa
MOI: Direct blow or friction
What are the three types of bursitis? What are the symptoms for each? How are they treated?
Trochanteric (most common): tenderness of greater trochanter, pain with resisted extension, abduction, ER, pain with ITB stretch (stretch/strengthen muscles, heat, US, steroid injection)
Illiopsoas: tenderness, pain with passive ER/extension and flexion/adduction (impairment based treatment)
Ischial and Gluteal: (least common) pain with sitting/compression
What is the difference between tendinitis, tendinosis and paratenonitis? (Cry or Heat?)
Tendinitis: acute inflammation of tendon (microtears) (COLD)
Tendinosis: intratendon degenerative lesion (USE HEAT)
Paratenonitis: inflammation of outer layers of tendon
What are the 3 most common hip tendinopathies?
Gluteus Medius/Minimus
Iliopsoas
Rectus Femoris
What is the MOI for tendinopathy? What 2 tendons are prone to tendinopathy?
MOI: Sudden overload and repetitive loading/unloading
Achilles’ tendon during late stance
Quadriceps during stair descent
(Eccentric conditions)
What is the clinical presentation of tendinopathy?
- Strong and Painful resisted isometrics
- Pain with stretch
- Tenderness with palpation
What is the treatment for tendinitis and tendinosis?
- itis: treat inflammation (ice massage)
- osis: loading based exercise (walking/strengthening)
ECCENTRIC BASED EXERCISE
Cross friction massage, stretching, NSAIDs
What is the most common sport injury?
Sprain/Strain
What is the MOI for a sprain/strain? What etiological factors contribute to developing a sprain/strain?
MOI: excessive strain/tension, contusions, lacerations, burns and myotoxic agents
Etiological Factors:
- Decreased flexibility/strength/endurance
- Dyssynergistic muscle contraction
- Insufficient warm up
- Not fully rehabbed from prior injury
What is the treatment for a muscle sprain/strain?
Controlled mobility and activity
Intervention depends on stage of healing
PREVENTION is easier than treatment
What is the most common type of hip fracture? MOI? THA procedure?
Posterior dislocation (85% of all cases)
MOI: impact w/ hip in flexion (MVA)
THA: posterolateral approach
What is the incidence, MOI, and THA approach for an anterior hip dislocation?
15% of all hip dislocations
MOI: impact w/ hip ER and extension
THA: anterior approach
What are the MOI for labral tears in the elderly and younger populations?
Young: twisting trauma (ER and hyper abduction)
Old: hx of hip/acetabular dysplasia or repeated twisting
What are the 4 types of hip labral tears?
Degenerative
Traumatic
Idiopathic: Femoral acetabular impingement
Dysplastic: abnormal coverage resulting in greater stress on labrum
What are the symptoms of a labral tear? What diagnostic image is needed to diagnose a labral tear?
Locking, instability, painful clicking
MOSTLY anterior groin pain
+ impingement test (hip IR, add, flexion)
MRI (gold standard)
What is femoral acetabular impingement? What 2 lesions does FAI consist of?
Anterior/anterosuperior labrum pinched between acetabulum and femoral neck
Cam Lesion: abnormal shape of femoral head/neck impinges acetabulum during movement
Pincer Lesion: acetabular retroversion causes over coverage and pinches labrum
What are the conservative/non conservative treatments for hip labral tears?
Conservative PT: pt. Education, ROM, strengthening, NSAIDs, corticosteroids
Surgical arthroscopy: treat underlying cause of labral tear if non-traumatic
What is the MOI, symptoms and treatment for a patellar fracture?
MOI: direct blow to knee (fall/MVA)
Symptoms: unable to stand/straighten knee, bruising, X-ray findings
Treatment: Modified WB, brace/immobilization, ORIF
What is the MOI, symptoms and treatment for a tibial plateau fracture? (Lateral/medial/high vs low energy)
MOI: Lateral plateau (axial loading + valgus)
MOI: Medial plateau (axial loading + varus)
MOI: high energy injury (MVA), low energy injury (osteoporosis)
Symptoms: cant WB, flex/extend knee, edema (X-RAY CONFIRM)
Treatment: brace/immobilization, decrease ROM, ORIF (most common treatment)
What is osteochondritis Dessicans? Incidence? Clinical Presentation? Imaging?
Loosening of subchondral bone resulting in cartilage fragmentation
Associated with injury
Most often in males
Most often in knee
Clinical presentation: antalgia, effusion, crepitius, vague non-localized knee pain
X-RAYS and MRI confirm diagnosis
What is the treatment for Osteochondritis Dessicans? Return to play?
Conservative: immobilization, NWB/PWB, activity modification
Surgical: indicated w/ loose bodies and unstable lesion
Drilling to increase vascularization and healing
What is an articular cartilage defect? What is the clinical presentation? Imaging?
Loose body: fragment of cartilage breaks off and floats in joint
Clinical presentation: vague/diffuse knee pain, swelling, locking/catching
MRI
What is the treatment for articular cartilage defects?
Microfracture Arthroscopy: holes drilled in defect to cause bleeding and healing
Osteochondral Autograft: healthy cartilage harvested from NWB bone and plugged into defect
What is the return to play (RTP) time frame for Osteochondritis Dessicans, collateral ligament injury, ACL tear, and PCL tears?
Osteochondritis Dessicans: 5 months
Collateral ligament injury: 8 weeks
ACL: 6+ months post op
PCL: 5-9 months post op
What is the most common cause of mechanical symptoms in the knee?
MENISCAL TEARS
Which meniscus is most susceptible to damage?
Medial meniscus
What is the difference between an acute and degenerative meniscal tear?
Acute: trauma to normal meniscus (axial loading with rotation)
Degenerative: normal force to degenerative meniscus
What is the clinical presentation of a meniscal tear? Imaging? Special tests?
Pain, stiffness, joint line tenderness, effusion
Clicking, locking, catching
MRI: gold standard
+McMurray’s and Thessaly’s
What is the treatment for a meniscal tear?
Conservative (small tears): NSAIDs. RICE, strengthening, stability
Partial meniscectomy: damaged meniscal tissue trimmed away
Meniscal repair (common): tear is sutured back together
What ligaments of the knee are intraarticular and extra articular? Which one’s heal better?
Intraarticular: ACL and PCL
Extraarticular: MCL and LCL
Extraarticular ligaments HEAL BETTER
What decreases a ligaments ability to to resist strain? How can this be combated?
Immobilization and disuse decrease ligament strength
Minimize immobilization and progressively stress ligament
What is the MOI for a collateral ligament injury? Clinical presentation? Imaging
MCL: valgus stress to knee (positive at 30)
***If positive at 0 degrees (PCL and ACL involved)
Clinical Presentation: medial knee pain, instability, tenderness
LCL: varus stress to knee
Clinical Presentation: lateral knee pain and instability (worse than MCL)
MRI to confirm sprain/strain
What is the treatment for collateral ligament injuries?
Grade I and II injury: immobilization and quad strengthening (functional rehab)
Surgical:
- **MCL repaired with shortening and allo/autograft
- ** LCL repaired with semitendinosis or Achilles graft
What is the MOI of an ACL tear? Incidence? Risk for re injury?
MOI: valgus/hyperextension force or deceleration/rotation injury
Increased risk in females (both for tear and reoccurrence)
15x higher risk of re injury or contralateral injury within 12 months of RTP
What does a patient report feeling following an ACL tear? Imaging? Special tests?
Audible pop, immediate swelling/pain, instability and giving way
MRI to confirm tear
+Lachman’s/pivot shift
How are ACL tears treated?
Non-operative (partial tear): ROM, strengthening and propioceptive training
Operative (complete rupture): autograft (using patellar/hamstring tendons); allograft (cadaveric donor)
DOUBLE BUNDLE
What makes up the unhappy triad?
- ACL tear
- MCL tear
- Medial meniscal tear
What is the MOI for PCL tears? Patient report? Imaging? Special tests?
MOI: direct blow to tibia with flexed knee (MVA/falling on flexed knee)
Patient Report: pain, swelling, stiffness (no pop)
MRI for confirmation
+Posterior drawer/reverse pivot/posterior large test
How are PCL tears treated?
Conservative: RICE, ROM, QUAD strengthening**
Surgical: Autograft or allograft
What is the MOI for a quad/patellar tendon rupture? Incidence?
MOI: occurs during strong eccentric contraction
Occurs secondary to tendinopathy
Quad tendon: >40y/o
Patellar tendon: <40y/o
What is the clinical presentation for quad and patellar tendon ruptures?
General: pain, bruising, buckling, inability to extend knee
Patella Alta: patella becomes prominent as quad retracts (patella rupture)
Quad retraction: suprapatellar gap forms (quad rupture)
How are patellar and quad ruptures treated?
Small tears: immobilize/PWB for 3-6 weeks, ROM, strengthening
Large tears: suture tendon to knee cap (SURGERY DONE ASAP TO PREVENT QUAD RETRACTION)
What is Patellofemoral Pain Syndrome and how is it related to chondromalacia? Incidence? Clinical Presentation?
Abnormal alignment of PFJ leads to cartilage damage
Age 12-17, female athletes
Clinical presentation: pain with loading over bent knee (stairs/squat/running); + Clarke’ sign
What is the MOI for patellar dislocation? Incidence? Clinical presentation?
Dislocation laterally can tear MPFL and medial retinaculum
MOI: slight knee flexion + valgus force/tibial IR
Common in female adolescents
+ Apprehension sign, medial patellar pain, swelling, tenderness
How are patellar dislocations treated?
Non-operative: patient education and quad strengthening
Proximal patellar realignment: MPFL reconstruction and lateral release
Distal Patellar Realignment: Trillat procedure (tibial tubercle medial relocation)
