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Pathophysiology II > Brown Lecture > Flashcards

Brown Lecture Flashcards

1
Q

What is the most common form of arthritis? Those with arthritis are more susceptible to what?

A

Osteoarthritis

2.5x more prone to falls/injury than those without arthritis

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2
Q

What are 2 indicators that increase risk of developing OA?

A
  1. Estrogen deficiency

2. High C-reactive Protein (CRP): indicative of generalized inflammation

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3
Q

What 2 ways can OA be detected by and diagnosed?

A

Gold standard: x-ray

Symptoms: direct complaint from patient

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4
Q

What medications are used to treat OA? What are the risks associated with each?

A

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

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5
Q

What are the signs and symptoms of hip OA?

A

Pain in groin, thigh, buttock or referred to knee

AM STIFFNESS

Decreased ROM and functional limitations

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6
Q

What is avascular necrosis? What are the symptoms?

A

Death of bone tissue due to poor blood supply

Pain in groin/hip/thigh with WB that eventually progresses to pain at rest

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7
Q

What is the incidence of avascular necrosis? How is it diagnosed?

A

Affects more males > females
40-65 y/o most commonly affected
Unilateral/bilateral
MRI, X-ray, bone scan

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8
Q

What are the risk factors for avascular necrosis?

A
  1. Trauma
  2. Alcoholism
  3. Long term corticosteroid use
  4. Fracture/disloaction
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9
Q

What does the conservative treatment for avascular necrosis consist of?

A

Rest, minimal WB, use of AD, gentle ROM

Electrical stimulation: stimulation bony regrowth

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10
Q

What is the surgical treatment for avascular necrosis?

A

Core decompression: removal of necrotic bone to stimulate regrowth

THA: when femoral head collapses

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11
Q

What is the most common cause of pelvic fractures?

A

MVA, crush injury, fall from high surface

Can also be caused by: stress, avulsion, osteoporotic bone

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12
Q

How are pelvic fractures treated? (Stable vs. unstable)

A

Stable: conservative/bedrest
NSAIDs, weight loss, isometric exercise, gentle motion

Unstable: ORIF/IRIF/Traction

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13
Q

What are the risk factors for a pelvic fracture?

A
  1. Age (55+)
  2. Obesity
  3. Trauma
  4. Female gender
  5. Repetitive squatting/kneeling
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14
Q

What are the symptoms associated with a pelvic fracture?

A

Worse pain in AM (exacerbated by activity)
Swelling
Pain
Loss of strength

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15
Q

What is bursitis? What is the MOI?

A

Inflammation of the bursa

MOI: Direct blow or friction

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16
Q

What are the three types of bursitis? What are the symptoms for each? How are they treated?

A

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

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17
Q

What is the difference between tendinitis, tendinosis and paratenonitis? (Cry or Heat?)

A

Tendinitis: acute inflammation of tendon (microtears) (COLD)

Tendinosis: intratendon degenerative lesion (USE HEAT)

Paratenonitis: inflammation of outer layers of tendon

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18
Q

What are the 3 most common hip tendinopathies?

A

Gluteus Medius/Minimus
Iliopsoas
Rectus Femoris

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19
Q

What is the MOI for tendinopathy? What 2 tendons are prone to tendinopathy?

A

MOI: Sudden overload and repetitive loading/unloading

Achilles’ tendon during late stance
Quadriceps during stair descent

(Eccentric conditions)

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20
Q

What is the clinical presentation of tendinopathy?

A
  1. Strong and Painful resisted isometrics
  2. Pain with stretch
  3. Tenderness with palpation
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21
Q

What is the treatment for tendinitis and tendinosis?

A
  • itis: treat inflammation (ice massage)
  • osis: loading based exercise (walking/strengthening)

ECCENTRIC BASED EXERCISE

Cross friction massage, stretching, NSAIDs

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22
Q

What is the most common sport injury?

A

Sprain/Strain

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23
Q

What is the MOI for a sprain/strain? What etiological factors contribute to developing a sprain/strain?

A

MOI: excessive strain/tension, contusions, lacerations, burns and myotoxic agents

Etiological Factors:

  1. Decreased flexibility/strength/endurance
  2. Dyssynergistic muscle contraction
  3. Insufficient warm up
  4. Not fully rehabbed from prior injury
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24
Q

What is the treatment for a muscle sprain/strain?

A

Controlled mobility and activity

Intervention depends on stage of healing

PREVENTION is easier than treatment

25
Q

What is the most common type of hip fracture? MOI? THA procedure?

A

Posterior dislocation (85% of all cases)

MOI: impact w/ hip in flexion (MVA)

THA: posterolateral approach

26
Q

What is the incidence, MOI, and THA approach for an anterior hip dislocation?

A

15% of all hip dislocations

MOI: impact w/ hip ER and extension

THA: anterior approach

27
Q

What are the MOI for labral tears in the elderly and younger populations?

A

Young: twisting trauma (ER and hyper abduction)

Old: hx of hip/acetabular dysplasia or repeated twisting

28
Q

What are the 4 types of hip labral tears?

A

Degenerative
Traumatic
Idiopathic: Femoral acetabular impingement
Dysplastic: abnormal coverage resulting in greater stress on labrum

29
Q

What are the symptoms of a labral tear? What diagnostic image is needed to diagnose a labral tear?

A

Locking, instability, painful clicking

MOSTLY anterior groin pain
+ impingement test (hip IR, add, flexion)

MRI (gold standard)

30
Q

What is femoral acetabular impingement? What 2 lesions does FAI consist of?

A

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

31
Q

What are the conservative/non conservative treatments for hip labral tears?

A

Conservative PT: pt. Education, ROM, strengthening, NSAIDs, corticosteroids

Surgical arthroscopy: treat underlying cause of labral tear if non-traumatic

32
Q

What is the MOI, symptoms and treatment for a patellar fracture?

A

MOI: direct blow to knee (fall/MVA)

Symptoms: unable to stand/straighten knee, bruising, X-ray findings

Treatment: Modified WB, brace/immobilization, ORIF

33
Q

What is the MOI, symptoms and treatment for a tibial plateau fracture? (Lateral/medial/high vs low energy)

A

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)

34
Q

What is osteochondritis Dessicans? Incidence? Clinical Presentation? Imaging?

A

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

35
Q

What is the treatment for Osteochondritis Dessicans? Return to play?

A

Conservative: immobilization, NWB/PWB, activity modification

Surgical: indicated w/ loose bodies and unstable lesion
Drilling to increase vascularization and healing

36
Q

What is an articular cartilage defect? What is the clinical presentation? Imaging?

A

Loose body: fragment of cartilage breaks off and floats in joint

Clinical presentation: vague/diffuse knee pain, swelling, locking/catching

MRI

37
Q

What is the treatment for articular cartilage defects?

A

Microfracture Arthroscopy: holes drilled in defect to cause bleeding and healing

Osteochondral Autograft: healthy cartilage harvested from NWB bone and plugged into defect

38
Q

What is the return to play (RTP) time frame for Osteochondritis Dessicans, collateral ligament injury, ACL tear, and PCL tears?

A

Osteochondritis Dessicans: 5 months
Collateral ligament injury: 8 weeks
ACL: 6+ months post op
PCL: 5-9 months post op

39
Q

What is the most common cause of mechanical symptoms in the knee?

A

MENISCAL TEARS

40
Q

Which meniscus is most susceptible to damage?

A

Medial meniscus

41
Q

What is the difference between an acute and degenerative meniscal tear?

A

Acute: trauma to normal meniscus (axial loading with rotation)

Degenerative: normal force to degenerative meniscus

42
Q

What is the clinical presentation of a meniscal tear? Imaging? Special tests?

A

Pain, stiffness, joint line tenderness, effusion
Clicking, locking, catching

MRI: gold standard

+McMurray’s and Thessaly’s

43
Q

What is the treatment for a meniscal tear?

A

Conservative (small tears): NSAIDs. RICE, strengthening, stability

Partial meniscectomy: damaged meniscal tissue trimmed away

Meniscal repair (common): tear is sutured back together

44
Q

What ligaments of the knee are intraarticular and extra articular? Which one’s heal better?

A

Intraarticular: ACL and PCL

Extraarticular: MCL and LCL

Extraarticular ligaments HEAL BETTER

45
Q

What decreases a ligaments ability to to resist strain? How can this be combated?

A

Immobilization and disuse decrease ligament strength

Minimize immobilization and progressively stress ligament

46
Q

What is the MOI for a collateral ligament injury? Clinical presentation? Imaging

A

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

47
Q

What is the treatment for collateral ligament injuries?

A

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
48
Q

What is the MOI of an ACL tear? Incidence? Risk for re injury?

A

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

49
Q

What does a patient report feeling following an ACL tear? Imaging? Special tests?

A

Audible pop, immediate swelling/pain, instability and giving way

MRI to confirm tear

+Lachman’s/pivot shift

50
Q

How are ACL tears treated?

A

Non-operative (partial tear): ROM, strengthening and propioceptive training

Operative (complete rupture): autograft (using patellar/hamstring tendons); allograft (cadaveric donor)

DOUBLE BUNDLE

51
Q

What makes up the unhappy triad?

A
  1. ACL tear
  2. MCL tear
  3. Medial meniscal tear
52
Q

What is the MOI for PCL tears? Patient report? Imaging? Special tests?

A

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

53
Q

How are PCL tears treated?

A

Conservative: RICE, ROM, QUAD strengthening**

Surgical: Autograft or allograft

54
Q

What is the MOI for a quad/patellar tendon rupture? Incidence?

A

MOI: occurs during strong eccentric contraction

Occurs secondary to tendinopathy

Quad tendon: >40y/o
Patellar tendon: <40y/o

55
Q

What is the clinical presentation for quad and patellar tendon ruptures?

A

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)

56
Q

How are patellar and quad ruptures treated?

A

Small tears: immobilize/PWB for 3-6 weeks, ROM, strengthening

Large tears: suture tendon to knee cap (SURGERY DONE ASAP TO PREVENT QUAD RETRACTION)

57
Q

What is Patellofemoral Pain Syndrome and how is it related to chondromalacia? Incidence? Clinical Presentation?

A

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

58
Q

What is the MOI for patellar dislocation? Incidence? Clinical presentation?

A

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

59
Q

How are patellar dislocations treated?

A

Non-operative: patient education and quad strengthening

Proximal patellar realignment: MPFL reconstruction and lateral release

Distal Patellar Realignment: Trillat procedure (tibial tubercle medial relocation)

Pathophysiology II (24 decks)

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