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MSK > Ch 9 MDT Hip, Thigh, Knee > Flashcards

Ch 9 MDT Hip, Thigh, Knee Flashcards

1
Q

Occurs when the femoral head is displaced from the acetabulum

A

Hip dislocation

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2
Q

Posterior hip dislocations are most common at ___%

A

90%

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3
Q

Affected limb short, hip is fixed in adducted and internally rotated

Severe tenderness

Decreased ROM

A

Posterior Hip Dislocation

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4
Q

Hip held in abduction and external rotation

Severe Tenderness

Decreased ROM

A

Anterior Hip dislocation

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5
Q

Diagnostic tests for hip dislocations

A

Radiograph of hip, knee, pelvis

CT scan to evaluate for fracture pattern

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6
Q

Treatment for hip dislocation

A

MEDEVAC

Reduction

SIQ until evaluated by Ortho

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7
Q

Mostly caused by high energy trauma

Severe pain in thigh

Unable to bear weight

Obvious deformity and edema

A

Fracture of the femoral shaft

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8
Q

Diagnostic tests for Femoral Shaft Fracture

A

Plain films of Hip, Knee, Pelvis, Femur

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9
Q

Treatment for Femoral Shaft Fracture

A

Immediate splinting and traction

MEDEVAC

Surgery

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10
Q

Occurs in patients who undergo repetitive impact
-Military recruits, athletes, runners

Vague pain in anterior groin or thigh, relieved with rest

Member increased their activity load

A

Stress Fracture of the Femoral Neck

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11
Q

Physical Exam:

  • Antalgic gait
  • Tenderness to proximal thigh/groin
  • Limited ROM, particularly internal rotation
  • Pain to groin or thigh with straight leg raise
A

Stress Fracture of the Femoral Neck

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12
Q

Diagnostic tests for Stress Fracture of the Femoral Neck

A

Bone scan/MRI

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13
Q

Treatment for Stress Fracture of the Femoral Neck

A

Analgesics

Ortho Evaluation

Activity Modification
-Crutches/Non-weight bearing

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14
Q

Pain in groin area with attempted weight bearing

Sensation of “coming apart” at the hip with bearing weight

High impact trauma

A

Fracture of the Pelvis

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15
Q

Diagnostics for Fracture of the Pelvis

A

Radiographs: Pelvis, hip, head, cervical, chest

UA: Hematuria is common

Hematocrit to evaluate blood loss

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16
Q

Treatment for Fracture of the Pelvis

A

MEDEVAC

Hemodynamic resuscitation

Activity modification, no weight bearing

Pain Management, Narcotics

PELVIC BINDER

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17
Q

Strain to muscles around the hip
-Iliopsoas, Sartorius, Rectus Femoris

Vigorous muscle contraction while muscle is stretched causes the injury

Pain over muscle exacerbated by activity

A

Hip Strain

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18
Q

Mild ecchymosis or edema

Tenderness to affected hip muscle

Increased pain while attempting to range the hip

Strength limited by pain, 4/5

Thomas test indicated for hip flexor tightness

A

Hip Strain

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19
Q

Diagnostics for Hip Strain

A

Plain films of pelvis and hip considered

MRI for chronic pain/unclear diagnosis

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20
Q

Treatment for Hip Strain

A

Light duty/Activity modification

NSAIDs

Pain free stretching and strengthening

Run-walk program

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21
Q

Injury happens when actively contracted muscle is put on a stretch

More often hamstrings are injured vs. quadriceps

A

Thigh strain

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22
Q

Hamstring strain typically reports a sudden onset of posterior or thigh pain that occurred while running, water skiing, or some other rapid movement

“Pop” perceived at the onset of pain

Quadriceps strains are associated with direct blows during contact sports resulting in a contusion

A

Thigh Strain

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23
Q

Physical Exam:

  • Ecchymosis is common
  • Tenderness to palpation to affected muscle group
  • Pain while attempting to flex/extend at the knee
A

Thigh Strain

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24
Q

Diagnostics for Thigh Strain

A

X-rays if suspicion of fractures

MRI or ultrasound can confirm but is rarely indicated

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25
Q

Initial Treatment for Thigh Strain

A

Prevent further swelling and hemorrhage by having patient rest and elevate limb while applying ice and compressive wraps

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26
Q

Treatment for Thigh Strain

A

RICE

Pain free stretching and strengthening

NSAIDs

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27
Q

Inflammation and hypertrophy of the greater trochanteric bursa

Lateral Hip pain

A

Trochanteric Bursitis

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28
Q

Trochanteric Bursitis can be associated with:

A

Lumbar spine disease

Intraarticular hip pathology

Significant limb-length inequalities

Inflammatory arthritis

Previous surgery around the hip

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29
Q

Pain and tenderness over the greater trochanter (lateral hip)

Pain may radiate distally to the knee or ankle or buttocks

Pain is worse when going from sitting to standing

May decrease after warming up but return after 30-60 minutes of walking

Unable to lay on affecting side

A

Trochanteric Bursitis

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30
Q

No deformities on exam with point tenderness on lateral hip

Patient has increased pain with adduction or abduction with internal rotation

Trendelenburg and Faber tests are positive

A

Trochanteric Bursitis

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31
Q

Diagnostics for Trochanteric Bursitis

A

Hip radiographs are not necessary

-Used to rule out bony abnormalities

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32
Q

Treatment for Trochanteric Bursitis

A

NSAIDs

Light duty - Activity modification

Hip Strengthening (focus on abduction) and stretching

Refer to ortho if failed conservative management

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33
Q

Primary stabilizer of the knee

A

Anterior Cruciate Ligament (ACL)

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34
Q

Results from rotational (twisting) or hyperextension force

Sudden pain and giving way of knee

1/3 report audible “pop”

Had to stop playing sport because of instability/pain

A

ACL Tear

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35
Q

Generalized knee tenderness

ROM limited by pain/effusion

Locking/popping sensation

Positive Anterior Drawer and Lachman test

A

ACL Tear

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36
Q

Diagnostics for ACL tear

A

MRI

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37
Q

Treatment for ACL Tear

A

RICE

Light duty

Ortho consult

Physical therapy consult

KNEE BRACE

38
Q

Strongest ligament in the knee

Less common than other ligamentous/meniscal injury

A

Posterior Cruciate Ligament (PCL)

39
Q

Four Injury patterns for PCL tears

A

Dashboard injury

Hyperflexion

Hyperextension

Fall onto flexed knee with foot in plantar flexion

40
Q

Positive Special tests for PCL Tears

A

Posterior Drawer Test

Positive Sag Test

41
Q

Diagnostics for PCL Tears

A

MRI

42
Q

Treatment for PCL Tears

A

RICE

NSAIDs/Tylenol

Light duty

Ortho Consult

Physical Therapy Consult

43
Q

Stabilize the knee against valgus and varus stresses

A

Collateral ligaments

44
Q

MCL tear results from _____ force

A

Valgus

45
Q

LCL tear results from _____ force

A

Varus

46
Q

24-48 hours, localized ecchymosis and small effusion

Tenderness to medial or lateral knee

Limited pain or effusion

Valgus/Varus test positive

A

Collateral ligament tear (MCL/LCL)

47
Q

Valgus/Varus stress testing is done with the knee at ___ degrees of flexion

A

25-30

48
Q

Diagnostics for Collateral Ligament tear

A

MRI

49
Q

Treatment for MCL Tear

A

Non-operation and heal in 4-6 weeks

Contact MO

Conservative management (NSAIDs, RICE, Hinged Brace)

50
Q

Treatment for LCL tear

A

May be treated non surgically depending on grade

Ortho consult

Conservative Management (RICE, NSAIDs, Hinged brace)

51
Q

What grade of LCL tear needs surgical treatment?

A

III

52
Q

Chronic pressure or friction causes thickening of synovial lining and subsequent excessive fluid formation, thereby leading to swelling and pain of the knee

A

Bursitis of the Knee

53
Q

Bursitis on the anterior aspect of the knee, superficial and lies between the skin and the bony patella

A

Prepatellar bursa (Housemaid’s knee)

54
Q

Bursa lies under the insertion site of the sartorius, gracilis, and semitendinosus muscles on the medial flare of the tibia just below the tibial plateau

A

Pes Anserine Bursitis

55
Q

Dome shaped swelling over the anterior aspect of the knee

Tenderness to fluid filled dome shaped over patella

A

Prepatellar bursitis

56
Q

Mild swelling to medial aspect of the knee

Tenderness focal medial flare of the tibia just below the tibial plateau

A

Pes Anserine Bursitis

57
Q

Diagnostic tests for Bursitis of the knee

A

Radiographs to rule out bony pathologies

Aspiration if septic bursitis is suspected

58
Q

Treatment for Bursitis of the knee

A

RICE

NSAIDs

Light duty-activity modification

Pain free stretching and strengthening

Antibiotic treatment for septic bursitis

59
Q

Dense, fibrous band of tissue that originates from the anterior superior iliac spine region, extends down the lateral portion of the thigh and inserts on the lateral tibia at the Gerdy tubercle

A

Iliotibial (IT) Band

60
Q

IT Band Functions to:

A

Stabilize hip

Limits tibial internal rotation

Limits over pronation

61
Q

Occurs with repetitive flexion and extension of the knee

Only occurs in people who exercise, runners & cyclists

Pain focal to the anterior lateral aspect of the knee that worsens with activity
-Especially running downhill, heel striking

A

IT Band Syndrome

62
Q

Positive tests with IT Band Syndrome

A

Obers

Pain when jumping on flexed knee

63
Q

Treatment for IT Band Syndrome

A

NSAIDs

Foam rolling

Light duty

Modifications to training regimen (Proper running progression, stretching, hip abductor strengthening)

64
Q

Fibrocartilaginous pads that function as shock absorbers between the femoral condyles and tibial plateaus

A

Menisci

65
Q

Tears that disrupt the mechanics of the knee, leading to varying degrees of symptoms, and predisposing the knee to degenerative arthritis

A

Meniscal tears

66
Q

Caused by a twisting injury to the knee

Usually, can ambulate and may be able to continue to participate in activities

Describe symptoms of mechanical locking, catching or popping

A

Meniscal Tear

67
Q

Mechanical symptoms of locking, catching, or popping

Moderate to severe effusion of knee

Tenderness over medial or lateral joint lines

Positive McMurray

A

Meniscal Tear

68
Q

Diagnostic tests for Meniscal Tear

A

MRI

69
Q

Treatment for Meniscal Tear

A

Mechanical or Traumatic effusion = Urgent Referral to Ortho

No Mechanical Locking:
-RICE, NSAIDs, ROM exercises, consult to ortho

70
Q

Jumper’s knee

Seen in patients who increase physical training too quickly

Anterior Knee Pain

Pain exacerbated by exercise

A

Quadriceps/Patellar Tendinitis

71
Q

Diagnostics for Quadriceps/Patellar Tendinitis

A

Clinically

Radiographs/MRI if diagnosis remains in question

72
Q

Treatment for Quadriceps/Patellar Tendinitis

A

NSAIDs

Ice Light Duty

Pain free stretching/strengthening

PATELLAR TENDON STRAP

73
Q

Overuse disorder characterized by pain around the patella aggravated by activities that load the patellofemoral joint

Most common cause of knee pain in the primary care setting

A

Patellofemoral Pain

74
Q

Common cited different Patellofemoral Pain causes

A

Overload

Malalignment

75
Q

Risk factors for Patellofemoral Pain

A

Fitness level

Prior exercise behavior

BMI over 25

Training load

76
Q

Diffuse aching anterior knee pain

Exacerbated by prolonged sitting, climbing stairs, jumping, or squatting

No preexisting trauma

No history of swelling

A

Patellofemoral Pain

77
Q

Tenderness noted to medial and/or lateral subpatellar borders

Crepitus maybe noted with patellar mobility

Unremarkable muscle tests and ROM

A

Patellofemoral Pain

78
Q

Special tests for Patellofemoral Pain

A

Patellar Apprehension

Hamstring Flexibility via popliteal angle

79
Q

Patellar Apprehension, Patellar movement should be:

A

One quadrant medially and two quadrants laterally

80
Q

Treatment for Patellofemoral Pain

A

NSAIDs

Ice

Light duty - Active Rest

Quadricep and hamstring flexibility and strengthening

Weight loss

Support biomechanical limitations (Taping, Brace, Shoe inserts)

81
Q

Popliteal Cyst is also called:

A

Bakers cyst

82
Q

Cysts in the popliteal fossa

Inflammation in the joint space can cause these cysts

A

Popliteal Cyst

83
Q

What differential must be considered in Popliteal Cyst?

A

DVT

84
Q

Edema in the popliteal fossa

Flexion limited by pain and excessive joint fluid

A

Popliteal Cyst

85
Q

Diagnostic tests for Popliteal Cyst

A

U/S shows size and extent

Radiographs if uncertain

MRI if uncertain AFTER ultrasound

86
Q

Treatment for Popliteal Cyst

A

NSAIDs and/or analgesics

Ice

Light duty

Ortho consult if symptomatic

87
Q

Common cause of anterior knee pain in younger population (14-18)
-Active adolescents

Pain and swelling at the tibial tubercle (insertion site of patellar tendon)

A

Osgood Schlatter Disease

88
Q

Insertion site of patellar tendon

Overuse causes chronic avulsion of the ossification center of the tibial tubercle

Proximal patellar tendon separates from the tibial tubercle which causes elevation

Causes callous over time as it heals, and the tibial tubercle becomes pronounced

A

Osgood Schlatter Disease

89
Q

Anterior knee pain that increases gradually over time

Exacerbated by direct trauma, kneeling, running, jumping
-Relieved by rest

Typically asymmetric, occasionally bilateral

A

Osgood Schlatter Disease

90
Q

Bony prominence over tibial tubercle

Tenderness to tibial tubercle

Full ROM

Pain with resisted extension of knee

A

Osgood Schlatter Disease

91
Q

When are radiographs indicated in Osgood Schlatter Disease?

A

Pain at night

Pain not related to activity

Acute onset of pain

Associated systemic complaints such as fever, chills

92
Q

Treatment for Osgood Schlatter Disease

A

Usually benign and self-limited
-Resolves when growth plate reaches skeletal maturity

NSAIDs

Protective pad over knee

Avoid complete rest

Home exercises

MSK (14 decks)

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