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Brad 4th Ed Part 2 > Ch.39 Lower Extremity > Flashcards

Ch.39 Lower Extremity Flashcards

1
Q

Intrinsic factors that lead to stress fx

A

Poor dietary habits, altered menstration, biomechanic ABN

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2
Q

Extrinsic factors that lead to stress fx

A

Hard training surfaces, training erros, improper footwear/insoles

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3
Q

What is the female athlete triad?

A

Disordered eating, amenorrhea and low bone density

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4
Q

A rigid pes cavus food can lead to __.

A

less shock absorption after heel strike

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5
Q

Pes planus foot does not allow ___.

A

Pronation

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6
Q

Imaging of choice for stress fx

A

MRI

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7
Q

Problem w/ using bone scan to evaluate stress fx

A

May remain positive after sx resolve

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8
Q

What can inhibit repair of stress fx?

A

NSAIDs may reduce bone remodeling

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9
Q

Femoral neck stress fx that require surgery

A

Lateral side, fx line >50% width of neck

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10
Q

Tx of femoral neck stress fx <50% of neck width

A

Strict non-wt bearing for 4-6 weeks followed by progressive wt bearing rehab for 4-8 weeks

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11
Q

Causes of AVN

A

steroids, alcohol abuse, diabetes, lupus, sickle cell anemia

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12
Q

When is surgery indicated in AVN?

A

Joint collapse> joint replacement

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13
Q

MC location affected by AVN

A

femoral head

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14
Q

What is Legg-Calve-Perthes dz?

A

Idipathic osteonecrosis of femoral head in children

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15
Q

MC affected by Legg-Calve-Perthes

A

Boys 4-8 yo

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16
Q

Hx of Legg-Calve-Perthes

A

Limping, restricted hip abduction, groin pain

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17
Q

Tx of Legg-Calve-Perthes

A

Observation in abduction brace <6 yo; Osteotomy in older children

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18
Q

What is the MC hip disorder in adolescents?

A

Slipped capiral femoral epiphysis

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19
Q

What is Slipped capiral femoral epiphysis?

A

Injury to physeal plate of proximal femur w/ medial displacement of femoral head relative to shaft

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20
Q

Who is affected by SCFE?

A

overweight boys <11 yoand girls <9 yo; hypothyroid and renal osteodystrophy

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21
Q

SCFE is bilateral ___ of the time

A

50%

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22
Q

Hx of SCFE

A

painful limp, leg held in flexion & ER

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23
Q

Tx of non-mild SCFE

A

Closed or open reduction; restricted wt bearin for 4-6 wks

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24
Q

How will a pt w/ posterior hip dislocation hold their leg?

A

Flexion, IR, ADDuction

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25
Q

How will a pt w/ anterior hip dislocation hold their leg?

A

Extended, , ER, ABDucted

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26
Q

MC direction of hip dislocation

A

Posterior

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27
Q

Tx of hip dislocation

A

Emergent reduction under anesthesia, non-wt bearing for 3-4 wks, then protected wt bearinf ro 3 wks

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28
Q

Hx of acetabular labral tears

A

Painful catching of hip in a particular angle

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29
Q

Imaging of choice for acetabular labral tears

A

MR arthrography w/ gadolinium contrast

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30
Q

Tx of acetabular labral tears

A

Relative rest, steroid injection, athroscopic surgery

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31
Q

What is Femoracetabular Impingement syndrome?

A

Contact b/w boney prominences limiting ROM

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32
Q

What is Pincer impingement?

A

Acetabular cause of impingement, overcoverage of femoral head

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33
Q

Whatis Cam impingement?

A

Femoral cause of impingement, aspherial portion of femoral head-neck junction

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34
Q

Hx of Athletic pubalgia or Sportsman’s hernia

A

Pain in lower abd and groin

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35
Q

Pain generators in Athletic pubalgia or Sportsman’s hernia

A

Lower abd muscles enar superior pubic ramus, strain of hip flexors/adductors or stress fx of pubic rami/symphysitis

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36
Q

Tx of Athletic pubalgia or Sportsman’s hernia

A

Strengthen abd muscles & hip girdle flexibility

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37
Q

What can be avulused w/ forceful contraction of rectus femoris?

A

ASIS

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38
Q

Tx of Rectus femoris avulusion

A

Ice, rest, gentle ROM & exercise as tolerated

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39
Q

What 2 muscles insert into the ITB band?

A

Gluteus maximus & tensor fascia lata

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40
Q

Where does the ITB insert?

A

Gerdy’s tubercle on anteriorlateral tibia

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41
Q

What imablance is seen in trochanter bursitis?

A

Gluteus maximus weakness & tensor fascia lata tightness

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42
Q

What is lateral snapping hip syndrome?

A

Audible snap as ITB band rubs over greater trochanter

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43
Q

What is internal snapping hip due to?

A

Iliopsoas tendon rubbing over iliopectineal eminence or femoral head

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44
Q

Thigh muscles strains MC in what kind of training?

A

Ballistic: power training where pt accelerates wt lifting & lowers wt suddenly (kettle bell swings)

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45
Q

When do hamstring strains occur?

A

forceful eccentric contraction at full flexion/extension when muscle at mech disadvantage

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46
Q

PE of hamstring strain

A

Pain w/ passive stretch, resistance or palpation over defect, bruising distal to site of injury

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47
Q

Rehab of hamstring strain

A

relative rest, gentle progressive ROM & stregthening, ballistic & sport specific exercises

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48
Q

MC group for ishcial avlusion fx

A

15-25 yo; gymnasts, hurdlers, dance

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49
Q

Hx of ischial avulsion fx

A

Sudden onset of pain at ischial site after forceful hamstring contraction w/ hip in full flexion & knee extension

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50
Q

MC location of adductor muscle strain

A

Close to origin at inferior pubic ramus

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51
Q

MC activities w/ adductor muscle strain

A

Soccer, hockey and skiing

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52
Q

MC invovled muscle in adductor strain

A

Adductor longus

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53
Q

Sartorius muscle strain can cause an avulsion at __.

A

ASIS origin

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54
Q

What is myositis ossificans?

A

calcific transformation of intramuscular hematoma

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55
Q

MC location for myositis ossificans

A

Quadriceps

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56
Q

What should be avoided in the first few days of intramuscular contusion?

A

ASA & antiinflammatory meds as they can increase bleeding

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57
Q

What is the MCC of knee pain in younger pts?

A

Patellofemoral pain syndrome

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58
Q

Causes of ABN patellar tracking in trochlear groove

A

Tight quads, tight TIB, pes planus w/ tibial IR, weak hip ER/ABDuctors

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59
Q

PE of patellofemoral pain syndrome

A

tenderness to medial/lateral aspects of patella, apprehension of gliding patella and weak single leg squat

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60
Q

What is Sinding-Larsen-Johansson disease?

A

Pain at proximal patellar tendon at inferior pole of patella assoicated w/ swelling in 10-14 yo

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61
Q

Tx of patellofemoral pain syndrome

A

activity modification, closed chain quad exercises at 0-30 deg, lower limb flexibility, and hip/core strenghtening

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62
Q

What is Osteochondritis dissecans?

A

Lesion of subchondral bone w/or w/o cartilage involvement

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63
Q

MC site for Osteochondritis dissecans

A

Inferior portion of medial femoral condyle

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64
Q

PE of Osteochondritis dissecans

A

focal pain & swellling w/ activity that lessens w/ rest and mechanical sx

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65
Q

MOI of acute meiscual tear

A

Sudden forceful twisting motion on a planted foot

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66
Q

What does locking of the knee suggest?

A

Bucket handle meniscus tear that has flipped into intercondylar notch

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67
Q

Hx of meniscal injury

A

Slow onset swelling, pain w/ wt bearing & twisting, clicking in knee

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68
Q

PE of meniscal injury

A

Medial or lateral joint line tenderness, effusion, + McMurrays

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69
Q

Image of choice for meniscal injury

A

MRI

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70
Q

Best prognosis of meniscal tears

A

Simple>complex, Outer (vascularized)>Inner(nonvascularized)

71
Q

When to refer for surgery for meniscal tear

A

limited function, persistent mechanical sx, recurrent pain & swelling, elite athletes who need to return to activity quickly

72
Q

MC injured knee ligaments

A

MCL & ACL

73
Q

Describe course of MCL

A

Medial femoral condyl to proximal medial tibia; provides resistance against valgus force

74
Q

MOI of MCL sprain

A

sudden valgus force w/ foot planted

75
Q

Tx of MCL sprain

A

Immobilizer 1-2 wks w/ early gentle knee flex/ext, gradual return to full activies over 1-4 wks

76
Q

Describe course of ACL

A

Medial wall of lateral femoral condyle anteromedially to anterior spine of tibial plateau

77
Q

What does the ACL prevent?

A

Anterior displacement of tibia relative to femur

78
Q

MOI of ACL tear

A

Rotation on a planted foot w/ knee in flexion & activated quads

79
Q

Hx of ACL tear

A

Feeling pop, effusion, sense of unstable knee

80
Q

What is a Segond fx?

A

small capsular avulusion fx of lateral tibial plateau pathognomic of ACL tear

81
Q

What muscle can be inhibited due to ACL tear?

A

Quadriceps

82
Q

Tx of ACL tear

A

Knee immobilizer/hingebrace, ROM, quad strengthening, reconstruction after 1-2 wks to allow swelling to decrease, functional knee brace w/ activity if no surgery

83
Q

Describe course of PCL

A

Posteriorly & inferiorly from femoral intercondylar knotch to posterior tibial spine

84
Q

What does the PCL prevent?

A

Posterior displacement of tibia relative to femur

85
Q

MOI of PCL injury

A

Forceful blow to proximal, anterior leg driving tibia posterior to femur

86
Q

Describe course of LCL

A

lateral femoral condyle to fibular head

87
Q

What does the LCL prevent?

A

Varus froces at the knee

88
Q

What can be injured in the posterolateral corner of the knee?

A

LCL, politeus tendon, peroneal nerve, posterolateral joint capsule, biceps femoris tedon, lateral head of gastroc, lateral meniscus, posterior meniscofemoral ligament

89
Q

Tx of prepatellar bursitis

A

Ice, compression, NSAIDs & avoiding kneelinig

90
Q

What inserts in the Pes Anserine?

A

Sartorius, gracilis, semitedninosus insert at proximal anterior tibia

91
Q

Hx of Pes Anserine bursitis/tendonitis

A

Pain in region of Pes Anserine

92
Q

What are biomechanical deficits associated w/ Pes Anserine inflammation?

A

Weak core, medial hamstrins & hip adductors

93
Q

Hx of patellar tendionpathy/Jumper’s knee

A

pain alone patellar tendon, usually at inferior pole of patella

94
Q

Risk of developing patellar tendonopathy

A

Overloaded, repetitive knee flex/ext activities

95
Q

What are the biomechanic deficits associated w/ patellar tendonopathy?

A

poor lumbar/hip extensor/ankle dorsiflexion activation

96
Q

Tx of patellar tendonpathy

A

NSAID, ice, cross-friction masage, quad stretching, “Cho-Pat” strap

97
Q

Hx of Osgood-Schlatter dz

A

Adolescent w/ pain at tibial tuberostiy exacerbated w/ activites & direct contact

98
Q

Radiographic hallmark of Osgood-Schlatter dz

A

Irregularity and fragmentation of the tibial tuberosity

99
Q

Radiographic hallmark of Sinding-Larsen-Johansson dz

A

Irregularity and fragmentation at origin of patellar tendon at inferior pole of patella

100
Q

Tx of Osgood-Schlatter dz & Singding-Larsen-Johansson dz

A

Rest, Ice, quad stretch/strengthening, activity modification

101
Q

Hx of Quadriceps/patellar tendon rupture

A

Forceful quad contraction w/ foot planted

102
Q

PE of Quadriceps/patellar tendon rupture

A

Anterior knee swelling, palpable defect at proximal or distal patella, pt unable to extend knee

103
Q

Tx of Quadriceps/patellar tendon rupture

A

Acutely placted in knee immobilize, NWB w/ crutches, surgical repair w/in a few days

104
Q

What is the “dreaded black line”?

A

tension-type stress fx of anterior cortex of middle 1/3 of tibia

105
Q

What is the risk of complete fx if activity is continued w/ tibial stress fx?

A

60%

106
Q

Tx of tibial fx

A

activity modification, pneumatic leg splints, IM fixation

107
Q

PE of chronic Achilles tendonopathy

A

Swollen, nodular, tender Achilles tendon

108
Q

Tx of Achilles tendonopathy

A

ICE, NSAIDs, activity modifcation, stretching & strengthening

109
Q

What can toe running cause?

A

place excessive eccentric demands on ankle plantor flexors

110
Q

Rehab for Achilles tendonopathy

A

Eccentric strengthening

111
Q

MOI of Achilles tendon rupture

A

Sudden, powerful eccentric force usually during ballistic sport

112
Q

Hx of Achilles tendon rupture

A

Audible pop, feel as they were kicked in the calf

113
Q

Tx of Achilles tendon rupture

A

Surgical reconstruction, immobilization up to 3 mo & aggressive rehab

114
Q

What is the function of tibialis posterior?

A

Ankle inverter, weak plantor flexor, supoorts medial longitudinal arch

115
Q

What is associated w/ posterior tibialis dysfxn?

A

pes planus, calcaneal eversion, RA

116
Q

How can you assess tibialis posterior?

A

Resistance test of ankle inversion w/ plantar flexion, viewing calcaneal motion from behind as pt performs slow heel raises

117
Q

A normally functioning tibialis posterior will allow the calcaneus to ___.

A

Rise in line w/ the leg or slight calcaneal varus

118
Q

Dyfxn of tibialis posterior allows the calcaneus to __

A

Rise in valgus

119
Q

What is shin splints?

A

Medial tibial stress syndrome

120
Q

Hx of medial tibial stress syndrome

A

Pain along medial &/or posteromedial border of tibia w/ rapid increase in activity

121
Q

What can cause excessive eccentric overload to ankle plantar flexors?

A

Toe walker or toe runner

122
Q

Tx of medial tibial stress syndrome

A

Ice, activity modification, tibialis posterior strengthening, foot orthoses for pes planus foot

123
Q

What is compartment syndrome?

A

Pressure in given muscle compartment ABN elevated

124
Q

What is acute compartment syndrome?

A

Caused by significant trauma, fx, crush injury, surgical emergency

125
Q

What is Chronic exertional compartment syndrome (CECS)?

A

Recurrent leg cramping or pain w/ activity esp in high volume runners

126
Q

What can occur w/ CECS?

A

temporary foot weakness during activity due to high pressures causing ischemia to tibial or peroneal nerves

127
Q

What is the definitive dx of CECS?

A

Intramuscular compartment pressure testing: preexercise >15mmHg, 1 min postexercise >30mmHg, 5 min postexercise >20 mmHg

128
Q

Tx of CECS

A

avoiding inciting activities, massage, fasciotomy or fasciectomy

129
Q

MOI of peroneal muscle injury

A

Lateral ankle sprain, peroneal muscles activate eccentrically to counteract the inversion moment

130
Q

PE of peroneal muscle injury

A

Tenderness to lateral leg 12 cm proximal to lateral malleolus

131
Q

Tx of peroneal muscle injury

A

Ankle rehab &/or surgery

132
Q

What can damage to the superior peroneal retinaculum cause?

A

Subluxation of peroneal tendons around lateral malleolus

133
Q

Navicular fx have a higher likelihood of ___ than other stress fx

A

Delayed union, nonuion or AVN

134
Q

Imaging of navicular fx

A

MRi or bone scan

135
Q

Which navicular fx has the best px?

A

Cortical break at dorsal aspect, heal in 3 mo

136
Q

Tx of navicular fx

A

NWB boot immobilization for 6-8 wk, bone stimulator or surgery if sx persist

137
Q

What are 5th metatarsal fx prone to?

A

Nonunion & refracture

138
Q

Tx of early 5th metatarsal fx

A

NWB boot immobilization for 6 wk, surgery if sx persist or if clear fx in an elite athlete

139
Q

Hx of Osteochondral lesions of the ankle

A

Hx of trauma, deep ankle pain, worse w/ WB & improved w/ rest

140
Q

PEof Osteochondral lesions of the ankle

A

Tenderness at subtalar joint & movement

141
Q

Imaging of Osteochondral lesions of the ankle

A

MRI

142
Q

MOI of lateral talus osteochondral lesions

A

Forced eversion & dorsiflexion

143
Q

What is the MC predictor of ankle sprains?

A

Previous ankle sprain

144
Q

What is the MC ligament injured in akle sprains?

A

Anterior talofibular ligament

145
Q

MC MOI in ankle sprains

A

Inversion & plantarflexion force

146
Q

What is a high ankle sprain?

A

Syndesmotic injury of thick ligaments connecting tibia & fibula

147
Q

How is the deltoid ligament injured?

A

Forceful & suddent ankle eversion

148
Q

What is a grade 1 ankle sprain?

A

partial ligament tear w/ no instability

149
Q

What is a grade 2/3 ankle sprain?

A

partial to complete ligament tear w/ instability

150
Q

What is indicative of a grade 2/3 ankle sprain?

A

Postive anterior drawer test

151
Q

What is indicative of a syndesmotic injury?

A

pain w/ squeeze test & ER w/ foot dorsiflexed

152
Q

How can avulsion fx of the 5th metatarsal occur?

A

pull of peroneus brevis tendon

153
Q

What can reduce risk of future ankle sprains?

A

Balance & proprioceptive training to improve sensimotor control

154
Q

What functional tests should be used to test ability to return to sport after ankle sprain?

A

Shuttle run & single leg hopping

155
Q

What is Sever’s dz?

A

Traction apophysitis of Achilles tendon insertion on posterior calcaneus

156
Q

Who is commonly affected by Sever’s dz?

A

Adolescents during time of rapid growth

157
Q

Tx of Sever’s dz

A

Ice, relative rest, progressive heel cord stretching & calf strengthening, heel lift for a short period

158
Q

Who is commonly affected by Flexor hallucis longus overload?

A

Dancers, gymnasts, repetitive forceful toe flexion

159
Q

PE of flexor hallucis longus overload

A

Pain w/ resisted toe flexion, tender to muscle/tendon palpation, passive stretch of muscle does not reliably produced sx

160
Q

What muscles originate at the volar calcaneus?

A

Adductor hallucis, quadratus plantae, flexor digitorum brevis and abductor digiti minimi quinti

161
Q

Hx of plantar fascitis

A

volar heal pain worse w/ first few steps of the morning & tender from medial to midline w/ palpation

162
Q

Tx of plantar fascitis

A

resting night splint to prevent tight heel cord & plantar structures

163
Q

What should be evaluated in plantar fascitis?

A

Tibialis posterior/anterior, tight hamstring/heel cords & hip ER

164
Q

What is Morton’s neuroma?

A

Irritation of one of the interdigital nerves of the foot as it passes through the transverse ligament of the metatarsal heads

165
Q

What is the MC location of Morton’s neuroma?

A

B/W 3rd & 4th metatarsal heads

166
Q

Hx of Morton’s neuroma

A

pain at metatarsal heads, referred pain or parasthesia to 2 toes innervated by the nerve, sensation of wrinkle in sock or pebble in shoe

167
Q

What can exacerbate the pain in Morton’s neuroma?

A

Forefoot WB, narrow toe boxes & high heels

168
Q

PE of Morton’s neuroma

A

Click when palpating neuroma esp w/ squeezing metatarsal heads

169
Q

What is the MC metatarsal head involved in metatarsalgia?

A

2nd metatarsal head

170
Q

Tx of sesmoiditis, metatarsalgia & Morton’s neuroma

A

Unload forefoot w/ gel inserts, orthoses, premetatarsal pads, larger toe boxes, avoiding high heels, steroid/lidocaine injection

171
Q

What is turf toe?

A

sudden forceful hyperextension of 1st MCP joint causing sprain of joint capsule/ligametns

172
Q

What has increased the incident of turf toe?

A

Artificial turf

173
Q

Tx of turf toe

A

Stiff-soled shoes to protect joint for 3-4 wks

Brad 4th Ed Part 2 (28 decks)

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