Chapter 11 MSK LE Flashcards
1
Q
what is the MOI of hip injuries
A
twisting, kicking, rapid acceleration adn decelleration
2
Q
who is more at risk of hip injuries, males or females
A
males
3
Q
what are some risk factors that increase the incidence of hip injury
A
-history of previous hip or groin injury
-age
-BMI inc or dec
-ecreased hip ABD and tROM loss,
-strength deficits between abd and add
-difference in hip ext strength bilaterally
4
Q
according to the 2015 consensus statement on hip and groin pain what are the classifications
A
hip joint
adductor
public bone stress injry
iliopsoas/abdominal wall issue
**HIP/JOINTmost common
5
Q
___% of athetes show findings of
A
FAI
6
Q
7/10 young patients with hip fractures have had previous existing signs or symptoms of
A
osteoporosis
7
Q
pediatric hip fractures are most often caused by
A
MVA
8
Q
what are risks and possible bad things associated with pediatric hip fractures
A
failure of physeal plate to close, AVN, chondrolysis
9
Q
what is the risk of acetabular fracture
A
AVN of femoral head
10
Q
what kind of sports get pelvic fractures
A
high speed, such as motor sports
11
Q
what are S+S of atraumatic bone stress injures
A
hip thigh groin pain, worse with activity relieved with rest
12
Q
what are some risk factors or things that can lead to stress injuries
A
training intensity, surface changes, diet, female sex and triad, biomechanics with landing
13
Q
how to best idenify a bone stress
A
MRI
14
Q
what are tests to look for stress fractures in the hip and groin
A
FABER, flamingo and fulcrom test
15
Q
femur stress fractures are likely associated with coxa ____, and happen at the _____ of the femur
A
vara,
neck of femur
16
Q
what types and locations of stress fractures in the femur require surgical fixation
A
high stress at the head or the lateral side of the femoral neck (because this is the tension side)
17
Q
what side of the femoral neck is the low risk femur fracture
A
the medial side of the femoral neck, and this can be NWB/PWB
18
Q
what two things have been shown to speed up the bone healing
A
pulsed ultrasound and e-stim
19
Q
what ages are chondral injuries common
A
14-25
20
Q
where do apophyseal injuries happen
A
at the immature bone-tendon attachment
21
Q
signs of apophyseal injury
A
pain and tenderness at apophysis, painful stretching and strengthening, and swelling.
22
Q
RTP following apophyseal injury
A
~3 months
23
Q
avulsion sites
A
ASIS (sartorius) , AIIS (RF), iliac crest (TFL, abdominals), ischial tuberosities (HS), LT (iliopsoas), pubis ramus (adductors)
24
Q
management of acute avulsion fracture WB status
A
TTWB for 1-2 months
25
role of the labrum
absorption, joint stability and nutrition
26
what is the most common intra-articular hip pathology
labrum
27
labral tears are common in hips with coxa ___, femoral and acetabular _____, and ____ center edge angle
vara, retroversion, increased center edge angle
28
s+s of labral tear
anterior groin, hip pain or butt pain with clicking, locking or giving way
29
MOI of anterior vs posterior labral tearing
anterior: twisting or pivoting, posterior from a direct blow posteriorly, usually with dislocations.
30
traumatic vs atraumatic labral tears
traumatic, from a rapid twist, pivot or fall. atraumatic from cumulative microtrauma
31
tests for labral tears
FADIR, flex-IR test, posterior impingement test
32
difference between cam and pincer type
cam is a fat femoral neck, pincer is an overgrown acetabular rim
33
what is a pistol grip deformity
from a cam lesion where the femoral head and neck are fat at the junction
34
where are cam and pincer more common
cam in athletes due to repetitive stresses causing over growth
pincer in middle age active females
35
when to suspect FAI
painful clicking, locking, giving way, lateral/post hip pain, groin pain with pivoting, rotational movements, hip in flex/add/IR
pain worse with prolonged sitting, standing waking.
C sign
36
special tests for FAI
FADIR, FABER, modified Thomas test, Flex-IR test, resisted SLR and log roll
37
which test has sensitivity of 100% for FAI/labral tears
flexion IR test
38
dx of fai best done with
MRI
39
non-op FAI management
avoid aggravating positions, core strength, avoid end range movements
40
what things may cause structural instability in the hip
shallow acetabulum, excessive acetabular ante/retroversion, inferior acetabulum insufficiency, neck/shaft angle >140 degrees
41
focal rotary instability can be seen in
kicking repeated forceful rotation such as ballet, golf, martial arts,
42
which ligament is often involved in the abnormal loading of the anterosuperior labrum with focal rotary instability
iliofemoral
43
what is the most common position of hip dislocations
posteriorly, with a big posterior force in the flex/add position.
44
atraumatic instability signs and symptoms
coxa___
locking, giving way, clicking and c/o pan in the hip. hip dysplasia s+s on imaging and caxa valga.
45
tests for instability in the hip
pain with FABER, FADIR, AB-HEER (abd, ext and ER apprehension), hip IR less than 30 degrees at 90 degrees hip flexion
46
what ligament is affected in those with anterior capsule instability
ligamentum teres
47
what are the actions that cause a hip flexor tendinopathy
kicking or decelerations and eccentric contractions
48
severe injuries which lead to swelling can lead to what kind of palsy
femoral nerve palsy
49
most common muscles injured in the thigh
hamstrings
50
what are some things associated with prolonged recovery from a hamstring pull
ROM deficits with the hip flex to 90, over 1 day being unable to ambulate without pain, greater than 1 week from injury to consultation, stretching type injuries, participating in rec sports, and increased pain
51
what is the strongest predictor of adductor pain
previous adductor injury
52
adductor MOI
running, jumping twisting with hip ER,
53
which adductor most commonly involved
adductor longus
54
predictive things for adductor strains
add/abd weakness imbalance, hip/abd muscle imbalance,
55
how long for rehabb
4-8 weeks
56
what is the LSI of strength that they say you need
70%
57
where does AP-sports hernia affect
Rectus abdominus and hip adductors
58
in sports hernia ___ is strong and ___ is weak
strong adductors and weak abdominals
59
s+s of sports hernia
twisting, kicking lateral movements and change direction pain, insidious onset of pain, deep groin/lower abdomen, worse with resisted sit ups, sprinting cutting pain with adductor testing,
60
non-op PT for sports hernia
6-8 weeks, with strength, flexiblity, NM control...
61
what is the surgical option for sports hernia
abdominal wall repair with bilateral adductor tenotomy.
62
how long after sports hernia repair can PT start
4 weeks
63
how does sports hernia rehab start
light PREs (progressive resistance exercises) adductor strengthening, propriocetion and coordination,
64
when can add and abdominal pres be added after Sports hernia repair
6 weeks
65
what is the difference between intra-articular and extra-artcular snapping hip
intra: labral tears, chondral injuries, ligamentum teres...
extra: have internal and external snapping hip
66
internal snapping hip is AKA
coxa saltans interna
iliopsoas over the iliopectineal eminence or the femoral head
67
tests for coxa saltans interna
Thomas test for tight iliopsoas, positive active iliopsoas snapping testing, glute med weakness
68
external snapping hip AKA
coxa saltans externa from the ITB or Glute max over the greater trochanter.
69
tests for external snapping hip
thightness in the ITB obers test, positive bike test
70
what is overactive and what is underactive in external snapping hip
TFL overactive and glute max underactive
71
what type of eccentric training is needed for external snapping hip
eccentric glute muscles
72
what are the 3 stages and considerations for hip rehab
protective phase, rehabilitation phase and functional phase
73
what is it about non contact injuries to the ACL
there is a strong quad contraction on the knee extended with some valgus, which created a IR of the femur on the tibia
74
what are some criteria to be able to get surgery for your ACL
full ROM, walking ok, minimal swelling,
75
what parts of the patellar tendon and hamstring are used for ACL
central third, or distal hamstring
76
what is the avg return to running post ACl as per textbook
12 weeks
77
RTP following ACL-R as per textbook
9-12 months
78
what kind of tibial rotation can cause MCL injury
twisting and a tibial lateral rotation
79
where are the different tissues (deep and superficial) layers of the MCL most often injured
in extension, the whole ligament is messed up
in 20+ degrees flexion, usually just the superficial tissue
80
grades of MCL injury
grade I: pain with palpation to medial joint line, no instability, minimal swelling,
grade II 1+: 0-5 mm laxity, with an end feel
grade II 2+: 6-10 mm laxity, end feel harder to ID
grade III: no end feel
81
grade II or more injuries should be managed how
in a locked slight flexion brace around 20-25 degrees
82
RTP for MCL injuries grade I vs II
I: within 7-10 days
II: up to 3 weeks
83
what is the PLC
the posterolateral complex made up of the posterior joint capsule, LCL, popliteus tendon and the popliteofibular ligament.
84
what are some clinical findings/exams to clue into a PLC injury
-laxity posteriorly with varus testing
-laxity with dial test
-laxity with ER recurvatum test of Hughston test
85
what is the dial test
increased ER of the tibia noted while prone with knee flex at 30 than 90 degrees flexion
86
tests for PCL injury
posterior sag sign and posterior drawer test/clancy step off test
87
what is the largest concern with PCL injury
tibial lag sign
88
post op PCL... WB status and bracing
in full extension brace for 4-6 weeks, can WB if knee extended
89
when can you do HS exercises following PCL-R
6-8 weeks
90
what are risk factirs for Patellofemoral dislocation
-inc Q angle,
-female, wider pelvis,
-shallow femoral groove,
-flat lateral sulcus,
-high riding patella,
-ligamentous laxity,
-pronated feet and
-vastas medialis weakness
91
do pronated or supinated feet leave you more prone to patellofemoral dislocation
pronated
92
which way does a patella usually dislocate
laterally
93
what way do you move the knee to relocate a dislocated patella
move it from flex to ext and that should reduce it.
94
what is ruptured in most lateral patella dislocations
MPFL
95
how long do you immobilize following dislocation of patella
3-4 weeks
96
what kind of brace helps the knee after initial immobilization in patella dislocation
lateral buttress
97
can you do QS right after patella dislocation
yes
98
how many ligaments need to be disrupted to have a tibiofemoral disloaction
3+
99
what are things to be mindful of with tibiofemoral dislocation
distal pulses, sensation, vascular supply due to popliteal artery, peroneal and tibial nerve
100
how long do you immobilize after tibiofemoral dislocation
in full extension for 4 weeks
101
what muscle is important to strengthen for tibiofemoral dislocation
vastas medialis oblique, as that is the only medial dynamic stabilizer.
102
what provides blood supply to the meniscus
the medial and lateral genicular arteries
103
where the is meniscus red zone
THE OUTER PORTION OF THE
104
white zone is the _____1/3
inner
105
s+s of meniscus tear
pain, twisting, giving way, locking, catching sensation,
106
test for meniscus tear
joint line tenderness, McMurrays, Apleys
107
partial meniscectomy WB status ?
RTP?
as soon as feel comfortable, and RTP in 6-8 weeks.
108
meniscus repair WB? bracing? ROM limitations
either PWB or FWB, and first 6 weeks, ROM limited to 90 flexion.
109
RTP following meniscus repair
16-20 weeks
110
what are the grades of chondral injuries/lesions
grade 1: softening and swelling of cartilage
grade 2: fissuring and fragmentation of less than 1/2 inch in diameter
grade 3: fissuring and fragmentation greater than 1/2 inch in diameter
grade 4: cartilage eroded down to subchondral bone
111
what location is the most common for OCD
the lateral portion of the medial femoral condyle
112
what kind of view can you see an OCD lesion on
a notch view
113
following OCD lesion surgery WB status? and early activities?
early quad sets, and usually WB status is restricted for first 4-6 weeks.
114
patellofemoral pain is characterized by
pain int he anterior knee which is inc with compression of the patella against the femur.
115
peak prevelance of PFPS
12-17 years old
116
what are some anatomical risk factors of PFPS
anteversion of the hip and trochlear or patellar dysplasia
117
when moving from ext to flexion, the patella has to translate...
has to translate medially as it enters the trochlear groove, around 20-30 degrees knee flexion, then will follow groove and translate laterally.
118
what kind of things compound tracking issues
patella alta, baja, laterall pressure syndome
119
PFPS is increased with what tasks
squatting, climbing stairs, kneeling.
120
what could lateral PFPS mean
excessive lateral pressure syndrome or small nerve endings.
121
what could medial PFPS mean
medial plica, stretchng of retunaculum.
122
what could inferior pain with PFPS mean
patella tendinitis, fat pad
123
what could retropatella PFPS mean
chondromalacia or articular cartilage
124
what does a laterall tilted patella mean in full extension
tightness in the fibers of the retinaculum.
125
how can you assess retinaculum with patella mobility
patella mobs in slight knee flexion.
126
what is normal amount of tilting that should be able to occur medially at the patella
15 degrees past neutral, into medial position
127
what kind of foot and tibia position can lead to tracking patella issues
pronated foot and tibial IR/MR
128
who benefits more from orthotics
older folks, while younger do better with exercises
129
taping and orthotics are good for those with what kind of structural things
excessive foot pronation
130
what can inhibit quad firing which leads to atophy
pain
131
why is intra-artcular swelling bad
becuse it can irritate the synovium and create articular cartilage issues
132
whats better? ice alone or ice with compression
ice with compression for knee injruies
133
cartilage procedures have what kind of WB restrictions
NWB for 6 weeks
134
what is a fully extended knee gait pattern caled
quad avoidance gait pattern
135
why is it a good idea to start balance exercises of 30 degrees knee flexion
becuase you get a co-contraction of quad to HS
136
what kind of things do you need to do to get cleared for RTP
strngth within 10%, OKC testing (to isloate issues) CKC chain testing too
jump assessment
137
which is the actual most important part of jump testing assessments
the landing ecentric phase tells us the most.
138
what are jump height cut offs for men and women
(and single hop too)
jump men: 90-100% their height
women: 80-90% height
(single HOP: men: 80-90%, women 70-80%)
139
what is a good LE test for RTP
LEFT lower extremity functional test with 15 conditions on a 30-10ft diamond.
