Chronic Hip & Knee Pain Flashcards
1
Q
DDx of Chronic Hip Pain
A
- Trochanter bursitis
- Groin strain
- SD
2
Q
DDx of Chronic Knee Pain
A
- Patellofermoral synd
- Ilio Tibial Band synd
- DJD (OA)
- Patellar tendonitis
- Osgood Schlatter dz
- Stress fracture
- SD
3
Q
What is Trochanteric Bursitis?
A
Inflam & swelling of bursae lateral to the greater torchanter of femur caused by overuse or inappropriate use of the LE
4
Q
What is the Hx of Trochanteric bursitis?
A
- Hip pain over greater trochanter
- Chronic overuse
- May have hx of trauma
- Compensaited gait
5
Q
What will be found on PE of Trochanteric Bursitis?
A
- Swelling & tender over greater trochanter
- May feel fluid filled bursae
- ROM–piriformis, gluteus or ITB SD
6
Q
What tests may be + w/ Trochanteric bursitis?
A
Ober & Piriformis testing
7
Q
What is the Ober test used for?
A
Dx tightness of IT band
8
Q
What does the pt do during the Ober test?
A
Pt lies on uneffected side w/ bottom leg flexed & in line w/ should & pelvis
9
Q
What does the doc do during the Ober test?
A
Doc stabilizs iliac crest & lifts top leg which is flexed @ knee & extended @ hip. Doc slowly lowers leg.
10
Q
What is a + Ober test?
A
If pt cant adduct leg past neutral.
(IT band is too tight)
11
Q
What is the Piriformis test used for?
A
Look for tightness in the muscle or sciatic n. pain
12
Q
What does the pt do during the piriformis test?
A
Pt lies on uneffected side w/ hip @ 60° F & knee F
13
Q
What does the doc do during the piriformis test?
A
Stabilize pelvis, apply downward traction on knee & internally rotate leg
14
Q
What is + Piriformis test?
A
Pain shoots down posterior thigh
15
Q
Radiology for Trochanteric bursitis
A
- Unnecessary
- MSK US may view fluid in bursa & add in aspiration
16
Q
Tx for Trochanteric bursitis
A
- Inflam: NSAIDs, steroids, injection/aspiration
- SD: OMT, PT, HEP
17
Q
What is a Groin strain?
A
- Partial tear of hip (adductor) muscles
- Overuse or inappropriate use of LE
- Acute injury→ chronic hip pain
18
Q
What is the Hx of a Groin strain?
A
- Deep, achy or sharp w/ motion of hip
- Hx of trauma
- compensated gait
19
Q
What is a compensated gait?
A
- Trendelenburg gait
- Weakness of abductors (gluteus medius & minimus)
- Pelvis tilts on contralateral side
20
Q
What is antalgic gait?
A
Stance phase of gait ABN shortened relative to swing phase. Wt bearing pain
21
Q
What will be found on PE of a Groin strain?
A
- Tender over groin & lesser trochanter
- ROM–hip flexor dysfxn
22
Q
What tests may be + w/ Groin strain?
A
Thomas & Hip Scouring tests
23
Q
What is Thomas test used for?
A
To rule out a hip flexion contracture
24
Q
What does the pt do during the Thomas test?
A
Pt lies supine w/ one leg bent & the other extended
25
What is a + Thomas test?
* Contralateral hip flexes w/o knee extension→ tight iliopsoas
* Hip abducts during test→ tight tensor fascia lata (IT band)
* Knee extension occurs→ tigh rectus femoris
26
What is the Hip Scouring test used for?
* Hip labrum
* Capsulitis
* Osteochondral defects
* Acetabular defects
* Osteoarthritis
* Avascular necrosis
* Femoral acetabular impingment syndrome
27
What does the pt do during the Hip Scouring test?
Pt lies supine w/ affected leg F
28
What does the doc do during the Hip Scouring test?
Doc F & ADDucts hip while applying a downward force. Then, externally/internally R knee
29
What is a + Hip Scouring test?
Pain or pt is apprehensive
30
What are the Relative CI to OMT in LE?
* Neurovascular compromise
* Undx trauma
* Fracture
* Knee internal derangement
* Undx LE edema
* LE infection
31
What is Patrick's test used for?
Assessment for gross hip motion. Differentiate b/w hip joint pathology & SI SD
(Pain is either deep in the hip joint or toward the back)
32
What does FABRE stand for?
* Flexion
* ABDuction
* External Rotation
* Extension
33
What is Posterior Capsule Stretch?
* Knee & hip flexed
* Heel of left hand on greater trochanter
* Impaction compression w/ right arm while A/P compression
* Vary AB/ADduction to fine tune restrictive barrier
34
What muscles are tested w/ ABduction?
* Adductor Magnus
* Adductor Brevis
* Adductor Longus
35
What muscles are tested w/ ADduction & External rotation?
* Gluteus medius
* Gluteus minimus
36
What muscles are tested w/ Internal rotation?
* Gluteus Maximus
* Glamella
* Obturator
* Piriformis
37
What muscles are tested w/ flexion?
Hip extensors & Hamstring
38
What is the OIA of Piriformis?
* O: anterior surface of sacrum
* I: greater trochanter of femur
* A: external rotation of the femur @ the hip
* If contracted resists internal rotation
39
What is Psoas Syndrome?
Classic pattern of SD of the low back & hip which centers around shortening of the Psoas on one side
40
What are the characteristics of Psoas Syndrome?
* Tight psoas on one side→ SB of lumbars to that side & shortening of leg w/ eversion of the foot on that side
* Tight piriformis on other side→ ext R of the leg & sciatica
41
What is the pain pattern on the side of the Psoas spasm?
Thoracolumbar junction & anterior medial thigh on ispilateral side
42
What is the pain pattern on the side of the tight piriformis?
Pain in butt from ILA of sacrum to greater trochanter of femur & posterior, lateral thigh to the knee but not below
43
What is Patellofemoral Syndrome (Chondromalacia Patellae)?
* Poor tracking of the patella in the femoral condyles→ inflam & condral degeneration
* Weakness of vastus medialis or lateral retinaculum
44
What is the Hx of Patellofemoral Syndrome?
* Anterior knee pain, vague, achy mild to moderate
* MC in young to middle age FEMALES
* Pain common when going UP STAIRS
* Common after prolonged sitting
45
What is found on PE of Patellofemoral Syndrome?
* Antalgic gait
* Mild effusion (fluid around knee)
* ROM--limited F or pain w/ extreme F
46
What tests may be + w/ Patellofemoral Syndrome?
* Patellar grind test
* Apprehension test
* Apley's test
47
How is Patella Femoral Grinding Test done?
* Pt supine w/ knee extended
* Doc pushes patella caudad in trochlear groove & holds it
* Pt contracts quads against doc
48
What indicates a + Patella Femoral Grinding test?
Crepitus or pain→ roughness of articulating surfaces
49
Radiology for Patellofemoral Syndrome
Usually unecessary (Sunrise view to see posterior surface of patella)
50
Tx for Patellofemoral Syndrome?
* Inflam: NSAIDs, Steroids, Injection/aspiration
* SD: OMT, PT, HEP, strenghten vastus medialis, surgery
51
What is IT Band Syndrome?
Overuse synd in runners & cyclists who repetively flex the knee
52
What are the predisposing factors to IT band synd?
* Tightness in IT band
* Excessive foot pronation
* Genu Varum
* Tibial torsion
53
What is the Hx of IT band synd?
* Lateral knee pain
* Pain worse w/ running esp DOWNHILL or going UP STAIRS
54
What is found on PE of IT Band synd?
* Antalgic gait
* Mild effusion
55
What tests may be + w/ IT Band synd?
Obers or Nobles Tests
56
What is Nobles test?
Repetitive F/E of knee while palpating lateral epicondyle
57
What indicates a + Nobles test?
Pt complains of pain over lateral epicondyle @ 30° F
58
Radiology for IT Band Synd
Usually unnecessary
59
Tx for IT Band Synd
* Inflam: Protect, Rest, Ice, NSAIDs, steroids
* SD: OMT, PT, HEP, stretching
60
What is Knee Effusion Test (Bounce-Home test) used for?
Degenerative Joint dz (osteoarthritis)
61
How is Knee Effusion Test perfomed?
* Pt is supine w/ knee semi-flexed
* Pt's heel is supported in one hand & the calf is supported w/ the other
* The hand under the calf is carefully removed & the knee allowed to extend fully
62
What indicates a + Knee Effusion Test?
Failure to extend knee fully→ Inc joint fluid
63
What is found on X-ray in DJD?
* Joint space narrowing
* Boney deformation
* Calcium deposition
* Chondral erosion
* Cysts
64
What is found on MRI in DJD?
Cartilage degradation & joint space narrowing
65
What is the Tx for DJD?
* Pain: NSAIDs/ analgesics
* Effusions: steroids, aspiration/injection, viscosupplementation
* SD: OMT, PT, HEP, exercise
66
What is viscosupplementation?
Hyaluronic acid injection to lubricate joint
67
What is Patellar tendonitis?
Overuse injury of quads & patellar tendon
68
What can Patellar tendonits be assoc w/?
Patellar bursitis or Osgood Schlatter's dz in young pts
69
What is the Hx of Patellar Tendonits?
* Anterior knee pain esp tendonous insertion @ tibial tuberosity
* Reduced knee F d/t pian & quad contraction
* Athletes, runners, soccer players, gymnasts
70
What will be found on PE of Patellar tendonitis?
* Fluid filled patellar burase
* Boney deformation above tibial tuberosity
* Reduced ROM esp knee flexion
71
Tx for Patellar Tendonitis
* Pain: rest, NSAIDs/analgesics
* Bursitis: NSAIDs/steroids, aspiration/injection
* SD: OMT, PT, HEP, stretching
72
Who gets Osgood Schlatter Dz?
Very common cause of knee pain in children/young athletes b/w ages of 10-15 .
Runners, gymnats, soccer players MC
73
What cause Osgood Schlatter dz?
Occurs d/t period of rapid growth w/ high level of sporting activity
74
What is the Hx of Osgood Schlatter dz?
* Pain at tibial tuberosity just below knee
* Tenderness & pain worse during & after exercise
* Pain when contracting quads against resistance & contracting the muscles w/ the leg straight
75
What will be found on PE w/ Osgood Sclatter dz?
* Tenderness & swollen/inflam @ tibial tuberosity
* Palpable boney prominence at epiphesial growth plate
76
What is found on X-ray in Osgood Schlatter dz?
Ca deposition @ tibial tuberosity (growth plate)
77
Tx of Osgood Schlatter dz
* RICE
* NSAIDs
* Stretching
* Taping/bracing
* Sports Massage
78
What is a Stress Fracture?
Overuse injury of a bone
79
What causes a stress fracture?
Repetitive loads overwhelm the ability of the bone to repair itself & small cracks begin to occur w/in bone
80
What are the risk factors of stress fracture?
* Low Ca
* Female athletes who stop menstruation
* Eating disorders
* Osteoporosis
* Atheletes, runners, jumping sports
81
What is the Hx of Knee Stress facture?
Gen knee pain
82
Radiology for knee stress fracture
* X-ray may not demonstrate fracture
* CT scan, bone scan, MRI--more sensitive
83
What are the Quadriceps muscles?
* Quadriceps femoris
* Rectus femoris
* Vastus lateralis
* Vastus intermedius
* Vastus medialis
84
Where do quadriceps insert?
Superior & medial borders of patella
Continues to from infrapatellar tendon
85
What are the Hamstring muscles?
* Semitendinosus
* Semimembranosus
* Biceps femoris
