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MSS Conditions > Chronic Hip & Knee Pain > Flashcards

Chronic Hip & Knee Pain Flashcards

1
Q

DDx of Chronic Hip Pain

A
  • Trochanter bursitis
  • Groin strain
  • SD
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2
Q

DDx of Chronic Knee Pain

A
  • Patellofermoral synd
  • Ilio Tibial Band synd
  • DJD (OA)
  • Patellar tendonitis
  • Osgood Schlatter dz
  • Stress fracture
  • SD
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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

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4
Q

What is the Hx of Trochanteric bursitis?

A
  • Hip pain over greater trochanter
  • Chronic overuse
  • May have hx of trauma
  • Compensaited gait
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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
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6
Q

What tests may be + w/ Trochanteric bursitis?

A

Ober & Piriformis testing

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7
Q

What is the Ober test used for?

A

Dx tightness of IT band

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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

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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.

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10
Q

What is a + Ober test?

A

If pt cant adduct leg past neutral.

(IT band is too tight)

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11
Q

What is the Piriformis test used for?

A

Look for tightness in the muscle or sciatic n. pain

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12
Q

What does the pt do during the piriformis test?

A

Pt lies on uneffected side w/ hip @ 60° F & knee F

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13
Q

What does the doc do during the piriformis test?

A

Stabilize pelvis, apply downward traction on knee & internally rotate leg

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14
Q

What is + Piriformis test?

A

Pain shoots down posterior thigh

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15
Q

Radiology for Trochanteric bursitis

A
  • Unnecessary
  • MSK US may view fluid in bursa & add in aspiration
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16
Q

Tx for Trochanteric bursitis

A
  • Inflam: NSAIDs, steroids, injection/aspiration
  • SD: OMT, PT, HEP
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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
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18
Q

What is the Hx of a Groin strain?

A
  • Deep, achy or sharp w/ motion of hip
  • Hx of trauma
  • compensated gait
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19
Q

What is a compensated gait?

A
  • Trendelenburg gait
  • Weakness of abductors (gluteus medius & minimus)
  • Pelvis tilts on contralateral side
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20
Q

What is antalgic gait?

A

Stance phase of gait ABN shortened relative to swing phase. Wt bearing pain

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21
Q

What will be found on PE of a Groin strain?

A
  • Tender over groin & lesser trochanter
  • ROM–hip flexor dysfxn
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22
Q

What tests may be + w/ Groin strain?

A

Thomas & Hip Scouring tests

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23
Q

What is Thomas test used for?

A

To rule out a hip flexion contracture

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24
Q

What does the pt do during the Thomas test?

A

Pt lies supine w/ one leg bent & the other extended

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25
Q

What is a + Thomas test?

A
  • 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
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26
Q

What is the Hip Scouring test used for?

A
  • Hip labrum
  • Capsulitis
  • Osteochondral defects
  • Acetabular defects
  • Osteoarthritis
  • Avascular necrosis
  • Femoral acetabular impingment syndrome
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27
Q

What does the pt do during the Hip Scouring test?

A

Pt lies supine w/ affected leg F

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28
Q

What does the doc do during the Hip Scouring test?

A

Doc F & ADDucts hip while applying a downward force. Then, externally/internally R knee

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29
Q

What is a + Hip Scouring test?

A

Pain or pt is apprehensive

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30
Q

What are the Relative CI to OMT in LE?

A
  • Neurovascular compromise
  • Undx trauma
  • Fracture
  • Knee internal derangement
  • Undx LE edema
  • LE infection
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31
Q

What is Patrick’s test used for?

A

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)

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32
Q

What does FABRE stand for?

A
  • Flexion
  • ABDuction
  • External Rotation
  • Extension
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33
Q

What is Posterior Capsule Stretch?

A
  • 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
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34
Q

What muscles are tested w/ ABduction?

A
  • Adductor Magnus
  • Adductor Brevis
  • Adductor Longus
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35
Q

What muscles are tested w/ ADduction & External rotation?

A
  • Gluteus medius
  • Gluteus minimus
36
Q

What muscles are tested w/ Internal rotation?

A
  • Gluteus Maximus
  • Glamella
  • Obturator
  • Piriformis
37
Q

What muscles are tested w/ flexion?

A

Hip extensors & Hamstring

38
Q

What is the OIA of Piriformis?

A
  • O: anterior surface of sacrum
  • I: greater trochanter of femur
  • A: external rotation of the femur @ the hip
  • If contracted resists internal rotation
39
Q

What is Psoas Syndrome?

A

Classic pattern of SD of the low back & hip which centers around shortening of the Psoas on one side

40
Q

What are the characteristics of Psoas Syndrome?

A
  • 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
Q

What is the pain pattern on the side of the Psoas spasm?

A

Thoracolumbar junction & anterior medial thigh on ispilateral side

42
Q

What is the pain pattern on the side of the tight piriformis?

A

Pain in butt from ILA of sacrum to greater trochanter of femur & posterior, lateral thigh to the knee but not below

43
Q

What is Patellofemoral Syndrome (Chondromalacia Patellae)?

A
  • Poor tracking of the patella in the femoral condyles→ inflam & condral degeneration
  • Weakness of vastus medialis or lateral retinaculum
44
Q

What is the Hx of Patellofemoral Syndrome?

A
  • 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
Q

What is found on PE of Patellofemoral Syndrome?

A
  • Antalgic gait
  • Mild effusion (fluid around knee)
  • ROM–limited F or pain w/ extreme F
46
Q

What tests may be + w/ Patellofemoral Syndrome?

A
  • Patellar grind test
  • Apprehension test
  • Apley’s test
47
Q

How is Patella Femoral Grinding Test done?

A
  • Pt supine w/ knee extended
  • Doc pushes patella caudad in trochlear groove & holds it
  • Pt contracts quads against doc
48
Q

What indicates a + Patella Femoral Grinding test?

A

Crepitus or pain→ roughness of articulating surfaces

49
Q

Radiology for Patellofemoral Syndrome

A

Usually unecessary (Sunrise view to see posterior surface of patella)

50
Q

Tx for Patellofemoral Syndrome?

A
  • Inflam: NSAIDs, Steroids, Injection/aspiration
  • SD: OMT, PT, HEP, strenghten vastus medialis, surgery
51
Q

What is IT Band Syndrome?

A

Overuse synd in runners & cyclists who repetively flex the knee

52
Q

What are the predisposing factors to IT band synd?

A
  • Tightness in IT band
  • Excessive foot pronation
  • Genu Varum
  • Tibial torsion
53
Q

What is the Hx of IT band synd?

A
  • Lateral knee pain
  • Pain worse w/ running esp DOWNHILL or going UP STAIRS
54
Q

What is found on PE of IT Band synd?

A
  • Antalgic gait
  • Mild effusion
55
Q

What tests may be + w/ IT Band synd?

A

Obers or Nobles Tests

56
Q

What is Nobles test?

A

Repetitive F/E of knee while palpating lateral epicondyle

57
Q

What indicates a + Nobles test?

A

Pt complains of pain over lateral epicondyle @ 30° F

58
Q

Radiology for IT Band Synd

A

Usually unnecessary

59
Q

Tx for IT Band Synd

A
  • Inflam: Protect, Rest, Ice, NSAIDs, steroids
  • SD: OMT, PT, HEP, stretching
60
Q

What is Knee Effusion Test (Bounce-Home test) used for?

A

Degenerative Joint dz (osteoarthritis)

61
Q

How is Knee Effusion Test perfomed?

A
  • 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
Q

What indicates a + Knee Effusion Test?

A

Failure to extend knee fully→ Inc joint fluid

63
Q

What is found on X-ray in DJD?

A
  • Joint space narrowing
  • Boney deformation
  • Calcium deposition
  • Chondral erosion
  • Cysts
64
Q

What is found on MRI in DJD?

A

Cartilage degradation & joint space narrowing

65
Q

What is the Tx for DJD?

A
  • Pain: NSAIDs/ analgesics
  • Effusions: steroids, aspiration/injection, viscosupplementation
  • SD: OMT, PT, HEP, exercise
66
Q

What is viscosupplementation?

A

Hyaluronic acid injection to lubricate joint

67
Q

What is Patellar tendonitis?

A

Overuse injury of quads & patellar tendon

68
Q

What can Patellar tendonits be assoc w/?

A

Patellar bursitis or Osgood Schlatter’s dz in young pts

69
Q

What is the Hx of Patellar Tendonits?

A
  • Anterior knee pain esp tendonous insertion @ tibial tuberosity
  • Reduced knee F d/t pian & quad contraction
  • Athletes, runners, soccer players, gymnasts
70
Q

What will be found on PE of Patellar tendonitis?

A
  • Fluid filled patellar burase
  • Boney deformation above tibial tuberosity
  • Reduced ROM esp knee flexion
71
Q

Tx for Patellar Tendonitis

A
  • Pain: rest, NSAIDs/analgesics
  • Bursitis: NSAIDs/steroids, aspiration/injection
  • SD: OMT, PT, HEP, stretching
72
Q

Who gets Osgood Schlatter Dz?

A

Very common cause of knee pain in children/young athletes b/w ages of 10-15 .

Runners, gymnats, soccer players MC

73
Q

What cause Osgood Schlatter dz?

A

Occurs d/t period of rapid growth w/ high level of sporting activity

74
Q

What is the Hx of Osgood Schlatter dz?

A
  • 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
Q

What will be found on PE w/ Osgood Sclatter dz?

A
  • Tenderness & swollen/inflam @ tibial tuberosity
  • Palpable boney prominence at epiphesial growth plate
76
Q

What is found on X-ray in Osgood Schlatter dz?

A

Ca deposition @ tibial tuberosity (growth plate)

77
Q

Tx of Osgood Schlatter dz

A
  • RICE
  • NSAIDs
  • Stretching
  • Taping/bracing
  • Sports Massage
78
Q

What is a Stress Fracture?

A

Overuse injury of a bone

79
Q

What causes a stress fracture?

A

Repetitive loads overwhelm the ability of the bone to repair itself & small cracks begin to occur w/in bone

80
Q

What are the risk factors of stress fracture?

A
  • Low Ca
  • Female athletes who stop menstruation
  • Eating disorders
  • Osteoporosis
  • Atheletes, runners, jumping sports
81
Q

What is the Hx of Knee Stress facture?

A

Gen knee pain

82
Q

Radiology for knee stress fracture

A
  • X-ray may not demonstrate fracture
  • CT scan, bone scan, MRI–more sensitive
83
Q

What are the Quadriceps muscles?

A
  • Quadriceps femoris
  • Rectus femoris
  • Vastus lateralis
  • Vastus intermedius
  • Vastus medialis
84
Q

Where do quadriceps insert?

A

Superior & medial borders of patella

Continues to from infrapatellar tendon

85
Q

What are the Hamstring muscles?

A
  • Semitendinosus
  • Semimembranosus
  • Biceps femoris

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