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CLASS 22010 MSK > CLINICAL CARE OF THE HIP, THIGH, AND KNEE > Flashcards

CLINICAL CARE OF THE HIP, THIGH, AND KNEE Flashcards

1
Q

What happens when the femoral head is displaced from the acetabulum?

A

Hip dislocation

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2
Q

What kind of hip dislocation is the most common?

A

Posterior dislocation (90%)

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3
Q

In what hip dislocation is the affected limb short, the hip is fixed in adduction and internally rotated?

A

Posterior dislocation

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4
Q

In what hip dislocation is the affected hip held in abduction and external rotation?

A

Anterior dislocation

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5
Q

What imaging should be obtained for a hip dislocation?

A
  1. Radiographs of hip, knee, and pelvis

2. CT to eval for fracture pattern

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6
Q

What is the disposition for a patient with a hip dislocation?

A

MEDEVAC

SIQ until eval by ortho

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7
Q

What should be performed ASAP to reduce the risk of osteonecrosis (happens in about 10% of cases)?

A

Reduction

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8
Q

Fractures of the femoral shaft are mostly caused by what?

A

High energy trauma

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9
Q

When evaluating the neurovascular status of a patient with a fracture of the femoral shaft what nerves should be assessed?

A
  1. Femoral
  2. Peroneal
  3. Posterior tibial
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10
Q

When evaluating the neurovascular status of a patient with a fracture of the femoral shaft what pulses should be assessed?

A
  1. Femoral
  2. Popliteal
  3. Posterior tibialis
  4. Dorsalis Pedis
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11
Q

What plain films should be obtained for a patient with a suspected fracture of the femoral shaft?

A
  1. Hip
  2. Knee
  3. Pelvis
  4. Femur
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12
Q

What is the treatment for a patient with a fracture of the femoral shaft?

A
  1. Immediate traction and splinting
  2. MEDEVAC
  3. Surgery
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13
Q

What fracture is often misdiagnosed or completely missed and often occurs in patients who undergo repetitive impact?

(Recruits, athletes, runners)

A

Stress fracture of the femoral neck

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14
Q

The following are symptoms associated with what?

  1. vague pain in the anterior groin or thigh
    a. worse with activity or weight bearing
    b. relieved with rest
  2. story of increasing activity before onset
A

Stress fracture of the femoral neck

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15
Q

A patient presenting with the following may be experiencing symptoms associated with what?

  1. Antalgic gait
  2. Tenderness to proximal thigh/groin
  3. Limited ROM (internal rotation)
  4. Pain to groin/thigh with straight log roll
A

Stress fracture of the Femoral Neck

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16
Q

For patients with a stress fracture of the femoral neck radiographs are usually not diagnostic in most cases, what imaging would be more sensitive at detecting the fractures?

A

Bone scan/MRI

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17
Q

What is the treatment for a patient with a stress fracture of the femoral neck?

A
  1. analgesics
  2. ortho eval
  3. activity mod
    a. crutches
    b. non weight bearing
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18
Q

True or False

Usually fractures of the hip involve the pelvic ring or the acetabulum and vary greatly in severity

A

True

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19
Q

Patients with what kind of fracture will have a sensation of “coming apart” with weight bearing?

A

Fracture of the pelvis

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20
Q

True or False

Presentation of patient with a fracture of the pelvis depends on the severity

A

True

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21
Q

True or False

Peripheral nerve injuries are common in fractures of the pelvis

A

True

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22
Q

What radiographs should be obtained for patients with a fracture of the pelvis ?

A
  1. Pelvis
  2. Hip
  3. Head
  4. Cervical
  5. Chest
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23
Q

A hip strain usually involved several muscle groups around the hip such as what?

A
  1. Iliopsoas
  2. Sartorius
  3. Rectus femoris
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24
Q

True or False

Hip strains occur from vigorous muscle contraction while the muscle is in stretch

A

True

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25
Q

What special test would be used for a patient with a possible hip strain?

A

Thomas test for hip flexor tightness

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26
Q

What is the treatment for a hip strain?

A
  1. LLD/activity mod
  2. NSAIDS
  3. Pain free stretching and strengthening
  4. Run-walk program
    a. progressive return to full duty
  5. Send to ortho if failed conservative management
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27
Q

What injury of the thigh usually occurs when the actively contracted muscle is put on a stretch?

A

Thigh strain

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28
Q

True or False

The anterior thigh muscles (quadriceps) are more often injured more than the posterior thigh muscles (hamstring muscles)

A

False

The posterior thigh muscles (hamstring muscles) are injured more often than the anterior thigh muscles (quadriceps)

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29
Q

Strains or tears in the thigh typically occur where?

A

musculotendinous junction

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30
Q

A patient with what kind of strain typically reports a sudden onset of posterior or thigh pain that occurred while running or some other rapid movement?

A

Hamstring strain

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31
Q

True or False

Quadriceps strains are associated with direct blows during things such as contact sports

A

True

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32
Q

What is the more common strain of the thigh?

A

Hamstring strain

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33
Q

Are radiographs or other specialized imaging studies typically needed for patients with a thigh strain?

A

No

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34
Q

What imaging can confirm the thigh strain but is rarely indicated?

A

MRI

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35
Q

What is the cheaper and quicker alternative to confirm a thigh strain?

A

Ultrasound

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36
Q

What is the treatment for a thigh strain?

A
  1. RICE
  2. pain free stretching and strengthening of injured muscle
  3. NSAIDS
  4. Rehab depends on pts activity level and severity of injury
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37
Q

True or False

Inflammation and hypertrophy of the greater trochanteric bursa may develop without apparent cause

A

True

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38
Q

What could possibly be associated with lumbar spine disease, intraarticular hip pathology, significant limb-length inequalities, inflammatory arthritis, or previous surgery around the hip?

A

Trochanteric bursitis

*cause of lateral hip pain

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39
Q

Patients with the following symptoms may be experiencing what?

  1. Pain and tenderness over the greater trochanter (lateral hip pain)
  2. Pain may radiate distally to knee or ankle (not the foot) or proximally into the buttocks
  3. Pain worse when going from sitting to standing
  4. Unable to lie on the affected side
A

Trochanteric bursitis

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40
Q

Point tenderness over the lateral greater trochanter is the essential finding in what?

A

Trochanteric bursitis

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41
Q

Patients with what will report increased discomfort with hip adduction or adduction with internal rotation; resisted hip abduction also causes pain?

A

Trochanteric bursitis

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42
Q

What special tests should be performed for trochanteric bursitis?

A
  1. Trendelenburg

2. Faber

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43
Q

What is the treatment for trochanteric bursitis?

A
  1. NSAIDS
  2. LLD/ activity mod
  3. Hip strengthening (focus on abduction) and stretching
  4. Refer to ortho if conservative management failed
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44
Q

What ligament of the knee is a primary stabilizer of the knee?

A

Anterior cruciate ligament (ACL)

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45
Q

What ligament of the knee limits anterior translation of the tibia on the femur?

A

ACL

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46
Q

A tear in what ligament of the knee results from rotational (twisting) or hyperextension force?

A

ACL Tear

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47
Q

Patients with a tear to the ____ usually report sudden pain and giving way of the knee from a twisting or hyperextension injury?

A

ACL

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48
Q

What amount of patents report and audible “pop” as the ligament of the knee tears?

A

1/3

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49
Q

The physical exam findings below are associated with what ligamentous injury of the knee?

  1. Moderate to severe effusion
  2. Possible hemarthrosis
  3. Generalized knee tenderness
  4. Range of motion is limited by pain and effusion
  5. locking/popping sensation
A

ACL tear

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50
Q

What special tests should be performed for a patient with a suspected ACL Tear?

A
  1. Anterior drawer
  2. Lachman

Negative in many patients with ACL tear

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51
Q

True or False

ACL tear

Radiographs are needed to rule out other pathology but will typically be positive for effusion or avulsion fractures

A

True

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52
Q

What is the primary imaging study to confirm an ACL tear?

A

MRI

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53
Q

What is the treatment for an ACL tear?

A
  1. RICE
  2. LLD to include no running and cutting down activity
  3. Ortho consult
  4. PT consult
  5. Knee immobilizer or ROM brace can be used for comfort until acute pain subsides
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54
Q

Patients with a suspected ACL tear require an eval by who?

A

Ortho

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55
Q

What is the strongest ligament in the knee?

A

Posterior cruciate ligament (PCL)

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56
Q

What ligament of the knee prevents posterior translation of the tibia on the femur ?

A

PCL

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57
Q

What ligamentous injury of the knee is much less common than other ligamentous/meniscal injuries?

A

PCL tear

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58
Q

These four injury patterns suggest the possibility of what injury to the knee?

  1. Dashboard injury- posteriorly directed force to the anterior knee while in flexion
  2. Pure hyperflexion injury to the knee
  3. Hyperextension injury to the knee
  4. Fall onto flexed with with foot in plantar flexion
A

PCL injuries

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59
Q

These physical exam findings are associated with what injury to the knee?

  1. moderate to severe effusion with ecchymosis
  2. general knee tenderness with focus to the posterior knee
  3. ROM limited by pain and effusion
A

PCL injury/tear

60
Q

What special test should be used for a possible PCL injury?

A
  1. Posterior Drawer
    a. positive
  2. Sag test
    a. posterior subluxation of tibia in relation to the femur is a positive sign
61
Q

What imaging can be useful in confirming PCL tears, as well as any concomitant injuries to ligament, menisci, and articular cartilage?

A

MRI

62
Q

What is the treatment for a PCL tear?

A
  1. RICE
  2. NSAIDS/Tylenol
  3. LLD to include no running and cutting down activity
  4. Ortho consult
  5. PT consult
63
Q

What ligaments are outside of the joint and stabilize the knee against valgus and varus stress?

A

Medial and lateral collateral ligaments

64
Q

What ligament tear of the knee results from valgus force ?

A

MCL tear

65
Q

What ligament tear of the knee results from varus force?

A

LCL tear

66
Q

What special tests should be performed for a suspected MCL/LCL tear?

A

Valgus/varus stress test

done with knee in 25-30 degrees of flexion

67
Q

What imaging is required for diagnosis of an MCL/LCL tear?

A

MRI

68
Q

True or False

MCL tears are usually non-operative and heal within 4-6 weeks

A

True

69
Q

What is the conservative treatment for an MCL tear?

A
  1. PT
  2. NSAIDS
  3. RICE
  4. Hinged brace
  5. Crutches, WBAT
  6. ortho consult if conservative management fails
70
Q

True or False

LCL tears may be treated non-surgically depending on the grade but grade III require surgical management

A

True

71
Q

What is the conservative management of an LCL tear?

A
  1. PT
  2. NSAIDS
  3. RICE
  4. Hinged brace
  5. Crutches, WBAT
72
Q

What lies between the skin and bony prominences or between tendons, ligaments and the bone?

A

Bursae

73
Q

What are lined by synovial tissue, which produces a small amount of fluid to decrease friction between adjacent structures?

A

Bursae

74
Q

True or False

Chronic pressure of friction (overuse) causes thickening of this synovial lining and subsequent excessive fluid formation, thereby leading to localized swelling and pain of the bursae of the knee

A

True

75
Q

What burse on the anterior aspect of the knee is superficial and lies between the skin and the bony patella?

A

Prepatellar bursae (housemaids knee)

76
Q

What bursa of the knee lies under the insertion site of the sartorius, gracilis, and semitendinous muscles on the medial flare of the tibia just below the tibial plateau ?

A

Pes anserine bursa

77
Q

Localized swelling over the involved structure is most marked with what form of bursitis?

A

Prepatellar bursitis

78
Q

Upon visual examination of a patient, a dome shaped swelling over the anterior aspect of the knee suggests what?

A

Prepatellar bursitis

79
Q

Upon visual examination of a patient, a mild swelling to the medial aspect of the knee may suggest what form of bursitis?

A

Pes anserine bursitis

80
Q

In a patient with suspected bursitis of the knee, increased pain, warmth, and erythematous changes may indicate what?

A

Septic bursitis

81
Q

In what form of bursitis will you see tenderness to the focal medial flare of the tibia just below the tibial plateau?

A

Pes anserine bursitis

82
Q

True or false

Bursitis of the knee

Radiographs are needed to rule out bony pathology or Osteoarthritis

A

True

83
Q

True or False

Aspiration should be performed if septic prepatellar bursitis is suspected

A

True

84
Q

What is the treatment for bursitis of the knee?

A
  1. RICE
  2. NSAIDS
  3. LLD/activity mod
  4. Pain free LE stretching and strengthening exercises
  5. Antibiotic treatment for septic bursitis
85
Q

What is a 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 band

86
Q

What provides as muscle attachment for the tensor fascia latae, a portion of the gluteus maximus and gluteus medius and function to do the following:

  1. Stabilizes the hip
  2. Limits tibial internal rotation
  3. Limits over pronation
A

Iliotibial band

87
Q

True or False

ITBS occurs with repetitive flexion and extension of the knee

A

True

88
Q

What it thought to be secondary to friction as the IT band rubs against the lateral femoral epicondyle?

A

ITBS

89
Q

What syndrome is very common and is seen in up to 25% of physically active people?

A

ITBS

90
Q

In what people is ITBS mostly seen in?

A

Runners and cyclists

91
Q

Pain focal to the anterior lateral aspect of the knee that worsens with activity and is worse with downhill running, mostly during the heel strike suggests what syndrome?

A

ITBS

92
Q

Patients with the following may be suffering from what syndrome?

  1. Genu varum (bow legs)
  2. Pes planus
  3. Tibial internal rotation
A

ITBS

93
Q

Patients with what syndrome may experience tenderness to direct palpation over/near the lateral femoral condyle and the tenderness may extend above or below the lateral femoral condyle?

A

ITBS

94
Q

What special test is used to asses ITB tightness?

A

Obers

95
Q

A positive Obers test may suggest what?

A

ITBS

Positive pain when jumping on flexed knee

96
Q

Are radiographs typically needed for a patient with ITBS?

A

No, obtained in patients with persistent symptoms despite treatment

97
Q

What is the treatment for ITBS?

A
  1. NSAIDS
  2. Foam rolling
  3. LLD
  4. Modification to training regimen
    a. running time/distance progression
    b. hamstring and ITB stretching
    c. hip abductor strengthening
98
Q

What are the fibrocartilaginous pads that function as shock absorbers between the femoral condyles and tibial plateau?

A

Medial and lateral menisci

99
Q

True or False

Meniscal tears can occur alone or in association with ligament injuries such as ACL or MCL tears

A

True

100
Q

Patients with traumatic tears to the what typically report a significant twisting injury to the knee?

A

Meniscal tears

101
Q

Patients with what tear in the knee may describe symptoms of mechanical locking, catching, or popping?

A

Meniscal tear

102
Q

True or False

Traumatic meniscal injuries typically lead to little to no effusion

A

False

Moderate to severe effusion

103
Q

Patients with a meniscal tears will typically be tender to palpation where?

A

medial or lateral joint lines

104
Q

True or False

Locked knee (bucket handle tears) constitutes and URGENT referral to ortho for surgery

A

True

105
Q

Patients with what injury of the knee feels as though it is “catching” through the ROM?

A

Meniscal tears

106
Q

What special test should be performed for a patient with a suspected meniscal tear?

A

Mcmurray (will be positive)

107
Q

What imaging is highly specific and sensitive for meniscal pathology?

A

MRI

108
Q

What is the treatment for a meniscal tear if there is an absence of mechanical locking?

A
  1. RICE
  2. NSAIDS
  3. ROM and pain free strengthening exercises
  4. Ortho consult
109
Q

What is commonly referred to as “jumpers knee”?

A

Quadriceps/Patellar Tendinitis

110
Q

True or False

Quadriceps/Patellar Tendinitis is usually seen in patients who increase physical training to quickly

A

True

“too much, too fast, too soon”

111
Q

Anterior knee pain is the hallmark for what problem in the knee?

A

Quadriceps/Patellar Tendinitis

112
Q

What tendon inserts at the superior pole of the patella?

A

Quadriceps tendon

113
Q

What tendon originates at the inferior pole of the patella?

A

Patellar tendon

114
Q

What form of tendinitis is exacerbated by the following?

  1. exercise
  2. prolonged sitting, squatting, or kneeling
  3. Climbing or descending stairs
  4. running
  5. jumping
A

Quadriceps/Patellar Tendinitis

115
Q

True or False

You may see some mild infrapatellar bursa swelling in the visual inspection for a patient with Quadriceps/Patellar Tendinitis

A

True

116
Q

True or False

Patients with Quadriceps/Patellar Tendinitis will have normal knee motion but pain with extension

A

True

117
Q

What is the treatment for Quadriceps/Patellar Tendinitis?

A
  1. NSAIDS
  2. Ice
  3. LLD
  4. Pain free quadriceps and hamstring stretching and strengthening
  5. Patellar tendon strap - chopats for comfort
118
Q

What is the overuse disorder characterized by pain around the patella that is aggravated by activities that load the patellofemoral joint?

A

Patellofemoral Pain

119
Q

What is the most common cause of knee pain in the primary care setting?

A

Patellofemoral pain

120
Q

In what decade of life is patellofemoral pain the most common?

A

Third decade of life

121
Q

One function of the patella is to increase the leverage of the _____

A

quadriceps

122
Q

True or False

Patellofemoral pain is multifactorial and there is no clear consensus on the etiology

A

True

123
Q

What are the most commonly cited causes of patellofemoral pain?

A
  1. Overload

2. Malalignment

124
Q

Patellar malalignment and patellar tracking are thought to be risk factors for what?

A

Patellofemoral pain

125
Q

Studies performed among military recruits identified several risk factors for patellofemoral pain, what are they?

A
  1. fitness level before service
  2. prior exercise behavior
  3. BMI over 25
  4. Training load
126
Q

A patient presents to sick call with diffuse aching anterior knee pain that has been exacerbated by prolonged sitting, and climbing stairs. The patient reports no previous trauma or history of swelling. What is the most likely diagnosis?

A

Patellofemoral pain

127
Q

What are some examples of misalignments and deviations from normal during the physical exam for a patient with patellofemoral pain?

A
  1. Femoral anteversion
  2. genu valgum
  3. foot over pronation
  4. patellar tracking
  5. VMO definition
128
Q

Upon palpation you note tenderness to the medial and/or lateral subpatellar borders; these findings may be associated with what?

A

Patellofemoral syndrome

129
Q

What special tests are recommended for a patient experiencing patellofemoral syndrome?

A
  1. Patellar apprehension
  2. Patellar instability
  3. Hamstring flexibility via Popliteal angle
130
Q

Plain films should be considered in a patient with patellofemoral syndrome in what certain scenarios?

A
  1. History of trauma
  2. patellar instability
  3. effusion
  4. prior surgery
  5. severe pain at rest
  6. failure of conservative management
131
Q

What is the treatment for patellofemoral pain?

A
  1. NSAIDS
  2. Ice
  3. LLD - active rest
  4. Quadriceps and hamstring flexibility and strengthening
  5. Weight loss in fat patients
  6. Support biomechanical limitation
    a. McConnel taping
    b. Patellar tracking brace
    c. Motion control shoe/inserts
132
Q

Popliteal cysts are also called what?

A

Bakers cyts

133
Q

What are cysts in the popliteal fossa that communicate with the knee space?

A

Popliteal cysts

134
Q

True or False

Larger cysts can dissect down the posterior calf and/or rupture, resulting in severe calf pain and decreased motion at the ankle

A

True

135
Q

What is a differential diagnosis that must be considered for a suspected popliteal cyst?

A

DVT

136
Q

What is a good choice of imaging for a patient with a popliteal cyst?

A

UT

137
Q

What is the treatment for an uncomplicated popliteal cyst?

A
  1. NSAIDS and or analgesics
  2. ICE
  3. LLD/activity mod
138
Q

Where should patients experiencing constitutional symptoms associated with popliteal cysts be consulted to?

A

Ortho

139
Q

What is a common cause of anterior knee pain in the younger population?

A

Osgood Schlatter disease

140
Q

What disease of the knee is typically seen between the ages of 14-18, and possibly later in males?

A

Osgood Schlatter disease

141
Q

What disease is characterized by pain and swelling at the tibial tubercle?

A

Osgood Schlatter disease

142
Q

What is the insertion site of the patellar tendon?

A

Tibial tubercle

143
Q

The following is associated with what disease?

  1. overuse causes chronic avulsion of the ossification center of the tibial tubercle
  2. proximal patellar tendon separates from the tibial tubercle which causes elevation
  3. This causes callous’ over time as it heal and the tibial tubercle may become more pronounced
A

Osgood Schlatter

144
Q

What presents with the following clinical symptoms?

  1. Anterior knee pain that gets worse over time
  2. Exacerbated by direct trauma, kneeling, running, jumping, etc.
    a. Relieved with rest
  3. Typically asymmetric
A

Osgood Schlatter Disease

145
Q

True or False

Osgood Schlatter is usually benign and self limited

A

True

146
Q

What is the treatment for Osgood Schlatter Disease?

A
  1. NSAIDS
  2. Protective pad over the knee
  3. Duty modification
    a. avoid complete rest
  4. Home exercise program
    a. consider PT

CLASS 22010 MSK (12 decks)

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