CLINICAL CARE OF THE HIP, THIGH, AND KNEE

Question 1

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

Answer 1

Hip dislocation

Question 2

What kind of hip dislocation is the most common?

Answer 2

Posterior dislocation (90%)

Question 3

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

Answer 3

Posterior dislocation

Question 4

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

Answer 4

Anterior dislocation

Question 5

What imaging should be obtained for a hip dislocation?

Answer 5

1. Radiographs of hip, knee, and pelvis

2. CT to eval for fracture pattern

Question 6

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

Answer 6

MEDEVAC

SIQ until eval by ortho

Question 7

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

Answer 7

Reduction

Question 8

Fractures of the femoral shaft are mostly caused by what?

Answer 8

High energy trauma

Question 9

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

Answer 9

1. Femoral
2. Peroneal
3. Posterior tibial

Question 10

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

Answer 10

1. Femoral
2. Popliteal
3. Posterior tibialis
4. Dorsalis Pedis

Question 11

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

Answer 11

1. Hip
2. Knee
3. Pelvis
4. Femur

Question 12

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

Answer 12

1. Immediate traction and splinting
2. MEDEVAC
3. Surgery

Question 13

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

(Recruits, athletes, runners)

Answer 13

Stress fracture of the femoral neck

Question 14

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

Answer 14

Stress fracture of the femoral neck

Question 15

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

Answer 15

Stress fracture of the Femoral Neck

Question 16

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?

Answer 16

Bone scan/MRI

Question 17

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

Answer 17

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

Question 18

True or False

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

Answer 18

True

Question 19

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

Answer 19

Fracture of the pelvis

Question 20

True or False

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

Answer 20

True

Question 21

True or False

Peripheral nerve injuries are common in fractures of the pelvis

Answer 21

True

Question 22

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

Answer 22

1. Pelvis
2. Hip
3. Head
4. Cervical
5. Chest

Question 23

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

Answer 23

1. Iliopsoas
2. Sartorius
3. Rectus femoris

Question 24

True or False

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

Answer 24

True

Question 25

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

Answer 25

Thomas test for hip flexor tightness

Question 26

What is the treatment for a hip strain?

Answer 26

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

Question 27

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

Answer 27

Thigh strain

Question 28

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

Answer 28

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

Question 29

Strains or tears in the thigh typically occur where?

Answer 29

musculotendinous junction

Question 30

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?

Answer 30

Hamstring strain

Question 31

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

Answer 31

True

Question 32

What is the more common strain of the thigh?

Answer 32

Hamstring strain

Question 33

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

Answer 33

No

Question 34

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

Answer 34

MRI

Question 35

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

Answer 35

Ultrasound

Question 36

What is the treatment for a thigh strain?

Answer 36

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

Question 37

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

Answer 37

True

Question 38

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

Answer 38

Trochanteric bursitis *cause of lateral hip pain

Question 39

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

Answer 39

Trochanteric bursitis

Question 40

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

Answer 40

Trochanteric bursitis

Question 41

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

Answer 41

Trochanteric bursitis

Question 42

What special tests should be performed for trochanteric bursitis?

Answer 42

1. Trendelenburg | 2. Faber

Question 43

What is the treatment for trochanteric bursitis?

Answer 43

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

Question 44

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

Answer 44

Anterior cruciate ligament (ACL)

Question 45

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

Answer 45

ACL

Question 46

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

Answer 46

ACL Tear

Question 47

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

Answer 47

ACL

Question 48

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

Answer 48

1/3

Question 49

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

Answer 49

ACL tear

Question 50

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

Answer 50

1. Anterior drawer 2. Lachman Negative in many patients with ACL tear

Question 51

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

Answer 51

True

Question 52

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

Answer 52

MRI

Question 53

What is the treatment for an ACL tear?

Answer 53

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

Question 54

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

Answer 54

Ortho

Question 55

What is the strongest ligament in the knee?

Answer 55

Posterior cruciate ligament (PCL)

Question 56

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

Answer 56

PCL

Question 57

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

Answer 57

PCL tear

Question 58

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

Answer 58

PCL injuries

Question 59

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

Answer 59

PCL injury/tear

Question 60

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

Answer 60

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

Question 61

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

Answer 61

MRI

Question 62

What is the treatment for a PCL tear?

Answer 62

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

Question 63

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

Answer 63

Medial and lateral collateral ligaments

Question 64

What ligament tear of the knee results from valgus force ?

Answer 64

MCL tear

Question 65

What ligament tear of the knee results from varus force?

Answer 65

LCL tear

Question 66

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

Answer 66

Valgus/varus stress test done with knee in 25-30 degrees of flexion

Question 67

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

Answer 67

MRI

Question 68

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

Answer 68

True

Question 69

What is the conservative treatment for an MCL tear?

Answer 69

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

Question 70

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

Answer 70

True

Question 71

What is the conservative management of an LCL tear?

Answer 71

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

Question 72

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

Answer 72

Bursae

Question 73

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

Answer 73

Bursae

Question 74

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

Answer 74

True

Question 75

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

Answer 75

Prepatellar bursae (housemaids knee)

Question 76

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 ?

Answer 76

Pes anserine bursa

Question 77

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

Answer 77

Prepatellar bursitis

Question 78

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

Answer 78

Prepatellar bursitis

Question 79

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

Answer 79

Pes anserine bursitis

Question 80

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

Answer 80

Septic bursitis

Question 81

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

Answer 81

Pes anserine bursitis

Question 82

True or false Bursitis of the knee Radiographs are needed to rule out bony pathology or Osteoarthritis

Answer 82

True

Question 83

True or False Aspiration should be performed if septic prepatellar bursitis is suspected

Answer 83

True

Question 84

What is the treatment for bursitis of the knee?

Answer 84

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

Question 85

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?

Answer 85

Iliotibial band

Question 86

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

Answer 86

Iliotibial band

Question 87

True or False ITBS occurs with repetitive flexion and extension of the knee

Answer 87

True

Question 88

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

Answer 88

ITBS

Question 89

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

Answer 89

ITBS

Question 90

In what people is ITBS mostly seen in?

Answer 90

Runners and cyclists

Question 91

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?

Answer 91

ITBS

Question 92

Patients with the following may be suffering from what syndrome? 1. Genu varum (bow legs) 2. Pes planus 3. Tibial internal rotation

Answer 92

ITBS

Question 93

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?

Answer 93

ITBS

Question 94

What special test is used to asses ITB tightness?

Answer 94

Obers

Question 95

A positive Obers test may suggest what?

Answer 95

ITBS Positive pain when jumping on flexed knee

Question 96

Are radiographs typically needed for a patient with ITBS?

Answer 96

No, obtained in patients with persistent symptoms despite treatment

Question 97

What is the treatment for ITBS?

Answer 97

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

Question 98

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

Answer 98

Medial and lateral menisci

Question 99

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

Answer 99

True

Question 100

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

Answer 100

Meniscal tears

Question 101

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

Answer 101

Meniscal tear

Question 102

True or False Traumatic meniscal injuries typically lead to little to no effusion

Answer 102

False Moderate to severe effusion

Question 103

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

Answer 103

medial or lateral joint lines

Question 104

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

Answer 104

True

Question 105

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

Answer 105

Meniscal tears

Question 106

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

Answer 106

Mcmurray (will be positive)

Question 107

What imaging is highly specific and sensitive for meniscal pathology?

Answer 107

MRI

Question 108

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

Answer 108

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

Question 109

What is commonly referred to as "jumpers knee"?

Answer 109

Quadriceps/Patellar Tendinitis

Question 110

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

Answer 110

True "too much, too fast, too soon"

Question 111

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

Answer 111

Quadriceps/Patellar Tendinitis

Question 112

What tendon inserts at the superior pole of the patella?

Answer 112

Quadriceps tendon

Question 113

What tendon originates at the inferior pole of the patella?

Answer 113

Patellar tendon

Question 114

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

Answer 114

Quadriceps/Patellar Tendinitis

Question 115

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

Answer 115

True

Question 116

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

Answer 116

True

Question 117

What is the treatment for Quadriceps/Patellar Tendinitis?

Answer 117

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

Question 118

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

Answer 118

Patellofemoral Pain

Question 119

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

Answer 119

Patellofemoral pain

Question 120

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

Answer 120

Third decade of life

Question 121

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

Answer 121

quadriceps

Question 122

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

Answer 122

True

Question 123

What are the most commonly cited causes of patellofemoral pain?

Answer 123

1. Overload | 2. Malalignment

Question 124

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

Answer 124

Patellofemoral pain

Question 125

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

Answer 125

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

Question 126

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?

Answer 126

Patellofemoral pain

Question 127

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

Answer 127

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

Question 128

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

Answer 128

Patellofemoral syndrome

Question 129

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

Answer 129

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

Question 130

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

Answer 130

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

Question 131

What is the treatment for patellofemoral pain?

Answer 131

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

Question 132

Popliteal cysts are also called what?

Answer 132

Bakers cyts

Question 133

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

Answer 133

Popliteal cysts

Question 134

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

Answer 134

True

Question 135

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

Answer 135

DVT

Question 136

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

Answer 136

UT

Question 137

What is the treatment for an uncomplicated popliteal cyst?

Answer 137

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

Question 138

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

Answer 138

Ortho

Question 139

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

Answer 139

Osgood Schlatter disease

Question 140

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

Answer 140

Osgood Schlatter disease

Question 141

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

Answer 141

Osgood Schlatter disease

Question 142

What is the insertion site of the patellar tendon?

Answer 142

Tibial tubercle

Question 143

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

Answer 143

Osgood Schlatter

Question 144

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

Answer 144

Osgood Schlatter Disease

Question 145

True or False Osgood Schlatter is usually benign and self limited

Answer 145

True

Question 146

What is the treatment for Osgood Schlatter Disease?

Answer 146

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