Differential Diagnosis Flashcards
Diagnostic Tests: Bursitis
- FABER
- +Ober
- Pain with A/PROM based on bursa location
Q: Iliopsoas bursitis presents with pain during which motions?
Hip ER and flexion
Q: Trochanteric bursitis presents with pain during which motions?
Hip IR and ITB tightness
Q: Ischial bursitis presents with pain during which motions?
Limited hip flexion - tight hamstrings
Diagnostic Tests: OA (3)
- Scour
- FABER
- Limited ROM, CPR
Diagnostic Tests: Femoral Neck Stress Fx
Antalgic gait
(+ percussion test)
Diagnostic Tests: Muscle Strain (3)
- Local tenderness
- Decreased muscle power
- Pain with stretch/contraction
Diagnostic Tests: Piriformis Syndrome (3)
- Local tenderness
- Piriformis stretch test
- SLR
Diagnostic Tests: Legg-Calve Perthes Disease (2)
- Limb
- Limited ABD, IR, Flex
Diagnostic Tests: Labral Tear (Hip) (2)
- Scour
- Maybe + FABER
Diagnostic Test: Pubalgia
Bilateral adductor test
Description: The patient is supine with both hips flexed to 30, slightly abducted, and slightly internally rotated. The examiner places their forearms on the patient’s medial foot arches and instructs the patient to resist the examiner’s attempt to abduct the patient’s hips
Diagnostic Test: GTPS (4)
- Palpable tenderness at greater trochanter
- Ober’s positive or tight adductors
- Trendelenburg’s negative
- Resisted hip ABD or IR
Diagnostic Test: Hip Muscular Strain (Pull or Tear)
Femural-acetabular impingement test/anteriorsuperior labral tear
Diagnostic Tests: Meniscus Injury (5)
- Joint line palpation
- McMurray’s Test
- Apley’s compression
- Limited ROM
- AP PAM increases pain
Diagnostic Tests: ACL Injury
- Lachman
- Anterior Drawer
Diagnostic Tests: PCL Injury (2)
- Posterior sag
- Posterior drawer
Diagnostic Tests: PF Syndrome (2)
- Apprehension test
- Critical test
Diagnostic Tests: Patellar Tendinopathy
Ely’s Test
Diagnostic Test: DJD/OA (3)
- Decreased WB during gaitt
- Pain at end range of extension, > 90 flexion
- Negative meniscus/stability tests
Diagnostic Test: Patellofemoral Dysfunction (3)
- Poor terminal knee extension control
- Positive critical test
- Functional Tests
Diagnostic Test: Fat Pad Irritation
- Positive AP tilt
- Palpable tenderness at inferior pole
- Pain with extension + OP
Diagnostic Test: Patellar tendinitis (3)
- Small Q angle
- Palpable tenderness
- Muscle tightness and weakness
Content: Typical Hip Profiles
- Older population
- Women
- Children
- Middle aged
- Athletes
- Hip osteoarthritis
- Slap lesion, trochanter bursitis
- Legg-Calve-Perthes
- Avascular necrosis
- Labral tear
Content: Differential Diagnosis for Anterior Hip Pain (8)
- Osteoarthritis
- Hip flexor muscle strain/tendonitis
- Iliopsoas bursitis
- Hip fx (proximal femur)
- Stress fx
- Inflammatory arthritis
- Acetabular labral tear
- Avascular necrosis of femoral head
Q: What anterior hip pain condition is associated with snapping?
Iliopsoas bursitits
Q: What anterior pain sydrome is associated with morning stiffness?
Inflammatory arthritis
Content: Indications for differential diagnosis of acetabular labral tear due to anterior hip pain (3)
- Activity related sharp groin/anterior thigh pain, esp. upon hip extension
- Deep clicking felt (sensitivity 89%)
- Positive Thomas flexion/extension test
Content: Differential diagnosis for Lateral Pain (3)
- Greater trochanteric bursitis
- Gluteus medius muscle dysfunction
- Iliotibial band syndrome
Q: What special test will be positive for gluteus medius dysfunction?
Trendelenburg Test
Q: What is the sensitivity and specificity of the Trendelenburg test for gluteus medius muscle tear?
72.7% and 76.9%
Q: Lateral pain syndrome is associated with snapping?
IT Band Syndrome
Content: Differential diagnosis for Posterior Pain (3)
- Referred pain from L-spine
- Sacroiliac joint dysfunction
- Hip extensor or rotator muscle strain
Content: Indications for differential diagnosis of referred pain from L-spine due to posterior pain. (3)
- Hx of LBP
- Pain reproduced with isolated lumbar flexion or extension
- Radicular symptoms of hx consistent with spinal stenosis
Content: Knee Differential Diagnosis Based on Population Profile
- Adolescents
- Young adults
- Middle-aged
- Older
- Women
- Athletes
- Epiphysitis
- Femoral condyle defects, meniscus/ligament injuries
- Tendinophathies, articular surface damage, osteoarthritis
- OA
- PF syndrome
- Meniscus/ligament injuries
Content: Types of injuries that can occur at the tibiofemoral joint (5)
- Femoral condyle
- Meniscal
- Ligamentous
- Muscle/tendon
- Joint degeneration
Q: What injury is common at the patellofemoral joint?
PF tracking
Content: Superior tibiofibular joint (2)
- Important for posteriolateral stability, relatively stable joint
- Injuried with PF/Inv ankle injury
- Not affected by knee injuries
Content: Area of Symptoms - Tibiofemoral Joint (5)
- Deep pain
- Meniscus = local pain, catching
- Anterior/medial/lateral pain
- Joint line
- Referred pain from spine
Content: Area of Symptoms - Patellofemoral Joint (4)
- Around margins of patella
- Retro/deep patella
- Lateral knee
- Inferior patella
Content: Area of Symptoms - Superior tibiofibular Joint (2)
- Local pain
- Latera/Anterior leg
Content: Knee Area of Symptoms (6)
- Medial knee
- Lateral knee
- Retro-patella
- Inferior patella
- Behind the knee
- Generalized knee pain
Content: Typical Ankle Diagnoses Seen in Adults (5)
- Achilles tendonitis/tendinosis
- Plantar fascitis
- Ligamentous strains
- RA
- Gout
Content: Typical Ankle Diagnoses Seen in Children/Adolescents (3)
- Osteochondritis dissecans of talus
- Juvenile RA
- Epiphyseal Fx
Content: Typical Ankle Diagnoses Seen in Athletes (3)
- Ligament sprains
- Stress fx
- Muscle strains
Content: Diagnoses that agree with Lateral Ankle Pain (10 - 1 bold)
- Osteochondral fracture of the talus
- Distal Fibular Fracture
- Avulsion Fracture (5th MT)
- Peroneal tendon injury/subluxation
**5. Ligamentous injury (ATFL, CFL) - most common **
- High sprain of the anteroinferior tibial fibular ligament
- Fibular or sural nerve irritation
- Cuboid subluxation
- Achilles tendon injury
- Subtalar joint ligament injury
**Overall, most likely a ligament problem **
Content: Diagnoses that agree with Medial Ankle Pain (7 - 3 bold)
- Tarsal Tunnel Syndrome - tibia nerve pinched
**2. Posterior Tibial Tendonitis - most common **
3. Ligamentous Injury (Deltoid)
- Subtalar Joint Arthropathy
- Accessory Navicular syndrome - extra bone, congenital, not common
6. Medial tibial stress syndrome (shin splints)
- Maleolar Fractures
Content: Diagnoses that agree with Anterior Ankle Pain (4 - 1 bold)
1. Anterior Ankle Impingement - very common can be due to osteophytes
- Acute/Chronic Compartment Syndrome
- Deep Fibular Nerve lesion (trauma deep to superior edge of Ext Hallicus Brevis m.
- Talar dome injuries
Content: Diagnoses that agree with Posterior Heel Pain (6 - 2 bold)
1. Retrocalcaneal bursitis - can be due to tight shoes
- Haglunds’ deformity - more bone on posterior calcaneus, rare
**3. Achilles Tendinitis/Tendinosis - can be acute or chronic **
- Calcification within the Achilles Tendon
- Referred pain from Soleus trigger point
- Radiculopathy – S1
Content: Diagnoses that agree with Plantar Heel Pain (7 - 2 bold)
**1. Plantar Fasciitis - very common **
- Neuropathy – tibial nerve branch entrapment
**3. Heel spur - typically in older individuals **
- Stress Fracture
- Tarsal tunnel syndrome
- Radiculopathy – S1
- Systemic problems (Reiter’s, RA, Gout )
Content: Inclusion criteria for considering hip osteoarthritis (according to the american college of RA) (2)
- Hip pain AND hip IR < 15 AND hip flexion < 115 OR
- Hip pain AND hip IR > 15 AND pain on hip IR AND morning stiffness < 60 min AND age > 50
Diagnostic Tests: Achilles Tendon Rupture
+ Thompson’s
Can’t perform heel raise
