Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTH 517: Orthopedic Management I > Exam 1: LE > Flashcards

Exam 1: LE Flashcards

1
Q

How many bones are there in the foot? How many synovial joints are there?

A

-28 bones
-30 synovial joints
-55 articulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the function of the foot and ankle?

A

Convert the rotational movements that occur with weight bearing activities into sagittal, frontal, and transverse movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What joint sustains the greatest load per surface area in the body?

A

The ankle joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are peak weight bearing forces through the ankle during walking and running?

A

-Walking: 120%
-Running: 275%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the three subdivisions of the foot?

A

-Rearfoort/hindfoot
-Midfoot
-Forefoot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the rearfoot/hindfoot consist of?

A

-Tibia
-Fibula
-Calcaneus
-Talus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the midfoot consist of?

A

-Navicular
-Cuboid
-3 cuneiforms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does the forefoot consist of?

A

-14 bones of the toes
-5 metatarsals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are common ankle disorders?

A

-Ankle sprains/instability
-Osteochondritis Dissecans of talus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where do most of ankle sprains occur?

A

85% of ankle sprains occur on the lateral ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What ligament is involved in 60-70% of all ankle sprains?

A

Anterior talofibular ligament (ATFL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What ligament is involved 20% of the time when the ATFL is sprained?

A

Calcaneofibular ligament (CFL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the sequence of tears for ankle sprains?

A
  1. ATFL
  2. Anterolateral capsule
  3. Distal tibiofibular ligament
  4. CFL
  5. Posterior talofibular ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why might someone with a lateral ankle sprain experience medial ankle pain?

A

Due to bone bruising of the talus at the time of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How long do bone bruises typically take to heal?

A

6 months or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What grades of sprains are there?

A

-Grade I: 1-24% is torn
-Grade II: 25-99% torn
-Grade III: 100% torn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a high ankle sprain?

A

-High ankle sprains occur when the syndesmosis is stretched and torn
Other structures that can be torn include:
-Anterior inferior tibiofibular ligament
-Posterior inferior tibiofibular ligament
-The transverse ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the typical mechanism of injury for high ankle sprains?

A

External rotation or dorsiflexion as these motions can cause the distal tibia and fibula joint to separate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the recovery time of a high ankle sprain compared to a lateral ankle sprain?

A

A high ankle sprain usually takes twice as long to recover from

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the mechanism of injury for a lateral ankle sprain?

A

Inversion and plantarflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a medial ankle sprain? How common is it?

A

-Injury to the deltoid ligament
-Less common than lateral ankle sprains
-Usually due to trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the mechanism of injury for a medial ankle sprain?

A

Excessive eversion and dorsiflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the Ottawa ankle rules?

A

-After traumatic incidents or injuries
An ankle X-ray is required if there is any pain in the malleolar zone and any of these findings:
-Bone tenderness at lateral malleolus
-Bone tenderness at medial malleolus
-Inability to weight bear both immediately and in the ER/office

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the Ottawa foot rules?

A

A foot X-ray is required if there is pain in the midfoot zone and any of these findings:
-Bone tenderness at navicular bones
-Bone tenderness at base of the 5th metatarsal
-Inability to weight bear both immediately and in ER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How should you treat an ankle sprain during the acute stage?

A

-Minimize effusion
-Promote early protected motion
-Early supported/protected WBAT
-Cryotherapy
-Compression
-Elevation
-Ankle pumps in free range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How should you treat an ankle sprain during the subacute stage?

A

-Begin dynamic balance and proprioceptive exercises
-Open chain resistive exercises
-Stationary bike

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How should you treat an ankle sprain during the advanced healing stage?

A

-Restore normal ROM
-Normalize gait
-Pain-free with full weight bearing
-Functional activities
-Enhanced proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is chronic ankle instability (CAI)? How can it be diagnosed?

A

-Repeated acute inversion ankle sprains
-Initial sprain being more than 12 months ago
-Frequent episodes of ankle sprains, reports of “giving way”, chronic ankle weakness
-Presentation with pain and instability
-Diagnosis: tenderness, + anterior drawer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are treatment options for CAI?

A

-Conservative: PT, splints
-Balance and strength training
-Surgical: repair or reconstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is osteochondritis dissecans of the talus? What is it caused by?

A

-Fracture of the joint surface (cartilage that can also damage the bone)
-Usually effects the domes of the talus
-Can break off into fragments
-Caused by torsional stress through either impact or cyclical loading and usually follow a twisting injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the clinical presentation of osteochondritis dissecans? How is it diagnosed?

A

-Persistent pain and swelling with stiffness
-Diagnosis: tenderness, diffuse swelling (needs imaging)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How is osteochondritis dissecans treated?

A

-Non-displaced lesions are treated with rest and cast immobilization
-Displaced lesions require arthroscopic removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the 4 grades of osteochondritis dissecans?

A

-Grade I: subchondral impaction
-Grade II: partly detached fragment
-Grade III: non-displaced free fragment
-Grade IV: fragment with 180° shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the most common ankle tendon disorders?

A

-Tibialis posterior
-Peroneal tendons
-Achilles tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the origin of the posterior tibial tendon? What is the insertion?

A

-Origin: posterior surface of tibia
-Insertion: 3 cuneiforms, base of 2-4 metatarsals, cuboid, and navicular tubercle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the function of the tibialis posterior?

A

-Plantar flexion and inversion
-Stabilizes the medial longitudinal arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are common pathologies of the posterior tibialis tendon?

A

-Tenosynovitis
-Incomplete tear
-Complete disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is tenosynovitis?

A

Inflammation of the tendon sheath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What patient population is posterior tibialis tendon dysfunction most common in?

A

-Younger patients with inflammatory arthropathy/traumatic rupture
-Older, typically female patient with degenerative tears (knee valgus, over pronation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the subjective findings of a patient with posterior tibialis tendonitis?

A

-Insidious onset of pain
-Pain felt in one of 3 locations: distal to medial malleolus in area of navicular, proximal to medial malleolus, at the musculotendinous origin or insertion
-Swelling on the medial aspect of the ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the objective findings with posterior tibialis tendonitis?

A

-Swelling and tenderness posterior and inferior to the medial malleolus, along the course of the tendon, and at its insertion into the navicular
-Medial arch is decreased or completely flattened
-Heel shows increased valgus
-Pain on resisted ankle PF and inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are some treatment options for posterior tibialis tenosynovitis?

A

-Rest
-NSAIDs
-Short leg walking cast
-Orthoses
-Steroid injection in tendon sheath
-Synovectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are some treatment options for incomplete tear of the posterior tibialis?

A

Repair or augmentation with either FDL or FHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are some treatment options for complete tear of the posterior tibialis?

A

-Repair in traumatic cases in young patients
-Tendon transfer with medial calcaneal displacement osteotomy and subtalar/triple arthrodesis (fixed hindfoot)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the origins and insertions of the peroneus longus and brevis?

A

-Origin: fibula and interosseus membrane
-Insertion: Base of I & V metatarsals respectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are common pathologies of the peroneal tendons?

A

-Tenosynovitis
-Sprain/subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are symptoms of peroneal tendon dysfunction?

A

-Pain in the outer part of the ankle or just behind the lateral malleolus
-Pain worsens with activity and eases with rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is non-surgical treatment options for peroneal tendon dysfunction?

A

-Rest
-Short leg walking cast
-Lateral heel wedge
-PT
-NSAIDs
-Cortisone injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are surgical options for peroneal tendon dysfunction?

A

-Tenosynovectomy and repair of split
-Stabilization of dislocating tendons by groove deepening, peroneal retinaculum reconstruction, and bone blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is achilles tendinosis?

A

There will be clinical inflammation but objective pathologic evidence for cellular inflammation is lacking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is achilles tendonitis?

A

-Peritendinous inflammation
-Seen in adults in their 30s-40s
-Most commonly affects runners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the two types of achilles tendon dysfunction?

A

-Non-insertional: occurs proximal to retrocalceneal bursa, generally responds well to non-operative treatment
-Insertional: tenderness is localized to calcaneal tendon insertion, more difficult to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the subjective findings of achilles tendonitis?

A

-Gradual onset of pain and swelling in the Achilles tendon
-Exacerbated by activity
-Some patients will present with pain and stiffness along the achilles tendon when rising in the morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the objective findings of achilles tendonitis?

A

-Tenderness & warmth to palpation along tendon
-Decreased active and passive dorsiflexion
-Gait may include: antalgia, premature heel off, leg may be held in ER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the conservative treatment options for achilles tendonitis?

A

-Rest
-Ice
-PT: eccentric loading, correction of lower chain asymmetries
-Orthoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the surgical treatment options for achilles tendonitis?

A

-Achilles tendon decompression and debridement if unrelieved by 6 months of conservative measures
-90% will have significant relief of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the three types of Achilles tendonitis? How much activity should be reduced with each type?

A

-Type I: pain is only experienced after activity; reduce activity by 25%
-Type II: pain that occurs both during and after activity but does not affect performance; reduce activity by 50%
-Type III: pain during and after activity that does affect performance; temporarily discontinue activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What does current evidence suggest is a good treatment plan for achilles tendonitis?

A

-12 week eccentric program
-Knee bent and knee straight
-To floor level for insertional tendonitis
-Below floor level for non-insertional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the mechanism of injury of achilles tendon rupture? What patient population is this most common in?

A

-Loading on a dorsiflexed ankle with the knee straight or repeated microtrauma
-Consider systemic conditions such as gout, hyperparathyroidism, or previous steroid injections
-Commonly affects young and middle aged athletes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Approximately how long does it take to recover from an achilles tendon rupture?

A

6-8 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the subjective findings for achilles tendon rupture?

A

-Feels like being kicked or shot in the leg
-Mechanism: eccentric loading, sudden unexpected dorsiflexion, or direct blow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the objective findings for achilles tendon rupture?

A

Positive Thompson’s test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is non-operative treatment options for achilles tendon rupture?

A

-Non-op is indicated in older adults with minimally displaced ruptures
-Serial casting over 10-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is operative treatment options for achilles tendon rupture?

A

-Repair is indicated in younger patients with clinically displaced ruptures
-Surgery followed by casting regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are possible complications of achilles tendon ruptures?

A

-Wound healing
-Sural nerve damage
-Possible DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the rates of return to pre-injury level of activity with achilles tendon ruptures?

A

-Non-operative: 69%
-Operative: 83%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are the rates of patient satisfaction with achilles tendon ruptures?

A

-Non-operative: 66%
-Operative: 93%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the rates of re-rupture with achilles tendon ruptures?

A

-Non-operative: up to 33%
-Operative: 2-3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the most common cause of heel pain? What is often associated with this condition?

A

-Plantar fasciitis
-Heel spurs often associated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are causes of plantar fasciitis?

A

-Obesity
-Excessive walking/sporting activity
-Tight plantar fascia & flattening of the arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are treatment options for plantar fasciitis?

A

-Orthoses
-PT
-Injections
-NSAIDs
-In rare cases, surgical release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the subjective findings in plantar fasciitis?

A

-Hx of pain and tenderness on the plantar medial aspect of the heel
-Pain with first steps in the morning
-Pain worsens with activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are objective findings with plantar fasciitis?

A

-Localized pain on palpation along the medial edge of the fascia or at the origin on the anterior edge of calcaneus
-Positive Windlass test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the prognosis for plantar fasciitis?

A

90% who undergo a conservative intervention improve significantly within 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is retrocalcaneal bursitis?

A

Inflammation of the retrocalcaneal bursa (subtendinous) or the subcutaneous calcaneal bursa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What are the causes of retrocalcaneal bursitis?

A

-Repetitive trauma from shoe wear and sports
-Gout, RA, and ankylosing spondyloarthropathies
-Bursal impingement between the Achilles tendon and an excessively prominent posterior-superior aspect of the calcaneus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the subjective findings of retrocalcaneal bursitis?

A

-Posterior ankle pain
-Pain with walking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the objective signs of retrocalcaneal bursitis?

A

-Tenderness
-Lump
-Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the conservative treatment of retrocalcaneal bursitis?

A

-PT
-Appropriate shoe wear
-Injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the surgical intervention for retrocalcaneal bursitis?

A

-Resection of Haglund deformity (removal of calcaneal superoposterior prominence, aka “pump bump”)
-Excision of the painful bursa and tendon debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are the most common foot disorders?

A

-Hallux valgus
-Pes planus (“flat foot”)
-Metatarsal stress fracture
-Morton neuroma
-Tarsal coalition
-Turf toe
-Tarsal tunnel
-Cuboid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is hallux valgus (“bunion”)?

A

-Lateral deviation of great toe
-1st MTP joint and proximal phalanx deviated laterally
-Angle between 1st ray and phalanges greater than 20 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the etiology of hallux valgus?

A

-Familial
-Inappropriate footwear/toe box
-Flat feet
-Long first ray
-Incongruous 1st MTP joint articular surface
-Metatarsus primus varus
-RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What can hallux valgus cause in the other toes?

A

Can cause hammer toes (especially in the 2nd toe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What are signs of hallux valgus?

A

-Bunion and inflammed overlying bursa and skin
-Valgus and pronation deformity of hallux
-Painful callus on 2nd toe
-Transfer metatarsalgia/thickened skin over MT heads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What are conservative treatment options for hallux valgus?

A

-Properly fitted, low heeled stiff-soled shoes
-Wide square toe box
-Toe portion stretched to accommodate bunion
-Extra depth shoe to accommodate dorsiflexed 2nd toe
-Splint that separates 1st and 2nd toe
-Silicone bunion pad for pressure relief
-Acute pain management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are surgical treatment options for hallux valgus?

A

-Bunionectomy
-Correction of the joint angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is pes planus/flat foot?

A

-Disappearance of the medial longitudinal arch when weight bearing
-Can be flexible (99%) or rigid (1%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

How can you distinguish between flexible or rigid pes planus?

A

-Jack test
-Toe raise test (if calcaneus does not move into inversion then it is rigid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is the etiology of rigid pes planus?

A

Congenital vertical talus & tarsal coalition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is tarsal coalition?

A

-Bones can fuse together
-Can happen between calcaneo-navicular or talocalcaneal
-Can be bony, cartilaginous, or fibrous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What are symptoms of rigid pes planus?

A

-Foot pain
-Difficulty walking on uneven surfaces
-Foot fatigue
-Peroneal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is the treatment for rigid pes planus?

A

-Surgical resection of connecting bar & soft tissue interposition, subtalar arthrodesis, triple arthrodesis
-4-6 weeks of cast immobilization post surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are the most common metatarsal stress fractures?

A

2nd and 3rd metatarsals most frequently injured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What causes stress fractures?

A

-Develops after cyclical submaximal loading
-Running on hard surfaces, improper shoes, sudden increase in jogging distances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What are the subjective findings with metatarsal stress fractures?

A

-Pain and swelling on weight bearing
-Hx of sudden increase in activity, change in running surface, prolonged walking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What are the objective findings for a metatarsal stress fracture?

A

-Swelling
-Ecchymosis (bruising)
-Tenderness over fractured metatarsal
-May not show on radiographs for 2-3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is a Morton’s neuroma?

A

-Mechanical entrapment of the interdigital nerve
-Not a true neuroma, but rather a perineural fibrosis of the common digital nerve as it passes between metatarsal heads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is the etiology of Morton’s neuroma?

A

-Trauma
-Ischemia
-Entrapment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What are the subjective findings of a Morton’s neuroma?

A

-Symptom of shooting/constant pain on walking
-Pain relieved by rest and removal of footwear
-Clinical sign of third/second cleft tenderness and palpable click on metatarsal squeeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What patient population is a Morton’s neuroma most prevalent in?

A

Women are 8-10x more likely to have this condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Between what digits is a Morton’s neuroma most common?

A

Between digits 3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is non-operative treatment for Morton’s neuroma?

A

-Metatarsal pad
-Orthoses
-Injection
-Supportive shoes with wide toe box or shoes with heels more than 2 inches high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What are operative treatments for Morton’s neuroma?

A

-Excision
-Compression dressing and post-op shoe is placed on the foot
-Dorsal approach allows for immediate weight bearing and suture removal after 2 weeks (plantar approach delays by 2 more weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is tarsal tunnel?

A

Entrapment neuropathy of the posterior tibial nerve as it passes between the flexor retinaculum and the medial malleolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are the subjective findings for tarsal tunnel?

A

-Onset may be acute or insidious
-Patient reports poorly localized burning sensation or pain and paresthesia at the medial plantar surface of the foot
-Worse after activity and worse at the end of the work day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What are the objective findings for tarsal tunnel?

A

-Positive tinel sign
-Pain with passive dorsiflexion or eversion
-Decreased 2 point discrimination on the plantar aspect of the foot
-Varus or valgus deformity of the heel
-Weakness of foot intrinsics with sustained PF of the toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What are treatment options for tarsal tunnel?

A

-Local corticosteroid injections
-Orthoses
-Strengthening of foot intrinsics to restore medial longitudinal arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is Turf Toe?

A

Sprain of 1st MTP joint of the great toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is the mechanism of injury for turf toe?

A

Most commonly occurs with hyperextension and varus/valgus stress of the 1st MTP joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the subjective findings with turf toe?

A

-Complaints of red, swollen, stiff 1st MTP joint
-Joint may be tender on plantar and dorsal surface
-May have limp and may be unable to run or jump
-Hx of a single DF injury or multiple injuries to great toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What are objective findings of turf toe?

A

Pain with ligamentous stability testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What are the grades for turf toe?

A

-Grade I: minor stretch to soft tissues; little pain or swelling
-Grade II: partial tear of the capsulo-ligamentous structures; moderate pain and swelling, ecchymosis
-Grade III: complete tear of the plantar plate with severe swelling, pain, ecchymosis, inability to weight bear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is treatment for Turf toe?

A

-Rest, ice, compression, elevation
-NSAIDs
-Toe tapes to limit DF
-Grade I: return to activities as soon as symptoms allow
-Grade II: 3-14 days of rest
-Grade III: 6 weeks rest from sport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is cuboid syndrome?

A

-Disruption of the structural congruity of the calcaneo-cuboid joint complex
-Often misdiagnosed
-Lack of valid and reliable diagnostic tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

How common is cuboid syndrome?

A

Relatively uncommon (less than 3%) after a lateral ankle sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is the important anatomy of the cuboid?

A

-The keystone of the lateral column of the foot: concave cuboid rests of convex navicular and lateral cuneiform
-Cuboid is the only mid-tarsal that articulates with the navicular
-Peroneus/fibularis longus slings laterally and inferiorly into a fibrous-osseus tunnel in the plantar aspect of the cuboid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is the etiology of cuboid syndrome?

A

-The degree and direction of the force of the peroneus with sudden inversion of the foot causes a medial and inferior glide of the cuboid
-Cuboid subluxes medially and inferiorly
-Disruption of cuboid ligaments occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What are objective signs of cuboid syndrome?

A

-Persistent and localized pain over the cuboid following an inversion sprain
-Pain with toe off during gait
-Inability to perform plyometrics
-Pain radiating along the medial arch and/or the length of the 4th metatarsal
-Limited and painful DF, INV, EV localized to CC joint
-Painful dorsal glides of the cuboid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are the recommended treatments for cuboid syndrome?

A

-Cuboid whip (Grade V)
-Cuboid squeeze
-Mobs with movement
-Retraining of the intrinsics of the foot to ensure stable midfoot
-Rehab of whole kinetic chain
-Peroneal & gastroc stretches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What shoe type do people with flat feet need? Why?

A

-Motion control/stability shoes
-They are over-pronated which “unlocks” the midfoot and does not allow for much stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What shoe type do people with neutral feet need? Why?

A

-Neutral shoes
-They have neutral feet therefore do not require special shoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What shoe type do people with high arches need? Why?

A

-Cushion shoes
-They are over-supinated and cannot move into pronation to absorb shock during gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is joint stability dependent upon in the knee?

A

-Static restraints of the joint capsule, ligaments, and menisci
-Dynamic restraints of the lower limb muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What is one of the most commonly injured joints in the body? Why?

A

-The knee
-Because the tibia and femur are nearly flat so there is less stability at the joint surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

How much internal tibial rotation should occur at the knee joint?

A

30-40°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

How much external tibial rotation should occur at the knee joint?

A

20-30°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What are the 4 main ligaments of the knee?

A

-ACL
-PCL
-MCL
-LCL

129
Q

What movements does the MCL and LCL restrict?

A

-MCL: restricts valgus force and external tibial rotation
-LCL: restricts varus force and external tibial rotation

130
Q

What are the smaller ligaments of the knee joint?

A

-Coronary ligament
-Transverse ligament
-Meniscofemoral (deep MCL)
-Arcuate ligament
-Oblique popliteal ligament

131
Q

What are some special characteristics of the patella?

A

-Sesamoid bone (largest in the body)
-5 facets: superior, inferior, lateral, medial, and odd
-During flexion to extension, different parts of the patella articulate with the femoral condyles

132
Q

What is the purpose of the patella?

A

-Increase the leverage of torque of quads by increasing distance from the axis of motion
-Provide bony protection to distal joint surface of femoral condyles when knee is flexed
-Prevent damaging compression forces on the quadriceps tendon with resisted knee flexion such as squats

133
Q

What facets of the patella are in contact with the femur at different degrees of knee flexion?

A

-0 degrees: no contact
-15-20 degrees: inferior pole
-45 degrees: middle pole
-90 degrees: all facets (NOT odd)
-Full flexion: odd facet and lateral aspect

134
Q

What activities increase the patellar loading?

A

-Walking: 0.5x BW
-Cycling: 1.5x BW
-Up stairs: 3.3x BW
-Down stairs: 5x BW
-Jogging: 7-8x BW
-Deep squatting: 20x BW
-Jumping: 20x BW

135
Q

What are the biomechanics of the superior tib-fib joint?

A

-Simple synovial joint
-Oriented anterior-lateral, and posterior-medial
-Closed pack: weight bearing during dorsiflexion

136
Q

What are the ligaments of the superior tib-fib joint?

A

-Anterior and posterior tib-fib ligament
-Interosseous membrane

137
Q

What are some key mechanical symptoms to ask a pt about their knee?

A

-Locking or catching
-Popping
-Giving way
-Pain with stairs
-Difficult walking around corners

138
Q

What are the 5 Ottawa Knee Rules? What are they used for?

A

-Age > 55 or < 18
-Unable to walk
-TTP on patella
-TTP on fibular head
-Unable to flex to 90 degrees
-Used to determine if someone needs an X-ray

139
Q

What are common orthopedic conditions of the knee?

A

-ACL tear
-PCL tear
-Collateral ligament strain
-Baker’s cyst
-Medial gastroc strain
-Meniscal tear
-Osgood Schlatter’s Disease
-Patellofemoral pain syndrome
-Plica syndrome
-Prepatellar bursitis
-Iliotibial band syndrome
-Patellar dislocation
-Osteoarthritis of the knee

140
Q

What are the secondary restraints of the ACL?

A

Internal and external rotation in the NWB knee

141
Q

What are the subjective findings for ACL tears?

A

-Risk of injury 2-8x more in women
-Twisting or hyperextension of the knee
-Sensation of their knee “popping” or “giving out”
-Pain and immediate dysfunction
-Instability in the involved knee and inability to walk without assistance
-Immediate swelling

142
Q

What are the objective findings for ACL tears?

A

-Large hemarthrosis
-Pain
-Positive special tests for anterior stability
-Involvement of other knee structures

143
Q

What is the prognosis for an ACL tear?

A

-Not usually an isolated injury
-Post-op: 8-12 months until full activity

144
Q

What is an “autograft” vs an “allograft”?

A

-Autograft: using your own tissue (HS tendon)
-Allograft: using tissue from a cadaver

145
Q

What is the rejection rate for ACL allografts?

A

25% rejection rate

146
Q

What are the pros of using allografts?

A

-Lack of harvest morbidity
-Less trauma and quicker surgery
-Decreased post op pain
-Easier and early rehab
-Lack of limit to the size of graft

147
Q

What is the load to failure of the native ACL? What about in ACL autografts?

A

-Native ACL: 1,725-2,160 N of force
-HS tendon: 2,640 N
-Patellar tendon: 1,580 N
-Quad tendon: 2,185 N

148
Q

What is the rate of contralateral ACL injury after one ACL injury?

A

13%

149
Q

What are the major goals of ACL rehab?

A

-Gain good functional stability
-Repair muscle strength
-Reach the best possible functional level
-Decrease the risk for re-injury
-Closed and open kinetic chain exercises

150
Q

What is the general time frame for return to sport post ACL repair/reconstruction?

A

-Minimum of 6 months, but better to wait 7-10 months
-Generally, light jogging can be started around 4-5 months

151
Q

How many patients return to sport after ACL repair/reconstruction?

A

-81% return to some form of sport
-65% return to pre-injury level of activity
-55% return to competitive sports

152
Q

What is the strongest and largest ligament in the knee?

A

PCL

153
Q

What percent of outpatient knee injuries are PCL?

A

3%

154
Q

What is the mechanism of injury of PCL tears?

A

-Often not an isolated injury and other ligaments will be injured or there will be a fx
-“Dashboard injury”
-Direct blow to the anterior tibia or a fall onto the knee w/ the foot in a plantar flexed position

155
Q

What are special tests for PCL tears?

A

-Posterior drawer
-Sag sign

156
Q

What are the subjective findings for collateral ligament sprains?

A

-Localized swelling or stiffness
-Medial or lateral pain and tenderness
-Most patients are able to ambulate after an acute collateral ligament injury

157
Q

What are the objective findings for collateral ligament sprain?

A

-Tender to palpation along its entire course
-MCL may have isolated tenderness at most proximal or distal end
-Positive varus or valgus stress tests
-Laxity in full extension indicates a more extensive injury

158
Q

What is the most common mechanism of injury for MCL sprains?

A

Contact/hit on the outside of the knee with a planted foot

159
Q

What are the different grades of MCL sprains?

A

-Grade I: pain but no laxity on valgus stress test
-Grade II: laxity only present at 30 degrees
-Grade III: severe laxity at full extension

160
Q

What is the prognosis for MCL injuries?

A

-Grade I: 10 days
-Grade II: 3-4 weeks low end
-Grade III: 6-8 weeks

161
Q

What should be the focus of treatment for MCL sprains?

A

-With proper rehab, even a full tear can be healed without surgery
-Initially should be focused on controlling edema and slowly progress to improving ROM

162
Q

What is a Baker’s cyst?

A

-Abnormal collection of synovial fluid in the fatty layers of the popliteal fossa
-Most common synovial cyst in the knee

163
Q

What are the subjective findings for Baker’s cyst?

A

-Complaints of tightness/swelling behind the knee or pain down the back of the leg
-No history or trauma

164
Q

What are the objective findings Baker’s cyst?

A

-Pt prone & leg fully extended, an oblong mass is palpable and visible in the medial popliteal fossa
-Active knee flexion may be limited by 10-15 degrees with a large cyst

165
Q

What are interventions for Baker’s cyst?

A

-RICE
-For large cysts that interfere with knee function= aspirate

166
Q

Why are doctors cautious with aspirating a Baker’s cyst?

A

Due to risk of intra-articular infection

167
Q

What is the mechanism of injury of a medial gastroc strain?

A

-Typically results from an acute, forceful push-off with the foot joint in activities such as hill running, jumping, or tennis
-Also from increased volumes of running load, acceleration and deceleration as well as during fatiguing conditions of play or performance

168
Q

What are subjective findings of medial gastroc strain?

A

-Complaints of pulling or tearing sensation in the calf (think velcro)
-May hold ankle in PF to avoid placing tendon on the injured muscle

169
Q

What are the objective findings of medial gastroc strain?

A

-TTP and swelling over medial gastroc
-Pain aggravated with passive DF
-Inability to perform a single-leg toe raise
-Negative Thompson test
-Peripheral pulses intact

170
Q

What is the grading for a medial gastroc strain?

A

-Grade I: little to no loss of strength, less than 10% of fibers disrupted
-Grade II: clear loss of strength, 10-50% of fibers disrupted
-Grade III: more than 50% of fibers disrupted, pain, swelling, tenderness, and bruising

171
Q

What are interventions for medial gastroc strain?

A

-Acute: control pain and inflammation
-Gentle AROM & PROM
-Once painfree with symmetrical ROM & strength, full activities can be resumed
-Stretching and strengthening should be continued for several months to overcome increased risk for re-injury

172
Q

What is the most common cause of mechanical symptoms of the knee?

A

Meniscal tear

173
Q

What is the mechanism of injury for a meniscus tear?

A

-Usually occur when the patient attempts to turn, twist, or change direction when weight bearing
-Also can occur from contact to the lateral or medial aspect of the knee

174
Q

How do patients with meniscal tears have pain if there are no pain fibers in the menisci?

A

The tearing and bleeding into the peripheral attachments as well as traction on the capsule that causes production of pain

175
Q

What are the subjective findings with meniscal tears?

A

-Reports of significant twisting injury to the knee
-Hx of popping, swelling, or clicking
-Pain along the joint line, particularly with twisting or squatting activities

176
Q

What is the function of the menisci?

A

-50% load transmitted in extension
-85% load transmitted at 90 degrees flexion

177
Q

How much of a pressure increase is there with resection of a meniscus?

A

Resection of 15-34% increases pressure by 350%

178
Q

What is the average excursion of the medial and lateral meniscus with knee flexion?

A

-Medial: 5.2 mm
-Lateral: 11 mm

179
Q

What are the objective findings for a meniscal tear?

A

-Tenderness over the medial or lateral joint line
-Some degree of effusion
-Forced flexion and circumduction of the tibia frequently elicit pain

180
Q

What are the 4 main intervention approaches for meniscal tears?

A

-Rehab
-Menisectomy
-Meniscus repair
-Allograft transplantation

181
Q

What is Osgood Schlatter’s disease? When does it occur?

A

-Osteochondritis of inferior patella, tibial tuberosity, or tibial tubercle traction apophysitis
-A form of periostitis of the tibial apophysitis type that manifests as a partial avulsion of the tibial tuberosity with subsequent osteonecrosis of the fragmented bone
-Occurs during growth spurts

182
Q

What are the subjective findings of Osgood Schlatter’s?

A

-Gradually increasing pain and swelling below the involved knee
-Involvement in sporting activities that involve running

183
Q

What are the objective findings of Osgood Schlatter’s?

A

-Prominence over the tibial tubercle
-Mild swelling may be evident
-Pinpoint tenderness over the tibial tuberosity
-PROM reveals limitation of knee flexion
-AROM is painful at end ranges
-Resisted knee extension typically reproduces the pain
-Flexibility testing may reveal adaptive shortening of the HS, quads, and calf muscles

184
Q

What is the prognosis of Osgood Schlatter’s?

A

Self-limiting and spontaneously remitting over a period of 6-24 months as the tibial tubercle ossifies

185
Q

What is patellar tendonitis? What is the mechanism of injury?

A

-Inflammation of the patellar tendon at the inferior pole of the patella or at its insertion at the tibial tubercle
-Overuse condition frequently associated with eccentric overloading during deceleration activities

186
Q

What are the subjective findings for patellar tendonitis?

A

-Hx of jumping or kicking sports
-Anterior knee pain
-Pain noted immediately at the end of exercise of following sitting that has been preceded by exercise
-Pain with sitting, squatting, or kneeling
-Pain with climbing or descending stairs, jumping, or running

187
Q

What are the objective findings of patellar tendonitis?

A

-Localized tenderness at either the inferior pole of the patella, tibial tubercle, or both
-AROM typically normal
-Pain with passive hyperflexion of the knee
-Pain with resisted knee extension

188
Q

What are the 3 stages of intervention for patellar tendonitis?

A
  1. Relative rest from aggravating activities
  2. Regaining pain-free motion, flexibility of quads and HS, and exercises focusing on pain-free quad strengthening
  3. Gradual resumption of the activities that causes the symptoms
189
Q

What is the prognosis for patellar tendonitis?

A

Usually self-limiting and responds to rest, stretching, eccentric strengthening, and bracing

190
Q

What is patellofemoral pain syndrome?

A

Common disorder that is diagnosed on the presence of anterior or retropatellar knee pain associated with prolonged sitting or with weight bearing activities that load the PF joint (squatting, kneeling, running, and stairs)

191
Q

What are the subjective findings of patellofemoral pain syndrome?

A

-Reports of anterior knee pain with going up or down stairs
-Instability of patella with activities
-Usually no hx of trauma and swelling is uncommon
-More common in female than in male patients

192
Q

What are the objective findings for patellofemoral pain syndrome?

A

-May see valgus alignment of knees, femoral anteversion, and abnormal tracking
-Quad weakness
-Generalized laxity of patellofemoral ligaments
-Hip weakness
-Poor eccentric quad control in weight bearing
-Positive Clarke’s sign
-Positive apprehension test

193
Q

What is the plica?

A

A normal fold in synovium

194
Q

What is plica syndrome?

A

Plica that becomes inflamed and thickened from trauma or overuse and may interfere with normal joint motion

195
Q

What are subjective findings of plica syndrome?

A

-Insidious onset of knee pain, but can be related to fall or injury
-Activity-related aching in the anterior or anteromedial aspect of the knee
-May be painful snapping or popping

196
Q

What are the objective findings for plica syndrome?

A

-Tenderness according to the location of the symptomatic plica
-May be able to reproduce the snapping or popping at 60° of knee flexion with passive extension

197
Q

What are interventions for plica syndrome?

A

-Stretching of the quads, HS, and gastroc
-Strengthening
-Ice
-Patellar bracing
-NSAIDs
-Altered sports training schedule
-Surgical if conservative fails

198
Q

What is prepatellar bursitis?

A

When the prepatellar bursa becomes inflamed or infected as a result of trauma to the anterior knee such as a direct blow or from chronic irritation from kneeling or hyperextension

199
Q

What are subjective findings for prepatellar bursitis?

A

Complaints of knee swelling and knee pain just over the front of the knee

200
Q

What are the objective findings for prepatellar bursitis?

A

-Swelling directly over the inferior portion of the patella
-Palpation reveals bursal sac tenderness or bursal sac thickening
-Normal AROM of the knee

201
Q

What are interventions for prepatellar bursitis?

A

-Decrease inflammation using cryotherapy
-Patient education on activity modification
-Stretches if there is adaptive shortening of quads, HS, or IT band

202
Q

What is the prognosis for prepatellar bursitis?

A

-50% of traumatic bursitis resolves spontaneously
-10% progresses to chronic bursitis and may require bursectomy

203
Q

What is iliotibial band tendonitis/friction syndrome?

A

-Excessive friction between iliotibial band (ITB) & lateral femoral condyle
-Common in runners and cyclists

204
Q

What are subjective findings of iliotibial band friction syndrome?

A

-Pain at lateral knee
-Progresses to pain immediately with activity

205
Q

What are the objective findings of iliotibial band friction syndrome?

A

-Tender at lateral femoral condyle
-Soft tissue swelling & crepitus
-Positive ober’s and/or noble’s compression test

206
Q

What are interventions for iliotibial band tendonitis/friction syndrome?

A

-Relative rest
-Ice
-NSAIDs
-Stretching
-Cortisone
-PRP

207
Q

What is the prognosis for ITB friction syndrome?

A

-Long recovery!!!
-Improves with rest

208
Q

Who is most at risk for patellar dislocation or instability?

A

-Young active patients at highest risk (13-20)
-Common in football and basketball
-More common in women than in men

209
Q

How common is recurrent patellar dislocation?

A

Recurrence is common, especially if initial dislocation is before the age of 15

210
Q

What is the mechanism of injury of patellar dislocation?

A

Indirect trauma most common; strong quad contraction while leg is in valgus w/ foot planted

211
Q

What are the subjective findings of patellar dislocation?

A

-Feel a “pop” and immediate pain
-Obvious knee deformity
-Painful, difficult to bend knee
-May spontaneously relocate

212
Q

What are the objective findings of patellar dislocation/instability?

A

-Laterally shifted patella
-Swelling
-Positive patellar apprehension test

213
Q

What are interventions for patellar dislocation/instability?

A

-NSAIDs
-Ice
-Patellofemoral knee brace (rigid)
-PT: ROM, quad strengthening, e-stim
-Surgery for recurrent instability

214
Q

What is the prognosis for patellar dislocation/instability?

A

Recurrent instability is common but rehab is very useful

215
Q

What compartment of the knee is most frequently involved with OA?

A

Medial compartment

216
Q

What are the subjective findings for knee OA?

A

-Insidious onset of pain
-Pain with weight bearing
-May have complaints of buckling, locking, or giving way
-Difficulty climbing or descending stairs
-Increased stiffness in AM

217
Q

What are the objective findings for knee OA?

A

-Angular deformity through the knee
-Effusion
-Diffuse tenderness along the joint lines
-Loss of AROM in a capsular pattern

218
Q

What is the prognosis for knee OA?

A

-Progressive condition
-Can somewhat control symptoms and progression with meds, shoe inserts, strengthening, and bracing
-Severe functional limitations and pain at rest or at night may indicate need for surgery

219
Q

What are the 4 stages of OA?

A

-Stage I: doubtful
-Stage II: mild
-Stage III: moderate
-Stage IV: severe

220
Q

What is the evidence for clinical diagnosis of knee OA?

A

-Age > 50
-Stiffness > 30 min
-Crepitus
-Bony tenderness
-Bony enlargement
-No palpable warmth
-If greater than 3, sensitivity is 0.95, specificity 0.69

221
Q

What is involved in the management of OA?

A

-Weight loss
-Exercise program
-Ambulatory AD
-Insoles
-Unloader knee braces

222
Q

What medications are there to help manage OA?

A

-Glucosamine/chondroitin sulfate
-Acetaminophen
-NSAIDs
-Cox-2 inhibitors
-Intraarticular injections (glucocorticoids, hyaluronic acid)

223
Q

Who is a candidate for unicompartmental knee replacement?

A

-Arthritis in only 1 compartment
-Used in either young or old patient
-Ligaments intact
-No systemic disease
-Weight < 200#
-Dependent on occupation

224
Q

What are the advantages of unicompartmental knee replacements?

A

-Better kinematics as cruciate ligaments are retained
-Better ROM
-Better function, especially stairs
-Pain relief is better
-Less frequent and severe complications
-More rapid recovery
-Lower cost

225
Q

What is the surgical procedure for a TKA?

A

-Resurface all three surfaces: tibia, femur, patella
-Components fixed to bone with “cement”
-Traditional approach has 20-30cm incision

226
Q

What is the different between standard TKA and mini/Q-S TKAs?

A

-Standard: 20-30cm incision
-Mini: 12-14 cm incision, quad snip
-Q-S: 7-10 cm, no quad snip

227
Q

What is the benefit of minimally invasive (mini and Q-S) TKAs?

A

-Earlier mobilization
-Less pain
-Cost
-Shorter hospital stay
-Quicker rehab
-Less blood loss

228
Q

What is the pattern of the trabeculae in the proximal femur?

A

-Horizontal and vertical patterns that cross over each other
-There is a zone of weakness where there is no trabeculae in the inferior portion of the neck of the femur

229
Q

What is the capsular pattern of the hip?

A

-Flexion
-Abduction
-Medial rotation

230
Q

How many bones make up the hip joint?

A

-4 bones
-Pubis
-Ilium
-Ischium
-Femur

231
Q

How many Newton pounds does it take to dislocate the hip?

A

400

232
Q

What is the vascularity of the femoral head?

A

-Ligamentum teres (1/3 supply)
-Circumflex artery
-Superior & inferior gluteal arteries

233
Q

What is the labrum?

A

Fibrocatilaginous tissue that increases the joint congruency and stability

234
Q

What are the 4 major ligaments of the hip?

A

-Anterior iliofemoral “Y” ligament
-Pubofemoral
-Posterior ischiofemoral
-Ligamentum teres

235
Q

What motions does the ligamentum teres restrict?

A

At 90 degrees of hip flexion it limits IR & ER

236
Q

What are the flexors of the hip?

A

-Iliacus
-Psoas
-TFL
-Rectus femoris
-Sartorius
-Adductor longus
-Pectineus

237
Q

What are the extensors of the hip?

A

-Glute max
-Hamstrings
-Adductor magnus

238
Q

What are the abductors of the hip?

A

-Glute med
-TFL
-Superior glute max
-Glute min

239
Q

What are the adductors of the hip?

A

-Adductor group
-Pectineus
-Gracilis
-Pectineus

240
Q

What are the medial rotators of the hip?

A

-No pure rotator
-TFL
-Glute minimus
-Glute medius anterior fibers
-Adductor group
-Semimembranosus/tendinosis

241
Q

What are the lateral rotators of the hip?

A

-Obturator internus/externus
-Gemelli
-Quadratus femoris
-Piriformis
-Glute max
-Posterior fibers of glute med
-Biceps femoris

242
Q

What is normal hip extension ROM?

A

10-15 degrees

243
Q

What is normal hip abduction ROM?

A

30-50 degrees

244
Q

What is normal hip adduction ROM?

A

25-30 degrees

245
Q

What is normal hip external rotation ROM?

A

40-60 degrees

246
Q

What is normal hip internal rotation ROM?

A

30-40 degrees

247
Q

What is the normal angle between the femoral neck and shaft?

A

125 degrees

248
Q

What is coxa vara?

A

-Decreased angle between the femoral neck and shaft
-105 degrees
-More horizontal

249
Q

What is coxa valga?

A

-Increased angle between the femoral neck and shaft
-140 degrees
-More vertical

250
Q

Does coxa vara or valga put someone at higher risk of fx?

A

Coxa vara because now there is an increased load on the neck of the femur

251
Q

What complications can occur from having coxa valga?

A

-Increased stress across joint surfaces due to more vertical femoral neck
-Increases overall length of LE
-Decrease physiologic angle at knee
-More likely to get FAI

252
Q

What complications can occur from having coxa valga?

A

-Results in increased downward shear forces of the femoral head
-Reduces compressive forces but increase shear and torsional forces at the femoral head/neck junction
-More likely to fx

253
Q

What is femoral anteversion?

A

-Increased anterior angle between neck and shaft of femur in the transverse plane
-Anterior orientation of the femoral neck
-Results in more hip IR

254
Q

What is femoral retroversion?

A

-Increased posterior angle between neck and shaft of femur in the transverse plane
-Results in more hip ER
-Out toeing gait

255
Q

What are common orthopedic conditions of the hip?

A

-Avascular necrosis of the femoral head
-Legg-Calve Perthes Disease
-Slipped capital femoral epiphysis (SCFE)
-Stress fracture of the femoral neck
-Hamstring strain
-Hip adductor tendinopathy
-OA of the hip
-Snapping hip
-Trochanteric bursitis
-Hip labral tears

256
Q

What occurs during avascular necrosis of the femoral head?

A

Variable areas of dead trabecular bone and bone marrow extending to and including the subchondral plate

257
Q

What are the subjective findings of avascular necrosis of the femoral head?

A

-Pain in the groin, can radiate to the lateral hip, knee, or buttocks
-“Throbbing and deep”
-Most often pain is intermittent and gradual onset
-Antalgic shift

258
Q

What are common risk factors for avascular necrosis of the femoral head?

A

-Cumulative corticosteroid total dose
-Alcohol use
-Systemic lupus
-Sickle cell disease
-Trauma
-Cancer

259
Q

What are objective findings for avascular necrosis of the femoral head?

A

-Usually painful ROM, especially IR
-Patients have pain with attempted SLR
-Antalgic gait

260
Q

What is used to diagnose avascular necrosis?

A

Imaging

261
Q

What interventions are available for avascular necrosis?

A

Surgery

262
Q

What is the prognosis for avascular necrosis of the femoral head?

A

-Success is related to the stage at which care is initiated
-Complication of AVN include incomplete fx and superimposed degenerative arthritis

263
Q

What is Legg-Calve-Perthes Disease?

A

-Idiopathic osteonecrosis of the femoral head in kids aged 4-10 years
-Children are usually malformed with less blood
-The speculated cause is localized manifestation of generalized disorder of the epiphyseal cartilage in the proximal femur
-Unilateral in 90% of patients

264
Q

Who is at higher risk of Legg-Calve-Perthes disease?

A

4x more common in boys

265
Q

What are subjective findings in Legg-Calve-Perthes?

A

-Vague ache in the groin that radiates to the medial thigh and inner aspect of the knee
-Muscle spasm

266
Q

What are objective findings of Legg-Calve-Perthes?

A

-Limp
-Dragging of the leg
-Atrophy of thigh muscles
-Child may be small for their age
-Positive trendelenburg
-Out-toeing of the involved LE
-Decreased abduction and IR
-May be a hip flexion contracture

267
Q

What is used to diagnose Legg-Calve-Perthes?

A

-Imaging
-AP and frog-lateral radiographs of the pelvis

268
Q

What are interventions for Legg-Calve-Perthes?

A

-For children less than 6 years old and minimal capital femoral epiphysis and normal ROM, physical exams and radiographs every 2 months
-More severe cases would likely be treated with surgery

269
Q

What is slipped capital femoral epiphysis (SCFE)?

A

-Displacement of the femoral head through the epiphysis that typically occurs during the adolescent growth spurt
-Femoral head remains in acetabulum and neck is displaced anteriorly
-Most common disorder of the hip in adolescents

270
Q

What are the subjective findings for slipped capital femoral epiphysis (SCFE)?

A

-Pain exacerbated by activity
-Hx of groin pain or medial thigh pain
-May be mild weakness in the leg
-May be no hx of trauma, can be as minimal as turning over in bed

271
Q

What are the objective findings for slipped capital femoral epiphysis (SCFE)?

A

-Limp
-Decreased ROM
-The involved extremity may be 1-3 cm shorter

272
Q

What is the only pediatric disorder that causes greater loss of IR when hip is moved into a flexed position?

A

Slipped capital femoral epiphysis (SCFE)

273
Q

What are risk factors for slipped capital femoral epiphysis (SCFE)?

A

-Obesity
-Male
-Greater involvement with sports activities

274
Q

What is used to diagnose slipped capital femoral epiphysis (SCFE)?

A

-Radiographs
-IR with hip flexed to 90 degrees

275
Q

What are interventions for slipped capital femoral epiphysis (SCFE)?

A

-Relief of symptoms
-Containment of the femoral head
-Restoration of ROM
-Surgical fixation

276
Q

What is the mechanism of injury for a stress fracture of the femoral neck?

A

-Results from accelerated bone remodeling in response to repeated stress
-Occurs commonly in military recruits and athletes, especially runners

277
Q

Where does a stress fracture of the femoral neck typically occur in older people? What about in younger people?

A

-Older: superior side of the femoral neck
-Younger: inferior side of the femoral neck

278
Q

What are subjective findings of stress fractures of the femoral neck?

A

-Onset of hip pain, often associated with recent change in training or change in training surface
-Pain in the deep thigh
-Pain usually occurs with weight bearing or at the extremes of hip motion

279
Q

What are the objective findings of stress fractures of the femoral neck?

A

-Physical exam usually negative
-May be empty end feel or pain at end ranges of IR & ER

280
Q

What special tests can help diagnose stress fractures of the femoral neck?

A

-Resisted straight leg raise + for pain
-Auscultory patellar-pubic test +
-Fulcrum test + for pain
-Radiographs

281
Q

What are interventions for stress fractures of the femoral neck?

A

-Surgically for all tension-side fx
-Bed rest or complete NWB

282
Q

What is a hamstring strain?

A

-Strain or rupture of 1 or more HS muscles
-Usually takes place during eccentric loading

283
Q

What are the key subjective findings for a HS strain?

A

-Distinct mechanism of injury w/ immediate pain during full stride running or while decelerating quickly
-May hear a “pop”
-Posterior thigh pain, worsened with knee flexion

284
Q

What are objective findings for a HS strain?

A

-TTP
-Tenderness reported with passive stretching
-Pain with resisted knee flexion

285
Q

What are rehab timelines for the 3 grades of HS strain?

A

-Grade I: continue activities
-Grade II: 5-21 days
-Grade III: 3-12 weeks

286
Q

What is the most common adductor pathology?

A

Hip adductor tendinopathy

287
Q

What is the most common cause of groin pain?

A

Adductor strain or tendinopathy

288
Q

What is the mechanism of injury for hip adductor tendinopathy?

A

-Constant exposure to repetitive loading with activities that involve twisting and turning
-Other theory is muscular imbalance of the combined action of the muscles stabilizing the hip joint

289
Q

What are the subjective findings for adductor tendinopathy?

A

-Twinging or stabbing pain in the groin area with quick starts and stops
-Edema or ecchymosis
-Symptoms are aggravated with running, especially directional changes, kicking, SL exercises, cutting, and lunges

290
Q

What are the objective findings for adductor tendinopathy? What degree of hip flexion targets which muscles?

A

-Pain with passive abduction
-Pain with resistance
-TTP
-0 degrees: gracilis
-45 degrees: add. longus
-90 degrees: pectineus

291
Q

What are interventions for adductor tendinopathy?

A

-RICE in acute stage
-Hip adductor isometrics
-Graded resistive program

292
Q

What is the prognosis for adductor tendinopathy?

A

Most patients fully recover fully or only have minimal pain with high intensity activities

293
Q

What are subjective findings with hip OA?

A

-Insidious onset of pain
-Progressively worsens with activity
-Painful, limping gait
-Physical activity may induce bouts of pain that last several hours
-May have difficulty climbing stairs & putting on socks

294
Q

What are objective findings for hip OA?

A

-Early signs include restriction of IR, abduction, or flexion and pain at end range
-Scour +
-FABER may be +

295
Q

What are interventions for hip OA?

A

-Relieving symptoms, reduce risk of progression
-Education
-Modalities
-Swimming or cycling
-Reduction in BW
-Walking stick
-Joint mobs
-Stretches
-Hip strengthening

296
Q

What is snapping hip?

A

-Characterized by a snapping or popping sensation that occurs as tendons around the hip move over bony prominences
-Internal: iliopsoas snapping over structures deep to it
-External: snapping of ITB pr glute max over greater trochanter
-Intra-articular: synovial chondromatosis, loose bodies, fracture fragments, and labral tears

297
Q

What are subjective findings of snapping hip?

A

-Complaints of snapping or popping localized to greater trochanter
-Snapping cause by subluxation of the iliopsoas tendon
-May be complaints of pain associated with the snapping if the trochanteric bursitis is inflammed

298
Q

What are objective findings for snapping hip?

A

-IT band can be felt subluxing
-Snapping of the iliopsoas tendon may be palpated
-Obers may be +
-Thomas may be +

299
Q

What are interventions for snapping hip?

A

-Improve muscle length
-Correct strength imbalances

300
Q

What is the prognosis for snapping hip?

A

Responds well to conservative management

301
Q

What are the subjective findings with trochanteric bursitis?

A

-Lateral thigh, groin, or gluteal pain
-Pain when lying on involved side
-Pain usually worse when rising from a seated or recumbent position

302
Q

What are objective findings of trochanteric bursitis?

A

-TTP
-Pain will get much worse with STM
-Resisted abd, ER, or ext painful
-Tightness of hip adductors
-Obers test +

303
Q

What are interventions for trochanteric bursitis?

A

-Stretching lateral thigh soft tissues
-Flexibility of ER
-Hip abd strengthening
-Establishing muscular balance
-Orthotics

304
Q

What is the prognosis for trochanteric bursitis?

A

-Responds well to conservative measures
-Corticosteroid injection may help

305
Q

What is the etiology of hip labral tears?

A

-Trauma
-FAI
-Capsular laxity or hip hypermobility
-Dysplasia
-Degeneration
-Often goes undiagnosed for extended periods of time

306
Q

What are the subjective findings of labral tears?

A

-Anterior hip or groin pain
-Often mechanical symptoms of clicking, locking, or giving way

307
Q

What are the objective findings of hip labral tears?

A

-FADIR +
-Anterior or posterior labral tear tests +

308
Q

What are interventions for hip labral tears?

A

-PT/conservative management: limit pivoting motions, strengthen inhibited muscles, assess foot motion
-Arthroscopic debridement of tear

309
Q

What is femoral acetabular impingement (FAI)?

A

-Abnormal bony prominences on the neck of the femur or acetabular rim due to contact between the femoral head-neck junction and the acetabular rim
-Impingement occurs with combined movements, usually flexion and IR or ER
-Prolonged impingement can lead to damage to the labrum and subchondral bone

310
Q

What is FAI a precursor to?

A

OA and labral tears

311
Q

What can PTs do to manage FAI?

A

-Restore mobility and function
-Decrease pain
-Correct muscular imbalances
-Avoid surgery

312
Q

What is the prevalence of FAI?

A

-More common in 20-40 y.o.
-Athletes make up 15% of reported FAI cases
-Sport with repetitive end range hyperextension or hyperflexion combined with abduction at an increased risk for labral tears

313
Q

What are the two types of FAI?

A

-CAM
-Pincer

314
Q

What is CAM FAI?

A

-Aspherical femoral head
-Bony prominence at anterolateral head-neck junction
-Impinges on the rim of the labrum
-Leads to superior OA
-More common in young athletic males
-FADIR +

315
Q

What is pincer FAI?

A

-Over-coverage of femoral head by the acetabulum which impinges on the neck of the femur
-Leads to posterior inferior or central OA
-Middle aged females more common
-Hip extension + ER will be painful

316
Q

What percent of patients with FAI have both CAM and pincer impingement?

A

86%

317
Q

What are common symptoms with FAI and/or labral tears?

A

-Anterior groin pain
-The C sign
-Described as dull and aching
-Pain is worse with prolonged sitting
-Occasional sharp catching pain with activity
-Increase symptoms with flexion, adduction, and internal rotation
-May limp

318
Q

What activities should patients with FAI avoid?

A

-End range flexion, adduction, and internal rotation
-Treadmill running as it encourages internal rotation
-Upright cycling
-Sitting with hips flexed and neutral spine for long periods of time

319
Q

What surgical options are there for FAI and/or labral tears?

A

-Arthroscopic repair
-Trimming of bony rim
-Severe cases may require open operation with larger incision

PHTH 517: Orthopedic Management I (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions