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Advanced Patient Evaluation > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q
  • Mechanism of Injury: hyperextension OR twisting with valgus force
  • most common disabling knee injury in athletes
  • contact injury (males) vs non contact (females)
  • at risk activities- cutting, jumping, pivoting
  • patient feels a “pop” and have immediate effusion(swelling)
  • At risk activities: cutting, jumping, pivoting

HIgher incidence in female athletes -increased Q angle

A

ACL injury

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2
Q

special tests for ACL injury? diagnosis? treatment

A

Special tests
* lachman’s (best test)
* pivot shift (most specific but hard to do with patient awake)

Diagnosis
* confirmed with MRI
* x-ray to rule out fractions
* associated with meniscal tears in about half of ACL injuries

Treatment
* usually surgical reconstruction of ACL

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3
Q
  • Mechanism of Injury: Dashboard injury often due to motor vehicle accident, excessive posterior translation of tibia on femur, hyperextension
  • special tests: posterior drawer; posterior sag sign
  • diagnosis: MRI
  • Treatment: conservative, surgery indicated if posterior lateral corner is involved
A

PCL injury

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4
Q
  • valgus force
  • point tender over insertion site
  • PE: valgus stress at 0 +30
  • gradual swelling, point tender over proximal and/or distal insertion sites
  • usually heals well on its own
  • tx: hinged knee brace
A

MCL

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5
Q
  • varus force
  • gradual swelling; point tender over proximal and/or distal insertion sites
  • point tender over insertion site
  • varus stress test at 0 +30
  • treatment: surgery if acute avulsion or if rotational instability is present
  • acutely should be braced and referred to ortho
A

LCL

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6
Q
  • most common of all knee injuries
  • mechanism: twisting injury, hyperextension, hyperflexion
  • signs/sx: pain, swelling, mechanical locking, joint line tenderness, locked knee
  • special tests: Mcmurrray’s test
  • diagnose with MRI
  • tx: conservative- asymptomatic, ROM, quadricep strengthening; surgical- outer 1/3 (meniscal repair) inner 2/3 (debridement or meniscectomy)
A

Meniscal injury

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7
Q

Peds hip conditions

A
  • congential hip dysplasia
  • legg-calve perth dx (ages 3-10(
  • slipped femoral capital epiphysis (SCFE) ages 10-16; obese
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8
Q

adult hip conditions?

A
  • avascular necrosis
  • hip fractures
  • DJD
  • greater trochanter bursitis
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9
Q

physical exam
* shortening of the affected side
* asymmetric skin folds
* limited aBduction of hip

A

developmental dysplasia of the hip

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10
Q
  • osteonecrosis of proximal femoral epiphysis (results in degenerative changes in femoral head secondary to decrease blood supply)
  • unknown cause; most common in boys age 3-10
A

Legg-Calve-Perthes disease

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11
Q

signs and symptoms of legg-calve-perthes disease? Treatment?

A

signs/sx: painless limp, hip/groin/knee pain, decreased ROM
Treatment: keep head in acetabulum
* conservative: immobilization, NWB
* surgical: To keep head located, prevent significant deformation (pinning, osteotomy)
* usually self limiting

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12
Q
  • most common disorder affecting adolescent hips and commonly missed
  • more common in: obese, puberty (10-16), AA, pacific islanders, lations, endocrine disorders (hypothyroid, GH, hypogonadism, panhypopituitarism), males, left>right
  • unknown cause
A

slipped capital femoral epiphysis

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13
Q

signs/sx of SCFE? what would you see on physical exam? Diagnosis? tx?

A
  • Signs/sx: Groin and thigh pain-most common; limp-antalgic gait, externally rotated foot; can lead to misdiagnosis
  • PE: abnormal gait (waddling, trendelenburg) drehmann sign: obligatory external rotation in supine position with passive flexion; weakness, abnormal leg alignment, decreased ROM
  • Diagnosis: XRAY (frog leg view)
  • tx:surgical
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14
Q

what should you know about avascular necorsis, hip fractures, DJD, greater trochanter bursisits, hip dislocation

A

avascular necrosis
* chronic steroid use, ETOH, drugs
* painful
* usually present 45-50 y/o

hip fractures
* shortening of the affected leg

DJD
* OA: morning stiffness
* RA: increased pain with activity

Greater trochanteric bursitis
* pint tenderness of PE

Hip dislocation
* typically posterior- present with shortened, internal rotation and adduction

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15
Q
  • inversion: most common MOI
  • talar tilt test: to measure the integretity of the calcaneofibular ligament is as follows
  • anterior drawer test: to measure the integrity of the anterior talofibular ligament
  • mechanism of injury: usually clues you in to area of injury
A

ankle injury

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16
Q

ankle ligments and their mechanism of injury

A
  • deltoid/eversion and external rotation injuries
  • ATF/landing on a plantar flexed and inverted foot
  • calcaneofibular ligament/ foot is dorsiflexed and inverted
  • posterior talofibular ligament
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17
Q

casting pearl

A
  • deep peroneal nerve and superficial peroneal nerve are vulnerable to damage due to fracture of the fibula or compression, which was caused by the case as in this case and can lead to foot drop
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18
Q

following trauma or fracture- rapid onset of pain true emergency

A

compartment syndrome

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19
Q

treatment of ankle conditions

A
  • a closed, acute, bimalleolar fracture: 100% instability and surgical treatment is recommended
  • treatment: reduction(ASAP), stabilization, and referral for surgical fixation
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20
Q

what are risk factors for back pain? how do you rule out bad stuff? what tests do you do?

A
  • risk factors: smokers, physical inactivity, occupation, age, lifestyle
  • what test do you do? MRI (most common)
  • rule out: slipped disk, cauda equina, (loss of bladder or bowel control) metastasis, stenosis; Age> 50 y.o, unexplained weight loss, night sweats, fevers, chills, hx of malignancy
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21
Q

is a fracture/defect of the pars interarticularis. it is not associated with herniated disc, scoliosis, or other types of fractures

A

spondylolysis

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22
Q
  • pain: anterior thigh
  • numbness anterior patella
  • motor weakness: extension of quadriceps
  • screening exam: squat and rise
  • reflexes: knee jerk diminished
A

L4 dermatome

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23
Q
  • pain: posterior buttocks and lateral thigh and leg
    numbness: lateral leg
  • motor weakness: dorsiflexion of great toe and foot
  • screening exam: heel walking
  • reflexes: none reliable
A

L5

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24
Q
  • Pain: posterior buttocks medial thigh
  • numbness: gastrocnemius, plantar foot and toes
  • motor weakness: plantar flexion of great toe and foot
  • screening exam: walking on toes
  • reflexes: ankle jerk diminished
A

S1

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25
Q

most common noncancerous bone growth?

A

osteochondroma- bone and cartilage, pedunculated bone mass

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26
Q

most common type of malignant bone tumors

A
  • metastatic
  • PTBLK (prostate, thyroid, breast, lung, kidney)
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27
Q

edges are well demarcated, no periosteal rx, and the bony cortex is not involved

A

Benign bone tumors

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28
Q

often have poorly defined boders that extend into the cortex. Soft tissue masses and have periosteal reaction are present

A

malignant bone tumors

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29
Q

Increased interstitial pressure in closed fascial compartments which can potentially compromise associated nerves and muscles

A

compartment syndrome

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30
Q
  • bleeding into compartment due to trauma
  • direct blow
  • fractures
  • crush injuries
  • surgery
A

acute compartment syndrome

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31
Q

treatment of acute compartment syndrome

A

emergency fasciotomy
(a sugery to relieve swelling and pressure in compartment of the body)

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32
Q
  • elevated compartment pressures associated with exercise
  • common in runners, soccer, lower extremity fractures
  • symptoms are relieved with rest
  • tx: Ice, NSAIDs, stretching, strengthening orthotics
  • fasciotomy with failure of conservative treatment
A

chronic compartment syndrome

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33
Q
  • presents with shortening and external rotation of affected leg
  • unwillingness to move leg
  • inability to weight bear or progressive pain w/weight bearing
  • elderly population
  • 4x more likely in female
  • risk of AVN due to vascular insult
A

femoral neck fracture

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34
Q
  • elderly population
  • 5x more likely in female
  • better outcomes secondary to low risk of interruption of blood supply
  • presentation: Shortened affected leg, external rotation
  • treatment: ORIF with dynamic hip screw
A

interochanteric fracture

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35
Q

treatment of femoral neck fracture if it is a stress fracture? stable fracture? unstable fracture?

A

stress–> ORIF or NWB (non-weight bearing)
stable—> percutaneous pinning
unstable fracture—> hemi-arthroplasty

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36
Q
  • most common in endurance athletes
  • progressively increasing pain with exercise
  • that eventuallly becomes pain at rest
  • pain usually referred to groin
A

femoral neck stress fracture

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37
Q

Treatment of a femoral neck stress fracture?

A
  • compression side: conservative with non-weight bearing until pain (about 8 weeks)
  • traction side- fracture on superior aspect of neck–> ORIF becaues pull of hip musculature puts traction on fracture side
38
Q
  • posterior most common

treatment: treat immediately due to risk of complications
* hip reduction
* ER—>reduce with sedation
* OR–>reduce with general anesthesia

complications
* avascular necrosis
* arthritis

A

femoral head dislocation

39
Q
  • posterior most common

treatment: treat immediately due to risk of complications
* hip reduction
* ER—>reduce with sedation
* OR–>reduce with general anesthesia

complications
* avascular necrosis
* arthritis

A

femoral head dislocation

40
Q

what should be evaluated in a femoral shaft fracture?

A

evaluate sciatic nerve injury

treatment:
* traction applied for initial management
* external fixator
* intramedullary rod or nail
* ORIF of femur

41
Q
  • Abuse is the most common cause under 1
  • abuse can be present in ages 1-4, but incidence is less

What is this fracture? what is the treatment?

A

Femoral shaft fracture (children)

treatment:
* <6 months old- pavlik harness
* 7monts-5 years- hip spica
* 5-10 years- flexible nails/rods

42
Q
  • impaired blood supply to femoral head
  • occurs most often between ages 40-50 y/o
  • bilateral involvement 40-80% of time
  • causes: steroid use, trauma, gout, connective tissue disorders
  • presentation: groin pain, painful limp with progressive decreased ROM
A

avascular necrosis

43
Q

managment of avascular necrosis

A
  • x-ray
  • MRI (most sensitive)
  • early treatment- conservative with non-weight bearing
  • surgical decompression for pain relief
  • late treatment- total hip arthroplasty
44
Q
  • more common in females because of increased Q angle
  • point tenderness over greater trochanter
  • may feel a snapping sensation as ITB crosses over the trochanter
  • repetitive hip flexion provoked by running or uneven surfaces or striding across midline
  • tx: rest, NSAIDs, stretching, injections, surgery (last resort)
A

trochanteric bursitis

45
Q
  • dislocation of hip due to deformation or malformation
  • ligamentous laxity
  • increased prevalence with breech births, family history and females
  • PE: shortening of the affected side, asymmetric skin folds, limited abduction of hip, positive galeazzi sign, ortolani click test (flex hip with posterior compression and listen for click)
A

congential hip dyspalasia

46
Q

treatment of congenital hip dysplasia?

A
  • pavlik harness for 6-12 weeks
  • harness keeps knees in flexion and hips in abduction
  • brace allows contact between articulating surface and helps strengthen muscles in early development
47
Q
  • most common in boys ages 3-10
  • presentation: gradual painless limp hip, groin, knee pain, decreased ROM
  • tx: keep head in acetabulum; conservative- immobilization, non weight bearing
  • surgical- keep head located, prevent significant deformation
A

legg-calve-perths disease

48
Q
  • most common in boys ages 3-10
  • presentation: gradual painless limp hip, groin, knee pain, decreased ROM
  • tx: keep head in acetabulum; conservative- immobilization, non weight bearing
  • surgical- keep head located, prevent significant deformation
  • usually self-limiting
A

legg-calve-perths disease

49
Q
  • Presentation: gradual onset, groin and thigh pain, limp- antalgic gain, externally rotated foot, knee pain can lead to misdiagnosis
  • PE: Drehmann sign- obligatory external rotation in supine passive flexion; weakness, abnormal leg alignment, decreased ROM
  • treatment: percutaneous pinning, non-weigh bearing for 6 weeks
  • may lead to avascular necrosis
A

Slipped capital femoral epiphysis (SCFE)

50
Q
  • one hand of the examiner will secure and stabilize the distal femur while the other hand will secure and stabilize the proximal tibia
  • gentel anterior translation force is applied to the proximal tibia to determine if there is an endpoint
  • more reliable than anterior drawer sign
A

lachman’s test

51
Q

performed with the patients knee starting in full extension
-while maintaining internal rotation of the tibia, a valgus force is applied and knee is slowly flexed to 25-30 degrees
-feel for subluxation of the lateral tibial plateau as it reduces its normal position

A

pivot shift

52
Q
  • traumatic injury (fall from heights, MVA)
  • types: split, depression, split with depression
  • treatment: stable–> immobiliztion, unstable—> surgery
A

tibial plateau fracture

53
Q
  • avulsion fracture
  • common age 12-16
  • boys>girls
  • causes: violent quad contraction as in football, soccer, basketball, jumping sports, overweight, history of osgood schlatter
A

tibial tuberosity fractures

54
Q

what is considered the terrible triad?

A

ACL, MCL, medial meniscus

55
Q
  • occurs laterally
  • usually a result of twisting mechanism (predisposition with weak quadriceps and increased Q angle)
  • presentation: tenderness over medical patellar border, large knee effusion, positive apprehension sign
  • tx: patella is reduced with knee extension immobilization (no longer than 1-2 weeks), ice, rest, PT
A

patella dislocation

56
Q
  • high energy injury
  • 3 or 4 ligaments torn
  • limb threatening injury
  • tx: reduce joint immediately, procedural sedation as indicated, note distal and popliteal pulses, obtain ankle-brachial index, perform bedside duplex ultrasound screen if available
A

knee dislocation

57
Q
  • morning stiffness progressing to persisten pain
  • bakers cyst (fullness in the popliteal fossa that will change in size, sx of osteoarthritis)
  • progresses to underlying boney changes (bone spurs, cyst formation)
  • treatment: conservative: RICE, PT, Steroids; surgical: total knee arthroplasty
A

osteoarthritis

58
Q
  • caused by maltracking of patella in femora groove (weak quadriceps, previous patella subluxation/dislocation
  • presentation: vague anterior knee pain or ache; increased pain with running, stairs, prolonged sitting; may have point tendersnes s
  • tx: PT, activity modification, quadricep strengthening, stretching
A

patella femoral stress syndrome (PFSS)

59
Q
  • inflammation of patellar tendon sheath
  • **most common in jumpers
  • presentation: point tender over patella tendon, usually proximally and possibly over distal patellar pole
  • creptitus or squeaking with knee extension**
  • pain with knee flexion, stairs , running
  • tx: Rest, ice, streching quads, NSAIDs
A

Patella tendonitis

60
Q
  • inflammation of patellar tendon sheath
  • **most common in jumpers
  • presentation: point tender over patella tendon, usually proximally and possibly over distal patellar pole
  • creptitus or squeaking with knee extension**
  • pain with knee flexion, stairs , running
  • tx: Rest, ice, streching quads, NSAIDs
A

Patella tendonitis

61
Q
  • housemaid’s knee
  • inflammation of bursa surrounding knee
  • caused by repetitive trauma to knee or direct blow
  • tx: rest, ice and compression, NSAIDs, avoid or modify offending activities, aspiration is no recommended because of risk of infection (Septic bursitis- red, warm and painful)
A

pre-patella bursitis

61
Q
  • housemaid’s knee
  • inflammation of bursa surrounding knee
  • caused by repetitive trauma to knee or direct blow
  • tx: rest, ice and compression, NSAIDs, avoid or modify offending activities, aspiration is no recommended because of risk of infection (Septic bursitis- red, warm and painful)
A

pre-patella bursitis

62
Q
  • pain with running, jumping, resisted knee extension, deep flexion (active or passive stretching) and stairs. point tender over tibial tubercle, may progress to pain at rest
  • apophysitis of tibial tubercle
  • repititous micro-avulsion of tibial tubercle at insertion of patella tendon
  • tx: rest, ice, activity modification-no jumping or running until pain free, self-limiting with epiphyseal closure, patellar tendon strap, NSAIDS,
A

osgood-schlatter’s disease

63
Q
  • inflammation of ITB as it corsses the knee
  • most common in runners and bikers (reptitious knee flexion and extension, tight ITB)
  • ITB slides across lateral femoral condyle
  • Presentation: Clicking over lateral joint line, point tender over ITB, pain with activity especially, repititious knee flexion and extension
  • tx: ice, activity modification, NSAIDS; PT- stretching, iontopohoresis
A

ITB syndrome

64
Q
  • ligamentous injury or sprain with bony attachment involvement (dorsal, navicular, talus)
  • treate like sprain unless: pain involvement, does not improve with time (non-union)
A

avulsion fracture

65
Q

nondisplaced: Cated nonweight bearing 6-8weeks
displaced: ORIF, nonweight bearing x6weeks, early ROM

A

Medial malleolus fracture

66
Q

treatment based on:
* displacements
* medial pain
* morise widenining possible stress views
* nonweight bearing or neutral

A

distal fibula fracture

67
Q
  • rarely isolated
  • fracture size based on the direction of force
  • treatment based on whether >25% of the joint is involved
A

posterior malleolus fracture

68
Q
  • fracture into 2 parts
  • most commonly medial and lateral malleoli
  • unstable fracture
  • often associated with dislocation
  • usually surgery is recommended
A

bimalleolar fracture

69
Q
  • fracture into 3 parts
  • all 3 malleoli are fractured
  • unstable fracture
  • treated surgically
  • posterior fracture repair based on same
  • criteria as for individual fracture
  • bulky splint for 2 weeks, then case in neutral
A

trimalleoular fracture

70
Q
  • proximal fibula fracture with tear or interossous membrane and distal tibiofibular syndesmosis and deltoid injury
  • treatment with syndesmosis reduction
A

Maisonneuve Fracture

71
Q
  • crushing or pount injuries
  • typically high energy injuries
  • extensive surgery and bracing necessary
A

pilon/plafond fracture

72
Q
  • most common tarsal fracture
  • typically occurs from fall from heights and landing on feet
  • pain, bruising, and inability to bear weight
  • treatment: cast, no posterior splint for tongue fractures, nonweight bearing for 12 weeks
A

calcaneal fracture

73
Q

can be located at midshaft, base, head or neck
any are possible but 5th is most common
traumatic or stress

A

metatarsal fractures

74
Q
  • avulsion injury of base of 5th metatarsal (tuberosity)
  • avulsion of the peroneus brevis tendon
  • typically with an inversion sprain of the ankle
  • not a serious injury and treated like an ankle sprain
  • surgical only if bony fragment is significantly displace
A

dancer’s fracture

75
Q
  • fracture of the 5th metatarsal metaphyseal diaphyseal junction
  • poor healing potential (nonunion, avascular necrosis)
  • most require surgery
  • long healing period even with surgery
A

jone’s fracure

76
Q
  • injury to lisfranc joint in foot
  • joint connecs metatarsal bones to tarsal bones
  • treat with hardware
A

lisfranc injury

77
Q
  • catching toes on furniture or objects
  • excruciating pain
  • tx: closed reduction with nerve block, alignment, buddy tape stiff soled shoe, heals in 6-8 weeks
A

phalange fractures

78
Q
  • continued inflammation near ATFL post injury
  • pinching one time cortisone at focal area of pain as diagnostics
  • ankle scope

fracture and sprain complication

A

impingment

79
Q
  • snapping ankle
  • occurs when peroneal tendon slips out of the groove behind the lateral malleolus
  • tear of the flexor retinaculum, use of dynamic ultrasound to evaluate retinaculum
  • tx: acute- reduce and cast; taping techniques, use of surgery; may involve groove deepening procedure
A

subluxing peroneal tendons

80
Q
  • talar dome fracture
  • sprain that doesn’t heal
  • medial>lateral
  • CT or MRI to confirm
  • if intact, can wait for body to heal- consider arthroscopy debridement and drilling
A

osteochondral lesions

81
Q
  • nerve entrapment
  • tunnel- canal between medial malleolus and flexor retinaculum
  • nerve pain worse at night
A

tarsal tunnel syndrome

82
Q
  • can be from proximal fibula fracture, scar tissue at the ankle, pressure on nerve from cast or boot
  • most common symptoms is foot drop
  • electromyography (EMG) or nerve
  • conduction velocity (NCV) test for cyst or tumor
A

peroneal nerve entrapment

83
Q
  • tendon does not have good blood supply
  • injury or overuse
  • ossification- insertional tendinitis
  • can lead to rupture
  • tx:RICE, aches, avoid stairs and hills to offload, NSAIDs, stretching, immobilization, surgery (rupture)
A

achilles tendenitis and rupture

84
Q
  • causes: tight calf, obesity, high arches, repetitive high impact activities, age- fat pad thinning, heel spur
  • tx: night split to remain in dorsiflexion, orthotic management, stretching, hot and cold contrast baths
A

plantar fascitis

85
Q
  • flat foot
  • rigid: MLA not present seating or standing
  • flexible: MLA present sitting or standing on toes but missing when standing on entire foot
  • developmental- children may outgrow by age
  • acquired: posterior tibial tendon dysfunction, neuropathic foot, arthritis, fractures
  • contributory factors: footwear, tight achilles, obesity, ligamentous laxity
A

pes planus

86
Q
  • fracture of the pars interarticularis
  • scottie dog
  • can be congential defect and trauma may make pre-existing lesion painful
  • twisting and flexion or hyperextension injury causes fractures
  • presentation: lower back pain or tenderness over the fracture site; usually normal neurological exam unless radicular symptoms from nerve irritation
A

spondylolysis

87
Q

treatment of spondylosis? diagnosis?

A

diagnosis
* xray, CT scan (better than MRI in detecting pars defect)
* MRI (if radicular symptoms)

treatment
* custom brace, lifting and twisting restrictions, pain management by injection to fracture site, serial xrays every 4-6 weeks to monitor

  • chronic: pain as guide + conservative treatement (PT, medication) monitor for neurological defect, may need surgery secondary to pain
88
Q
  • anterior displacement of a vertebra on the one beneath it
  • due to facet degeration, pars fracture or congenital anomalies
    degree of slippage is seen on image and graded
  • tx: based on pain, duration of symptoms and neurological exams, ranges from conservative to surgical fusion
A

Spondylolisthesis

88
Q
  • anterior displacement of a vertebra on the one beneath it
  • due to facet degeration, pars fracture or congenital anomalies
    degree of slippage is seen on image and graded
  • tx: based on pain, duration of symptoms and neurological exams, ranges from conservative to surgical fusion
A

Spondylolisthesis

89
Q
  • narrowing of the central spinal canal by bone or soft tissue
  • usually due to hypertofacy of facet joints and thickening of ligamentum flavum
  • can be due to trauma, tumor, slip, large herniation of the nucleus pulposus
  • presentation: dull aching back pain, leg pain, numbness or paresthesia, weakness, loss of balance, decreased endurance of physical activities
  • MRI best imaging
  • tx: based on neurologic symptoms and pain
A

central canal stenosis

Advanced Patient Evaluation (2 decks)

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