Exam 4 Clinical Flashcards
- More common in female infants
- Majority of children w/ this condition have ligamentous laxity which causes the hip to become unstable & slip out of position
- Majority of infants w/ the condition were in a breech position during the birth process
Developmental Dysplasia (congenital dislocation)
Long term effects from:
- Pain
- Abnormal gait
- unequal leg length
- osteoarthritis
- twisting of the femur (femoral anteversion)
- Contracture of the hip muscle
Developmental Dysplasia (congenital dislocation)
- Most common, which allows the femoral head to pass through a tear in the capsular ligament & over the acetabulum, ending up on the ilium
- May compromise the sciatic nerve
Posterior dislocation of the hip joint
- Dislocation which allows the head of the femur to end up in the obturator foramen
- May compromise the obturator nerve
Anterior dislocation of the hip joint
- Caused by friction b/t the skin & the patella
- or direct blow or falling on a flexed knee
- If the condition becomes chronic, the bursae will become distended w/ fluid & form a swelling anterior to the knee
Prepatellar Bursitis (housemaid’s)
- Casued by excessive friction b/t the skin & the tibial tubercle
- AKA. “clergyman’s knee” but is common in roofers & floor tillers (wear knee pads to avoid)
Subcutaneous Infrapatellar
- Caused by bacteria from an abrasion or penetrating wound
- Infection may spread to the knee joint cavity, causing local redness & pain as well as enlarged lymph nodes
Suprapatellar Bursitis
Unhappy Triad refers to a blow to the lateral aspect of the joint while it is weight bearing & cause damage to what ligaments?
Medial collateral
Anterior cruciate
Medial meniscus
- Most commonly injured ligament of the joint
- Can occur not only by a lateral blow to the joint but also by rotational forces during trauma
Damage to the Medial Collateral ligament
- More vulnerable than lateral ____
- pt.’s complain of knee “clicking”, locking up, pain when going up stairs
- Small tears can sometimes repair themselves (4-6 weeks PT)
- Larger tears need surgery
- If large parts of the menisci are removed, forces are now transmitted to the condyles of the tibia & can lead to damage of the articular cartilage & lead to osteoarthritis
Damage to the medial Meniscus
- Damaged in sports that require twisting or jumping
- @ time of injury pt. may state they heard a popping sound, or say my knee gave out
- Knee becomes swollen, as the cavity fills with blood
- Will produce the tibia can be pulled excessively forward under the femur (positive anterior drawer test)
Damaged to the Anterior Cruciate lig.
- injured less often than the anterior cruciate
- Tibia can be pulled excessively backward under the femur (positive posterior drawer test)
Damage to the Posterior Cruciate lig.
- Used to replace diseased portions of the knee (both femoral & tibial portions)
- Can be total or partial
Knee replacements
- Disruption of the epiphyseal plate of the tibial tuberosity that occurs around puberty in active teens
- Ex. of what is known as apophyseal injury or a traction apophysitis
- Apophyses is a secondary ossification center that develops w/ growth
- bilateral in half of those affected
- pt. will complain of pain in the area of the tibial tuberosity
- Avulsion fractures of the tubercle are common
- Can take 1-2 years to run its course
Osgood- Schlatter’s disease
- Most commonly fractured bone of the lower leg
- Compound fractures are common from direct trauma
- Relatively poor blood supply, making fractures taking longer to heal
Fractures to the tibia
- Usually fracture just proximal to the lateral malleolus or just distal to the head of the bone
Fracture to the fibula
Fractures to the area below the head (neck) of the fibula may damage the ________ _______ nerve which can lead to atrophy & paralysis of the anterior & lateral leg musculature
Common fibular nerve
- During ossification of the talus, under certain circumstances a secondary ossification center MAY develop for the lateral tubercle of the bone
- May be due to applied stress to the talus @ puberty
- Seen commonly in teenage soccer players or ballet dancers
- Mostly asymptomatic, but may be mistaken for a fracture on an x-ray
Os Trigonum
- Fractures usually occur through the neck during serve dorsal flexion @ the ankle
- Blood supply may become compromised & lead to avascular necrosis of the head of the bone
Fracture of the Talus
- Fractures may be comminuted
- These fractures are usually quite disabling & may disrupt the SUBTALAR JOINT
Fractures of the calcaneus
- Fine hairline fracture that appear w/o evidence of soft tissue damage
- Fracture may become visible for several weeks
- These fractures are commonly found on the: shaft of the tibia, 2nd , 3rd, & 4th metatarsals, & navicular bone
Stress fractures
What are the 2 types of stress fractures?
- bone is normal, but is overloaded as a result of a sudden increase in activity
- The bone is abnormal as a result of ostroporosis, drugs or some other metabolic disorder (pathological fracture)
- Result from increased pressure w/in a myofascial compartment, resulting in ischemia & pain
- Muscles in the compartment will swell from overuse & the edema & muscle inflammation will reduce the blood flow to the muscles
- Maybe acute or chronic
Compartment syndrome
- Most commonly occurs due to some trauma
Acute compartment syndrome
- Also referred to as external compartment syndrome (ECS)
- Typically in runners & walkers
- Compartments mostly affected are the anterior & deep posterior
Chronic Compartment Syndrome
Some precipitating factors for chronic compartment syndrome include:
- Sudden increases in intensity & duration of exercise
- More time spent on hard surfaces
- Shoes
- pain along the medial aspect of the tibia, usually involving the tibial anterior muscle
- AKA Medial tibial stress syndrome (MTSS)
Shin Splints
Ski boot syndrome is the term used to indicate compression neuropathy to the:
Deep fibular nerve
Motor damage to the deep fibular nerve:
Loss of dorsal flexion of the foot & extension of the toes along w/ diminished inversion of the foot
Sensory damage to the deep fibular nerve:
Loss of sensation to the skin in the web space b/t digits 1 & 2
- Due to microscopic tears in the collagen fibers of the tendons, usually just proximal to the attachment on the calcaneus
- Often occurs during repetitive activities & seen more commonly in baseball, tennis, runners, dancers
Achilles Tendonitis
Heel lifts & stretching may help to decrease symptoms of:
Achilles Tendonitis
- History of Achilles tendonitis
- ruptured during forceful plantar flexion (when the knee is extended)
- May hear a snap & feel intense pain
- ## Individual will have a hard time carrying out plantar flexion
Rupture of the tendon calcaneus
- Calcaneal tendon reflex test is segmental innervation of:
S1 & S2
