Exam 7 Flashcards
HLA common type
B27, usually class II MHC
Central tolerance
Cells expressing auto antibodies are marked and destroyed through apoptosis
Clonal anergy
Inactive T cells that have not encountered antigen
Immunological ignorance
Lack of antigen antibody encounter
Active regulation
Surveillance for self reacting antibodie
Rheumatoid arthritis definition
Chronic and systemic inflammatory dz affecting synovial tissues
Synovitis of multiple joints
Genetic risk factor for RA
HLA with shared epitope, 4x great risk of RA, but only present in 30% of population
How long are autoantibodies present in RA before onset of sx?
5-10 years
RA pathophysiology
Synovial fluid increases as synovial tissue proliferates, pannus develops
Pannus infiltrates adjacent structures and destroys them
RA joint symptoms
Early pain and stiffness
Symmetric swelling and pain of multiple joints
Worse with activity, worse in morning
Joint deformities in RA in the hands
Swan neck- hyperextension of PIP
Boutonnière- hyperflexion of PIP
Ulnar deviation of MCP
Other RA symptoms
*constitutional symptoms
Rheumatoid nodules (over bony prominences, bursae, tendons)
Dry eye, scleral nodules
Felty syndrome
Found in RA
RA, splenomegaly, neutropenia
RA diagnostics
Anti-CCP (most correlated and more specific)
RF (not as specific)
RA imaging
Early- soft tissue swelling of wrists and feet, juxta-articular demineralization
Late- joint space narrowing, bony erosions
What does RA have that OA doesn’t?
MCP involvement Systemic symptoms Extra articular symptoms Persistent morning stiffness Symmetrical joint involvement Erosions on x rays Increased ESR, CRP, RF, and anti-CCP
What is more specific to OA vs. RA?
Asymmetrical joint involvement
Osteophytes on x ray
3 types of juvenile idiopathic arthritis
Oligoarticular
Polyarticular
Systemic onset
What is an ocular risk of all JIA patients?
Uveitis
JIA diagnosis
Effusion noticed acutely by parents
Pain and stiffness that restricts motion
Arthritis onset slow
JIA exam
Inflammation, erythema, tenderness, effusion
Still disease general
Related to chronic juvenile arthritis
Young adult onset
Still disease symptoms
High fevers
Sore throat
Evanescent rash
Destructive arthritis
Dramatic increased WBC, ferritin
What are the lupus criteria?
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis
- Kidney disease
- Neurological disease
- Hematologic disorders
- Immunologic abnormalities
- Positive ANA
How many criteria does a patient need to be diagnosed with lupus?
Any 4 or more of the 11
Systemic sx of lupus
Fever, anorexia, malaise, weight loss
Malar rash
SLE
Butterfly rash, red/purple, mildly scaly, spares nasolabial folds
Discoid rash
SLE
Erythema, inflammation, scaling/crust. May scar
Photosensitivity of SLE
Rash in sun exposed areas
What may be the earliest sign of SLE?
Arthritis
Serositis in SLE
Inflammation of serous tissue
Pericarditis, pleural effusions common
Screening test of choice for SLE?
ANA!
If it is negative, need to consider other dx’s
Polymyositis
Insidious proximal muscle weakness and maybe pain
Dysphagia fairly common
Polymyositis diagnostic
Muscle biopsy
White blood cells attacking muscle cells
Dermatomyositis
Similar weakness to polymyositis
Heliotrope rash
Gottron papules
Shawl sign
Rhabdmyolysis
Acute necrosis of skeletal muscle
Very increased CK levels
Renal failure
Common causes of rhabdo
Crush injury
Cocaine, alcohol
Prolonged inactivity
Statins
Scleroderma types
Diffuse and limited
Scleroderma
Fibrosis of skin and internal organs
CREST syndrome
Aka limited scleroderma
Calcinosis cutis Raynauds Esophageal motility disorder Sclerodactyly Telangiectasia
Diffuse scleroderma manifestations
Tendon friction rubs over forearm, shins
Renal, cardiac dz
Interstitial lung dz
Tightening of skin
Tightening of skin with CREST
Just face and hands, greater risk of digital ischemia
What autoantibody marker does CREST have more commonly than diffuse scleroderma?
Anti-centromere
Sjogren syndrome
Dry eye, dry mouth
Usually females
Schirmer test to quantify tears
Polymyalgia rheumatica
Pain/stiffness in axial muscles (shoulders, hips/pelvis)
Associated with giant cell arteritis
Difficulty putting on coat, standing from chair
Behcet disease
Oral aphthae is the hallmark
Genital lesions, CNS involvement, vasculitis, arthritis
Uveitis- severe!
Behcet disease diagnosis
Recurrent oral ulcerations plus 2 more things, like…
Genital ulcerations
Eye lesions
Skin lesions
Positive pathergy test
Pathergy
Behcet diagnosis
Formation of a sterile pustule at the site of needle insertion
Polyarteritis nodosa
Medium vessel disease
Skin, nerves, mesenteric vessels, brain, etc.
Polyarteritis nodosa manifestations
Livedo reticularis
Digital gangrene
Primary angiitis of CNS
Rare vasculitis limited to brain and spinal cord
Brain bx is only way to make dx
Leukocytoclastic vasculitis
Small vessel vasculitis
Most commonly of skin, aka hypersensitivity vasculitis
Leukocytoclasatic vasculitis exam
Palpable purpura
Urticarial lesions- last greater than 24 hours, burning more than itching
Henoch schonlein purpura
Most common systemic vasculitis in kids
Palpable purpura, arthritis, hematuria and maybe abdominal pain
Essential cryoglobulinemia
Hep C is the most common cause
Cold precipitable immune complexes
Essential cryoglobulinemia findings
Palpable purpura
Peripheral neuropathy
Glomerulonephritis
Positive serum test for cryoglobulins
Osteoarthritis general
Most common joint disease
Degenerative dz due to cartilage breakdown in joints, bony and synovial changes
What joints does OA commonly affect?
Knee
Hip
Spine
Feet
Weight bearing joints!
Asymmetrical
OA pathophysiology
Edema of cartilage early
Progression- cartilage softens and loses elasticity
Loss of joint space
Bony degeneration and osteophyte/cyst formation
OA presentation
NO systemic sx
Slowly progressive joint pain
Deep and achy, tenderness
Worse with heavy use, better with rest
Gelling
Stiffness during rest with OA
Heberdens nodes
Palpable osteophytes and or cysts at DIP joint
OA
Bouchard’s nodes
Palpable osteophytes and or cysts at PIP joints
OA
Imaging findings of OA
Narrowed joint space
Osteophytes
Increased density of subchonral bone
Bony cysts
OA prevention
Weight loss
Correct any vitamin D deficiency
Joint fluid analysis general rule
RBC/WBC ratio in blood and normal fluid is 1000/1
More WBCs suggests infection or inflammation
Gout general
Associated with consumption of fish foods and alcohol
High purine foods are main trigger
Gout pathophysiology
Monosodium urate crystal formation
Often excess uric acid
Synovial fluid cooler than body temp, supersaturation and crystal aggregation
Inflammation via macrophage response
Podagra
Gout of the MTP joint (most common site)
Gout presentation
Sudden onset arthritis
Night onset common
Erythema, swelling, fever, warmth, TENDERNESS
Monoarticular usually
Tophi
Granulomataous inflammation around a deposit of MSU crystals
Chronic gouty arthritis
Persistent elevation in articular MSU
Chronic changes to bone, cartilage
“Rat bites” on X-RAYS
Gout diagnosis
Joint aspirate is key, especially for 1st diagnosis
Negatively birefringent needle like crystals
Chondrocalcinosis
Calcium salts in articular cartilage
Usually XR diagnosis
Pseudogout
Aka calcium pyrophosphate crystals
Gouty sx of large joints, knees and wrists common
Chondrocalcinosis of joint almost always seen
Diagnostic finding of pseudogout
Rhomboid, positively birefringent crystals under polarized light
Spondyloarthropathy general
Group of systemic inflammatory diseases
Musculoskeletal findings, extra articular manifestations, immunogenicity issues
Ankylosing spondylitis
Young adults
Chronic, inflammatory dz of axial skeleton
Low back pain that improves with activity
Ascending disease, lumbar curve flattens and cervical curvature exaggerated
Ankylosing spondylitis other findings
Peripheral arthritis
Uveitis
Entesthopathy (disordered tendon/ligament attachment)
Think of AS with…
Less than 30 years old, inflammatory pain that improves with activity
Reactive arthritis
Preceded by infection, but joints are not infected
Usually GI or STD pathogens
Reactive arthritis classic triad
Asymmetric arthritis, uveitis, and urethritis
“Can’t see, can’t pee can’t climb a tree”
Fever, weight loss, arthritis of large weight bearing joints
Septic arthritis definition, causes and pathogen
Bacterial joint infection
Hematogenous spread, direct inoculation, immunocompromise are the causes
Staph aureus most common!
Septic arthritis presentation
Acute pain, effusion, and warmth of joint
Fever, chills common
Knee most common site
Septic arthritis diagnostics
Synovial fluid analysis- increased WBCs
Often blood culture is positive
Prosthetic joint worries
Periprosthetic lucency!!
Gonoccoccal arthritis common patient populations
Menses, pregnancy, MSM
Gonococcal arthritis presentation
Migratory polyarthralgia, then EITHER
- tenosynovitis of wrist, hands or feet
- purulent monoarthritis
Osteomyelitis
Bony infection due to direct or hematogenous spread (always get blood cx)
Manifestations of osteomyelitis
Fever, chills, pain and elevated ESR/CRP
Wound that probes the bone is a clinical dx
Best imaging for osteomyelitis
MRI
Best way to obtain cultures for osteomyelitis?
Bone bx
Diskitis
Vertebral osteomyelitis
Insidious onset
Fever, back pain
Spinal/paraspinal tenderness
Elevated ESR, CRP, WBC
MRI best imaging
What do you see on an MRI for diskitis?
Disk collapse, irregular vertebral bodies
Epidural abscess
Can complicate diskitis
Increased neuro signs
-cord compression, so weakness, numbness, and radicular pain
Lemierre syndrome
Suppurrative thrombophlebitis of the jugular vein
Clot in setting of bacteremia
Typical bacteria for lemierre syndrome
Oral flora, usually fusobacterium
Osteomyelitis from Tb
Prolonged monoarticular arthritis
Send synovial fluid for AFB cx
Pott disease- spinal TB, months of back pain
Sickle cell disease with osteomyelitis
Salmonella is most common pathogen, microinfarcts in gut cause leakage, bony infarcts are setting for infection
Long bones
Osteosarcoma
Persistent bone pain, often epiphyseal
Rare, usually under 20 or over 65
Ewing sarcoma
1/3 of bony cancers effecting kids
Femur and pelvis most commonly
Fever and weight loss common here
Ewing sarcoma imaging
Moth eaten, finely destructive lesions
Onion skinning also seen
Soft tissue mass
Essential treatment for ewing sarcome
Radiation
Scapular winging
Damage to long thoracic nerv
Impingement syndrome definition
Inflamed subacromial bursa and related tendons
Impingement syndrome presentation
Pain with overhead motion
Anterolateral pain, instability, decreased active ROM
Impingement syndrome exam
Positive neer/hawkins test
Greater pain with at least 90 degrees abduction
Best imaging for impingement syndrome
MRI
Frozen shoulder phases
Inflammatory- very painful shoulder without trauma
freezing- pain decreases, joint stiffens
thawing- slow recovery of motion over a year
Frozen shoulder related conditions
Endocrine disorders, especially diabetes
Rotator cuff muscles
Subscapularis
Supraspinatus
Infraspinatus
Teres minor
Rotator cuff tear presentation
Weakness, catching, grating, especially when raising arm overhead
Chronic shoulder pain for several months
Rotator cuff tear physical exam
Back of shoulder appears sunken, indication atrophy of infraspinatus
Active ROM limited
Tenderness over greater tuberosity
Special test for rotator cuff tears
Open can test- supraspinatus
Internal and external rotation
Treatment for full thickness tears?
Surgery for formal repair
Caution with steroid injections
Only short term relief, may weaken tendon or accelerate tears
PT directed exercises
Light weight, high reps, don’t push it!
Most common direction for shoulder dislocation
Anterior (fall or forceful throwing)
Shoulder dislocation exam
Pain with movement
Joint hypermobility
Numb over deltoid- axillary
Special tests for shoulder dislocation
Apprehension test
Sulcus sign
Jerk test
Complication of clavicle fracture
Brachial plexus injury, paresthesias and loss of motor function distally
Grade 1 clavicle fracture
Middle 1/3, 80% of fractures
Floating shoulder
Disruption of clavicle and scapula
High energy trauma
Need surgery
De quervain’s tenosynovitis
Repetitive motion of the tendons of the 1st dorsal compartment causing an inflamed tendon sheath
Which tendons are involved in de quervain’s?
Extensor pollicis brevis
Abductor pollicis longus
De quervain’s presentation
Pain in 1st dorsal compartment
Positive finkelstein’s
Gamekeeper’s thumb aka skier’s thumb
Acute valgus force to the thumb, ruptured/sprained ulnar collateral ligament
Can be associated with an avulsion fracture
Test with gamekeeper’s thumb
Laxity with stress test (stress on the UCL)
Gamekeeper’s thumb treatment
Needs surgery asap!
Ganglion cyst
Benign tumor near a joint or tendon sheath
Leaking out of synovial fluid
Ganglion cyst presentation
Mass, usually asymptomatic
Rubbery and subq
Pain from compression on nearby nerve
Carpal tunnel syndrome
Compression neuropathy of median nerve
Positive exams for carpal tunnel syndrome
Tinel's Phalen Median nerve compression Thenar wasting 2 point discrimination
What is the workup for carpal tunnel?
EMG to make sure there is not impingement higher up in the arm
Treatment for carpal tunnel
Cock up wrist splint
Surgical release
Nursemaids elbow
Most common elbow injury in kids less than 5
Slipping of radial head from annular ligament
Nursemaid’s elbow presentation
Child doesn’t use affected arm
Hold their elbow flexed and close to body
No swelling or point tenderness
What muscle types attach to the lateral epicondyle?
Extensors and supinators
Which muscle types attach to the medial epicondyle?
Flexor and pronators
Epicondylitis
Repetitive use of wrist extensors or flexor, tendinopathy at the numeral epicondyle
Epicondylitis presentation
Pain just distal to the involved epicondyle
Pain with resisted muscle contraction
Normal elbow ROM
Epicondylitis treatment
Cock up wrist splint
Steroid injection
Surgical release
Metacarpal fracture
Loss of knuckle prominence
Axial load, distal fragment usually angulated volarly
What kind of splint does a boxer’s fracture need?
Ulnar gutter splint
Scaphoid fracture mechanism
Usually FOOSH
Most commonly fractured carpal bone
Blood supply enters distally, proximal fractures are more at risk for non-union or avascular necrosis
Scaphoid fracture presentation
Tenderness in the anatomical snuffbox
What kind of splint does a scaphoid fracture need?
Thumb spica splint
Colles fracture
Type of distal radial fracture, extension of the distal portion of the fracture
Smith’s fracture
Distal radial fracture, distal part of fracture flexes
What kind of splint does a distal radial fracture need?
Sugar tong splint
Supracondylar fracture presentation
Swelling with pain
As swelling decreases, may be confused with posterior elbow dislocation
Fat pad posteriorly! Highly suggestive
De quervain’s tenosynovitis mechanism
Repetitive motion of the tendons in the 1st dorsal compartment
Inflamed tendon sheath
EPB and APL
De quervain’s tenosynovitis presentation
Repetitive use of wrist or thumb
Swelling, pain, crepitus
Finkelsteins test
Gamekeeper’s thumb mechanism
Acute valgus force to the thumb resulting in a ruptured ulnar collateral ligament
Can have associated avulsion fracture
Gamekeeper’s thumb presentation
Pain, swelling, ecchymosis
Stress test, laxity in the UCL
**needs surgery asap
Ganglion cysts mechanism
Benign tumor near a joint or tendon sheath
Leaking out of synovial fluid
Ganglion cyst presentation
Mass, usually asymptomatic
Rubbery
Pain from compression on nearby nerve
Carpal tunnel syndrome mechanism
Compression neuropathy of median nerve
Repetitive use, inflammation, ischemic injury to nerve
Carpal tunnel syndrome presentation
Pain, paresthesias in median nerve distribution, hand weakness
Tinel sign, phalen sign, median nerve compression, thenar wasting, 2 point discrimination
Nursemaid’s elbow
Traction on distal radius with elbow extended- slipping of the radial head from the annular ligament
Nursemaid’s elbow presentation
Child doesn’t use affected arm
Hold elbow flexed, close to trunk
No swelling or point tenderness
Extensors and supinators are…
Lateral
Flexor and pronators are…
Medial
Epicondylitis
Tendinopathy at the humeral epicondyles
Epicondylitis presentation
Pain just distal to involved epicondyle
Pain with resisted muscle contraction
Normal elbow ROM
Epicondylitis treatment
Cock up wrist splint
Metacarpal fractures
Striking an object with a closed fist, axial load
Loss of knuckle prominence
Treatment of metacarpal fracture
Ulnar gutter splint, splinted at 50 degrees of flexion to keep ROM
Scaphoid fractures
Blood supply enters distally, proximal fractures are more at risk for non union or avascular nerosis
Scaphoid fracture presentation
Tenderness in the anatomic snuffbox
Scaphoid fracture traetment
Thumb spica splint
Radial inclination
Angle formed between a line drawn through the tip of the radial styloid and the medial corner of the lunate facet, intersected with a line drawn perpendicular to the long axis of the radius
Normal is 22-23 degrees
Smith’s fracture
Flexion fracture of the radius
Colle’s fracture
Extension fracture of the radius
Sugar tong splint
Colle’s fracture, forearm fracture
Supracondylar fracture
Swelling, may be confused with dislocation
Posterior fat pad sign
Acute back pain
< 6 weeks
Chronic back pain
> 3 months
Pain from the spine rarely goes…
Below the knee, without the radicular component
Red flags
Numbness Weakness Saddle anesthesia Loss of anal sphincter tone Bowel or bladder dysfunction
And way more!
Testing L4
Heel walking
Testing L5
Toe dorsiflexion
Testing s1
Toe walking
L4 dermatome
Medial calf/ankle
Patellar reflex
L5 dermatome
Dorsal foot and 1st web space
S1 dermatome
Plantar and lateral foot
Achilles reflex
Straight leg raise test
Radiation past knee suggests l4-s1 nerve root irritation
Crossed straight leg raise test
Opposite leg raise inducing pain on the affected side, more specific
Upper motor neuron signs
Babinskis sign
Clonus
Hoffmann’s sign
Lumbar strain
Injury to lunar intrinsic musculature
Mechanical overload
Lumbar strain presentation
Acute onset of pain
No neuro complaints
Decreased ROM, sometimes sharp pain on movement but usually dull ache
Spasm
Disc herniation f
Most common levels in lumbar- l4-s1
Cervical- c5-c7
Posterolateral is the mos common way for it to herniated
Degenerative disc disease
Breakdown of intervertebral discs
Seen in conjuction with osteoarthritis
Back pain or radicular pain of impingement of nerve root
Spinal stenosis
Narrowing of the spinal canal or foramen
Can lead to impingement/compression on the nerve or nerve root leading to back pain or radiculopathy
Spinal stenosis presentation
Pain, numbness, tingling, often bilateral
Shopping cart sign (relieved by bending over)
Neurogenic claudication
Symptoms with walking and standing
Variable walking distance
Relief with sitting and flexion
Pulses are all okay
What is the most common ankle injury?
Sprain
Strain
Stretching or tearing of muscle or tendon
Sprain
Stretching or tearing of ligament
What is the most common mechanism for an ankle sprain?
Inversion
Most common ligament to be sprained in inversion?
Anterior talofibular ligament
With a medial ankle sprain, what ligament is effected?
Medial deltoid ligament
Eversion
Grade 1 sprain
Micro tear
Minimal swelling
No joint instability
Fully or partial weight bearing
Hopkin’s test
Squeeze test
Help identify syndesmotic injury by compressing fibula against tibia at mid calf level
Ottawa ankle rules
X ray an ankle if there is pain at:
Lateral of medial malleolus
Inability to bear weight
Mortise x ray
Shows medial clear space
Between lateral border of medial malleolus and medial talus
<4mm is normal, greater than that is lateral talus shift
High ankle sprain
Syndesmosis injury
Dorsiflexion and eversion injury with internal rotation of tibia
Maisonneuve fracture
Proximal fibular fracture coexisting with a medial malleolus fracture or disruption of deltoid ligament
Associated with partial or complete disruption of the syndesmosis
Trimalleolar fracture
Medial and lateral malleolus with posterior tibia involvement
Weber A
At level of epiphyseal plate fibular fracture
Weber B
Oblique fracture of fibula communicating distally with epiphyseal plate
Weber C
Upper fibular fracture
Pilon fracture
Tibial plafond fracture due to axial load
High velocity trauma
Plantar fasciitis
Degenerative change of plantar fascia
Repetitive micotrauma. And collagen degeneration of plantar fascia
Plantar fasciitis presentation
Pain worse with first few steps in the morning
Pain with excessive walking
Pain with dorsiflexion
Morton’s neuroma
Benign neuroma of an intermetatarsal plantar nerve, most commonly 2nd and 3rd intermetatarsal spaces
Nerve entrapment of fibrous tissue around the nerve
Morton’s neuroma presentation
Pain weight bearing
Complaint of walking on marble or rock
Numbness or tingling in the toes
Calcaneal fractures
Compression fracture from high velocity
Calcaneal fracture presentation
Pain, swelling, ecchymosis at bottom of heel aka mondor sign
Mondor sign
Associated with calcaneal fracture, hematoma extending to sole of the foot
Avascular necrosis risks
Hip fracture
Steroid use
Alcohol use
Avascular necrosis manifestations
Groin or thigh pain, buttock pain
Weight bearing or movement pain
Pain at rest or at night
Avascular necrosis imaging finding
Crescent sign
Avascular necrosis treatment
Bed rest, partial weight bearing
Extracorporeal shock wave therapy
Hyperbaric oxygen
Developmental dysplasia of the hip
Teratologic dyslocation (usually with neuromuscular disorder)
Typical dislocation, before or after birth
Associated with breech presentation, postnatal positioning, torticollis, matatarsus adductus, club foot
DDH presentation
Ligament laxity that persists a few months into life
Asymmetrical skin folds
Galeazzi sign (shortened femur)
Barlow and ortolani test
DDH
Barlow- displace unstable hip
Ortolani- relocate displaced hip
Klisic test
DDH
Line drawn from greater trochanter through ASIS should point to umbilicus
Imaging for DDH
Ultrasound
Femoral head doesn’t ossify for 4-6 months so an x ray will miss this
DDH treatment
Pavlik harness providing flexion and limiting adduction
Hip spica cast with 6 months if pavlik fails
Surgery if all else fails
Legg calve perthes disease
Idiopathic avascular necrosis of capital epiphysis of femoral head, leads to flattening of the bone
Associated with hypercoagulable state
Legg calve perthes imaging
Radionucleotide bone scan better for early disease
SCFE
Orthopedic emergency
Obesity is the biggest risk factor
Stable SCFE
Antalgic gait
Limit time on affected leg to minimize pain, lurch of trunk
Klein’s sign
Line along upserior edge of femoral neck, should pass through femoral head.
If it doesn’t, SCFE
Trochanteric bursitis
Gait disturbance is most common cause
Lateral hip pain worse with pressure, patients rub their hip
Normal ROM
Hip fracture
Increasing frequency in elderly
Significant mortality
Half of patients with fx cannot return to independent living
Hip fracture presentation
Groin pain
Non wt bearing
Positive trendelenburg
Discoid lateral meniscus
Meniscus are typically semilunar
Discoid meniscus is less mobile
Displaces with flexion
Discoid lateral meniscus presentation
Pain, swelling
Widened joint space
Osteochondritis dessicans
Vascular insult causes cartilage to separate from bone
Older pts usually need surgery
Osgood. Schlatter disease
Common after growth spurt
Micro fx or avulsion of tibial tuberosity with quad contraction
Pain during or after activity, pain and swelling over tubercle
Patellofemoral disorder
“Runner’s knee”
Anterior knee pain
Repetitive motion, pain worsens with activity or soreness after sitting for a long time
Patellofemoral disorder diagnosis
Apprehension sign with lateral deviation of patella
Patellar grind test
Lateral deviation or tilting of patella on XR
Most common patellar dislocation
Usually lateral
Patellar fracture
Usually traumatic
Difficulty or inability to extend knee or ambulate
Patellar tendon rupture.
Abrupt onset of severe pain
Athletes
Proximally displaced patella
Imcomplete extensor function
Popliteal cyst
Baker’s cyst
Distension of bursae along posterior knee
May spontaneously resolve
Can precipitate DVT
IT band syndrome
Bursitis caused by tightness of IT band and overuse
Mesicus injury presentation
Catching or locking sensation due to meniscal fragment
Tenderness along joint line
Meniscal tests
Mcmurray and. Thessaly
Better test for ACL?
Lachman (over anterior drawer)
Segond fracture
Pathognomonic for ACL tear
Posterior cruciate ligament tear
Sag sign
Posterior drawer test
PCL injury generally from significant trauma, neurovascular exam is key
Most common injured ligament of the knee? Mechanism?
MCL- valgus stress to flexed knee
LCL tear
Medial blow to knee
