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Final Exam Flashcards

1
Q

Leg-Calve-Perthes

A
  1. AVN of femoral head
  2. MOI - unknown etiology
  3. Exam - no in/external hip rotation, Trendelenburg gait, hip knee or thigh pain
  4. Dx - X-ray shows head of femur flattening
  5. Tx - brace, rest, PT, surgery
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2
Q

Slipped Capital Femoral Epiphysis

A
  1. Hx - hip, groin, knee, thigh pain, males 10-14yo, obese males
  2. Exam - spasm, reduced ROM, external rotation with hip flexion
  3. Dx - X-ray shows medial dislocation. Grades 1-3 depend on dislocation
  4. Tx - surgical reduction
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3
Q

Trochanteric Bursitis

A
  1. irritation/inflammation of bursae due to repetitive activity/trauma (trochanteric, ischial, illiopectineal)
  2. trochanteric pain during flexion/extension, increased with coxa varum
  3. MOI - runner with tight IT band, groin pain
  4. Exam - pain with external rotation and abduction, positive Ober test with tight IT band
  5. Tx - stretching, steroid injection, modify activity
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4
Q

Avulsion Hip Fractures

A
  1. Rapid growing males (stronger than growth plate)
  2. Can happen in several places
    - Iliac crest
    - ASIS
    - AIIS
    - Lesser trochanter
  3. Dx - radiograph
  4. Tx - PRICE, stretch/strengthening
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5
Q

ASIS Avulsion Fracture

A
  1. TFL, sartorius (sudden/forced contraction of sartorius with knee flexed/hip extended)
  2. Exam - POP at ASIS, flexion/abduction of thigh provokes symptoms
  3. Dx - X-ray shows displaced ASIS
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6
Q

AIIS Avulsion Fracture

A
  1. Rectus Femoris
  2. Hx - forced contraction, kicking, groin pain
  3. Exam - POP, pain with hip flexion/knee extension
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7
Q

Ischia Tuberosity Fracture

A
  1. Hx - strong hamstring contraction, hip flexed/knee extended, hurdlers, pain in butt, can’t go on
  2. Ischial apophysis last to unite, adductor magnus origin
  3. Exam - POP, reproduce pain with hip flex/knee extend
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8
Q

Hamstring Strain

A
  1. Hx - baseball/track with poor warm-up/fatigue
  2. Exam - POP of muscle belly, visible/palpable knot
  3. Tx - NSAIDs, PRICE, tolerated WB, E-stim, stretching
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9
Q

Pirifomis Syndrome

A
  1. Hx - benchwarmer’s syndrome, prolonged sitting, dull ache in butt, pain walking up stairs, pain from compression of sciatic nerve
  2. Exam - POP, Trendelenburg gait, hold leg externally rotated, pain with flexion/add/internal rotation
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10
Q

Iliopsoas Tendonitis/Bursitis

A
  1. Snapping hip syndrome, groin pain
  2. Hx - pain worse with activity, snapping with hip flexion
  3. Exam - POP pubic ramus, pain with resisted hip flexion
  4. Tx - steroids, NSAIDs, modify activity, strengthening/stretching, E-stim
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11
Q

ACL Injury

A
  1. Anterior medial tibial plafond -> medial aspect of lateral femoral condyle. Limits anterior tibial displacement and some internal rotation
  2. More common injury in females
  3. MOI - cutting move, deceleration, hyperextension
  4. Exam - X-ray, Anterior Drawer Test, Lachmann Test
  5. Tx - surgical repair
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12
Q

PCL Injury

A
  1. Limits posterior displacement of tibia and some external rotation
  2. Less common than ACL injury
  3. Hx - pop/no pop injury, no edema for 48 hours
  4. Exam - popliteal tenderness, more stability than ACL injury, Sag Test, Posterior Drawer Test
  5. Arthroscopy is best diagnostic tool
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13
Q

MCL Injury

A
  1. Anatomy - deep later is thickened capsule, stability against valgus stress
  2. O’Donahue’s triad = ACL, MCL, medial meniscus
  3. Hx - struck from lateral side, pain increases over time
  4. Exam - medial edema/ecchymosis(24hrs)/instability
  5. Grades 1-3 (no opening, opens w/firm end point, opens w/soft end point)
  6. Dif Dx - epiphyseal fracture
  7. Tx - 1-2 brace hinge with lock point, 3 cast immobilization
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14
Q

LCL Injury

A
  1. Very rare
  2. Major trauma with knee dislocation
  3. Major vascular injury
  4. Cruciates/common peroneal nerve also damaged
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15
Q

Meniscus Injury

A
  1. Fibrocartilage with poor blood supply, degeneration over time due to mechanics, redistribute pressure from femur
  2. MOI - WB, cutting/lateral rotation while squatting
  3. Types
    - Bucket Handle - medial more common. prone to locking, younger athletes
    - Flap - start as bucket handle, impingement but not locking
    - Degenerative - older athletes, pain with activity, can’t squat
  4. Hx - snap/pop heard, may lock right away
  5. Exam - McMurray Test, Apley Compression
  6. Dx - arthrogram/MR
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16
Q

Patella Injury

A
  1. Tendency to displace laterally
  2. Hx - knee flexed, quads contract, foot externally rotated, immediate disability/effusion
  3. Exam - pain at retinaculum/vastus medialis, can’t extend knee past 10-15 degrees
  4. Fulkerson Classification
    - 1 subluxed
    - 2 sublixed/tilt
    - 3 tilt alone
    - 4 no malalignment
  5. Tx - immobilize to 10 degrees flexion for 48 hours, PRICE, quad contractions, daily E-stim on VM
17
Q

Patella Femoral Dysfunction

A
  1. More in females, patellalgia, anterior knee pain
  2. Chondromalacia Patella
    - 1 softening/degeneration of articular cartilage
    - 2 cleavage of AC
    - 3 cleaving and fronds of AC
    - 4 wearing away of AC to subchondral bone
  3. Hx - feel popping, changed activity
  4. Exam - patella acta = hight, patella baja = low, squinting = knock knees, frog eye = up and out
  5. Dx - AP for position, lateral at 45 for height, sunrise view for articulation
18
Q

Plica

A
  1. Redundant fold in the synovial lining of the knee, Tears at femoral condyles
  2. Hx - gradual onset, if fibrosed it can pop on extension
  3. Exam - positive theatre sign, tight hamstrings, weak quads
19
Q

Illiotibial Band Syndrome

A
  1. Tight IT band, genuvarum/runner’s varus
  2. When running with a narrower base of gait, tibia positioned more varus
  3. Lateral knee pain from IT band popping anterior/posterior on femoral condyle
  4. Ober’s test will be positive
20
Q

What percentage of stress fractures are in the lower extremity?

21
Q

What is the definition of a stress fracture?

A

Partial or complete fracture of bone due to its inability to withstand repetitive non-violent force

22
Q

What are considered to be the non-critical stress fractures?

A
  1. Distal metatarsals
  2. Lateral malleolus
  3. Calcaneus
23
Q

Posterio-Medial Shin Splints

A
  1. Tibialis posterior overuse
  2. Increased velocity of pronation
  3. Eccentric contraction at heel contact, when moments around STJ are hightest
24
Q

Anterior-Lateral Shin Splints

A
  1. Most common shin splints
  2. Overuse of tibialis anterior muscle
  3. Due to increased velocity of ankle joint plantarflexion
  4. Also associated with STJ pronation
  5. Eccentric contraction at heel contact when the ankle joint moments are highest
25
Q

Chronic Compartment Syndrome

A
  1. Medical emergency (compared to shin splints)
  2. High pressures in fascial boundaries causing ischemia
  3. Pain subsides after activity
26
Q

Achilles Tendonitis

A
  1. Non-insertional - weekend warriors, males, depression on tendon, worse in AM, palpable knot
  2. Insertional - with retrocalcaneal bursitis, medially seen with overpronation, x-ray can show Haglund’s or spur
  3. Binnell surgery primarily, walking boot, orthoses
27
Q

Posterior Tibial Tendonitis Disease (PTTD)

A
  1. Linked to excessive pronation, no calcaneal inversion with heel raises
  2. Females»males
  3. Pain against inversion resistance, or with heel raises
28
Q

Peroneal Tendonitis

A
  1. Periods of inactivity followed by intense workouts
  2. Brevis - pain at base of 5th met
  3. Longus - pain at cuboid and 1st met/1st cuneifiorm
  4. Both can produce pain at posterior lateral malleolus
29
Q

Extensor Tendonitis

A
  1. Seen in skating/skiing due to tight boots
  2. Weakness in anterior compartment/tight posterior group
  3. Rapid plantarflexion, foot slap possible
  4. Possible excessive STJ pronation
30
Q

Anterior Talofibular Ligament

A
  1. Runs from lateral malleolus to neck of talus
  2. Weak band
  3. Tight during plantarflexion
  4. Limits anterior translation of the talus on tibia
31
Q

Calcaneofibular Ligament

A
  1. Runs from lateral malleolus to lateral surface of calcaneus
  2. Round cord
  3. Taut at end of dorsiflexion
  4. Restrains talar inversion
32
Q

Posterior Talofibular Ligament

A
  1. Runs from posterior malleolus to lateral tubercle of talus
  2. Thick, strong cord
  3. Strongest lateral ligament
  4. Limits posterior displacement of talus
33
Q

Deltoid Ligament

A
  • Limit eversion of talus and lateral rotation of tibia
    1. Anterior tibiotalar
    2. Tibionavicular
    3. Tibiocalcaneal
    4. Posterior tibiotalar
34
Q

Ankle Tests

A
  1. Anterior drawer test
    - 4-5 mm deviation = ok
    - 8-10 mm deviation = ATFL
    - 11-15 mm deviation = ATFL, CFL + PTFL
  2. Stress test (radiographic)
  3. Squeeze test (compress mid-calf checking tib/fib syndesmosis)
35
Q

Ottawa Ankle Rules

A

Films required if:

  • Pain at malleolar area, navicular, styloid process – avulsion fracture
  • Bony tenderness
  • Inability to bear weight
36
Q

What are the phases of ankle sprains?

A
  1. Acute phase (1-3 days)
  2. Subacute phase (3 days-3 weeks)
  3. Repairative phase (3 weeks-3 months)
37
Q

Turf Toe

A
  1. Sprain of the 1st MTP joint
  2. Usually caused by hyperextension force
  3. Caused by flexible shoes on turf

Sports Medicine (1 decks)

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