Final Exam Flashcards
Osteoarthritis Primary Changes
- Loss of Cartilage
- Remodeling of Bone
- Osteophytes
Osteoarthritis affects who the most?
- > 65
- Women
Osteoarthritis: Knee exam findings
- Decreased ROM
- Crepitus
- Deformity
- Effusion
Osteoarthritis: Hip exam findings
- Loss of IR
- Loss of ABD
- Leg Length changes
- Trandelenberg gait
Osteoarthritis: Radiograph findings
- weight bearing
- narrowing
- osteophytes
- cysts
- deformity
Inflammatory: Possible problems
- RA
- Lupus
- Psoriatic arthritis
- Ankylosing Spondylitis
- Poor bone
- On steroids
- Multiple joint involvement
- Less responsive to PT
- Significant deformity
- High complications and infection
- Cervical spine involvement in RA
- Stiffness in AS
- UE involvement in RA-platform walker
- Severe valgus deformity
Osteonecrosis: Need to Know
- Primary in HIP
- 10% of THA due to necrosis
- 80% Bilateral
- MRI is 99% sensitive and specific
Osteonecrosis: Causes
- Alcohol abuse
- Steroids
- Irradiation
- Idiopathic
Femoroacetabular Impingement: Need to Know
- 2nd to arthritis
- Repetitive problem due to structure abnormalities
- CAM = Young Males
- Pincer = Young Females
- LABRAL Tears
Femoroacetabular Impingement: Treatment
- Arthroscopy
- Pelvic Osteotomy
- THA
Osteoarthritis: Medical Management
- NSAIDS
- Acetaminophen
- PT/HEP
- Glucosamine/Chondrotin
- Activity modification
- Exercise Program
- Knee sleeve
- Injections
- TJR when ALL ELSE FAILS
TKA: Goal
- Restore normal alignment
- Improve Function
- Decrease pain
TKA: Gold Standard
Cemented
TKA: need to know
- Pre-op ROM = >post-op ROM
- Goal = 0-115
- 95% last >10 years
- Immediate WB
- Knee noise
- 1 year for full recovery
TKA: Post-op
- NO running / jumping
- CAN cross legs
- CAN kneel
Partial Knee Replacement: Contraindications
- Inflammatory Arthritis / RA
- Absent ACL
- Obesity
- Lateral Patellofemoral wear
THA: Approaches
- Direct Anterior
- Direct Lateral
- Posterior
THA: Anterior approach
- Quick recovery (2-4 weeks)
- LOW risk for dislocation
- Femoral N. injury/pain
- Higher blood loss
THA: Lateral approach
- Low dislocation rate
- Heterotropic ossification
- better for potential future surgery
- LIMP
THA: Posterior approach
Higher risk of dislocation
THA: need to know
- non cemented more common
- Similar recovery (6 weeks)
- Anterior approach very difficult (1 surgeon)
THA: Complications
- Heterotropic ossification
- Vascular injury <1%
- Dislocation 1-3%
- Infection 1-2%
- DVT
THA: Take Home Points
- WBAT
- ROM and Strength will return
- Cane in opp.
- Leg Length Discrepancy <7mm
- Precautions only within 3 months
Bipolar Hemiarthroplasty
Break of Femoral neck
Bipolar Hemiarthroplasty: Need to Know
- Displaced femoral neck fractures
- Replace Femur only
- Older / Frail low demand patients
- Quicker and less blood loss
- Less risk of dislocation than THA
- Rapid Mobilization
- High rate of failure in younger population so THA best
Osteoarthritis: Primary Pathology
- age
- biochemical cellular alterations over time
- genetic
Osteoarthritis: Secondary Pathology
- fractures
- high impact loads
- ligament injuries
- dysplasia
- infection
- AVN
- Pagets, Hemophilia
- Charcot
Osteoarthritis: Treatment
- Treat cause for secondary cases
- focus on non op means
- NSAIDS CANE PT NUTRACEUTICALS
Hip Dysplasia: Definition
Abnormal development of the Hip Joint
Hip Dysplasia: Pathology
- Cartilage dysplasia
- Developmental
Muscle Strains: Treatment
- Restoring Mobility / Strength / Function
- NSAIDS
Slipped Capital Epiphysis:
- Males 2x> Females
- Pain / Limp /
Avascular Necrosis: Pediatrics Causes
- Perthes Disease
- SCFE and Rx
- Osteomyelitis
- Metabolic
- Steroids
Avascular Necrosis: Pediatrics Treatment
- ATTEMPT non-OP
- Contain and let Hip REMODEL
- osteotomy
Avascular Necrosis: Adult Causes
- Steroids for Rx of various med conditions
- ETOH
- Deep Diving
- Trauma
Avascular Necrosis: Adult Treatment
- Usually THA
- Core decompress
Perthes Disease: Definition
- AVN of Femoral Head in Children
- most common in kids
Hip Arthroscopy: REMEMBER
- Groin pain is hip joint pain until proven otherwise
- Medial Knee pain can be referred hip joint pain by OBTURATOR N.
Labral Tears: Mechanism of Injury
- Hyperextension
- ER
Labral Tears: REHAB
Day 2-14: Bike, PROM, AAROM, PWB, isometric, thigh mm
Day 14-28: AROM, stretching, WBAT, PRE’s, core
Day 14— : functional activity as tolerated
Osteochondritis Dissecans:
- disease of subchondral bone
Osteochondritis Dissecans: mechanism of injury
- Trauma
- ischemia
- Abnormal ossification
- endocrine abnormalities
ACL: mechanism of injury
Passive: Valgus (clipping)
Active: sudden stop (supra maximal quad contraction) ***most common form
ACL Insufficiency: Signs and Symptoms
- Pop
- pain w/ WB
- Swelling
- 85% of effusions in knee =ACL
- feels like it “gives way”
PCL: mechanism of injury
- Pre-tibial trauma
- Hyperextension
- Knee Dislocation
PCL Insufficiency: Signs and Symptoms
- Patella pain
- Medial Pain
- Hyperextension
- Pre-tibial pain
- drop back
Posterolateral Instability: MOI
- same as ACL and PCL
- VIOLENT
Posterolateral Instability: S/S
- Acutely - same as ACL and PCL
- Chronic - repeated “giving way” / pain / swelling
ACL: Treatment (low demand person)
- brace
- restrict activities (cutting, jumping, twisting)
- 30% will develop OA
- 75-80% will have menisci tear
Lateral Ankle Sprains: Classifications (1-3)
1st - partial / complete tear of ATFL
2nd - ATFL and partial / complete CFL
3rd - ATFL, CFL , PTFL injury
Lateral Ankle Sprains: Treatment
- Functional Rehab
- RICE
- WBAT
- ROM prn
- early mobilization
Lateral Ankle Sprains: need to know
- 20% will develop chronic instability
- Surgery IF:
Direct repair
tendon/graft augmentation
realignment procedures
Syndesmotic Injuries: History
- ER injury
- Pain anterolateral ankle
- unable to play
Syndesmotic Injury: Exam
- Pain w/ DF
- ER test
- “squeeze” test
- deltoid tenderness
Syndesmotic Injury: Treatment (stable)
- Functional Rehab
- RICE
- CAM walker w/ protected WB initially
- Progress to strengthening, proprioception, functional activities as tolerated
Syndesmotic Injury: Time frame
- Minimum 6 weeks up to 3-6 months
Syndesmotic Injury: Treatment (unstable)
- screws
- cast 6 weeks
- CAM walker 6 weeks w/ Progressive WB
- remove screw at 3 months
Chronic Exertional Compartment Syndrome: definition
- increased pressure within one or several of the 4 fascial compartments of the leg during or shortly after exercise
Chronic Exertional CS: History
- symptoms at specific distance / speed / duration
- pain in leg or referred pain in foot following N.
- Fatigue in leg or foot weakness
- numbness or tingling
Chronic Exertional CS: Treatment
Non-OP - Rest / NSAIDS / running mechanics / orthotics
Surgery - athletes / fasciotomies
