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TRI 2 - MSK > Final exam info > Flashcards

Final exam info Flashcards

1
Q

Describe hip capsular pattern

A
  • Hard to predict capsular pattern

- Flexion, abduction and medial rotation are most restricted

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2
Q

Describe Legg-Calve-perthes disease

A
  • Hip osteochondrosis
  • Disorder or deformation of the epiphysis of a bone
  • Interventions
    Relieve pain
    Restore ROM
    Conserative
    surgical
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3
Q

Describe Slipped Capital femoral epiphysis

A
  • Disorder of adolescent hip
  • Anterior displacement of the femoral neck from the capital femoral epiphysis
  • Etiology
    Weak epiphyseal growth plate
    Growth spurts
    Overweight for Hight
  • Interventions
    ROM restoration
    Relief symptoms
 - Complications
AVN
Chondrolysis
Long term DJD
Limb length discrepancy
  • To test draw klein’s line along the superior border of the femoral neck
    Normal - should cross at least a portion of the femoral epiphysis
    SCFE if line does not touch the femoral head
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4
Q

Describe Hip OA/DJD

A
  • Primary OA - no cause wear down with age
  • Secondary - predisposing factors

Sequelae - joint pain, stiffness, functional impairments

 - Risk factors
Family history
Obesity
Joint capsule mobility impairments
Biomechanical insults

ROM/Flexibility loss IR flexion
prolonged morning stiffness

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5
Q

Describe total hip arthroplasty and considerations for the various approaches

A

indications - severe joint damage, arthritis, displaced fractures, necrosis

  • THA precautions
  • Any anterior, posterior or lateral approach
    Avoid hip flexion >90, adduction past neutral
  • Posterior or posterolateral approach
    Avoid hip IR past neutral and combination of flexion/add/IR
  • anterior / anterior lateral or direct lateral approach
    Avoid hip EXT, ER past neutral and combination of FLEX/ABD/ER
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6
Q

Describe acetabular labral tear

A 
- Causes 
Impingement
Trauma
Sports
Twisting/torsional movements
Insidious
  • Location
    anterior / superior/ posterior
  • Etiology
    Degenerative, traumatic, idiopathic
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7
Q

Describe femoral acetabular impingement

A

Abnormal contact between femoral neck and acetabular rim

  • Types
    cam - femoral head
    pincer - acetabular rim
    mixed - both
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8
Q

Describe Acetabular labral tear

A

Could be caused by Femoral acetabular impingement
Imaging to confirm
Anterior, Anterior superior, posterior superior, posterior

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9
Q

Describe Chondral lesions

A

Acetabular labrum or cartilage tear
Acute or traumatic
Signs of impingement
Could become hip OA

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10
Q

What are some common types of hip tendinopathy

A

glutes, Adductors, iliopsoas, hamstrings, rectus femoris

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11
Q

Describe trochanteric bursitis

A

Lateral hip pain
Common in females 40-60 years of age
Caused by friction or direct trauma

  • Common bursa
    Subgluteus medius
    Subgluteus maximus
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12
Q

Describe femoral neck fractures

A

Intracapsular
geriatric populations
Displaced and nondisplaced

  • Complications
    Avascular necrosis
    Non-union
    DJD
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13
Q

Describe a posterior fracture

A
  • MOI - MVA/Dashboard injury/fall
    More common than anterior dislocations
    Accompanied by acetabular fractures
  • presentation
    Groin pain, lateral hip pain
    Leg shortness, flexed adducted IR
- Medical emergency/ complications
Blood vessel damage to femoral head
Sciatic nerve damage
Post traumatic DJD
Labral tears
Acetabular fractures
  • Interventions
    Closed reduction
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14
Q

Describe an anterior fracture

A

Anterior fracture
MOI - Forced abduction

  • Presentation
    Groin pain/ tenderness
    Superior/ anterior - leg held in extension, ER
    Inferior - anterior leg held in flexion, abduction, ER
  • Complications
    Nerve damage-Femoral
    Post traumatic DJD
    Labral tears
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15
Q

Describe femoral anteversion and retroversion

A

Anteversion
Normal 8-15 of IR
If excessive more IR and lack of full ER
Normal cartilage end feel

Retroversion
Relative retroversion 0-8 IR on craig
Absolute retroversion - less than 0 or any amount of ER
More ER lack of full internal rotation
Normal cartilage end feel with IR
Out-toeing gait pattern
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16
Q

Describe angle of inclination

A

Angle between the femoral neck and shaft of femur - 120-135
Coxa valga >135
Coxa Vara < 120
Coxa plana - flat femoral head

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17
Q

Describe synovitis and hemarthrosis

A
  • Synovitis
    excessive synovial fluid accumulation in the capsule due to synovial irritation
    Gradual effusion 6-12 hours
    dull/ achy pain
    Swelling end feel, may be empty in severe cases
    Rest/PRICE
 - Hemarthrosis
Blood in joint capsule due to severe trauma, blood needs to be removed immediately
Sudden effusion
Very painful, hot/inflamed
Very painful - no end feel
Aspiration of blood, rest/PRICE
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18
Q

Describe Osgood-Schlatter disease

A

osteochondrosis /apophysitis of tibial tubercle
Results in bigger tibial tuberosity
May result in avulsion fracture

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19
Q

What are some common tendinopathies of the knee

A

Patellar
Pes anserine
Popliteus
Semimembranosus

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20
Q

Describe patellar tendinopathy

A

Jumper’ knee - common in people who eccentrically load the patellar tendon
May be similar to osteochondrosis of the tibial tubercle

 - Presentation
Pain on to the inferior pole of the patella
Load related pain that increases with the demand of the knee extensors
Pain palpating patellar insertion
Pain with loading
Dose dependent pain
No pain when resting
Pain improves with warm up
Pain after energy storage exercise
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21
Q

Describe pes anserine tendinopathy

A

Proximal medial knee pain

All have different actions at the hip

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22
Q

Describe popliteus tendinopathy

A

Attaches to posterior capsule and lateral meniscus
IR of tibia flexes and unlocks the knee
Should be able to differentiate from semimembranosus due to location and actions that produce pain
Lateral side pain

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23
Q

Describe semimembranosus tendinopathy

A

Pain with hip extension

Medial side pain

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24
Q

Describe Iliotibial band friction syndrome

A

Not a TSI
Friction as the TFL passes over the lateral femoral condyle
Could be caused by TFJ or PFJ capsular issues, muscle imbalances, TFL tightness
Reduce stress, heat, ice, strengthen hip abductors, stretch ITB

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25
Describe patello femoral pain syndrome
Most common injury of the LE Anterior knee pain Patellar mal alignment Not TSI With PFPS patella tracks laterally Closed chain femoral ADD and IR overpower femoral ABD and ER, causing excessive IR and ADD of the femur Lateral tracking is due to the femur rotating internally and adducting Treat weak glutes, or hypertonic IR and ADD
26
What are some contributing factors to PFPS
``` Anatomic structure Gender Q angle Subtalar joint position Muscle imbalances Landing pattern Altered core/ LE kinematics Soft tissue restrictions ```
27
What are some interventions for PFPS
``` NSAIDs Minimize PFJ loading Stretch lateral structures Correct muscle imbalances Tapping Activity modification ```
28
Describe chondromalacia patella
May cause anterior or retro patella knee pain Softening or wearing of posterior patellar articular cartilage cartilage - Types Age dependent - symptomatic Trauma dependent - symptomatic
29
Describe TKR
``` - Indications Pain and physical/functional limitations due to OA Rheumatoid arthritis Ligamentous instability Infection Avascular necrosis ``` The goal is to prevent these whenever we can Treat OA before it gets to this point 3 parts of the replacement Metal femur, metal tibia, plastic cap for patella
30
What are some TKR complications
``` Embolism Poor healing Infection Fractures Neurological/ Vascular injuries Extensor mechanism disruption Restricted ROM ```
31
What variable predicts post operative knee ROM
pre-operative knee ROM
32
Describe symptomatic plica
Thickening of knee joint synovium Hard to confirm, diagnosis of exclusion Remnant of synovial folds in the developing knee Anterior or medial knee pain
33
Describe tibial plateau fractures
- Crushing injury to the tibial plateau - MOI Valgus force in elders Blunt force trauma to plateau - Complications Intra articular adhesions/stiffness DJD Damage to popliteal structures - Treatment Closed reduction-external fixator Closed reduction-internal fixation
34
Describe the concept of reflex inhibition
Joint effusion causes reflex inhibition in the surrounding muscles Could lead to atrophy Treat effusion before strengthening
35
Describe patellar dislocation
Acute trauma or overuse injury Subluxation - patella slides back into position normally ``` - presentation Swollen knee with hemarthrosis Patella laying on lateral side of knee If suddenly returns its a subluxation Guarding and apprehension No weight bearing on involved leg ``` - treatment Closed reduction with extended knee brace External support - Complications Repetitive dislocations Articular damage, chondromalacia patella, degeneration
36
Describe the plica stutter test
Positive if patella jumps or stutters between 45 and 60 degrees of flexion Only effective if there is no swelling Not a great test
37
Describe the knee joint capsule
3 compartments Medial and lateral tibiofemoral Patellar compartment Cruciate ligaments - extracapsular Popliteus - intracapsular Gastroc - extracapsular
38
Describe how the cruciate ligaments can affect the PROM A findings at the knee
Cruciate ligament position Intra articular Could lead to positive PROM A findings when injured
39
Describe a healthy ACL
Extra capsular with fibers blending with joint capsule Taut in full knee extension and tibial internal rotation Limits anterior tibial translation and posterior femoral translation
40
Describe injuries to the ACL
- MOI non contact - valgus/ER force Contact - valgus/ hyperextension - Unhappy triad ACL, MCL, Medial meniscus injury - ACL injury examination Limit anterior tibial translation Avoid terminal open chain knee extension in early phases Closed chain knee extension to decrease shear forces - ACL intact Vs. Torn Patellar and hamstring graft commonly used to repair
41
Describe a healthy PCL
Extra capsular Taut in full knee flexion and tibial internal rotation Limits posterior tibial translation in NWB and anterior femoral translation in WB
42
Describe PCL injuries
``` - MOI Falling on flexed knees Direct blow to anterior tibia Forced hyperflexion/hyperextension Fall onto tibia - where the tibia is forced posteriorly ``` - PCL injury examination Limit posterior tibial translation Avoid terminal knee flexion in early phases Strengthen quads early to decrease posterior tibial translation Closed chain flexion before open chain
43
Describe a healthy MCL
Medial epicondyle to shaft of tibia Extracapsular but blends with capsule and medial meniscus Taught in full extension and ER of Tibia Restrains excessive valgus/ABD force Prevents anterior displacement of tibia on femur
44
Describe an injured MCL
MOI - valgus stress Diagnosis - valgus test Considerations - attaches to Med meniscus and SM
45
Describe a the LCL
Lateral epicondyle to fibular head MOI blow to medial knee Varus test
46
Describe meniscal tears
Function - lubrication, load distribution, shock absorption Medial injuries are more common than lateral - less mobile Medial meniscus attachments - tibia, MCL, capsule semimembranosus Lateral meniscus attachments - tibia, capsule, popliteus - MOI Non-contact rotational/ twisting force with varus/valgus stress during weight bearing contact Presents with acute joint line tenderness clicking/popping is common Types of tears - TSI Medial or lateral tear Prognosis changes with central vs peripheral Peripheral may heal on their own
47
Describe some meniscal tear interventions
meniscectomy/ excising the menisci Meniscus repair-arthroscopy To protect the sutures used in the repair WB is not allowed early in recovery With meniscectomy WB is allowed and could happen, as they begin to weight bear they need to make sure not to overdo it in their early phase of healing Look above and below the knee and see if there is anything that may cause stress to the meniscus repair
48
Describe a lateral ankle sprain
77-83% anterior talofibular ligament ATFL fibers blend with capsule CLF is extracapsular - MOI ATFL/CFL - INversion and PF CF alone or along with ATFL - inversion and neutral df/pf Sequence of injury Anterior talofibular ligament sprain is the most common in the body Because of its capsular plend it may present with positive PRM a findings Rick factors intrinsic / extrinsic - Prognostic factors Grade of injury Age Recurrence ``` - complications Chronic ankle instability Clinical findings are based on age Additional injuries Peroneal tendons, nerves, other injuries ```
49
Describe some uncommon ankle sprains
Medial/ eversion sprain to the deltoid ligament 5% occurrence High ankle sprain - anterior/ posterior inferior tibiofibular ligament or interosseous membrane MOI - dorsiflexion, eversion, external rotation or planted foot
50
What are some differences between fractures and sprains in the structures of the ankle
Bone heals faster due to better vascular supply Ligament collagen heals weaker than before Ligament sprains can decrease proprioception increasing chances of recurrence At the ankle stability is provided mostly by the ligaments rather than the muscles, placing more strain on other ligaments if one it torn
51
What are some types of ankle fractures
Unimalleolar - one malleoli Bimalleolar - two malleoli Trimalleolar - bothe malleoli and posterior margin of the tibia Pott’s fracture/ dislocation - any dislocation and fracture of malleoli
52
What are some types of tibial fractures
Acute Oblique Stress
53
What is the required great toe mobility
45-65 degrees to walk normally lack of this can affect the windlass effect Limitations - muscular imbalances or joint pathology
54
What are the differences between hallux limits and hallux rigidus
Hallux limitus: 1st MTP progressive degenerative disorder - less extension Hallux rigidus: 1st MTP joint ankylosis - even les extension ``` - Presentation 1st ray DF stiffness Pain, swelling, tenderness Gait deviations Difficulty running and stair walking ``` - Interventions ``` Limitus Rest/NSAID Orthoses/shoe modification Manual therapy Therapeutic exercises ``` Rigidus - upward rotation blocked by bone spur Surgical - cheilectomy
55
Describe hallux valgus
1st MTP joint alignment deformity Hallux and first 1st MT shift medially More common women, could be hereditary Bunion - overgrowth of bone and tissue on the medial side of the 1st MT head - Structural vs functional Functional - if big toe is brought into abduction and the bunion disappears it is functional Structural - if it stays it is structural
56
Describe a tailors bunion
Bunion of the 5th MTP on lateral side of the foot Irritation and pressure to the 5th metatarsal head May have overlapping fifth toe or varus deformity of toe Could be hereditary
57
Describe hammer toes, claw toes and mallet toes
- Hammer toes Extension of MTP and DIP Flexion of PIP Claw toes Hyperextension of MTP Flexion of PIP and DIP - Mallet toes Flexion of DIP
58
Describe an Achilles tendon rupture
- Etiology Spontaneous microtrauma/tendon degeneration Steroid injections - MOI - sudden push off or DF
59
Describe Metatarsalgia
Pain under plantar aspects of MT heads Repetitive high loading under MT heads Global diagnosis not TSI
60
Describe Interdigital Neuroma
Interdigital Neuroma Aka morton’s neuroma Thickened tissue around the interdigital nerve Causes chronic id nerve irritation and trauma ``` - Presentation Tenderness b/w the metatarsal heads Neurological symptoms Imaging required to confirm the neuroma Neuroma does not respond to neuroma and requires surgical excision ```
61
What are the differences in presentation between Metatarsalgia and Interdigital Neuroma
- Metatarsalgia Pain under MT heads No neurological symptoms - Morton's neuroma Pain between MT heads Neurological symptoms present
62
Describe Server's disease
Calcaneal osteochondritis-calcaneal traction apophysitis | Heel pain in young and active children
63
Describe compartment syndrome
Compartment Syndrome Increased tissue pressure within a closed orofacial space Compromised local blood flow- neurovascular compromise ``` - Presentation 5 Ps Pain paralysis Paresthesia Pallor Pulses ``` - Acute/traumatic MOI Tight bandage / plaster cast Decreased arterial flow increased venous pressure - Chronic MOI Exertional, exercise induced Acute CS is a clinical emergency and needs to be treated by a physician PT’s treat chronic or exercise induced
64
What are the regions of CS and what structures are at risk in each region
- Anterior Deep peroneal nerve Anterior tibial artery and vein Dorsiflexors - Lateral compartment Superficial peroneal nerve Peroneal - Deep posterior compartment Tibial nerve Posterior tibial and peroneal artery and vein Tom dick and harry
65
Describe medial tibial stress syndrome
Tibial periostitis/tibial stress syndrome/shin splints Medial soleus or posterior tibialis Exercise induced anterior and medial leg pain - presentation Anteromedial tibial tenderness Activity induced Resolves with rest - Causes Biomechanical imbalances Poor training ``` - Interventions Correct biomechanical impairments Activity modification Proper training surgical ```
66
Describe anterior tibial periostitis
Muscles - tibialis anterior, EHL Exercise induced anterior and lateral leg pain ``` - presentations Anterolateral tibial tenderness Activity modification Resolves with rest Treatment similar to shin splints ```
67
Describe plantar heel pain
Aka plantar fasciitis/ fasciopathy/ fascialgia ``` - Contributing factors Obesity occupational Acute injury anatomical biomechanical Can be TSI ```
68
What are the presentations and interventions that go along with plantar heel pain
``` - presentation Plantar surface tenderness Aggravating factors swelling Positive windlass test Limited TCJ mobility Kinetic chain impairments ``` - Interventions - treat the biomechanical impairment splinting / orthotics/ taping/shoe modification Therapeutic exercises - stretching/ strengthening Physical agents Patient education Activity modification Manual therapy-soft tissue and joint mobilizations Kinetic chain
69
What is Homans sign
Special test that tests for deep vein thrombosis Poor test Positive if tenderness on the calf
70
Describe a pronated foot
Increased angulation b/w hindfoot and forefoot Some pronation during Gait is required Weak and hypermobile flat foot - Causes congenital , developmental acquired
71
Describe Flat foot
PES planus Decreased medial longitudinal arch Acquired/ rigid or flexible/ mobile flatfoot
72
Describe high foot
``` Pes cavus or high arch Abnormally supinated / stiff foot, high longitudinal arch Tibial external rotation Rigid/mobile Neurological and muscular causes ```
73
Describe rearfoot varus and vallgus
Hindfoot/ rearfoot varus Calcaneus varus/calcaneal inverted/ supinated rearfoot Associated with tibia vara or pes cavus Rearfoot valgus Calcaneus valgus/ cancaneal everted, pronated rearfoot Associated with tibia valga or pes planus
74
Describe how rearfoot varus and valgus affect the kinetic chain
Forefoot varus - hindfoot valgus - Knee valgus/ tibial IR - Hip IR Forefoot valgus - hindfoot varus - knee varus/ ER - Hip ER
75
Describe the rays of the foot
1st - metatarsal, medial cuneiform 2nd - intermediate cuneiform 3rd ray - metatarsal, lateral cuneiform 4th and 5th
76
Describe pronation and supination at the talocrural joint
- Pronation Dorsiflexion and tibial IR Posterior talar glide and medial talar glide - Supination Plantarflexion and Tibial external rotation Anterior glide of the talus and lateral talar glide
77
Describe pronation and supination at the subtalar joints
- pronation Eversion Lateral arc glide - supination inversion Medial arc glide 2:1
78
Describe pronation and supination in the forefoot
- Forefoot pronation 1-2 TMT - plantar glide 3-4 TMT - dorsal glide - Forefoot supination 1-2 TMT - dorsal glide 3-4 TMT - plantar glide

TRI 2 - MSK (3 decks)

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