Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CASEM > High Yield 3 > Flashcards

High Yield 3 Flashcards

1
Q

MOI + RF DIP dislocation

A

MOI - Hyperextension injury of DIP joint
RF: basketball, football, baseball
Usually dorsal dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Physical for DIP dislocation

A

Hold PIP joint in extension, check FDP + extensor function
Apply radial + ulnar stress at full extension + 30 degrees flexion to look for laxity
If increased hyperextension of joint = volar plate injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

XRs for DIP dislocation

A

AP, lateral, oblique if won’t delay reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of DIP dislocation

A

Apply steady traction to distal finger
If irreducible - refer to ortho
Splint in slight flexion for 1-2 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MOI for PIP dislocation

A

Hyperextension or hyperflexion, entrapment between objects, fall
Usually dorsal dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physical for PIP dislocation

A

Volar tenderness = volar plate injury
Lateral joint line tenderness = collateral ligament injury
Dorsal tenderness = central slip injury
Extend PIP + DIP joints
If unable to extend PIP but able to extend DIP, think central slip rupture
Flex DIP + PIP joints
If unable to flex DIP joint, consider FDP rupture = refer to plastics
Apply radial + ulnar stress at full extension + 30 degrees flexion to look for laxity
If increased hyperextension of joint = volar plate injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

XRs for PIP dislocation

A

AP + lateral if won’t delay reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of PIP dislocation

A

Apply steady traction to distal finger
Splint for 1-2 wks in slight flexion until pain free
If co-existing volar plate injury, splint for 4-5 wks
Buddy tape for additional 3-4 wks
Could buddy tape alone for 3-6 wks if no volar plate injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Dupuytren’s Contracture?

A

Contracture of palmar fascia causing flexion deformity
Autosomal dominant
Often bilateral
Ring finger more frequent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RF for Dupuytren’s Contracture

A

Males
Northern European
Fam hx
Smoking
Alcohol use
Increasing age
Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sx of Dupuytren’s Contracture

A

Mild pain
Later, painless lump on palm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Physical of Dupuytren’s Contracture

A

Firm nodule in palm of hand proximal to MCP
Hueston tabletop test - positive if pt unable to flatten hand on table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of Dupuytren’s Contracture

A

Steroid shot or collagenase clostridium histolyticum shot
Surgery - partial fasciectomy if contracture reaches 30 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the TFCC?

A

Primary stabilizers to distal radioulnar joint
Cushion to carpal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOI of TFCC injury

A

Acute collision (fall on outstretched hand, traction or hyperrotation)
Repetitive injury (chronic loading of ulnar wrist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sx of TFCC injury

A

Ulnar sided pain + clicking
Weak hand grip
Pain pushing out of chairs
Pain w/ pronation, supination or extension w/ axial load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Physical for TFCC injury

A

TFCC compression test positive
Fovea sign (point tenderness at recess of TFCC)
Ulnar compression test to r/o instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ix for TFCC injury

A

Lateral + PA XRs
MRI
Arthroscopy can be diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DDx for TFCC injury

A

Tendinopathy (ECU, FCU)
DRUJ instability
Carpal instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management + RTP of TFCC injury

A

Conservative up 8-12 wks
NSAIDs
Immobilization (ulnar deviation, slight volar flexion) in short arm cast x4-6 wks if traumatic
Surgery
If sx persist despite immobilization or if any instability
RTP
3mo post op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Carpal tunnel syndrome, and what are the causes?

A

Entrapment of median nerve
Can be acute but usually chronic
Idiopathic
Inflammation, trauma, tumors, OA, RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hx of Carpal tunnel syndrome

A

Pain, weakness, paresthesias on palmar surface of first 3 ½ digits
Nighttime sx
Improved w/ flicking hands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

RF for Carpal tunnel syndrome

A

Females
Increasing age
Repetitive wrist motion
Pregnancy (usually 3rd trimester + often bilateral)
Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Physical for Carpal tunnel syndrome

A

Positive Tinel sign
Positive Phalen test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

DDx for Carpal tunnel syndrome

A

De Quervain tenosynovitis
C6-7 radiculopathy
Ulnar neuropathy
Brachial plexus neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Management of Carpal tunnel syndrome

A

Conservative
Splinting (24/7 ideally but nighttime still helpful)
NSAIDs
Steroid shot
Oral steroids

Surgery
If failed conservative therapy or severe sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is Ulnar Tunnel Syndrome, what are the types?

A

Compression of ulnar nerve in Guyon canal
1 = combined motor + sensory
2 = motor only
3 = sensory only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

RF for Ulnar Tunnel Syndrome

A

Repetitive occupational wrist trauma
Baseball catchers
Cyclists
Racquet sports
Wheelchair athletes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Sx of Ulnar Tunnel Syndrome

A

4th + 5th digit paresthesia
Weakness of grip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Physical for Ulnar Tunnel Syndrome

A

Positive Tinel sign at pisiform
Sensory loss at tip of little finger
Weakness w/ resistance of adductor pollicis
Decreased grip strength
Ulnar claw hand w/ paralysis of the deep motor branch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

DDx for Ulnar Tunnel Syndrome

A

Proximal ulnar entrapment
Calcific tendonitis of FCU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of Ulnar Tunnel Syndrome

A

NSAIDs
Steroid shot
Splinting
Surgical decompression
RTP 4-8 wks after surgical decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Sx of Cubital Tunnel Syndrome/Ulnar nerve entrapment

A

Medial elbow + forearm pain
Paresthesias in 4th + 5th digits
Worsening grip
Clumsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

RF for Cubital Tunnel Syndrome/Ulnar nerve entrapment

A

Males
Overhead throwing athletes
Repetitive upper extremity activities
Diabetes
Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Physical for Cubital Tunnel Syndrome/Ulnar nerve entrapment

A

Pain w/ palpation of cubital tunnel
Elbow flexion test: flex the elbow past 90°, supinate the forearm, and extend the wrist. Results are positive if discomfort is reproduced or paresthesia occurs within 60 seconds. The addition of shoulder abduction may enhance the diagnostic capacity of this test.
Positive Tinel test in ulnar groove
↓sensation of little finger
Loss of grip and pinch strength and loss of fine dexterity, clawing of baby finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Management of Cubital Tunnel Syndrome/Ulnar nerve entrapment

A

Conservative: rest (minimize elbow flexion), splint or foam elbow pad, NSAIDs
Surgery if sx after 3mo
Screen overhead athletes for ulnar collateral ligament instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a Colles #?

A

Distal rad # w/ Dorsal displacement
Silver fork deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is a Smith #?

A

Distal rad # w/ Volar displacement + angulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is a Barton #?

A

Fracture dislocation of distal rad w/ displacement of carpus w/ distal fragment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a Hutchinson/ Chaffeur #?

A

Lateral-oriented # through radial styloid process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is a Galeazzi #?

A

Fracture of distal ⅓ of radius w/ dislocation of distal ulnar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is a Monteggia #?

A

Ulnar fracture Radius dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MOI + RF for distal radius #

A

FOOSH w/ wrist in extension

OP
Falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Sx + exam for distal radius #

A

Pain, swelling, limited ROM

Wrist exam
Tenderness dorsal aspect of wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Ix for distal radius #

A

XRs (consider bilateral) - AP + lateral of wrist, forearm + elbow
CT for surgical planning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Management of distal radius # (displaced, non displaced, general management, recovery timeframe)

A

Non displaced
Immobilised in radial gutter splint
Repeat XR in 3 days
Short arm cast 4-6 wks
Repeat XRs q2wks
Displaced
Finger trap reduction
Repeat XR in 3 days
Long arm cast 3-4 wks then short arm cast 3-4 wks
Repeat XRs weekly

Vitamin C 500mg PO x50 days reduces incidence of CRPS
Activity modification recommendations + home exercises
Time frame for recovery
6-8 wks in adults
3-4 wks in kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When to refer to ortho for distal radius #

A

Open #
Unstable
Neurovascular compromise
Tenting
Significantly displaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Complications of distal radius #

A

TFCC injury
Median nerve neuropathy
Ulnar nerve neuropathy
Malunion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Prevention of distal radius #

A

Wrist guards during high risk activities (beginner snowboarders)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

MOI for Scapholunate ligament injury

A

FOOSH
Axial compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Sx of Scapholunate ligament injury

A

Pain and swelling in dorsal wrist
Pain or weakness w/ hyperextension + loading of wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Physical for Scapholunate ligament injury

A

Wrist effusion in acute injuries
Tenderness between lunate and scaphoid
Pain in loaded wrist extension (Ex. push up)
Increase in pain with combined movement of extension and radial deviation of the wrist
Positive Watson test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Ix for Scapholunate ligament injury

A

Wrist x-rays: AP, lateral, scaphoid view, pencil grip PA, clenched fist view
Clenched fist views may show widened gap between the scaphoid and the lunate (> 3mm is concerning)
Comparison views

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

DDx for Scapholunate ligament injury

A

Scaphoid #
Radius #
Synovitis
OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Management of Scapholunate ligament injury

A

Stabilize w/ thumb spica splint + refer to plastics
Immobilization x6 wks in short arm cast - may be effective in partial tear or patients with lower functional requirements
If complete tear or unstable, refer to surgeon
Immobilize post op x8 wks
RTP when showing progression in strength + ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

MOI Ulnar styloid #

A

FOOSH
Often associated w/ distal radius #

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

MOI for monteggia #

A

Usually in children
Direct blow to posterior elbow
Hyper-pronated force on an outstretched arm
Contracted biceps resists forearm extension causing dislocation and followed by impact leading to ulna fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Types of metacarpal shaft #

A

Transverse, oblique/ spiral, comminuted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Types of metacarpal base #

A

Intra-articular:
Bennett fracture: fracture combined with a subluxation or dislocation of the metacarpal joint
Rolando fracture: T- or Y-shaped fracture involving the joint surface

Extra-articular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

MOI of metacarpal neck #

A

axial load on MCP joint while in flexed position (throwing a punch)
AKA Boxer’s # - most common hand #

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Sx + physical of metacarpal neck #

A

Immediate pain + swelling
Extreme angulation can cause pseudoclawing (hyperextension of the MCP joint along with proximal interphalangeal (PIP) joint flexion as the patient attempts to extend the finger)
Evaluate for malrotation by getting pt to bring fingernails into palm - should point towards base of 1st metacarpal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

XRs for metacarpal #

A

AP, oblique, true lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Management of metacarpal neck #

A

NSAIDs, reduction if significant angulation (flex the MCP, PIP, and distal PIP joints all to 90 degrees. Apply dorsally directed pressure along the proximal phalanx shaft through the flexed PIP joint while simultaneously applying volarly directed pressure over the proximal fracture fragment)
Immobilize in radial (for 2nd + 3rd) or ulnar (4th + 5th) gutter splint with the wrist in 30 degrees extension, MCP joint in 70 to 90 degrees of flexion, and PIP/distal interphalangeal (DIP) joints near full extension x3-4 wks
Surgery if significant angulation or any malrotation, open #
RTP when pain free ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

MOI metacarpal base + shaft #

A

Direct blow versus indirect blow with rotational torque: Rotational torque often leads to spiral fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

physical for metacarpal base + shaft #

A

Tenderness + swelling dorsal hand
Pain w/ motion
Inability to make fist
Evaluate for malrotation
All the fingers of a semiclenched fist should point to the scaphoid tubercle.
In comparison to the asymptomatic hand, no crowding or digital overlap should be present when the digits are fully flexed.
With metacarpophalangeal (MCP) at 90 degrees flexion and digits in extension, the plane of the fingernails should be parallel on the injured and normal hand
Flexor + extensor tendon function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Management of metacarpal base + shaft #

A

Splinting
Reduction (for transverse fractures, isolated spiral/oblique fractures with <3 mm of shortening, and extra-articular fractures of the thumb)
Closed reduction of metacarpal shaft fractures is performed with longitudinal traction, dorsal pressure at the fracture site, and rotation as needed.
Closed reduction of extra-articular base fractures typically requires only longitudinal traction.
Post reduction XRs + XRs 1 wk after
Ulnar gutter splint for 3 to 4 wk for extra-articular metacarpal base fractures if ring and/or little finger(s) are involved
Volar or radial gutter for 3 to 4 wk for extra-articular metacarpal base fractures of index and long finger
Functional brace (Galveston) if fracture requires significant reduction
Thumb spica cast for extra-articular fractures of the thumb for 4 to 6 wk
Referrals
Referral is needed for unstable or unsatisfactory reductions in children.
Long oblique and spiral fractures typically require closed reduction and percutaneous pinning in children
Metacarpal fractures that are more distal and ulnar are better tolerated and are more amendable to nonoperative treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is a Stener lesion?

A

Displacement of the ruptured ligament proximal to the adductor pollicis aponeurosis, effectively preventing healing without surgical intervention
Common w/ complete tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is a skier’s thumb injury?

A

UCL Injury +/- avulsion #

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

RF for skier’s thumb

A

Ski poles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

MOI for skier’s thumb

A

Stress to the thumb in extended and/or abducted position
Usually in skiing but often occurs in other sports, such as football and mixed martial arts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Sx + physical of skier’s thumb

A

Pain at origin + insertion of UCL
Swelling over ulnar aspect of 1st MCP joint

Mild-to-complete instability on stress testing of UCL with MCP joint in flexion, depending on whether it is a 1st-, 2nd-, or 3rd-degree sprain:
Tested at 0 and 30 degrees of metacarpal phalangeal joint flexion
There is significant side-to-side variability in UCL testing in noninjured individuals
Most important physical finding is lack of an end point because this indicates complete ligament disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Imaging for skier’s thumb

A

XR: PA, lateral, stress views. Consider local anesthetic infiltration prior to XRs
Sag sign - Volar subluxation of the proximal phalanx in relation to the metacarpal at the MCP joint may indicate UCL injury
May need MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

DDx for skier’s thumb

A

Radial collateral ligament sprain
Metacarpal fracture
Proximal phalanx fracture
MCP sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Management of skier’s thumb

A

Acute - ice, elevation, immobilization

Partial tears or complete tears without stener lesion - non surgical
Protection with thumb spica splint or cast
2 to 4 wk of immobilization followed by 2 to 4 wk of protection during activity
Start range of motion after period of immobilization.
Progress to strengthening exercises as symptoms allow.

Avulsion #
Thumb spica cast x4-6 wks

Complete tears w/ Stener lesion or chronic instability
Surgery
Cast or splint x4-6 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Complications of skier’s thumb

A

Instability leading to decreased pinch strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Qs to ask in hx of wrist laceration

A

Hand dominance
Pain
Numbness + tingling
Loss of strength
Bleeding
Tetanus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Physical exam for wrist laceration

A

Inspection - swelling, bleeding, visible tendons/ nerves, hand/ finger resting position
ROM: wrist flexion and extension, ulnar and radial deviation, supination, pronation
Test flexor digitorum superficialis (FDS) by flexing DIP and flexor digitorum profundus (FDP) by flexing PIP and test extensors with flexed MCP
Neuro: test sensation in ulnar and median nerve distributions, radial on dorsum
Vascular: check radial pulse, cap refill
Volar laceration: median and ulnar nerves, FDP, FDS, flexor pollicis longus, flexor carpi radialis and ulnaris, ulnar and radial arteries
Dorsal laceration: extensors and retinaculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Management of wrist laceration

A

Control bleeding
Tetanus if not up to date
If nerve or tendon injury refer to plastics for repair, clean and cover wound
Worse prognosis is associated with injuries in zones II and IV, due to the propensity to form adhesions between tendons within a confined space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

MOI + sx of acute scaphoid #

A

FOOSH
Sx:
Pain and swelling in wrist
Worse w/ gripping + squeezing

79
Q

Physical for acute scaphoid #

A

Wrist effusion
Tenderness in anatomical snuffbox (dorsal) and/or scaphoid tubercle (volar)
Pain with resisted pronation
Reduced grip strength

80
Q

Ix for acute scaphoid #

A

Wrist x-rays - PA, true lateral, oblique, scaphoid specific (PA of wrist in full pronation + ulnar deviation) + clenched fist views
Look for >3mm scapholunate widening
X-rays may be normal initially, therefore immobilization in thumb spica and repeat x-rays are recommended in 2 weeks if there is clinical suspicion.

If suspicion is still high, can do MRI for radiologically occult fractures.

81
Q

Management of acute scaphoid #

A

Stable, non-displaced, waist or distal pole fractures: Immobilization in thumb spica splint or cast. The immobilization time is longer than for other upper extremity fractures. Need to regularly follow and document radiologic healing.
Unstable, displaced > 1mm, vertical or oblique, proximal pole fractures, or any concerning features: Immobilization in thumb spica splint or cast and refer to orthopedics for surgery, semi-urgent.

82
Q

DDx for acute scaphoid #

A

Scapholunate dissociation
Distal radius fracture
Extensor carpi radialis sprain
1st metacarpal fracture
Flexor carpi radialis sprain
Carpometacarpal or radiocarpal arthritis

83
Q

Complications of acute scaphoid #

A

Non union - more common in pole #
AVN leading to OA
Chronic SLAC

84
Q

What is a Mallet finger?

A

Mallet finger is defined as a stretching or tearing of the extensor tendon or a complete avulsion of the tendon insertion from the dorsal base of the distal phalanx with or without bony avulsion

85
Q

MOI Mallet finger

A

Sudden forced flexion of the fingertip while the DIP joint is actively extended (struck on tip of finger by ball)
Less commonly, it can occur when the DIP joint is forcefully hyperextended with a resulting fracture at the dorsal base of the distal phalanx

86
Q

Sx + physical of Mallet finger

A

Pain, swelling, and deformity at the DIP joint of the affected finger
Tenderness especially at the dorsal aspect, with inability to actively extend the DIP joint

Physical
Tenderness on palpation over dorsum of DIP joint
Inability to actively extend the distal interphalangeal (DIP) joint

87
Q

Ix for Mallet finger

A

XRs - PA, lateral, oblique (to assess for avulsion #)

88
Q

Management of Mallet finger

A

Splint in full extension - no flexion should occur
6-8 wks
Monitor compliance at 2 wk intervals
At the end of continuous immobilization, if a mallet deformity of >20 degrees recurs, continue splinting for an additional 1 to 2 mo.
Consider extension splinting during athletic activities for an additional 2 mo after continuous splinting has been completed.
After splinting, ROM exercises

89
Q

Complications of Mallet finger

A

Swan neck deformity if untreated or poor compliance

90
Q

What is a Jersey finger?

A

Flexor tendon avulsion injury

91
Q

MOI Jersey finger

A

In classic cases this injury happens when a player goes to grab a jersey of an opponent. The DIP is in flexion, holding onto the jersey, and then is suddenly pulled into extension as the opponent pulls away. This causes avulsion of the FDP tendon off the distal phalanx

92
Q

Sx + physical for Jersey finger

A

Most common in ring finger
Pain, swelling and weakness in flexion at DIP

Physical
DIP may be in slight extension
Unable or very weak flexion at DIP
Joint swelling and pain to palpate volar aspect of the joint
Sometimes can palpate retracted tendon

93
Q

Ix for Jersey finger

A

XR (AP, lateral, oblique) to r/o bony fragment
MRI

94
Q

DDx for Jersey finger

A

DIP joint dislocation
Distal phalanx fracture
Flexor digitorum superficialis avulsion

95
Q

Management of Jersey finger (immediate, general + RTP)

A

Immediate: dorsal splint to maintain slight flexion at DIP + PIP
Refer urgently to ortho for surgery
Post surgery: dorsal blocking splint w/ wrist in midflexion, MCP joints at 75 degrees flexion + PIP/DIP joints in extension x6 wks
Strengthening at 12 wks
RTP = 4-6mo

96
Q

What is a trigger finger?

A

Nodule on flexor tendon catching on first annular (A1) pulley

97
Q

RF for trigger finger

A

Females
Age <8yrs or 55-60 y/o
Diabetes
RA
CTD
Repetitive trauma w/ compressive force against MCP (arc welding)

98
Q

Hx + sx of trigger finger

A

Painful catching/clicking with finger flexion or extension
Pain over MCP; may refer to palm or proximal interphalangeal (PIP) joint
Digit may be locked, usually in flexion.
Stiffness develops with prolonged symptoms

99
Q

Physical of trigger finger

A

Tender, palpable nodule on flexor tendon, just proximal to MCP
Active fist closing reproduces lock/snap.

100
Q

DDx of trigger finger

A

Dupuytren contracture
Carpal tunnel syndrome
Gamekeeper’s thumb
RA
Tendon sheath ganglion

101
Q

Management of trigger finger

A

Activity modification
Splinting of MCP joint at 10 to 15 degrees of flexion × 6 to 10 wk
Steroid injection into tendon sheath
NSAIDs
Surgical release of A1 pulley if:
locked digit or pediatric trigger thumb, although there is increasing argument toward conservative management for the latter
Indicated if repeat injections ineffective

102
Q

Complications of trigger finger (if untreated, of injection + of surgical release)

A

If untreated:
PIP joint flexion contracture
Distal triggering from FDS tendon degeneration
Of injection:
Fat atrophy and necrosis
Local skin depigmentation
Theoretical risk of tendon rupture
Of surgical release:
Bowstringing of flexor tendon
Second annular (A2) pulley injury
Digital nerve injury
Infection
Long-term scar tenderness

103
Q

Causes of hip labral tear

A

Trauma
Repetitive movement

104
Q

RF for hip labral tear

A

Dysplasia
FAI
Ballet, golf and swimming, football and hockey

105
Q

Hx + sx for hip labral tear

A

Pain in the hip or groin, often made worse by long periods of standing, sitting or walking or athletic activity
A locking, clicking or catching sensation in the hip joint
Stiffness or limited range of motion in the hip joint

106
Q

Physical for hip labral tear

A

FADIR painful
FABER normal

107
Q

Ix for hip labral tear

A

XR
MRA
US guided LA for diagnostic purposes

108
Q

Management of hip labral tear

A

Rest from aggravating activity
Strengthening of the pelvic and lower extremity muscles helps to stabilize the joint and correct abnormal pelvic tilt, relieving some of the abnormal stress placed on the labrum
If not working, consider arthroscopy

109
Q

Types of SCFE

A

Preslip
Acute
Acute on chronic
Chronic

110
Q

Sx of SCFE

A

Pain, stiffness, instability in affected hip
Can occur after trauma or a fall
May or may not be able to wt bear

111
Q

Physical for SCFE

A

Ht + wt
Knee, hip + back exam
Leg length
Shortened externally rotated leg
Decreased ROM of hip
Only do AROM
Positive Trendelenburg
Palpate adductors
Quadrant test
Tenderness over hip joint capsule
Positive Whitman sign - hip rotates externally and abducts when flexed
Thigh + gluteal muscle atrophy common in SCFE
Unstable SCFE - unable to wt bear, leg in ext rotation
Reduced ROM, muscle guarding, pain at extremes of motion

112
Q

Ix for SCFE

A

XR - AP, lateral, frogs leg view (Klein’s line, slip angle)
XR - slipper head of femur
Can have normal XRs initially - MRI then useful

113
Q

DDx for SCFE

A

Avascular necrosis/Legg-Calvé-Perthes disease (in younger age range)
Septic arthritis
Transient synovitis
Iliac apophysitis or apophyseal avulsion fracture at avulsion anterior inferior iliac spine (AIIS) and avulsion anterior superior iliac spine (ASIS)
Femoral cutaneous nerve entrapment (more common in muscular girls)
Proximal femur fracture
Avascular necrosis
Juvenile rheumatoid arthritis
Osteomyelitis

114
Q

RF for SCFE

A

Pre-teens + teens
Boys > girls
Rapid growth purt
Radiation therapy
Obesity
RF for bilateral slip: DM, hypothyroidism, black, hispanic, obese

115
Q

Complications of SCFE

A

AVN
Arthritis

116
Q

Management of SCFE

A

Non wt bearing
Emergent ortho for acute, urgent ortho for chronic
Usually in situ screw fixation to prevent further slippage or ORIF
If high risk, may fix other side
Wt bearing after 6 wks

117
Q

What is osteitis pubis?

A

Inflammation of pubic symphisis

118
Q

Sx of osteitis pubis

A

Gradual onset anterior medial groin pain
Reduced flexibility
Dull ache or sharp stabbing pain when running, kicking or changing direction or standing/ getting out of car
Loss of acceleration
Pain in hip, groin, testicles, adductors

119
Q

Physical for osteitis pubis

A

Reduced hip ROM
Lumbar spine/ SI joint dysfunction
Increased rectus abdominus tone
Pain provoked by active adduction if distal symphysis is involved
Squeeze test positive (adductors against resistance)
If pt gets pain more laterally, could be sports hernia

120
Q

Ix for osteitis pubis

A

XR (widening of pubic symphysis, although could be normal)
Flamingo test - pt stands on 1 leg while AP view taken - positive if >2mm vertical displacement of pubis
MRI

121
Q

DDx for osteitis pubis

A

Athletic pubalgia (sports hernia - pain more lateral + superior)
Adductor sprain (usually recovery quicker)
Inguinal hernia
Hip OA, labral tear, SCFE, FAI
Bursitis
Stress #
Osteomyelitis
Referred pain (lumbar, SI)
AS
Appendicitis, diverticulitis

122
Q

Management of osteitis pubis

A

Rx - relative rest (x2-3mo), NSAIDs, ice, stretching
Correct biomechanical abnormalities (leg length discrepancy, excessive pronation)
Core shorts

Activity modification recommendations + home exercises
Adductor strengthening (pelvic tilts, dynamic stabilization)
Abdo + hip strengthening
Time frame for recovery = 9 months

Refractory cases
PRP, steroid
Surgery w/ wedge resection in severe cases

123
Q

RF for osteitis pubis

A

Sports: running, football, soccer, ice hockey, tennis
Exercising on hard surface
Exercising on uneven ground
Training after long layoff
Increasing exercise intensity + duration too quickly
Ill-fitting shoes
Tight hip/ groin muscles
Leg length discrepancy
Males > females
Complication of suprapubic + pelvic surgery
pregnancy

124
Q

RF for abdo muscle strain/ tear

A

Poorly conditioned abdominal musculature or deficits in core strength
Previous abdominal wall muscle strain/tear
Poor weight training or conditioning techniques
Participation in activities that require abrupt and/or repetitive movements of the torso early in the sport season

125
Q

Sx + physical of abdo muscle strain/ tear

A

Can be acute or subacute
Abdo wall pain
Worse w/ active contraction

Physical
Tenderness

126
Q

DDx for abdo muscle strain/ tear

A

Abdominal wall contusion
Abdominal wall hematoma:
Swelling, periumbilical contusion, and a mass with rigidity and/or guarding are signs of a rectus sheath hematoma.
Abdominal wall hernia (umbilical, spigelian)
Intra-abdominal injury (contusion, laceration, perforation)
Intra-abdominal process (e.g., infection, mass)
Iliac apophysitis
Osteitis pubis

127
Q

Management + RTP of abdo muscle strain/ tear

A

Stop aggravating activity
Ice, compression wrap, NSAIDs
Rehab
Passive stretching
Strengthening
RTP = When no tenderness, normal strength
Usually 2-6 wks

128
Q

What is athletic pubalgia?

A

Sports hernia
Sports hernia is a syndrome of chronic pain d/t weakness or injury of any soft tissue in lower abdomen or groin
Most commonly oblique muscles or adductors attaching to pubis

129
Q

What structures could be involved in athletic pubalgia?

A

Rectus abdominus
Conjoint tendon (internal oblique + transversus abdominus)
External oblique
Adductor longus
Gracialis

130
Q

RF for athletic pubalgia

A

Males
Soccer, football, hockey, rugby

131
Q

Sx of athletic pubalgia

A

Activity-related lower abdominal and proximal adductor-related pain with quick acceleration, deceleration, kicking, twisting, or lateral movement
Often occurs in soccer players from hard or long kicks
Severe pain at time of injury or gradual onset
Reduced pain w/ rest
Increased pain w/ playing, twisting movements
Radiating pain to testes, adductors or lateral thigh
Aggravated by coughing/ sneezing, sex, valsalva

132
Q

Physical for athletic pubalgia

A

Resisted sit up = painful
Single or bilateral resisted leg adduction = painful

Diagnosis of sports hernia may be made if at least three of the following five signs exist:
Pinpoint tenderness to the pubic tubercle at conjoint tendon insertion
Tenderness over deep inguinal ring
Pain and/or dilation of the external ring with no palpable hernia
Pain at origin of adductor longus tendon
Dull diffuse groin pain often radiating to perineum and inner thigh or across the midline

Complete exam for other causes of groin pain should be performed:
Hip adductor origin tenderness AND pain with resisted adduction suggest adductor-related groin pain.
Tenderness at pubic symphysis suggests pubic-related groin pain.
Pain with resisted hip flexion AND/OR stretching of hip flexors suggests iliopsoas-related groin pain.
Hip joint–related groin pain may elicit pain with passive range of motion (ROM); flexion, adduction, and internal rotation (FADIR); and flexion, abduction, external rotation (FABER) tests.

133
Q

DDx for athletic pubalgia

A

Inguinal or femoral hernia
Hip adductor strain
Rectus abdominis strain
FAI
Osteitis pubis
Bursitis
Snapping hip syndrome
Femoral neck stress fracture
Pubic ramus fracture
Hip apophysitis or avulsion fracture
Nerve entrapment:
Obturator
Ilioinguinal
Genitofemoral
Iliohypogastric
Referred pain from lumbar spine or sacroiliac joint
Intra-articular hip pathology
Testicular/ovarian pathology
Spondyloarthropathy
Lymphadenopathy

134
Q

Ix, Management + RTP of athletic pubalgia

A

MRI
Rest x6 wks, compression wrap, NSAIDs,

Then PT rehab x6 wks to increase strength + flexibility in abdo + inner thighs
Initial focus on hip adductor stretching, then advancing to eccentric strengthening of abdominal oblique, rectus abdominis, and adductors, and then progressing to sports-specific functional exercise

RTP usually 8-12wks
If pain w/ RTP, consider surgery
Herniorrhaphy
RTP 6-12 wks post op

135
Q

What are the adductors?

A

adductor longus, magnus, and brevis; gracilis; obturator externus; and pectineus

136
Q

RF for adductor tendon injury/ groin strain

A

Increasing age
Previous adductor injury
Weak, inactive, or fatigued adductor muscles have less ability to absorb energy and are more likely to undergo acute strain.
Core muscle weakness

137
Q

Sx of adductor tendon injury/ groin strain

A

Stretch injury (abrupt cutting motion as in soccer or a straddling injury as in gymnastics, cheerleading, or horseback riding)
May have only minor discomfort with walking, but pain and weakness are noticeable with cutting or running

138
Q

Physical of adductor tendon injury

A

Classic triad of tenderness to palpation of the muscle and its bony attachments (proximal third of medial thigh and tendinous origin in pubic region), pain with passive stretching (hip abduction), and pain with resisted contraction (hip adduction)
Swelling, ecchymosis, and significant weakness increase suspicion for tear.
With complete rupture, palpable depression and retraction of torn muscle may be present

139
Q

DDx of adductor tendon injury

A

Osteitis pubis
Stress fracture of femoral neck or pubic ramus
Iliopsoas or rectus femoris tendonitis, iliopsoas bursitis
Avascular necrosis of femoral head
Groin disruption (sports hernia, Gilmore groin, athletic pubalgia)
Femoro-acetabular impingement, labral tear, osteochondral lesion, hip osteoarthritis
Myositis ossificans
Avulsion fracture, apophysitis in adolescents
Slipped capital femoral epiphysis (usually seen in early teens)
Inguinal hernia
Nerve entrapment, specifically obturator nerve
Referred pain from spine

140
Q

Management + RTP for adductor tendon injury

A

Protection, rest, ice, compression, and elevation (PRICE) is beneficial.
Heat may be added after 2 to 3 days.
Limit activity for 1-2 wks
Refer to ortho if grade 3 tear

PT
Isometric stretching
​​Progress to dynamic, eccentric strengthening, balance training, and proprioceptive exercises of hip and groin musculature

RTP
When pain free
Grade 1 = 1-3 wks
Grade 3 = 4-8 wks

141
Q

MOI for posterior hip dislocation

A

MVA, falls, high energy sports injuries

142
Q

Sx + physical for posterior hip dislocation

A

Immediate, severe pain, and disability
Limb shortening with hip flexion, internal rotation, and adduction. In the obtunded patient, the examiner may have to recognize the position of posterior hip dislocation if the patient is not able to verbalize.
Classic position may be absent if there is an associated femoral shaft fracture.
Vital signs and complete trauma evaluation essential because of the high association with life-threatening injuries
Pelvic rocking and pubic compression tests to examine for associated pelvic rim fractures
Distal neurovascular examination to assess for sciatic nerve or vascular injures, which merit more urgent reduction

143
Q

Imaging for posterior hip dislocation

A

XR - AP, lateral

CT before reduction in hip dislocation + suspected nondisplaced femoral neck #
Femoral neck # is CI to reduction

144
Q

Management of posterior hip dislocation

A

Reduction in under 6hrs reduces rate of AVN
Can be reduced in ED (1 attempt only) or operatively (best)

145
Q

Complications of posterior hip dislocation

A

AVN
OA
Sciatic nerve injury
Myositis ossificans
Recurrent instability
Labral tears

146
Q

Sx, physical findings + causes of iliopsoas injury

A

Aching pain, gradual onset, in groin or anterior thigh
Tenderness to pressure between midpoint of inguinal ligament
Positive Thomas test
Causes: bursitis, overuse injury

147
Q

Imaging + Rx for iliopsoas injury

A

Imaging: US or MRI
Rx: rest, NSAIDs, heat
PT
Stretching of the hip flexors, including iliopsoas and quadriceps
Strengthening of same and of hip rotators (internal and external)

148
Q

What is snapping hip syndrome, and what are the common causes?

A

Condition where a snapping sensation occurs when muscle or tendon moves over hip
Lateral = IT band
Anterior = rectus femoris tendon, iliopsoas
Posterior = hamstring tendon

149
Q

Complications of snapping hip syndrome

A

Bursitis

150
Q

What is Legg Calve Perthe’s dz?

A

Juvenile avascular necrosis of femoral head

151
Q

Causes of Legg Calve Perthe’s dz

A

Idiopathic
SCFE
Trauma
Steroids
Sickle cell
Congenital hip dislocation

152
Q

Sx of Legg Calve Perthe’s dz

A

Insidious onset
Intermittent limp, especially after exertion
Mild anterior hip/ groin pain, can be referred to thigh

153
Q

Physical of Legg Calve Perthe’s dz

A

Reduced ROM (limited abduction and internal rotation)
Leg roll test positive

154
Q

Ix of Legg Calve Perthe’s dz

A

AP, frog leg views
Femoral head smaller on affected side
With disease progression, a crescent-shaped radiolucent line may be seen in the central portion of the femoral head, especially on the lateral view.
MRI o r bone scan

155
Q

DDx of Legg Calve Perthe’s dz

A

Osteomyelitis
Septic joint
Juvenile idiopathic arthritis
Hemophilia
SCFE
Tumor

156
Q

Management of Legg Calve Perthe’s dz

A

Refer to peds ortho
NSAIDs, activity restriction, crutches
Wide stance brace, (abduction bracing), casts
D/C when XR evidence of subchondral reossification (12-18mo)
Can consider surgery (containment of femoral head)
Abduction stretching

157
Q

Complications of Legg Calve Perthe’s dz

A

OA, especially if dx >10 y/o
Femoral head deformity

158
Q

RF for Legg Calve Perthe’s dz

A

Low birth weight
Short stature
Delayed bone maturation
Involved family member (after index sibling, incidence 1/35)
Familial thrombophilia and hypofibrinolysis (controversial)
Lower socioeconomic status
Typically kids 4-10 y/o
More common in boys
White + chinese pts

159
Q

What is FAI?

A

Pathologic malformation of hip
The acetabular rim and the proximal femur have excess contact during the end range of motion (ROM) of the hip.
Leads to pain and restricted hip motion and can lead to chondral or labral injury

160
Q

RF for FAI

A

Idiopathic
Trauma—malunion of femoral neck fracture, posttraumatic retroversion of the femoral head
Childhood orthopedic conditions—Legg-Calvé-Perthes disease, slipped capital femoral epiphysis (SCFE), hip dysplasia
Iatrogenic—femoral osteotomy, overcorrection of retroversion in dysplastic hips
High-impact sports/activities during bone development (i.e., soccer, basketball, and ice hockey)

161
Q

Sx of FAI

A

Anterior or anterolateral hip pain that refers to the groin, associated with activity
Inability to perform activities such as high hip flexion or internal rotation, including prolonged sitting or squatting
Painful clicking, locking or instability from a labral tear secondary to undiagnosed FAI
Past history of developmental dysplasia, trauma or predisposing factors of avascular necrosis
Insidious onset of symptoms in active young and middle-aged adults
History limited with children, keep FAI in differential with knee or thigh pain, limp after activity
Adults may describe a stiffness in the hip.

162
Q

Physical exam of FAI

A

Restricted internal rotation, flexion + adduction
FADDIR positive
Positive posterior inferior impingement test—positive test if pain elicited with the hip in hyperextension, passively by hanging the leg over the end of the bed; the affected hip is passively externally rotated.

163
Q

DDx of FAI

A

Hip dysplasia
Leg-Calvé-Perthes disease/avascular necrosis femoral head
SCFE
Hip subluxation—microinstability
Labral tear not associated with impingement
Osteoarthritis
Muscular pathology of iliopsoas/snapping hip syndrome
Spinal deformities—scoliosis or kyphosis
Prior femoral neck fractures or pelvic osteotomy may also cause impingement.

164
Q

Ix for FAI

A

XR - AP pelvis + lat femoral neck view, Dunn view, cross table projection - look for CAM or pincer morphologies
Alpha angle calculated to determine amount of cam deformity (>60 degrees = abnormal)
Crossover sign + lateral center edge angle used to determine amount of pincer deformity (>40 degrees = abnormal)

CT (in position of discomfort) or MRA

165
Q

Management of FAI

A

Surgery (1st line) to achieve impingement free motion - cam morphology can be reshaped, labrum or articular cartilage resection (hip arthroscopy)
Toe touch wt bearing + ambulate w/ aids for 2-4 wks
Recovery = 6mo

Conservative (NSAIDs, activity modification (avoid excessive hip end ROM)), PT to improve hip stability, movement patterns

166
Q

Complications of FAI

A

Nonsurgical care:
Hip degenerative arthritis
Labral tears
Chondral defects/delamination

Complications of surgery:
Trochanteric nonunion, heterotopic ossification, sciatic nerve palsy, osteonecrosis of the femoral head, femoral neck fracture, injury of the lateral cutaneous femoral nerve, neurapraxia of nerves around the hip joint

167
Q

What is Shenton’s line?

A

Formed by medial edge of femoral neck + inferior edge of superior pubic ramus on XR
Loss of Shenton’s line = # neck of femur

168
Q

Distal femur # MOI

A

Fractures generally occur from significant axial loading with associated varus, valgus, or rotation force.
May occur from direct trauma as well
In young adults, fractures are usually associated with high-energy trauma such as:
Motor vehicle accidents, falls from heights, direct impact.
Motor sports, downhill skiing.
In older individuals, especially those with osteoporosis, a slip and fall may be enough force to cause injury.

169
Q

Distal femur # complications

A

Proximal or shaft fractures of the femur.
Ligament and cartilage injuries of the knee.
Proximal tibia fractures.
Open fractures: 5–10% of all supracondylar fractures.
Quadriceps tendon injury.

170
Q

Physical of Distal femur #

A

Tenderness on examination, deformity, thigh shortening, swelling (secondary to hematoma), and crepitus with movement
Limited movement of hips and knees
Commonly presents with associated injuries: chest or abdominal trauma, hip or knee injury, direct blow to the extremity
Vascular compromise (arterial injury): expanding hematoma, absent or diminished pulses, progressive neurologic deficits in a closed fracture (1)
Hypotension and tachycardia secondary to significant blood loss

171
Q

Imaging Distal femur #

A

XR - Anteroposterior (AP) view of pelvis, true lateral of hip, AP and lateral views of femur, and complete knee series
CT

172
Q

Management Distal femur # (acute + ED)

A

Acute
Long leg splint
In line traction if signs of neurovascular compromise
Wet saline dressing over open #

ED
Reduce w/ in line traction
Tetanus
Ancef + gentamicin if open #
Ortho referral for surgery ASAP

173
Q

Sx ACL injury

A

Pain - lateral tibial plateau
Instability, gives way
Audible pop or tear
Quick onset swelling
Locking sensation, loss of full ROM

174
Q

Physical for ACL injury

A

Acute: effusion, difficulty weight bearing
Loss of full knee extension can occur
Lachman test
Anterior drawer
Pivot shift (if still positive 3mo after injury, strong predictor for future reconstruction needed)
Posterior sag
Functional tests - squat, hop, single knee squat

175
Q

Ix for ACL injury

A

Normal XR (or Segond # anterior lateral capsular avulsion)
MRI

176
Q

DDx for ACL injury

A

PFPS, patella subluxation

177
Q

RF for ACL injury

A

Females 4-8x greater risk
Anatomical - narrower intercondylar notch, smaller ACL XC area, increased knee joint laxity
Hormonal - increased injuries during follicular phase
Biomechanical - cutting + landing motions w/ reduced flexion and increased valgus

178
Q

MOI for ACL injury

A

Sudden changes in direction
Landing from jump in deep flexion, force of quads causes ACL to pop
Contact ACL injury usually in football, causes unhappy triad of ACL, MCL, medial meniscus

179
Q

Management for ACL injury

A

Incomplete or partial tears can be managed non operatively
Hinged brace

Complete tears usually require surgery
Patella or hamstring tendon autograft
RTP 6-12mo post surgery

180
Q

Rehab for ACL injury

A

Phase 1 pre-op - maintain ROM
Phase 2 (0-2wks) Achieve full extension; maintain quadriceps strength, reduce swelling, and achieve flexion to 90 degrees.
Phase 3 (3 to 5 wk): Maintain full extension and increase flexion up to full ROM; stair climbers and stationary cycle may be used.
Phase 4 (6 wk to 9 mo): Increase strength and agility; progressive return to sports

181
Q

Prevention of ACL injury

A

Neuromuscular training - plyometric, strength + balance
Ideally start in early teenage years

182
Q

Conditions commonly associated w/ ACL injury

A

Meniscal tears (acutely usually lateral and then medial as ACL tear is more chronic)

183
Q

MOI LCL tear

A

Varus stress to partially flexed knee in internal tibial rotation from direct force or distal indirect stress (stepping into a hole) with a fixed foot
Wrestling most common

184
Q

Sx of LCL tear

A

Acute lateral knee pain
Pop
Mild-mod swelling
Instability if high grade

185
Q

Physical for LCL tear

A

Tender to palpation over ligament
Readily palpated in “figure-of-4 position”: normally, a pencil-like structure but less distinct with partial tears (grade II) or complete tears (grade III)
Varus stress testing
grade I sprain, no increased laxity
grade II sprain, increase in laxity with semifirm endpoint at 25 to 30 degrees of flexion isolates the LCL
grade III sprain, increase in laxity with soft or no endpoint compared with the uninjured knee indicates injury.
Peroneal nerve sensory and motor function should be checked as well

186
Q

Ix for LCL tear

A

XR to r/o #
MRI

187
Q

DDx for LCL tear

A

Proximal fibula avulsion fracture
Biceps femoris strain
Iliotibial band strain
Popliteus strain/tear/tendinopathy
Associated anterior or posterior cruciate injury
Lateral meniscus tear
Lateral compartment chondral/osteochondral injury
Tibial plateau fracture
Proximal tibiofibular syndesmosis injury

188
Q

Management + RTP for LCL tear

A

Ice, compression, NSAIDs
Immobilization:
Grade I injury: crutches PRN for pain; hinged bracing (stabilization while allowing range of motion [ROM]), 4 to 5 wk during weight-bearing activities
Grade II: crutches and knee immobilizer × 1 to 2 wk for pain control and then progress from non–weight-bearing to partial–weight-bearing weeks 2 to 3. A hinged brace may be used once the patient is partial–weight-bearing, usually at 2 to 3 wks.
Grade III: immobilization, non–weight-bearing with crutches, and consultation with an orthopedic surgeon. Immobilization will likely be maintained until surgery is performed, preferably within 2 wk of injury.

When to consider surgery
Grade 3 (if no improvement in 2-4 wks) or combined ligamentous injuries

RTP
Grade 1 = 4 wks
Grade 2 = 10 wks

189
Q

Rehab for LCL tear

A

In the acute setting, start isometric quadriceps exercises and straight-leg lifts.
Electrical stimulation/biofeedback to vastus medialis oblique (VMO) quads
Gentle hamstring and calf strengthening in protective ROM
ROM exercises with progression to full ROM over 4 to 8 wk to allow ligament to heal without too much stress
Stair stepper or similar for cardiovascular (CV) conditioning can be added, limiting knee flexion to 45 to 60 degrees when tolerated.
Stationary bike later in rehabilitation when able to flex knee to 115 degrees without pain or residual swelling afterwards
When gait is normal, begin jogging and enhanced resistance exercises.
Progress to half sprints, full sprints, and cutting maneuvers once ligament fully healed

190
Q

MOI MCL tear

A

Valgus stress (blow to lateral knee) when foot is planted
In kicking sports, the injury may be seen in players who are struck on the instep while passing the ball.
Skiers can injure the MCL by a noncontact valgus external rotation injury.
Overuse injuries to the MCL have been reported in breaststroke swimmers.

191
Q

RF + sx of MCL tear

A

Wrestling, hockey, martial arts

Pop or swelling is more concerning for meniscus or ACL injury

192
Q

Physical for MCL tear

A

Valgus stress at 0 degree and at 20 degrees. Laxity at 20 degrees alone indicates an isolated MCL injury. Laxity at both 0 degree and 20 degrees indicates an injury to the MCL and POL, knee capsule, and/or ACL

193
Q

Ix for MCL tear

A

XR (AP, notch, lateral, sunrise)
Pellegrini Stieda lesion is a calcification of proximal MCL seen in chronic injuries
MRI

194
Q

DDx for MCL tear

A

Medial meniscal tear
Medial knee contusion (soft tissue or bony)
Patellar instability (subluxation or dislocation)
Fracture of the distal femoral or proximal tibial physis
Tibial plateau fracture

195
Q

Management of MCL tear

A

Grade 1 + 2
PRICE, NSAIDs
Wt bearing as tolerated
Hinged knee brace for comfort
Active ROM immediately
RTP 1-4 wks

Grade 3
Usually non operative
Non wt bearing x1-3 wks
Bracing
Strengthening once painfree + full ROM achieved
RTP 5-7 wks
Operative if complete ligament tear, intra-articular entrapment of the end of the ligament, a large bony avulsion injury, a tibial plateau fracture, a complete tibial side avulsion in athletes, or when AMRI is present

CASEM (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions