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CAM III > Hip and Ankle/Foot > Flashcards

Hip and Ankle/Foot Flashcards

1
Q

Causes of AVN

A 
Trauma
EtOH
Steroid use
RA
Sickle cell
"Bends"
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2
Q

HPI of AVN

A

Progressive groin pain
Achy or throbbing
Decreased ROM due to pain

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3
Q

PE of AVN

A

Pain c ROM of hip
Dec ROM
Antalgic gait

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4
Q

What will X-ray show in AVN?

A

First X-rays may be nl

First X-ray change will be crescent sign

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5
Q

What imaging needs to be done to diagnose AVN?

A

MRI

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6
Q

Tx for AVN

A 
Protected WB
Discontinue EtOH/steroids
Bone grafting
Fibular grafting
Replacement
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7
Q

How does AVN present in children?

A

Leg-Calve-Perthes dz
-Idiopathic osteonecrosis in children
History of limping that worse with activities, groin/hip pain
Dec ROM of hip

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8
Q

Characteristics of hip dislocation

A

90% posterior
High energy trauma
Other associated injuries

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9
Q

Hx/PE components of a hip dislocation

A

Unable to move/WB
Shortened, internally rotated, and flexed
N/V exam

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10
Q

Tx of hip dislocation

A

CR vs open

ALWAYS get post-reduction films

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11
Q

What are the types of hip fxs?

A

Intrascapular (femoral neck) fx
Intertrochanteric fx
Subtrochanteric fx

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12
Q

RFs of hip fxs

A 
Age
Female
Smoking
Diet
Medications
Neuropathies
EtOH
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13
Q

Components of hip fxs

A 
Fall/trauma cause
Inability to WB
Groin pain
Leg is shortened and externally rotated
Unable to straight leg raise
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14
Q

Hx components of OA

A 
Gradual onset
Groin pain
May refer to knee
Worse with activity
Limp/stiffness
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15
Q

PE components of OA

A

Decreased ROM of hip (internal rotation)
Antalgic gait
Weakness in hip muscles

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16
Q

X-ray findings in OA

A

Joint space narrowing
Subchondral cysts
Sclerosis
Bone spurs

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17
Q

Tx for OA

A 
Tylenol 
NSAIDs
Activity modification
Assistance devices
Low-impact exercise
Strengthening 
Injections (intra-articular)
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18
Q

Hx components of trochanteric bursitis

A 
Inflammation of bursa
Lateral hip pain
Night pain
Unable to lie on side
Pain with activity
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19
Q

PE components of trochanteric bursitis

A

Pain over greater trochanter
Tight IT band
Rest of exam is usually nl

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20
Q

Tx for trochanteric bursitis

A

NSAIDs
Injection
PT
Modifications (i.e., sleep with pillow btwn legs)

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21
Q

What is nl ROM for the ankle joint?

A

15 degrees dorsiflexion

55 degrees plantarflexion

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22
Q

Slap gait

A

Weakness of foot/ankle dorsiflexors

Hear slap during walk

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23
Q

Drop foot gait

A

Anterior tibial weakness or peroneal nerve palsy (sciatic)

Difficulty clearing toes

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24
Q

Trendelenburg gait

A

Weakness of hip abductors (superior gluteal n.)

If bilateral- waddling

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25
Q

Where does the posterior tibial tendon run?

A

Behind medial malleolus

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26
Q

What does posterior tibial tendon dysfunction look like?

A

Ankle suppination

Too many toes

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27
Q

Pes cavus

A

High arch

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28
Q

Pes planus

A

Low arch

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29
Q

Claw toe

A

Hyperextension of MTP joint and flexion of IPs

Causes: DM, RA

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30
Q

Hammer toe

A

PIP flexed, DIP extended

Caused by improper shoes

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31
Q

Mallet toe

A

PIP extended, DIP flexed

Caused by improper shoes

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32
Q

Tx for toe deformities

A

Splints
Good shoes
Stretching
Surgery

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33
Q

Hallux valgus

A

Bunion
Lateral deviation of great toe at MTP joint
F > M (high-heeled tight shoes: higher risk)
Severity based on degree

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34
Q

How to determine severity of hallux valgus

A

Take the angle of the first and second metatarsals

35
Q

PE of hallux valgus

A

Pain
Callus
Shoe wearing

36
Q

Tx of hallux valgus

A

Changing shoe wear (pad shoes, wider shoes) OR

Refer for surgery

37
Q

Nl metatarsal angle

A

0-8

38
Q

Small severity: metatarsal angle

A

9-12

39
Q

Moderate severity: metatarsal angle

A

13-15

40
Q

Large severity: metatarsal angle

A

16-18

41
Q

Severe severity: metatarsal angle

A

18+

42
Q

Components of hallux rigidus

A

Arthosis of 1st MTP joint
Seen in 30 onward
Pain c WB and sports

43
Q

Tx for hallux rigidus

A

NSAIDs
Stiff shoes
Surgery

44
Q

Grade 0 diabetic foot ulcers

A

Intact skin but foot at risk

Pt education, foot wear

45
Q

Grade 1 diabetic foot ulcers

A

Superficial ulceration, not infected

External pressure relief: TCC, prefabricated pneumatic braces, walking brace

46
Q

Grade 2 diabetic foot ulcers

A

Deep ulceration with exposed tendons, joints (superficial infection)
Surgical debridement and wound care

47
Q

Grade 3 diabetic foot ulcers

A

Deep ulceration with exposed bone with deep infection

Surgical debridement, abx, wound care

48
Q

Grade 4 diabetic foot ulcers

A

Partial gangrene

Vascular evaluation, amputation

49
Q

Grade 5 diabetic foot ulcers

A

Complete gangrene

Amputation

50
Q

Causes of Charcot foot

A

Uncontrolled DM

51
Q

Pathology of Charcot foot

A

DM leads to neuropathy and poor circulation leads to changes in bone and unfelt micro trauma leads to deformed foot (no arch)

52
Q

Eichenholtz stage 1

A

Development- fragmentation

53
Q

Eichenholtz stage 1- clinical

A

Erythema
Warmth
Swelling

54
Q

Eichenholtz stage 1- radiography

A

Bony debris
Fragmentation
Subluxation
Dislocation

55
Q

Eichenholtz stage 2

A

Coalescence

56
Q

Eichenholtz stage 2- clinical

A

Decreased erythema
Warmth
Swelling

57
Q

Eichenholtz stage 2- radiography

A

Absorption debris
New bone
Coalescence/sclerosis

58
Q

Eichenholtz stage 3

A

Consolidation

59
Q

Eichenholtz stage 3- clinical

A

Resolution of edema

Residual deformity

60
Q

Eichenholtz stage 3- radiography

A

Remodeling, rounding of bone

Decreased sclerosis

61
Q

Components of plantar fasciitis

A 
Heel pain MC
Stretching plantar fascia c dorsiflexion (increasing pain)
Worst first thing in AM
Insidious
Worse with walking, better with rest
62
Q

Tx for plantar fasciitis

A 
Take 6-12 months to resolve
NSAIDs 
PT/stretching (+ Achilles)
Night splint
Heel pad
Cast
Injection (don't inject fat pad- will cause atrophy)
Surgery (rare)
63
Q

Components of Achilles tendonitis

A 
Pain in posterior heel
Connects calf to heel bone
Largest tendon in body
Inflammation of tendon
Insertion or non-insertional
Worse at first step 
Worse with activities/tight calf muscles
64
Q

How does one r/o Achilles tendon rupture?

A

Thompson test
Calf squeeze leads to movement- nl
No movement leads to a positive Thompson test

65
Q

Tx for Achilles tendonitis

A 
NSAIDs
PT
Stretching
Activity modification
Surgery
66
Q

Components of Morton’s neuroma

A 
Plantar interdigital neuroma
Fibrosis of common digital nerve
Secondary to nerve irritation
MC btwn 3rd and 4th metatarsal heads (3rd web space)
F>M
67
Q

Hx and physical of Morton’s neuroma

A 
Plantar pain in forefoot between metatarsals
Pos squeeze test
Numbness/burning of toes
"Walking on a marble"
Aggravated by tight shoes/heels
68
Q

Tx for Morton’s neuroma

A

Shoe modification
Metatarsal pads
Injection
Surgical excision

69
Q

Components of tarsal tunnel syndrome

A

Pain
Paresthesia/sensation
Pos Tinels
EMG/MRI

70
Q

Tx for tarsal tunnel syndrome

A

NSAIDs
Injections/aspiriaton
Immobilization
Surgery

71
Q

What is the most common ligament that is sprained in the ankle?

A

ATFL

72
Q

Hx components of ankle sprain

A 
Lateral > medial
Inversion type injury
"Pop"
Swelling
Pain
Difficulty WB
73
Q

PE components of ankle sprain

A

Tenderness over ligaments
Anterior drawer of ankle test
Squeeze test

74
Q

Squeeze test for ankle sprain

A

Used to determine it’s not a high ankle sprain

Squeeze 1/2way up calf

75
Q

How do you determine whether it’s an ankle sprain or an ankle tear?

A

Test the anterior drawer of the ankle for ATF

76
Q

What are the Ottawa ankle rules for ankle sprains?

A

Pain over malleolus AND
Inability to bear weight
Pain at base of 5th
Tenderness at navicular

77
Q

Grade I ankle sprain

A

Mild stretching of a ligament with microscopic tears
No joint instability
Can WB with mild pain

78
Q

Grade II ankle sprain

A

Incomplete tear of a ligament
Mild joint instability
WB is painful

79
Q

Grade III ankle sprain

A

Complete tear of a ligament
Unstable
Unable to WB unassisted
Might need surgery

80
Q

Components of Lis Franc fracture

A

Fracture/dislocation of midfoot
Easily missed!
Swelling/pain in midfoot
Pain with midfoot rotation

81
Q

In a Lis Franc fracture, what will you see on X-ray?

A

Bigger space btwn the metatarsals affected

82
Q

Components of a Jones fx

A 
Occurs at base of 5th metatarsal
Zone 2 fx
High incidence of malunion or nonunion
Blood supply is distal
Pain c palpation
83
Q

Tx for Jones fx

A

Immobilize
Non-WB for 6 wks
Surgical intervention

CAM III (12 decks)

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