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Ortho > Hip and Knee > Flashcards

Hip and Knee Flashcards

1
Q

how to test hip flexor muscles

A

pt seated, hip flexed upward with resistance applied

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2
Q

how to test hip extensor

A

pt prone
knee flexed 90 degrees
resit hip extension

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3
Q

how to test hip abductor

A

pt on unaffected side, abduct against resistance

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4
Q

how to test hip adductors

A

pt supine

adduct against resistance

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5
Q

what does trendelenburg test evauluate?

A

hip abductor strength

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6
Q

someone with a positive trendelenburg sign; if pelvis is dropping to the left what hip abductor is weak?

A

right hip abductor (opposite side)

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7
Q

what is the FABER test

A

Flexion-abduction-external rotation

perform on affected side

if painful, indicates hip of SI involvement

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8
Q

what does the scouring test assess

what are you doing

A

hip labrum

passively flex, adduct and internally rotate the affected hip

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9
Q

someone with a hip stain/pain - where is there pain and tenderness

they will have difficulty doing what

A

quads

AIIS

ASIS

  • difficulty walking, running and with stairs
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10
Q

Treatment for hip strains/pain

A
  • RICE
  • NSAIDs
  • limit physical activity for 10-14 days
  • X rays: look for alvusion fx (younger)
  • PT
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11
Q

Sx of trochanteric bursitis

A

FOCAL tenderness over greater trochanter

pain may spread down thigh and across hip

exacerbated by pressure, prolonged sitting or walking, stairs

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12
Q

risk factors for trochanteric bursitis

A
  • female
  • overuse injury
  • bone spurs, RA
  • previous surgery
  • injury to the area
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13
Q

Trochanteric bursitis treatment

A
  • NSAIDs
  • Ice
  • rest
  • PT
  • corticosteroid injection
  • bursa padding
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14
Q

in a hip dislocation the head of the femur is displaced from what?

A

acetabulum

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15
Q

most common type of hip dislocation - how does it present

A

posterior - femur is displaced posteriorly

knee is flexed, limb is shortened and adducted

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16
Q

what may happen in relation to the nerves with a posterior hip dislocation

A

sciatic nerve palsy

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17
Q

how would an anterior hip dislocation present

A

hip in mild flexion

limb abducted and external rotated

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18
Q

what nerve injury in possible with anterior hip dislocation

are nerve injuries more common with anterior or posterior hip dislocation

A

femoral nerve injury

nerve injuries are less common in anterior hip dislocations

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19
Q

what imaging would you order for a hip dislocation

A

X-rays of pelvis AP view, lateral view of femur and head

CT to further evaluate fractures (fx of acetabulum = common)

post-reduction views

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20
Q

Acute traumatic hip dislocations are emergencies and need prompt reduction to reduce incidence of what?

A

osteonecrosis

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21
Q

Hip dislocation: Reduction can be done under ____ sedation or in the ___

A
  1. conscious

2. OR

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22
Q

what needs to be assessed after reduction of a hip dislocation

A

nerve and vascular status

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23
Q

Recovery process for hip disolocation

A
  • crutches to WBAT
  • crutches 2-4 weeks then transition to cane
  • PT to work on strength and ROM
  • Can take several months to fully recover
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24
Q

what nerve is most commonly affect with hip dislocations

A

sciatic nerve

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25
Q

proximal femur fractures (femoral neck, intertrochanteric) occur most often in who

A

> 60

white women (2x more likely than other ethnicities)

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26
Q

Hip fractures have groin pain that may refer to the ___

A

knee

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27
Q

in a hip fracture how will the affected limb present

A

shortened and externally rotated

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28
Q

what imaging would you order for a hip fracture

A

X rays: AP pelvis and lateral view

Consider CT or MRI if xray is negative

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29
Q

Tx of hip fracture

A
  • surgery (nonsurgical risk = high)

- screw, plate, nail, arthroplasty

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30
Q

in AVN as time passes what happens to the bone and articular cartilage

A

bone destruction

articular cartilage collapse

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31
Q

presentation of AVN

A
  • M > F

- gradual onset of dull ache or pain in hip, groin, or BUTTOCKS

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32
Q

Risk factors of AVN

A
  • male
  • injury: damage to blood vessels
  • alcoholism
  • long-term steroid use
  • smoking
  • CD, sickle cell, SLE, RA, scuba diving (the bends), chronic pancreatitis
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33
Q

what imaging would you order for AVN

A

AP pelvis

frog-lateral

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34
Q

what would you expect to see in x rays of AVN

A

Crescent sign - sclerotic area beneath the articular surface (initially may be normal)

femoral head flattens

35
Q

AVN treatment

A

meds, crutches

surgical (most successful)

  • w/o femoral head collapse: core decompression, vascularized fibular graft
  • femoral head collapse: total hip arthroplasty
36
Q

Disorder affecting ADOLESCENTS where the upper part of femur displaces from the capital femoral epiphysis

  • usually occuring during a period of rapid growth
  • slip occurs through the physis
  • slow process
  • bilateral in 40-50%
A

Slipped capital femoral epiphysis (SCFE)

37
Q

Risk factors for SCFE

A

MALES > F (aged 13-15)

females aged 11-13

HEAVYSET

african american

38
Q

presentation of SCFE

A
  • pain
  • limp
  • possibly unable to bear weight on affected side
  • LE externally rotated
  • Lose hip internal rotation
  • shortened limb
  • pain at extremes of motion
  • guarding
39
Q

imaging for SCFE

A

AP pelvis and frog-lateral xrays –> Klein line

may need MRI

40
Q

classifcations based on degree of displacement of SCFE?
Mild:
Moderate:
Severe:

A

Mild: <30 degree
Moderate: 30-50
Severe >50

41
Q

Tx of SCFE

A

surgical - stabilize with screws to close the physis

crutches for TTWB x 6 weeks

normal activities at 6-9 mo.

f/u and monitor other hip

42
Q

normal flexion of knee (degrees0?

A

0-135

43
Q

how would you test the tendons of the knee

A

straight leg raise

44
Q

what does the Mcmurry test evaluate?

A

Meniscus

45
Q

how do you evaluate the medial and lateral meniscus in the mcmurry test

A

medial: flex knee and externally rotate the foot; then extend the knee
lateral: flex knee, internally rotate the foot; extend knee

46
Q

Valgus force is applied to extended knee to assess ___

A

MCL

47
Q

varus force is applied to extended knee to assess ___

A

LCL

48
Q

What does the lachman test assess

A

ACL

49
Q

what are you looking for when doing the lachman test

A

ACL - look for translation and end point

50
Q

what does the anterior/posterior drawer assess

A

ACL and PCL

51
Q

what type of injury would cause a meniscal tear

A

twisting

52
Q

history of meniscal tear

A
  • able to ambulate
  • swelling and stiffness occurs in days following the tear
  • may experience locking or catching
  • pain to medial or lateral aspects that is increased with bending or twisting
53
Q

what would you observe in a PE of a meniscal tear

A
  • pain over medial or lateral joint lines
  • effusion
  • pain with full extension or flexion
  • limited ROM
  • positive mcmurray test
54
Q

what imaging would you order for a meniscal tear

A

X-ray: AP, lateral, sunrise

MRI

55
Q

TX for meniscal tears

A
  • Locked knee –> prompt surgical intervention
  • RICE
  • NSAIDs, tylenol, narcotics
  • Restrict, modify activity
  • PT
  • younger patients = arthroscopy
  • older pts = corticoid steroid injection or arthroscopy
56
Q

the MCL stabilizes the knee against what kind of stresses?

A

valgus stresses

57
Q

the LCL stabilizes the knee against what kind of stresses?

A

varus stresses

58
Q

ACL prevents the 1 from sliding out in front of the 2 and provides 3 stability

A
  1. tibia
  2. femur
  3. rotational
59
Q

what ligament prevents the tibia from sliding behind the femur

A

posterior cruciate ligament (PCL)

60
Q

is the MCL or LCL more commonly injured

A

MCL - blow to lateral aspect of the knee

61
Q

what test would you perform to asses the collateral ligaments

A

varus/valgus test: pain? opening?

62
Q

Tx for MCL/LCL injury

A

RICE
NSAIDs
Brace
PT

surgical not often performed for MCL

LCL surgery depends on the tear itself and other injuries

63
Q

imaging for MCL injury

A

X rays and/or MRI

64
Q

what else can occur with MCL injury

A

ACL injury

65
Q

in collateral ligament injuries, if the ___ is injured then other structures are likely involved as well

A

LCL (smaller and thicker than MCL)

66
Q

imaging for LCL

A

X-ray and MRI

67
Q

MOI for ACL

A
  • sudden deceleration and change in direction or pivoting motion that causes rotation and lateral bending

direct blow to the knee causing hyperextension and valgus motion

can occur during MVC

68
Q

presentation of ACL injury

A

may have hear “pop”

swelling and effusion

difficult with ROM and weight bearing

laxity on Lachman’s or AP drawer (within 24 hours)

knee feels unstable and “gives out”

69
Q

imaging of choice for ACL injury

A

MRI

70
Q

Tx for ACL injury

A

RICE, crutches, NSAIDs

operative and non-operative tx –> if surgical intervention is not selected then PT is necessary

after surgery return to normal activity in 6-12 months

71
Q

what is the least common ligament injury

A

PCL

72
Q

MOI for PCL

A

substantial force required

  • fall onto bent knee
  • MVC
73
Q

PCL tx

A

often heals w/o intervention

74
Q

overuse injury in children due to repetitive stress

quads pull on the tendons and thus the growth plate of the tibial tubercle

A

osgood-schlatter disease

75
Q

when in development would someone develop osgood-schlatter disease

A

period of rapid growth

76
Q

type of knee pain and presentation in osgood-schlatter dx

A

FOCAL knee pain

possible deformity

inflammatory

77
Q

tx for osgood-schlatter

A

limit exercise

NSAIDs

ice

stretching

78
Q

most common cause of knee pain - “runners knee” or “jumper’s knee”

anterior knee pain

diagnosis of exclusion

A

patellofemoral syndrome

79
Q

is patellofemoral knee syndrom more common in males or females

A

females

80
Q

causes of patellafemoral syndrome

A

overuse - most common; assoc with periods of increased physical activity, normal imaging

patellar misalignment: unbalance in forces - leg length, muscle tightness, muscle weakness and imbalance, hip weakness

81
Q

Tx of petellofemoral syndrome

A

alleviate pain

PT - stretching, hip and thigh muscle strengthening

orthotics

gradual return to activity

no improvement in 6 mo. –> MRI

82
Q

what can an US show you in the hip

A

tendons (tendonitis)

bursitis

labrum injuries

83
Q

what can US show you in the knee

A

tendons

ligaments

popliteal cyst

bursitis

84
Q

where could you put a corticosteroid injection

A

joint

tendon sheath

bursa

Ortho (9 decks)

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