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MSK > Hip and Knee MDT > Flashcards

Hip and Knee MDT Flashcards

1
Q

Most common hip dislocation

A

Posterior dislocation

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2
Q

Most common cause of hip dislocation

A

trauma

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3
Q

Pt presents with:
-Severe pain of hip
-Fixed extremity
-Numbness/tingling common

A

hip dislocation

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4
Q

Posterior hip dislocation signs

A

Affected limb short, hip is fixed in adducted and internally rotated position

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5
Q

Anterior hip dislocation signs

A

Hip held in abduction and external rotation

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6
Q

Rads for hip dislocation

A

Radiographs of hip, knee, pelvis
CT to eval fracture pattern

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7
Q

Treatment of hip dislocation

A

MEDEVAC
Reduction
SIQ until eval by ortho

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8
Q

What mostly causes fracture of femoral shaft

A

High energy trauma

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9
Q

Sx of fracture of femoral shaft

A

Severe pain in thigh
Unable to bear weight

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10
Q

Signs of fracture of femoral shaft

A

Obvious deformity, edema, possible open injury

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11
Q

Rads for fracture of femoral shaft

A

Plain films with hip, knee, pelvis and femur

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12
Q

Treatment of femoral shaft fracture

A

Immediate splinting and traction
MEDEVAC
Surgical management

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13
Q

What is often misdiagnosed or completely missed in military recruits, athletes and runners?

A

Stress fracture of femoral neck

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14
Q

Pt presents with:

-Vague pain in anterior groin or thigh
-Increasing of activity prior to onset

A

stress fracture of the femoral neck

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15
Q

Signs of stress fracture of femoral neck

A

Antalgic gait
Tenderness to proximal thigh/groin
Limited ROM
Pain to groin or thigh with straight leg raise

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16
Q

Rads for stress fracture of femoral neck

A

Bone scan/MRI

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17
Q

Treatment for stress fracture of femoral neck

A

Analgesics
Ortho evaluation
Activity mods
Crutches
Non weight bearing

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18
Q

What is a pelvic fracture?

A

Fracture of pelvic ring or acetabulum

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19
Q

Pt presents with:
-Pain in groin area with attempted weight bearing
-Sensation of “coming apart” at the hip
-High energy fracture with other distracting injuries “head, chest, abdomen”

A

Pelvic fracture

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20
Q

Signs of pelvic fracture

A

Antalgic gait vs deformities
TTP
Limited ROM

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21
Q

Rads for pelvic fracture

A

Plain films
Pelvis, hip, head, cervical, chest

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22
Q

Labs for pelvic fracture

A

UA: Hematuria is common
Hematocrit: Blood loss

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23
Q

Treatment of pelvic fracture

A

MEDEVAC
Hemodynamic resuscitation
Pain management
Pelvic binder

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24
Q

Muscles involved in hip strain

A

Iliopsoas
Sartorius
Rectus femoris

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25
Q

Pt presents with:
Pain over injured hip muscle
Exacerbated by activity

A

hip strain

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26
Q

Signs of hip strain

A

Mild ecchymosis or edema
Tenderness to affected muscle group
Strength limited by pain

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27
Q

Special tests for hip strain

A

Thomas test

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28
Q

Rads of hip strain

A

Plain films of pelvis and hip considered
MRI reserved for chronic pain/unclear diagnosis

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29
Q

Treatment of hip strain

A

Light duty/Activity mods
NSAIDS
Stretching/Strengthening
Run-walk program
Send to ortho if failed conservative management

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30
Q

Which thigh muscles are injured more often?

A

Posterior thigh muscles (hamstrings) are injured more often than anterior thigh muscles (quadriceps)

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31
Q

Pt presents with:
-Sudden onset during rapid movement of thigh
-“pop” may be heard
-Direct blows during contact sports that result in contusion

A

Thigh strain

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32
Q

Signs of thigh strain

A

Ecchymosis
TTP
Pain while attempting to flex/extend at the knee

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33
Q

Rads for thigh strain

A

MRI can confirm but rarely indicated
US is cheaper and quicker if needed

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34
Q

Treatment of thigh strain

A

RICE
NSAIDS

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35
Q

Pt presents with:

-Pain and tenderness over greater trochanteric
-Pain may radiate distally to knee or ankle or proximally into the buttock
-Pain worse when going from sit to stand
-May decrease after warming up but returns after 30-1 hour of walking
-Unable to lie on affected side

A

trochanteric bursitis

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36
Q

Pt presents with:
-Point tenderness over the lateral greater trochanter is essential finding
-Increased discomfort with hip adduction or adduction with internal rotation
-Resisted hip abduction also causes pain

A

trochanteric bursitis

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37
Q

Special tests for trochanteric bursitis

A

Trendelenburg
Faber

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38
Q

Treatment of trochanteric bursitis

A

NSAIDS
Light duty
Hip strengthening and stretching
Refer to ortho if conservative management failed

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39
Q

A tear in the ACL is result of what?

A

Twisting or hyperextension

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40
Q

Pt presents with:
-Sudden pain and giving way of knee from a twisting or hyperextension
-1/3 report an audible pop

A

ACL tear

41
Q

Pt presents with:
-Moderate to severe effusion
-Possibly hemarthrosis
-Knee tenderness

A

ACL tear

42
Q

Rads for ACL tear

A

Radiographs
MRI

43
Q

Treatment of ACL tear

A

RICE
Light duty
Ortho/PT consult
Knee immobilizer

44
Q

What is the strongest ligament of the knee?

A

PCL

45
Q

4 injury patterns of PCL tear

A

Dashboard injury
Hyperflexion injury
Hyperextension (ACL tears first, then PCL)
Fall onto flexed knee with foot in plantar flexion

46
Q

Pt presents with:
Moderate to severe effusion with ecchymosis
Knee tenderness, especially posterior

A

PCL tear

47
Q

Special tests for PCL tear

A

Posterior Drawer
Sag test

48
Q

Rads for PCL tear

A

MRI
Radiographs

49
Q

Treatment of PCL tear

A

RICE
NSAID/Tylenol
Light duty
Ortho/PT consult`

50
Q

What force tears MCL

A

Valgus force

51
Q

What force tears LCL

A

Varus force

52
Q

Special tests for MCL/LCL

A

Valgus/varus

53
Q

Rads for MCL/LCL

A

Radiographs to r/o fracture
MRI

54
Q

Treatment of MCL tear

A

Usually non-operative and heal within 4-6 weeks
PT
NSAIDS, RICE
Hinged brace, crutches
Ortho consult if conservative fails

55
Q

Treatment of LCL

A

May be treated non-surgically
Grade III requires surgical management
PT
NSAIDS, RICE
Hinged brace, crutches
Ortho consult if conservative fails

56
Q

Pt presents with:

-Pain more severe in knee after patient has been sedentary for some time
-Localized swelling

A

bursitis in the knee

57
Q

Signs of prepatellar bursitis

A

Dome shaped swelling over anterior aspect of the knee
Increased pain, warmth and erythematous changes may indicate septic bursitis

58
Q

Signs of Pes Anserine bursitis

A

Mild swelling to medial aspect of knee
Tenderness focal medial flare of the tibia just below the tibial plateau

59
Q

When should you aspirate bursitis?

A

Septic bursitis is suspected

60
Q

Treatment of bursitis

A

RICE, NSAIDS, antibiotics for septic bursitis
Light duty
Stretching/strengthening

61
Q

What causes IT band syndrome

A

Repetitive flexion and extension of the knee

62
Q

Who is mainly affected by IT band syndrome

A

25% physically active people
Not reported in people who do not exercise

63
Q

Pt presents with:
Pain focal to anterior lateral aspect of the knee that worsens with activity
Worse downhill
Discomfort or a complete resolution at rest

A

It band syndrome

64
Q

Signs of IT band syndrome

A

Tenderness to direct palpation over/near lateral epicondyle
Tenderness may extend above or below the lateral femoral condyle

65
Q

Special tests for IT band syndrome

A

Ober
Jumping on flexed knee

66
Q

Rads for IT band syndrome

A

MRI

67
Q

Treatment of IT band syndrome

A

NSAIDS
Foam rolling
Light duty

68
Q

What injuries are associated with meniscal tears

A

ACL and MCL tears

69
Q

What injury causes meniscal tears?

A

Twisting

70
Q

How do old people hurt their meniscus?

A

No history or trauma, just fucking standing up from a chair

71
Q

Pt presents with:

Locking, catching and popping and usually experience pain with twisting or squatting

A

meniscal tear

72
Q

Signs of meniscal tear

A

Moderate to severe effusion
Tenderness over joint lines

73
Q

Special tests for meniscal tear

A

McMurray

74
Q

Rad for meniscal tear

A

MRI

75
Q

Treatment if meniscal tear

A

Locked knee should be urgent referral to ortho
RICE, NSAIDS
ROM and pain free strengthening
Consult to ortho

76
Q

Pain at superior pole of the patella is which tendon insertion?

A

Quadriceps tendon insertion

77
Q

Pain at inferior pole of patella

A

Patellar tendon

78
Q

Pt presents with:
-Pain exacerbated by exercise
-Exacerbated by prolonged sitting, squatting or kneeling
-Climbing or descending stairs, running and jumping increases pain

A

quadriceps/patellar tendinitis

79
Q

Signs of quadriceps/patellar tendinitis

A

Tenderness at tendon insertion/origination sites
Crepitus

80
Q

Rads for quadriceps/patellar tendinitis

A

Imaging usually not required
MRI/Radiographs if diagnosis is in question

81
Q

What is the most common cause of knee pain in primary care setting?

A

Patellofemoral pain

82
Q

Overload causes of patellofemoral pain

A

Runners total mileage correlates with development
Pain onset during physical activity

83
Q

Malalignment causes of patellofemoral pain

A

Patellar malalignment and patellar tracking thought to be a risk factor

84
Q

Risk factors for patellofemoral pain in military recruits

A

Fitness level upon entry of service
Prior exercise behavior
BMI >25
Training load

85
Q

Pt presents with:
-Diffuse aching anterior knee pain
-Worsened by prolonged sitting, climbing stairs, jumping or squatting
-Sense of instability or retro patellar catching or grinding

A

patellofemoral pain

86
Q

Signs of patellofemoral pain

A

Any gross misalignments and deviations
Tenderness to medial and/or lateral subpatellar borders
Crepitus

87
Q

Special tests for patellofemoral pain

A

Patellar apprehension
Hamstring flexibility

88
Q

Treatment of patellofemoral pain

A

NSAIDS, Ice
Light duty
Quadriceps and hamstring flexibility and strengthening
Weight loss
Biomechanical support limitation
Patellar tracking brace

89
Q

Popliteal cyst is also called?

A

Bakers cyst

90
Q

Pt presents with:
-Swelling/fullness in popliteal fossa
-Posterior knee pain
-Knee stiffness
-Smalll cysts may be asymptomatic

A

popliteal cyst

91
Q

Pt presents with:

Dissect down the posterior calf and/or rupture, resulting in severe calf pain and decreased motion at ankle

A

large popliteal cyst

92
Q

Pt presents with:
-Edema to the popliteal fossa
-Palpate area to determine size, consistency and amount of tenderness

A

popliteal cyst

93
Q

Rads for popliteal cyst

A

US
Radiographs
MRI

94
Q

Treatment of popliteal cyst

A

NSAIDS and or analgesics
Ice
Orthopedic consult if symptomatic

95
Q

What is a common cause of anterior knee pain in younger population, typically in 14-18 and possibly later in males

A

Osgood Schlatter Disease

96
Q

Pt presents with:
-Pain and swelling at the tibial tubercle
-Exacerbated by direct trauma, kneeling, running and jumping and other activity

A

Osgood Schlatter disease

97
Q

Signs of Osgood Schlatter disease

A

Tenderness to tibial tubercle
Pain with resisted extension of knee

98
Q

When are rads needed for Osgood Schlatter disease

A

Pain at night
Pain not related to activity
Acute onset of pain
Associated systemic complaints

99
Q

Treatment of Osgood Schlatter

A

Benign and self limited
NSAIDs
Protective knee pad
Light duty
HEP or PT

MSK (9 decks)

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