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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
Pt presents with: Pain over injured hip muscle Exacerbated by activity
hip strain
26
Signs of hip strain
Mild ecchymosis or edema Tenderness to affected muscle group Strength limited by pain
27
Special tests for hip strain
Thomas test
28
Rads of hip strain
Plain films of pelvis and hip considered MRI reserved for chronic pain/unclear diagnosis
29
Treatment of hip strain
Light duty/Activity mods NSAIDS Stretching/Strengthening Run-walk program Send to ortho if failed conservative management
30
Which thigh muscles are injured more often?
Posterior thigh muscles (hamstrings) are injured more often than anterior thigh muscles (quadriceps)
31
Pt presents with: -Sudden onset during rapid movement of thigh -“pop” may be heard -Direct blows during contact sports that result in contusion
Thigh strain
32
Signs of thigh strain
Ecchymosis TTP Pain while attempting to flex/extend at the knee
33
Rads for thigh strain
MRI can confirm but rarely indicated US is cheaper and quicker if needed
34
Treatment of thigh strain
RICE NSAIDS
35
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
trochanteric bursitis
36
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
trochanteric bursitis
37
Special tests for trochanteric bursitis
Trendelenburg Faber
38
Treatment of trochanteric bursitis
NSAIDS Light duty Hip strengthening and stretching Refer to ortho if conservative management failed
39
A tear in the ACL is result of what?
Twisting or hyperextension
40
Pt presents with: -Sudden pain and giving way of knee from a twisting or hyperextension -1/3 report an audible pop
ACL tear
41
Pt presents with: -Moderate to severe effusion -Possibly hemarthrosis -Knee tenderness
ACL tear
42
Rads for ACL tear
Radiographs MRI
43
Treatment of ACL tear
RICE Light duty Ortho/PT consult Knee immobilizer
44
What is the strongest ligament of the knee?
PCL
45
4 injury patterns of PCL tear
Dashboard injury Hyperflexion injury Hyperextension (ACL tears first, then PCL) Fall onto flexed knee with foot in plantar flexion
46
Pt presents with: Moderate to severe effusion with ecchymosis Knee tenderness, especially posterior
PCL tear
47
Special tests for PCL tear
Posterior Drawer Sag test
48
Rads for PCL tear
MRI Radiographs
49
Treatment of PCL tear
RICE NSAID/Tylenol Light duty Ortho/PT consult`
50
What force tears MCL
Valgus force
51
What force tears LCL
Varus force
52
Special tests for MCL/LCL
Valgus/varus
53
Rads for MCL/LCL
Radiographs to r/o fracture MRI
54
Treatment of MCL tear
Usually non-operative and heal within 4-6 weeks PT NSAIDS, RICE Hinged brace, crutches Ortho consult if conservative fails
55
Treatment of LCL
May be treated non-surgically Grade III requires surgical management PT NSAIDS, RICE Hinged brace, crutches Ortho consult if conservative fails
56
Pt presents with: -Pain more severe in knee after patient has been sedentary for some time -Localized swelling
bursitis in the knee
57
Signs of prepatellar bursitis
Dome shaped swelling over anterior aspect of the knee Increased pain, warmth and erythematous changes may indicate septic bursitis
58
Signs of Pes Anserine bursitis
Mild swelling to medial aspect of knee Tenderness focal medial flare of the tibia just below the tibial plateau
59
When should you aspirate bursitis?
Septic bursitis is suspected
60
Treatment of bursitis
RICE, NSAIDS, antibiotics for septic bursitis Light duty Stretching/strengthening
61
What causes IT band syndrome
Repetitive flexion and extension of the knee
62
Who is mainly affected by IT band syndrome
25% physically active people Not reported in people who do not exercise
63
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
It band syndrome
64
Signs of IT band syndrome
Tenderness to direct palpation over/near lateral epicondyle Tenderness may extend above or below the lateral femoral condyle
65
Special tests for IT band syndrome
Ober Jumping on flexed knee
66
Rads for IT band syndrome
MRI
67
Treatment of IT band syndrome
NSAIDS Foam rolling Light duty
68
What injuries are associated with meniscal tears
ACL and MCL tears
69
What injury causes meniscal tears?
Twisting
70
How do old people hurt their meniscus?
No history or trauma, just fucking standing up from a chair
71
Pt presents with: Locking, catching and popping and usually experience pain with twisting or squatting
meniscal tear
72
Signs of meniscal tear
Moderate to severe effusion Tenderness over joint lines
73
Special tests for meniscal tear
McMurray
74
Rad for meniscal tear
MRI
75
Treatment if meniscal tear
Locked knee should be urgent referral to ortho RICE, NSAIDS ROM and pain free strengthening Consult to ortho
76
Pain at superior pole of the patella is which tendon insertion?
Quadriceps tendon insertion
77
Pain at inferior pole of patella
Patellar tendon
78
Pt presents with: -Pain exacerbated by exercise -Exacerbated by prolonged sitting, squatting or kneeling -Climbing or descending stairs, running and jumping increases pain
quadriceps/patellar tendinitis
79
Signs of quadriceps/patellar tendinitis
Tenderness at tendon insertion/origination sites Crepitus
80
Rads for quadriceps/patellar tendinitis
Imaging usually not required MRI/Radiographs if diagnosis is in question
81
What is the most common cause of knee pain in primary care setting?
Patellofemoral pain
82
Overload causes of patellofemoral pain
Runners total mileage correlates with development Pain onset during physical activity
83
Malalignment causes of patellofemoral pain
Patellar malalignment and patellar tracking thought to be a risk factor
84
Risk factors for patellofemoral pain in military recruits
Fitness level upon entry of service Prior exercise behavior BMI >25 Training load
85
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
patellofemoral pain
86
Signs of patellofemoral pain
Any gross misalignments and deviations Tenderness to medial and/or lateral subpatellar borders Crepitus
87
Special tests for patellofemoral pain
Patellar apprehension Hamstring flexibility
88
Treatment of patellofemoral pain
NSAIDS, Ice Light duty Quadriceps and hamstring flexibility and strengthening Weight loss Biomechanical support limitation Patellar tracking brace
89
Popliteal cyst is also called?
Bakers cyst
90
Pt presents with: -Swelling/fullness in popliteal fossa -Posterior knee pain -Knee stiffness -Smalll cysts may be asymptomatic
popliteal cyst
91
Pt presents with: Dissect down the posterior calf and/or rupture, resulting in severe calf pain and decreased motion at ankle
large popliteal cyst
92
Pt presents with: -Edema to the popliteal fossa -Palpate area to determine size, consistency and amount of tenderness
popliteal cyst
93
Rads for popliteal cyst
US Radiographs MRI
94
Treatment of popliteal cyst
NSAIDS and or analgesics Ice Orthopedic consult if symptomatic
95
What is a common cause of anterior knee pain in younger population, typically in 14-18 and possibly later in males
Osgood Schlatter Disease
96
Pt presents with: -Pain and swelling at the tibial tubercle -Exacerbated by direct trauma, kneeling, running and jumping and other activity
Osgood Schlatter disease
97
Signs of Osgood Schlatter disease
Tenderness to tibial tubercle Pain with resisted extension of knee
98
When are rads needed for Osgood Schlatter disease
Pain at night Pain not related to activity Acute onset of pain Associated systemic complaints
99
Treatment of Osgood Schlatter
Benign and self limited NSAIDs Protective knee pad Light duty HEP or PT

MSK (9 decks)

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