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MSK Redemption Arc > Hip, Thigh, Knee MDT > Flashcards

Hip, Thigh, Knee MDT Flashcards

1
Q

Name the injury:

  • Causative injury usually is high-energy trauma, such as a motor vehicle accident or a fall from a height
  • Posterior dislocations account for more than 90% of hip dislocations
  • Occurs when the femoral head is displaced from the acetabulum
A

Hip dislocation

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2
Q

Pt presents with:
- Severe pain
- Unable to move the lower extremity
- May experience numbness throughout the lower limb
- Most have multiple injuries and may be unconscious from associated head trauma

A

Hip dislocation

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3
Q

Pt PE:
- Leg is short, hip is fixed in adduction and internally rotated

A

Posterior hip dislocation

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4
Q

Pt PE:
- hip assumes a position of mild flexion, abduction, and external rotation

A

Anterior dislocation

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5
Q

What is the difference in neurovascular assessment of anterior and posterior hip dislocation

A
  • Sciatic nerve injuries are common with posterior dislocations
  • Femoral nerve palsy may be present with anterior dislocations
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6
Q

Rads for hip dislocation

A
  • Plain films
  • CT
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7
Q

Treatment of Hip dislocation

A
  • MEDEVAC
    -A reduction should be performed as soon as possible to decrease the risk of osteonecrosis
  • Neurovascular function should be evaluated both before and after reduction
  • SIQ until evaluated by orthopedics
  • Narcotic level analgesic
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8
Q

What is of concern after reduction of hip dislocation

A

Osteonecrosis

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9
Q

The following describes what injury:
- high-energy trauma such as a motor vehicle accident
- associated with potentially life-threatening pulmonary, vascular complications, intra-abdominal and head injuries

A

Fracture of the Femoral Shaft

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10
Q

Pt presents with:
- Severe pain in the thigh
- Unable to move or weight bear on affected extremity
- May have multi-systems involved

A

Fracture of the Femoral Shaft

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11
Q

How Fracture of the Femoral Shaft confirmed?

A

Plain film radiographs

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12
Q

Treatment of Fracture of the Femoral Shaft

A
  • Immediate splinting AND traction
    -MEDEVAC
  • Surgery required
  • If open wound, apply dressing
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13
Q

The following describes what injury:
- Often misdiagnosed or missed
- Most commonly occur in military recruits, athletes and runners
- Result from dynamic, continuing process rather than single acute, traumatic event

A

Stress Fracture of the Femoral Neck

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14
Q

Pt presents with:
- Patient presents with vague pain in groin, anterior thigh or knee
- Associated with weight bearing activities and typically subside after cessation of activity
- Reports increase in exercise intensity or activity level In the few weeks preceding symptoms

A

Stress Fracture of the Femoral Neck

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15
Q

Pt PE:
- Antalgic gait
- Tenderness at proximal thigh or groin may be present
-Limited ROM, most significantly in internal rotation
- Pain to groin or thigh with straight leg raise

A

Stress Fracture of the Femoral Neck

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16
Q

How is Stress Fracture of the Femoral Neck diagnosed?

A
  • Radiographs are not diagnostic in most patients
  • Bone scan will detect fracture within 24-48 hours after injury
  • MRI is sensitive for differentiating compression side or tension side stress fracture
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17
Q

Treatment of Stress Fracture of the Femoral Neck

A
  • MEDEVAC
  • Analgesics
  • Orthopedic Evaluation
  • Activity modification
  • Crutches
  • Non weight bearing status
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18
Q

The following describes what injury:
- fractures of the pelvic ring and acetabulum
- injuries range in severity from stable, low-energy fractures to severe, life-threatening

A

Pelvis fracture

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19
Q

Pt presents with:
- Patients typically complain of pain in groin area with attempted weight bearing and inability bear weight
- May describe a feeling of coming apart in the hip with attempted weight bearing
- Associated symptoms could be from head, chest and abdomen
- High-energy injuries can present in shock and often have associated musculoskeletal or multisystem injuries

A

Pelvis Fracture

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20
Q

Pt PE:
- Patients able to ambulate will have an antalgic gait
- may see hip and knee displacement
- Gentle compression of pelvis will localize the area of injury

A

Pelvis Fracture

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21
Q

What areas of the body need plain film x rays for pelvic fracture

A
  • Pelvis
  • Hip
  • Head
  • Cervical
  • Chest
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22
Q

Why and what labs would be drawn for pelvic fracture

A

Urinalysis: hematuria is common
Hematocrit: evaluate blood loss

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23
Q

Treatment of Pelvis Fracture

A
  • MEDEVAC
  • Definitive treatment of unstable pelvic and acetabular fractures usually requires operative intervention
  • Hemodynamic resuscitation
  • No weight bearing
  • Narcotic level pain management
  • Treat other associated injuries
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24
Q

The following describes what injury:
-Strains to several muscles:
Iliopsoas
Sartorius
Rectus femoris
-Vigorous muscular contraction while the muscle is on stretch frequently causes the injury
- Results from acute or overuse injury

A

Hip Strain

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25
Q

Pt presents with:
Pain over hip that is exacerbated when that area continues to be used during strenuous activity

A

Hip strain

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26
Q

Pt PE:
- Hip adductors is identified by tenderness in the groin
- Iliopsoas typically causes pain in the deep groin or inner thigh
- Hip flexors is identified by tenderness to the tendons in the ASIS region
- Increased pain with motion to hip

A
  • Hip Strain
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27
Q

What special test will be positive for hip strain

A

Positive Thomas test- for tight hip flexors

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28
Q

Why would you need rads for hip strain?

A
  • Radiographs of pelvis and hip can rule out fracture or other bony lesion
  • MRI may be needed if un-resolving chronic hip pain
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29
Q

Treatment of hip strain

A
  • Light duty with a focus on activity modification
    NSAIDS
  • Pain free hip stretching and strengthening
  • Run-walk program for progressive run schedule
  • Failed conservative therapy needs to be evaluated be orthopedics to rule out other pathology
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30
Q

The following describes what injury:
- Injury happens when actively contracted muscle is put on a stretch
- The posterior thigh muscles (hamstring muscles) are injured more often than the anterior thigh muscles (quadriceps)
- Strain/tear typically occurs at the musculotendinous junction

A

Thigh strain

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31
Q

Pt presents with:
- sudden onset of posterior or thigh pain that occurred while running, water skiing, or some other rapid movement
- A “pop” may have been perceived at the onset of pain
- direct blows during contact sports that results in a contusion

A

Thigh strain

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32
Q

Pt PE:
- Muscle injury and associated hemorrhage may be evident by ecchymosis located in the posterior thigh
- Local tenderness at the site of the injured muscle
- Hamstring- pain with hip flexion and knee extension
- Quadriceps- pain with hip extension and knee flexion

A

Thigh strain

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33
Q

What special test will be positive for thigh strain

A

Positive Thomas test with rectus femoris strain

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34
Q

What is more common, hamstring or quadricep strain?

A

Hamstring

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35
Q

What radiologic study should be used for thigh strain?
- Plain film
- MRI
- US

A

Plain film- not needed
MRI- can confirm but rarely indicated
US-cheapest and fastest for confirmation

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36
Q

Treatment of Thigh strain

A

-rest and elevate the limb while applying ice and compressive wraps as needed
- rehabilitation with pain free stretching and strengthening of the injured muscle
- NSAIDs

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37
Q

The following describes what injury:
- may develop without apparent cause
- Possibly associated with lumbar spine disease, intra-articular hip pathology, significant limb-length inequalities, inflammatory arthritis, or previous surgery around the hip
- Cause of lateral hip pain

A

Trochanteric Bursitis

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38
Q

Pt presents with:
- Patients usually have pain and tenderness over the lateral hip
- The pain may radiate distally to the knee or ankle (but not onto the foot) or proximally into the buttock
- Pain worse when going from sit to stand
- May decrease after warming up but return after 30 to 1 hours of walking
- Unable to lie on affected side

A

Trochanteric Bursitis

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39
Q

Pt PE:
- Point tenderness over the lateral greater trochanter
- Tenderness above the trochanter suggests tendinitis of the gluteus medius tendon
- Patients report increased discomfort with hip adduction or adduction with internal rotation

A

Trochanteric Bursitis

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40
Q

What special tests will be positive for Trochanteric Bursitis

A

Resisted hip abduction also causes pain
Trendelenburg test
Faber

41
Q

Treatment of Trochanteric Bursitis

A
  • NSAIDS
  • Light Duty- Activity modification
  • Hip strengthening(focus on abduction) and stretching
  • Refer to Ortho if conservative management failed
42
Q

The following describes what injury:
- results from a rotational (twisting) or hyperextension force
- About half the time, is accompanied by a significant meniscal tear

A

ACL tear

43
Q

Which ligament is the primary stabilizer of the knee?

A

The anterior cruciate ligament (ACL) is a primary stabilizer of the knee

44
Q

Pt presents with:
- usually report sudden pain and giving way of the knee from a twisting or hyperextension-type injury
- 1/3 report an audible “pop” as the ligament tears
- unable to continue participating in athletic activity because of pain and/or instability

A

ACL tear

45
Q

Pt PE:
- Moderate to severe effusion
- Possibly hemarthrosis (bleeding in the joint)
- Generalized knee tenderness
- Limited by pain and effusion
- Locking/popping sensation

A

Knee ligament tear

46
Q

How do you confirm ACL tear

A

MRI

47
Q

Treatment of ACL tear

A
  • RICE
  • Light Duty to include running or cutting activities
    Orthopedic Consult
  • Physical Therapy Consult
  • A knee immobilizer or range-of-motion brace may be used for comfort when necessary until acute pain subsides
48
Q

What is the strongest ligament in the knee?

A

PCL

49
Q

The following describes what injury:
- Injury caused by stretch or complete rupture of the ligament
- Less common than other ligamentous/meniscal injury

A

PCL Tear

50
Q

What are the 4 injury patterns that suggest PCL tear

A
  • Dashboard injury—a posteriorly directed force to the anterior knee with the knee in flexion, as in a motor vehicle accident
  • Fall onto a flexed knee with the foot in plantar flexion
  • A pure hyperflexion injury to the knee
  • A hyperextension injury to the knee-typically, the ACL ruptures first, and then with sufficient force, injury to the PCL follows
51
Q

What special tests will be positive for PCL tear

A

Posterior Drawer
Sag test

52
Q

What radiolgic studies can confirm PCL tear

A
  • MRI
  • Plain film to r/o other pathologies
53
Q

Treatment of PCL tear

A
  • RICE
  • NSAIDs/Tylenol
  • Light Duty to include running or cutting activities
  • Orthopedic Consult
  • Physical Therapy Consult
54
Q

What ligaments of the knee resist valgus and varus force?

A

MCL= valgus
LCL= varus

55
Q

What special tests are used for MCL and LCL

A

MCL= valgus stress test
LCL= varus stress test

56
Q

Treatment of MCL tear

A
  • Usually non operative and heal within 4-6 weeks
  • Conservative treatment
  • Physical therapy
  • NSAIDS
  • RICE
  • Hinged brace
  • Crutches, weight bearing as tolerated (WBAT)
  • Ortho consult if conservative management fails
57
Q

What grade of LCL tear requires surgical management?

A

Grade III

58
Q

Conservative treatment of LCL tear

A
  • Physical therapy
  • NSAIDS
  • RICE
  • Hinged brace
  • Crutches, weight bearing as tolerated (WBAT)
59
Q

The following describes what injury:
- Chronic pressure or friction (overuse) causes thickening of this synovial lining and subsequent excessive fluid formation, thereby leading to localized swelling and pain

A

Knee bursitis

60
Q

What injury Forms dome shaped swelling over anterior aspect of the knee

A

Prepatellar bursitis

61
Q

What are common sites for bursitis of the knee

A

Prepatellar and pes anserine bursa

62
Q

Pt presents with:
- Pain with activity and direct pressure
- The pain often is more severe after the patient has been sedentary for some time, and patients will notice a limp when first arising from a chair
- Possible localized swelling over the involved structure
- This is most marked with prepatellar bursitis

A

Knee bursitis

63
Q

Pt PE:
- dome shaped swelling over the anterior aspect of the knee
- tenderness to fluid filled dome shape over patella

A

Prepatellar bursitis

64
Q

Pt PE:
- mild swelling to medial aspect of the knee
- Tenderness focal medial flare of the tibia just below the tibial plateau

A

Pes anserine bursitis

65
Q

How should you treat septic prepatellar bursitis

A

Aspiration

66
Q

Treatment of knee bursitis

A
  • RICE
  • NSAIDS
  • Light duty- activity modification
  • Painfree LE stretching and strengthening exercises
  • Antibiotic treatment for septic bursitis
67
Q

The following describes what injury:
- occurs with repetitive flexion and extension of the knee
- up to 25% of physically active people
- This syndrome HAS NOT been reported in people that do not exercise
- Mostly seen in runners and cyclists

A

IT band syndrome

68
Q

Pt presents with:
- Pain focal to the anterorlateral aspect of the knee that worsens with activity
- Worse with downhill running, mostly during heel strike
- Discomfort or complete resolution at rest

A

IT band syndrome

69
Q

Pt PE:
- Tenderness to direct palpation over/near the lateral femoral condyle
- Tenderness may extend above or below the lateral femoral condyle
- genu varum(bow legs)
- pes planus
- tibial internal rotation

A

IT band syndrome

70
Q

What special tests will be positive for IT band syndrome

A

Positive Obers
Positive pain when jumping on flexed knee

71
Q

Treatment of IT band syndrome

A
  • Foam rolling
  • Light Duty
  • Modifications to training regimen
  • Proper running time/distance progression
  • Hamstring and ITB stretching
  • Hip abductor strengthening
72
Q

The following describes what injury:
- Patients with traumatic tears typically report a significant twisting injury to the knee
- Older patients with a degenerative tear may have a history of minimal or no trauma, such as simply rising from a squatting position
- Patients usually can ambulate after an acute injury and frequently may be able to continue to participate in athletics
- May describe symptoms of mechanical locking, catching or popping

A

Meniscal tear

73
Q

Pt presents with:
Mechanical symptoms such as locking, catching, and popping can then develop; patients usually experience pain with twisting or squatting

A

Menisal tear

74
Q

Pt PE:
- moderate to severe effusion
- Tenderness over the medial or lateral joint lines
- Knee may feel as though it is “catching” thru range of motion

A

Meniscal tear

75
Q

What special test will be positive for meniscal tear

A

McMurray

76
Q

What study confirms meniscal tear

A

MRI

77
Q

Treat of meniscal tear

A
  • Locked knee (ie: bucket handle tear) should promptly be treated with urgent referral to ortho
  • If absence of mechanical locking then treatments should start with RICE
  • NSAIDS
  • ROM and pain free strengthening exercises
  • Consult to orthopedics
  • Patient with traumatic effusion and mechanical symptoms need urgent orthopedic evaluation
78
Q

The following describes what injury:
- “Jumpers knee”
- Associated with jumping sports
- Also seen in patients who increase physical training too quickly
- “too much, too fast, too soon”

A

Quadriceps/Patellar Tendonitis

79
Q

Pt presents with:
-patients often point to a tender spot where symptoms concentrate
- Pain is exacerbated by exercise
Exacerbated by prolonged sitting, squatting, or kneeling in some cases
- Climbing or descending stairs, running, and, of course, jumping often increase the pain

A

Quadriceps/Patellar Tendonitis

80
Q

What is the difference in location for quadricep and patellar tendonitis?

A

Superior pole of patella - quadricep tendonitis
Inferior pole of patella - patellar tendonitis

81
Q

Pt PE:
- Mild infrapatellar bursa swelling
- Tenderness at tendon insertion/origination sites as discussed
- Crepitus
- Knee motion normal but pain with extension

A

Quadriceps/Patellar Tendonitis

82
Q

Treatment of Quadriceps/Patellar Tendonitis

A
  • NSAIDS
  • Ice
  • Light duty
  • Pain free quadriceps and hamstring stretching and strengthening
  • Patellar tendon strap-Chopats for comfort
83
Q

The following describes what injury:
- Most common cause of knee pain in primary care setting
- Around 20% among adolescents
- Most common in third decade of life
- Runners total mileage correlates with development

A

Patellofemoral pain

84
Q

What factors among military recruits put them at risk for patellofemoral pain

A
  • Fitness level upon entry to service
  • Prior exercise behavior
  • BMI over 25
  • Training load
85
Q

Pt presents with:
- Diffuse aching anterior knee pain
- Exacerbated by prolonged sitting (theater sign), climbing stairs, jumping, or squatting
- Usually no preexisting trauma
- Some patients report a sense of instability or a retropatellar catching or grinding sensation
- Usually no history of swelling is reported

A

Patellofemoral pain

86
Q

Pt PE:
- Femoral anteversion
- Genu valgum
- Foot over pronation
- Tenderness noted to medial and/or lateral subpatellar borders
- Crepitus maybe noted with patellar mobility (nonspecific finding)

A

Patellofemoral pain

87
Q

What special test should be done for patellofemoral pain

A

Patellar apprehension
Hamstring flexibility

88
Q

Treatment of Patellofemoral Pain

A
  • NSAIDS
  • Ice
  • Light Duty-Active Rest
  • Quadricep and hamstring flexibility and strengthening
  • Weight loss is recommended when a patient is obese
  • Support biomechanical limitations
  • McConnel taping
  • Patellar tracking brace
  • Motion control shoe/Inserts
89
Q

The following describes what injury:
- Also called Bakers cyst
- Common in both children and adults
- Associated with knee injury and chronic inflammation
- Fluctuate in size and symptoms
- Rupture can lead to severe pain and edema of the lower extremity

A

Popliteal cyst

90
Q

Pt presents with:
- Swelling/fullness in the popliteal fossa
- Posterior knee pain
- Knee stiffness
- Small cysts may be asymptomatic
- Larger cysts can dissect down the posterior calf and/or rupture, resulting in severe calf pain and decreased motion at the ankle

A

Popliteal cyst

91
Q

What must be r/o prior to dx of popliteal cyst

A

DVT

92
Q

Pt PE:
- Edema to the popliteal fossa
- Palpate the area to determine the size, consistency, and amount of tenderness
- Flexion may be limited by pain and excessive joint fluid

A

Popliteal cyst

93
Q

What radiologic study should be done for popliteal cyst

A

US

94
Q

Treatment of Popliteal Cyst

A
  • NSAIDS and or analgesics
  • Ice
  • Light duty-activity modification
  • Return to activities pain free
  • Orthopedic consultation if symptomatic
95
Q

The following describes what injury:
- Typically seen between ages of 14-18, possibly later in males
- Much more common in active adolescents who participate in sports
- Characterized by pain and swelling at the tibial tubercle
- Overuse causes chronic avulsion of the ossification center of the tibial tubercle

A

Osgood Schlatter

96
Q

Pt presents with:
- Anterior knee pain that increases gradually over time
- Exacerbated by direct trauma, kneeling, running ,jumping and other activity
- Relieved by rest
- Typically asymmetric, occasionally bilateral

A

Osgood Schlatter

97
Q

Pt PE:
- slight swelling/bony prominence of tibial tubercle
- Tenderness to tibial tubercle
- Pain with resisted extension of knee

A

Osgood Schlatter

98
Q

When should radiograph plain films be obtained for Osgood Schlatter

A
  • Pain at night
  • Pain not related to activity
  • Acute onset of pain
  • Associated systemic complaints such as fever, chills
99
Q

Treatment of Osgood schlatter

A
  • Usually benign and self limited
  • Resolves when the growth plate reaches skeletal maturity (ie: stop growing)
  • NSAIDS
    -Protective pad over knee
  • Duty modification
  • Avoid complete rest
  • Home Exercise Program
  • May consider physical therapy

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