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Clin Med II - Exam 2 > Jaynstein - LE Topics in MSK > Flashcards

Jaynstein - LE Topics in MSK Flashcards

1
Q

what is the action of the acl (anterior cruciate ligament)

A

stabilization against anterior movement

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2
Q

what is the action of the pcl (posterior cruciate ligament)

A

stabilization against posterior movement

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3
Q

what is the action of the lateral collateral ligament (lcl)

A

stabilization of the knee against varus strain

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4
Q

what is the action of the medial collateral ligament (mcl)

A

stabilization of the knee against valgus strain

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5
Q

the acl connects the posterior aspect of the __

to the anterior aspect of the __

A

femoral condyle

tibia

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6
Q

the acl controls

A
  1. anterior translation of the tibia on the femur
  2. rotational stability
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7
Q

name 3 moi for acl tears

A
  1. non contact deceleration producing valgus twisting
  2. hyperestension
  3. marked internal rotation
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8
Q

what do you think of when you hear, female pt, heard a “pop,” in knee, feels unstable

A

acl injury

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9
Q

acl injuries are common in what sports (4)

A
  1. soccer
  2. basketball
  3. football
  4. skiing
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10
Q

what are the 3 exams to evaluate an acl injury

A
  1. lachman’s
  2. anterior drawer
  3. lever sign
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11
Q

what is the soc for all ligament injuries of the knee

A

MRI

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12
Q

when can xray be useful in an acl injury

A

to evaluate for avulsion fx

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13
Q

what is an avulsion fx w. acl injury

A

segond fx

acl tear w. tibial plateau fx

75% of acl tears have this

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14
Q

what will you see on MRI of acl injury

A

large effusions (fluid accumulation)

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15
Q

how would you tx acl injury in a young and active pt

A

surgical repair

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16
Q

what is an acl autograph

A

replacement w. your own patellar or hamstring tendon

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17
Q

what is an acl autograph

A

replacement with cadaver tendon

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18
Q

what is the tx for an older/sedentary pt with an acl injury

A

conservative → PT, control inflammation

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19
Q

what type of brace would you use for an acute acl tear

A

immobilizer

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20
Q

what type of brace would you use in a chronic/subacute acl injury

A

hinged

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21
Q

which ligament is the strongest in the knee

A

pcl (posterior cruciate ligament)

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22
Q

bc the pcl is so strong, __

and __ are more common,

and __% have associated injury

A

sprains

partial tears

70%

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23
Q

what is the moi for pcl tear

A

blow to the knee while it is flexed → dashboard injury

falling on knee when it is flexed

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24
Q

what are 4 sx of a pcl injury

A
  1. immediate profound swelling
  2. severe pain
  3. limited ROM
  4. instability/inability to ambulate
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25
Q

what do you call this, and what does it make you think

A

sag sign → set-off of the tibia posteriorly

pcl injury

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26
Q

what is the dx for pcl injury

A

MRI

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27
Q

what is the tx for isolated pcl tears

A

+/- non op tx w. PT → failure = surgery

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28
Q

what is the tx for pcl injury in combo with another knee ligament injury

A

surgery

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29
Q

are knee ligament injuries operated on immediately

A

no → ortho likes to let them chill and have swelling go down before surgery

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30
Q

MCL injury is often associated w. __ injury

A

acl

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31
Q

effusions in mcl injuries are

A

less common

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32
Q

what is the moi for mcl injury

A

valgus stress on partially flexed knee

mediala to lateral imact

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33
Q

what are 3 symptoms of an mcl injury

A
  1. focal pain over ligament
  2. minor swelling
  3. limited ROM acutely
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34
Q

what test is used to evaluate mcl injury

A

valgus stress exam

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35
Q

MRIs in mcl injuries are

A

not needed acutely → watch and wait

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36
Q

what is the tx for mcl injury

A
  1. graduated wt bearing as tolerated
  2. bracing
  3. PT
  4. 6-8 weeks for healing
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37
Q

what injury is caused by varus stress (medial impact) on a partially flexed knee

A

lateral collateral ligament (lcl) injury

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38
Q

what knee injury is evaluated w. the varus stress exam

A

lcl injury

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39
Q

does lcl injury require an MRI acutely

A

no → watch and wait

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40
Q

what are the shock absorbers of the knee

A

lateral and medial meniscus

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41
Q

what injury do you think when you see “locking or clicking,” joint line tenderness, and painful walking and squatting

A

meniscus injuries

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42
Q

meniscus injuries are usually related to what action

A

twisting

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43
Q

what exam is used to evaluate meniscus injuries

A

mcmurray exam

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44
Q

what is the dx test for meniscus injuries

A

MRI

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45
Q

meniscus injuries can be caused by __

or __

A

degeneration

acute injury

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46
Q

what is the tx for degeneration related meniscus injuries

A

non op

PT

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47
Q

what is the tx for acutely injured meniscus

A

arthroscopic meniscus repair

or debridement

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48
Q

what is the definition of a knee dislcoation

A

dislocation of the tibiofemoral joint

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49
Q

in terms of tx, knee dislocations are considered

A

a medical emergency!

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50
Q

knee dislocations are often associated w.

A

multi trauma → 50%

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51
Q

to dislocate the knee, you must tear at least __ (if not more) of the 4 major ligaments

A

3

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52
Q

why are knee dislocations considered a medical emergency

A

popliteal and peroneal arteries → risk for vascular emergency

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53
Q

what is the soc test for knee dislocations

A

ABI → must evaluate for neurovascular injury

also pt sensation and strength

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54
Q

in the evaluation of knee dislocations, palpable distal pulses are

A

not enough! → order ABI

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55
Q

what is nl for the ABI test

A

>0.9

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56
Q

if a pt w. a knee dislocation has an ABI of >0.9, what should you do

A

monitor w. serial exams

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57
Q

if a pt w. a knee dislocation has an ABI of <0.9, what is the next step

A

advanced imaging

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58
Q

besides ABI, what is another soc test for knee dislocations

A

CTA

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59
Q

what are 6 tx steps in knee dislocation

A
  1. IV pain control
  2. do exams and imaging BEFORE reducing
  3. reduce no matter what → even if vascular injury
  4. post-reduction xray
  5. long leg splint
  6. admit + ortho
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60
Q

should you reduce a dislocated knee if the pt has vascular injury

A

yes!

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61
Q

what pt population is mc for knee bursitis

A

construction/flooring workers

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62
Q

how do you differentiate bursitis from a possible tear injury

A

history → no trauma w. bursitis

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63
Q

dx for knee bursitis is

A

clinical

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64
Q

what is the tx for acute bursitis

A

NSAIDs

RICE

eliminate pressure

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65
Q

what is the tx for refractory knee bursitis

A

prepatellar corticosteroid bursa injxns

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66
Q

what is the mc location for oa

A

medial compartment of the knee

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67
Q

what are 4 symptoms of knee oa

A
  1. morning stiffness <30 min
  2. crepitus
  3. mild effusion
  4. pain relieved w. rest
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68
Q

what might you see on physical exam of a pt w. knee oa

A

genu valgum

genu varum

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69
Q

what is the soc for dx of knee oa

A

xray

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70
Q

what do you think when you see joint space narrowing and osteophytes on xray

A

oa

71
Q

what is conservative tx for knee oa (3)

A

wt loss

gradual exercise → quad strengthening

APAP/NSAIDs

72
Q

what is short term tx for knee oa

A

intra-articular corticosteroid

73
Q

what might Synvisc be prescribed for

A

knee oa

74
Q

what is the only true fix for knee oa

A

total or partial knee arthroplasty

75
Q

what is this surgery called and when might it be indicated

A

total knee arthroplasty

knee oa

76
Q

what is the most common site for patellar subluxation and dislocation

A

lateral

77
Q

what might be the moi for patella subluxation/dislocation

A

direct blow to one side of the knee

78
Q

what do you think when you see knee pain, deformity, swelling, limited ROM, and leg locked in extension

A

patellar subluxation and dislocation

79
Q

what imaging protocol should you use for knee subluxation and dislocation

A

xray pre AND post reduction

80
Q

what is the tx for patellar subluxation/dislocation

A

reduction → apply pressure while extending the knee

usually no meds required

PT → quad strengthening

81
Q

what might cause a patellar fx

A

direct patellar impact

dashboard or fall onto flexed knee

82
Q

what 3 xray images do you need for patellar fx dx

A
  1. AP
  2. lateral
  3. sunrise views
83
Q

what is this image showing

A

sunrise xray of patellar fx

84
Q

with a patellar fx, it is important to document __ is intact using

__ test

A

patellar tendon

SLR (straight leg raise)

85
Q

a non-operative patellar fx is when

A

extensor mechanism (patellar tendon) is intact → non displaced, vertical fx

86
Q

an operative patellar fx occurs when

A

there is extensor mechanism (patellar tendon) failure → open fx, displaced fx, comminuted fx

87
Q

what is the tx for non operative patellar fx

A

extensor bracing with wt bearing

88
Q

what is the tx for operative patellar fx

A

ORIF

89
Q

what is a bipartate patella

A

patella composed of 2 bones → normal variant in 1/50 people

90
Q

what is this MRI showing

A

elevated patella → patella tendon rupture

91
Q

name 2 MOI for patellar tendon rupture

A
  1. jumping sports
  2. missing a step on the stairs

→ sudden quadricep contraction

92
Q

what is the tx for patellar tendon rupture

A

ortho referral

surgery

93
Q

what is caused by damage to the undersurface cartilage of the patella 2/2 to poor patellar tracking

A

chondromalacia / patellofemoral syndrome - aka runners knee

94
Q

in what pt population is chondromalacia / patellaofemoral syndrome mc

A

adolescent and. young adult females

95
Q

chondromalacia / patellofemoral syndrome increases risk for

A

lateral patellar subluxation

96
Q

what two pe tests are used to evaluate chondromaliacia/ patellofemoral syndrome

A

grind test

apprehension sign

97
Q

what imaging is used to dx chondromalacia / patellofemoral syndrome

A

xrays → AP and sunrise

MRI to assess cartilage drainage

98
Q

a pt must have met what criteria to be eligible for surgery for chondromalacia/patellofemoral syndrome

A

failed PT for a year

99
Q

what are 2 surgical options for chondromalacia/patellofemoral syndrome

A
  1. arthroscopic debridement
  2. patellar tendon realignment
100
Q

a fx is always more concerning if it has __ involvement

A

articular → intraarticular fx

101
Q

tibial plateau fx are commonly missed, so it is important to xray

A

entire length of the bone, including knee joint AND ankle joint

102
Q

all tibial plateau fx’s get

A

ortho consult → wt bearing bone!

103
Q

tx for tibial plateau fx w. no to minimal displacement

A

no-op

hinged brace/crutches

104
Q

tx for displaced, comminuted, or open tibial plateau fx

A

surgery

105
Q

what is a major concern in tibial plateau fx

A

compartment syndrome → mc affects calf

106
Q

dx for tibial shaft fx

A

xray alone

107
Q

tx for tibial shaft fx with minimal displacement

A

splint w. crutches

108
Q

tx for displaced or comminuted tibial plateau fx

A

splint w. crutches

109
Q

why are fibula fx’s less concerning than tibial fx’s

A

non wt bearing bone

110
Q

tx for fibula fx

A

cast

wt bearing is fine

111
Q

mc injured ligament in ankle sprain is __

bc it is also the weakest ligament

A

atfl

112
Q

2nd weakest ligament and 2nd mc site of injury in ankle sprain

A

cfl ligament

113
Q

3rd mc site of injury in ankle sprain

A

lateral malleolus

114
Q

high ankle sprains account for __% of sprains

low ankle sprains account for __% of sprains

A

high: 10%
low: 90%

115
Q

high ankle sprains are a __ injury

involving __

and __ ligaments

A

syndemosis injury

tibiofibular and interosseous ligaments

116
Q

what ligaments to low ankle sprains involve

A

atfl

cfl

117
Q

1st degree ankle sprain involves a

A

stretched ligament

118
Q

a 2nd degree ankle sprain involves a

A

partial tear

119
Q

a 3rd degree ankle sprain involves a

A

complete tear

120
Q

2 ankle tests

A

anterior drawer

talar tilt

121
Q

anterior drawer test evaluates which ligament

A

atfl

122
Q

talar tilt test evaluates

A

atfl

cfl

123
Q

what is the mc reason for missed sports participation

A

ankle sprain

124
Q

80% of ankle sprain are caused by __ injury

A

inversion

125
Q

is imaging generally helpful in ankle sprain

A

no

126
Q

what criteria should you use to decide whether or not to image an injured ankle

A

ottawa

127
Q

what are the 4 ottawa ankle rules

A

inability to bear wt

medial or lateral malleolus bony tenderness

SMT base tenderness

navicular tenderness

none of these → no xray

128
Q

tx for 1st degree ankle sprain

A

walk it off!

prolonged immobilization leads to more complications

129
Q

tx for 2nd degree ankle sprain

A

+/- moderate walking

130
Q

tx for 3rd degree ankle sprain

A

no waking 3-7 days

walk asap

+/- surgery

131
Q

lateral malleolus fx is a fx of the

A

fibula

132
Q

medial malleolus fx is a fx of the

A

tibia

133
Q

what is the ankle mortus

A

line over the talar dome → joint of ankle → must be evaluate in ankle fx

134
Q

what is this showing

A

ankle mortus

135
Q

what bone bears the most wt per unit

A

ankle

136
Q

all ankle fx’s must be

A

reduced (realigned)

137
Q

what is a bad complication of ankle fx’s

A

arthritis

138
Q

which ankle fx is less concerning

A

lateral malleolus → fibula → non wt bearing joint

139
Q

tx for isolated vs displaced lateral fibula injury

A

isolated: walking boot → ortho

displaced/comminuted → surgery

140
Q

medial malleolar fx are more likely to need

A

surgery → wt bearing bone

141
Q

what is this showing

A

medial malleolar fx

142
Q

what type of injury involves a “shattered ankle”

A

trimalleolar fx

143
Q

bimalleolar fx involves

A

medial AND lateral malloli

144
Q

trimalleolar fx involves the

A

medial, lateral, AND posterior malloli

145
Q

what is this showing

A

trimalleolar fx

146
Q

what injury are you thinking of if a pt says it felt like they got shot in the back of the leg and heard a pop

A

achilles tendon rupture

147
Q

2 rf for achilles tendon rupture

A

weekend warrior

fluoroquinolone use

148
Q

test for achilles tendon rupture

A

thompson

149
Q

what is the largest tendon in the body

A

achilles

150
Q

gold standard for achilles tendon rupture dx

A

MRI

151
Q

what is this showing

A

MRI of achilles tendon rupture

152
Q

tx for phalangeal fx

A

buddy tape

hard soled cast to keep foot flat

153
Q

what 3 types of metatarsal fx require surgery

A

any open fx

multiple fx

any displacement in 1st metatarsal

154
Q

what is a dancers fx / Jones fx

A

5th metatarsal fx

155
Q

what is a pseudo Jones (avulsion) fx

A

transverse fx through the base of the 5th metatarsal

156
Q

what is a jones fracture

A

transverse fracture through the proximal 5th metatarsal bone

157
Q

tx for pseudo jones fx

A

wt bearing ok → less serious

158
Q

tx for jones and stress fx

A

non wt bearing → more concerning

159
Q

what injury might a pt describe as “pins and needles,” or “feels like i’m stepping on a tac”

A

plantar fasciitis

160
Q

plantar fasciitis involves sharp pain in the __

and pain w. __

A

heel

dorsiflexion

161
Q

tx for plantar fasciitis

A

stretch w. tennis ball or water bottle

NSAIDs

arch support

162
Q

hammer toe is common in __

and can only occur in toes __

A

people who wear high heels

2-5

163
Q

is hammer toe deformity reversible

A

no!

164
Q

a corn is a

A

paunful, raised, small center

165
Q

a callus is

A

larger than a corn, non painful

166
Q

what is this

A

corn

167
Q

what is this

A

callus

168
Q

tx for a corn

A

file/remove

corn pads

169
Q

tx for callus

A

if no issues, leave it alone

170
Q

what is hallux valgus

A

bunion

171
Q

bunions involve what joint

A

MCP → displacement of the lateral head

172
Q

all most all bunions need

A

surgery once painful

173
Q

pathogen of concern in ingrown toenails

A

pseudomonas

174
Q

___ knee dislocations are the mc

A

anterior

Clin Med II - Exam 2 (14 decks)

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