Jaynstein - LE Topics in MSK Flashcards
what is the action of the acl (anterior cruciate ligament)
stabilization against anterior movement
what is the action of the pcl (posterior cruciate ligament)
stabilization against posterior movement
what is the action of the lateral collateral ligament (lcl)
stabilization of the knee against varus strain
what is the action of the medial collateral ligament (mcl)
stabilization of the knee against valgus strain
the acl connects the posterior aspect of the __
to the anterior aspect of the __
femoral condyle
tibia
the acl controls
- anterior translation of the tibia on the femur
- rotational stability
name 3 moi for acl tears
- non contact deceleration producing valgus twisting
- hyperestension
- marked internal rotation
what do you think of when you hear, female pt, heard a “pop,” in knee, feels unstable
acl injury
acl injuries are common in what sports (4)
- soccer
- basketball
- football
- skiing
what are the 3 exams to evaluate an acl injury
- lachman’s
- anterior drawer
- lever sign
what is the soc for all ligament injuries of the knee
MRI
when can xray be useful in an acl injury
to evaluate for avulsion fx
what is an avulsion fx w. acl injury
segond fx
acl tear w. tibial plateau fx
75% of acl tears have this
what will you see on MRI of acl injury
large effusions (fluid accumulation)
how would you tx acl injury in a young and active pt
surgical repair
what is an acl autograph
replacement w. your own patellar or hamstring tendon
what is an acl autograph
replacement with cadaver tendon
what is the tx for an older/sedentary pt with an acl injury
conservative → PT, control inflammation
what type of brace would you use for an acute acl tear
immobilizer
what type of brace would you use in a chronic/subacute acl injury
hinged
which ligament is the strongest in the knee
pcl (posterior cruciate ligament)
bc the pcl is so strong, __
and __ are more common,
and __% have associated injury
sprains
partial tears
70%
what is the moi for pcl tear
blow to the knee while it is flexed → dashboard injury
falling on knee when it is flexed
what are 4 sx of a pcl injury
- immediate profound swelling
- severe pain
- limited ROM
- instability/inability to ambulate
what do you call this, and what does it make you think
sag sign → set-off of the tibia posteriorly
pcl injury
what is the dx for pcl injury
MRI
what is the tx for isolated pcl tears
+/- non op tx w. PT → failure = surgery
what is the tx for pcl injury in combo with another knee ligament injury
surgery
are knee ligament injuries operated on immediately
no → ortho likes to let them chill and have swelling go down before surgery
MCL injury is often associated w. __ injury
acl
effusions in mcl injuries are
less common
what is the moi for mcl injury
valgus stress on partially flexed knee
mediala to lateral imact
what are 3 symptoms of an mcl injury
- focal pain over ligament
- minor swelling
- limited ROM acutely
what test is used to evaluate mcl injury
valgus stress exam
MRIs in mcl injuries are
not needed acutely → watch and wait
what is the tx for mcl injury
- graduated wt bearing as tolerated
- bracing
- PT
- 6-8 weeks for healing
what injury is caused by varus stress (medial impact) on a partially flexed knee
lateral collateral ligament (lcl) injury
what knee injury is evaluated w. the varus stress exam
lcl injury
does lcl injury require an MRI acutely
no → watch and wait
what are the shock absorbers of the knee
lateral and medial meniscus
what injury do you think when you see “locking or clicking,” joint line tenderness, and painful walking and squatting
meniscus injuries
meniscus injuries are usually related to what action
twisting
what exam is used to evaluate meniscus injuries
mcmurray exam
what is the dx test for meniscus injuries
MRI
meniscus injuries can be caused by __
or __
degeneration
acute injury
what is the tx for degeneration related meniscus injuries
non op
PT
what is the tx for acutely injured meniscus
arthroscopic meniscus repair
or debridement
what is the definition of a knee dislcoation
dislocation of the tibiofemoral joint
in terms of tx, knee dislocations are considered
a medical emergency!
knee dislocations are often associated w.
multi trauma → 50%
to dislocate the knee, you must tear at least __ (if not more) of the 4 major ligaments
3
why are knee dislocations considered a medical emergency
popliteal and peroneal arteries → risk for vascular emergency
what is the soc test for knee dislocations
ABI → must evaluate for neurovascular injury
also pt sensation and strength
in the evaluation of knee dislocations, palpable distal pulses are
not enough! → order ABI
what is nl for the ABI test
>0.9
if a pt w. a knee dislocation has an ABI of >0.9, what should you do
monitor w. serial exams
if a pt w. a knee dislocation has an ABI of <0.9, what is the next step
advanced imaging
besides ABI, what is another soc test for knee dislocations
CTA
what are 6 tx steps in knee dislocation
- IV pain control
- do exams and imaging BEFORE reducing
- reduce no matter what → even if vascular injury
- post-reduction xray
- long leg splint
- admit + ortho
should you reduce a dislocated knee if the pt has vascular injury
yes!
what pt population is mc for knee bursitis
construction/flooring workers
how do you differentiate bursitis from a possible tear injury
history → no trauma w. bursitis
dx for knee bursitis is
clinical
what is the tx for acute bursitis
NSAIDs
RICE
eliminate pressure
what is the tx for refractory knee bursitis
prepatellar corticosteroid bursa injxns
what is the mc location for oa
medial compartment of the knee
what are 4 symptoms of knee oa
- morning stiffness <30 min
- crepitus
- mild effusion
- pain relieved w. rest
what might you see on physical exam of a pt w. knee oa
genu valgum
genu varum
what is the soc for dx of knee oa
xray
what do you think when you see joint space narrowing and osteophytes on xray
oa
what is conservative tx for knee oa (3)
wt loss
gradual exercise → quad strengthening
APAP/NSAIDs
what is short term tx for knee oa
intra-articular corticosteroid
what might Synvisc be prescribed for
knee oa
what is the only true fix for knee oa
total or partial knee arthroplasty
what is this surgery called and when might it be indicated
total knee arthroplasty
knee oa
what is the most common site for patellar subluxation and dislocation
lateral
what might be the moi for patella subluxation/dislocation
direct blow to one side of the knee
what do you think when you see knee pain, deformity, swelling, limited ROM, and leg locked in extension
patellar subluxation and dislocation
what imaging protocol should you use for knee subluxation and dislocation
xray pre AND post reduction
what is the tx for patellar subluxation/dislocation
reduction → apply pressure while extending the knee
usually no meds required
PT → quad strengthening
what might cause a patellar fx
direct patellar impact
dashboard or fall onto flexed knee
what 3 xray images do you need for patellar fx dx
- AP
- lateral
- sunrise views
what is this image showing
sunrise xray of patellar fx
with a patellar fx, it is important to document __ is intact using
__ test
patellar tendon
SLR (straight leg raise)
a non-operative patellar fx is when
extensor mechanism (patellar tendon) is intact → non displaced, vertical fx
an operative patellar fx occurs when
there is extensor mechanism (patellar tendon) failure → open fx, displaced fx, comminuted fx
what is the tx for non operative patellar fx
extensor bracing with wt bearing
what is the tx for operative patellar fx
ORIF
what is a bipartate patella
patella composed of 2 bones → normal variant in 1/50 people
what is this MRI showing
elevated patella → patella tendon rupture
name 2 MOI for patellar tendon rupture
- jumping sports
- missing a step on the stairs
→ sudden quadricep contraction
what is the tx for patellar tendon rupture
ortho referral
surgery
what is caused by damage to the undersurface cartilage of the patella 2/2 to poor patellar tracking
chondromalacia / patellofemoral syndrome - aka runners knee
in what pt population is chondromalacia / patellaofemoral syndrome mc
adolescent and. young adult females
chondromalacia / patellofemoral syndrome increases risk for
lateral patellar subluxation
what two pe tests are used to evaluate chondromaliacia/ patellofemoral syndrome
grind test
apprehension sign
what imaging is used to dx chondromalacia / patellofemoral syndrome
xrays → AP and sunrise
MRI to assess cartilage drainage
a pt must have met what criteria to be eligible for surgery for chondromalacia/patellofemoral syndrome
failed PT for a year
what are 2 surgical options for chondromalacia/patellofemoral syndrome
- arthroscopic debridement
- patellar tendon realignment
a fx is always more concerning if it has __ involvement
articular → intraarticular fx
tibial plateau fx are commonly missed, so it is important to xray
entire length of the bone, including knee joint AND ankle joint
all tibial plateau fx’s get
ortho consult → wt bearing bone!
tx for tibial plateau fx w. no to minimal displacement
no-op
hinged brace/crutches
tx for displaced, comminuted, or open tibial plateau fx
surgery
what is a major concern in tibial plateau fx
compartment syndrome → mc affects calf
dx for tibial shaft fx
xray alone
tx for tibial shaft fx with minimal displacement
splint w. crutches
tx for displaced or comminuted tibial plateau fx
splint w. crutches
why are fibula fx’s less concerning than tibial fx’s
non wt bearing bone
tx for fibula fx
cast
wt bearing is fine
mc injured ligament in ankle sprain is __
bc it is also the weakest ligament
atfl
2nd weakest ligament and 2nd mc site of injury in ankle sprain
cfl ligament
3rd mc site of injury in ankle sprain
lateral malleolus
high ankle sprains account for __% of sprains
low ankle sprains account for __% of sprains
high: 10%
low: 90%
high ankle sprains are a __ injury
involving __
and __ ligaments
syndemosis injury
tibiofibular and interosseous ligaments
what ligaments to low ankle sprains involve
atfl
cfl
1st degree ankle sprain involves a
stretched ligament
a 2nd degree ankle sprain involves a
partial tear
a 3rd degree ankle sprain involves a
complete tear
2 ankle tests
anterior drawer
talar tilt
anterior drawer test evaluates which ligament
atfl
talar tilt test evaluates
atfl
cfl
what is the mc reason for missed sports participation
ankle sprain
80% of ankle sprain are caused by __ injury
inversion
is imaging generally helpful in ankle sprain
no
what criteria should you use to decide whether or not to image an injured ankle
ottawa
what are the 4 ottawa ankle rules
inability to bear wt
medial or lateral malleolus bony tenderness
SMT base tenderness
navicular tenderness
none of these → no xray
tx for 1st degree ankle sprain
walk it off!
prolonged immobilization leads to more complications
tx for 2nd degree ankle sprain
+/- moderate walking
tx for 3rd degree ankle sprain
no waking 3-7 days
walk asap
+/- surgery
lateral malleolus fx is a fx of the
fibula
medial malleolus fx is a fx of the
tibia
what is the ankle mortus
line over the talar dome → joint of ankle → must be evaluate in ankle fx
what is this showing
ankle mortus
what bone bears the most wt per unit
ankle
all ankle fx’s must be
reduced (realigned)
what is a bad complication of ankle fx’s
arthritis
which ankle fx is less concerning
lateral malleolus → fibula → non wt bearing joint
tx for isolated vs displaced lateral fibula injury
isolated: walking boot → ortho
displaced/comminuted → surgery
medial malleolar fx are more likely to need
surgery → wt bearing bone
what is this showing
medial malleolar fx
what type of injury involves a “shattered ankle”
trimalleolar fx
bimalleolar fx involves
medial AND lateral malloli
trimalleolar fx involves the
medial, lateral, AND posterior malloli
what is this showing
trimalleolar fx
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
achilles tendon rupture
2 rf for achilles tendon rupture
weekend warrior
fluoroquinolone use
test for achilles tendon rupture
thompson
what is the largest tendon in the body
achilles
gold standard for achilles tendon rupture dx
MRI
what is this showing
MRI of achilles tendon rupture
tx for phalangeal fx
buddy tape
hard soled cast to keep foot flat
what 3 types of metatarsal fx require surgery
any open fx
multiple fx
any displacement in 1st metatarsal
what is a dancers fx / Jones fx
5th metatarsal fx
what is a pseudo Jones (avulsion) fx
transverse fx through the base of the 5th metatarsal
what is a jones fracture
transverse fracture through the proximal 5th metatarsal bone
tx for pseudo jones fx
wt bearing ok → less serious
tx for jones and stress fx
non wt bearing → more concerning
what injury might a pt describe as “pins and needles,” or “feels like i’m stepping on a tac”
plantar fasciitis
plantar fasciitis involves sharp pain in the __
and pain w. __
heel
dorsiflexion
tx for plantar fasciitis
stretch w. tennis ball or water bottle
NSAIDs
arch support
hammer toe is common in __
and can only occur in toes __
people who wear high heels
2-5
is hammer toe deformity reversible
no!
a corn is a
paunful, raised, small center
a callus is
larger than a corn, non painful
what is this
corn
what is this
callus
tx for a corn
file/remove
corn pads
tx for callus
if no issues, leave it alone
what is hallux valgus
bunion
bunions involve what joint
MCP → displacement of the lateral head
all most all bunions need
surgery once painful
pathogen of concern in ingrown toenails
pseudomonas
___ knee dislocations are the mc
anterior
