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Med School Year 2 Flash Cards > Knee And hip acute Pain > Flashcards

Knee And hip acute Pain Flashcards

1
Q

What is the origin of vastus medialis?

A

Lower intertrochanteric line, spiral line, medial lines appear, and medial intermuscular septum

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2
Q

What is the insertion of vastus medialis?

A

Medial quad tendon to patella and patellar tendon to tibial tuberosity

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3
Q

What is the action of vastus medialis?

A

Extend knee, stabilize patella

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4
Q

What is the innervation of vastus medialis?

A

Posterior division of the femoral nerve (L3, L4)

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5
Q

What are the muscles of the quadriceps?

A

Vastus medialis, vastus lateralis, vastus intermediate, rectus femoris

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6
Q

What is the origin of vastus lateralis?

A

Greater trochanter of femur

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7
Q

What is the insertion of vastus lateralis?

A

Quad tendon to patella and patellar tendon to tibial tuberosity

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8
Q

What is the action of vastus lateralis

A

Extends the knee

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9
Q

What is the innervation of vastus lateralis?

A

Femoral nerve L2-L4

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10
Q

What is the origin of vastus intermedius ?

A

Anterior and lateral surfaces of the femur

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11
Q

What is the insertion of vastus intermedius?

A

Quad tendon to patella and patellar tendon to tibial tuberosity

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12
Q

What is the action of vastus intermedius?

A

Extends the knee

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13
Q

What is the innervation of vastus intermedius?

A

Femoral nerve (L2-L4)

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14
Q

What is the origin of rectus femoris?

A

Anterior inferior iliac spine

Ilium above acetabulum

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15
Q

What is the insertion of rectus femoris?

A

Quad tendon to patella and patellar tendon to tibial tuberosity

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16
Q

What is the action of rectus femoris

A

Flexes the hip

Extends the knee

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17
Q

What is the innervation of rectus femoris?

A

Femoral nerve L2-L4

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18
Q

What are the muscles that make up the hamstrings?

A

Biceps femoris
Semitendinosus
Semimembranosus

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19
Q

What is the origin of biceps femoris (long head), semitendinosus, semi membranosus?

A

Ischial tuberosity

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20
Q

What is the innervation of vastus lateralis, intermedius, and rectus femoris?

A

Femoral nerve (L2-L4)

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21
Q

What is the insertion of biceps femoris long head?

A

Lateral condyle of the tibia and fibular head

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22
Q

What is the action of biceps femoris long head?

A

Extends the hip

Flexes the knee and laterally rotates the leg

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23
Q

What is the innervation of the biceps femoris long head?

A

Tibial portion of the sciatic nerve (L5, S1,S2)

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24
Q

What is the insertion of biceps femoris short head?

A

Fibular head and lateral condyle of the tibia

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25
What is the origin of the biceps femoris short head?
Distal linea aspersions, lateral supracondylar ridge of the femur
26
What is the action of biceps femoris short head?
Flexes knee, lateral rotates leg
27
What is the innervation of biceps femoris short head?
Peroneal part of sciatic nerve (L5, S1, S2)
28
What is the insertion of semitendinosus?
Proximal tibia - MEDIAL to tibial tuberosity
29
What is the action of semitendinosus?
Flexes the knee Extends hip Medially rotates the leg
30
What is the innervation of semitendinosus?
Tibial portion of the sciatic nerve (L5, S1, S2)
31
What is the insertion of semi membranosus?
Medial condyle of the tibia
32
What is the action of semi membranosus?
Extends hip Flexes knee Medially rotates the leg
33
What is the innervation of semi membranosus?
Tibial portion of the sciatic nerve (L5, S1, S2)
34
What is the origin of gastrocnemius?
Medial head at the medial condyle of femur | Lateral head at lateral condyle of femur
35
What is the insertion of the gastrocnemius?
Calcaneal tendon
36
What is the action of gastrocnemius?
Flexes the Knee | Plantar flexes the foot
37
What is the innervation of gastrocnemius?
Tibial nerve (S1,S2)
38
What is the origin of soleus?
Proximal 1/2 of posterior surface of the tibia | Proximal 1/3 of posterior surface of fibula
39
What is the insertion of the soleus?
Calcaneal tendon
40
What is the action of soleus?
Plantar flexes foot
41
What is the innervation of soleus?
Tibial nerve (S1,S2)
42
What are the pes tendons?
It is the tendon of 3 conjoined muscles : sartorius, gracilis, semitendinosus.
43
Where do the pes tendons insert?
Superficial to the MCL
44
What is be first line of imaging after a good H&P?
X-ray | Rules of fractures/dislocations, avulsions of ligaments or tendons
45
What imaging is used for detecting ACL, PCL, meniscal tears
MRI
46
What is usually in the hx of an ACL tear?
``` Deceleration and rotation Hyperextended Valgus position Direct blow Pop heard Knee instability with cutting and pivoting Knee felt like shifting Immediate hemarthosis ```
47
What will you see on MRI of ACL tear?
Ligament tear | Bone bruise pattern of lateral femoral condyle and tibial plateau
48
When is the non operative treatment appropriate for an ACL tear?
For Sedentary lifestyle patients | Focus on quad strengthening
49
When do you operate on an ACL tear?
Young, healthy, active, cutting sports | Older patients who fail with non op management
50
What must happen before surgery?
ROM and swelling must be normal
51
What is usually in the hx of MCL tear?
``` No contact external rotation Hit on medial side of knee Hear a pop Little swelling Medial knee pain Instability ```
52
What are the tests for MCL pathology?
Valgus test with abduction of the hip and flexion of the knee to 20-30 degrees. Positives = clicking, thump, pain, restriction
53
What are the tests for ACL tear?
Lachman's and anterior drawer test
54
What might you see on X-ray for an MCL tear?
Fractures | Pellegrini Stieda lesion
55
What is the confirmatory imaging diagnostic test for MCL.?
MRI
56
How do you trea MCL tear?
If it is isolated - non op with hinge knee brace and PT for quad strengthening
57
When do you operate for a MCL tear?
When there are other ligaments injured | When there is severe laxity after non op treatment
58
What is in the hx for LCL injury?
Lateral knee pain Instability Hit lower leg from outside making tibia go midline
59
What are the ortho tests for an LCL injury?
Varus test
60
What is in the hx for a PCL tear?
Dashboard injury | Fall on to flexed knee with plantar flexion
61
What would you find on physical exam in a PCL tear?
Bruising anterior tibia | Posterior sag
62
What are the ortho tests for PCL?
Posterior drawer test
63
What is the treatment for PCL.?
If isolated treat nonop | Surgical : repair avulsions or reconstruct mid substance tears or chronic injuries
64
What is usually the hx of meniscal tears?
Traumatic | Chronic / degenerative
65
What will be in the hx if the meniscal tear is due to trauma?
``` Axial load and rotation Pain Swelling Clicking/catching Locking knee and twist to unstick ```
66
What other tear is associated with a lateral meniscus tear?
ACL
67
What is in the hx of meniscal tear if it's chronic?
``` Insidious onset of pain and swelling Locking Catching Pain along joint line May or may not know of injury ```
68
What is usually found on physical exam of a meniscal tear?
Mild effusion | Joint line pain
69
What are the tests for meniscal tears?
Apley's | McMurray's
70
What are the non op treatments for a meniscal tear?
``` NSAIDs PT Low impact activity Glucosamine Steroid shots ```
71
What is in the hx for a patellar tendon rupture?
Felt pop Younger than 40 years old Missed a step, playing basketball, jumping Can't extend the knee
72
What is found on physical exam of a patella tendon rupture?
``` Unable to extend the knee Unable to hold leg in the air High riding patella Defect below patella Hemarthosis ```
73
Who gets quad tendon rupture?
Older people with comorbidities such as gout, diabetes, chronic renal failure, SLE, infection Using steroids, fluoroquinolnes
74
What is found on physical exam of a quan tendon rupture?
``` Unable to extend the knee Unable to hold leg in air Low riding patella Defect above patella Hemarthrosis ```
75
What is in the hx of patella dislocation?
Acute hemarthrosis Valgus force and external rotation of tibia to a flexed knee Feel patella out laterally Feels like knee is shifted medially
76
Who usually has a patella dislocation?
Females in 2nd decade
77
What is the J sign?
When the patella moves laterally on extension of the knee
78
What are you looking for on X-ray of a patella dislocation?
Osteochondral loose pieces/fractures
79
What is the treatment for patellar dislocation?
Knee brace Cast with knee in extension Reduction maneuver - push the patella over Surgery
80
Who gets a patellar sleeve fracture?
8-12 year olds
81
What are the physical signs of a patellar sleeve fracture?
Extensor tendon lag | Inability to straight leg raise
82
What are the X-ray findings of a patellar sleeve fracture?
Small fleck of bone inferior patella | More articular cartilage to attached piece
83
What is the protocol for a patellar sleeve fracture?
Refer to ortho surgeon for likely internal fixation
84
What bone makes up the acetabulum?
Ischium, ilium, pubis
85
What is the blood supply to the femoral head?
For weight bearing dome: medial femoral circumflex artery
86
What is in the hx of a femoral neck fracture?
Patient over 50 who fell | Trauma
87
What is on the PE of a femoral neck fracture?
Shortened, externally rotated leg | Hip motion is painful
88
What X-rays should be ordered for a femoral neck fracture?
AP and lateral
89
What is the treatment for a femoral neck fracture?
Surgical: internal fixation Joint replacement Post op: vit D, calcium, bisphosphonates
90
What is the difference between femoral neck fractures and intertrochanteric fractures?
Intertrochanteric fractures have more cancellous bone so are more likely to heal and less likely to have nonunion and a vascular necrosis
91
What is in the hx of intertrochanteric fractures?
Older patients than fem neck fractures Low energy fall Pain in groin Unable to bear weight
92
What is in the hx of stress fractures?
``` Female Recent increase in training Poor nutrition Menstrual disturbances Low bone density Pain worse with activity ```
93
What is found on PE of a stress fracture of the femur?
Pain worse with running or jumping Slight antalgic gait May be normal
94
What is found on X-RAY of a stress fracture?
Usually normal
95
What is the treatment for a stress fracture?
Crutches, partial weight bearing | Cross training
96
What is the management of stress fractures?
Work up for osteopenia and poor nutrition | Need counseling, OCPs, better diet
97
Who gets a hip dislocation?
Younger active patients from trauma and sports
98
What is found on PE on hip dislocation?
``` Posterior = short, adducted, internally rotated Anterior = flexed, abducted, externally rotated ```
99
What is the diagnostic test for a hip dislocation?
X-ray
100
What is a CT Scan used for in hip dislocations?
To determine loose bodies, concentric reduction, and fractures
101
What is the treatment for a hip dislocation?
Emergent reduction
102
What is SCFE?
Slipped capital femoral epiphysis - the ball of the hip slips off posteriorly
103
What is in the hx of SCFE?
``` Subacute pain over one month Aching pain Obese child Limp 11-13 yo ```
104
What do you find on physical exam of SCFE?
Loss of abduction, internal rotation | Obligatory external rotation and flexion of the hip
105
What are the diagnostic tests for SCFE?
AP and frog leg lateral
106
What is the treatment?
Prompt surgical treatment | This is progressive!!!!
107
Why does SCFE occur?
Due to weakness of the growth plate
108
What is the hx of Perthes?
4-10 yo Painless limp Mild pain that radiates to thigh or knee
109
What is found on physical exam of Perthes?
``` Atrophy of thigh Decreased ROM of hip Loss of abduction Loss of internal rotation Can only flex to 30 degrees ```
110
What do X-rays reveal about Perthes?
Early on X-rays are normal | Overtime there is collapse of the head
111
What is the treatment of Perthes?
Maintain motion Observe Hip brace if progresses
112
What is the pathogenesis of Perthes?
Not enough blood supply to the femoral head so the bone dies
113
What is in the H&P of a quad contusion?
Direct blow to the thigh; often football Pain on palpation Pain with knee motion in thigh region
114
What is a quad contusion a risk factor for?
Myositis ossificans
115
What is the treatment for a quad contusion?
Elevation Flex hip and knee Gentle ROM after a few days
116
Which quad muscle is most anterior?
Rectus femoris
117
What part of the hip is affected by hip pointer?
Iliact crest
118
What is the treatment of hip pointer?
Rest, ice
119
What is hip pointer?
Contusion on the pelvis
120
What is a pelvis avulsion?
When a piece of bone tears away from the site where the muscle attaches to the bone
121
Who gets a pelvic avulsion?
14-25 year old active patients
122
Where is the weak link in the skeletal attachments?
The apophyses
123
What is the treatment for a pelvic avulsion?
Symptomatic tx with rest and ambulatory with crutches for about 4 weeks 6-10 weeks return to sports

Med School Year 2 Flash Cards (18 decks)

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