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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
Q

What is the origin of the biceps femoris short head?

A

Distal linea aspersions, lateral supracondylar ridge of the femur

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26
Q

What is the action of biceps femoris short head?

A

Flexes knee, lateral rotates leg

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27
Q

What is the innervation of biceps femoris short head?

A

Peroneal part of sciatic nerve (L5, S1, S2)

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28
Q

What is the insertion of semitendinosus?

A

Proximal tibia - MEDIAL to tibial tuberosity

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29
Q

What is the action of semitendinosus?

A

Flexes the knee
Extends hip
Medially rotates the leg

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30
Q

What is the innervation of semitendinosus?

A

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

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31
Q

What is the insertion of semi membranosus?

A

Medial condyle of the tibia

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32
Q

What is the action of semi membranosus?

A

Extends hip
Flexes knee
Medially rotates the leg

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33
Q

What is the innervation of semi membranosus?

A

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

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34
Q

What is the origin of gastrocnemius?

A

Medial head at the medial condyle of femur

Lateral head at lateral condyle of femur

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35
Q

What is the insertion of the gastrocnemius?

A

Calcaneal tendon

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36
Q

What is the action of gastrocnemius?

A

Flexes the Knee

Plantar flexes the foot

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37
Q

What is the innervation of gastrocnemius?

A

Tibial nerve (S1,S2)

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38
Q

What is the origin of soleus?

A

Proximal 1/2 of posterior surface of the tibia

Proximal 1/3 of posterior surface of fibula

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39
Q

What is the insertion of the soleus?

A

Calcaneal tendon

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40
Q

What is the action of soleus?

A

Plantar flexes foot

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41
Q

What is the innervation of soleus?

A

Tibial nerve (S1,S2)

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42
Q

What are the pes tendons?

A

It is the tendon of 3 conjoined muscles : sartorius, gracilis, semitendinosus.

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43
Q

Where do the pes tendons insert?

A

Superficial to the MCL

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44
Q

What is be first line of imaging after a good H&P?

A

X-ray

Rules of fractures/dislocations, avulsions of ligaments or tendons

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45
Q

What imaging is used for detecting ACL, PCL, meniscal tears

A

MRI

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46
Q

What is usually in the hx of an ACL tear?

A 
Deceleration and rotation
Hyperextended 
Valgus position
Direct blow
Pop heard
Knee instability with cutting and pivoting
Knee felt like shifting
Immediate hemarthosis
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47
Q

What will you see on MRI of ACL tear?

A

Ligament tear

Bone bruise pattern of lateral femoral condyle and tibial plateau

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48
Q

When is the non operative treatment appropriate for an ACL tear?

A

For Sedentary lifestyle patients

Focus on quad strengthening

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49
Q

When do you operate on an ACL tear?

A

Young, healthy, active, cutting sports

Older patients who fail with non op management

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50
Q

What must happen before surgery?

A

ROM and swelling must be normal

51
Q

What is usually in the hx of MCL tear?

A 
No contact external rotation
Hit on medial side of knee
Hear a pop
Little swelling 
Medial knee pain
Instability
52
Q

What are the tests for MCL pathology?

A

Valgus test with abduction of the hip and flexion of the knee to 20-30 degrees.

Positives = clicking, thump, pain, restriction

53
Q

What are the tests for ACL tear?

A

Lachman’s and anterior drawer test

54
Q

What might you see on X-ray for an MCL tear?

A

Fractures

Pellegrini Stieda lesion

55
Q

What is the confirmatory imaging diagnostic test for MCL.?

A

MRI

56
Q

How do you trea MCL tear?

A

If it is isolated - non op with hinge knee brace and PT for quad strengthening

57
Q

When do you operate for a MCL tear?

A

When there are other ligaments injured

When there is severe laxity after non op treatment

58
Q

What is in the hx for LCL injury?

A

Lateral knee pain
Instability
Hit lower leg from outside making tibia go midline

59
Q

What are the ortho tests for an LCL injury?

A

Varus test

60
Q

What is in the hx for a PCL tear?

A

Dashboard injury

Fall on to flexed knee with plantar flexion

61
Q

What would you find on physical exam in a PCL tear?

A

Bruising anterior tibia

Posterior sag

62
Q

What are the ortho tests for PCL?

A

Posterior drawer test

63
Q

What is the treatment for PCL.?

A

If isolated treat nonop

Surgical : repair avulsions or reconstruct mid substance tears or chronic injuries

64
Q

What is usually the hx of meniscal tears?

A

Traumatic

Chronic / degenerative

65
Q

What will be in the hx if the meniscal tear is due to trauma?

A 
Axial load and rotation 
Pain
Swelling
Clicking/catching
Locking knee and twist to unstick
66
Q

What other tear is associated with a lateral meniscus tear?

A

ACL

67
Q

What is in the hx of meniscal tear if it’s chronic?

A 
Insidious onset of pain and swelling
Locking 
Catching
Pain along joint line
May or may not know of injury
68
Q

What is usually found on physical exam of a meniscal tear?

A

Mild effusion

Joint line pain

69
Q

What are the tests for meniscal tears?

A

Apley’s

McMurray’s

70
Q

What are the non op treatments for a meniscal tear?

A 
NSAIDs
PT
Low impact activity 
Glucosamine
Steroid shots
71
Q

What is in the hx for a patellar tendon rupture?

A

Felt pop
Younger than 40 years old
Missed a step, playing basketball, jumping
Can’t extend the knee

72
Q

What is found on physical exam of a patella tendon rupture?

A 
Unable to extend the knee
Unable to hold leg in the air
High riding patella
Defect below patella
Hemarthosis
73
Q

Who gets quad tendon rupture?

A

Older people with comorbidities such as gout, diabetes, chronic renal failure, SLE, infection
Using steroids, fluoroquinolnes

74
Q

What is found on physical exam of a quan tendon rupture?

A 
Unable to extend the knee
Unable to hold leg in air
Low riding patella
Defect above patella
Hemarthrosis
75
Q

What is in the hx of patella dislocation?

A

Acute hemarthrosis
Valgus force and external rotation of tibia to a flexed knee
Feel patella out laterally
Feels like knee is shifted medially

76
Q

Who usually has a patella dislocation?

A

Females in 2nd decade

77
Q

What is the J sign?

A

When the patella moves laterally on extension of the knee

78
Q

What are you looking for on X-ray of a patella dislocation?

A

Osteochondral loose pieces/fractures

79
Q

What is the treatment for patellar dislocation?

A

Knee brace
Cast with knee in extension
Reduction maneuver - push the patella over
Surgery

80
Q

Who gets a patellar sleeve fracture?

A

8-12 year olds

81
Q

What are the physical signs of a patellar sleeve fracture?

A

Extensor tendon lag

Inability to straight leg raise

82
Q

What are the X-ray findings of a patellar sleeve fracture?

A

Small fleck of bone inferior patella

More articular cartilage to attached piece

83
Q

What is the protocol for a patellar sleeve fracture?

A

Refer to ortho surgeon for likely internal fixation

84
Q

What bone makes up the acetabulum?

A

Ischium, ilium, pubis

85
Q

What is the blood supply to the femoral head?

A

For weight bearing dome: medial femoral circumflex artery

86
Q

What is in the hx of a femoral neck fracture?

A

Patient over 50 who fell

Trauma

87
Q

What is on the PE of a femoral neck fracture?

A

Shortened, externally rotated leg

Hip motion is painful

88
Q

What X-rays should be ordered for a femoral neck fracture?

A

AP and lateral

89
Q

What is the treatment for a femoral neck fracture?

A

Surgical: internal fixation
Joint replacement
Post op: vit D, calcium, bisphosphonates

90
Q

What is the difference between femoral neck fractures and intertrochanteric fractures?

A

Intertrochanteric fractures have more cancellous bone so are more likely to heal and less likely to have nonunion and a vascular necrosis

91
Q

What is in the hx of intertrochanteric fractures?

A

Older patients than fem neck fractures
Low energy fall
Pain in groin
Unable to bear weight

92
Q

What is in the hx of stress fractures?

A 
Female
Recent increase in training
Poor nutrition 
Menstrual disturbances 
Low bone density
Pain worse with activity
93
Q

What is found on PE of a stress fracture of the femur?

A

Pain worse with running or jumping
Slight antalgic gait
May be normal

94
Q

What is found on X-RAY of a stress fracture?

A

Usually normal

95
Q

What is the treatment for a stress fracture?

A

Crutches, partial weight bearing

Cross training

96
Q

What is the management of stress fractures?

A

Work up for osteopenia and poor nutrition

Need counseling, OCPs, better diet

97
Q

Who gets a hip dislocation?

A

Younger active patients from trauma and sports

98
Q

What is found on PE on hip dislocation?

A 
Posterior = short, adducted, internally rotated
Anterior = flexed, abducted, externally rotated
99
Q

What is the diagnostic test for a hip dislocation?

A

X-ray

100
Q

What is a CT Scan used for in hip dislocations?

A

To determine loose bodies, concentric reduction, and fractures

101
Q

What is the treatment for a hip dislocation?

A

Emergent reduction

102
Q

What is SCFE?

A

Slipped capital femoral epiphysis - the ball of the hip slips off posteriorly

103
Q

What is in the hx of SCFE?

A 
Subacute pain over one month
Aching pain
Obese child
Limp
11-13 yo
104
Q

What do you find on physical exam of SCFE?

A

Loss of abduction, internal rotation

Obligatory external rotation and flexion of the hip

105
Q

What are the diagnostic tests for SCFE?

A

AP and frog leg lateral

106
Q

What is the treatment?

A

Prompt surgical treatment

This is progressive!!!!

107
Q

Why does SCFE occur?

A

Due to weakness of the growth plate

108
Q

What is the hx of Perthes?

A

4-10 yo
Painless limp
Mild pain that radiates to thigh or knee

109
Q

What is found on physical exam of Perthes?

A 
Atrophy of thigh
Decreased ROM of hip
Loss of abduction
Loss of internal rotation
Can only flex to 30 degrees
110
Q

What do X-rays reveal about Perthes?

A

Early on X-rays are normal

Overtime there is collapse of the head

111
Q

What is the treatment of Perthes?

A

Maintain motion
Observe
Hip brace if progresses

112
Q

What is the pathogenesis of Perthes?

A

Not enough blood supply to the femoral head so the bone dies

113
Q

What is in the H&P of a quad contusion?

A

Direct blow to the thigh; often football
Pain on palpation
Pain with knee motion in thigh region

114
Q

What is a quad contusion a risk factor for?

A

Myositis ossificans

115
Q

What is the treatment for a quad contusion?

A

Elevation
Flex hip and knee
Gentle ROM after a few days

116
Q

Which quad muscle is most anterior?

A

Rectus femoris

117
Q

What part of the hip is affected by hip pointer?

A

Iliact crest

118
Q

What is the treatment of hip pointer?

A

Rest, ice

119
Q

What is hip pointer?

A

Contusion on the pelvis

120
Q

What is a pelvis avulsion?

A

When a piece of bone tears away from the site where the muscle attaches to the bone

121
Q

Who gets a pelvic avulsion?

A

14-25 year old active patients

122
Q

Where is the weak link in the skeletal attachments?

A

The apophyses

123
Q

What is the treatment for a pelvic avulsion?

A

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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