LE Flashcards
1
Q
True hip pain
A
groin area
2
Q
Buttocks pain
A
often associated with the spine
3
Q
Femoroacetabular Impingement (FAI) types
A
Pincer (acetabular involvement), Cam (femoral head involvement), or combination
4
Q
Pincer
A
impingement due to acetabulum
5
Q
Cam
A
impingement due to femoral head
6
Q
Presentation of FAI
A
groin pain/lateral hip pain; sharp, stabbing or dull ache; aggravated with turning, twisting, prolonged standing or squatting
7
Q
FAI testing
A
FADIR and FABER
8
Q
FADIR
A
adduction and internal rotation with knee/hip flexion; more specific to impingement
9
Q
FABER
A
abduction and external rotation (figure 4, Patrick’s); ipsilateral hip pathology vs. contralateral SI joint dysfuncion
10
Q
Ipsilateral positive FABER
A
hip pathology
11
Q
Contralateral postiive FABER
A
SI joint dysfunction
12
Q
FAI imaging
A
x-ray initially; CT/MRI if need (MRI will show destruction of labrum)
13
Q
FAI treatment
A
decrease aggravating activity, NSAIDs, PT; surgery if conservative tx fails
14
Q
Labral tear sx
A
dull/sharp groin pain, often rotates to lateral hip, anterio thigh or buttock; insidious onset vs acute trauma; catching, clicking that may cause pain
15
Q
Groin pain
A
FAI, Labral tear (radiates to anterior thich/buttock, catching/clicking)
16
Q
PE for labral tear
A
ROM and strenghtt esting, FADIR/FABER (sensitive, not specific)
17
Q
Imaging for labral tear
A
MR ARHROGRAM, (x-ray, MRI)
18
Q
Tx for labral tear
A
conservative (inside) vs. surgical (on edge)
19
Q
Dancer’s commonly get this
A
Snapping Hip Syndrome
20
Q
Sx of snapping hip syndrome
A
snapping/popping in hip with walking, getting up from chair or swinging leg; worse with activity; PSEUDOSUBLUXATION (sensation of subluxation/dislocation of hip); difficult with stairs, running, arising from sitting (internal) or backpacking (external)
21
Q
Cause of snapping hip syndrome
A
muscle/tendon sliding over bony prominence, which can lead to bursitis
22
Q
External snapping hip syndrome
A
IT band over greater trochanter (leg swinging will cause pop)
23
Q
Internal snapping hip syndrome
A
iliopsoas tendon over iliopectineal eminence or femoral head (leap and turn; often no pain just popping)
24
Q
Who is at increased risk of snapping hip syndrome
A
adolescents, athletes with repetitive hip flexion, and DANCERS
25
Internal snapping hip syndrome patients may have trouble
arising from seated position
26
PE for snapping hip syndromee
reproducible snapping;
external: passitve internal/external rotation of hip while laying on side
internal: flex, abduct and externally rotate hip (FABER) then extend hip
27
Tx for snapping him syndrome
NSAIDS, avoid specific activities, +/- steroid injection
PT: stretching (U/S, iontophoresis, heat/ice, micofascial release)
Surgery RARELY INDICATED
28
Most common cause of lateral hip pain in adults
greater trochanteric pain syndrome (Trochanteric bursitis)
29
Greater trochanteric pain syndrome is also called
trochanteric bursitis
30
Cause of greater trochanteric pain syndrome
repetitive overload tendinopathy (glueal medius and minimus)- hip abduction and pelvic stability, bursa may become inflamed
31
Presentation of greater trochanteric pain syndrome
LATERAL hip pain with LOCALIZED pain to greater trochanter; pain increased with pressure over greater trochanter (lying on side), pain increases with walking, stairs, inclines, prolonged standing
32
greater trochanteric pain syndrome PE
TTP over greater trochanter, pain with resisted abduction, Trendelenburg sign, difficulty maintain standing on one foot
33
Tx for greater trochanteric pain syndrome
self-limiting, NSAIDs, heating pad, adjust positioning, STEROID INJECTION
34
Positive trendelenburg test
Greater trochanteric pain syndrome; contralateral side will drop
35
Hip disorders
FAI, labrum tear, snapping hip syndrome, greater trochanteric pain syndrome
36
Triad of O'Donoghue (Terrible/Unhappy Triad)
ACL, MCL, medial meniscus
37
MOI of MCL tear
knee flexion + food planted AND lateral impacting causing valgus stress + rotation
38
MOI of LCL tear
rare; tibial internal rotation and medial impact
39
Valgus test
apply lateral pressure; tests MCL
40
Varus test
apply medial pressure; tests LCL
41
Most common ligament in the knee to be injured
ACL (50% associated with meniscus injury)
42
Sports most likely to cause ACL injury
football, gymnastics, skiing, women's soccer and basketball
43
Most important structure for stability of the knee
ACL
44
Job of the ACL
prevents anterior translation of tibia, secondarily prevents rotation of tibia
45
MOI of ACL tear
noncontact: quick position change w/ cutting/pivoting; lateral bend (valgus stress);
contact: direct blow causing hyperextension or valgus deformity with lateral impact
46
Why is ACL injury more common in females?
quad dominance during deceleration, increased valgus stress w/ pivoting or deceleration, decreased proprioception, decreased intercondylar notch width, estrogen
47
ACL Injury Sx
feeling or hearing "pop," immediate pain and swelling, report feeling of instability; joint effusion (hemarthosis), guarding, often able to bear weight, laxity
48
Tests for ACL
Lachman, anterior drawer, pivot shift
49
Dx of ACL tear
MRI (xray may be considered for bony involvement)
50
Tx of ACL tear
RICE, refer to ortho
conservative vs surgical
Surgery: younger patients and athletes; brace, PT
51
PCL
prevents posterior translation of tibia, secondarily prevents external rotation
52
Largest and strongest ligament of the kneee
PCL
53
MOI of PCL tear
high energy trauma: MVA
| low energy trauma: sports (soccer)
54
Least ligament to be injured
PCL
55
PCL Sx
depends on MOI; mild to moderate knee effusion/hemarthrosis; generalized knee pain, feeling "something isn't right"; limp
56
Tests for PCL
posterior drawer sign and posterior sag sign
57
What is the purpose of Menisci?
increase contact acea for articulation
increase joint stability
facilitate lubrication
shock absorption
58
Most common cause of lateral hip pain in adults
greater trochanteric pain syndrome (Trochanteric bursitis)
59
Greater trochanteric pain syndrome is also called
trochanteric bursitis
60
Cause of greater trochanteric pain syndrome
repetitive overload tendinopathy (glueal medius and minimus)- hip abduction and pelvic stability, bursa may become inflamed
61
Presentation of greater trochanteric pain syndrome
LATERAL hip pain with LOCALIZED pain to greater trochanter; pain increased with pressure over greater trochanter (lying on side), pain increases with walking, stairs, inclines, prolonged standing
62
greater trochanteric pain syndrome PE
TTP over greater trochanter, pain with resisted abduction, Trendelenburg sign, difficulty maintain standing on one foot
63
Tx for greater trochanteric pain syndrome
self-limiting, NSAIDs, heating pad, adjust positioning, STEROID INJECTION
64
Positive trendelenburg test
Greater trochanteric pain syndrome; contralateral side will drop
65
Hip disorders
FAI, labrum tear, snapping hip syndrome, greater trochanteric pain syndrome
66
Triad of O'Donoghue (Terrible/Unhappy Triad)
ACL, MCL, medial meniscus
67
MOI of MCL tear
knee flexion + food planted AND lateral impacting causing valgus stress + rotation
68
MOI of LCL tear
rare; tibial internal rotation and medial impact
69
Valgus test
apply lateral pressure; tests MCL
70
Varus test
apply medial pressure; tests LCL
71
Most common ligament in the knee to be injured
ACL (50% associated with meniscus injury)
72
Sports most likely to cause ACL injury
football, gymnastics, skiing, women's soccer and basketball
73
Most important structure for stability of the knee
ACL
74
Job of the ACL
prevents anterior translation of tibia, secondarily prevents rotation of tibia
75
MOI of ACL tear
noncontact: quick position change w/ cutting/pivoting; lateral bend (valgus stress);
contact: direct blow causing hyperextension or valgus deformity with lateral impact
76
Why is ACL injury more common in females?
quad dominance during deceleration, increased valgus stress w/ pivoting or deceleration, decreased proprioception, decreased intercondylar notch width, estrogen
77
ACL Injury Sx
feeling or hearing "pop," immediate pain and swelling, report feeling of instability; joint effusion (hemarthosis), guarding, often able to bear weight, laxity
78
Tests for ACL
Lachman, anterior drawer, pivot shift
79
Dx of ACL tear
MRI (xray may be considered for bony involvement)
80
Tx of ACL tear
RICE, refer to ortho
conservative vs surgical
Surgery: younger patients and athletes; brace, PT
81
PCL
prevents posterior translation of tibia, secondarily prevents external rotation
82
Largest and strongest ligament of the kneee
PCL
83
MOI of PCL tear
high energy trauma: MVA
| low energy trauma: sports (soccer)
84
Least ligament to be injured
PCL
85
PCL Sx
depends on MOI; mild to moderate knee effusion/hemarthrosis; generalized knee pain, feeling "something isn't right"; limp
86
Tests for PCL
posterior drawer sign and posterior sag sign
87
What is the purpose of Menisci?
increase contact acea for articulation
increase joint stability
facilitate lubrication
shock absorption
88
Cause of meniscus injury
excessive rotational force (femur on tibia)
89
Which meniscus is more susceptible to injury and why?
Medial; greater forces medially and less mobile structure than lateral meniscus
90
Sx of meniscus injury
JOINT LINE PAIN, inability to fully extend knee, described as "locking" or "catching," walking up and down stairs & squatting is difficult and painful
91
Testing for meniscus injury
McMurray's, Apley's compression/distraction
92
Imaging for meniscus injury
MRI
93
Tx for torn mensicus
conservative vs. surgical based on location and extent of tear
94
McMurray test
lateral stress and foot ouward = medial meniscuc;
| medial stress and foot inward: lateral mensicus
95
Grading for Knee Sprains
Grade 1: Mild stretch- RICE, WB as tolerated
Grade 2: Partial tear- RICE, brace immobilization, +/- crutches, PT, possible surgical repair
Grade 3: complete tear- surgical repair, crutches, brace, aggressive PT
96
Patellofemoral Pain Syndrome (Runner's Knee) Sx
anterior pain under the patella (involves retinaculum), pain worse with going up and down stiars, positive THEATER SIGN, usually see crepitus, popping, feelings of joint stability
97
Testing for patellofemoral pain syndrome
patellar glide and Apprehension test
98
Dx of patellofemoral pain syndrome
imaging not need with absence of trauma or overt instability
99
Tx of patellofemoral pain syndrome
acute: ice, NSAIDs, activity modifications
recovery/prevention: PT (strength quads VMO, stretch hamstrings, core stabilization; taping or patellar stabilizing brace)
100
Bakers cyst
accumulation of joint fluid in the popliteal fossa
101
Sx of Baker's cyst
often asymptomatic or found incidentally; pain and swelling may occur with prolonged standing or activity
102
Tx for popliteal cyst
NSAID, aspiration/injection, compressive neoprene brace, surgery rare
103
Jumpers knee
patellar tendonitis
104
Runner's knee
Patellofemoral pain syndrome
105
Cause of patellar tendonitis
repetitive trauma (athletes involved in running, jumping, kicking sports; usually occurs after skeletal maturity (ages 16-40, M>F); excessive foot pronation & running hills can exacerbate these symptoms
106
Tx of patellar tendonitis
Conservative (ice, NSAIDs, bracing & strapping), activity modification (rest & PT)
107
cause of ITBS
overuse injury (runners, cyclists)
108
Sx of ITBS
gradual onset of LOCALIZED pain, initially sharp/burning during activities, may develop into constant deep ache
109
PE of ITBS
localized tenderness and reproducible with ROM and compression to ITB; evaluate for LLD
110
Imaging for ITBS
not needed in non-traumatic presentation
111
Tx of ITBS
conservative (RICE), NSAIDs, PT
112
Knee bursitis
inflammatory disorder of the bursa (thin walled sac lined with synovial fluid); caused by trauma or overuse
113
Tx of achilles tendon
refer to ortho (conservative vs. surgery); immobilization (Equinus splinting, boot allowing for continued plantar flexed position)
114
Sx of knee bursitis
pain, swelling & tenderness; R/O infection
115
Treatment of knee bursitis
avoid precipitating factors, NSAIDs, aspiration/steroid injections, padding/bracing
116
Osteochondritis Dissecans (OCD)
idiopahtic osteonecrosis of subchondral bone; usually 10-20 YO, possible etiology: repetitive trauma, vascular disruption, ischemia following trauma, +/- genetic predisposition
117
Progression of OCD
trauma, focal hypovascularity, necrosis, chondromalacia, articular fragment
118
OCD locations
elbow, knee; sometimes other joints
119
OCD elbow etiology
chronic valgus stress or micro trauma with compression attributed to overhead activities (commonly affects capitellum, teens/young adults, throwing, gymnastics)
120
OCD knee etiology
repetivie axial load (valgus/varus stress); most common location (lateral portion of medial femoral condyle), preteen population
121
OCD symptoms
gradual onset of poorly localized deep pain (elbow: typically lateral), decreased ROM in elbow but not knee, may cause limited WB in LE lesions, +/- intermittent swelling, + popping, locking, or catching in more advanced disease
122
PE for OCD
+/- swelling;
Elbow: pain/guarding with passive motion (lateral pain with valgus stress)
Knee: pain with flexion over medial condyle (gait disturbance)
123
Imaging for OCD
x-ray (flattening of articular surface, crater);
| MRI if x-rays inconclusive
124
Anterior knee pain
quadriceps/patellar tendons, patellofemoral pain syndrome, bursitis, patellar fracture/dislocation, osgood-schlatter disease
125
Medial knee pain
MCL, medial meniscus, pes anserine bursitis
126
Lateral knee pain
LCL, IT band ynsdrome, lateral meniscus
127
Posterior knee pain
Baker's cyst, DVT
128
Types of ankle sprains
lateral, medial, syndesmotic
129
Lateral ankle sprain
most commonly injured; INVERSION injury with plantar flexion; affects lateral ligament complex (anterior talofibular ligament, clacenofibular ligament & posterior talofibular ligament); ROLLED ANKLE
130
Lateral Ligament Complex
anterior and posterior talofibular ligmanet, and calcaneofibular ligament (CFL)
131
Testing for lateral ankle sprain
anterior drawer
132
Medial ankle sprain
deltoid ligament complex, EVERSION injury
133
Syndesmotic ankle sprain
high ankle sprain;
Includes: anterior/posterior tibiofibular ligament, and transverse tibiofibular ligament, interosseous membrane;
Dorsifelxed/rotational ankle injury
134
Testing for syndesmotic ankle sprain
Squeeze test
135
Sx of ankle sprain
swelling, pain, ecchymosis, difficulty w/ WB; evaluate for bone pain
136
Imagine for ankle sprain
radiographs to r/o fracture
137
Tx of ankle sprain
RICE and NSAIDs, +/- short immobilization for Grade 2-3, PT to prevent repeat injuries, bracing/taping
138
Achilles tendon
Common insertion of gastrocnemius/soleus;
Function: plantar flexion
Acute injury: tendinopathy, rupture
Pediatric: calcaneal apophysitis (sever's disease)
139
Sx of achilles tendon
Tendinopathy (recent increase in training regiment, burning pain, increased with activity); rupture: sudden pivoting or rapid acceleration "sensation of violent hit or pop" (pain may be absent)
140
PE for achilles tendon
examine lying prone, palpate along tendon for pain, edema, and/or defect
palpate in both plantar and dorsiflexion
141
Testing for achilles tendon
+ Thompson test: squeezing calf should cause plantarflexion, but doesn't here
142
Imaging for achilles tendon
not always needed; U/S, plain radiographs, and MRI
143
Tx of achilles tendon
refer to ortho (conservative vs. surgery); immobilization (Equinus spliting, boot allowing for continued plantar flexed position)
144
Plantar fasciitis
one of the most common causes of foot pain; inflammation of fascia due to activity, heel spurs, pes planus/cavus, ankle pronation, and poor shoe wear; most common on plantar aspect of heel
145
Sx of plantar fasciitis
pain with onset of walking (FIRST STEP IN MORNING), unilateral or bilateral
146
PE of plantar fasciitis
point tenderness in the area of involvement (insertion of fascia at the calcaneus or along entire arch); pain aggravated by ROM that places fascia under strain, such as dorsiflexion;
R/O S1 radiculopathy: weakness with dorsiflexion of great toe (SLR and achilles tendon reflex)
147
Dx of plantar fasciitis
radiographs of the foot: AP, Lateral and WB (assess for bony abnormalities (calcaneal fx, heel spur);
U/S or MRI only if chronic and minimal response to conservative tx
148
Tx of plantar fasciitis
ice, NSAIDs, rest
149
Prevention of plantar fasciitis
improve shoe wear (heel pads, cups or orthotics);
PT: achilles stretching exercises, +/- taping and modalities as indicated
Massage;
Ortho or podiatry referral for severe cases: steroid injection, splinting, casting
