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Clin Med Exam 3 > LE > Flashcards

LE Flashcards

1
Q

True hip pain

A

groin area

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2
Q

Buttocks pain

A

often associated with the spine

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3
Q

Femoroacetabular Impingement (FAI) types

A

Pincer (acetabular involvement), Cam (femoral head involvement), or combination

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4
Q

Pincer

A

impingement due to acetabulum

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5
Q

Cam

A

impingement due to femoral head

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6
Q

Presentation of FAI

A

groin pain/lateral hip pain; sharp, stabbing or dull ache; aggravated with turning, twisting, prolonged standing or squatting

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7
Q

FAI testing

A

FADIR and FABER

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8
Q

FADIR

A

adduction and internal rotation with knee/hip flexion; more specific to impingement

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9
Q

FABER

A

abduction and external rotation (figure 4, Patrick’s); ipsilateral hip pathology vs. contralateral SI joint dysfuncion

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10
Q

Ipsilateral positive FABER

A

hip pathology

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11
Q

Contralateral postiive FABER

A

SI joint dysfunction

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12
Q

FAI imaging

A

x-ray initially; CT/MRI if need (MRI will show destruction of labrum)

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13
Q

FAI treatment

A

decrease aggravating activity, NSAIDs, PT; surgery if conservative tx fails

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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

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15
Q

Groin pain

A

FAI, Labral tear (radiates to anterior thich/buttock, catching/clicking)

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16
Q

PE for labral tear

A

ROM and strenghtt esting, FADIR/FABER (sensitive, not specific)

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17
Q

Imaging for labral tear

A

MR ARHROGRAM, (x-ray, MRI)

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18
Q

Tx for labral tear

A

conservative (inside) vs. surgical (on edge)

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19
Q

Dancer’s commonly get this

A

Snapping Hip Syndrome

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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)

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21
Q

Cause of snapping hip syndrome

A

muscle/tendon sliding over bony prominence, which can lead to bursitis

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22
Q

External snapping hip syndrome

A

IT band over greater trochanter (leg swinging will cause pop)

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23
Q

Internal snapping hip syndrome

A

iliopsoas tendon over iliopectineal eminence or femoral head (leap and turn; often no pain just popping)

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24
Q

Who is at increased risk of snapping hip syndrome

A

adolescents, athletes with repetitive hip flexion, and DANCERS

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25
Q

Internal snapping hip syndrome patients may have trouble

A

arising from seated position

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26
Q

PE for snapping hip syndromee

A

reproducible snapping;

external: passitve internal/external rotation of hip while laying on side
internal: flex, abduct and externally rotate hip (FABER) then extend hip

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27
Q

Tx for snapping him syndrome

A

NSAIDS, avoid specific activities, +/- steroid injection
PT: stretching (U/S, iontophoresis, heat/ice, micofascial release)
Surgery RARELY INDICATED

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28
Q

Most common cause of lateral hip pain in adults

A

greater trochanteric pain syndrome (Trochanteric bursitis)

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29
Q

Greater trochanteric pain syndrome is also called

A

trochanteric bursitis

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30
Q

Cause of greater trochanteric pain syndrome

A

repetitive overload tendinopathy (glueal medius and minimus)- hip abduction and pelvic stability, bursa may become inflamed

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31
Q

Presentation of greater trochanteric pain syndrome

A

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

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32
Q

greater trochanteric pain syndrome PE

A

TTP over greater trochanter, pain with resisted abduction, Trendelenburg sign, difficulty maintain standing on one foot

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33
Q

Tx for greater trochanteric pain syndrome

A

self-limiting, NSAIDs, heating pad, adjust positioning, STEROID INJECTION

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34
Q

Positive trendelenburg test

A

Greater trochanteric pain syndrome; contralateral side will drop

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35
Q

Hip disorders

A

FAI, labrum tear, snapping hip syndrome, greater trochanteric pain syndrome

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36
Q

Triad of O’Donoghue (Terrible/Unhappy Triad)

A

ACL, MCL, medial meniscus

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37
Q

MOI of MCL tear

A

knee flexion + food planted AND lateral impacting causing valgus stress + rotation

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38
Q

MOI of LCL tear

A

rare; tibial internal rotation and medial impact

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39
Q

Valgus test

A

apply lateral pressure; tests MCL

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40
Q

Varus test

A

apply medial pressure; tests LCL

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41
Q

Most common ligament in the knee to be injured

A

ACL (50% associated with meniscus injury)

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42
Q

Sports most likely to cause ACL injury

A

football, gymnastics, skiing, women’s soccer and basketball

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43
Q

Most important structure for stability of the knee

A

ACL

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44
Q

Job of the ACL

A

prevents anterior translation of tibia, secondarily prevents rotation of tibia

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45
Q

MOI of ACL tear

A

noncontact: quick position change w/ cutting/pivoting; lateral bend (valgus stress);
contact: direct blow causing hyperextension or valgus deformity with lateral impact

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46
Q

Why is ACL injury more common in females?

A

quad dominance during deceleration, increased valgus stress w/ pivoting or deceleration, decreased proprioception, decreased intercondylar notch width, estrogen

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47
Q

ACL Injury Sx

A

feeling or hearing “pop,” immediate pain and swelling, report feeling of instability; joint effusion (hemarthosis), guarding, often able to bear weight, laxity

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48
Q

Tests for ACL

A

Lachman, anterior drawer, pivot shift

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49
Q

Dx of ACL tear

A

MRI (xray may be considered for bony involvement)

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50
Q

Tx of ACL tear

A

RICE, refer to ortho
conservative vs surgical
Surgery: younger patients and athletes; brace, PT

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51
Q

PCL

A

prevents posterior translation of tibia, secondarily prevents external rotation

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52
Q

Largest and strongest ligament of the kneee

A

PCL

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53
Q

MOI of PCL tear

A

high energy trauma: MVA

low energy trauma: sports (soccer)

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54
Q

Least ligament to be injured

A

PCL

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55
Q

PCL Sx

A

depends on MOI; mild to moderate knee effusion/hemarthrosis; generalized knee pain, feeling “something isn’t right”; limp

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56
Q

Tests for PCL

A

posterior drawer sign and posterior sag sign

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57
Q

What is the purpose of Menisci?

A

increase contact acea for articulation
increase joint stability
facilitate lubrication
shock absorption

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58
Q

Most common cause of lateral hip pain in adults

A

greater trochanteric pain syndrome (Trochanteric bursitis)

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59
Q

Greater trochanteric pain syndrome is also called

A

trochanteric bursitis

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60
Q

Cause of greater trochanteric pain syndrome

A

repetitive overload tendinopathy (glueal medius and minimus)- hip abduction and pelvic stability, bursa may become inflamed

61
Q

Presentation of greater trochanteric pain syndrome

A

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
Q

greater trochanteric pain syndrome PE

A

TTP over greater trochanter, pain with resisted abduction, Trendelenburg sign, difficulty maintain standing on one foot

63
Q

Tx for greater trochanteric pain syndrome

A

self-limiting, NSAIDs, heating pad, adjust positioning, STEROID INJECTION

64
Q

Positive trendelenburg test

A

Greater trochanteric pain syndrome; contralateral side will drop

65
Q

Hip disorders

A

FAI, labrum tear, snapping hip syndrome, greater trochanteric pain syndrome

66
Q

Triad of O’Donoghue (Terrible/Unhappy Triad)

A

ACL, MCL, medial meniscus

67
Q

MOI of MCL tear

A

knee flexion + food planted AND lateral impacting causing valgus stress + rotation

68
Q

MOI of LCL tear

A

rare; tibial internal rotation and medial impact

69
Q

Valgus test

A

apply lateral pressure; tests MCL

70
Q

Varus test

A

apply medial pressure; tests LCL

71
Q

Most common ligament in the knee to be injured

A

ACL (50% associated with meniscus injury)

72
Q

Sports most likely to cause ACL injury

A

football, gymnastics, skiing, women’s soccer and basketball

73
Q

Most important structure for stability of the knee

A

ACL

74
Q

Job of the ACL

A

prevents anterior translation of tibia, secondarily prevents rotation of tibia

75
Q

MOI of ACL tear

A

noncontact: quick position change w/ cutting/pivoting; lateral bend (valgus stress);
contact: direct blow causing hyperextension or valgus deformity with lateral impact

76
Q

Why is ACL injury more common in females?

A

quad dominance during deceleration, increased valgus stress w/ pivoting or deceleration, decreased proprioception, decreased intercondylar notch width, estrogen

77
Q

ACL Injury Sx

A

feeling or hearing “pop,” immediate pain and swelling, report feeling of instability; joint effusion (hemarthosis), guarding, often able to bear weight, laxity

78
Q

Tests for ACL

A

Lachman, anterior drawer, pivot shift

79
Q

Dx of ACL tear

A

MRI (xray may be considered for bony involvement)

80
Q

Tx of ACL tear

A

RICE, refer to ortho
conservative vs surgical
Surgery: younger patients and athletes; brace, PT

81
Q

PCL

A

prevents posterior translation of tibia, secondarily prevents external rotation

82
Q

Largest and strongest ligament of the kneee

A

PCL

83
Q

MOI of PCL tear

A

high energy trauma: MVA

low energy trauma: sports (soccer)

84
Q

Least ligament to be injured

A

PCL

85
Q

PCL Sx

A

depends on MOI; mild to moderate knee effusion/hemarthrosis; generalized knee pain, feeling “something isn’t right”; limp

86
Q

Tests for PCL

A

posterior drawer sign and posterior sag sign

87
Q

What is the purpose of Menisci?

A

increase contact acea for articulation
increase joint stability
facilitate lubrication
shock absorption

88
Q

Cause of meniscus injury

A

excessive rotational force (femur on tibia)

89
Q

Which meniscus is more susceptible to injury and why?

A

Medial; greater forces medially and less mobile structure than lateral meniscus

90
Q

Sx of meniscus injury

A

JOINT LINE PAIN, inability to fully extend knee, described as “locking” or “catching,” walking up and down stairs & squatting is difficult and painful

91
Q

Testing for meniscus injury

A

McMurray’s, Apley’s compression/distraction

92
Q

Imaging for meniscus injury

A

MRI

93
Q

Tx for torn mensicus

A

conservative vs. surgical based on location and extent of tear

94
Q

McMurray test

A

lateral stress and foot ouward = medial meniscuc;

medial stress and foot inward: lateral mensicus

95
Q

Grading for Knee Sprains

A

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
Q

Patellofemoral Pain Syndrome (Runner’s Knee) Sx

A

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
Q

Testing for patellofemoral pain syndrome

A

patellar glide and Apprehension test

98
Q

Dx of patellofemoral pain syndrome

A

imaging not need with absence of trauma or overt instability

99
Q

Tx of patellofemoral pain syndrome

A

acute: ice, NSAIDs, activity modifications
recovery/prevention: PT (strength quads VMO, stretch hamstrings, core stabilization; taping or patellar stabilizing brace)

100
Q

Bakers cyst

A

accumulation of joint fluid in the popliteal fossa

101
Q

Sx of Baker’s cyst

A

often asymptomatic or found incidentally; pain and swelling may occur with prolonged standing or activity

102
Q

Tx for popliteal cyst

A

NSAID, aspiration/injection, compressive neoprene brace, surgery rare

103
Q

Jumpers knee

A

patellar tendonitis

104
Q

Runner’s knee

A

Patellofemoral pain syndrome

105
Q

Cause of patellar tendonitis

A

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
Q

Tx of patellar tendonitis

A

Conservative (ice, NSAIDs, bracing & strapping), activity modification (rest & PT)

107
Q

cause of ITBS

A

overuse injury (runners, cyclists)

108
Q

Sx of ITBS

A

gradual onset of LOCALIZED pain, initially sharp/burning during activities, may develop into constant deep ache

109
Q

PE of ITBS

A

localized tenderness and reproducible with ROM and compression to ITB; evaluate for LLD

110
Q

Imaging for ITBS

A

not needed in non-traumatic presentation

111
Q

Tx of ITBS

A

conservative (RICE), NSAIDs, PT

112
Q

Knee bursitis

A

inflammatory disorder of the bursa (thin walled sac lined with synovial fluid); caused by trauma or overuse

113
Q

Tx of achilles tendon

A

refer to ortho (conservative vs. surgery); immobilization (Equinus splinting, boot allowing for continued plantar flexed position)

114
Q

Sx of knee bursitis

A

pain, swelling & tenderness; R/O infection

115
Q

Treatment of knee bursitis

A

avoid precipitating factors, NSAIDs, aspiration/steroid injections, padding/bracing

116
Q

Osteochondritis Dissecans (OCD)

A

idiopahtic osteonecrosis of subchondral bone; usually 10-20 YO, possible etiology: repetitive trauma, vascular disruption, ischemia following trauma, +/- genetic predisposition

117
Q

Progression of OCD

A

trauma, focal hypovascularity, necrosis, chondromalacia, articular fragment

118
Q

OCD locations

A

elbow, knee; sometimes other joints

119
Q

OCD elbow etiology

A

chronic valgus stress or micro trauma with compression attributed to overhead activities (commonly affects capitellum, teens/young adults, throwing, gymnastics)

120
Q

OCD knee etiology

A

repetivie axial load (valgus/varus stress); most common location (lateral portion of medial femoral condyle), preteen population

121
Q

OCD symptoms

A

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
Q

PE for OCD

A

+/- swelling;
Elbow: pain/guarding with passive motion (lateral pain with valgus stress)
Knee: pain with flexion over medial condyle (gait disturbance)

123
Q

Imaging for OCD

A

x-ray (flattening of articular surface, crater);

MRI if x-rays inconclusive

124
Q

Anterior knee pain

A

quadriceps/patellar tendons, patellofemoral pain syndrome, bursitis, patellar fracture/dislocation, osgood-schlatter disease

125
Q

Medial knee pain

A

MCL, medial meniscus, pes anserine bursitis

126
Q

Lateral knee pain

A

LCL, IT band ynsdrome, lateral meniscus

127
Q

Posterior knee pain

A

Baker’s cyst, DVT

128
Q

Types of ankle sprains

A

lateral, medial, syndesmotic

129
Q

Lateral ankle sprain

A

most commonly injured; INVERSION injury with plantar flexion; affects lateral ligament complex (anterior talofibular ligament, clacenofibular ligament & posterior talofibular ligament); ROLLED ANKLE

130
Q

Lateral Ligament Complex

A

anterior and posterior talofibular ligmanet, and calcaneofibular ligament (CFL)

131
Q

Testing for lateral ankle sprain

A

anterior drawer

132
Q

Medial ankle sprain

A

deltoid ligament complex, EVERSION injury

133
Q

Syndesmotic ankle sprain

A

high ankle sprain;
Includes: anterior/posterior tibiofibular ligament, and transverse tibiofibular ligament, interosseous membrane;
Dorsifelxed/rotational ankle injury

134
Q

Testing for syndesmotic ankle sprain

A

Squeeze test

135
Q

Sx of ankle sprain

A

swelling, pain, ecchymosis, difficulty w/ WB; evaluate for bone pain

136
Q

Imagine for ankle sprain

A

radiographs to r/o fracture

137
Q

Tx of ankle sprain

A

RICE and NSAIDs, +/- short immobilization for Grade 2-3, PT to prevent repeat injuries, bracing/taping

138
Q

Achilles tendon

A

Common insertion of gastrocnemius/soleus;
Function: plantar flexion
Acute injury: tendinopathy, rupture
Pediatric: calcaneal apophysitis (sever’s disease)

139
Q

Sx of achilles tendon

A

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
Q

PE for achilles tendon

A

examine lying prone, palpate along tendon for pain, edema, and/or defect
palpate in both plantar and dorsiflexion

141
Q

Testing for achilles tendon

A

+ Thompson test: squeezing calf should cause plantarflexion, but doesn’t here

142
Q

Imaging for achilles tendon

A

not always needed; U/S, plain radiographs, and MRI

143
Q

Tx of achilles tendon

A

refer to ortho (conservative vs. surgery); immobilization (Equinus spliting, boot allowing for continued plantar flexed position)

144
Q

Plantar fasciitis

A

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
Q

Sx of plantar fasciitis

A

pain with onset of walking (FIRST STEP IN MORNING), unilateral or bilateral

146
Q

PE of plantar fasciitis

A

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
Q

Dx of plantar fasciitis

A

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
Q

Tx of plantar fasciitis

A

ice, NSAIDs, rest

149
Q

Prevention of plantar fasciitis

A

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

Clin Med Exam 3 (7 decks)

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