LE Clinical Syndromes Flashcards
Hip Osteoarthritis
- defn, symptoms & moi
- inclusion criteria
slowly progressive joint disease that causes articular cartilage breakdown and loss, capsular fibrosis & osteophyte formation
Symptoms: insidious onset of pain in anterolateral hip and groin region; decreased ROM
Inclusion Criteria:
1. hip pain AND IR 15 w/ pain AND morning stiffness less than 60 min and greater than 50 years old
2. Hip pain AND IR less than 15 AND hip flexion less than 115
MOI: aging, trauma, repetitive abnormal stress, obesity or systemic diseases
Kellgren & Lawrence Classification Scale of OA
Grade I = doubtful narrowing of joint space but symptoms are present
Grade II = definite osteophytes & joint space narrowing
Grade III = Moderate, multiple osteophytes, increased joint space narrowing, some sclerosis & possibly contour deformity
Grade IV = large osteophytes, marked narrowing, severe sclerosis & definite deformity
Hip Labral Tears
-defn, symptoms & MOI
tear in acetabular labrum due to excessive forces or pressure at the hip joint
-mainly females, atraumatic, hard to diagnose
Symptoms: anterior/groin pain (90%), clicking/catching, giving way, stiffness
MOI
- Traumatic - MVA, falling, sports (frequent ER)
- Atraumatic - repetitive microtrauma
Trochanteric Bursitis - Greater Trochanteric Pain Syndrome (GTPS)
defn, symptoms, special tests & MOI
chronic, intermittent pain w/ tenderness to palpation over lateral aspect of the hip
- usually affecting females
Symptoms: persistent pain tender to palpation
AGG - lying on affected side, prolonged standing, sit to stand, sitting w/affected leg crossed, climbing stairs, running or other high impact
Special tests: resisted ABD & IR, Ober’s test
MOI - chronic microtrauma, regional muscle dysfunction, overuse, obesity or muscle fatigue
Hip Muscular Strains
defn, symptoms & MOI
pull or tear of a hip muscle; commonly the hamstring (bicep femoris esp), quads & adductors
Symptoms: pain over injured muscle, increased pain w/ palpation, swelling & loss in strength
MOI: stretched muscle forced to contract suddenly, overstertching, fall or direct blow, overuse, inadequate warm up, lack of flexibility
Classification/Grades of Muscle strains
Grade I - small tears in fibers, pain but MINIMAL loss in strength & ROM
Grade II - more amt of fibers torn but lesion incomplete; pain, swelling, bruising, compromised strength but not complete loss
Grade III - most fibers are torn & can be completely ruptured, movement is difficult or impossible & loss of function
Avascular Necrosis of the Femoral head
-defn, symptoms, MOI
progressive ischemia & death of bone cells of the femoral head due to disruption of circumflex arteries
Symptoms: pain (groin, prox thigh or gluteal region) that is increased w/ WB, limitations in ROM & antalgic gait
MOI:
- Traumatic - falls, fracture & dislocation
- Atraumatic - long-term use of corticosteroids & excessive alcohol intake
Femoral Neck Stress Fracture
-defn, categories, symptoms, MOI
stress fracture of the neck (2in from joint)
- typically affects young & active OR old & frail
Categories:
- Compression fx - on inferior aspect of femoral neck
- Tension fx - on superior aspect, more likely to progress & fx completely or dislocate
Symptoms: groin pain w/ activity, deep thigh pain, limping, rest relieves pain
MOI: sudden change in activity (athletes, military recruits) or falls (elderly)
Piriformis Syndrome
defn, symptoms, MOI
irritation or compression of sciatic nerve caused by spasm or contracture of the piriformis muscle
Symptoms: pain, N/T posterior leg, difficulty sitting, sore feeling & tenderness w/ palpation
-Special tests: piriformis test, femoral-acetabular impingement test
MOI: overuse, inadequate stretching, poor posture during walking/running or fall on buttocks
commonly seen in cyclists or rowers
Pubalgia
defn, symptoms, MOI
groin pain in athletes w/o inguinal hernia that usually occurs where the adductor muscles & abdominal muscles meet at the pubic bone
Symptoms: unilateral insidious groin pain, acute hx of sudden tearing sensation
-relief w/ rest & aggravation when activity resumes
MOI: muscular imbalances that result in uneven distribution of forces, usually due to significant twisting & cutting
Difficult to diagnose, must rule out other possibilities
Grades/Classifications of Pubalgia
Grade I - single or multiple tears of rectus abdominus or adductor muscles
Grade II - partial avulsion from pubic symphysis
Grade III - complete avulsion w/ associated microtears
Femoral Condyle Injury
defn, symptoms, MOI & diagnosis
focal articular cartilage defects OR osteochondritis dissecans (OCD lesion)
defn - focal lesion in the articular cartilage; more common in males (12-35) & related to sports trauma
Symptoms - pain, swelling, catching, tenderness, limited ROM
- reproduce pain w/ palpation of joint line
MOI - unknown, may be heriditary
diagnosed by arthroscopic surgery: Grades I/II will have less swelling & may be able to perform some activitives whereas grade IV will have severe limitations & pain & swelling
Meniscal Injury
defn, symptoms, MOI & diagnostics
tear in the meniscus
- medial > lateral b/c medial more tightly bound
Symptoms: pain & limited motion especially w/ extension/compression, hard end feel, tenderness w/ palpation of joint line
MOI -
- traumatic: compression (WB) AND rotation; sudden acc/deceleration combined w/ change in direction
- degenerative: stiff & less compliant
Diagnostics: Apleys compression, McMurrays test; gold standard = MRI
ACL Injury
defn & risk factors, symptoms, MOI
injury to the ACL Risk factors: females (why?) - smaller intercondylar notch - female hormones - increased valgus posture when landing/cutting - delayed hamstring reflex when landing
Symptoms: knee giving out, acute hemarthrosis, immediate dysfunction, inability to walk unassisted, “pop”
MOI -
- Just ACL = hyperextension + anterior translation
- contact (valgus stress) or noncontact (sudden deceleration w/ massive quads contraction) - ACL + med meniscus = hyperext + rotation
- ACL + med meniscus + MCL = extension + valgus force + rotation
PCL injury
defn, symptoms, MOI
injury of PCL - less common than ACL b/c 50% stronger
Symptoms: similar to ACL
MOI: hyperflexion + posterior translation
“dashboard injury”
MCL & LCL Injury
defn, symptoms, MOI
injury to medial or lateral collateral ligament
Symptoms: varus/valgus stress tests, Apley’s distraction test, instability, pain
MOI:
- valgus stress w/ planted foot = MCL
- Varus stress w/ planted foot = LCL
Patellofemoral Pain Syndrome
defn, symptoms, MOI (contributing factors)
patellar tracking problem or patellar dislocation
Symptoms: anterior, lateral, or retropatellar knee pain, dull achiness, clicking or popping, giving out
AGG w/ knee flexion
MOI/contributing factors:
- anatomical abnormalities: increased Q angle, patella alta or pes planus foot strike
- muscle weakness of hip abductors & quads (especially VMO)
- flexiblity: tight ITB or lateral retinaculum
- poor muscle control during sports/training errors
Patellar Tendinopathy
defn, symptoms, MOI & contributing factors
chronic degeneration of patellar tendon due to overuse and microtrauma; most commonly at proximal portion near inferior pole
Symptoms: pain over posterior aspect of tendon, mild stiffness in the AM or after sitting, pain worsens w/ activity
MOI: overuse leading to microtrauma, sudden changes in activity, repeated jumping & landing
Contributing factors:
- lack of flexibility or strength –> decreased ROM
- high riding patella
- postural alignment, reduced patellar glide or foot structure
Osgood-Schlatter’s Disease
defn, symptoms, MOI
benign traction apophysitis to occurs at tibial tubercle
- -> can lead to avulsion fractures or hetertrophic bone formation
- -> occurs in children 11-18
- -> males > females
Symptoms: unilateral acute pain w/ activities, often a visible lump over the site or pain reproduced w/ knee extension or stress of the quads
MOI: repetitive quad contraction onto partially developed apophysis (usually during periods of rapid growth)
Baker’s Cyst
defn, symptoms, MOI
fluid filled cyst that causes a bulge & feeling of tightness behind the knee
- -> excess synovial fluid in popliteal fossa
- -> primary (idiopathic) or secondary (underlying knee problem)
Symptoms: swelling or lump distal to popliteal crease on medial side; general pain, stiffness & clicking
MOI: inflammation of the joint resulting in excess of synovial fluid
- due to gout, OA/RA, injury, lupus, etc
IT Band Syndrome
defn, symptoms, MOI
irritation & inflammation of distal IT band usually due to repeated friction between ITB & lateral femoral condyle
- knee flexed its behind, and as you extend it moves in front of the condyle
- most common in runners or bicyclists
Symptoms: local ache/pain on outer knee or gr. troch., repitus or popping along lateral knee
AGG - walking, climbing stairs, running, cycling
MOI: overuse, poor training habits, poor flexiblity, mehcanical imbalances, leg-length discrepency, abnormal pelvic tilt, bowed legs
Ankle Sprain
defn, symptoms (by grade), MOI
stretching or tear of lateral/medial ligaments of the ankle joints
Symptoms:
Grade I - minimal pain & swelling, no difficulty w/ WB
Grade II - moderate pain & swelling, frequently bruising w/ some difficulty w/ WB
Grade III - severe pain & swelling w/ definite bruising & difficulty WB
MOI: inversion or eversion
- Inversion most common due to excessive load on a supinated foot (inverted, PF & IR)
Grading of Ankle Sprains
Grade I: PF & Inversion = anterior talofibular
–> PF, Inversion & IR = anterior talofib & tibfib*****
Grade II: 26-75% tear, moderate pain & swelling, loss of ROM & slight instability
–> PF & inversion (& IR) = + calcaneofibular
Grade III: total tear, severe pain & swelling, loss of ROM & instability, unable to WB w/ loss of function 4-26 weeks
–> PF & inversion (& IR) = + posterior talofibular
Functional Ankle Instability (FAI)
defn, symptoms, MOI/possible contributing factors
chronic instability that leads to recurrent sprains and or feeling of the ankle “giving way”
Symptoms: recurrent ankle sprain & sensation of instability
MOI: previous ankle sprain
Possible factors related to teh cause of chronic instability
- increased joint flexibility or stiffness
- muscular weakness
- proprioceptive impairments
- balance control impairments
- delayed peroneal activation time
Achilles Tendinopathy
defn (types), symptoms, MOI/contributing factors
tendonitis/tendinosis of Achilles tendon
Types:
- Non-insertional: fibers near the middle of the tendon have tears, swell & thicken
- Insertional: involves the insertion point into the calcaneus
Symptoms: pain, stiffness, thickening, swelling, increases w/ activity
MOI: overuse (most common overuse injury of LE)
Contributing factors:
1. biomechanics: quick/repetitive movements from pronation to supination
2. rapid loading forces (eccentric contraction)
3. Over-pronation
4. Lack of stretching, training variables
Classification of Achilles Tendinopathy
Non-insertional vs. Insertional
Type I - pain only after activity
Type II - pain during & after activity but doesnt affect performance
Type III - pain during & after that DOES affect performance
Medial Tibial Stress Syndrome
defn, symptoms, MOI/Risk factors
increased pressure w/n small fascial compartment due to edema causing ischemia of tissues –> atrophy of muscles
Acute vs. Chronic
- most common musle affected in MTSS = posterior tib, soleus or flexor digitorum longus
Symptoms: pain in mid-bottom 1/3 of shin, pain w/ palpation, ache during or after exercise
MOI: due to hypertrophy or overuse of muscles
Risk factors: flat arch (over-pronation), athlete, female, excessive hip ROM, high BMI
Heel Spurs
defn, symptoms, MOI
bony exotosis (new bone on bone formation) usually found on medial-plantar aspect of calcaneal tubercle
Symptoms: similar pain as plantar fasciitis due to bone affecting the soft tissue in the plantar area
- pain w/ WB, heel strike & palpation
- inflammation around Achilles tendon
MOI: chronic & repetitive stress to the heel, inadequate footwear, prolonged standing, poor gait mechanics & athletes
- age & pes planus/cavus increases risk
Plantar Fasciitis
defn, symptoms, MOI/Risk factors
inflammation or degenerative changes of the plantar fascia
Symptoms: pain just anterior to calcaneus on plantar side that increases in the morning, w/ stairs, long day of standing/walking or intense activity
MOI: overstretch or strain causing microtears which leads to inflammation & pain
Risk factors = age (40-60), women, overpronation, high arches or flat feet, posterior tightness, obesity or poor footwear
Cuboid Syndrome
-defn, symptoms, MOI
cuboid subluxation/plantar neuritis - disruption of the arthrokinematics or structural congruity of calcaneocuboid joint due to displacement or tearing of soft tissues
Symptoms: pain along lateral side of foot greatest during push-off or side to side movements, restricted ROM, inflammation & discoloration, tenderness along peroneus tendon, cuboid and/or dorsolateral foot
MOI: trauma (sprained ankle) or repetitive use
- excessive traction by peroneus longus
- repetitive micro-trauma to surrounding ligaments
Calcaneus Fracture
defn, symptoms, MOI
fracture of the calcaneus (most frequently fractured tarsal bone)
Symptoms: sudden onset of heel pain & tenderness, edema, bruising, deformity, pain w/ palpation, inability to WB, occasional N/T, positive x-ray
MOI: high impact or traumatic events
- requires a large force to fracture so often involves fracture of the hip or L spine as well
