Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > LE Part 1 > Flashcards

LE Part 1 Flashcards

1
Q

What are the hip abductors?

A
  • Gluteus medius
  • Gluteus minimus
  • Tensor fascia lata
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the hip extensors?

A
  • Gluteus maximus
  • Adductor magnus
  • Biceps femoris
  • Semitendinosus
  • Semimembranosus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the hip adductors?

A
  • Pectineus
  • Adductor brevis
  • Adductor longus
  • Gracilis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the hip flexors?

A
  • Iliacus
  • Psoas majro
  • Pectineus
  • Rectus femoris
  • Sartorius
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anatomy of LE: Arteries

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anatomy of LE: Nerves

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Inspection/palpation of the hip and thigh

A
  • Inspect anterior and posterior noting deformities, muscle atrophy, swelling, discoloration, etc,
  • Palpate iliac crests, posterior iliac spine, and greater trochanter
  • Palpate anterior region for masses, adenopathy, or tenderness in the region of the anterior superior iliac spine
  • Note gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Flexion ROM of hip and thigh

A
  • Zero starting position is with patient lying supine with lumbar spine flat on table
  • Maximum flexion is point at which pelvis begins to rotate
  • Normal is 0-110 to 130
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal hip and thigh ROM: extension

A
  • Perform standing, with leg hanging off side of table, or prone
  • Normal 20-30 degrees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Normal hip and thigh abduction/adduction

A
  • Abduction: normal is 35-50
  • Adduction: normal is 25-35
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Internal and external rotation in felxion of hip and thigh

A
  • Assess with knee and hip flexed
  • Normal is 25-35
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the thomas test?

A
  • Evaluate for hip flexor contracture or tight psoas
  • Patient lies supine with legs hanging off end of table
  • Patient pulls one hip into maximum flexion while you observe the contralateral hip to see if it flexes off the surface of the table
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is trendelenburg test?

A
  • Patient stands on one leg
  • With normal hip abductor strength, pelvis will stay level
  • If hip abductor strength is inadequate pelvis will dip towards opposite side: positive trendelenburg test
  • Muscle weakness is on stance side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is FABER testing?

A
  • Figure of 4 test
  • Stress maneuver to detect hip and sacroiliac pathology
  • If painful, hip or sacroiliac region may be affected
  • Pain on ipsilateral side anteriorly - hip problem
  • Pain in contralateral SI joint = SI dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is leg length measurement performed and what is it for?

A
  • Measure from anterior iliac crest to medial malleolus of tibia of same leg
  • > 3 cm difference can lead to significant back and hip problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the log roll test?

A
  • Internally and externally rotate relaxed lower extremity in supine position
  • Pain in anterior hip or groin, particularly in internal rotation is indicative of OA or femoral head osteonecrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is piriformis test?

A
  • Patient lies supine or on unaffected side with hip and knee flexed to approx 90 degrees
  • Stabilize pelvis with one hand and apply flexion, adduction, and internal rotation pressure at the knee
  • Pain in buttock or down the leg = + piriformis test –> piriformis is impinging on sciatic nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is scouring test

A
  • Flex hip and knee at 90 degrees, apply posterolateral force through the hip as the femur is rotated in the acetabulum
  • Passively adduct and internally rotate the hip followed by abduction and external rotation
  • Pain or grating sound = labral pathology, a loose body, or internal derangement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Imaging of the hip and femur

A

Hip series:
* AP
* Lateral

Specialty hip views:
* Frog leg view
* Obturator/oblique view

AP pelvis for comparison if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Disorders of the hip

A
  • Hip dislocation
  • Hip fracture
  • Greater trochanteric bursitis
  • Avascular necrosis of the hip
  • Iliotibial band syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is usual MOI for hip dislocation

A
  • High grade, multi-trauma presentation
  • Posterior (MC90%) MOI: Posterior force applied to a flexed knee
  • Anterior: hyperextension force against an abducted leg or an anterior force on posterior femoral head
  • Prosthetic joints can dislocate under much less force
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When are complicated injuries due to hip dislocation most likely?

A

Posterior dislocations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What can be complicated injuries in hip dislocation?

A
  • Acetabular or femoral head/neck fracture
  • Sciatic nerve damage: sciatic and peroneal nerve most often affected
  • Ligamentous injuries or fractures of the knee
  • Avascular necrosis of the femoral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Clinical presentation of hip dislocation

A
  • Severe pain
  • Inability to move affected leg
  • Numbness, tingling, muscle weakness with nerve injury
  • Peroneal damage: drop foot and sensory changes along lateral lower leg and dorsal foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Physical exam of hip dislocation

A
  • Deformity based on direction of dislocation
  • Must assess NV status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PE of posterior hip dislocation

A

Leg is shortened, adducted and internally rotated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

PE of anterior hip dislocation

A
  • Abduction iwth external rotation and flexion of the hip
  • Can be anterior superior or inferior
  • Direction determined by degree of hip flexion at time of injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Diagnostics for hip dislocation

A
  • Stat x-ray hip series: femur and knee may be needed to rule out associated injuries
  • CT hip without contrast: utilized after reduction to asssess for fracture and trapped intra-articular loose bodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of hip dislocation

A
  • Acute traumatic hip dislocations are emergency
  • Posterior dislocation: urgent closed reduction (w/i 6 hours), Allis maneuver most common
  • Anterior dislocations; may require open reduction
  • All require procedural sedation and post reduction films
  • Post reduction immobilization with a triangular abduction pillow or knee immobilizer
  • Ortho consult/referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the hip reduction maneuvers

A
  • Allis
  • Stimson gravity
  • Captain morgan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When would an ortho consult/referral be indicated emergent?

A
  • Anterior dislocation
  • POsterior reduction is unsuccessful
  • NV comrpomise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Disposition of hip dislocation

A
  • Most require hospital admission
  • Non-weight bearing, +/- traction and parenteral pain control
  • Uncomplicated: crutch assisted weight bearing followed by physical therapy until ambulation without pain
  • Patient followed and monitored for avascular necrosis for 2-3 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

MOI of hip fracture

A
  • Fall MC
  • Posterior force to flexed knee
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Classifications of hip fracture

A
  • Intracapsular: femoral head or neck
  • Extracapsular: intertrochanteric or subtrochanteric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Hip fracture risk factors

A
  • Elderly age
  • Caucasian
  • Female
  • Sedentary lifestyle
  • Smoking
  • Chronic alcohol use
  • Psychotropic medication
  • Dementia
  • Osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Hip fracture presentation

A
  • Pain in groin, hip, buttock radiating to knee
  • Inability to ambulate
  • Externally rotated, abducted, shortened leg
  • Stress fractures = no obvious deformity
  • Pain with minimal ROM or SLR
  • May have associated injuries ie pelvic fracture, NV compromise, knee injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Diagnostics for hip fracture

A
  • Standard hip XR series with pelvis
  • Additional images of back, femur, and/or knee if needed
  • MRI or CT if clinical presentation and negative x-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Management of hip fracture

A
  • Urgent ortho consult
  • Surgical interventions (w/i 48 h) most often required
  • ORIF in young patients
  • Arthroplasty in older patients to allow for immediate ambulation
  • Additional immobilization not necessary - maintain position of comfort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Ccontraindications of hip fracture surgery

A
  • Medically unstable
  • Patients who were previously non-ambulatory
  • Dementia patients with minimal pain during transfers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Complications of hip fracture

A
  • Infection
  • DVT/PE
  • Pneumonia
  • Decubitus ulcer
  • UTI
  • Nonunion and avascular necrosis
  • Implant failure more common with extracapsular fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Prognosis and follow up of hip fracture

A
  • All patients evaluated post-op for osteoporosis
  • One year mortality rate 14-36% often due to complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

MOI of greater trochanteric bursitis

A
  • Repetitive trauma
  • Blunt trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Clinical presentation of greater trochanteric bursitis

A
  • Lateral hip pain
  • Radiates down lateral aspect of the thigh past the knee or up into the buttock
  • Worse when rising from seated or recumbent position, night time when lying on affected side
  • Improves after the first few steps but worsens again after prolonged walking (>30 minutes)
  • Point tenderness over greater trochanter
  • Pain with active abduction and adduction + internal rotation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Diagnostics for greater trochanteric bursitis

A

Hip series: only to rule out other ddx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Management of greater trochanteric bursitis

A
  • NSAIDs
  • Activity modification
  • Ice
  • Short term use of cane if needed: hold cane in hand that’s opposite to side that needs support
  • Home stretching: heat 15 mins before and ice for 20 mins after
  • Bursal injection with local anesthetic and corticosteroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Other names for avascular necrosis

A
  • Aseptic necrosis
  • Ischemic necrosis
  • Osteonecrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pathology of avascular necrosis

A
  • Bone infarction due to lack of adequate blood supply
  • Traumatic or systemic in nature
  • MC sites are the proximal and distal femoral heads resulting in hip and knee pain respectively
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Epidemiology of avascular necrosis

A

MC 20-50 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Risk factors for avascular necrosis

A
  • Trauma
  • Alcohol/tobacco use
  • Radiation therapy
  • Long term steroid use
  • Bisphosphonates
  • Hx of tissue/organ transplant
  • Chronic medical conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Clinical presentation of avascular necrosis

A
  • Initial severe pain during cell death
  • Later becomes dull aching and throbbing
  • Painful/loss of ROM
  • Painful weight bearing
  • Femur: antalgic gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Diagnostics of avascular necrosis

A
  • Hip and pelvic x-ray
  • Early disease: x-ray normal
  • Later: patchy areas of sclerosis and lucency
  • Late: “crescent sign”
  • MRI, CT, and/or bone scan needed if clinical suspicion and x-ray is negative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is crescent sign?

A
  • Present in late avascular necrosis
  • Well-defined sclerotic area just beneath the articular surface indicative of a subchondral fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Initial management of avascular necrosis

A
  • Avoid weight bearing
  • Adequate pain management: NSAIDs with break-through opiates
  • Refer to ortho
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is required in most patients due to young age of occurance of avascular necrosis

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is non-surgical management of avascular necrosis

A
  • Note: doesn’t halt disease progression
  • Bedrest
  • Partial weight bearing with crutches
  • Progressing as tolerated
  • Pain management
  • PT- can restore ROM and improve gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Complications of avascular necrosis

A
  • Collapse of femoral head leading to secondary degenerative arthritis
  • Chronic pain
  • Loss of ROM
  • Decreased ambulatory capacity
  • Abnormal gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

MOI of femoral shaft fractures

A
  • High energy trauma such as MVA
  • Less common pathologic fractures: osteopenia, tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Clinical presentation of femoral shaft fractures

A
  • Pain
  • Localized tenderness
  • Swelling
  • Shortening and deformity of leg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What should be assessed in femoral shaft fractures?

A
  • NV status
  • Evidence of open fx
  • Assess for complications: extensive blood loss, compartment syndrome, multi-system injuries
60
Q

Diagnostics of femoral shaft fractures

A
  • Femur (AP and lateral)
  • Hip, knee and pelvis radiographs
61
Q

Management of femoral shaft fractures

A
  • Pain management
  • Fluid resuscitation
  • Temporary stabilization: long leg, posterior and stirrup splint with a traction device
  • Ortho consultation
62
Q

What is present on the medial surface of the knee

A
  • Adductor tubercle
  • Medial epicondyle
  • Medial condyle
63
Q

What is present on the anterior surface of the knee

A
  • Patella
  • Patellar tendon
  • Tibial tuberosity
64
Q

What is present on the lateral surface of the knee

A
  • Lateral epicondyle
  • Lateral condyle
  • Head of fibula
65
Q

Joints of the knee

A
  • Tibiofemoral joint
  • Patellofemoral joint
66
Q

Knee flexors

A

Hamstring muscles: semimebranosus, gracilis, sartorius, semitendinosus

67
Q

Knee extensors

A

Quadriceps: rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

68
Q

Additional structures of the knee

A
  • Medial meniscus
  • Lateral meniscus
  • MCL, LCL
  • ACL, PCL
  • BUrsae
69
Q

Anterior, lateral, and posterior views of physical exam of knee

A
  • Assess for asymmetry, deformities, atrophy of muscles, swelling, erythema
  • Valgus/varus deformity
70
Q

What are you assessing with gait for knee

A
  • Abnormal gait: antalgic gait (limp)
  • Wide-stance gait
  • Waddling
  • Trendelenburg gait
71
Q

What can pain with squatting indicate?

A

Meniscal injury

72
Q

How is joint line palpation performed?

A

Knee flexed at 90 and relaxed

73
Q

What does focal and generalized tenderness of medial/lateral joint line suggest?

A
  • Focal: torn meniscus
  • Generalized: arthritis
74
Q

Where is the infrapatellar bursa located?

A

Inferior and lateral to the patella

75
Q

What may be noted in knee effusion

A
  • Fullness and loss of parapatellar dimpling in large effusions
  • Bulge sign: + test fluid wave over medial knee
  • Ballottement: + test rapid rebound, indicating increased fluid pressure
76
Q

How is the bulge sign performed?

A

Direct fluid superiorly over medial recess then inferiorly from the suprapatellar pouch inferiorly

77
Q

How is ballottement performed?

A

Push down patella and rapidly release

78
Q

What should the joint be palpated for during passive ROM

?

A

Crepitus

79
Q

What are the primary knee motions?

A

Flexion and extension
Zero starting point is full extension of the knee
Normal flexion is 0 degrees to 135-145 degress

80
Q

How can active flexion of the knee be assessed?

A

Have patient squat or while lying supine or prone

81
Q

Knee hyperextension is more often seen in which populations?

A

Children or patients with joint instability

82
Q

How do you assess quadriceps muscle strength

A

While sitting, have the patient extend the knee against resistance

83
Q

How do you assess hamstring muscle strenght

A

Patient prone, place knee in approx 90 degree flexion and ask patient to flex knee further against resistance
Flex knee against resistance in sitting position

84
Q

What is patellar tracking

A
  • Patient flex and extend knee and patella movement observed
  • Normal: patella slightly lateral in extension and centrally in flexion
  • Abnormal: exaggerated arc of movement either laterally or medially = patellar instability
85
Q

How is patellar apprehension sign performed

A
  • Patient lies supine with knee relaxed in 30 degree flexion
  • Displace patella laterally by applying medial pressure
86
Q

What does a + patellar apprehension sign look like? What does this mean?

A
  • Patient contracts the quadriceps or becomes apprehensive due to pain
  • Indicates patellofemoral syndrome, patellar subluxation, patellar dislocation
87
Q

What is patellar grind sing?

A

Assesses for cartilage degeneration under the patella in patellofemoral syndrome (chondromalacia)

88
Q

Technique for patellar grind sing

A
  • Patient supine and knee fully extended
  • One hand superior to patella gently push patella inferiorly as you instruct patient to contract quadricep
89
Q

interpretation of patellar grind sing

A

Pain, grinding, or clicking is + test

90
Q

What does valgus stress test assess?

A

Medial collateral ligament

91
Q

Technique to perofrm valgus stress test

A

Abduct and flex knee to 30 degrees
Examiner applies a valgus pressure

92
Q

Technique to perform varus stress test

A

Assesses the lateral collateral ligament
Medial pressure applied to knee

93
Q

Tecnique to perform mcmurray test

A
  • Patient uspine with examiner at side of patient
  • One hand on the heel while other palpates joint line
  • Medial meniscus: external rotation, valgus stress and slowly extending the leg (MEG)
  • Lateral meniscus: (LIR) internal rotation, varus stress and slowly extending knee
94
Q

What is the interpretation and indication for mcmurray test

A

+ test pain, popping, or clicking noted
-indications: assess for meniscal injuries

95
Q

What is the most sensitive test for ACL?

A

Lachman test

96
Q

Technique for Lachman test

A
  • Patient supine with knee flexed approx 25-30 degrees and instructed to relax quadriceps muscle
  • Place one hand on the distal femur and one on proximal tibia
  • Pull anteriorly on the tibia
97
Q

Interpretation of lachman test

A

+ test: anterior translation = partial or complete tear of ACL

98
Q

What is anterior drawer test?

A
  • Negative in 50% of ACL tears
  • Assess ACL stability
  • Patient supine with hamstrings and quads relaxed and knee flexed to 90 degrees, sit on foot to help stabilize
  • Grasp proximal tibia with both hands and slide tibia anteriorly
99
Q

Interpretation of anterior drawer

A

+ test: signficant laxity compared to opposite side

100
Q

What is pivot shift test?

A

Used to assess dysfunction of the ACL: postiive in severe grade II or grade III tears
Generally performed under anesthesia

101
Q

Technique for pivot shift test

A

Place the knee in full extension and then slowly flex the knee while examiner applies a valgus stress and internal rotation

102
Q

Interpretation of pivot shift test

A

Subluxation occurs at 20-40 degree flexion if positive

103
Q

What is posterior drawer test used to assess?

A

Posterior cruciate ligament

104
Q

Technique to perform posterior drawer test

A

Perform same way as anterior drawer but slide tibia posteriorly

105
Q

+ posterior drawer test

A

tibia falls back posterior to the femur

106
Q

What is noble’s test used to assess?

A

Iliotibial band

107
Q

Technique for noble’s test

A

Patient supine with knee flexed to 90 degrees
Apply pressure to lateral femoral condyle or 1-2 cm proximal to it as the knee is passively extended

108
Q

What is a + noble’s test

A

tenderness over lateral femoral condyle at approx 30 degrees of flexion

109
Q

What is ober’s test used to assess

A

tensor fascia lata and iliotibial band tightness

110
Q

technique for ober’s test

A

lie on unaffected side with unaffected knee and hip flexed
place affected knee in 90 degree of flexion
abduct and extend the ipsilateral hip while stabilizing the pelvis then slowly lower the thigh as far as possible

111
Q

interpretation of ober’s test

A

inability of the extremity to drop below horizontal to the level of the table indicates tightness in the fascia an IT band

112
Q

imaging of the knee

A

x-ray: knee series standard 2 V
additional views ordered on a case by case basis

113
Q

disorders of the thigh and knee

A

iliotibial band syndrome
distal femur fractures
patellar fracture
patellofemoral syndrome
prepatellar bursitis

114
Q

what is the it band

A

dense, fibrous band of tissue
originates from asis region
extends down lateral portion of the thigh and inserts on lateral tibia

115
Q

physiology of it band

A

in knee extension it band sits anterior to lateral femoral condyle
in knee felxion, it band moves posterior to the lateral femoral condyle

116
Q

pathophysiology of it band syndrome

A

repetitive flexion-extension leads to inflammation, usually in runners/cyclers

117
Q

presentation of it band syndrome

A
  • pain in anterolateral aspect of the knee, worse with repetitive activity and most intense at heel-strike
  • resolves with rest
    • audible popping with walking/running
  • tenderness over lateral femoral epicondyle
    • ober’s and noble’s test
  • Lateral knee pain when patient hops with a flexed knee
118
Q

diagnosis of it band syndrome

A

clinical, knee series only to rule out other disorders

119
Q

management of it band syndrome

A

conservative therapy: NSAIDs, ice, rest
PT focusing on stretching and strengthening of surrounding muscles, patient education on how to modify exercise
refer to ortho if no improvement with conservative therapy: local corticosteroid injection, surgical IT band lengthening

120
Q

MOI of distal femur fractures

A

low energy trauma in osteoporotic geriatric patient
high-energy trauma in young patient

121
Q

how is distal femur fracture classified

A

based on location: supracondylar, intercondylar (right, left, or both condyles may be affected)

122
Q

presentation of distal femur fracture

A
  • sudden onset of pain after trauma with the inability to bear weight

<swelling, deformity, rotation
- limited ROM
Assess NV status
Look for evidence of open fracture
Assess for associated injuries

123
Q

Diagnostics for distal femur fractures

A

Knee series: AP, lateral
Oblique view or CT: often needed to determine amount of displacement prior to surgical repair
MRI: further assess non-displaced fractures and soft tissue injuries
CTA: if vascular compromise

124
Q

Management of non-displaced distal femur fracture

A

Long leg splint –> cast
non-weight bearing
ortho referral

125
Q

management of displaced or intra-articular distal femur fracture

A

temporary long leg splint for protection and stabilization
urgent ortho consult for ORIF (within 24 hours?

126
Q

Management of open fracture, vascular compromise, or compartment syndrome for distal femur fracture

A

emergent ortho consult

127
Q

MOI of patellar fracture

A

Direct force: fall, direct blow
Indirect force: powerful contraction of the quadriceps

128
Q

Associated injury possible with patellar fracture

A

patella dislocation

129
Q

presentation of patellar fracture

A

localized tenderness and swelling
patellar defect may be palpable if significant displacement
assess for intact extensor mechanism: active extension of the knee or SLR
joint effusion may be present

130
Q

diagnostics for patellar fracture

A

knee series: ap, lateral, sunrise view
ct to rule out occult fracture
mri to assess for internal derangement

131
Q

management of non-displaced with intact extensor mechanism patellar fracture

A

pain management
knee immobilizer or posterior long-leg splint with knee intextension
refer to ortho for outpatient f/u

132
Q

management of displaced, complex, open, or loss of extensor function patellar fracture

A

consult ortho for surgical intervention
emergent if open otherwise urgent consult

133
Q

moi of patellar dislocation

A

direct trauma
landing on hyperextended knee
quadricep contraction during knee flexion

134
Q

clinical presentation of patellar dislocation

A

most often dislocates laterally
pain, tenderness, and deformity
hemarthrosis may be present
+ patellar apprehension test in spontaneously reduced dislocations

135
Q

diagnostics for patellar dislocation

A

knee xr: ap, lateral, sunrise

136
Q

management of patella dislocation

A

reduction: procedural sedation, gradually flex hip and extend knee while applying medial force to the patella
Post-reduction films
knee/patella immobilizer in full extension x 4-6 weeks
ortho f/u in 1 week

137
Q

what is patellofemoral syndrome

A

overuse syndrome involving patellofemoral region
anterior knee pain with excessive use resulting from:
-abnormal patellar tracking
-ligamentous hyperlaxity causing the aptella to sublux
-hip/knee muscle weakness, flexibility imbalance
-abnormal hip-knee biomechanics: increased Q-angle (valgus knee deformity)

138
Q

presentation of patellofemoral syndrome

A

diffuse aching pain over the anterior knee, behind the knee cap with activities that increase the load of the patellofemoral joint: running, walking, stairs, jumping, kneeling, squats
- pain worse after prolonged sitting

139
Q

physical exam of patellofemoral syndrome

A

Gait with patellar squinting (patella pointing toward each other during ambulation)
tenderness along articular surface of patella when leg extended and relaxed
apprehension sign = associated instability
-patellar grind test = associated chondromalacia
-one-leg squat to assess for quad and hip strength
+ trendelenburg sign = weak hip abductor

140
Q

diagnostics for patellofemoral syndrome

A

clinical diagnosis
x-ray: knee AP, lateral, and axial view may show lateral deviation or tilting of patella and rules out other pain causes
MRI only if surgery is considered

141
Q

management of patellofemoral syndrome

A

rest, ice, nsaids
-patellar stabilizer brace or taping techniques –> mcconnell taping
-weight loss if applicable
- PT hallmark of treatment: quad strengthening and stretching, hamstring stretching
refer to ortho if no improvement with conservative therapy: patellar alignment, patellar resurfacing, patellofemoral arthroplasty

142
Q

what is prepatellar bursitis

A

inflammatory or infectious swelling of the prepatellar bursa

143
Q

mechanism of prepatellar bursitis

A

inflammatory: direct blow, chronic compression via wrestling, praying, carpet installation
bacterial infection: direct penetration

144
Q

presentation of prepatellar bursitis

A

early on pain only with activity or direct pressure which progresses to constant pain
localized swelling over the knee: unable to differentiate patella from surrounding joint, differentiates this from joint effusion
septic bursitis: erythema, warmth, increased pain
Inflammatory: less painful, minimal warmth

145
Q

diagnostics for prepatellar bursitis

A

knee x-ray to rule out bony conditions, will show diffuse anterior soft tissue swelling
bursal aspiration: if septic bursitis is suspected and synovial fluid analysis, gram stain, culture, cell count, crystal analysis

146
Q

management of inflammatory bursitis

A

NSAIDs, ice, activity modification
corticosteroid injection only if septic bursitis is ruled out in those who fail conservative treatment

147
Q

management of infectious bursitis

A

oral antibiotics for mild cases: oral keflex to cover MSSA, bactrim or clindamycin to cover MRSA if hx suggestive
IV abx for more severe cases: iv ceftriazone, cefazolin-MSSA; IV vanc for MRSA

MSK (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions