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DPT 616 : MSK > LE Pathology > Flashcards

LE Pathology Flashcards

1
Q

what are the s/s of OA?

A

stiffness following inactivity (am) is often the 1st symptom

pain unrelated to imaging present in buttock, groin, thigh, knee

pain not proportionate with radiograph

pain subsequent to exercise may persist

loss of motion in capsular pattern (IR>ext>abd) with capsular end feel

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2
Q

what is the end feel with OA?

A

capsular

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3
Q

what is the capsular pattern of OA in the hip?

A

IR>ext>abd

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4
Q

what would radiographs of hip OA find?

A

<2.5 mm Jt space

osteophyte formation

subchondral bone sclerosis and cysts

whiter appearance of bone

(radiographs lack sensitivity)

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5
Q

what are the hip tests for hip OA?

A

femoral grind (Scour)

flexion abd ER (FABER) test

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6
Q

what are the interventions for hip OA?

A

educate and modify ADLs

regular and controlled loading interspersed w/rest (or useful avoidance) is encouraged

ROM and prolonged stretching (FABER)

PREs

manual therapy

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7
Q

why do we do ROM and prolonged stretching (FABER) for hip OA intervention?

A

for generalized capsular tightness to dispurse WB forces through more of the jt

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8
Q

why do we do PREs for hip OA intervention?

A

to strengthen the muscular around the jt to add stability around the jt

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9
Q

why do we do manual therapy for hip OA intervention?

A

to reduce capsular tightness

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10
Q

what is the progression of interventions in hip OA?

A

start with isometrics, mid-range, straight plane, OKC and move towards full range, triplanar, and CKC

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11
Q

what is the pathogenesis of congenital hip dysplasia?

A

in utero, subluxation may occur that results in a flattened posteriomedial femoral head, anteversion, and shallow acetabulum

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12
Q

when the femoral head dislocated and rests on the iliac crests in congenital hip dysplasia, what can happen?

A

a false acetabulum can form around the femoral head

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13
Q

t/f: prolonged and repeated dislocation of the femoral head in congenital hip dysplasia may cause greater incidence of hip OA

A

true

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14
Q

congenital hip dysplasia is also called what?

A

developmental dysplasia of the hip (DDH)

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15
Q

t/f: early diagnosis of congenital hip dysplasia is crucial?

A

true

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16
Q

what are the diagnostic tests for congenital hip dysplasia

A

Barlow (pop out) and Ortolani (pop back in) tests

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17
Q

what are the signs of congenital hip dysplasia?

A

gluteal fold height differences, knee height differences, decreased amount of hip abduction

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18
Q

what are the abnormal gait patterns of congenital hip dysplasia?

A

toe walking, in-toeing/out-toeing gait

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19
Q

what are the interventions for congenital hip dysplasia?

A

reduce the hip

Pavlick harness uses flexion and free abduction to produce effective reduction in 90% cases

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20
Q

how does the Pavlick harness work in congenital hip dysplasia?

A

it uses flexion and free abduction to produce effective reduction in 90% cases

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21
Q

how long does the Pavlick harness have to be worn?

A

3-6 months of continuous wear

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22
Q

if the Pavlick harness is ineffective, what may be done for congenital hip dysplasia?

A

skin traction, closed reduction, spica cast

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23
Q

t/f: congenital hip dysplasia puts pts at risk for THA later in life

A

true

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24
Q

what is a SCFE?

A

when the femoral neck slips up off the femoral head

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25
Q

what is the epidemiology and pathogenesis of SCFE?

A

most common disorder of the hip in adolescents

girls 12 yo, boys 14 yo

displacement of the femoral neck from the capital femoral epiphysis

coxa valga of the developing femur produces shear forces

injury occurs from innocuous causes

neck migrates up and out as the head remains in the acetabulum

neck fuses with the capital epiphysis toward the end of adolescence

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26
Q

injury in SCFEs occur from what causes?

A

innocuous causes

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27
Q

45% of pts with SCFE have what as the initial symptom?

A

knee or lower thigh pain

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28
Q

t/f: radiographs, physical exam, and symptoms are used to determine if the hip is stable or unstable in SCFE

A

true

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29
Q

intervention for SCFE focuses on what?

A

symptom relief, containment of femoral head, and restoration of ROM

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30
Q

what are the interventions for SCFE?

A

traction for days to weeks

PWB

NSAIDs

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31
Q

what is the etiology of Legg-Calve-Perthes disease?

A

avascular necrosis - trauma resulting in ischemia

idiopathic osteonecrosis - atraumatic mechanical interruption of femoral head circulation associated w/ETOH and steroid use

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32
Q

t/f: LCPD produces osteochondritis dissicans (damage to jt surface)

A

true

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33
Q

what is LCPD?

A

damage to vascular supply that may occur at birth

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34
Q

t/f: 70-90% of LCPD pts are pain-free regardless of intervention

A

true

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35
Q

what is the emphasis of treatment in LCPD?

A

containment of the femoral head and avoiding collapse

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36
Q

what does the Scottish Rite brace do for LCPD?

A

holds the femur in abduction w the ability to flex

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37
Q

what are the s/s of LCPD?

A

pain in groin, buttock, and proximal thigh

exacerbated by WB

non-capsular loss of motion

antalgic gait

radiographic evidence shows coxa magna (enlarged femoral head) and demineralization

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38
Q

what is the intervention for LCPD?

A

surgical intervention is usually done (hip resurfacing vs THA)

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39
Q

t/f: 70-80% of LCDP progress to collapse of the femoral head

A

true

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40
Q

what are the 2 types of FAIs?

A

CAM and pincer

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41
Q

what is a CAM lesion?

A

overgrowth of the femoral head

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42
Q

what is a Pincer lesion?

A

overgrowth of the acetabulum

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43
Q

what are the symptoms of an FAI?

A

anterior hip/groin pain

pain with flexion, active SLR

intra-articular jt sounds

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44
Q

what are the signs of an FAI?

A

decreased flex, abd, and rotation

MR arthrogram (70-91% accurate)

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45
Q

what is the pathophysiology of acetabular labral tears?

A

chondrocyte proliferation of labral fibrocartilage at the border of the defect

increased microvascularity at the base of the tear adjacent to the bone insertion

osteophyte/stress that caused the tear may cause bone irritation and growth

labrum becomes detached or torn from the acetabulum

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46
Q

what is the most common cause of hip dysfunction in young, active populations?

A

acetabular labral tears

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47
Q

what are the anatomical features of type 2 acetabular labral tears?

A

variable depths w/in substance of the labrum

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47
Q

what is the cause of groin pain in >20% of athletes?

A

acetabular labral tears

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47
Q

what is the most common location for acetabular labral tears?

A

anterior>posterior>superior (lateral)

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48
Q

what is the etiology of acetabular labral tears?

A

degenerative, dysplastic, traumatic, idiopathic

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48
Q

how are acetabular labral tears diagnosed?

A

torsional forces in WB

pain in the groin, trochanteric region, buttock w/flexion and rotation (likely IR)

sharp pain w/clicking, catching, locking (FAI usually doesn’t click)

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48
Q

what are the anatomical features of type 1 acetabular labral tears?

A

detachment of the labrum from the cartilage at the transition zone, which may extend to subchondral bone

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49
Q

what causes reproduction of pain with anterior labral tears?

A

abd, ER, flexion TO add, IR, ext

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49
Q

t/f: acetabular labral tears are confirmed by arthrography, MRI w/contrast

A

true

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50
Q

what causes reproduction of pain with posterior labral tears?

A

add, IR, flexion TO abd, ER, ext

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51
Q

what are the interventions for acetabular labral tears?

A

bed rest w/traction

NSAIDs

protected WB phase

arthroscopy w/labral resection or reattachment

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52
Q

what is the second most frequent cause of lateral hip pain?

A

greater trochanteric bursitis

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53
Q

where would a pt be tender if they had greater trochanteric bursitis?

A

with direct palpation over the GT

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53
Q

greater trochanteric bursitis would cause weakness of what muscle groups?

A

abductors and ERs

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53
Q

what is the cause of greater trochanteric bursitis?

A

direct trauma or repeated friction

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53
Q

greater trochanteric bursitis would cause tightness of what muscle group?

A

adductors

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54
Q

what would cause pain with greater trochanteric bursitis?

A

stretching the ITB into add, ER, IR

resisted abd, ext, ER

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55
Q

t/f: greater trochanteric bursitis is associated with LBP

A

true

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56
Q

t/f: greater trochanteric bursitis may cause Trendelenburg gait

A

true

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57
Q

what is the intervention for greater trochanteric bursitis?

A

stretch the TFL/ITB

phonophoresis, iontophoresis

transverse friction massage (TFM)

glut med, ER PREs

correction of biomechanical causes anywhere along the chain (likely overpronation)

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58
Q

patellofemoral pain syndrome (PFPS) makes up __% of outpatient visits and __% of all knee pathologies

A

5.4, 25

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59
Q

PFPS is the most common in what population?

A

ectomorphic female athletes

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60
Q

what is the etiology of PFPS?

A

muscles imbalances

inflammation

instability

anatomic variance

LE alignment

foot contributions

hip contributions

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61
Q

what anatomic variances are associated with PFPS?

A

femoral condyle dysplasia, patellar congruence, patellar position

62
Q

what is the most common cause of mechanical knee pain?

A

meniscus injuries

63
Q

what % of >45 yo have asymptomatic meniscus tears?

A

16-36%

64
Q

what motions cause reproduction of pain with meniscus tears?

A

turning, twisting, or change of direction in WB

65
Q

what causes meniscal injuries?

A

medial or lateral contact w/foot planted

66
Q

t/f: aging leads to delamination of the menisci

A

true

67
Q

why does edema produces symptoms in meniscus tears?

A

from increased pressure in the knee jt

68
Q

which meniscus is more frequently injured?

A

the medial meniscus

69
Q

what are the symptoms of meniscus injuries?

A

swelling, popping, clicking, catching at the jt line

locked in flexed position (bucket handle)

pain with flexion and WB

(+)McMurray, (+)Appley, and (+)Thessaly

tender medial jt line

70
Q

what are the surgical interventions for meniscus injuries?

A

menisectomy (inner third)

meniscus repair (peripheral)

allograft transplantation

71
Q

the ACL controls what forces?

A

anterior translation and rotation

72
Q

are ACL injuries 2-8x more common in males or females

A

females

73
Q

what are the intrinsic factors of ACL injuries make females more at risk?

A

females have narrower intercondylar notches causing impingement of the ACL in full ext

females are more likely to have LE malalignment (knee valgus)

females are more likely to have generalized jt laxity

female hormones estrogen, estradiol, relaxing lead to lig laxity in women

women have smaller ACLs

strength and recruitment

74
Q

what are the extrinsic factors that lead to ACL injuries?

A

abnormal quad to HS ratio (5:3) makes the quads pull more on the tibia forward

altered neuromuscular control

playing surface

playing style

shoewear

75
Q

almost all ACL tears are what kind of tears?

A

complete midsubstance tears

76
Q

what is the terrible triad?

A

ACL, MCL, and meniscal injury together

77
Q

when there is an ACL tear, __% of the time, it involves the terrible triad

A

49

78
Q

t/f: cartilage degeneration is progressive due to altered proprioception and kinematics

A

true

79
Q

what are the mechanisms of injury for the ACL?

A

sudden deceleration

abrupt change in direction

foot planted

valgus forces (72% non contact)

full ext w/ER of the femur on a fixed tibia (ski boot, turf)

extreme hyperext or hyper flex

80
Q

what are the s/s of an ACL injury?

A

“pop” at the time of injury

giving away

hemarthrosis (immediate swelling)

quad atrophy

(+)ant drawer, (+)Lachman (+)KT- 1000 findings

rotatory instability: AMRI, ALRI, PMRI, PLRI

(+)MRI (not sensitive for discrimination bw partial and complete tears)

81
Q

what are the post-surgical management principles for ACL injuries?

A

consult w/the surgeon for the latest protocol

understand potential risk factors of gait disruption

control pain and edema

utilize locked brace early during some PREs

respect healing constraints

emphasize early restoration of ROM (esp ext)

emphasize CKC

emphasize HS recruitment

focus on fxn

82
Q

how long will an ACL injury typically take to heal?

A

at least 6 months for the tendon to become more like a ligament

83
Q

what are the types of bursitis?

A

superficial and deep infrapatellar bursitis

prepatellar bursitis (housemaid’s knee)

superficial pes anserine bursitis

MCL bursitis

84
Q

what is superficial and deep infrapatellar bursitis?

A

inflammation from mechanical irritation or direct trauma

85
Q

what is prepatellar bursitis (housemaid’s knee)?

A

recurrent trauma

often from kneeling too much

easily observable

86
Q

what is superficial pes anserine bursitis?

A

swimmer and runners

medial knee pain

tibia in ER

87
Q

what is MCL bursitis?

A

deep to the MCL

often misdiagnosed

palpable mass and tender w/ER and IR of the tibia

88
Q

what are the interventions for bursitis?

A

correct malalignment

correct mechanics

stretching

strengthening

surgical resection

89
Q

what is another name for patellar tendonitis?

A

jumper’s knee

90
Q

what causes patellar tendonitis?

A

eccentric overload

91
Q

where is a pt with patellar tendonitis tender?

A

at the tibial insertion site or mid substance

92
Q

t/f: patellar tendonitis is often self-limiting and will get better with rest

A

true

93
Q

what are some interventions for patellar tendonitis?

A

RICE

tendon strap during activity

TFM

correct malalignment (ankle often not DF enough)

94
Q

what is the most common overuse injury (esp runners)

A

ITB friction syndrome

95
Q

what causes ITBFS?

A

repeated friction of the ITB at 30 deg knee flex

96
Q

why does downhill walking often make ITBFS worse?

A

bc it required knee flexion >30 deg

97
Q

t/f: ITBFS is better with faster speeds

A

true

98
Q

where is a pt with ITBFS tender?

A

over Gurdy’s tubercle

99
Q

what are the s/s of ITBFS?

A

structural/functional malalignment

weak abductors/ERs

(+) Ober, (+) Noble

100
Q

what tests would be positive with ITBFS?

A

Ober and Noble

101
Q

______ instability and ________ instability can cause recurrent ankle sprains

A

mechanical, functional

102
Q

what % of ankle sprains involve the LM projecting more distally and a stronger deltoid lig

A

85%

103
Q

what lig is involved in 60-70% of all ankle sprains?

A

ATF lig

104
Q

what % of ankle sprains involve the ATF and CF ligs?

A

20%

105
Q

what % of ankle sprains are midsubstance tears?

A

86%

106
Q

what % of ankle sprain are avulsion fxs?

A

14%

107
Q

what is the sequence of events in lateral ankle sprains?

A

ATF–>anterolateral capsule–> CF–>PTF–>LM avulsion–>MM or talar neck compression fx

108
Q

with forced DF, what ankle sprain is likely?

A

tib fib syndesmosis sprain

109
Q

with forced PF, what ankle sprain is likely?

A

ant capsule sprain

110
Q

with inversion and PF, what ankle sprain is likely?

A

lat ankle sprain

111
Q

what is a grade 1 ankle sprain?

A

min edema

localized tenderness over the ATF

112
Q

a grade 1 ankle sprain takes ____ b4 return

A

12 days

113
Q

what is a grade 2 ankle sprain?

A

localized edema

localized tenderness over ATF

begin to see fxnal problems

114
Q

a grade 2 ankle sprain takes ____ b4 return

A

2-6 weeks

115
Q

what is a grade 3 ankle sprain?

A

edema

ecchymosis

116
Q

a grade 3 ankle sprain takes ____ b4 return

A

> 6 weeks

117
Q

what % of grade 3 ankles sprains are surgery free 1-4 years post injury

A

25-60%

118
Q

what are the sn and sp of ankle sprains if an exam is performed within 48 hrs of injury (better if delayed 4 days)?

A

84% and 96%

119
Q

what are the s/s of a lat ankle sprain?

A

edema and hematoma suggests rupture

TTT over ATF

(+) ant drawer

120
Q

what are the interventions for lateral ankle sprains?

A

control edema

early, supported WB (taping and bracing)

proprioceptive training

OKC to CKC using non-dominant to dominant plane (sag to frontal)

multiplane fxnal training

plyometrics

sport-specific training

121
Q

what % of obese males will get plantar fasciitis?

A

40%

122
Q

what % of obese females will get plantar fasciitis?

A

90%

123
Q

jobs that require what activities, put pts at risk for plantar fasciitis?

A

prolonged walking/standing

124
Q

what is more common, acute or chronic plantar fasciitis?

A

chronic

125
Q

what biomechanical factors pose risk for plantar fasciitis?

A

pes cavus, pes planus, over pronation, weak foot intrinsics, and hallux rigidus/limitus

126
Q

what % of pts with plantar fasciitis have it in both feet?

A

15-30%

127
Q

what are the symptoms of plantar fasciitis?

A

AM pain (first few steps after waking up or after inactivity)

GS tightness in 78%

TTT med calc tubercle

pain with great toe extension

presence of heel spurs

HAV

128
Q

what often leads to HAV (hallux abductor valgus (HAV)?

A

overpronation and medial foot stress

129
Q

what are the interventions for plantar fasciitis?

A

low dye taping

orthotics

night splints

TFM

calf stretching

great toe mobility

NSAIDs

foot intrinsic PREs

iontophoresis/phonophoresis

injection

surgery (release PF)

130
Q

t/f: night splints are a long-term intervention for plantar fasciitis

A

false, they are for short term use

131
Q

what is the most common overuse syndrome of the lower leg?

A

Achilles tendonopathy

132
Q

what tendinopathy accounts for 5-18% of all running injuries?

A

Achilles tendonopathy

133
Q

t/f: Achilles Tendonopathy is associated with Hagland’s deformity and Sever’s disease

A

true

134
Q

what is a Hanglund’s deformity?

A

tension of the Achilles tendon on the calcaneus causes irritation of the insertion and bone over growth (“pump bump”) over the posterior heel

135
Q

what is Sever’s disease?

A

Haglund’s deformity in children

136
Q

what is the etiology for Achilles tendonopathy?

A

largely biomechanical having to do with eccentric loading which increases w/overpronation

137
Q

what actions may cause Achilles tendonopathy?

A

rupture from push off, sudden DF in WB, or forceful DF

138
Q

what are interventions for Achilles tendonopathy?

A

correct biomechanical contributions, RICE in acute phase, TFM, stretching, eccentric training

139
Q

what are the symptoms of tibialis posterior tendinopathy?

A

navicular pain, pain proximal to medial malleolus, and medial shin pain

pain with PF, inversion

TTT over medial ankle

140
Q

what causes tibialis posterior tendinopathy?

A

overpronation, change in direction, tight GS complex, weak PT

141
Q

what do we treat for tibialis posterior tendinopathy?

A

inflammation, biomechanical contributions, impairments

142
Q

what is the too many toes sign?

A

a sign of tibialis posterior tendinopathy where there is too much foot abduction

143
Q

what is tarsal tunnel syndrome?

A

peripheral neuropathy of the tibial nerve bw the flexor retinaculum and medial malleolus

involves the tibial nerve including terminal branches med/lat plantar nerves

144
Q

what test would be positive with tarsal tunnel syndrome?

A

Tinel

145
Q

what 2 things may contribute to tarsal tunnel syndrome?

A

accessory FDL and over pronation

146
Q

what are interventions for tarsal tunnel syndrome?

A

orthotic w/rearfoot control

proper footwear

PREs for inverters

injection

surgical release

147
Q

what is the Lauge-Hansen Classification system?

A

a way to classify about 95% of all ankle fxs

148
Q

what is the Salter-Harns Growth Plate Classification system?

A

a way to classify ankle fxs in younger pts

149
Q

what is a type 1 fx in the Salter-Harns Growth Plate Classification system?

A

an epiphyseal fx across the epiphyseal plate

150
Q

what is a type 2 fx in the Salter-Harns Growth Plate Classification system?

A

a fx across the epiphyseal plate and triangle of the shaft that’s attached to it proximally

151
Q

what is a type 3 fx in the Salter-Harns Growth Plate Classification system?

A

a fx through the epiphysis that extends into the epiphyseal plate

152
Q

what is a type 4 fx in the Salter-Harns Growth Plate Classification system?

A

a fx of the epiphysis and shaft crossing the epiphyseal plate for a portion and some of the metaphysis

153
Q

what is a type 5 fx in the Salter-Harns Growth Plate Classification system?

A

damage to the epiphyseal plate w/o a fx

154
Q

what is a Jones fx?

A

avulsion fx of the 5th metatarsal

155
Q

how may a Jones fx occur?

A

when rolling over the lateral ankle

156
Q

what is the MOI for stress fxs?

A

overuse

157
Q

what are the symptoms of a stress fx?

A

point tenderness over the fx

(+)US test - pain with US over the fx

(-) x-ray initially

(+) bone scan

158
Q

what is a March fx?

A

2nd metatarsal fx

159
Q

what is the ratio of males to females for Morton’s neuroma?

A

1:9

160
Q

what is Morton’s neuroma?

A

compression of the interdigital nerve (usually bw the 3-4 metatarsals)

161
Q

what may occur as a result of Morton’s neuroma?

A

perineural fibrosis, demyelination, endoneurial fibrosis

162
Q

what are the symptoms of Morton’s neuroma?

A

pain and tingling in the forefoot

tenderness bw met heads plantarlly

pain with compression pof the forefoot

(+) Tinel, (+)EMG/NCV

163
Q

what test would be positive with Morton’s neuroma?

A

(+) Tinel

(+) EMG/NCV

164
Q

what are the interventions for Morton’s neuroma?

A

wider shoes

orthotics w/metatarsal pad

NSAIDs

interspace injection

surgery (last resort)

DPT 616 : MSK (15 decks)

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