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PH2001 MSK > LL pathologies > Flashcards

LL pathologies Flashcards

1
Q

aetiology of femoral acetabular impingement- 2 types

A

2 mechanisms- CAM type= extra bony growth of femoral head on anterior superior aspect of the femoral head-junction, cam impingement can become symptomatic in physical young males- extra growth plates
Pincer- result of excess acetabular coverage of femoral head,can be global (coxa profunda)-deep hip socket, or focal anteriorly (acetabular retroversions)- altered orientation of acetabilim, can occur in extreme ROM

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2
Q

symptoms of FAI

A

stiffness, hip pain worse during physical activity or after sitting, limping

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3
Q

diagnosing FAI

A

imaging tests- CAM- radiographyh- alpha angle- X ray hip at 90° flex and 20° abd, pincer- can be located on radiographic imaging by looking at lateral centre head angle- line from head of femur and second line going to rim of acetabulum- angle <40° is positive
impingement test- flex hip and rotate towards opposite shoulder

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4
Q

physio management of FAI

A

corticosteroids, NSAIDs, hip surgery, exercise to strengthen hip, stretch hip flexors, balance and proprioception exercise

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5
Q

aetiology- greater trochanteric pain syndrome

A

common cause of lat hip pain, attribute tendinopathy of glut med/min or bursal pathology. compressive forces cause impingement of these structures onto the greater trochanter by the ITB- puts pressure on tendons and structures, on bursa and glut med/min tendon
female 40-60 and post menopausal, lower femoral neck shaft angle and increase BMI

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6
Q

symptoms of GTPS

A

pain in the outer bottom/thigh/buttick area, worse pain when lying on side, pain increasing with exercise such as long periods of walking, standing or running. altered walking pattern, more noticeable pain when walking briskly, tenderness to touch, pain sitting with your legs crossed
test with FADER/FADER-R

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7
Q

treatment for GTPS

A

isometric abduction against wall, single leg stand, side lying abduction against pillow, wall squat, pelvic dips, bridge
pain relief, NSAIDs, cold

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8
Q

Meniscus vascularization- left

A

the blood supply to the meniscus, left- through fully vascularized birth, the blood vessels in the meniscus recede during maturity. in adulthood, the red region contains the overwhelming majority of blood vessels. Red-red region= blood supply, white- red region and white-white region are avascular.

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9
Q

meniscus vascularization- right

A

cells in outer, vascularized section of meniscus (red-red region) are spindle shaped, display cell process, and are more fibroblast like, while cells in the white-red region and inner section (white-white region) are morre chondrocyte like, though they are phenotypically distinct from chondrocyte. cells in the superficial layers of the meniscus are small and round

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10
Q

meniscal pathology

A

meniscus lesions most common intra-articular knee injury, medial injury more frequent, often associated with ACL tearsm can get degenerative meniscal tears
MOI- involves components of flex and rotational forces under compressions e.g. twisting/ squatting, manoeuvres, joint line tenderness/ effusion,

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11
Q

signs of MOI

A

most will not require MRI- pick up 95% of cases

apleys, McMurrys, thessalys

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12
Q

meniscal pathology- clinical presentation

A

symptoms are produced by instability of torn fragment. these symptoms can result in locking of knee, popping knee and clicking, medial and lateral knee pain, joint line tenderness, occurs mostly in 50 years of age, hyperflexion for long periods

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13
Q

meniscal pathology- treatment

A

PEACE & LOVE, strengthen exercises for quads and hamstrings- start with isometric, then progress to isotonic
joint mobs- superior tibiofibular, patellofemoral joint, tibiofemoral joint
plyrometrics

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14
Q

meniscal pathology- treatment

A

PEACE & LOVE, strengthen exercises for quads and hamstrings- start with isometric, then progress to isotonic
joint mobs- superior tibiofibular, patellofemoral joint, tibiofemoral joint
pylorometrics

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15
Q

MOI MCL

A

knee hit directly on lateral aspect- stretches ligament too far, commonly injured at similar time to ACL,
can also be injured through repeated stress

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16
Q

symptoms of tears in MCL

A

pain, stiffness, swelling, tenderness alongside inside knee, a feeling that knee may give way (instability) and locking/catching

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17
Q

diagnosis of MCL

A

valgus test

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18
Q

physio management MCL

A

good blood supply so responds well to treatment, lightweight cast initially to allow flex and ext but prevent rotation, restore strength and ROM, then complete proprioception work

19
Q

PCL injury- MOI

A

posterior force to proximal tibia, if combined with rotational force injury to P-L complex, may occur in car crash- hit knee’s on dash board

20
Q

S and S PCL

A

positive posterior draw test, often asymptomatic or may have vague symptoms of pain in posterior knee, pain on kneeling

21
Q

LCL MOI

A

main cause of LCL injury is direct trauma to the inside of the knee. this puts pressure on the outside of the knee and causes the LCL to stretch and tear

22
Q

symptoms of LCL

A

swelling of the knee, stiffness at the knee that can cause locking of the knee, pain or soreness on the outside of the knee, instability of the knee joint

23
Q

diagnosis of LCL injury

A

varus test, or MRI scan

24
Q

treatment for all ligament injuries

A

PEACE and LOVE, pain relief, strengthening and ROM exercise, proprioception work
train breaks- ACL= hamstrings, PCL- quads, LLS- evertors

25
Q

anterior knee pain

A

indicates no individual structures can be isolated for pain, could be tightness of muscles infront or behind knee- altered biomechanics at PF joint, altered alignment, could be due to high or low riding patella

26
Q

S and S of anterior knee pain

A

adolescent people generally, triggered by overuse, aching infront of knee, aggravated by deep flexion- going up stairs, rest receives symptoms

27
Q

clinical presentation- anterior knee pain

A

functional deficits, crepitus and/or instability, pain when walking down stairs/ squatting/ depressing the clutch pedal in car/ wearing high-heeled shoes, sitting for long periods with knees in a flexed position, instability when walking on stairs,

28
Q

differential diagnosis- Anterior knee pain

A

symptoms- pain (location and type) or instability problems, alignment of the entire LL (squinting patella, high Q-angle), patellar position, muscle and soft tissue (hypertrophy-VMO, muscle imbalance between VL and VM, weakness of knee extensors, hip flexors or hip abductors), knee function- during functional activities

29
Q

physical therapy anterior knee pain

A

knee taping and exercise for mal alignment, proprioceptive training, shoe inserts, improve eccentric muscle control, improve knee ext strength,

30
Q

ankle lateral ligament- MOI

A

usually after a traumatic event/acute presentation, excessive inversion/PF movements,
risk factors- BMI, slow eccentric inversion strength, fast concentric PF, passive inversion joint position sense, reaction time of peroneus brevis were associated with increased risk

31
Q

assessment of the joint- ankle lateral ligament

A

amount of instability present by assessing the grade of the sprain, loss of ROM, loss of muscle strength, levels of reduced proprioception
special tests, anterior draw (ATFL and CFL), talar tilt (ATFL and CFL), proprioception

32
Q

ankle lat ligament- reduce pain and swelling (early treatment)

A

initial management (within first 48-72 hours)- PEACE and LOVE, if weight bearing painful start with NWB, but quickly progress to PWB

33
Q

physio management- ankle lat ligament

A

ROM- AROM, strength- eversion is particularly important, proprioception, plyometrics- twisting, jumping, hoping on one leg, running, figure 8 running

34
Q

achilles tendinopathy-

A

is an overuse injury caused by repetitive energy storage and releases with excessive compression. this can lead to sudden injury, or rupture. risk factors- lack of flexibility or stiffness Achilles tendon
2 types:
insertional- transition between tendon and bone, mid-portion- within tendon body

35
Q

achilles tendinopathy- first stage

A

is non-inflammatory proliferative response in the cell matrix, this is as. result of compressive or tensile load, straining the tendon during physical activity can cause repetitive micro traumas, these are linked with a non-uniform tension between the gastroc and soleus, causing frictional forces between the fibres and abnormal concentrations of loading in the tendon

36
Q

consequences of micro traumas

A

inflammation of the tendon sheath, degeneration, or a combination of both. without the minimum time for recovery, this can lead to tendinopathy.

37
Q

possible factors that lead to chronic tendon overuse injuries

A

decreased arterial blood flow, local hypoxia, decreased metabolic activity, nutrition, and persistent inflammatory response

38
Q

acute stage of Achilles tendinopathy

A

caused by acute overload, blunt trauma or acute muscle fatigued, and is characterised by an inflammatory reaction and oedema formation. if the treatment is overlooked, it can cause a fibrin and form adhesions off the tendon

39
Q

progression of achilles tendinpathy

A

the progression of the reactive tendinopathy to tendon disrepair can occur if the tendon is not offloaded and allowed to regress back to normal state. During this phase, there is the continuation of increased protein production which has been shown to result in seperation of the collagen and disorganisation within the cell matrix. this is the attempt of tendon healing

40
Q

degenerative Achilles tendinopathy

A

the final stage of the continuum and it is suggested that at this stage there is a poor prognosis for the tendon and change is now irreversible. often, tendon degeneration is found in combination with peri-tendinous adhesions, but this does not mean one condition causes the other one

41
Q

risk factors of achilles tendinopathy

A

obesity, high blood pressure, rapid changed to load, type 2 diabetes, prolonged steroid use, family history of tendinopathy, inappropriate footwear

42
Q

clinical presentation

A

morning pain, swelling and pain are less common, the tendon may appear thicker in M-L and A-P outline

43
Q

anterior knee pain

A 
clarkes test (reproduction in symptoms), see biomechanics changes- changes in Q angle, knee more medially causes patella to be forced laterally, 
treat- sort biomechanics out, ER hip resisted straightening leg- step forward into it, quad strength

PH2001 MSK (14 decks)

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