Lower extremities Flashcards
articular
in the joint
periarticular
around the joint, like trochanteric bursa
what signals a congenital pathology
-pain persistent from infancy or appearing before 40
what signals degenerative dz (arthitis)
pain after 60YO
pelvic fx
- MC MOA
- can cause?
- dx
- tx
- complications
- lab tests to monitor complications?
high impact injuries–like MVA
can cause a lot of bleeding–fluid resucitation is needed
dx=cray
tx=severity and location of fx
COMPS=dvt, scatic nerve damage and BLEEDING
BLEEDING**
LABS: cbc, blood type and screen to monitor bleeding
Hip dislocation -what is it -MCC MC type CM and complictions PE Tx
head of femur pops out of acetabulum
MCC=high impact injury–MVA aka truama mcc
MC type=POSTERIOR–>axial loading on an adducted femur
CM
*POSTERIOR: affected limb is ADDucted, internally rotated and shortened
*anterior: abducted, externally rotated and shortened
*severe pain on mobilization
COMPLICATION OF POSTERIOR: sciatic nerve injury
PE
*always check femoral artery and nerve—can be compressed with anterior dislocation
TX
-conservative=closed reduction under conscious sedation
OR
ORIF surgery
always think about these potential complications with hip dislocations—5
- avascular necrosis— risk reduced if hip reduced early (<6 hours)
- sciatic nerve injury (posterior)
- DVT
- bleeding
- if anterior—check femoral artery and nerve
Hip Fx
- MC in?
- MOAs
- where is pain felt
- what does limb look like when PT supine
- three types
- complications
MC in elderly, esp women who are prone to osteoporosis
MOA: minor or indirect trauma in eldery, high impact injuries in younger PT
Pain MC felt in groin
*when patient is supine—affected limb will lie ABducted, externally rotated with some shortening
TYPES
- femoral head fx—-HIGHER chance of AVASC necrosis*******
- intertrochanteric—b/w greater and less trochs
- subtrochanteric–distal (below) the trochs
COMPS
- avasc necrosis–esp with femoral head fx
- DVT—-high chance—>give patient prophylactic antithrombotic therapy if indicated
TX
Surgical ORIF
limb presentation for:
1. posterior hip dislocation
vs
2. hip fx
DISLOCATION=leg shortened, internally rotated and adducted
FX=shortened, abducted and externally rotated
Slipped Capital Femoral Epiphyis (SCFE)
- define
- RF
- CM + PE
- DX
*displacement of femoral head (epiphysis) from the femoral neck through growth plate–SALTER 1
RF:
- children 8-16YO
- obese
- AA
- males during growth spurt
- if seen in kids b4 puberty–suspect hormonal or systemic disorders –hypothyroidism or hypopituitarism
CM
- ipsilateral (same side) dull achy HIP/GROIN/THIGH/KNEE pain with a PAINFUL LIMP
- worse with activity
PE
- externally rotated leg on affected side
- altered gait
DX
*XRAY: posterior displacement of femoral epiphysis—-best seen on FROG LEG lateral pelvis or lateral hip view
“ice cream cone fell off the cone”
TX
*non-weight bearing with crutches followed by internal fixation
what direction does the femora head epiphysis slip in a SCFE
posterior and inferior
Legg-Calve-Perthes Disease -define -etiology -bilateral or unilateral -age group MC -RF -CM -dx: early and late tx
- idiopathic avascular osteonecrosis of femoral head in children
- due to ischemia of capital femoral epiphysis
- MC unilateral
- MC in 4-10YO
RF:
- age 4-10
- males—4x more likely
- obesity
- coagulation abnormalities (face V leiden)
DECR RF: low incidence in AAs
CM
- painless limping for weeks—worse with actiity esp at the end of day
- intermittent hip, thigh, knee or groin pain
- restricted ROM–loss of abduction and internal rotation
- +/- atrophy of thigh muscles
DX
- early: incr density of the femoral epiphysis–widening of cartilage space
- late: deformity, (+) crescent sign—microfracturs with collapse of bone
TX
- observation with activity restriction (non-weight bearing inititally)
- orthro f/u
- usually self limiting condition–revascularization within 2 years
- PT
- brace/cast
- surgical for advanced cases
Femoral Shaft FX
- MOA for healthy adult
- MC complication
- MC associated with?
MOA for healthy adult=high energy trauma
MC compliaciton= BLEEDING** very significant amount** can cause hemodynamic instability
MC associated with femoral neck fx–always look out for this bc it can lead to avasc necrosis
Tibial and Fibular fx
- MC open or closed?
- PE: what must you always check?
MC open fxs with soft tissue injury
PE: Always check for: (and compare everything to the other side)
1. dorsalis pedis and posterior tibial pulses!!!!
2. Check ROM in toes
3. nerve injury
TX
- nondisplaced and closed: tx with full leg cast for 4-6 weeks–>then below knee walking cast for another 4-6 weeks
- comminuted or displaced–>ORIF
role of menisci
“spacers”
absorb shock
role of ligaments
hold joint together (connect bone-bone)
blood supply to leg comes from?
tibial artery
where does tibial artery pass?
behind the knee— why it is highly susceptible to trauma
what nerve passed laterally below the fibular head
Peroneal nerve
*also high risk for injury
Valgum
- define
- etiology
“GUM” makes your knees stick together
- knock-knee*
- deformity where tibia is bent or twisted laterally
- occurs result of collapse of lateral compartment of knee and rupture of MCL
Varum
- define
- etiology
RUM makes your knees spread apart
- bow leged
- deformity which tibia is bent medially
- occur from collapse of the medial compartment and rupture of LCL
Valgus stress test
- describe it
- what does it test for
ABDUCTION
*pt supine–>knee flexed–>pushing medially against the knee and pull laterally at the ankle–opens knee joint on medial side
PAIN= (+) test and indicatede MCL injury
Varus stress test
- describe it
- (+) test means
ADDUCTION
*pt supine–>knee flexed–>push laterally against the knee and pull medially at the ankle–>opens the knee joint on the lateral side
(+) test=PAIN=LCL injury
McMurrary Test
- descr it
- what does it indicate
*knee bent–>then externally rotated and extended
CLICKING SOUND= (+) test and indicated medical and/or lateral meniscal tear
**MEDIAL 3x more common than lateral
Anterior Drawer Test
- describe it
- indicates?
- knees bent–>feet flat on table–>cup hands around the knee with the thumbs on medial and lateral joint line— fingers are wrapped around on hamstrings–>push tibia forward
- **look to see if it slides forward from under the femur
**(+) test= ACL injury
Posterior drawer test
same as anterior set up– but you are pushing the tibia posteriorly—
(+) test=PCL injury
***less common than ACL
