Lower Extremity

Question 1

Aseptic Necrosis (hip) Characteristics

Answer 1

1. loss of blood supply to trabecular bone which causes collapse of femoral head (cresent sign)
2. children: Legg-Calve-Perthes disease

Question 2

Aseptic Necrosis Clinical Features

Answer 2

1. dull/throbbing ache localized to groin, lateral hip, butt
2. pain with WB, alleviated with rest
3. loss of rotation or ABDuction

Question 3

Aseptic Necrosis adverse outcomes

Answer 3

1. secondary OA
2. femoral head collapse
3. disability

Question 4

Aseptic Necrosis Imaging

Answer 4

1. MRI for early detection

2. xray (cresent sign later in disease)

Question 5

Aseptic Necrosis Treatment

Answer 5

1. alendronate to prevent collapse
2. surgery: decompression, THA
3. protected weight-bearing

Question 6

Slipped Capital Femoral Epiphysis (SCFE) Characteristics

Answer 6

1. weakening of epiphyseal plate of femur, results in displacement of femoral head
2. 10-16yo
3. boys more than girls, African-Americans more
4. younger children: metabolic cause (hypothyroid, hypopituitary)

Question 7

SCFE Clinical Features

Answer 7

1. insidious hip, thigh, knee pain

2. limp

Question 8

SCFE Imaging

Answer 8

lateral xray (frog-leg lateral view)

Question 9

SCFE Treatment

Answer 9

1. pinning in situ

2. crutches, avoid WB after surgery

Question 10

Meniscal Injury Characteristics

Answer 10

1. excessive rotational force of femur on tibia

2. medial meninscus torn more than lateral

Question 11

Meniscal Injury Clinical Feature

Answer 11

1. joint line pain on side of injury
2. unable to fully extend knee (LOCKING)
3. knee “giving way”
4. swelling
5. difficulty stairs/squatting
6. Mcmurry, Apley

Question 12

Meniscal Injury Imaging

Answer 12

MRI

Question 13

Meniscal Injury Treatment

Answer 13

1. activity modification
2. NSAIDs
3. quad strengthening
4. Indications for arthroscopy: persistant sxs unresponsive to treatment

Question 14

Osgood-Schlatter Characteristics

Answer 14

1. apophysitis of tibial tubercle
2. 8-15 yo
3. males more than females
4. self-limited

Question 15

Osgood-Schlatter Clinical Features

Answer 15

1. anterior knee pain
2. localized pain and swelling over tibial tuberosity
3. pain when active, relieved with rest

Question 16

Osgood-Schlatter Imaging

Answer 16

lateral xray may show fragmentation of tibial tuberosity

Question 17

Osgood-Schlatter Treatment

Answer 17

1. rest for several months

2. stretching, ice, NSAIDs after exercising

Question 18

Cruciate Ligament Injury Characteristics

Answer 18

1. ACL injured more than PCL
2. ACL injury associated with pivot
3. women more than men

Question 19

Cruciate Ligament Injury Clinical Features

Answer 19

1. hear POP
2. feel instability in knee
3. Hemarthrosis (bleeding into joint space) within 3-4 hours
4. Lachman test for ACL

Question 20

Cruciate Ligament Injury Imaging

Answer 20

1. MRI

2. xray to r/o fracture

Question 21

Cruciate Ligament Injury Treatment

Answer 21

1. PT/bracing for non-athletes

2. surgical reconstruction with autograft/allograft for patients under 40 and athletes

Question 22

Ankle Sprain/Strain Characteristics

Answer 22

1. Inversion injury
2. most often associated with lateral ligaments
3. ATL (anterior tibulocalcaneal ligament)

Question 23

Ankle Sprain/Strain Clinical Features

Answer 23

1. report hearing “pop”
2. ecchymosis, tenderness
3. stability tested with anterior drawed test

Question 24

Ankle Sprain/Strain Imaging

Answer 24

xray to r/o fracture

Question 25

Ankle Sprain/Strain Treatment

Answer 25

1. RICE 2. crutches 48-72 hours 3. PT

Question 26

Achilles Tendonitis Characteristics

Answer 26

1. common in runners and patients who increased fitness 2. overuse injury, result of improper stretching/training 3. if untreated: results in achilles rupture

Question 27

Achilles Tendonitis Clinical Feature

Answer 27

1. pain during/after activity 2. pain on posterior calf (2-6cm above insertion of Achilles tendon) 3. normal ankle ROM 4. Thompson squeeze test to r/o rupture

Question 28

Achilles Tendonitis Imaging

Answer 28

1. xray (shows calcification) | 2. MRI (r/o rupture, shows hypertrophy)

Question 29

Achilles Tendonitis Treatment

Answer 29

1. NSAIDs 2. PT 3. Cortisone injection

Question 30

Bunions (Hallux Valgus) Characteristics

Answer 30

1. most common deformity of metatarsalphalangeal (MTP) joint 2. result of lateral deviation of proximal phalanx 3. more common in women

Question 31

Bunion Clinical Feature

Answer 31

1. medial eminence pain, metatarsal head pain, deformities of the toes, and inablilty of shoes to fit

Question 32

Bunion Imaging

Answer 32

1. weight-bearing xray of foot (valgus deformity an angle greater than 15 degrees)

Question 33

Bunion Treatment

Answer 33

1. buy shoes with wide toe box 2. pads on medial eminence 3. surgery for serve deformity

Question 34

Morton Neuroma Characteristics

Answer 34

1. result of traction of interdigital nerve against the transverse metatarsal ligament causing degeneration of nerve and chronic inflammation 2. affects 3rd web space

Question 35

Morton Neuroma Clinical Features

Answer 35

1. pain and localized numbness with activity, relieved with rest 2. pain localized to web space, mass often palpable 3. squeezing forefoot will often reproduce sxs

Question 36

Morton Neuroma Diagnosis

Answer 36

clinical

Question 37

Morton Neuroma Treatment

Answer 37

1. soft metatarsal pad and shoes with wide toe box 2. cortisone injection 3. surgical removal of neuroma

Question 38

Plantar Fasciitis Characteristics

Answer 38

1. common in runners and overweight patients | 2. cause by microscopic tears in plantar fascia

Question 39

Plantar Fasciitis Clinical Features

Answer 39

1. pain with first few steps in the morning 2. heel pain at night 3. inflexible achilles tendon

Question 40

Plantar Fasciitis Treatment

Answer 40

1. 6-12 months conservative treatment (PT) 2. steroid injections 3. surgery for severe cases