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X Clin Med Exam 3 > Lower Extremity > Flashcards

Lower Extremity Flashcards

1
Q

Where is true “hip” pain seen?

A

In the groin (near the joint socket)

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2
Q

What is femoroacetabular impingement?

A

Bone overgrowth or abnormality in bone development (like tearing of the labrum or destruction of the articular cartilage leading to osteoarthritis)

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3
Q

Types of femoroacetabular impingement

A

Pincer (acetabular involvement)
Cam (femoral head involvement)
Combo

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4
Q

Clinical presentation of femoracetabular impingement

A

Groin pain and/or lateral hip pain
Pain might be sharp/stabbing or deep/dull ache
Pain worse with turning, twisting, standing, squatting

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5
Q

Tests for femoracetabular impingement

A

FADIR or FABER

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6
Q

FADIR impingement test

A

Knee/hip flexion with ADduction and Internal Rotation of the hip

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7
Q

FABER/Patricks/Figure Four

A

Flexion, ABduction, External Rotation of hip
Ipsilateral pain in the front is hip pathology
Contralateral pain in back is SI joint dysfunction

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8
Q

When would you use an MRI for a femoroacetabular impingement?

A

If there is clicking or catching

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9
Q

Tx for femoracetabular impingment

A

Decrease aggravating activities, NSAIDS, pt

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10
Q

What is a common precursor for a labral tear of the hip?

A

Femoroacetabular impingement

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11
Q

Clinical presentation of labral tear

A

Dull/sharp groin pain, often radiates

Catching/clicking that may cause the pain

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12
Q

Gold standard for imaging of labral tear

A

MR arthrogram (want to be able to see fluid densities with a fluid injection)

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13
Q

When do you let a labral tear heal on its own?

A

If inside the cup of the labrum and it is not rubbing/clicking

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14
Q

What is snapping hip syndrome?

A

Snapping or popping sensation in the hip with walking, getting up from a chair or swinging the leg

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15
Q

Cause of snapping hip syndrome

A

Muscle or tendon sliding over a bony prominence, which can lead to bursitis

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16
Q

External snapping hip syndrome

A

IT band over the greater trochanter (can see it while swinging the leg)

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17
Q

Internal snapping hip syndrome

A

Iliopsoas tendon over iliopectineal eminence or femoral head (anterior groin popping)

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18
Q

Who is at increased risk of snapping hip syndrome?

A

Adolescents, athletes with repetitive hip flexion, dancers

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19
Q

Clinical presentation of snapping hip syndrome

A

Snapping/popping sensation
Pseudosubluxation (sensation of hip subluxation or dislocation)
Difficulty with stairs, running, arising from seated (internal) etc

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20
Q

Physical exam for external snapping hip syndrome

A

Passive internal/external rotation of hip while laying on side

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21
Q

Physical exam for internal snapping hip syndrome

A

Flex, abduct and externally rotate hip (FABER) then extend hip

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22
Q

Tx for snapping hip syndrome

A

NSAIDs, avoidance, corticosteroid injection, PT

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23
Q

What is the most common cause of lateral hip pain in adults?

A

Greater trochanteric pain syndrome (previously trochanteric bursitis)

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24
Q

What is greater trochanteric pain syndrome?

A

Repetitive overload tendinopathy (glut med and min) with hip abduction and pelvic instability

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25
Q

Clinical presentation of greater trochantetic pain syndrome

A

Lateral hip pain with localized pain to greater trochanter, pain increased with pressure over trochanter

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26
Q

Physical exam for greater trochanteric pain syndrome

A

TTP over greater trochanter, pain with resisted abduction, Trendelenburg sign due to pain not weakness

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27
Q

Terrible/Unhappy triad or Triad of O’Donoghue

A

ACL, MCL, medial meniscus

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28
Q

Most common MOI for MCL sprain

A

Knee flexion + foot planted AND lateral impact causing valgus stress and rotation

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29
Q

MOI for LCL sprain

A

Tibial internal rotation and medial impact

30
Q

What is the most important structure for stability of the knee?

A

ACL

31
Q

What does the ACL do?

A

Prevent anterior translation and rotation of the tibia

32
Q

MOI for ACL injury

A

Noncontact: quick position change with cutting/pivoting (lateral bend)
Contact: direct blow causing hyperextension or valgus deformity with lateral impact

33
Q

Why is an ACL injury more common in females?

A

Quad dominance during deceleration, increased valgus stress with pivoting or deceleration, decreased proprioception, decreased intercondylar notch width, estrogen

34
Q

History for ACL injury

A

Feeling or hearing a pop, immediate pain and swelling, report feeling of instability

35
Q

Specialized tests for ACL injury

A

Lachman, anterior drawer or pivot shift

36
Q

Gold standard for diagnosis of ACL injury

A

MRI

37
Q

What does the PCL do?

A

Prevents posterior translation and external rotation of the tibia (largest and strongest ligament of the knee)

38
Q

MOI for PCL injury

A

High energy trauma: MVA

Low energy trauma: sports (mostly soccer)

39
Q

Clinical presentation of PCL injury

A

Generalized knee pain and a feeling of something not being right, presentation varies based on MOI

40
Q

Specialized tests for PCL injury

A

Posterior drawer sign and posterior sag sign

41
Q

What is a meniscus?

A

C-shaped cartilage that increases contact area for articulation
Increases joint stability, facilitates lubrication and shock absorption

42
Q

When does a meniscus injury occur?

A

Due to excessive rotational force of femur on tibia

43
Q

Clinical presentation of meniscus injury

A

Joint line pain, inability to full extend knee (locking or catching)

44
Q

Specialized test for meniscus injury

A

McMurrays (Medial is Bolander- out laterally, Lateral is bermingham-rotate in), Apley’s compression/distraction

45
Q

Treatment based on grade of knee sprain

A

I (mild stretch): RICE, WB as tolerated
II (partial tear): RICE, brace, crutches, PT, maybe surgery
III (complete tear): surgical repair, crutches, brace, aggressive PT

46
Q

Clinical presentation of patellofemoral pain syndrome (Runners knee)

A

Anterior pain under the patella (involves retinaculum), positive theater/car ride sign
Usually see crepitus, popping, feelings of instability

47
Q

Specialized tests for patellofemoral pain syndrome

A

Patellar glide and patellar apprehension test

48
Q

What is a baker’s cyst?

A

Accumulation of joint fluid in the popliteal fossa

49
Q

What is patellar tendonitis?

A

Patellar tendon inflammation from repetitive trauma

Steroid injection is not recommended because it is near the insertion site and there is risk for rupture

50
Q

Clinical presentation of ilitotibial syndrome

A

Gradual onset of localized pain at the insertion point of the IT band
Initially sharp/burning pain during activity that may develop into a constant deep ache
Overuse

51
Q

What is knee bursitis and where is it most commonly seen?

A

Inflammatory disorder of the bursa (thin walled sac lined with synovial fluid)
Prepatellar and pes anserine are most common (there is also suprapatellar and infrapatellar tho)
Presents with pain, swelling and tenderness

52
Q

What is osteochondritis dissecans?

A

Idipathic osteonecrosis of subchondral bone (10-20 yo)

53
Q

What is the process of osteochondritis dissecans?

A 
Trauma
Focal hypovascularity
Necrosis
Chondromalacia
Articular fragment
*Each step is a different grade
54
Q

Reason for osteochondritis in the elbow

A

Chronic valgus stress or micro trauma with compression attributed to overhead activities (commonly affecting capitellum)

55
Q

Reason for osteochondritis in the knee

A

Repetitive axial loading (valgus/varus stress)

Most commonly lateral portion of medial femoral condyle

56
Q

Clinical presentationof osteochondritis dessicans

A

Gradual onset of poorly localized deep pain (elbow seen laterally), elbow tends to have decreased ROM
Popping, locking or catching in advanced disease

57
Q

Importance of imaging in osteochondritis dessicans

A

See flattening of articular surface (crater) which is usually when a provider first thinks about this disease as a diagnosis

58
Q

What are the pathologies causing anterior knee pain?

A

Quads/patellar tendons, patellofemoral pain syndrome, bursitis, patellar fracture/dislocation, Osgood-Schlatters

59
Q

What are the pathologies causing medial knee pain?

A

MCL, medial meniscus, pes anserine bursitis

60
Q

What are the pathologies causing lateral knee pain?

A

LCL, IT band syndrome, lateral meniscus

61
Q

What are the pathologies causing posterior knee pain?

A

Baker’s cyst, DVT

62
Q

What is the most common ankle sprain and what is the MOI?

A

Lateral ligament complex (mostly anterior talofibular ligament, but also included calcaneofibular ligament and posterior talofibular ligament )
Inversion injury with plantar flexion
Test: anterior drawer

63
Q

What occurs in a medial ankle sprain?

A

Eversion injury of deltoid ligament complex

64
Q

What occurs in a syndesmotic/ high ankle sprain and what is the MOI?

A

Usually involves anterior/posterior tibiofibular and transverse tibiofibular ligaments and the interosseus membrane
Dorsiflexed/rotational ankle injury
Test: squeeze test

65
Q

What is the function of the Achilles Tendon?

A

Plantarflexion

66
Q

What is the associated disease in kids of the achilles tendon?

A

Calcaneal apophysitis (Sever’s disease)

67
Q

Clinical presentation of tendinopathy associated with achilles tendon

A

Recent increase in training, burning pain increased with activity

68
Q

Clinical presentation of rupture of achilles tendon

A

Sudden pivoting or rapid acceleration with a sensation of a violent hit or pop

69
Q

Specialized test for achilles tendon

A

Thompson test

70
Q

What is important to remember for immobilization for an achilles tendon rupture

A

Splint them in a continued plantar flexed position to allow for correct healing

71
Q

Clinical presentation of plantar fasciitis

A

Pain with onset of walking (first step in the morning)

Most common on plantar aspect of heel

72
Q

What do you want to rule out with plantar fasciitis presentation?

A

S1 radiculopathy (weakness with dorsiflexion of great toe)

X Clin Med Exam 3 (8 decks)

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