Lower Extremity Flashcards
What age group commonly gets osteochondirtis dessicans
10-20yo
If the pt has greater trochanter pain syndrome on their right hip, which leg will they have trouble standing on?
Their right leg (left hip will drop)
What is thei treatment for greater troachanter pain syndrome?
Self-limiting
Heating pad
Steroid injections work very well
What specialized test is done for LCL injury
Varus stress at 0 and 30 degrees flexion
Should you do imaging for FAI? What type?
Yes, X-ray initially
Maybe CT or MRI for soft tissue
What is the most common location of osteochondirtis dessicans?
Knee (specifically the lateral portion of the medial femoral condole)
Is ACL tear more common in men or women?
Women
Should we do imaging to diagnose patellorfemoral pain syndrome/
No, not unless there is trauma or severe instability
Are steroid injections a good idea for patellar tendonitis? Why’?
No, not recommended. Because it is a direct insertion point.
What is the most common MOI to injure ACL
Non contact!
Quick position change with cutting/pivoting that causes a lateral bend
What is the treatment for snapping hip
Don’t do that
Stretching, ice, etc
NSAIDS
Steroid injection if it caused bursitis (not in kids)
Not surgery
Name it:
Bone overgrowth or abnormality that changes the function of the hip joint. (Either through labral tear of destruction of articular cartilage)
Femoroacetabular impingement
How can a patient prevent plantar fasciitis?
Improve shoes
Stretching the Achilles
Massage of the fascia (painful)
Ortho/podiatry referral for SEVERE cases so they can do steroid injections
Is osteochondirist dessicans a process?
Yes, and it can be caught at any point
Can pts reproduce their snapping hip on command
Yes
What causes a syndesomtic ankle sprain?
Dorsiflexed/rotational ankle injury
What can cause rupture of Achilles’ tendon?
Sudden pivoting or rapid acceleration. “Sensation of violent hit or pop.”
How will Achilles’ tendon injuries present?
Tendionpathy: burning pain that increases with activity
Rupture: “sensation of violent hit or pop” and pain may be absent
What is the treatment for patellofemoral pain syndrome
Ice
NSAIDS
Activity modification
PT to strengthen quads, stretch hammies, and stabilize core.
Taping or brace PRN
What ligaments are injured with a medial ankle sprain?
Deltoid ligament complex
How would you test for external snapping hip
Passive internal/external rotation while lying on side
Is osteochondirittis dessicans visible on x ray?
Yes, you will see flattening of articular surface (crater)
You can do an MRI if the x ray is inconclusive
What is the name for an accumulation of joint fluid in the popliteal fossa?
Bakers cyst
What constitutes a grade III knee sprain and what is the treatment?
Complete tear.
Treatment:
Surgery
Crutches
Brace
Aggressive PT
What is it:
Idiopathic osteonecrosis of subchondral bone
Osteochondirits Dessicans
What specialized test is done for MCL injury
Valgus stress at 0 and 30 degrees
Where will it hurt on a physical exam for osteochondritis dessicans?
Elbow: pain/guarding with passive motion.
Lateral pain with valgus stress
Knee: pain with flexion over medial condyle. Gait disturbances
What is knee bursitis?
Inflammatory disorder of the bursa
What is the treatment for FAI?
“Don’t do that”
NSAIDS
PT
Surgery for bony abnormalities
What are the two ways that the Achilles’ tendon can be injured?
Tendinopathy
Rupture
What is the treatment of knee bursitis?
Avoid precipitating factors (tilers, roofers, etc)
NSAIDS
Aspiration/steroid injections
Padding/bracing
What is the clinical presentation of patellofemoral pain syndrome (Runner’s knee)?
Anterior pain UNDER the patella
Pain with stairs
Positive theater/car ride sign
Usually crepitus, popping, feeling of instability
What is the treatment for ankle sprain?
RICE and NSAIDS
+/- short immobilization for grades 2-3
PT to prevent repeat injuries, bracing/taping
What is the most common knee complaint in primary care medicine?
Patellorfemoral pain syndrome (runners knee)
What is the treatment for patellar tendinitis/
Ice
NSAIDS
Bracing/strapping
Rest/PT
NOT steroid injections
Should you do imaging for an ankle sprain?
Only to RO fracture
How would you test for internal snapping hip?
FABER and then extend hip while in FABER position
What are the specialized tests for ACL injury?
Lachman
Anterior Drawer
Pivot shift (pt must be sedated)
How will Femoroacetabular impingement (FAI) present?
Groin/lateral hip pain that is aggravated with turning, twisting, squatting, or prolonged standing
What is important to do when a pt presents with IT band syndrome?
Evaluate for limb length discrepancy
What is the treatment for bakers cysts?
NSAID
Aspiration
Compressive brace
Surgery almost never
What causes external snapping hip
IT band over the greater troachanter
Does snapping hip always hurt?
No
What should you always think when you hear “catching or clicking”
Soft tissue tear
What should you be sure to do if someone presents with knee bursitis?
Rule out infection
Who is most likely to get osteochondritis dessicans in the knee?
Preteens
What constitutes a grade II knee sprain and what is the treatment?
Partial tear
Treatment:
RICE
Brace immobilization
+/- crutches, PT, surgery
The PCL is rarely injured, but what sport most commonly causes it to tear if it does
Soccer
What causes osteochondirtis dessicans
We don’t know
Maybe repetitive trauma, vascular disruption, ischemia following trauma, genetic predisposition
How does labral tear of hip present?
Groin pain that can radiate to lateral hip, thigh, or butt
What specialized tests are done for patellofemoral pain syndrome/runners knee?
Patellar glide
Apprehension test
Are bakers cysts painful?
They can be with prolonged standing or activity
Which meniscus is more susceptible to injury? Why?
Medial
-greater medial forces and it is less mobile than the lateral meniscus
What does the PCL do to provide stability to the knee
Prevents posterior translation of tibia
How does the ACL provide stability to the knees
Prevents anterior translation of tibia***
What causes iliotibial band syndrome
Overuse
Which is why its common in runners and cyclists
What is the treatment for Achilles’ tendon injury?
Equinus Splinting*****
Ortho referral
Boot allowing for continued plantar flexion
What is the most important structure for stability of the knee**
ACL
What kid of injury will cause a Medial ankle sprain?
Eversion
What are the two types of femoroacetabular impingement (FAI)
Pincer- acetabular “roof” overgrowth
Cam- femoral head too fat.. can’t slip under
(Can be a combo)
What is the treatment for ACL tear
RICE
Ortho referral
Surgery maybe
Brace
PT
How will pt present with greater trochanteric pain syndrome?
Very localized pain over greater trochanter that they can point to with one finger
Pain with resisted abduction
What is the most common cause of lateral hip pain in adults?
Greater trochanter pain syndrome
Aka trochanteric bursitis
Who do we give surgery to for ACL tear
Young people and athletes
How do you injure your meniscus
Rotation force of the femur on the tibia
Who is most likely to get patellar tendonitis (jumpers knee)?
Athletes involved in running, jumping and kicking sports
16-40
M>F
Excessive foot pronation (“weak ankles”) and running hills can exacerbate these symptoms
What is it:
Anterior pain under the patella
Pain with stairs
Positive theater sign/car ride sign
Crepitus, popping, feeling unstable
Patellofemoral pain syndrome (Runner’s knee)
Who commonly gets osteochondirtis dessicans in their elbow?
Teens, young adults
Throwing/gymnastic sports
What is the treatment for IT band syndrome?
RICE
NSAIDS
PT
What are the specialized tests for PCL tear
Posterior drawer sign
Sag sign
What is it:
Joint Line pain
Inability to fully extend knee
“Locking” or “catching” when extending knee
Stairs and squatting are painful
Meniscus injury
Should we do imaging on IT band syndrome?
No, not unless traumatic
What is the largest and strongest knee ligament
PCL
What is the specialized test for Achilles’ tendon rupture?
Thompson test
What will increase the pain of plantar fasciitis?
ROM that strains the fascia, such as dorsiflexion of the toes or ankle
Where in the elbow is most commonly affected by osteochondirtis dessicans
Capitulum
What is the most common way to injure the MCL
Knee flexed, foot planted, and a lateral blow
What shape are the menisci?
C-shaped
Is imaging needed for an Achilles’ tendon injury?
Not always
What is the gold standard test to diagnose a labral tear of the hip?
MR Arthrogram
Are bakers cysts often asymptomatic and found incidentally?
Yes
What constitutes a Grade I knee sprain and what is the treatment?
Mild stretch
Treatment is:
RICE
WB as tolerated
What is the treatment for plantar fasciitis?
Conservative- ice, NSAIDs, rest
What can cause Achilles’ tendon tendinopathy
Recent increase in training regimen
What specialized test can be done for a syndesmotic ankle sprain?
Squeeze test
How does snapping hip present?
Snapping/popping sensation
Might hurt
Sensation of the hip popping out of socket
Should you do imaging for plantar fasciitis?
Only if you are concerned about bony abnormalities such as bone spurs
Who most commonly gets iliotibial band syndrome?
Runners and cyclists
What is one of the most common causes of foot pain?
Plantar fasciitis
What causes snapping hip syndrome?
Muscle or tendon sliding over a bony prominence
Is LCL sprain common?
No very difficult MOI
What is the clinical presentation of iliiotibial band syndrome?
Gradual onset of pain on lateral knee (insertion point of IT band)
Starts as a Sharp and burning pain with activity
Develops into constant deep ache
What is the Triad of O’Donoghue (unhappy triad)
ACL
MCL
Medial meniscus
What will a patient with plantar fasciitis complain about?
Pain in the heel with the First Step of the day ***
What is the clinical presentation of ankle sprain?
Swelling, pain, bruising, difficulty with weight bearing
What is a syndesmotic ankle sprain?
A high ankle sprain
Tons of ligaments + interosseous membrane are injured
What causes internal snapping hip?
Iliopsoas tendon over iliopectineal eminence of femoral head
What specialized test can be done for a lateral ankle sprain>
Anterior drawer
What is the most common location for ankle sprain, and which ligaments are torn?
Lateral ligament complex:
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament
What knee ligament do you think is injured if the pt doesn’t really complain about instability, but says “something doesn’t feel right”
PCL
If a pt comes in and says “ i feel so unstable, like my knee could give out at any moment” what should you suspect
ACL tear
What is the clinical presentation or osteochondritis dessicans?
Gradual onset of poorly localized deep pain
Popping/locking/catching in late disease due to loose fragments
Limited WB in knee lesions
Decreased ROM in elbow lesions
+/-swelling
What is the go-to imaging modality for meniscus injury?
MRI
What kind of injury will cause a lateral ankle sprain?
Inversion
What is the most common ligament in the knee to be injured?
ACL
What kind of imaging do we do for ACL tear?
MRI
X-ray maybe
What causes patellar tendinitis?
Inflammation from Repetitive trauma
Who is most at risk for snapping hip?
Dancers
Runners
Adolescents
(Anyone who does extreme ROM or repetitive movements)
How do you test for FAI?
FADIR for impingement
FABER/figure 4 for determining ipsilateral hip pathology vs contralateral SI joint dysfunction
Where will a pt point to their pain if they have patellar tendinitis/ jumper’s knee?
Just distal to the patella
What are the different bursae in the knee that can become inflamed and which ones are the more common ones?
Prepatellar
Suprapatellar
Infrapatellar
Pes anserine
Prepatellar and pes anserine are the most CLASSIC presentations**
What is a common cause of Labral tear of hip?
FAI
Why do pts with greater troachnter pain syndrome have a positive trendelenberg test?
Due to PAIN not actually weakness
What specialized tests do we do for meniscus injury?
McMurrays
Apley‘s compression/distraction
