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MSK final > lower extremity > Flashcards

lower extremity Flashcards

1
Q

most stable ball and socket joint

A

hip

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2
Q

hip dislocations require how much energy

A

high energy

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3
Q

clinical presentation of posterior hip dislocation

A

hip pain, limb length discrepancy on physical exam - shorted and internally rotated AE PI anterior - externally rotated posterior - internally rotated

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4
Q

blood supply to femoral head

A

median circumflex - dee profunda artery

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5
Q

after trauma, femoral head is at risk for

A

osteonecrosis

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6
Q

types of hip fractures

A

Intracapsular (Femoral neck)

Extracapsular (intertrochanteric)

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7
Q

classic presentation of hip fracture

A

limb shortened, externally rotated on exam

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8
Q
A

radiograph of right intertrochanteric hip fracture

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9
Q

intertrochanteric hip fracture characteristics

A

typical age > 70

often associated with osteopenia or osteoporosis

Often a low-energy mechanism (fall from standing height)

limb shortened and externally rotated

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10
Q
A

radiograph of left femoral nexk fracture

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11
Q

greater risk of nonunion osteonecrosis in this type of hip fracture

A

femoral neck fractures

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12
Q

treatment for hip fractures

A

almost always surgical

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13
Q

atypical femoral fractures

A

”Classic” bisphosphonate complication is jaw osteonecrosis

and proximal femoral stress and fractures

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14
Q

hip pain location can give clue to cause

articular pain

trochanteric pain

low back pain

A

Articular pain:
-Typically anterior/groin pain

Trochanteric pain:

-Typically lateral

Low back pain:

-Often bilateral

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15
Q

trochanteric bursitis

A

Tenderness; pain with activity

Patients will present with “hip pain” but all the pain will be lateral

x rays are normal

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16
Q

anterior hip pain (groin pain) is more likely to be

A

arthritis - rheumatoid or osteonecrosis

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17
Q

How to tell articular pain from bursitis pain?

A

Tenderness–more common with bursitis

limited range of motion—more common with joint issues

will have x ray deformities

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18
Q

common risk from cardiac catheterization

A

femoral nerve/quad deficit

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19
Q

pelvic sag away from affected side when walking

A

trendelenburg gait - superior gluteal nerve injury (compensation for weak hip abductors)

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20
Q

causes of trendelenburg gait

A

polio

superior gluteal nerve injury

emobolization to prevent hemmorhage after trauma

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21
Q

Femoral shaft fracture

A

Usually high energy injury (MVC)

Operative treatment (cast in children under 5 or so, internal fixation otherwise)

Clinically common

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22
Q

knee pain types

A

Articular

-OA/RA, Meniscus, Chondral, Ligamentous

Peri-articular

-Bursitic, Referred

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23
Q

articular pain vs bursitic pain

A

articular - decreased ROM

bursitis - normal ROM but focal tenderness over bursa

24
Q

common type of bursitis in knee

A

pes anserine bursitis

25
Q

how to evaluate a fracture or effusion

A

radiographs

26
Q

how to evaluate ligamentous/soft tissue/cartilage

A

MRI

27
Q

Medial collateral ligament resists

A

valgus

28
Q

Lateral collateral ligament resists

A

varus

29
Q

Neurovascular injuries _______ common than with knee dislocations/multiligament injuries

A

less

30
Q

collateral ligament injuries

A

Can be noncontact or direct blow

31
Q

70% ACL injuries are

A

noncontact (30% contact)

32
Q

Most common mechanism ACL injury:

A

cutting

(deceleration, direction change, planted foot)

33
Q

characteristics of ACL injury

A

Pain, “pop”
Inability to continue play

Effusion
Positive Lachman Positive anterior drawer

numb 30flexion go flexi

34
Q

females or males get more ACL injuries

A

females

35
Q

ACL deficiency

A

increased anterior translation of tibia

36
Q

a multi ligament knee injury

A

knee dislocation

37
Q

knee dislocation is a ____ energy mechanism

A

high

38
Q

tibial or fibular nerves more inured?

A

common fibular since wrapped around fibular head

39
Q
A

arteriogram demonstrating popliteral artery injury

40
Q

symptoms of meniscal knee injuries

A

locking, catching; knee effusion from joint irritation

can be acute or chronic (older)

41
Q

healing capacity of meniscus

A

poor - mostly cartilage

42
Q

unhappy triad

A

ACL, MCL, medial meniscus

43
Q

mechanism of patellar fractures

A

direct blow (from fall or from striking dashboard)

44
Q

patellar fracture

A

Inability to extend knee (extensor mechanism disruption; quadriceps cannot exert normal force to extend knee through patella)

45
Q

segmental injury

A

a break in more than one place - high energy required

46
Q

compartment syndrome

A

Pain
Pallor
Paresthesias
Pulselessness
Paralysis

Early: pain out of proportion

47
Q

anterior compartment pressure pain

A

plantarflexion is very painful, there is no more room for the compartment to stretch!

48
Q

more common ankle sprain

A

lateral injury

  • anterior talofibular ligament
49
Q

if medial ankle injury

A

deltoid ligament

50
Q

charcot foot

A

Complication of neuropathy (diabetics)
In acute phase, can be difficult to distinguish from infection

Multifactorial: repetitive multitrauma due to altered sensation/proprioception, changes in circulation

Progressive collapse of foot

Patient may have less pain than you would expect from radiographic findings

51
Q
A

Radiographic and clinical appearance of neuropathic foot./charcot foot. Note the bony fragmentation and arch collapse. There will be swelling and erythema in the

acute phase

52
Q

ankle fracture is on the

A

medial/lateral or both malleolus

53
Q

osseous tenderness and inability to bear weight with this fracture

A

ankle fracture

54
Q

talus fracture

A

“At risk” bone due to tenuous blood supply

Risk of AVN/osteonecrosis

Mechanism: forced

Dorsiflexion (high energy/floorboard)

55
Q

gout

A

great toe pain - without apparent inciting event

episodic - considerable local inflammation

56
Q

hallux rigidus

A

OA of first MTP joint

Progressive, activity-related

57
Q

Radiographic hallmarks of OA:

A

joint space narrowing, sclerosis, osteophytes, cysts

MSK final (11 decks)

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