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ICM Unit 4 MSK > Lower extremity Disorders > Flashcards

Lower extremity Disorders Flashcards

1
Q

strain

A

stretching or partial tear in muscle or muscle-tendon unit

UE, LE, back

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2
Q

Sprain

A

Stretching or tearing of ligament (bone-bone) or joint capsule

ankle, knee, wrist

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3
Q

Contusion

A

injury to soft tissue from direct trauma and result of body part against sm hard

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4
Q

SUbluxation

A

partial dislocation

(partial ligaments may be torn)

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5
Q

Dislocation

A

acute or chronic ligamentous laxity/tearing fx

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6
Q

Avulsion fracture

A

small portion of bone that was broken

sometimes may disrupt portion of ligament

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7
Q

Pelvis (female)

A

larger and more broad

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8
Q

Pelvis (male)

A

taller, higher iliac crest, more narrow ant compact

distance b/w ischium smaller

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9
Q

Hamstring strains

A

1-3 muscles involved (semitendinosus, semimembranosus, biceps femoris)

excessive stretching or forceful contraction - can cause avulsion fx

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10
Q

Hamstring strains found in

A

sprinters, dancers, runner, “ball sports”, adolescents

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11
Q

Hamstring strains causes

A

inadequ. muscle strength or endurance
lack of flexibility
Insuff. warm up

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12
Q

Hamstring strains s/s

A

sudden (pain)
swelling
bruising in back of thigh

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13
Q

Hamstring strains PE

A

pain in HS or actions that cause contraction of HS

x-ray only if exam warrants (sore area or attachment to bony sturctures)

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14
Q

Hamstring strains Tx

A

NSAIDs
crutches? severe
Compression
early ROM and eventual strength/flexibility exercises

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15
Q

Adductor Strains “pulled groin”

Anatomy

A

Hip Joint adductor complex =
- adductor longus (MC injured)
- adductor magnus
- adductor brevis
- gracilis
- obturator brevis
- pectineus

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16
Q

Adductor strains “pulled groin”

Causes

A

forceful hip extension
external rotation of abducted leg

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17
Q

Adductor strains “pulled groin”

found in

A

soccer
hockey players

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18
Q

Adductor strains “pulled groin”

S/S

A

immediate pain in groin area

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19
Q

Adductor strains “pulled groin” PE

A

tender at injury site and subQ border of pubic ramus

pain and/or decreased strength w/ resisted leg adduction

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20
Q

Adductor strains “pulled groin” - Dx

A

xray of hip

MRI for professionals

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21
Q

Adductor strains “pulled groin” - TX

A

Rest, Ice, protected weight bearing/ NSAIDs

crutches - severe

early ROM - strength/flex exercises

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22
Q

Avascular necrosis

A

w/o blood supply - bone dies and collapses

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23
Q

Avascular necrosis - etiology

A

long term steriods

alcohol use

trauma, lupus, Gout, Sickle cell dz

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24
Q

Avascular necrosis - S/S

A

PAIN- groin, thigh, buttock (increased with motion/weightbearing)

? eventual LIMITED ROM (internal rotation and abduction)

+/- LIMP

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25
Q

Avascular necrosis - DX

X-ray (positions and buzzword)

A

Hip A/P, frog-leg lateral

CRESCENT SIGN (curved subchondral radiolucent)

MRI?

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26
Q

Avascular necrosis - Tx

A

supportive care (rest, PT, analgesics, assistive walking devices)

surgery (joint preserve or total replacement)

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27
Q

Greater Trochanteric Pain Syndrome
(Trochanteric Bursitis)

A

gluteus medius or minimis tendinopathy

overuse

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28
Q

Greater Trochanteric Pain Syndrome
(Trochanteric Bursitis)

risk factors

A

females
obesity
knee pain
low back pain

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29
Q

Greater Trochanteric Pain Syndrome
(Trochanteric Bursitis)

S/S

A

lateral hip pain near greater trochanter

exacerated by = ambulation, prolonged standing, rising from chair, climbing stairs, direct pressure)

sleep disturbance

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30
Q

Greater Trochanteric Pain Syndrome
(Trochanteric Bursitis)

PE

A

TTP of greater trochanter

FABER TEST (Flexion, ABduction, External Rotation)

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31
Q

Greater Trochanteric Pain Syndrome
(Trochanteric Bursitis)

Dx

A

clinical

x-ray for other path
MRI if refractory s/s

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32
Q

Greater Trochanteric Pain Syndrome
(Trochanteric Bursitis)

Treatment

A

exercise/activity modification

pain control - steriod injection or NSAIDs

PT

surgery if refractory

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33
Q

Eval of Knee

A

location
injury/trauma?
what makes better/worse?
F/C/warmth/redness?
hx of tick bite = lyme?
rash w/ plaques = psoriasis arthritis?

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34
Q

Eval of Knee - common sayings may suggest

meniscus

A

“locking”
pain at joint line
recurrent knee effusion after activity

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35
Q

Eval of Knee - common sayings may suggest

ligamentous injury

A

“popping”

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36
Q

varus means

A

pushing away from center of body

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37
Q

valgus means

A

pushing in toward center of body

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38
Q

Imaging for the knee

X-rays

A

A/P, lateral, Sunrise (115 degrees flex) (sometimes)

standing if possible

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39
Q

Imaging for the knee

MRI

A

if suspected meniscus, ligamentus injury, occult fx

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40
Q

Ottawa Knee rules

must have 1 or more, 99% sensitive, 49% specific

A

age 55 +

isolated tenderness of patella

tenderness at head of fibula

inability to flex knee 90 degress

inability to bear weight immed after injury or while being eval for more than 4 steps

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41
Q

Pittsburgh Knee rules

99% sensitive, significantly more specific in adults

A

blunt trauma or fall + one of following:

age <12 or >50
inability to walk 4 weight bearing steps immed after or in ED, regardless of age

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42
Q

Other test for the knee

A

aspiration of effusion -> pain relief and valuable dx

Always consider if you think a joint is septic!!

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43
Q

aspiration findings of knee and what is may mean

frank blood =

A

rupture of ACL

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44
Q

aspiration findings of knee and what is may mean

turbid =

A

infxn

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45
Q

aspiration findings of knee and what is may mean

straw colored

A

meniscus tear or arthritis

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46
Q

genu Varus

A

bow- legged

pushing out on femur

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47
Q

Genu Valgus

A

“knock-knee”

pushing in on femur

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48
Q

Anterior Cruciate Ligament Injury

CLASSIC sound heard with this

A

AUDIBLE “POP” WHEN KNEE BUCKLES

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49
Q

Anterior Cruciate Ligament Injury

commonly occurs in sports activities w/ ..

A

jumping and pivoting

contact- plated foot, lateral force (valgus force)
noncontact - pivoting, jumping, deceleration

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50
Q

Anterior Cruciate Ligament Injury

patients complain of..

A

instability or knee “giving way”

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51
Q

Anterior Cruciate Ligament Injury

s/s

A

instability - esp w/ lateral mvmt or down stairs

pain, swelling
75% hemarthrosis
25% associated meniscal tear

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52
Q

ACL injuries PE

A

ANTERIOR DRAWER
LACHMAN (greater sensitivity and specifity)
PIVOT SHIFT TEST

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53
Q

Anterior Cruciate Ligament Injury - DX

A

X-rays rule out fx
- SEGOND FX = small avulsion injury seen over lateral compartment

MRI = diagnostic

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54
Q

Anterior Cruciate Ligament Injury

Tx

A

refer - ortho

RICE
Brace - knee immobilizer
Surgery! - esp in young, atheltes
PT

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55
Q

Posterior Cruciate Ligament injury

A

uncommon = b/c strongest ligament in the knee

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56
Q

Posterior Cruciate Ligament injury

MC mechanism

A

direct blow to ant tibia w/ knee flexion -> drives tibia posteriorly

often w/ MVA = knee hits dash

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57
Q

Posterior Cruciate Ligament injury

associated injuries..

A

70-90% assoc MCL or ACL injuries

1/3 neurovascular injuries
- torn popliteal artery = EMERGENCY SURGERY

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58
Q

Posterior Cruciate Ligament injury

s/s

A

difficulty walking
laxity of joint
pain, swelling

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59
Q

Posterior Cruciate Ligament injury

PE

A

posterior drawer
sag sign

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60
Q

Posterior Cruciate Ligament injury

Dx

A

x-rays r/o fx
MRI = diagnostic

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61
Q

Posterior Cruciate Ligament injury

Tx

A

RICE
Bracing - locked knee in full extension
PT
Ortho refer/surg

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62
Q

Collateral ligaments - Medial

HX

A

valgus stress on partially flexed knee

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63
Q

Collateral ligaments - Medial and Lateral

Exam

A

pain along ligament ; min. swelling

limited ROM from pain

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64
Q

Collateral ligaments - Medial

special tests

A

valgus stress

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65
Q

Collateral ligaments - Medial and Lateral

imaging

A

X-rays = A/P and lateral r/o fx

MRI = only is sus for cruciate ligament injury

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66
Q

Collateral ligaments - Medial and Lateral

Treatment

A

protected weight-bearing
Brace
PT
rarely surg - only if assoc injuries

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67
Q

Collateral ligaments - Lateral

Hx

A

varus stress

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68
Q

Meniscal injuries causes

A

traumatic vs degenerative (rep. squatting or osteoarthritis)

young - acute
old - chronic

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69
Q

Collateral ligaments - Lateral

special test

A

varus stress

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70
Q

Meniscal injuries - which is higher incidence of injury

A

medial > lateral

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71
Q

Meniscal injuries

S/S

A

audible clicking
locking sensation

pain, diff. walking

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72
Q

Meniscal injuries - pts may or may not..

A

report specific injury
(rotational injury to flexed knee w/ audible “pop”

73
Q

Meniscal injuries

PE

A

MCMURRAY TEST
APLEY GRID TEST

74
Q

Meniscal injuries

presentation

A

antalgic gut
joint line tenderness
swelling?, pain or diff. squatting

75
Q

Meniscal injuries

DX

A

x-rays r/o fx

MRI = GOLD STANDARD

76
Q

Meniscal injuries

TX

A

rest
pain control
PT
intra-articular corticosteriods
surgery?

77
Q

Apley Distraction test

A

traction applied w/ rotation, pain occurs if damage to ligaments

no pain if it is meniscal

78
Q

Apley compression/grinding test

A

hard downward pressure w/ rotation

pain = meniscal injury

79
Q

Chondromalacia patella

A

aka PATELLOFEMORAL SYNDROME

80
Q

Chondromalacia patella

what is it

A

ant. knee pain from softening and degeneration of articular cartilage of patella

81
Q

Chondromalacia patella

“runner’s knee”

A

worse w/ deep flexion, stair climbing, hill ascent/descent

82
Q

Chondromalacia patella

causes and MC in

A

overuse
weakness of vastus medialis (quadricep)

young females

83
Q

Chondromalacia patella

s/s

A

anterior knee pain
swelling?

84
Q

Chondromalacia patella

PE

A

INCREASED Q ANGLE

patellar crepitus (audible, crunchy knee)

lateral deviation of patella
patellar hypermotility
apprehension sign

Patellar femoral grinding test

85
Q

Chondromalacia patella

DX

A

x-ray : AP, Lateral, SUNRISE VIEW (r/o narrowing or osteophytes)

86
Q

Chondromalacia patella

Rx

A

RICE
NSAIDs
bracing
PT
patellar taping/bracing
strengthening quad

87
Q

Patellar grind test

A

pt supine; involved knee extended

webbed space of hand superior to patella and apply pressure

pt contracts gently quads

+ = pain in patellofemoral joint

88
Q

Prepatellar bursitis

A

HOUSEMAID’S KNEE
NUN’S KNEE
CARPET’LAYER’S KNEE

89
Q

Prepatellar bursitis

what is it

A

inflamm., swelling of prepatellar bursa (rep. kneeling on hard surfaces)
OR
acute trauma (can develop into infxn bursitis = cover for S. aureus and strep)

90
Q

Prepatellar bursitis

s/s

A

tenderness to palpation
swelling

91
Q

Prepatellar bursitis

PE

A

restricted ROM

palpable swollen bursa (margins palpable)

92
Q

Prepatellar bursitis

DX

A

clinical

if trauma causes - xray
consider aspiration for infxn

93
Q

Prepatellar bursitis

TX

A

RICE
NSAIDs
avoid causative mechanism

recurrent = surgery to remove bursa

94
Q

Pes Anserinus Bursitis

A

medial side of knee at proximal tibia - medial knee pain

95
Q

Pes Anserinus Bursitis

onset

A

insiduous - usually not w/ injury

96
Q

Pes Anserinus Bursitis

common in who?

A

swimmers/ kickers

97
Q

Pes Anserinus Bursitis

PE

A

point tenderness

98
Q

Pes Anserinus Bursitis
DX

A

no x-ray findings

99
Q

Pes Anserinus Bursitis

tx

A

RICE
NSAIDs
steriod injections? - hypopigmentation and atrophy in superficial location

100
Q

Baker’s Cyst
(Popliteal Cyst)

A

accumulation of joint fluid in posterior aspect of knee

pushes on weakest point of posterior capsule

discrete bulging in popliteal fossa

usually from arthiritis or meniscus tear

101
Q

Baker’s Cyst
(Popliteal Cyst)

s/s

A

cyst rupture = may have severe swelling and tightness in calf (order ultrasound if so to r/o DVT!)

pain, swelling

102
Q

Baker’s Cyst
(Popliteal Cyst)

Dx

A

MRI r/o mass, esp kids

103
Q

Baker’s Cyst
(Popliteal Cyst)

Tx

A

RICE
NSAIDs
brace (compression)
Aspiration - large or painful
surgery (rare)

104
Q

Patellar tendinitis

A

inflammation, swelling of patellar tendon

105
Q

Patellar tendinitis

Mechanism

A

basketball
volleyball players

(Jumper’s knee)

106
Q

Patellar tendinitis
s/s

A

pain at base of patella w/ exercise

107
Q

Patellar tendinitis

PE

A

tenderness along tendon
increased pain w/ squatting or kneeling

108
Q

Patellar tendinitis

DX

A

MRI if concerned about needing surg/debridement

109
Q

Patellar tendinitis

Tx

A

RICE
NSAIDs
brace - compression
avoid kneeling - knee pads
steroid injection - could increase tendon rupture risk

110
Q

Ankle Sprains

peak age
and in what sports

A

15-19

basketball, football, soccer

111
Q

Ankle Sprains

3 diff types

A

lateral (MC)
medial
syndesmotic (high ankle)

112
Q

Ankle Sprains

grading sytem - Grade 1

A

intra-ligamentous tears w/ pain

113
Q

Ankle Sprains

grading sytem - Grade 2

A

incomplete tears w/ pain and mild-mod instability

114
Q

Ankle Sprains

grading sytem - Grade 3

A

severe and disabling, complete ligament rupture

cannot tolerate weight bearing, gross instability, pain, assoc. w/ “pop”

115
Q

Ottawa Ankle Rules

x- rays indicated for ..

A

Bony tenderness - post edge or tip of lateral or medial malleolus

OR

inability to bear weight at presentation (4 steps)

OR

bony tenderness - base of 5th metatarsal

116
Q

Ottawa Ankle Rules

where to palpate?
what is considered weight bearing?

A

if pt transfers weight twice to each foot - considered bearing weight if even limping

palpate distal 6 cm posterior edge of fibula

117
Q

Ankle Sprain - Lateral

A

Anterior Talofibular ligament (ATFL)
- WEAKEST and MC
- restricts internal rot of talus

Calcaneofibular ligament (CFL)
- resists adduction of talus

Posterior talofibular ligament (PTFL)
- STRONGEST
- resists posterior and rotatory instability

118
Q

Ankle Sprain - Lateral

s/s

A

pain
swelling (lateral ankle)
bruising
diff bearing weight
limping

119
Q

Ankle Sprain - Lateral

PE

A

ALWAYS PALPATE PROXIMAL FIBULA

ANTERIOR DRAWER

SUBTALAR TILT

120
Q

Ankle Sprain - Lateral

DX

A

x-rays based on Ottawa ankle rules, r/o fx
(AP, lateral, mortise views)

MRI - if need degree of tear

121
Q

Ankle Sprain - Lateral

Tx

A

RICE
brace - ankle stabilizer
crutches

122
Q

Ankle sprain - medial

A

injury to deltoid ligament
superficial vs deep

almost never isolated - commonly w/ lateral malleolus fx

123
Q

Ankle sprain - medial

mechanism

A

foot turned out, externally rotated and everted

124
Q

Ankle sprain - medial

s/s

A

severe pain not improved w/ conservative measures

worse w/ weight bearing

125
Q

Ankle sprain - medial

PE

A

any medial tenderness = palpate proximal fibula r/o Maisonneuve fx

External rotation stress test

126
Q

Ankle sprain - medial

Dx

A

X-rays = Ottawa ankle rules
MRI?

127
Q

Ankle sprain - medial

Tx

A

RICE
cast/walking boot
Rehab exercises
Referral?

128
Q

Syndesmotic injuries - HIgh ankle sprains

A

highly complex group of ligaments that stabilze the mortise and keep the fibula articulating w/ distal tibia

129
Q

Syndesmotic injuries - HIgh ankle sprains

Syndesmosis

A

Anterioinferior and posterioinferior tibiofibular ligament

interosseous ligament

inferior transverse ligament

130
Q

Syndesmotic injuries - HIgh ankle sprains

S/S, dx, tx

A

same as other ankle sprains

131
Q

Fibula Fx - Nondisplaced

A

MC fx treated by ortho surgeons

MC ankle fracture

132
Q

Fibula Fx - Nondisplaced

Mechanism

A

rotational - usually

above, below, or at the level of the ankle OR avulsion

133
Q

Fibula Fx - Nondisplaced

S/S

A

pain
swelling
limited ROM

134
Q

Fibula Fx - Nondisplaced

DX

A

X-rays

135
Q

Fibula Fx - Nondisplaced

Tx

A

RICE
brace, boot, crutches

136
Q

Achilles tendinopathy

A

swelling/pain over achilles tendon

137
Q

Achilles tendinopathy

Causes: younger

A

overuse
not stretching before activity
sudden trauma

138
Q

Achilles tendinopathy

Causes: Older

A

scondary to arthritis - bone spur may irritate tendon

139
Q

Achilles tendinopathy

S/S

A

“feels like I got hit by a rock in the back of my foot/heel”

pain in heel along tendon when walking/running; w/ standing on tiptoes

more painful/ stiff in morning

140
Q

Achilles tendinopathy

PE

A

THOMPSON TEST -r/o ACHILLES TEST

point tenderness; limited dorsiflexion; palpable defect (bone spur)

141
Q

Achilles tendinopathy

DX

A

x-rays = calcifications, spurs, avulsion

MRI

142
Q

Achilles tendinopathy

Tx

A

long, healing process

RICE

boot/brace

PT

143
Q

Achilles tendon rupture

MC what…
peak incidence.. (age and in who)

A

MC tendinous route in the LE

Peak incidence: 30-50 y/o
males > females
middle-aged athletes “weekend warriors”

144
Q

Achilles tendon rupture

S/S

A

swelling, pain, bruising

sudden pain, w/ a pop in back of heel
(may describe feeling like they have been hit)

145
Q

Achilles tendon rupture

PE

A

THOMPSON TEST - POS

point tenderness
palpable defect
inability to push off or toe walk (inability to plantarflex)

146
Q

Achilles tendon rupture

DX

A

MRI

147
Q

Achilles tendon rupture

Tx

A

ortho referral - surgical repair or cast immobilization

148
Q

Ankle Fx

A

lateral/medial malleolus, posterior tip of fibula or any combo

2 or more fx sites = unstable

149
Q

Ankle Fx

Dx

A

x-rays

150
Q

Ankle Fx

TX

A

RICE
Pain control
Depends on displacement or stability of joint
(cast, surgery)

151
Q

Retrocalcaneal Bursitis

A

inflamm of tissue w/i space in front of achilles

bursa- inflamm, hypertrophied, adherent to achilles -> degen. changes w/i achilles

152
Q

Retrocalcaneal Bursitis

S/S

A

dull, aching pain in retrocal area

aggravated during startup activity

153
Q

Retrocalcaneal Bursitis

PE

A

Haglund deformity

tenderness w/ applying pressure medial/laterally, squeezing anterior to achilles insertion

pain w/ dorsiflexion

154
Q

Retrocalcaneal Bursitis

Dx

A

x-rays

MRI

155
Q

Retrocalcaneal Bursitis

Tx

A

rest
orthoses
heel lifts
PT
surgery

156
Q

Interdigital neuritis - Morton Neuroma

A

inflamm changes of interdigital nerve (intermetatarsal lig compresses nerve)

157
Q

Interdigital neuritis - Morton Neuroma

MC where in foot?
MC in who?

A

2nd or 3rd webspace

middle-aged women - narrow or high heel shoes

158
Q

Interdigital neuritis - Morton Neuroma

S/S

A

burning pain b/w toes, esp w/ shoes on

159
Q

Interdigital neuritis - Morton Neuroma

PE

A

reproducible tenderness - 2nd/3rd interspace

160
Q

Interdigital neuritis - Morton Neuroma

Dx

A

clinical

161
Q

Interdigital neuritis - Morton Neuroma

Tx

A

NSAIDs
Proper footwear, orthotics
RICE
Injections
Surgery?

162
Q

Plantar Fasciitis

A

fibrous tissue from plantar calcaneal tuberosity to flexor tendon in forefoot

163
Q

Plantar Fasciitis

MC in what population?

A

older pts (40-60)

younger - runners, dancers

164
Q

Plantar Fasciitis

Risk factors

A

obesity,
pes planus
Pes cavus
Prolonged standing
Walking/running on hard surfaces
Improper/ill-fitting shoes

165
Q

Plantar Fasciitis

S/S

A

PAIN FIRST THING IN THE MORNING OR FOLLOWING PERIODS OF INACTIVITY

severe pain- bottom of foot/heel ; improves w/ weight bearing activity thru day; increased when walking

166
Q

Plantar Fasciitis

Dx

A

Clinical
X-rays (heel spur? - in flexor digitorum brevis NOT plantar fascia- remova DOES NOT help)

MRI

167
Q

Plantar Fasciitis

Tx

A

PATIENCE 80% RESOLVE W/I 12 MOS

RICE, massage, stretching/PT; night time splints; Heel cups/pads; Surgery - w/ no improvment 6-12 mos)

168
Q

Pes Planus means

A

flat foot

169
Q

Pes cavus means

A

high arch

170
Q

Posterior tibial tendon injuries

A

from posterior, upper 2/3 fibula and lateral post. tibia to plantar navicular, cuneiform, cuboid, metatarsal bases

171
Q

Posterior tibial tendon injuries

Function

A

adducts forefoot, inverts the heel

chronic - tendinitis
acute - rupture

172
Q

Posterior tibial tendon injuries

PE

A

“TOO MANY TOES” sign

swelling, bruising, tenderness
rupture = palpable defect?
inability to toe walk or heel raise
weakness w/ inversion against resistance

173
Q

Posterior tibial tendon injuries

Dx

A

X-rays
MRI

174
Q

Posterior tibial tendon injuries

Treatment

A

RICE
Analgesics
NSAIDs
PT
Brace/boot

175
Q

Stress Fx - Foot

A

stress rxn usually overuse (athletes)

rep. loading on bone -> microfx unable to heal from imbalance b/w bone resorption and formation

Pain (progressive onset) - worse w/ activity and relieved w/ rest

POINT TENDERNESS

176
Q

Stress Fx - Foot

Dx

A

X-rays
CT
MRI

177
Q

Stress Fx - Foot

TX

A

prevention
Activity restriction 1-6wks
Taping, bracing, boots, orthotics

178
Q

5th Metatarsal fx

A

vertical or medial/lateral force when foot inverted w/ heel raised

179
Q

Jones Fx

A

Proximal 5th metatarsal

Minimal blood supply and prone to poor healing after fx

ICM Unit 4 MSK (5 decks)

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