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Clin Med II MHM - FINAL > Lower Extremity Disorders > Flashcards

Lower Extremity Disorders Flashcards

1
Q

What makes the hip a more stable joint than the shoulder?

A

Acetabulum is a deep socket with much more coverage of femoral head

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2
Q

How is the hip joint different than the shoulder joint?

A

Weight bearing

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3
Q

Where is the sciatic nerve most vulnerable to pelvic fractures?

A

Sciatic notch

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4
Q

Where is the sciatic nerve most vulnerable to posterior dislocations?

A

Distal to sciatic notch

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5
Q

How does hip pain present?

A

Groin and anterior thigh

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6
Q

Describe avascular necrosis of the hip

A
  • Aseptic necrosis of hip
  • Results from loss of blood supply to femoral head
  • Males
  • 20-40 yo
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7
Q

Treatment of AVN of the hip

A
  • Restrict weight bearing and activity to prevent collapse

- Long term prognosis is poor usually requires total hip arthroplasty as OA progresses

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8
Q

Who is affected by OA of the hip?

A
  • Under 45 yo, MC in men

- Over 55 yo, MC in women

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9
Q

What is the sign of end stage OA of the hip?

A

Pain at rest

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10
Q

Post-op care of total hip arthroplasty

A
  • Rapid mobilization, wt bearing as tolerated w/crutches or a walker
  • Anticoag
  • Alternating compression sleeve and stocking
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11
Q

What is the MC approach to total hip arthroplasty?

A

Posterior - less risk of infection, quicker recovery

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12
Q

Describe trochanteric bursitis

A
  • Bursa overlies greater trochanter and can get irritated

- Pain over GT aggravated by lying on the affected side

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13
Q

What is the most likely cause of snapping hip?

A

Tight IT band that catches over greater trochanter with movement

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14
Q

What makes the knee inherently unstable? What keeps it stable?

A
  • Intrinsic bony configuration

- Surrounding network of soft tissue

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15
Q

What is the bony anchor of the extensor mechanism in the knee?

A

Patella

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16
Q

What is the largest sesamoid bone in the body?

A

Patella

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17
Q

What are the extrinsic ligaments of the knee?

A

MCL (femur and tibia)

LCL (femur and fibula)

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18
Q

What are the intrinsic ligaments of the knee?

A

ACL (resists anterior translation on tibia)

PCL (resists posterior translation on tibia)

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19
Q

MOI for ACL injury?

A
  • Valgus force to ER knee w/foot planted

- Hyperextension in IR

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20
Q

MOI for PCL injury?

A
  • Knee flexed

- Anterior to posterior translation of joint

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21
Q

What is the extensor apparatus of the knee and what does it do?

A

Straightens knee, prevents buckling

  • Quad muscle and tendon
  • Patella and tendon
  • Tibial tubercle
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22
Q

When ordering x-rays of the knee, what views should be obtained?

A

AP, lateral, tunnel view

Sunrise if tracking patella

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23
Q

What x-ray view is best if you suspect OA in a patient over 40?

A
  • AP view in standing position

- Lets you see joint space narrowing better

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24
Q

Describe MCL fibers

A
  • Posterior fibers are taut in extension

- Anterior fibers are taut in flexion

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25
Q

MCL is primary stabilizer to what type of stress?

A

Valgus (lateral) stress

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26
Q

MOI of MCL injury?

A

Lateral or valgus stress (often w/foot planted)

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27
Q

MCL injury grading

A

Grade I: 1-5 mm laxity
Grade II: 5-10 mm laxity
Grade III: Over 10 mm laxity

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28
Q

MOI of LCL injury?

A

Varus stress to medial aspect of knee

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29
Q

What is the most important single ligamentous stabilizer in the knee?

A

ACL

30
Q

ACL can be reconstructed with what type of grafts?

A

Patellar, semitendinosis, gracilis

31
Q

What is the strongest ligament of the knee?

A

PCL

32
Q

MOI of knee meniscal injuries

A
  • Usually a twisting injury

- In older patients may be as simple as squatting down

33
Q

Patients don’t like to have their knees touching in which knee injuries?

A

Meniscal

34
Q

PE of meniscal injuries shows:

A
  • Positive McMurray’s sign

- Positive Apley grind test

35
Q

Subtotal menisectomy may predispose patients to what?

A

OA

36
Q

How does a meniscal cyst of the knee present?

A
  • Similar to meniscal tear but usually with a painful lump along joint line
  • Requires a more extensive surgery
37
Q

What is a discoid meniscus? How does it present and how is it treated?

A
  • Congenitally abnormal meniscus (too big and not C shaped)
  • Can cause a painful click
  • Arthroscopy to remove excess meniscus
38
Q

What is chondrocalcinosis? How is it treated?

A
  • Pseudogout
  • Calcium pyrophosphate dihydrate deposition in mensicus
  • Arthroscopic partial or complete menisectomy
39
Q

What is a plica? Definitive treatment?

A
  • Silky membrane of tissues within the fetus’s knee
  • Usually dissolves at birth
  • 30% of people keep it (medial side of knee)
  • Some thicken and present similar to torn meniscus
  • Arthroscopic debridement
40
Q

What is a Baker’s cyst?

A
  • Not truly a cyst but a collection of fluid in a normally occurring bursa behind knee
  • Pts w/pain usually have torn meniscus due to synovial fluid being pumped out of the knee into the bursa
41
Q

What is osteochondritis dissecans? Who is affected?

A
  • Subchondral bone develops AVN
  • Mostly males, young adults
  • X-ray shows a lucency over medial femoral condyle
42
Q

AVN of the knee

A
  • Presents much like osteochondritis dissecans
  • X ray shows radiolucent defect
  • If no response to conservative tx, patient may need TKR
43
Q

Chondromalacia of the knee

A
  • Extensor apparatus dysfunction

- Softening of articular cartilage

44
Q

All patellofemoral disorders influence what?

A

Q angle (indicator of how patella tracks)

45
Q

Q angle in males vs. females

A

Males usually small angle

Females usually large angle

46
Q

Patellofemoral disorders affect who?

A

Young females usually athletes or those who ride horses

47
Q

PE of patellofemoral disorders

A
  • Crepitus
  • Large Q angle
  • Apprehension sign w/lateral displacement of patella
  • Positive squeeze test
48
Q

Describe patella tendinitis

A
  • Jumpers knee (bball players)

- Pain over tendon worse w/stairs and jumping

49
Q

Where does bursitis in the knee occur MC?

A

Pre-patellar (traumatic injury)

Pes anserine

50
Q

Compartments of the knee

A
  1. Medial
  2. Lateral
  3. Patellofemoral
51
Q

Septic arthritis of knee

A
  • Direct invasion of joint space by bacteria
  • MC S aureus
  • Young pts MC N. gonorrheae
52
Q

Early prosthetic joint infection (within 3 months) is MC caused by which bacteria?

A

S aureus

53
Q

Delayed prosthetic joint infections (3-24 months) are MC caused by which bacteria?

A

CoNs and gram negative aerobes

54
Q

Septic arthritis presenting triad

A

Fever, pain, impaired ROM

55
Q

Hallux valgus deformity

A
  • Bunion

- Enlarged bursa is the bump

56
Q

What is Tailor’s bunion?

A

Bunion on 5th MT

57
Q

What is pes planus? Treatment?

A
  • Overpronation of foot (flat feet)

- Orthotics to correct flat foot deformity

58
Q

Treatment of plantar fasciitis?

A
  • Orthotics (heel pads or cups do NOT work)

- Avoid walking barefoot

59
Q

What is Morton’s neuroma?

A

Fibrosis of interdigital nerve between 3rd and 4th toes

60
Q

Hammer toes

A
  • Deformity of 2nd, 3rd, 4th toes
  • Toe is bent at middle joint so it resembles hammer
  • If left untreated, can become fixed and require surgery
61
Q

What causes hammer toes?

A

Shoes that don’t fit properly and/or muscle imbalance

62
Q

Ankle sprain MOI

A

Inversion type injury

63
Q

High ankle sprain MOI

A

Twisting or rotational injury

64
Q

How does posterior tibial tendon injury occur?

A

Excessive pronation

65
Q

Cortisone injections of achilles tendinitis

A

NEVER (increases incidence of rupture)

66
Q

MOI achilles rupture

A
  • Explosive plantar flexion

- Forced dorsiflexion

67
Q

PE of achilles rupture

A

Positive Thompson test

68
Q

Positive Thompson test?

A

Achilles tendon rupture

69
Q

Plantaris tendon rupture

A
  • Long thin muscle that traverses through calf

- Same presentation as Achilles rupture

70
Q

What is retrocalcaneal bursitis?

A
  • Pump bump (Haglund’s deformity)

- Positive 2 finger squeeze test

71
Q

Who is affected by achilles rupture?

A
  • 40 yo or older males
  • Weekend warrior types
  • Basketball, racquet sports
72
Q

Presentation of Achilles rupture?

A

Feels like someone hit it with a baseball bat

Clin Med II MHM - FINAL (16 decks)

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