Lower Extremity MSK Flashcards
1
Q
What is the strongest ligament in the body and its function?
A
- Iliofemoral ligament
- Limits abduction, extension, and external rotation
2
Q
What carries blood supply from the acetabulum to the femoral head?
A
Ligamentum capitis femoris
3
Q
What muscles originate on the ASIS?
A
Sartorius and TFL
4
Q
What muscle originates on the AIIS?
A
Rectus femoris
5
Q
What are two early findings in hip osteoarthritis?
A
- Loss of internal rotation
- superolateral compartment narrowing
6
Q
How to you assess for a true leg length discrepancy?
A
Measure both sides from ASIS to medial malleolus and compare
- A: Normal
- B: True leg length discrepancy
- C: Tibial length discrepancy
- D: Femoral length discrepancy
7
Q
Hip precautions after a posterior approach THA?
A
- No hip flexion past 90 degrees
- No hip adduction past midline
- No extreme hip internal rotation
8
Q
Nerve injured with anterior hip dislocation
A
femoral
9
Q
Nerve injured with posterior hip dislocation
A
sciatic
10
Q
Describe a person who is at high risk for femoral neck fracture due to fall
A
old white osteoporotic elderly female with poor nutrition who is smoking and taking steroids
11
Q
Garden Clasification System for femoral neck fracture
A
Stages
- incomplete fracture line
- complete fracture line (non-displaced)
- partially displaced
- fully displaced with disruption of joint capsule
12
Q
Treatment for femoral neck stress fractures
A
- Compression side (inferior): Rehab with NWB -> WBAT
- Tension side (superior): Requires ORIF
13
Q
Describe the typical patient who suffers slipped capital femoral epiphysis
A
obese adolescent male
14
Q
Grading for Slipped Capital Femoral Epiphysis (SCFE)
A
15
Q
To whom should you refer a patient with SCFE and why?
A
Endocrinology to evaluate for growth hormone deficiency or thyroid disease
16
Q
Pincer lesion
A
acetabulum extends out too far and “pincers” the femoral head causing FAI
17
Q
CAM lesion
A
“knuckle” of bone coming out of the femoral neck seen in FAI
18
Q
Internal snapping hip
A
groin pain caused by iliopsoas tending snapping over the iliopectineal eminence, commonly seen in dancers
19
Q
External snapping hip
A
pain in lateral thigh due to a tight IT band or gluteus maximus snapping over the greater trochanter
20
Q
Commonly mistaken for greater trochanteric bursitis
A
Gluteus medius tendonitis/tendinopathy
21
Q
What is greater trochanteric bursitis?
A
inflammation of the subgluteus maximus bursa located just deep to the gluteus maximus muscle and just superficial to the gluteus medius tendon as it inserts onto the greater trochanter
22
Q
activity that commonly causes a hamstring strain
A
water-skiing
23
Q
Provacative test for piriformis syndrome
A
FAdIR
24
Q
most common causes of AVN of the femoral head in adults?
A
alcohol and corticosteroid use
25
Imaging for suspected AVN of the femoral head?
MRI of both hips
26
After total hip replacement, when is the risk for pulmonary embolism the highest?
during the 2nd and 3rd week post surgery
27
Hip precautions after an anterior approach THA?
Avoid hip extension and external rotation
28
Most common type of hip fracture?
Intertrochanteric Hip Fracture
29
most common cause and location for myositis ossificans?
hematoma, quadriceps
30
How long does it take for myositis ossificans to show up on XR?
2-3 weeks
31
What type of collage is in hyaline (articular) cartilage?
Type II
32
When is the PCL tense?
with knee flexion (think of dashboard injury)
33
When is the ACL tense?
with knee extension
34
What direction does the ACL run?
Antero-infero-medially (think putting hands into pockets)
35
What direction does the PCL run?
postero-infero-laterally (think bring hand across body and place on opposite pocket)
36
What does the ACL do as the knee flexes?
Pulls femur anteriorly
37
What is O'Donoghue's triad?
The "terrible triad" of ACL, MCL and medial meniscus tear with lateral blow to the knee
38
Describe the course of the lateral collateral ligament
It runs from the lateral femoral condyle to the fibular head (also called fibular collateral ligament)
39
Orthotic treatment for medial compartment OA of the knee?
lateral heel wedge
40
osteochondritis dissecans
repetitive stress causing AVN to an area of bone with resulting separation (*dissection*) of piece of bone
41
Segond fracture
Avulsion fracture of the lateral tibial plateau commonly associated with ACL tear (close to 100%)
42
Type of brace given for ACL injury?
Lenox-Hill Derotation orthosis
43
Most common knee ligament torn?
MCL
44
Knee ligament most commonly injured in sports?
ACL
45
How does blood supply of the medial meniscus affect surgical decison making and its ability to heal?
The inner 2/3rds is poorly vascularized and is usually surgically resected. The outer 1/3 is well vascularized and can be repaired.
46
Causes anterior knee pain with locking and buckling
Plica: redundant fold of synovial tissue that can become inflamed
47
Where is a Baker Cyst usually located?
between the semimembranosus and medial head of the gastrocnemius
48
Pain in the anterior knee at knee tendon with excessive kneeling
Superficial and Deep infrapatellar bursitis
49
Anterior knee pain worse with climbing stairs or running downhill. Associated with knee stiffness after prolong sitting.
Patellofemoral Pain Syndrome
50
Treatment for Patellofemoral Pain Syndrome
* Stretch tight IT band and vastus lateralis
* Strengthen VMO
* Patellar knee sleeve with patellar cutout
* Kinesiotaping
51
What group is Patellofemoral Pain Syndrome commonly seen in?
Runners
52
Lateral knee pain felt with downhill skiing or downhill running
Popliteus Tendonitis
53
Anterior/Lateral knee pain worse after running
IT Band Syndrome
54
Cause of IT Band Syndrome
* Gluteus medius weakness
* Tight/Weak IT Band and TFL
55
Physical exam test that is positive in IT Band Syndrome?
Ober
56
What provides attachement for the posterior horn of the lateral meniscus and stabilizes the posterior lateral knee?
Arcuate Popliteal Ligament Complex (APLC)
57
With McMurray's test, which way do you rotate the tibia to stress the medial compartment?
externally
58
What physical exam test is most specific for ACL injury?
Pivot Shift
* The tibia is internally rotated while a valgus stress and axial load is applied.
* Begin in full knee extension and gently flex the knee.
* Anterolateral subluxation of the lateral tibial plateau indicates a positive test.
* 5 mm of motion is considered a Grade I tear
59
With knee ligament testing, how much motion indicates a complete tear?
\> 10 mm
* Grade 1: 3 to 5 mm of translation
* Grade 2: 5 to 10 mm translation, likely reflecting partial tear
* Grade 3: \>10 mm translation, likely reflecting complete tear
60
What is the most sensitive clinical marker for acute ACL injury?
severe effusion in the first 2-12 hours following injury
61
List two factors that increase the Q angle
genu valgum and internal torsion of the femur
62
Internally rotated bicycle cleats stress what part of the knee?
anterior
63
Most common site of patellar tendonitis?
inferior pole
64
Describe the 4 compartments of the leg and their contents
* Anterior: TA, EHL, EDL, fibularis tertius, anterior tibial artery
* Lateral: fibularis longus, fibularis brevis, superficial fibular nerve
* Superficial Posterior: gastrocnemius, soleus, plantaris
* Deep Posterior: TP, FDL, FHL, posterior tibial artery, tibial nerve (Tom, Dick and Harry + tibial vessels)
65
How does the plantaris differ from the gastocnemius and soleus muscles and why is this important?
plantaris does not become part of the achilles tendon and can cause a falsely negative Thompson test.
66
How is the tarasl tunnel related to compartments of the leg?
All deep posterior compartment contents pass through the tarsal tunnel
67
Which malleolus of the ankle is lower?
lateral (extension of the fibula)
68
69
Most commonly injured ankle ligament?
Anterior talofibular (ATFL)
70
Second most commonly injured ankle ligament?
calcaneofibular ligament (CFL)
71
How much displacement defines a positive ankle anterior drawer test seen in ATFL tear?
\> 5mm
72
Which ligament is close to the fibularis longus and brevis tendons?
calcaneofibular ligament (CFL)
73
Maisonneuve Fracture
proximal fibular fracture due to a severe high ankle sprain with rupture of tibiofibular syndesmosis
74
common running error leading to medial tibial stress syndrome (shin splints)?
overpronation
75
mechanism of injury leading to talus fracture
forced dorsiflexion with an axial load
76
type of talus fracture with high risk of AVN?
talar body (dome)
77
most common foot fracture
calcaneus fracture
78
Sever's Disease
posterior heel pain in children 2/2 to calcaneal apophysitis
79
mechanism causing syndesmosis injury
excessive external rotation (common football injury)
80
Order of ligaments torn in a lateral ankle sprain
1. ATFL
2. CFL
3. PTFL
81
Grading of a lateral ankle sprain
1. Partially ATFL tear
2. Fully torn ATFL, partially torn CFL (Positive anterior drawer)
3. Fully torn ATFL and CFL (Positive anterior drawer and Talar Tilt)
82
What tendons can be damanged with lateral ankle sprain?
fibularis longus and brevis tendons
83
Work-up for lateral ankle sprain?
stress view XRs
84
What structures pass through the tarsal tunnel?
TP, FDL, FHL, tibial artery/nerve/vein
85
cause of tarsal tunnel syndrome?
compression of tarsal tunnel structures due to tight flexor retinaculum
86
Haglund deformity
bony deformity of posterior heel due to to increased achilles tendon tension
87
bursas in the posterior ankle?
retrocalcaneal and retroachilles
88
Which lower leg compartment most commonly develops acute compartment syndrome?
anterior
89
Presents with extreme pain with muscle stretch that is out of proportion to exam
compartment syndrome
90
lower leg pain, paresthesias, and weakness worse with prolonged exercise
chronic exertional compartment syndrome
91
What increases the risk of tibilais posterior tendon injury?
excessive pronation
92
presents with positive "too many toes" sign?
tibialis posterior tendon injury
93
population at risk for flexor hallucis longus (FHL) injury?
dancers
94
Cause of achilles tendon injury?
repetitive eccentric overload
95
Where is the achilles tendon prone to tears?
distal 2-6cm due to poor vascularity
96
risk factor for achilles tendon injury
older age, overtraining, overpronation, tight achilles tendon
97
Three main characteristics of acute compartment syndrome?
pain, paresthesias, and paralysis
98
In acute compartment syndrome, are pulses usually normal or abnormal?
normal
99
How is pain related to activity with shin splints?
pain may improve with exercise but worsens after completion of activity
100
most common stress fracture location in running sports?
tibia
101
X-ray findings seen with stress fracture?
periosteal thickening followed by cortical lucency
102
First choice test to dx stress fractures?
MRI (most sensitive and specific)
103
Supplementation rx'd to treat stress fractures?
* calcium 1,500mg daily
* vitamin D 400-800 IU daily
104
Describe the different bones in the foot
105
Lisfranc ligament
connects second metatarsal head to the first cuneiform
106
Test positive in complete tear of CFL?
Talar tilt
107
Pain on the anterolateral aspect of foot and ankle
Talocalcaneal ligament strain (Sinus Tarsi)
108
Surgical treatment for tibialis anterior spasticity?
SPlit Anterior Tibial Tendon Transfer (SPLATT)
109
What maintains the medial logitudinal arch of the foot?
calcaneonavicular "spring" ligament
110
Name two conditons that can cause clawing of the toes and intrinsic muscle weakness in the feet.
CMT, diabetic neuropathy
111
What is a March fracture?
metatarsal stress fracture
112
when is surgical treatment indicated for a metatarsal stress fracture?
involves 5th metatarsal or there is displacement
113
Jones fracture?
fracture across the base of the 5th metatarsal
114
Nutcracker fracture?
Cuboid fracture due to trauma (imagine a nutcracker cracking a cube)
115
Hammer Toe
MTP extension, **PIP flexion**, DIP extension
116
mallet toe
MTP normal, PIP normal, **DIP flexion**
117
Claw toe
MTP extension, **PIP flexion, DIP flexion**
118
Turf toe?
hyperextension injury of the 1st MTP
119
What is often misdiagnosed as a lateral ankle sprain?
Lisfranc joint/ligament injury
120
Treatement for lisfranc ligament injury?
* NWB for 6-8 weeks
* ORIF if unstable or displaced
121
Where does a morton neuroma usually present?
between 3rd and 4th metatarsals
122
Treatment for morton neuroma?
metatarsal pads
123
pulling-like medial heel pain worst with first steps in the morning?
plantar fasciitis
124
risk factors for plantar fasciitis?
tight achilles tendon, pes planus, pes cavus
125
provactive manuver for plantar fasciitis?
hyperextension of the great toe with palpation of medial plantar heel
126
most common metatarsal fractured?
5th
127
Dancer's fracture?
fracture of the 5th metatarsal distal shaft
