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PM&R > Lower Extremity MSK > Flashcards

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
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2
Q

What carries blood supply from the acetabulum to the femoral head?

A

Ligamentum capitis femoris

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3
Q

What muscles originate on the ASIS?

A

Sartorius and TFL

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4
Q

What muscle originates on the AIIS?

A

Rectus femoris

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5
Q

What are two early findings in hip osteoarthritis?

A
  • Loss of internal rotation
  • superolateral compartment narrowing
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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
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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
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8
Q

Nerve injured with anterior hip dislocation

A

femoral

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9
Q

Nerve injured with posterior hip dislocation

A

sciatic

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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

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11
Q

Garden Clasification System for femoral neck fracture

A

Stages

  1. incomplete fracture line
  2. complete fracture line (non-displaced)
  3. partially displaced
  4. fully displaced with disruption of joint capsule
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12
Q

Treatment for femoral neck stress fractures

A
  • Compression side (inferior): Rehab with NWB -> WBAT
  • Tension side (superior): Requires ORIF
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13
Q

Describe the typical patient who suffers slipped capital femoral epiphysis

A

obese adolescent male

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14
Q

Grading for Slipped Capital Femoral Epiphysis (SCFE)

A
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15
Q

To whom should you refer a patient with SCFE and why?

A

Endocrinology to evaluate for growth hormone deficiency or thyroid disease

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16
Q

Pincer lesion

A

acetabulum extends out too far and “pincers” the femoral head causing FAI

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17
Q

CAM lesion

A

“knuckle” of bone coming out of the femoral neck seen in FAI

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18
Q

Internal snapping hip

A

groin pain caused by iliopsoas tending snapping over the iliopectineal eminence, commonly seen in dancers

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19
Q

External snapping hip

A

pain in lateral thigh due to a tight IT band or gluteus maximus snapping over the greater trochanter

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20
Q

Commonly mistaken for greater trochanteric bursitis

A

Gluteus medius tendonitis/tendinopathy

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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

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22
Q

activity that commonly causes a hamstring strain

A

water-skiing

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23
Q

Provacative test for piriformis syndrome

A

FAdIR

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24
Q

most common causes of AVN of the femoral head in adults?

A

alcohol and corticosteroid use

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25
Q

Imaging for suspected AVN of the femoral head?

A

MRI of both hips

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26
Q

After total hip replacement, when is the risk for pulmonary embolism the highest?

A

during the 2nd and 3rd week post surgery

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27
Q

Hip precautions after an anterior approach THA?

A

Avoid hip extension and external rotation

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28
Q

Most common type of hip fracture?

A

Intertrochanteric Hip Fracture

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29
Q

most common cause and location for myositis ossificans?

A

hematoma, quadriceps

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30
Q

How long does it take for myositis ossificans to show up on XR?

A

2-3 weeks

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31
Q

What type of collage is in hyaline (articular) cartilage?

A

Type II

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32
Q

When is the PCL tense?

A

with knee flexion (think of dashboard injury)

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33
Q

When is the ACL tense?

A

with knee extension

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34
Q

What direction does the ACL run?

A

Antero-infero-medially (think putting hands into pockets)

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35
Q

What direction does the PCL run?

A

postero-infero-laterally (think bring hand across body and place on opposite pocket)

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36
Q

What does the ACL do as the knee flexes?

A

Pulls femur anteriorly

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37
Q

What is O’Donoghue’s triad?

A

The “terrible triad” of ACL, MCL and medial meniscus tear with lateral blow to the knee

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38
Q

Describe the course of the lateral collateral ligament

A

It runs from the lateral femoral condyle to the fibular head (also called fibular collateral ligament)

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39
Q

Orthotic treatment for medial compartment OA of the knee?

A

lateral heel wedge

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40
Q

osteochondritis dissecans

A

repetitive stress causing AVN to an area of bone with resulting separation (dissection) of piece of bone

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41
Q

Segond fracture

A

Avulsion fracture of the lateral tibial plateau commonly associated with ACL tear (close to 100%)

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42
Q

Type of brace given for ACL injury?

A

Lenox-Hill Derotation orthosis

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43
Q

Most common knee ligament torn?

A

MCL

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44
Q

Knee ligament most commonly injured in sports?

A

ACL

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45
Q

How does blood supply of the medial meniscus affect surgical decison making and its ability to heal?

A

The inner 2/3rds is poorly vascularized and is usually surgically resected. The outer 1/3 is well vascularized and can be repaired.

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46
Q

Causes anterior knee pain with locking and buckling

A

Plica: redundant fold of synovial tissue that can become inflamed

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47
Q

Where is a Baker Cyst usually located?

A

between the semimembranosus and medial head of the gastrocnemius

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48
Q

Pain in the anterior knee at knee tendon with excessive kneeling

A

Superficial and Deep infrapatellar bursitis

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49
Q

Anterior knee pain worse with climbing stairs or running downhill. Associated with knee stiffness after prolong sitting.

A

Patellofemoral Pain Syndrome

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50
Q

Treatment for Patellofemoral Pain Syndrome

A
  • Stretch tight IT band and vastus lateralis
  • Strengthen VMO
  • Patellar knee sleeve with patellar cutout
  • Kinesiotaping
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51
Q

What group is Patellofemoral Pain Syndrome commonly seen in?

A

Runners

52
Q

Lateral knee pain felt with downhill skiing or downhill running

A

Popliteus Tendonitis

53
Q

Anterior/Lateral knee pain worse after running

A

IT Band Syndrome

54
Q

Cause of IT Band Syndrome

A
  • Gluteus medius weakness
  • Tight/Weak IT Band and TFL
55
Q

Physical exam test that is positive in IT Band Syndrome?

A

Ober

56
Q

What provides attachement for the posterior horn of the lateral meniscus and stabilizes the posterior lateral knee?

A

Arcuate Popliteal Ligament Complex (APLC)

57
Q

With McMurray’s test, which way do you rotate the tibia to stress the medial compartment?

A

externally

58
Q

What physical exam test is most specific for ACL injury?

A

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
Q

With knee ligament testing, how much motion indicates a complete tear?

A

> 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
Q

What is the most sensitive clinical marker for acute ACL injury?

A

severe effusion in the first 2-12 hours following injury

61
Q

List two factors that increase the Q angle

A

genu valgum and internal torsion of the femur

62
Q

Internally rotated bicycle cleats stress what part of the knee?

A

anterior

63
Q

Most common site of patellar tendonitis?

A

inferior pole

64
Q

Describe the 4 compartments of the leg and their contents

A
  • 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
Q

How does the plantaris differ from the gastocnemius and soleus muscles and why is this important?

A

plantaris does not become part of the achilles tendon and can cause a falsely negative Thompson test.

66
Q

How is the tarasl tunnel related to compartments of the leg?

A

All deep posterior compartment contents pass through the tarsal tunnel

67
Q

Which malleolus of the ankle is lower?

A

lateral (extension of the fibula)

68
Q
A
69
Q

Most commonly injured ankle ligament?

A

Anterior talofibular (ATFL)

70
Q

Second most commonly injured ankle ligament?

A

calcaneofibular ligament (CFL)

71
Q

How much displacement defines a positive ankle anterior drawer test seen in ATFL tear?

A

> 5mm

72
Q

Which ligament is close to the fibularis longus and brevis tendons?

A

calcaneofibular ligament (CFL)

73
Q

Maisonneuve Fracture

A

proximal fibular fracture due to a severe high ankle sprain with rupture of tibiofibular syndesmosis

74
Q

common running error leading to medial tibial stress syndrome (shin splints)?

A

overpronation

75
Q

mechanism of injury leading to talus fracture

A

forced dorsiflexion with an axial load

76
Q

type of talus fracture with high risk of AVN?

A

talar body (dome)

77
Q

most common foot fracture

A

calcaneus fracture

78
Q

Sever’s Disease

A

posterior heel pain in children 2/2 to calcaneal apophysitis

79
Q

mechanism causing syndesmosis injury

A

excessive external rotation (common football injury)

80
Q

Order of ligaments torn in a lateral ankle sprain

A
  1. ATFL
  2. CFL
  3. PTFL
81
Q

Grading of a lateral ankle sprain

A
  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
Q

What tendons can be damanged with lateral ankle sprain?

A

fibularis longus and brevis tendons

83
Q

Work-up for lateral ankle sprain?

A

stress view XRs

84
Q

What structures pass through the tarsal tunnel?

A

TP, FDL, FHL, tibial artery/nerve/vein

85
Q

cause of tarsal tunnel syndrome?

A

compression of tarsal tunnel structures due to tight flexor retinaculum

86
Q

Haglund deformity

A

bony deformity of posterior heel due to to increased achilles tendon tension

87
Q

bursas in the posterior ankle?

A

retrocalcaneal and retroachilles

88
Q

Which lower leg compartment most commonly develops acute compartment syndrome?

A

anterior

89
Q

Presents with extreme pain with muscle stretch that is out of proportion to exam

A

compartment syndrome

90
Q

lower leg pain, paresthesias, and weakness worse with prolonged exercise

A

chronic exertional compartment syndrome

91
Q

What increases the risk of tibilais posterior tendon injury?

A

excessive pronation

92
Q

presents with positive “too many toes” sign?

A

tibialis posterior tendon injury

93
Q

population at risk for flexor hallucis longus (FHL) injury?

A

dancers

94
Q

Cause of achilles tendon injury?

A

repetitive eccentric overload

95
Q

Where is the achilles tendon prone to tears?

A

distal 2-6cm due to poor vascularity

96
Q

risk factor for achilles tendon injury

A

older age, overtraining, overpronation, tight achilles tendon

97
Q

Three main characteristics of acute compartment syndrome?

A

pain, paresthesias, and paralysis

98
Q

In acute compartment syndrome, are pulses usually normal or abnormal?

A

normal

99
Q

How is pain related to activity with shin splints?

A

pain may improve with exercise but worsens after completion of activity

100
Q

most common stress fracture location in running sports?

A

tibia

101
Q

X-ray findings seen with stress fracture?

A

periosteal thickening followed by cortical lucency

102
Q

First choice test to dx stress fractures?

A

MRI (most sensitive and specific)

103
Q

Supplementation rx’d to treat stress fractures?

A
  • calcium 1,500mg daily
  • vitamin D 400-800 IU daily
104
Q

Describe the different bones in the foot

A
105
Q

Lisfranc ligament

A

connects second metatarsal head to the first cuneiform

106
Q

Test positive in complete tear of CFL?

A

Talar tilt

107
Q

Pain on the anterolateral aspect of foot and ankle

A

Talocalcaneal ligament strain (Sinus Tarsi)

108
Q

Surgical treatment for tibialis anterior spasticity?

A

SPlit Anterior Tibial Tendon Transfer (SPLATT)

109
Q

What maintains the medial logitudinal arch of the foot?

A

calcaneonavicular “spring” ligament

110
Q

Name two conditons that can cause clawing of the toes and intrinsic muscle weakness in the feet.

A

CMT, diabetic neuropathy

111
Q

What is a March fracture?

A

metatarsal stress fracture

112
Q

when is surgical treatment indicated for a metatarsal stress fracture?

A

involves 5th metatarsal or there is displacement

113
Q

Jones fracture?

A

fracture across the base of the 5th metatarsal

114
Q

Nutcracker fracture?

A

Cuboid fracture due to trauma (imagine a nutcracker cracking a cube)

115
Q

Hammer Toe

A

MTP extension, PIP flexion, DIP extension

116
Q

mallet toe

A

MTP normal, PIP normal, DIP flexion

117
Q

Claw toe

A

MTP extension, PIP flexion, DIP flexion

118
Q

Turf toe?

A

hyperextension injury of the 1st MTP

119
Q

What is often misdiagnosed as a lateral ankle sprain?

A

Lisfranc joint/ligament injury

120
Q

Treatement for lisfranc ligament injury?

A
  • NWB for 6-8 weeks
  • ORIF if unstable or displaced
121
Q

Where does a morton neuroma usually present?

A

between 3rd and 4th metatarsals

122
Q

Treatment for morton neuroma?

A

metatarsal pads

123
Q

pulling-like medial heel pain worst with first steps in the morning?

A

plantar fasciitis

124
Q

risk factors for plantar fasciitis?

A

tight achilles tendon, pes planus, pes cavus

125
Q

provactive manuver for plantar fasciitis?

A

hyperextension of the great toe with palpation of medial plantar heel

126
Q

most common metatarsal fractured?

A

5th

127
Q

Dancer’s fracture?

A

fracture of the 5th metatarsal distal shaft

PM&R (78 decks)

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