Lower Extremity X3 Flashcards
Femoroacetabular impigement
Bown overgrowth of abnormailty in development whcih changes function of the hip joint
- can cause secndary problems > labral tear or OA
Pincer (acetabulum) and Cam(neck of femur) type
Femoroacetabular impigement present
Groin pain +- lat hip pain
- described as sharp stabbing or deep dull ache
- aggravate with turning, teisting, prolonged standing or squatting
Femoroacetabular impigement tests
FADIR- impingment specifcally
FABER- “figure four”
- also can show SI disfunction so ask where do you have pain
Imaging: X ray and CT if needed
Femoroacetabular impigement tx
- Decreaseing aggrvating activities
- NSAIDs
- PT
- surgery maybe
Trochanteric Pain syndrome
repetitive overload tendinopath
- lateral hip pain with localized pain to greater tochanter
- pain increase with prresure and increase with repetative motion
Trochanteric pain syndrome dx
TTP over greater trochanter
- pain with resisted abduction
Trendelenburg sign
Trochanteric pain synrome Tx
NSAIDs
heat
adjust positioning
injection
Labral Tear Present
Dull or ahrp groin pain
- may radiate to lat hip or ant thigh or but
- insidious onset vs. acute trauma
- catching or clicking that causes pain
Labral Tear Dx
ROM and strength testing
-FADIR and FABER
Imaging: X ray MRI or ***MR arthrogram- test of choice
Snapping Hip Syndrome
Snapping or poppin sensation in hip with walking, getting up
Cause: muscle or tendom sliding over bony prominence
External: IT band over greater troch
Internal: Iliopsoas over iliopectineal eminence
Snappin Hip Syndrome pres
Snapping or popping sensation
- may or may not be painful
- Pseudosubluxation
- difficulty with stairs, running
Snapping Hip Syndrome Dx
Physical exam: snapping is reproducible
external: passive IR ER rotation of hip while laying on side
Interal: FABER then extend hip
Snapping hip
NSAID, avoidance of specific activities +/- corticosteroid inj
PT
surgery rarely indicated
MCL sprain MOI
knee flexion and foot planted and a lateral inpact causing valgus and rotation
- usually in combo with triad of Donnoghue
Unhappy triad
ACL, MCL, Medical meniscus
ACL injury MOI
- quick position change with cutting/pivoting
c- contact: direct blow causing hyperextention
ACL present
feeling pop + immediate pain and swelling+ report feeling very very unstable
Present: joint effusion, gaurding, often able to bear weight , laxity
ACL test/ Dx
Lachman, ANterior drawer, Pivot shift
MRI! but X ray may be considered for bony involvment
ACL Tx
RICE refer to ortho conservative vs surgical - surgery for younger pt or athletes - brace or PT rehabilitation
PCL MOI
Prevents post translation
MOI
- high evergy trauma MVA
- can be in sports but least likely in athlets
PCL presentation
Special test
variable - grossly instable - may be very subtle finding - mild to moderate knee effusion/hemarthrosis Test: posterior testing
Menisci MOI
Increases stability and shock absorption
- during rotational force
- medial is more suspecptible to injury
Meniscus Present
joint line pain
inability to full etend knee and described as locking or catching
- walking down stairs and squatting is diff or painful
Meniscu Dx
McMurray, Apley Gring
Image: MRI
Tx: conservative vs surgical
Knee sprain grade c tx
I- rice WB as tolerated
II- patrial tear
rice, brace immobilixation +/- crutches maybe surgery
III: complete tear
surgical repair, crutches, brace, aggressive PT
Patellofemoral Pain Syndrome cause/pres
“runner knee”
Anterior pain under patella
- pain worse with going up and down stairs
- postive theatre sign or long car ride
- common crepitus, popping, feeling of joint instability
Runners knee test
Patellar glide and apprehension test
Dx: history and physical exam
Tx: Ice, NSAIDs, PT
- strengthen hip abductors and quads, stretching, core stability
Bakers Cyst
Accumulation of joint fluid of the popliteal fossa
Clin present: often asymptomatic or found incidentaly, pain and swelling with prolonged standing or activity
Bakers cysts tx
NSAID
aspiration/injection
compressive neoprene brace
surgery rarely indicated
Patellar tendonitis
jumpers knee
tendon inflamattion typically involved in running often after skeletal maturity
- seen with pronation or running hills
Patellar tendonitis tx
Conserv: Ice, NSAID, bracing, strapping, act modification and PT
Iliotibial band syndrome present
Overuse injury Gradual onset of localized pain
- initially sharp burning and will develope a deep ache
Exam: localized tenderness
evaluate LLD
Tx: RICE, NSAIDS, PT
Knee Bursitis
Inflam or the bursa
prepattelar, suprpatellar,infrapatellar, pes anserine
Knee bursitis pres/tx
pain swelling
R/O infection
Tx: avoid preipitating factors, NSAID, asapiration/steroid injection
Osterochondritis Dissecans
Presentation gradual onset of poorly localized deep pain - decrease ROM in elbow but not knee may have sweeling, popping locking need X ray or MRI
Osterochondritis Dissecans tx
1-III avoidance of activitu and immobilication may be required +- pt
IV- surgery
Ankle Sprain lateral
Lateral- most common
lateral ligament complex
anterior talofibular ligament, calcaeofibular ligament and post talofibular lig
Dx: anterior draw
Ankle sprain dx
radiographs to rule out fracture
tx: RICE and NSAIDs
+/- short immobilize grade 2/3
PT to prevent future injuries
Achilled Tendon issues present
tedinopathy- maybe new repative training or buring pain
Rupture: sudden pivoting or rapid acceleration sunden pop with severe pain
Achilles tendon exam
palpate along tendon for pain edenma palpate both plantar and dorsal flexon Special: thompon test Tx: ortho referal immobilization, equinus splinting , boot to keep in felxed position
