Lower Quarter Flashcards
3 tests for appendicitis
Rebound tenderness
Precussion tenderness
Rigidity
+ LR of appendicitis tests
Rebound tenderness = 1.99
Percussion tenderness = 2.86
Rigidity = 2.96
Characteristics of SCFE
Obese adolescent males
Gradual onset of thigh or knee pain
painful limp
limited hip motion especially IR
Physis of the femur is distal to the femoral neck
Legg Cale Perthes Disease
Children 2-15
Pain in the hip, knee or groin
pain typically mild
painless limp
limited hip AROM, especially IR and abduction
Increased pain with hip movement
Sulcus angle and the reason
Depth of the groove
Norms are 132 - 144 with shallower meaning an increased risk of subluxation/dislocation of the patella
What is a congruence angle of the knee
Patella position in the trochlear groove with midpoint of the sulcus angle compared to the lowest portion of the patellar ridge
Medial tilt of the patella
6 degrees
lateral tilt of the patella
16 degrees or larger is associated with lateral patellar subluxation
Femoral tibia angle should be?
180-185 for slight valgus
what is the above and below angles for femoral tibia angle?
> 185 is genu valgum
< 175 degrees is genus varum
what portion of the menisci is avascular
Lateral side that is seperated by the popliteus tendon
Which part of Menisci is most likely involved when the ACL is torn
ACL for anterior and PCL for posterior
Posterior menisci is reinforced by? and what force does it resist
Posterior oblique ligament and the semimembranosus. valgus force resistors
Posterior capsule of the knee is supported by?
POL for medial side, arcuate popliteal ligament, LCL and popliteofibular ligament
ACL anteromedial bundle characteristics
Taut in knee flexion or tibia IR
Tested in knee flexion
If injuried could bring a false positive for Anterior drawer since posterolateral bundle is intact
ACL posterolateral bundle characteristics
Taut in extension
Provides greatest restraint to anterior translation in 20 degrees of knee flexion
ACL characteristics
Resists 85% of anterior translation at 30 degrees
Common injury of the ACL
Deceleration in a slight knee flexion position w/ medial or lateral tibial rotation.
ER or IR of the tibia will involve ACL how?
Tibial IR will cause ACL to wind around the PCL.
Tibial ER will cause ACL to stretch over the lateral condyle
PCL anterolateral and posteromedial bundle
Anterolateral is taut in flexion and priority for surgery if torn
posteromedial bundle is taut in extension.
CKC biomechanics of the knee flexion
Flexion results in posterior rolling of the femoral condyles and anterior glide of tibia
CKC biomechanics of the knee extension
Femoral condyles roll anteriorly and glide posteriorly on a fixed tibia
Tibial rotation with TKE
ER of the tibia to achieve screw home mechanism with extension
IR of the tibia to unlock and initiate flexion
Ottawa knee rules
> 55 years old
Inability to bear weight both immediately and in the ED
Isolated tenderness of the patella
Tenderness at head of fibula
Inability to flex to 90
** unable to bear weight twice onto each limb regardless of limping
Pittsburgh criteria
Age < 12 or > 50 will need an x-ray
Inability to walk 4 steps weight bearing in the ED
Side effects of paracetamol (acetaminophen) w/ panadol
GI ulceration and bleeding with dose of 3g/day
What is diclofenac?
NSAID
What is Etoricoxib used for?
inhibitor of COX - 2 for pain and inflammation with OA
OA routes for medicine
Cortisone or glucocorticoid injection
Hyaluronans
Platelet rich plasma
Autologous conditioning serum
Reason for cortisone or glucocorticoid injection
1-4 week of symptom relief
Increases rate of articular cartilage loss over 2 years
Useful in a severe symptomatic knee
Reason for Hyaluronans
Small effect for OA and is < 500$
Used for grease/oil change
Reason for platelet rich plasma
Groth factor transplant
Better for youthful patients
300-600$
Autologous conditioning serum
More effective that HA
1000$
Combined actions of cortisone and platelet rich plasma
Time for injections and exercise
5 days off exercise then after 7 days to resume progressive strengthening
Post 6-8 weeks with no improvement warrants a surgical opinion
Meniscectomy results
No benefit over sham surgery and potentially harmful
What are a few signs of compartment syndromes
Pain
acute or chronic
Cramping with exercises
numbness - permanent tissue damage
Hypermobility Beighton score
> or equal to 5/9
Beighton tests
Pull little finger back beyond 90
Pull thumb to touch forearm
Bend elbow backwards beyond 10 degrees
Bend knee backwards beyond 10 degrees
Lie hand flat on the floor with knees straight.
Peripheral arterial dysfunction symptoms and tests
Pain with activity
Loss of color, temperature and pulse
Seated bicycle will make PAD worse
Treadmill will make spinal stenosis worse
WOMAC
Sn 77%
Sp 78%
MDC 26%
Victorian institute of sport assessment questionnaire
MDC 11.1
MCID > 13
Lysholm knee score for meniscus and ligamentous injury
95-100 excellent
84-94 good
65-83 fair
< 65 poor
MDC is 10
Cincinnati knee rating system
2.45 pain MDC
2.86 swelling
2.82 partial giving away
2.3 full getting away
KOS
8.87 MDC
LEFS
9 for LE and new joints
10 for OA of the hip and knee
8 for anterior knee pain
Global rating of change
-5 very much worse
0 no change
+5 completely recovered
15 point scale
Patient specific functional scale
3 MDC for knee
2 MDC for single activity
Patella action with knee flexion
glides inferiorly
How do you measure the Q angle?
line from ASIS to the midpoint of the patella to the tibial tuberosity
Q angle norms
10-15 for men
15-20 for women
If greater then a increase of lateral patella force and displacement
For Patella femoral pain syndrome what angles should you avoid
0-30 degrees with OKC
Patella joint forces
Walking is 50% body weight force on the knee
Jogging is 3-4x body weight on knee
Rising from a chair is 6.7x body weight on knee
Ottawa foot and ankle rules
Inability to bear weight immediately and in the ED
Tenderness 6 cm posterior edge of the lateral malleolus
Tenderness 6cm posterior edge of the medial malleolus
Navicular tenderness
Base of 5th metatarsal tenderness
Wells criteria for DVT ( 9 )
Active cancer
Paralysis, paresis, or recent plaster immobilization of the lower extremities
recently bedridden for 3 days or major surgery in the last 12 weeks
Localized tenderness along the deep venous system
Entire leg swollen
Calf swelling > or equal to 3cm compared to asymptomatic side
Pitting edema confined to symptomatic leg
Collateral superficial veins
Previously documented DVT
Lumbar myelopathy CPR
> 40 years old
+ babinski
+ hoffmans
+ inverted supinator sign
Gait deviations
lumbar myelopathy CPR (SN/SP)
3/5 = Sp .99/ LR+ 30.9
1/5 = Sn .94/ LR- 1.8
Hip OA CPG
> 50 years old
Morning stiffness < 1 hour
Moderate anterior or lateral hip pain with WB activities
Hip IR < 24 and < 15 flexion compared to opposite side
Signs and symptoms of hip labrum
C-sign pain
clicking locking, catching stiffness, instability, or giving way
Anterior pinching pain with sitting hip rotation and morning stiffness
ACR knee OA guidelines altman criteria
Crepitus
morning stiffness > 30 mins and bony enlargement