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Lower quarter > Lower Quarter > Flashcards

Lower Quarter Flashcards

1
Q

3 tests for appendicitis

A

Rebound tenderness
Precussion tenderness
Rigidity

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2
Q

+ LR of appendicitis tests

A

Rebound tenderness = 1.99
Percussion tenderness = 2.86
Rigidity = 2.96

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3
Q

Characteristics of SCFE

A

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

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4
Q

Legg Cale Perthes Disease

A

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

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5
Q

Sulcus angle and the reason

A

Depth of the groove
Norms are 132 - 144 with shallower meaning an increased risk of subluxation/dislocation of the patella

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6
Q

What is a congruence angle of the knee

A

Patella position in the trochlear groove with midpoint of the sulcus angle compared to the lowest portion of the patellar ridge

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7
Q

Medial tilt of the patella

A

6 degrees

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8
Q

lateral tilt of the patella

A

16 degrees or larger is associated with lateral patellar subluxation

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9
Q

Femoral tibia angle should be?

A

180-185 for slight valgus

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10
Q

what is the above and below angles for femoral tibia angle?

A

> 185 is genu valgum
< 175 degrees is genus varum

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11
Q

what portion of the menisci is avascular

A

Lateral side that is seperated by the popliteus tendon

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12
Q

Which part of Menisci is most likely involved when the ACL is torn

A

ACL for anterior and PCL for posterior

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13
Q

Posterior menisci is reinforced by? and what force does it resist

A

Posterior oblique ligament and the semimembranosus. valgus force resistors

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14
Q

Posterior capsule of the knee is supported by?

A

POL for medial side, arcuate popliteal ligament, LCL and popliteofibular ligament

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15
Q

ACL anteromedial bundle characteristics

A

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

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16
Q

ACL posterolateral bundle characteristics

A

Taut in extension
Provides greatest restraint to anterior translation in 20 degrees of knee flexion

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17
Q

ACL characteristics

A

Resists 85% of anterior translation at 30 degrees

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18
Q

Common injury of the ACL

A

Deceleration in a slight knee flexion position w/ medial or lateral tibial rotation.

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19
Q

ER or IR of the tibia will involve ACL how?

A

Tibial IR will cause ACL to wind around the PCL.
Tibial ER will cause ACL to stretch over the lateral condyle

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20
Q

PCL anterolateral and posteromedial bundle

A

Anterolateral is taut in flexion and priority for surgery if torn
posteromedial bundle is taut in extension.

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21
Q

CKC biomechanics of the knee flexion

A

Flexion results in posterior rolling of the femoral condyles and anterior glide of tibia

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22
Q

CKC biomechanics of the knee extension

A

Femoral condyles roll anteriorly and glide posteriorly on a fixed tibia

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23
Q

Tibial rotation with TKE

A

ER of the tibia to achieve screw home mechanism with extension
IR of the tibia to unlock and initiate flexion

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24
Q

Ottawa knee rules

A

> 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

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25
Q

Pittsburgh criteria

A

Age < 12 or > 50 will need an x-ray
Inability to walk 4 steps weight bearing in the ED

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26
Q

Side effects of paracetamol (acetaminophen) w/ panadol

A

GI ulceration and bleeding with dose of 3g/day

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27
Q

What is diclofenac?

A

NSAID

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28
Q

What is Etoricoxib used for?

A

inhibitor of COX - 2 for pain and inflammation with OA

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29
Q

OA routes for medicine

A

Cortisone or glucocorticoid injection
Hyaluronans
Platelet rich plasma
Autologous conditioning serum

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30
Q

Reason for cortisone or glucocorticoid injection

A

1-4 week of symptom relief
Increases rate of articular cartilage loss over 2 years
Useful in a severe symptomatic knee

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31
Q

Reason for Hyaluronans

A

Small effect for OA and is < 500$
Used for grease/oil change

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32
Q

Reason for platelet rich plasma

A

Groth factor transplant
Better for youthful patients
300-600$

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33
Q

Autologous conditioning serum

A

More effective that HA
1000$
Combined actions of cortisone and platelet rich plasma

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34
Q

Time for injections and exercise

A

5 days off exercise then after 7 days to resume progressive strengthening
Post 6-8 weeks with no improvement warrants a surgical opinion

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35
Q

Meniscectomy results

A

No benefit over sham surgery and potentially harmful

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36
Q

What are a few signs of compartment syndromes

A

Pain
acute or chronic
Cramping with exercises
numbness - permanent tissue damage

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37
Q

Hypermobility Beighton score

A

> or equal to 5/9

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38
Q

Beighton tests

A

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.

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39
Q

Peripheral arterial dysfunction symptoms and tests

A

Pain with activity
Loss of color, temperature and pulse
Seated bicycle will make PAD worse
Treadmill will make spinal stenosis worse

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40
Q

WOMAC

A

Sn 77%
Sp 78%
MDC 26%

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41
Q

Victorian institute of sport assessment questionnaire

A

MDC 11.1
MCID > 13

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42
Q

Lysholm knee score for meniscus and ligamentous injury

A

95-100 excellent
84-94 good
65-83 fair
< 65 poor
MDC is 10

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43
Q

Cincinnati knee rating system

A

2.45 pain MDC
2.86 swelling
2.82 partial giving away
2.3 full getting away

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44
Q

KOS

A

8.87 MDC

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45
Q

LEFS

A

9 for LE and new joints
10 for OA of the hip and knee
8 for anterior knee pain

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46
Q

Global rating of change

A

-5 very much worse
0 no change
+5 completely recovered
15 point scale

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47
Q

Patient specific functional scale

A

3 MDC for knee
2 MDC for single activity

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48
Q

Patella action with knee flexion

A

glides inferiorly

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49
Q

How do you measure the Q angle?

A

line from ASIS to the midpoint of the patella to the tibial tuberosity

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50
Q

Q angle norms

A

10-15 for men
15-20 for women
If greater then a increase of lateral patella force and displacement

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51
Q

For Patella femoral pain syndrome what angles should you avoid

A

0-30 degrees with OKC

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52
Q

Patella joint forces

A

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

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53
Q

Ottawa foot and ankle rules

A

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

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54
Q

Wells criteria for DVT ( 9 )

A

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

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55
Q

Lumbar myelopathy CPR

A

> 40 years old
+ babinski
+ hoffmans
+ inverted supinator sign
Gait deviations

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56
Q

lumbar myelopathy CPR (SN/SP)

A

3/5 = Sp .99/ LR+ 30.9
1/5 = Sn .94/ LR- 1.8

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57
Q

Hip OA CPG

A

> 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

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58
Q

Signs and symptoms of hip labrum

A

C-sign pain
clicking locking, catching stiffness, instability, or giving way
Anterior pinching pain with sitting hip rotation and morning stiffness

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59
Q

ACR knee OA guidelines altman criteria

A

Crepitus
morning stiffness > 30 mins and bony enlargement

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60
Q

Achilles Tendon dysfunction and comobidities

A

Diabetes, HTN, Hyperlipidemia

61
Q

Achilles tendinopathy intrinsic risk factors

A

Decreased DF
Decreased subtalar ROM
Decreased plantar flexion strength
Excessive pronation/decreased pronation control

62
Q

Achilles tendinopathy extrinsic risk factors

A

Obesity, HTN, Diabetes
Quick change in training regime

63
Q

Objective data for Achilles tendinopathy

A

Tenderness to palpation 2-6 cm proximal to achilles insertion
decreased plantar flexion strength on affected side
Decreased ankle DF ROM on affected side

64
Q

Interventions for Achilles Tendinopathy

A

heavy load eccentrics of SL calf raise
3x15 with knee straight and extended 2x a day for better effect.

65
Q

Poor interventions for Achilles tendinopathy

A

manual therapy, taping, and DN on < 3 months AT.

66
Q

Functional requirements of the hip AORM

A

Up stairs = 40-70 degrees
down stairs = 40 degrees
gait = 20 - 40 degrees

67
Q

Functional requirements for knee and ankle AROM

A

11-21 DF for up and down stairs
80-100 knee flexion for stairs

68
Q

Lunge requirements of LE AROM

A

Ankle 10 DF degrees
Knee 95 flexion degrees
Hip 85 degrees

69
Q

Squat AROM requirements

A

Ankle 16 DF
Knee 100 Flexion for DL / 75 for SL
Hip 100 flexion

70
Q

Angle of inclination

A

> 135 coxa valga with instability
< 120 coxa vara with leg length discrepancy and weak hip ABD

71
Q

Torsion/version angle of the femoral neck

A

angle b/w the femoral neck and a line bisecting the femoral condyles

72
Q

Norms for torsion/version angle

A

8-20 degrees

73
Q

Anteversion traits

A

Significant anterior placement of the femoral neck in relation to the transcondylar axis
higher version angle
in-toeing
decreased loading of anterior joint

74
Q

Retroversion traits

A

Excessive posterior placement in the transverse plane and results in a lower than normal version angle
Out-toeing
Excessive ER with limited IR

75
Q

Alpha angle of the hip

A

Line through femoral head and neck
Line through femoral head and border of acetabulum
> 60 degrees indicated cam type deformity

76
Q

Lateral center edge angle

A

Vertical line from the middle of the femoral head and line from middle of femoral head to the edge of the acetabulum

77
Q

LCEA norms

A

25-39 = normal
< 25 = undercoverage
> 39 = overcoverage results in pincer FAI

78
Q

Iliofemoral ligament

A

Limits EXT/ABD/ADD/ER
Sits anteriorly

79
Q

Pubofemoral ligament

A

Limits ABD and EXT
Sits Anteriorly and inferior

80
Q

ischiofemoral ligament

A

Limits IR and EXT
Sits posteriorly

81
Q

Loose packed position of the hip

A

30 flexion
30 ABD
Slight ER

82
Q

Closed packed position of the hip

A

90 flexion
Slight ABD and ER

83
Q

Iliohypogastric nerve

A

T12-L1
S) Lateral gluteal
M) Internal Oblique, TrA

84
Q

ilioinguinial nerve

A

L1
S) Anterior and medial thigh, Scrotum and labia
M) Internal Oblique TrA

85
Q

Gentiofemoral Nerve

A

L1-2
S) Anterior and medial thigh, Scrotum and labia
M) Cremaster

86
Q

Lateral femoral cutaneous Nerve

A

L2-3
S) Lateral Thigh

87
Q

Obturator Nerve

A

L2-4
M) Adductors

88
Q

Femoral Nerve

A

L2-4
S) Anterior thigh w/ branch into saphenous Nerve for patella sensation
M) Quad, sartorius, articularis genu

89
Q

Lumbar plexus mnemonic

A

I
Irregularly
Get
Lunch
On
Fridays

90
Q

Ligamentum teres

A

Pediatrics seen with blood supply
Adult population seen with stability of the hip

91
Q

OKC arthrokinematics of the hip
Flexion/IR of the femur

A

Rolls anterior and glides posteriorly

92
Q

OKC arthrokinematics of the hip
Extension/ER of the femur

A

Rolls posterior and glides anteriorly

93
Q

OKC arthrokinematics of the hip
ABD of the femur

A

Rolls laterally and glides medially

94
Q

OKC arthrokinematics of the hip
ADD of the femur

A

Rolls medially and glides laterally

95
Q

CKC arthrokinematics of the hip
Forward flexion of the pelvis on the femur

A

Rolls anteriorly and glides anteriorly

96
Q

CKC arthrokinematics of the hip
Backward extension of pelvis on femur

A

Rolls posteriorly and glides posteriorly

97
Q

SLS Trendelenburg sign

A

Pelvic drop of > 2 cm to the opposite side of the stance leg

98
Q

Gait and hip mechanics
Initial contact

A

Flexed approximately 30 with slight ADD

99
Q

Gait and hip mechanics
Mid stance

A

Neutral moving into flexion

100
Q

Gait and hip mechanics
Pre swing

A

Extended approximately 10 with slight ABD

101
Q

Gait and hip mechanics
Early swing

A

Extended and moving into flexion with slight ABD

102
Q

Gait and hip mechanics
Mid swing

A

Flexed with slight ABD

103
Q

Gait and hip mechanics
Terminal swing

A

Flexed 30 with slight ABD

104
Q

FAI CPG

A

Anterior/lateral hip pain
Aggravated by sitting
+ FADIR
Hip IR < 20 in 90 degrees of hip flexion
AROM/PROM may be limited
Often popping, locking, or snapping of the hip are present

105
Q

Labral Tear CPG

A

Typically 30+ y/o
Anterior/groin or generalized hip pain
+FADIR and/or +FABER
Often popping, locking or snapping of the hip are present
May have sensation of instability with squatting

106
Q

CAM FAI

A

Sphericity of the femoral head and/or widening of the femoral neck
Doesn’t allow for the femoral head to glide smoothly in the acetabulum

107
Q

Pincher FAI

A

Over-coverage of the anterosuperior acetabular wall, and abnormal version of the femur or acetabulum
Rim is abnormally shaped

108
Q

Patella pubic percussion test

A

Stethoscope placed on the pubic tubercle and then you tap on the same side patella
Lack of sound indicate a femoral neck or pubic rami Fx

109
Q

CPG for inflammatory back pain

A

< 40 y/o
Insidious onset of pain
Improvement in pain with exercise
No improvement in pain at rest
Pain during the second half of the night that improves upon waking

110
Q

4/5 on CPG for inflammatory back pain

A

77% for ruling out
92% for ruling in

111
Q

FAI surgery ROM precautions for 1-2 weeks

A

Flexion 90
Extension 0
ABD 25-30
IR 90 with hip flexion at 0
ER at 90 with hip flexion at 30
ER 20 in prone

112
Q

FAI surgery avoid week 1

A

SLR and S/L hip ABD

113
Q

Week 4-8 avoidance

A

Hip flexor tendinitis

114
Q

CPG for hip pain mobility deficits and OA

A

1-5 times per week for 6-12 weeks
Ms stretching of the joint with hip flexor and ER stretch
Strengthening of the hip abductors/ER/Extensors

115
Q

4 phases of wound healing

A

Day 1-3 homeostasis
Day 3-20 inflammation with blood vessel growth
Week 1-6 Granulation with wound closure
Week 6-2 years remodeling

116
Q

When are hip precautions lifted?

A

Usually by week 6

117
Q

ROM to achieve by week 4-8 THA

A

Hip flexion 90-115
Hip ABD 15-25
Hip IR/ER 10-20

118
Q

ROM to achieve by week 6-8 TKA

A

Knee flexion 110-125
Knee extension 0

119
Q

ACL inflammatory phase 0-3 weeks

A

Patella mobs
PROM manual for knee flexion to 90
stretch depending on graft location

120
Q

ACL week 3

A

Full WB (depending on MD)
Recumbent bike
Knee flexion to 115
Shuttle 0-60 degrees

121
Q

ACL week 4-8

A

PROM 0-130
Graft is weakest at week 6
CKC stability
wall squats and lateral walking

122
Q

ACL week 7-12 weeks Criteria for phase

A

AROM 0-125
No PFPS
Minimal effusion

123
Q

ACL 12-16 weeks

A

Plyometrics
Running program
Sports specific training

124
Q

ACL month 3.5 - 4.5 test

A

Single leg hop test
6m timed hop
Triple hop for distance
Crossover hop for distance

125
Q

What is a hop test

A

Done for distance with either SL or DL and should be < 10% difference in distance of legs

126
Q

Plyometric progression

A

Maintain proximal control
Shuttle with TB (DL - SL)
Mini jump then controlled squat to a box line jump
Jump down for technique

127
Q

Meniscus Maximum protection week 1-4

A

WBAT
D/C crutches when safe gait is established

128
Q

Meniscus week 1-2 PROM

A

0-90 degrees for week 1
100-105 for week 2
115 - 120 week 3
125-135 week 4

129
Q

Meniscus repair week 3 exercises

A

Mini wall squats 0-45
Tandem
recumbent bike

130
Q

Meniscus repair week 9-16 components

A

Hamstring curls begun lightly
cardio
SL activities
leg press

131
Q

Meniscus repair week 4-6 months

A

4 months = straight plane running and deep squat
5 months = high speed agility and pivoting drills

132
Q

Achilles Sx week 0-4

A

usually casted in PF for 2 weeks
NWB 2 weeks then PWB at 3 weeks
Heel lift reduced weekly
Bike with boot on week 2
*No calf stretch

133
Q

Achilles Sx week 4-8

A

Seated BAPS
AROM Inv/Ev

134
Q

Achilles Sx week 8-12

A

PROM
Contract/relax
Seated HR
Weight shifts

135
Q

Achilles Sx week 12-20

A

PA glides
MWMs
Strengthening
DL - SL

136
Q

Achilles Sx week 18-20

A

Return to running
Repeated HR at an incline
Pool running and SL HR
Plyometrics

137
Q

Collateral ligaments of the lateral ankle

A

Anterior talo-fibular ligament
Calcaneo-fibular ligament
Posterior talo-fibular ligament

138
Q

what are the two common techniques for lateral ankle repair

A

Brostrom and tendon reconstruction

139
Q

Brostrom lateral ankle repair

A

reattach the ligaments to the fibular through small holes drilled into the bone

140
Q

Tendon reconstruction

A

Replace the lateral ligaments by using either an allograft from cadaver or autograft with the patient’s hamstring

141
Q

Lateral ankle reconstruction wks 0-6

A

Immobolized 10-14 days
NWB until CAM boot
PROM, edema
AROM (DF,PF,INV,EVER) if approved by MD

142
Q

Lateral ankle reconstruction wks 6-10 weeks

A

Discharge boot and ADs
Full ROM
Flexibility
Proximal strength

143
Q

Lateral ankle reconstruction wks 8-12

A

DL to SL
Slideboard and ladder drills
TM slow walk
plyometrics only if able to complete 25 SL HR

144
Q

Lateral ankle reconstruction wks 12-4 months

A

Pain free jogging
Y balance test and hop test
figure 8s

145
Q

Abnormal pronated foot posture

A

FPI 6 > 4
Midfoot hypermobility
decreased tibialis posterior ms strength
medially rotated lower extremity position

146
Q

Absolute contraindications for taping

A

Decreased sensation
Fx
Infectious disease
Malignancy
Osteoporotic changes

147
Q

Sinding-larsen Johansson syndrome

A

Repeated irritation of the patella growth plate resulting in swelling and pain on the inferior border of the patella

148
Q

Osgood schlatter disease

A

Traction apophysitis of the patella tendon on the tibial tubercle usually fixed with conservative care

Lower quarter (4 decks)

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