MSK - Lower Extremity Flashcards
What is the most common source of hip pain? What three muscles (or groups) are usually involved?
Muscle strains
Hip adductors, rectus femoris, and iliopsoas
What typically limits apophyseal injuries? When is surgery required?
Periosteum
If displacement >1cm
What is myositis ossificans? What does it result from? What is the initial treatment? If causing prolonged pain?
Bone deposit in tissue
Results form multiple contusions to same area
Initial - ice and do not re-injure
Surgery to remove if persists
What is your initial inclining if someone presents with a flexed hip, IR, and adducted?
Posterior dislocation
What is your initial inclining if someone presents with a flexed hip, ER, and abducted?
Anterior dislocation
What is the initial treatment for hip dislocations? Why?
Imminent reduction
To reduce chance of AVN
If a pt presents with groin pain, audible/palpable clicking in the hip, and decreased ROM, what is your diagnosis? What imaging would you order?
Labial tear
MRI
What presentation of hip dislocation is most common?
Posterior
What is initial treatment for a hip labial tear? Secondary treatment?
Initial: partial wtb and PT
Secondary: surgery
What population is most susceptible to stress fractures of the femoral neck? What are the three types? Stable/unstable?
High endurance athletes/marathoners/mountain climbers
Compression - fx in inferior neck, stable due to compression with wtb
Tension - fx in superior neck, unstable due to separation while wtb
Displaced - unstable
What is osteitis pubis? Where will a pt often complain of pain radiating? What is the treatment?
Inflammation/compressior of pubic bones
Pain in pubic region, radiating around hip
Treatment: NSAIDs, rest, ROM
What is external snapping hip syndrome? What can often be inflammed as a result? What test is used clinically to diagnose snapping hip?
Tightness of IT snapping over greater trochanter
Greater trochanteric bursa
Ober’s test (pt lies on unaffected side, doctor abducts bad leg and lets go. Leg will remain abducted if there is a problem)
What causes internal snapping hip syndrome?
Tight iliopsoas (probably with bursitis)
What population is most susceptible to SCFE? What is seen in physical exam? What is the treatment?
11-14 year old AA and obese children
Flexed hip tends to externally rotate
Closed reduction with percutaneous screws
What is it called when a bump develops along the superior lateral neck of the femur, restricting motion? What is the initial treatment? Secondary
CAM impingement
Maintain flexibility, injections
Surgery to resect if absolutely necessary
What mimics bursisits or external snapping hip but causes pain with resisted abduction? What is conservative treatment?
Gluteus medius tear
RICE, heat, stretching
What is the flower test? What does it help diagnose?
Flex hip and externally rotate, positive if pain
Osteoarthritis of hip
What diagnostic tool is most helpful in determining hip AVN?
MRI
What is the treatment for an elderly individual with a displaced intracapsular femoral head fracture?
Hemiarthroplasty
What is treatment for intertrochanteric fractures?
ORIF
What is the structure most commonly traumatically torn?
Medial meniscus
Which meniscus is more circular? Which is half-moon shaped?
Lateral - more circular
Medial - half moon shaped
What is the McMurrary’s test? Describe position and what it checks for?
Flexed knee with rotation applied
IR - lateral meniscus
ER - medial meniscus
What is initial treatment for a meniscus tear? Secondary?
Knee imboilizer, crutches, NSAIDs, RICE
Secondary - arthroscopy
What is a Baker’s cyst an enlargement of?
Semimembranosis bursa
Valgus laxity indicates problems with what knee structure? Varus laxity?
Valgus - MCL
Varus - LCL
What is donahues terrible traid?
Meniscus tear, CLC tear, ACL tear
What degree of knee flexion is best for collateral ligament testing?
30 degrees
What is a likely diagnosis given the following fluid aspirations from a painful knee: clear; blood w/o fat cells, blood w/ fat cells.
Clear - meniscus tear
Blood w/o fat - ligament tear
Blood w/ fat - fracture
What is always injured in a knee dislocation? What sequelae may persist?
Ligaments
Arterial injury, compartment syndrome
What population is susceptible to patella femoral pain syndrome? What is the treatment?
Adolescents/young adults
Patella tracking brace
What is osgood-schlatter’s disease? What age is it common in? What is conservative treatment?
Involves tibial tuberosity elevation or calcification of patellar tendon
8-15 years
Treatment: discontinue activity 3 months, gentle stretching, NSAIDS, slow increase in activity
Where is pes anserinus located?
Under medial hamstrings
How are all knee fractures treated?
ORIF
What is the most common foot and ankle problem?
Plantar fasciitis
What ligaments are most commonly torn in an inversion ankle sprain?
Anterior talofibular ligament
Calcanealofibular ligament
What are the Ottawa Ankle rules for? What are they?
Determining if an x-ray of the ankle is needed
Ankle pain + one of following
Bone tenderness along distal 6cm of posterior tibia or medial malleolus
Bone tenderness along distal 6cm posterior fibular or lateral malleolus
Inability to bear weight for more than 4 steps immediately after injury
What is the treatment for ankle sprains?
NSAID, RICE, contrast baths (supports, may cast, may MRI)
What must be done immediately for a dislocated ankle?
Reduction (splinting, nonWB, RICE)
What is cuboid syndrome? What population is it common in?
Cuboid remains flexed while rest of foot in normal position
Ballet dancers
What nerve is trapped in Tarsal Tunnel syndrome? What does it mimic? Where is pain felt? What is typical treatment?
Posterior tibial nerve
Diabetic neuropathy
Calf pain at night (may go to medial two toes)
Not usually conservative, typically need surgery
What may mimic distal leg compartment syndrome, but is treated with conservative stretching and sometimes surgical release?
Superficial peroneal nerve entrapment
What is Master knot of henry? What can result from entrapment of plantar nerve there? What is the treatment?
Crossing of flexor hallicus longus and flexor digitorum longus under medial calcaneus
Jogger’s foot
Local treatment - heat/injections, occasional surgery
What is Morton’s neuroma? Where is it most commonly found? Who is it most commonly found in?
Perineural fibrosis of common digital nerve at netacarpal head
3rd metatarsal space (between 3rd and 4th toe)
More women than men
Conservative treatment (surgery last resort)
What test is positive in an Achilles rupture?
Thompson’s test
Does a calcanealofibular spur cause plantar fasciitis? What is the treatment for plantar fasciitis?
No, it is a result of the plantar faciitis
Treatment: aggressive stretching, NSAIDs, ice
What is a normal hallus valgus angle? What is the treatment for <30 degrees? >30 degrrees?
<15 degrees
<30 degrees - distal osteotomy
>30 degrees - proximal osteotomy
What is bunion on the 5th toe called?
Bunionette
What is Hallus Rigidis? What is the treatment?
Pain and stiffness of dorsal MP with dorsiflexion
Surgical
What is the term for AVN of 2nd metatarsal head? Who is it most common in? What is the treatment?
Frieberg’s disease
Women
Restrict activity, metatarsal pad
What immediate treatment is necessary for ankle fractures? How many x-ray views must be obtained? How much displacement is acceptable?
Reduce
3 views
<2mm
What is common in talus fractures (similar to scaphoid fractures)? Why?
AVN due to distal blood supply
What must always be checked when a fractured calcaneous is found?
Check urine for blood
Spine films
Where is the lisfranc joint/ligament found? How must fractures in this area be treated?
Base of 2nd metatarsal
ORIF
Where is a Jone’s fracture located? What often occurs during the healing process? How must to be treated?
5th metatarsal
Non-union
Need screw
What must be used to evaluate the subtalar joint?
CT scan
What causes an avulsion of the 5th metatarsal?
Peroneal brevis tendon (pulling)
What two fractures of the toe phalanges must be treated with ORIF?
Mal-rotation
Great toe intra-articular fractures
