MSK Patho LE Flashcards
Pathology of AVN of the hip
- Multiple etiologies resulting in an impaired blood supply to the femoral head
- Hip ROM decreased in flexion, IR, and abduction
Symptoms of AVN of the hip
- Pain in the groin and/or thigh
- Tenderness with palpation at the hip joint
- Coxalgic gait
Medications for management of AVN of the hip
- Acetaminophen for pain
- NSAIDs for pain and/or inflammation
- Corticosteroids contraindicated since they may be a causative factor
What might cause coxa vara/valga
- Coxa vara usually results for a defect in ossification of head of femur
- Coxa vara/valga may result from necrosis of femoral head occurring with septic arthritis
MOI and common symptoms of greater trochanteric pain syndrome/gluteal tendinopathy/trochanteric bursitis
- MOI: excessive hip adduction and IR with weight bearing tasks
- Pain over greater trochanter that may extend down lateral thigh
- Worsens with laying on side, prolonged standing/walking, and stairs
Pathology of IT band tightness/friction disorder
- Tight ITB, abnormal gait
- Results in inflammation of trochanteric bursa
- Noble compression test and/or Ober’s test may be positive
Function of the Piriformis muscle
- Hip ER at <60º hip flexion
- Hip IR and abductor at 90º hip flexion
- Tightness or spasm of piriformis muscle can result in compression of sciatic nerve and/or sacroiliac dysfunction
Signs and symptoms of Piriformis syndrome
- Restriction in IR
- Pain with palpation of piriformis muscle
- Referral of pain to posterior thigh
- Weakness in ER, positive piriformis test
What are the 2 types of FAI (femoroacetabular impingement)
- CAM: impingement of a large aspherical femoral head in a constrained acetabulum
- Pincer: over-coverage of the femoral head by a prominent acetabular rim
- Frequently associated with acetabular labral tears
Pathology of groin pain in athletes (sports hernia)
- Common in sports requiring kicking, rapid acceleration/deceleration, & sudden change of direction
- May be related to pathology of adductor, iliopsoas, inguinal, or pubic
Signs and symptoms of a sports hernia
- Acute or gradual onset
- Symptoms and painful weakness localized to structures involved
What are the degree classifications for knee ligament injuries
- 1st degree: little or no instability
- 2nd degree: minimal to moderate instability
- 3rd degree: extreme instability
What is the “unhappy triad” of the knee
- Injury to the MCL, ACL, and medial meniscus resulting from a combination of valium, flexion, and ER forces at the knee while the foot is planted
MOI of meniscal and articular cartilage injuries
- Result from a combination of forces to include tibiofemoral joint flexion, compression, & rotation which places abnormal shear stresses on the meniscus
Symptoms of a meniscus/articular cartilage injury
- Lateral and/or medial joint pain
- Effusion
- Joint popping
- Knee giving way
- Limitations in movement
- Joint locking
Describe patella alta
- Malalignment in which patella tracks superiorly in femoral intercondylar notch
- May result in chronic patellar subluxation and also possibly patellar tendon rupture
- Positive camel back sign (2 bumps, one being the tibial tuberosity and the other being the patella)
Describe patella baja
- Malalignment in which patella tracks inferiorly in femoral intercondylar notch
- Results in restricted knee extension with abnormal cartilaginous wear, resulting in DJD and also possibly quadriceps tendon rupture
Pathology of patellofemoral pain syndrome (PFPS)
- Prescence of retropatellar or peripatellar pain
- Reproduction of pain with squatting, stair climbing, prolonged sitting
- Exclusion of all other conditions that may cause anterior knee pain
- Common dysfunction that is the result of elevated patellofemoral joint loading caused by trauma, biomechanical factors, and/or muscle tightness & weakness
- May be associated with patellar tendinopathy and/or chondromalacia patellae
Pathology of patellar tendinopathy/tendonosis (Jumper’s knee)
- Degenerative condition of the patellar tendon typically of the deep aspect
- May be related to overload and/or jumping activities
- May also be interrelated to PFPS
What are the typical causes of pes anserine bursitis
- Typically caused by overuse or a contusion
Which femoral condyle is most often involved in a fracture due to it’s anatomical design
- Medial femoral condyle
Common MOI for a tibial plateau fracture
- Combination of valgum & compression forces to knee when knee is flexed
- Often occurs in conjunction with a medial collateral ligament injury
MOI for an epiphyseal plate fracture in the knee
- Frequently a weight bearing torsional stress
- Presents more frequently in adolescents where an ACL injury would occur in an adult
Most common MOI for a patella fracture
- Direct blow to patella due to a fall
Pathology of acute compartment syndrome
- Elevated compartment (anterior, lateral, posterior) pressure that results in local ischemic condition
- Usually the result of direct trauma and/or fracture
What are the 6 P’s of compartment syndrome
- Pain
- Palpable tenderness
- Paresthesia
- Paresis
- Pallor (unhealthy pale appearance)
- Pulselessness
What is chronic external compartment syndrome and its symptoms
- Result of elevated compartment (anterior, lateral, posterior) pressure that restricts blood flow to muscles
- Symptoms depend on compartment but anterior is most common resulting in pain in the anteriolateral leg region but may also present with paresthesia
Pathology of medial tibial stress syndrome
- Overuse injury of posterior tibialis and/or the medial soleus resulting in periostea inflammation at the muscular attachments
- Etiology is thought to be excessive pronation
- Pain elicited with palpation of the distal posteromedial border of the tibia
What muscles make up the triceps surae
- Soleus
- Gastrocnemius
- Plantaris muscles
Pathology of lower leg stress fractures
- Overuse injury resulting most often in micro fracture of tibia or fibula
- Tibia is more commonly involved than fibula
- 3 common etiologies: abnormal biomechanical alignment, poor conditioning, & improper training methods
What is the grading system for ankle ligament sprains
- Grade I: no loss of function, minimal tearing of the anterior talofibular ligament
- Grade II: some loss of function, partial disruption of the anterior talofibular & calcaneofibular ligaments
- Grade III: complete loss of function, complete tearing of anterior talofibular & calcaneofibular ligaments and partial tear of posterior talofibular ligament
Pathology of Achilles tendonosis/tendonopathy
- Degenerative condition of the Achilles tendon
- Clinical examination including Thompson’s test helps to identify this condition
What are the 3 fracture types of the ankle
- Unimalleolar: involves the medial or lateral malleolus
- Bimalleolar: involves the medial and lateral malleoli
- Trimalleolar: involves the medial & lateral malleoli and the posterior tubercle of the distal tibia
Pathology of tarsal tunnel syndrome
- Entrapment of the posterior tibial nerve or one of its branches within the tarsal tunnel
- Over/excessive pronation, overuse problems resulting in tendonitis of the long flexor & posterior tibialis tendon, & trauma may compromise space in the tarsal tunnel
Symptoms of tarsal tunnel syndrome
- Pain, numbness & paresthesias along the medial ankle to the plantar surface of the foot
What population is flexor hallucis tendonopathy commonly seen in
- Commonly seen in ballet performers
How is a pes cavus (hollow foot) deformity observed
- Increase height of longitudinal arches
- Dropping of anterior arch
- Metatarsal heads lower than hind foot
- Plantar flexion and splaying of forefoot
- Claw toes
Pathology of equinus
- Etiology can include congenital bone deformity, neurological disorders ( Cerebral palsy), contracture of gastrocnemius and/or soleus muscles, trauma, or inflammatory disease
- Deformity observed is a PF foot
- Compensation 2ndy to limited DF includes subtalar or midtarsal pronation
Pathology of hallux valgus
- Etiology is varied to include biomechancial malalignment (excessive pronation), ligamentous laxity, heredity, weak muscles, & footwear that is tight
- Observed deformity: medial deviation of head of 1st metatarsal from midline; metatarsal & base of 1st phalanx move medially while distal phalanx then moves laterally
What is a normal metatarsophalangeal angle
- 8-20º
What are the Salter-Harris Fracture Classifications for the foot/ankle
- Type I: entire epiphysis; very few complications to growth of bone
- Type II: entire epiphysis & portion of metaphysis; may cause decreases bone growth but limited negative impact on long-term function
- Type III: portion of the epiphysis; may lead to long-term problems 2ndy to fracture
- Type IV: portion of epiphysis & portion of metaphysis; may lead to deformity of the joint
- Type V: compression injury of the epiphyseal plate; poor functional prognosis
Etiologies of metatarsalgia
- Mechanical: tight triceps surae group and/or Achilles tendon, collapse of transverse arch, short 1st ray, pronation of forefoot
- Structural changes in transverse arch possible leading to vascular and/or neural compromise in tissues of forefoot
- Changes in footwear
What is the frequently heard complaint with metatarsalgia
- Pain at 1st and 2nd metatarsal heads after long periods of weight bearing
Pathology of Charcot-Marie-Tooth disease
- Slowly progressive disorder with varying degrees of involvement depending on degree of genetic dominance
- Peroneal muscular atrophy that affects motor and sensory nerves
- May begin in childhood or adulthood
- Initially affects muscles in lower leg/foot and progresses to muscles of the hands/forearms
Deformity observed with rear foot varus (subtalar varus, calcaneal varus)
- Abnormal mechanical alignment of tibia, shortened rear foot soft tissues, or malunion of calcaneus
- Rigid inversion of calcaneus when subtalar joint is in neutral position
Pathology of rearfoot valgus
- Abnormal mechanical alignment of the knee (genu varum)
- Deformity observed: eversion of calcaneus with a neutral subtalar joint
- Due to increased mobility of hind foot, fewer musculoskeletal problems develop form this deformity than with rear foot varus
Pathology of forefoot varus
- Congenital abnormal deviation of head and neck of talus
- Deformity observed: inversion of forefoot when subtalar joint is in neutral
Pathology of forefoot valgus
- Congenital abnormal development of head and neck of talus
- Deformity observed: eversion of forefoot when the subtalar joint is in neutral
