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Clinical Med I > MSK/Rheumatology - Lower Extremity - Exam 3 > Flashcards

MSK/Rheumatology - Lower Extremity - Exam 3 Flashcards

1
Q

What is a femoroacetabular impingement? (FAI)

A

Bone overgrowth or abnormality in bone development that changes the function of the hip joint

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2
Q

What can a FAI result in?

A

Tearing of the labrum or destruction of articular cartilage leading to osteoarthritis

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3
Q

What are the 3 types of FAI?

A
  1. pincer- acetabular involvement
  2. cam- femoral head involvement
  3. combination
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4
Q

What is the clinical presentation of FAI?

A
  • Groin/ lateral hip pain

- Aggravated with turning, twisting, prolonged standing or squatting

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5
Q

What two tests can be used to test for FAI and which is superior?

A
  • FADIR (superior) = knee/ hip flexion with adduction and internal rotation of the hip
  • FABER = flexion, abduction, external rotation (aka Patricks, Figure of 4)
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6
Q

What imaging is used for FAI?

A

X-rays initially and CT/ MRI if needed

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7
Q

What is used in the treatment of FAI?

A

Decrease aggravating activities
NSAIDS
PT
If fails conservative treatment > surgical eval

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8
Q

What is the clinical presentation of a labral tear of the hip?

A
  • Groin pain that radiates to lateral hip, anterior thigh, or buttock
  • Catching, clicking that causes pain
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9
Q

What is performed in the physical exam for a labral tear of the hip?

A

ROM and strength testing, FADIR and FABER

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10
Q

What is the test of choice for imaging of a labral tear of the hip?

A

MR arthrogram

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11
Q

What is the snapping hip syndrome?

A

Snapping or popping sensation in hip with walking, getting up from chair, or swinging leg

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12
Q

What is the cause of the snapping hip syndrome?

A

Muscle or tendon sliding over bony prominence, which can lead to bursitis

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13
Q

What is an external cause of the snapping hip syndrome? Internal?

A

External: IT band over greater trochanter
Internal: Iliopsoas tendon over iliopentineal eminence or femoral head

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14
Q

Who is at increased risk of snapping hip syndrome?

A

Dancers, athletes with repetitive hip flexion, adolescents

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15
Q

What is the clinical presentation of snapping hip syndrome?

A
  • Snapping/ popping sensation
  • Pseudosubluxation
  • Difficulty with stairs, running, arising from seated position
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16
Q

How could you reproduce the movement with an external cause of snapping hip syndrome?

A

Passive rotation of hip while laying on side

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17
Q

How could you reproduce the movement with an external cause of snapping hip syndrome?

A

FABER and then extend hip

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18
Q

What is the treatment for snapping hip syndrome?

A

Decrease aggravating activities
NSAIDs
PT
Corticosteroid injection

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19
Q

What is the most common cause of lateral hip pain in adults?

A

Greater trochanteric pain syndrome

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20
Q

What is the cause of greater trochanteric pain syndrome?

A

Repetitive overload tendinopathy

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21
Q

What is the clinical presentation of greater trochanteric pain syndrome?

A

Lateral hip pain localized to greater trochanter

Pain increased with pressure, walking, stairs, or prolonged standing

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22
Q

What is seen on the physical exam of greater trochanteric pain syndrome?

A

TTP over greater trochanter Pain with resisted abduction

+ Trendelenburg sign

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23
Q

What is the treatment for greater trochanteric pain syndrome?

A

Self-limiting
Acetaminophen/ NSAIDS, Heating pad
Steroid injection

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24
Q

What is seen on an abnormal Trendelenburg test?

A

Pelvis drops on unaffected side when standing on affected side due to weak hip abductors

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25
Q

Although injury of the MCL may be isolated, what is most commonly seen?

A

Triad of O’Donoghue (terrible triad) = ACL, MCL, medial meniscus

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26
Q

What is the most common MOI for an MCL sprain?

A

Knee flexion + foot planted AND lateral impact causing valgus rotation

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27
Q

Although an LCL sprain is rare, what is the most common MOI?

A

Tibial internal rotation and medial impact

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28
Q

What tests are used to check MCL and LCL for stability?

A

Valgus (MCL) and varus (LCL)

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29
Q

What is the most common ligament in the knee to be injured and what injury is it also associated with?

A

ACL; meniscus injury

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30
Q

Why is the ACL so important anatomically?

A

Most important structure for stability of the knee; prevents anterior translation and rotation of tibia

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31
Q

What is the MOI for an ACL injury?

A 
Noncontact = quick position change with cutting
Contact = direct blow causing hyperextension or valgus deformity with lateral impact
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32
Q

What would be reported in the history and clinical presentation of a patient with an ACL injury?

A

Feeling or hearing a “pop”
Immediate pain/ swelling
Feeling of instability, guarding

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33
Q

What is the preferred specialized test for an ACL injury?

A

Lachman’s test

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34
Q

What imaging should be used for diagnosing an ACL injury?

A

MRI*, x-ray considered for bony involvement

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35
Q

What is the treatment for an ACL injury?

A

RICE, refer to ortho, conservative vs surgical

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36
Q

What is the role of the PCL?

A

Prevents posterior translation of tibia and prevents external rotation
Largest and strongest ligament,

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37
Q

What is the MOI for a PCL injury?

A

Ant. impact with knee flexed at 90 degree

High energy trauma (MVA), low energy trauma (sports)

38
Q

What is the clinical presentation of a PCL injury?

A

Mild-mod knee effusion
Generalized knee pain, “something isn’t right”
Limp

39
Q

What specialized testing is used for a PCL injury?

A

Posterior drawer sign and posterior sag sign

40
Q

What are the most important roles of the menisci?

A

Facilitate lubrication, shock absorption, stability

41
Q

How does a meniscus injury occur?

A

Excessive rotational force (femur on tibia)

42
Q

Which meniscus is more susceptible to injury and why?

A

Medial; greater forces and less mobile

43
Q

How does a meniscus injury present clinically?

A

“Locking, catching”- inability to extend knee, joint line pain, stairs and squatting is painful

44
Q

What is the most common specialized test used for a meniscus injury?

A

McMurray

Apley grind

45
Q

What imaging is used for a meniscus injury?

46
Q

What is the treatment for a meniscus injury?

A

Conservative vs surgical based on location and extent of tear

47
Q

If there is pain with McMurrays test during internal rotation and varus stress, what injury do you suspect?

A

Lateral meniscus

48
Q

If there is pain with McMurrays test during external rotation and valgus stress, what injury do you suspect?

A

Medial meniscus

49
Q

What are the grades of a knee “sprain”?

A

Grade I- mild stretch
Grade II- partial tear
Grade III- complete tear

50
Q

What is the treatment for a grade I, II, and III knee sprain?

A

I- RICE, WB as tolerated
II- RICE, brace, crutches, PT, possible surgery
III- surgery, crutches, brace, aggressive PT

51
Q

What is the most common knee complaint in primary care, and what is it also called?

A

Patellofemoral Pain Syndrome

AKA: runner’s knee

52
Q

What is the clinical presentation of patellofemoral pain syndrome?

A

Anterior pain under patella
Pain worse with stairs
Positive theater/ long car ride sign
Crepitus, popping, instability

53
Q

What specialized testing is used for patellofemoral pain syndrome?

A

Patellar glide

Apprehension test

54
Q

What is the treatment for patellofemoral pain syndrome?

A

Decrease aggravating activity
NSAIDs
Ice
PT

55
Q

What is a Baker’s/ popliteal cyst?

A

Accumulation of joint fluid in the popliteal fossa

56
Q

How does a Baker’s cyst present clinically?

A

Asymptomatic or pain/ swelling with prolonged standing/ activity

57
Q

What is the treatment for Baker’s cyst?

A

NSAIDs, aspiration/ injection, compression brace

58
Q

What is patella tendonitis?

A

Patellar tendon inflammation from repetitive trauma

59
Q

What is the treatment for patella tendonitis?

A

ICE, NSAIDs, Brace, PT

60
Q

What is the cause of iliotibial band syndrome (ITBS)?

A

Overuse injury

61
Q

What is the clinical presentation of ITBS?

A

Gradual onset of localized pain (sharp burning to constant deep ache)

62
Q

What is noted on the PE for ITBS?

A

Localized tenderness reproducible with ROM/ ITB compression

Evaluate for limb length discrepancy

63
Q

What imaging/ treatment is used for ITBS?

A

Imaging not needed, treatment = RICE, NSAIDS, PT

64
Q

What is knee bursitis and what are the most common areas affected?

A

Inflammation of the bursa caused by trauma/ overuse; prepatellar and per anserine

65
Q

What is the clinical presentation of knee bursitis and what should you rule out?

A

Pain, swelling, tenderness; r/o infection

66
Q

What is used for treatment/ prevention of knee bursitis?

A

Avoid precipitating factors, NSAIDS, aspiration/steroid injections, padding bracing

67
Q

What is osteochondritis dissecans (OCD)? Where is it most common?

A

Idiopathic osteonecrosis of subchondral bone

Knee- Lateral portion of medial femoral condyle

68
Q

What is the progression of OCD?

A

Trauma > hypovascularity > necrosis > chondromalacia > articular fragment

69
Q

What is the clinical presentation of OCD?

A

Gradual onset of poorly localized deep pain
Limited WB
Popping, locking, catching = advanced
Intermittent swelling

70
Q

What is seen with PE of knee OCD?

A

Pain with flexion over medial condyle

71
Q

What imaging is used for OCD?

A

X-rays

MRI if needed

72
Q

What treatment is used for stages I-III OCD?

A

Conservative treatment

73
Q

What treatment is used for stage IV OCD (intraarticular loose body) or in skeletally mature patients?

A

Surgery- drilling = vascular ingrowth/ new bone formation, removal of articular fragment

74
Q

What are the contents of the lateral ligament complex?

A

Anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament

75
Q

What specialized test is used for a lateral ankle sprain?

A

Anterior drawer

76
Q

What is the most commonly injured area in a medial ankle sprain and how is it injured?

A

Deltoid ligament complex; eversion injury

77
Q

What is a syndesmotic ankle sprain and what specialized test is used for this?

A

High ankle sprain; test= squeeze test

78
Q

What is the treatment for an ankle sprain?

A

RICE and NSAIDS

Short immobilization, PT

79
Q

What is an acute injury of the achilles tendon?

A

Tendinopathy, rupture

80
Q

What is an achilles tendon injury in a pediatric patient?

A

Calcaneal apophysitis (Sever’s disease)

81
Q

What is the clinical presentation of an achilles tendon injury?

A

Tendinopathy- burning pain

Rupture - “sensation of violent hit or pop”

82
Q

What is present on PE of an achilles tendon injury?

A

Patient prone, palpate along tendon for pain/ edema/ defect (plantar- and dorsiflexion)

83
Q

What specialized test will be positive with an achilles tendon injury?

A

Thompson test

84
Q

What treatment is used for an achilles tendon injury?

A

Ortho referral, immobilization, equinus splinting, boot for continued plantar flexed position

85
Q

What is plantar fasciitis?

A

Inflammation of the fascia due to activity, heel spurs, per planus/ cavus, ankle pronation, poor shoe wear
One of the most common causes of foot pain (plantar aspect)

86
Q

What is the clinical presentation of plantar fasciitis?

A

Pain with onset of walking (first step in morning)

87
Q

What is found upon PE of plantar fasciitis?

A

Point tenderness

Pain aggravated by ROM

88
Q

What diagnostics are used for plantar fasciitis?

A

X-ray

U/S or MRI if needed

89
Q

What treatment is used for plantar fasciitis?

A

Prevention, ice, NSAIDS, rest

90
Q

What is used for prevention of plantar fasciitis?

A

Improve shoe wear, PT, massaging, ortho/ podiatry referral if severe

Clinical Med I (24 decks)

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