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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
Although injury of the MCL may be isolated, what is most commonly seen?
Triad of O'Donoghue (terrible triad) = ACL, MCL, medial meniscus
26
What is the most common MOI for an MCL sprain?
Knee flexion + foot planted AND lateral impact causing valgus rotation
27
Although an LCL sprain is rare, what is the most common MOI?
Tibial internal rotation and medial impact
28
What tests are used to check MCL and LCL for stability?
Valgus (MCL) and varus (LCL)
29
What is the most common ligament in the knee to be injured and what injury is it also associated with?
ACL; meniscus injury
30
Why is the ACL so important anatomically?
Most important structure for stability of the knee; prevents anterior translation and rotation of tibia
31
What is the MOI for an ACL injury?
``` Noncontact = quick position change with cutting Contact = direct blow causing hyperextension or valgus deformity with lateral impact ```
32
What would be reported in the history and clinical presentation of a patient with an ACL injury?
Feeling or hearing a "pop" Immediate pain/ swelling Feeling of instability, guarding
33
What is the preferred specialized test for an ACL injury?
Lachman's test
34
What imaging should be used for diagnosing an ACL injury?
MRI*, x-ray considered for bony involvement
35
What is the treatment for an ACL injury?
RICE, refer to ortho, conservative vs surgical
36
What is the role of the PCL?
Prevents posterior translation of tibia and prevents external rotation Largest and strongest ligament,
37
What is the MOI for a PCL injury?
Ant. impact with knee flexed at 90 degree | High energy trauma (MVA), low energy trauma (sports)
38
What is the clinical presentation of a PCL injury?
Mild-mod knee effusion Generalized knee pain, "something isn't right" Limp
39
What specialized testing is used for a PCL injury?
Posterior drawer sign and posterior sag sign
40
What are the most important roles of the menisci?
Facilitate lubrication, shock absorption, stability
41
How does a meniscus injury occur?
Excessive rotational force (femur on tibia)
42
Which meniscus is more susceptible to injury and why?
Medial; greater forces and less mobile
43
How does a meniscus injury present clinically?
"Locking, catching"- inability to extend knee, joint line pain, stairs and squatting is painful
44
What is the most common specialized test used for a meniscus injury?
McMurray | Apley grind
45
What imaging is used for a meniscus injury?
MRI
46
What is the treatment for a meniscus injury?
Conservative vs surgical based on location and extent of tear
47
If there is pain with McMurrays test during internal rotation and varus stress, what injury do you suspect?
Lateral meniscus
48
If there is pain with McMurrays test during external rotation and valgus stress, what injury do you suspect?
Medial meniscus
49
What are the grades of a knee "sprain"?
Grade I- mild stretch Grade II- partial tear Grade III- complete tear
50
What is the treatment for a grade I, II, and III knee sprain?
I- RICE, WB as tolerated II- RICE, brace, crutches, PT, possible surgery III- surgery, crutches, brace, aggressive PT
51
What is the most common knee complaint in primary care, and what is it also called?
Patellofemoral Pain Syndrome | AKA: runner's knee
52
What is the clinical presentation of patellofemoral pain syndrome?
Anterior pain under patella Pain worse with stairs Positive theater/ long car ride sign Crepitus, popping, instability
53
What specialized testing is used for patellofemoral pain syndrome?
Patellar glide | Apprehension test
54
What is the treatment for patellofemoral pain syndrome?
Decrease aggravating activity NSAIDs Ice PT
55
What is a Baker's/ popliteal cyst?
Accumulation of joint fluid in the popliteal fossa
56
How does a Baker's cyst present clinically?
Asymptomatic or pain/ swelling with prolonged standing/ activity
57
What is the treatment for Baker's cyst?
NSAIDs, aspiration/ injection, compression brace
58
What is patella tendonitis?
Patellar tendon inflammation from repetitive trauma
59
What is the treatment for patella tendonitis?
ICE, NSAIDs, Brace, PT
60
What is the cause of iliotibial band syndrome (ITBS)?
Overuse injury
61
What is the clinical presentation of ITBS?
Gradual onset of localized pain (sharp burning to constant deep ache)
62
What is noted on the PE for ITBS?
Localized tenderness reproducible with ROM/ ITB compression | Evaluate for limb length discrepancy
63
What imaging/ treatment is used for ITBS?
Imaging not needed, treatment = RICE, NSAIDS, PT
64
What is knee bursitis and what are the most common areas affected?
Inflammation of the bursa caused by trauma/ overuse; prepatellar and per anserine
65
What is the clinical presentation of knee bursitis and what should you rule out?
Pain, swelling, tenderness; r/o infection
66
What is used for treatment/ prevention of knee bursitis?
Avoid precipitating factors, NSAIDS, aspiration/steroid injections, padding bracing
67
What is osteochondritis dissecans (OCD)? Where is it most common?
Idiopathic osteonecrosis of subchondral bone | Knee- Lateral portion of medial femoral condyle
68
What is the progression of OCD?
Trauma > hypovascularity > necrosis > chondromalacia > articular fragment
69
What is the clinical presentation of OCD?
Gradual onset of poorly localized deep pain Limited WB Popping, locking, catching = advanced Intermittent swelling
70
What is seen with PE of knee OCD?
Pain with flexion over medial condyle
71
What imaging is used for OCD?
X-rays | MRI if needed
72
What treatment is used for stages I-III OCD?
Conservative treatment
73
What treatment is used for stage IV OCD (intraarticular loose body) or in skeletally mature patients?
Surgery- drilling = vascular ingrowth/ new bone formation, removal of articular fragment
74
What are the contents of the lateral ligament complex?
Anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament
75
What specialized test is used for a lateral ankle sprain?
Anterior drawer
76
What is the most commonly injured area in a medial ankle sprain and how is it injured?
Deltoid ligament complex; eversion injury
77
What is a syndesmotic ankle sprain and what specialized test is used for this?
High ankle sprain; test= squeeze test
78
What is the treatment for an ankle sprain?
RICE and NSAIDS | Short immobilization, PT
79
What is an acute injury of the achilles tendon?
Tendinopathy, rupture
80
What is an achilles tendon injury in a pediatric patient?
Calcaneal apophysitis (Sever's disease)
81
What is the clinical presentation of an achilles tendon injury?
Tendinopathy- burning pain | Rupture - "sensation of violent hit or pop"
82
What is present on PE of an achilles tendon injury?
Patient prone, palpate along tendon for pain/ edema/ defect (plantar- and dorsiflexion)
83
What specialized test will be positive with an achilles tendon injury?
Thompson test
84
What treatment is used for an achilles tendon injury?
Ortho referral, immobilization, equinus splinting, boot for continued plantar flexed position
85
What is plantar fasciitis?
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
What is the clinical presentation of plantar fasciitis?
Pain with onset of walking (first step in morning)
87
What is found upon PE of plantar fasciitis?
Point tenderness | Pain aggravated by ROM
88
What diagnostics are used for plantar fasciitis?
X-ray | U/S or MRI if needed
89
What treatment is used for plantar fasciitis?
Prevention, ice, NSAIDS, rest
90
What is used for prevention of plantar fasciitis?
Improve shoe wear, PT, massaging, ortho/ podiatry referral if severe

Clinical Med I (24 decks)

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