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Ortho: Block 3 Flashcards

1
Q

Hip impingement is AKA ?

What causes this injury

A

Femoral acetebular impingement

Bone malformation at acetabulum rim or femoral head/neck

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2
Q

What are the two different types of hip impingements

How do PTs w/ hip impingement present?

A

Cam- deformity on femoral neck
Pincer: deformity on acetabulum rim

C-sign
Hip abductor weakness
Dec flexion/internal rotation
+ FADDIR test

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3
Q

What is the adverse outcome of non-Tx hip impingement?

What will be seen on x-ray of a hip impingement?

A

OA

Dec femoral head/neck distances
Cam= bump impinging on labrum w/ flexion, causes lateral tears/cartilage wear
Pincer: focal over coverage/protrusio
Cross over sign: anterior wall more lateral than posterior wall

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4
Q

What images are taken for surgical consideration on PTs w/ hip impingement

What are the non-op/op Tx plans for these PTs?

A

3D recon MRI

Non: RICE, NSAID, PT w/ muscle balance goal
Op: arthroscopy, Osteotomy

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5
Q

What would be seen on x-ray of OA in the hip?

How is it Tx w/ non-op/op

What is the adverse outcome of these Tx options

A

Dec joint space
Osteophytes
Subchondral Cyst/Sclerosis

Non: RICE, NSAID, injections
Op: Total HA, Osteotomy

Osteonecrosis

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6
Q

What risk factors can lead to osteonecrosis of the hip?

How will these PT present?

A 
Steroid use
Lupus
Alcohol abuse
Prior trauma
Sickle Cell
RA

Non specific pain, dec ROM and + straight leg raise

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7
Q

What is the unique radiographic finding for osteonecrosis of the hip?

How is it Tx?

What is an adverse outcome of this Tx

A

White Crescent sign

No non-surg Tx
Hip replacement

Femur Fx

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8
Q

Hip strains usually involve ? and are made worse w/ ?

When is imaging ordered?

A

Single muscle- hamstring
Resisted ROM

MRI of extreme athlete

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9
Q

How can trochanteric bursitis be Tx non-op?

How can it be Tx w/ surgery?

What is the adverse outcome of this Tx?

A

Injections
Rehab- stretch ITB, piriformis, and tensor fascia latate
Abductor strengthening

Bursectomy

Infection

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10
Q

What mechanism of injury causes an ACL tear?

What is unique about this knee injury?

A

Rotation +/- hyperflexion

Intrarticular location results in significant pain (hemarthrosis), PT won’t continue to play

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11
Q

What tests are done during PE for an ACL tear?

What type of Fx can come w/ an ACL tear?

A

Lachman test- more sens/spec test
Anterior drawer test- least sen/spec test, can be negative in 50% of tears

Lateral capsule sign
Segond Fx- avulsion of lateral tibia

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12
Q

How are ACL tears Tx non-surgically?

When are ACL tears red flagged for immediate referral?

A

Aspirate hemarthrosis
Early ROM
Elderly PT- rehab w/ goal to dec pain/inflammation w/ RICE and inc stability

Gross instability= limb vascularity threatening
Continued laxity

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13
Q

What are the 4 types of arthritis that can occur in the knee?

How will PTs w/ 1/2 present complaining of?

How would they present if it was a crystalline dz?

A

Primary OA- MC
2* OA- Hx of trauma
RA- symmetric
Crystalline- unilateral, single joint

Buckling/giving way- dz of extensor mechanisms

Pseduo gout w/ rhomboid crystals causing episodic, debilitating episodes

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14
Q

What two knee compartments are effected by arthritis of the knee?

What are the 3 compartments of the knee?

A

Genu Varum- MC
Genu Valgum

Lat: ACL to PCL, laterally
Medial: ACL to PCL, medialy
Patella: back of patella, front of trochlear femur surface

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15
Q

Which knee compartment supports the majority of the weight bearing?

What are the x-ray finding words for OA and RA?

A

Medial

Cysts Narrowing Sclerosis
Osteopenia Symmetric Erosion

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16
Q

How are knee arthritis’ Tx non-surg?

How are they Tx w/ surgery and what are the risks?

A

Injection, brace
NOT arthroscopy

Arthroplasty
Adv: infection, cartilage destruction, transient synovitis

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17
Q

What are the two major bursitis of the knee that are affected?

What lab tests are done to differentiate knee aspiration from bursal fluid or synovial fluid?

A

Prepatellar- a/septic from Staph or Strep
Pes anserine- OA, medial osteophytes on tibial plateau

Gram stain
Culture
Cell count
Microscopy for crystals

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18
Q

How are bursitis of the knee Tx non-surgically?

When are these PTs referred to Ortho

A

PO ABX if mild
IV ABX if severe

Septic bursitis
Bursitis secondary to OA

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19
Q

What is the difference of presentation between neuro/vascular claudication?

A

Neuro: not immediately resolving
Improves w/ stationary bike, prox to distal
Worse w/ walking down hill

Vascular: immediately resolves
Worse on stationary bike
Distal to proximal

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20
Q

On MRI, what are the black dots within the white spinal column space?

How is knee claudication Tx non-operatively?

What is the definitive Tx?

A

Nerves

Spine Tx
Feet Tx- similar to diabetic, avoid support hose

Spinal fusion

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21
Q

When are knee claudication PTs referred?

What type of force causes a valgus or varus force?

How do these PTs present differently?

A

Neuro- Ortho spine/neurosurgery
Vascular- to vascular surgery

MCL- valgus
LCL- varus

Return to activity/sport game

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22
Q

How are knee collateral ligament tears graded?

What could be seen on x-ray of an MCL tear?

What could be seen on x-ray of an LCL tear?

A

Varus/Valgus tests

1: <5mm
2: 5-10mm
3: >20mm

Medial femur avulsion Fx

Lateral fibia head avulsion Fx

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23
Q

Which collateral knee tears can be managed w/out surgery?

Which ones need surgery?

A

LCL 1 and 2
MCL 3

LCL-3 w/in 7 days
MCL avulsion Fx off of tibia

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24
Q

What types of injuries can cause compartment syndrome of the knee?

What compartment if more likely to collect fluids and swell?

A

Traumatic tibia Fz or Crush injury

Anterior chamber

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25
How much internal pressure causing exertional force is needed to cause compartment syndrome in the knee? What is the major presenting issue for this emergency?
>40mmHg Pain out of proportion to exam Main test= passive stretch of muscles in compartment
26
What is the limit indicating acute compartment pressure What are the adverse outcomes if the syndrome is not Tx?
Within 30mmHg of diastolic BP >30mm post-exercise >20mm 5min post-exercise Amputation Kidney failure from rhabdo
27
What muscles are passively stretched to isolate which knee compartment is involved w/ compression?
Anterior= paresthesia in 1st dorsal web space Weak dorsiflexion Passive great toe flexion Lateral= ankle inversion stretching peroneus longus/brevis Deep posterior= great toe extension Superficial posterior= dorsiflexion ankle
28
What is the name of the tool used to measure compartment pressures? How can chronic compartment syndrome be Tx w/out surgery?
Striker tool Retrain how they run
29
How are compartment syndromes Tx w/ surgery? What is the adverse outcome of this Tx?
Fasciotomy- surgical emergency Scars
30
When are leg contusions red flagged for referral? What two structures does the ITB connect to?
Coagulopathy Compartment syndrome Ileum Tibia Crosses both hip and knee joint, on outside of femoral condyle
31
What 2 PT populations develop ITB Syndrome? What is the name of the tubercle that the ITB inserts on?
Distance runners Cyclists Gerdy's tubercle
32
Where are gastrocnemius tears more likely to occur? What are adverse outcomes of this injury?
Medial head in +30y/o Shortened tendon DVT
33
Where do knee meniscal tears occur? What is an adverse outcome of this injury?
Anterior horn of medial meniscus OA
34
What exams are done during PE for meniscal tears? What type of tear is severe?
McMurray- audible/palpable click Apley- pain test Thessaly- pain test, specific Bucket handle- posterior fragment flips anterior, causes locked leg and beyond rehab ability
35
How are meniscus tears managed non-operatively? What types are Tx w/ surgery?
Rehab w/ early ROM goals Peripheral- repair Large- debridement
36
When are meniscus tears referred to Ortho? Where does osteonecrosis of the femoral condyle occur? What can cause this?
Mechanical Sxs Peripheral tears Weight bearing medial condyle Systemic steroids Systemic dzs- Gaucher Renal transplant/Sickle cell MC: female +60y/o
37
Since osteonecrosis of the femoral condyle can't be fixed w/out surgery, what operative Txs can be done? When are these PTs referred?
Arthroscopy Osteomies Arthroplasty ALL PTs are referred
38
Patellar/Quad tendonitis is AKA ? What do PTs complain of in clinic?
Jumper's knee Infer/Superior pole of patella Pain w/ quad exercise inc w/ resisted extension
39
What is different about patellar/quad tendon ruptures? What would be seen of an early case of this tendonitis?
No precursor of tendonitis is req'd Spurs If at tibial tuberosity- Hx of O-S
40
What are the 3 phases of non-surgical management of Patellar/Quad tendonitis? What is the adverse outcome of this management?
Rest Pain free ROM, flexibility and strengthening Resume activities- heat before, ice after Persistent functional impairment
41
How does the PT population differ between quad tendon and patellar tendon tears? What is the clinical triad at presentation?
Quad: white male, 40-60y/o Patella: black male, 40-60y/o Palapable defect Inability to extend Change in patella height on x-ray
42
What will be seen on PE of PT w/ patella/quad tendon rupture? What will be seen on x-ray and how is it quantified?
Palpable defect Effusion No extension Patella alta= patellar tendon rupture, patella is higher Patella baja= quad tendon rupture, patella is lower Quantify w/ MRI
43
What are the adverse outcomes of knee/quad tendon repair surgery? All of these tears need to be surgically repaired w/in ? time frame?
Thromboembolism Retearing of tendon 1wk
44
Patellofemoral maltracking usually occurs in ? direction but can be due to laxity of ? How are these dislocations reduced?
Laterally Medial patellofemoral ligament Spontaneously w/ knee bending
45
What is seen on exam of PTs w/ patellofemoral maltracking? What type of x-ray view is used to assess?
Retropatellar knee pain J-sign: abnormal lateral tracking of knee Apprehension test Sunrise- Merchant or Laurin view
46
How are patellofemoral maltracking PTs managed non-operatively? How are they repaired surgically? What adverse event can occur even w/ treatment?
``` Acute= Brace, NSAID Chronic= quad exercise, brace ``` MPFL repair Osteotomy Recurrent Sxs
47
Patellofemoral pain is characterized by the ? sign and presents w/ pain during ? How does PT pinpoint their pain?
Theater sign- pain w/ prolonged sitting Quad activities Circle around patella
48
How is patellofemoral pain Tx w/out surgery? Which plica is more likely to be affected?
Hamstring/Quad strength Full AROM Medial
49
What is an adverse outcome of plica syndrome How can this be Tx w/out surgery? What surgical Tx option is available
Erosion of femoral condyle Injection into plica Arthroscopy
50
Popliteal cysts are AKA ? PTs will pinpoint their pain to be between what two structures?
Baker cysts Synovial cyst- similar to ganglion cyst Medial gastrocnemius Semimembranous
51
What imaging modality is preferred for popliteal cysts? How can these be Tx w/ non-surgical and surgical methods?
US, also r/o DVT Non: US guided aspiration Surg: Tx
52
What is the function of the PCL? What type of injury force causes a tear?
Keeps tibia from tracking back/behind femur Forces applied to tibia and pushing it posterior (dashboard accidents) Knee dislocation, posterior direction is MC
53
What will be seen on exterior exam of PT w/ posterior shin splints? Where will PTs point their pain to be at which is also the hallmark of this condition?
Tibialis posterior muscle causing over pronation (pes planus) of ankle Distal 1/3 of posterior medial crest, origin site of tibialis posterior
54
How are kids w/ anterior knee pain Tx w/out surgery Which ones can be Tx w/ surgery but only when ?
Rest, Strength, Lengthen/Stretch Plica/Bipartite- after 3-6mon of PT
55
What risk factors can lead to developmental hip dysplasia? This deformity is associated w/ ? 3 issues
``` FamHx Breech birth Oligohydramnios First born Swaddling Female ``` Metatarsus adductus Congenital muscular torticolis Hyperextension of knee
56
What is the first inidcator a child has developmental dysplasia of the hip? W/out Tx, this issue can develop into ?
Walking creates pain Degenerative joint dz Secondary OA Pain w/ activity
57
Every child under 1yr old gets what two tests? What two additional tests can be done for further info?
Barlow- attempt to displace femur head posteriorly while pressing/adducting femur Ortolani- relocation maneuver w/ hip abduction, Galeazzi- leg length Dec abduction= hip out of socket
58
What is the preferred imaging modality for assessing developmental dysplasia of the hip in Peds? How is this Tx w/out surgery?
US Modified swaddling Concentric reduction= normal acetabulum Pavlik harness until 6mon
59
How is developmental hip dysplasia in Peds Tx w/ surgery? What are adverse events that can occur in this d/o?
Closed reduction- cast Surgical reduction Femoral nerve palsy Osteonecrosis
60
When do Peds hip dysplasias need to be referred to Ortho? When arethe rules for ordering x-rays for a child w/ a limp? What labs are ordered?
+ Ortolani- hip can be popped in + Barlow w/ US en route More than 2 views More than x-rays if >6wk MRI + contrast CBC w/ diff ESR/CRP
61
What degree of Genu Valgum in Peds is normal for their age Most of these cases are ?
Birth: 10-15* varus 12-18mon: neutral 2-4yr: 10-15* valgus 11y/o: 5-7* valgus ASx
62
What two angles are measured when assessing for Genu Valgum What x-ray images are used for measurement?
Tibiofemoral angle Intermalleolar distance Full length hip to ankle film
63
Non-operative Tx is used for Genu Valgum if the PT is what age? What surgical procedures are used for surgical Tx?
3-4y/o or, ASx Hemi-epiphysiodesis Osteotomy
64
When are Peds w/ Genu Valgum referred to Ortho? What two angles are used for measuring Genu Varum PTs?
Asymmetric Short stature After 12mon Tibofemoral angle Intercondylar distance
65
What 3 criteria indicate the need for x-rays in a PT w/ Genu Varum What surgical procedure is done to correct this?
At 2y/o <25th height percentile Asymmetric Osteotomy at 4y/o
66
When are Genu Varum cases referred to Ortho/ What are 3 causes of intoeing? What are 2 causes of outtoeing?
>5y/o Worsening condition Foot deformity Inward tibial rotation Inward femur rotation Outward rotation of femur or Tibia
67
How to Pts w/ in/out toeing present? What needs to be assessed on PE?
No pain Tripping/inability to keep up Assessment of femur, tibia, foot
68
How are in/out toeing Tx non-surgically or surgical? When are they referred?
Non: reassurance Op: osteotomy Assymetric No improvement Complaints of other issues
69
# Define Legg-Calve Perthes Dz What PT population does this occur in?
Osteonecrosis of femoral head Boys 4-8y/o
70
What are the Sxs of Legg-Calve Perthese Dz What are the adverse outcomes of this Dz?
Limp + groin pain Secondary OA Discrepancy in leg length
71
What is seen on PE of Legg Calve Perthes Dz What will be seen on x-ray
Dec abduction and internal rotation Pelvic shift when standing on one leg Crescent sign= subchondral Fx
72
What does it mean if a Legg Calve Perthes Dz x-ray shows a smaller epiphysis? What does it mean if there are angular changes?
Fragmentation stage Reossification stage
73
How is Legg Calve Perthes Dz Tx non-operative What is the only surgical Tx when the femoral head is misshapen?
Bed rest NSAID ROM therapy Joint replacement- means multiple surgeries through out life
74
When do LCP Dx PT need to be referred? Define Osgood Schlatter Dz Define Sinding Larsen Johansen
<6y/o w/ great involvement or <40* abduction >6y/o Apophysitis at tibia tubercle Apophysitis at patella
75
What causes Sxs in Peds w/ OS or SLJ Dz What will be seen on x-rays
Quad activities Theater sign TTP at tibial tubercle OR distal patella pole Heterotropic ossification Unfused apophysis
76
How is OS/SLJ Dz Tx non-surgically When are they referred to ortho?
RICE Stretch Inability to perform straight leg raise
77
Slipped capital femoral epiphysis is AKA ? What PT population does it occur in?
Saltar Harris Type 1 femur Fx Over weight, black males 13-15y/o or girls 11-13y/o
78
How do PTs w/ slipped capital femoral epiphysis present? What body mechanic is changed due to these Sxs?
Pain and limp worse w/ activity ``` External rotation (unstable Fx, non-weight bearing) Dec internal rotation ```
79
What is the name of the imaginary line used to asses Peds x-rays for slipped capital femoral epiphysis How is this Tx w/ surgery? When are they referred to Ortho?
Klein line- superior femoral neck into joint Stabilization of physis w/ screw fixation All are referred
80
What type of issue is transient synovitis of the hip in Peds? What do these PTs present complaining of?
Sterile effusion Groin pain
81
What motions have dec ROM in transient synovitis? What Labs/Rads are ordered?
Dec ROM w/ abduction or internal rotation US*, x-ray CBC w/ Diff- norm ESR/CRP- elevated
82
Hip dislocations usually occur in which direction? What adverse outcome can occur after these injuries?
Posterior Osteonecrosis
83
Define Posterior/Anterior hip dislocations w/ words
Post: short, flexed, adducted/internal rotated w/ sciatic nerve palsy Ant: flexed, aBducted and externally rotated; femoral nerve palsy
84
How do ant/posterior hip dislocations look differently on x-rays? What other injury is common with these dislocations and what imaging is used to assess them?
Ant: femoral head larger Post: femoral head smaller Acetabular Fx- CT
85
What is the sequence of events for hip dislocation on-surgical management? If it is a non-complicated dislocation/Fx, how long are they non-surgically managed?
``` NV exam Rad Sedate Reduction NV exam Rad + CT ``` Weight bearing as tolerated x 4wks
86
When are hip dislocations considered candidates for surgery? What must be included when x-raying femurs after Fx?
Unable to reduce Acetabulum Fx on posterior edge Femoral neck
87
What is the difference between a stable/unstable pelvis Fx? What PE findings indicate immediate refferals?
Stable- one Fx/disruption to the ring Unstable: poly trauma, more than one Fx/disruption to the ring Blood in perineal- do not cath, call Urology
88
What images are used to assess a pelvic Fx? If there is a suspected Fx of the acetabulum, what needs to be ordered to assess the pelvis?
Inlet/Outlet views CT
89
How are low energy pelvis Fxs treated w/out surgery? What type of injuries are Tx w/ surgery
WBAT x 6wks High energy
90
Hip joint capsule attaches on what structures of the femur? Proximal femur Fx includes Fxs where?
Ridge between trochanters Inside joint capsule and disrupts blood supply leading to multiple complications
91
What are the risk factors for a proximal femur Fx?
``` White female Dementia >50y/o Smoke/alcohol Osteoporosis Urban setting Psychotropic use Sedentary ```
92
What is the mechanisms of injury in a proximal femur Fx? What will be seen on PE?
Fall from standing height ``` Affected limb shorter Externally rotated Abducted leg + log roll test No straight leg raise ```
93
What important x-ray image can NOT be taken for proximal femur Fxs? When are these types of Fx Tx non-surgically?
Frog leg lateral- will displace Fx more Non ambulatory, transfer only PTs
94
When are proximal femur Fx referred? What are the two types of stress Fxs of the femoral neck?
Emergency when <60y/o Tension- superior side in older PTs Compression- young/active PT on inferior side of femur neck
95
What type of stress Fx in the femur neck are pressed apart by weight bearing? Which type is more likely to complete and displace?
Tension Tension
96
What are the adverse outcomes of femoral neck stress Fxs? What will be seen on PE?
Only issues if it's a complete Fx Dec ROM w/ IR Pain w/ straight leg raise
97
What time frame are which images ordered for stress Fx of femoral neck? What caution is needed when assessing these images?
``` 2-4wks= plain x-ray 24-48hrs= bone scan 72hrs= MRI* preferred ``` Radiographic healing lags behind true healing by 10-14 days
98
How are compression Fx stress Fxs of the femoral neck Tx non-surgically? How are tension Fxs Tx w/ surgery?
No training NWB x 8wks w/ serial x-rays to monitor progression All Tx surgically w/ internal fixation
99
When are stress Fx of femur neck referred to Ortho? Distal femur Fx are usually ?
Tesnsion Compression >8 wks of compliance Supracondylar Intra-condylar Periprosthetic
100
What type of force usually causes a Fx at the tibial plateau? What tests need to be done for Fxs about the knee?
Valgus force- lateral femur compresses weaker lateral tibial plateau NV exam w/ ABI <0.9 is bad
101
What image is ordered for any intra-articular or displaced Fx about the knee? When can these Fxs be Tx non-surgically? When are they emergent for surgery Tx?
CT W/ angiography if ABI <0.9 MRI if non-displaced Non-displaced: toe touch x 6wks Vascular/Compartment syndrome
102
What is the difference between anterior/posterior stress Fxs? How are these types of Fxs treated non-surgically?
Ant: tension side Post/Medial: compression side Pain w/ walking= cast and NWB x 6wks Less pain= swim/bike PT, no run x 6wks
103
What type of surgery can be done for anterior stress Fxs as prophylaxis? When are they referred to Ortho?
Prophylactic nail All anterior No improvement x 2wks
104
How are peds femur Fxs Tx non-operative? When are they Tx w/ surgery?
6mon-5yrs: casting if non-displaced Fx and intertrochanteric, shaft Fx >6y/o, displaced, trochanteric, distal femur
105
When are peds w/ diphyseal femur Fxs referred w/ red flags? What image is ordered for Peds w/ tibia Fxs? When are these Fxs Tx w/ surgery?
<36mon w/ abuse suspicion Tibia is common site for abuse related Fxs CT articular Displaced <5* Intra-articular/physeal Open
106
When are Peds tibia Fxs referred to ortho?
Angulation >10* Physeal Articular Open
107
Hip arthritis prevalence is highest in ? systemic Dz populations? End stage arthritis is commonly seen in PTs w/ ? systemic dz
RA Ankylosing spondylitis Lupus
108
What types of gaits can be observed in PTs w/ inflammatory hip arthritis? What is the most sensitive PE finding for adults w/ hip joint dz?
Antalgic- short step phase on affected side Trendelenbur gait- develops w/ loss of articular cartilage Restricted hip ROM w/ loss of internal rotation
109
How is synovial inflammation detected in PTs w/ inflammatory arthritis of the hip? What is seen on x-rays of early/late inflammatory arthritis?
PT prone, knee flexed, gentle "rolling pin" Early: osteopenia, effusions Late: symmetric loss of space, erosion
110
Why are flexion contractures so problematic in hip OA PTs? What two abnormalities can this problem be seen as?
Affected gait, compesation w/ inc lumbar extension Antalgic- short stride on painful leg Abductor lurch- swaying trunk over affected hip
111
Why would a PT be a candidate for hip fusion due to OA? Osteonecrosis of the femur usually presents at ? age and is often ?
Young PT who has to return to work as manual laborer or lives vigorously active life 3-5th decade Bilateral
112
When does the ITB sublux? PTs w/ ITB syndrome will point to their pain being ?
Walking Hip rotation Trochanter region
113
PTs w/ snapping iliopsoas usually feel pain ? when they do ? motion How are these snapping movement replicated during a PE?
Groin Hip extends from flexed position (rising from chair) ITB: stand and rotate hip w/ it held in adduction; tightness assessed w/ Ober test Ilio: hip extension from flexed position
114
Weakness of ? muscles is common in PTs w/ painful ITB syndrome Hip strains can encompass what 5 muscles?
Hip abductors Abdominals Hip flexor- iliopsoas, sartorius, rectus femoris Hip adductors
115
What is the usual mechanism of injury for hip strains? How is a strained abductor isolated on PE?
Vigorous muscle contraction while muscle is stretched- kicked ball and leg is blocked Groin pain w/ passive abduction
116
What are the 5 phases of hip strain rehab
1: 48-72hrs; RICE, crutches 2: 72hrs-7days; PROM, heat, electric stimulation, US 3: isometric exercises, sport related training to inc strength/flexibility
117
Origin and insertion of hamstring? Transient osteoporosis of the hip is AKA ?
Ischial tuberosity Tibia/fibula Bone marrow edema syndrome
118
How long does it take for transient osteoporosis to self resolve? What type of gait do they adopt?
6-12mon Atalgic
119
What non-leg sourced issues can lead to trochanteric bursitis? Where can this pain radiate to?
Lumbar spine dz Leg, butt, or knee, NOT to foot
120
What is the essential PE finding for trochanter bursitis? How is pain replicated? What is the issue if PT pin points pain to being above greater trochanter?
Point tenderness over trochanter Hip abduction Adduction w/ internal rotation Glutues medius tendon
121
What PT movements are essential when Tx trochanter bursitis w/ physical rehab? The main job of the ACL is prevention of knee ?
Hip abduction strengthening Anterior translation
122
What knee injury is most commonly from non-contact injuries? This injury can be accompanied by other knee injuries but rarely w/ injuries to ?
ACL tears LCL or PCL
123
What PT population is more likely to have tibial eminence Fxs w/ an ACL tear? How are older PTs Tx non-surgically?
PTs w/ open physes PT w/ goal of controlling instability
124
Most ACL repair surgeries are not actual repairs, but instead are ? OA of medial or lateral compartments lead to ?
Grafts using patellar tendon, hamstring/quad tendon or cadaver tissue Medial: Genu varum Lateal: Genu valgum
125
Isolated patellofemoral OA can exist, especially in ? PT population? This is more frequently found in PTs w/ ?
Patellar subluxation Patella baja Tibiofemoral OA
126
RA of the knee usually involves ? compartment Gout causes knee destruction via ? while pseudogout causes destruction via?
Genu valgum, lateral Uric acid Calcium pyrophosphate
127
OA usually affects what 3 PT populations? It is not uncommon for knee OA PTs to present w/ ? bilateral knee malformity?
>55y/o Obese FamHx of Dz Windswept deformity- one knee valgus, one knee varus
128
What type of x-rays are taken to measure the degree of joint space loss? What adjunct can PT use to decrease swelling and improve movement by keeping the oint warm?
Weight bearing AP w/ full extension Knee sleeve/elastic bandage
129
What is as effective as NSAIDs for OA Tx? What type of management/Tx is NOT done in knee OA PTs?
PT w/ strength, gait and balance focused plans Arthoscopic exams
130
What do osteotomy do for knee OA issues? Bursitis of the prepatellar bursa is AKA ?
Unloading tibial/femoral osteotomy can improve alignment, dec pain x 5-10yrs House maid knee
131
The pes anserinus burs lies between what structure landmarks? This form of bursitis can occur from overuse but is usually due to ?
Beneat insertion of sartorius, gracilis and semitendinous muscle on medial flare of tibia Early OA in medical compartment
132
How is pes anserinus bursitis differentiated from medial meniscus pathology? If this bursa swell, what neurological finding can be seen?
Pes anserine is distal to joint line Saphenous nerve and infrapatellar branch compression, numbness distal to patella
133
What therapeutic modalities can help w/ non-infected knee bursitis? What is the underlying issue of neurogenic claudication?
US and Phonophoresis Spinal stenosis causing Ischemia to clauda equina
134
What is the underlying issue of vascular claudication? Neurogenic claudication
Peripheral vascular dz and compromised vascular flow Buttocks and spreads while walking, inc w/ down hill waking Improved w/ bike riding Prox to distal
135
Vascular claudication Neurogenic claudication may have a normal exam at rest, what can be done to cause Sxs?
Pain stops w/ stopping activity Worse w/ bike riding Pain starts distally, works proximal Weakness/reflex changes after provocation exercises
136
What findings may be seen on PE in PTs w/ arterial insufficiency induced claudication? What two knee tendons are intra/extra articular?
Diminished pulses below waist Extremities are cool Ulcerations on toes Inc erythema/pallor w/ elevation Intra: ACL PCL Extra: LCL, MCL
137
What is the mechanism of injury in a MCL tear What is the mechanism of the less common LCL tear
Valgus, abduction Varus, adduction
138
What additional findings when examining a MCL injury should increase suspicion of a lateral meniscus tear? How is the LCL and MCL best examined?
Mechanical Sxs Lateral joint line tenderness MCL- knee in slight flexion LCL- leg in figure 4 position
139
What knee PE findings are considered knee dislocations w/ spontaneous reduction What tests are done after this discovery?
Valgus/Varus laxity in full extension= ACL/PCL disruption and posterior capsule involvement Neuro ABI
140
How can the knee be wrapped to expedite recovery after a severe quad contusion? Normally the ITB sits ? and bending the knee more than ?* moves the ITB in which direction?
Hyperflexion w/ elastic bandage Anterior to LatFemCon 30* Moves posterior to lateral femoral condyle
141
Athletes w/ ? pre-existing risk factors can develop ITB syndrome? What functional test can be done after an Ober test to confirm ITB syndrome?
Genu Varum Internal tibia rotation Excessive foot pronation One legged hop causing lateral knee pain
142
What 4 areas are focused on when PTs w/ ITB go to rehab? What 3 activities usually precede a gastrocnemius tear in ? population
Hamstring Tensor fasciae latate Hip external rotator flexibility Hip abductor weakness Tennis Hill running Jumping +30y/o
143
What test can be positive in a PT w/ a gastrocnemius tear that can also signify Achilles tendon tear? What movement modifiers are used when Tx this injury non-surgically?
- Thompson test- passive plantar flexion of the foot when calf is squeezed CAM boot 0.5" hell lift Calf sleeve/compression hose Crutches
144
What type of PT presentation is a warning of a non-functioning meniscal tear? What imaging needs to be done on all suspected meniscal tears prior to MRI?
Obese PT w/ pop followed by pain at posterior knee Weight bearing x-rays
145
When are arthroscopic surgical debridement surgeries indicated for meniscal tears? What x-ray findings indicate if femoral condyle osteonecrosis is early or late?
Young PT w/ substantial tear Locked knee Non-surgical Tx failure Early: sclerosis, flattened condyle Late: narrowing, osteophytes
146
What is the hallmark Sx of Jumper's Knee When do PTs say the pain is most noticeable
Anterior knee pain Right after exercise or, While sitting down after exercise
147
What adverse MSK issue can develop in long lasting Jumper knee? What would be seen on x-ray
Atrophy of Vastus Medialis Obliques Calcification at tendon insertions Heterotopic ossification at upper/lower poles
148
When assessing a knee for a quad/patella rupture, how is the knee placed for x-rays Medial patellar instability is rare but can occur in ? setting
30* flexion to assess angle between inferior pole and Blumensaat line Surgical lateral retinacular release
149
If PT can't recall a knee injury/dislocation, the Sxs usually mimic what other knee injury? What is the hallmark Sx of PT w/ malalignment
ACL tear Retropatellar pain
150
Why is gait assessed in PTs complaining of patellofemoral pain? What foot issue can increase/be present in this knee d/o? What muscle circumference needs to be measured and compared to contralateral side?
Patellar squinting- patella point towards each other during amublation, sing of femoral anteversion/weakness of glute medius) Foot pronation- flat foot Vastus medialis obliques
151
When assessing patellofemoral pain, examiner can bend knee to 30* and move the patella how far in each direction? What does a patellar tilt indicate?
One quadrant medial Two quadrants laterally Lateral retinacular tightness
152
What is the hallmark Tx of patellofemoral pain? What type of mechanical assistance can be used during rehab?
PT rehab McConnell taping
153
What is a pilca and how many are there? Which ones are more prominent and where are they located?
Fold of synovium in the knee, 5 Suprapatellar- under quad tendon to medial/lateral capsule Infrapatellar- ligamentum mucosa, ant/post and over ACL Medial- medial capsule to medial anterior fat pad
154
Why do inflamed plica cause issues? What complaint/Sx is rare w/ these inflammations? Patholocial plicas may pop when bent to __*
Bowstring over femoral condyle Locking, giving away, effusions 60*
155
How are pathological plicas Tx? What is the most common benign synovial cyst of the knee
Arthroscopic resection Popliteal/Baker's
156
Popliteal cysts are associated w/ ? 2 underlying conditions? What Sx may PTs complain of? What PT population usually experience a burst cyst?
RA Degenerative meniscus tears Numb plantar surface +40y/o w/ RA or degenerative joint dz
157
What are the red flags of a popliteal cyst? Where does the PCL originate and insert
CA like Sxs Pulsatile cysts may be popliteal aneurysms Medial intercondyle of femur, behind ACL inserts on posterior tibia below joint line
158
What 4 clinical patterns suggest a torn PCL What two nerves can be damaged by this injury if left un treated?
Dashboard injury Fall on flexed knee w/ plantar flexed foot Pure hyper flexion injury to knee Hyper extension knee injury after ACL ruptures Peroneal or Tibial nerves
159
What is the most common location for osteochondritis dissecans in the knee to occur? What is required to make a Dx of chondromalacia
Lateral aspect of medial femoral condyle Arthroscopy
160
Genu Varum can be caused by ? Dz What image is used to assess distal tibial Fxs in a child? What causes anterior knee pain in Peds PTs?
Blount Dz CT Repetitive stress MC= patellar maltracking
161
Where is pain localized in Peds w/ painful plica or bipartite patella? What other exam needs to be done in these PTs?
Plica: medial side Bipart: superolateral pole Hip- SCFE or Legg-Calve Dz
162
How are Peds w/ Sx Plica Tx The Ortolani maneuver becomes negative w/ age at ? What is the only modifiable risk factor of hip dysplasia?
7-10 days in knee rest in extended position 3mon Swaddling, avoid in new borns
163
Internal tibial torsion is the most common diagnosis in ? Inc femoral anteversion is most common in ? What is used to quantify in/out toeing of a child?
Toddlers Peds +4y/o Foot angle progression
164
What hip measurement w/ PT prone is indicative of tibial torsion? What condition can develop as result of out toeing? What additional test is performed for tibial out torsion?
Great than 10-15* Pes Planovalgus Ober test
165
If Peds PT requires surgery to correct in/out toeing, what ages can they have the surgery? Tibial torsion usually presents ? while femoral presents /
Tibia: 6-8y/o Femur: 10-12y/o Tibial: asymmetric Femur: symmetric
166
Male Peds w/ LCPD, 90% present w/ ? while another 1/3 tend to have ? and the smallest percent have ? What are the 3 phases of LCPD What is a common x-ray finding in PTs w/ LCPD
Delayed bone age ADHD Transient synovitis Crescent sign- subchondral fx Fragmentation- epiphysis collapse Resossification- healing starts Coxa magna Bilateral cases in different stages of dz
167
If Peds presents w/ bilateral LCPD, what additional lab test needs to be done after imaging? What is seen on radiographs of OS/SLJ dz? Peds w/ OS need to have parents educated that sports are to be avoided for ?
Hypothyroid OS: heterotopic ossification on tuberal tuberosity SLJ: elongation of inferior pole of patella 2-3mon
168
What is the MC presenting Sx of a SCFE? What finding is the most sensitive and specific on PE? How are these Dx's confirmed
Pain Loss of IR of hip AP and Frog-lateral x-rays Klein line front superior femoral neck doesn't intersect w/ lateral capital femoral epiphysis
169
What is the immediate next piece of info after the Dx of a SCFE is given? What is a common cause of childhood limping between 2-7y/o? What lab tests is added to imaging for these PTs?
No weight bearing at all Transient synovitis, b>g x3 Anti-strep O Ag test
170
What are the 3 most significant adverse outcomes from femur Fxs? PTs w/ open femur Fxs get what two things?
Fat embolism ARDS Multisystem organ failure Tetanus Systemic ABX
171
What meds are given prophylactically for Fxs about the knee? What is the draw back for taking x-rays to assess stress Fxs
Anticoags Fx may not be visible for 3wks or more after injury
172
How are non-displaced neck and intertrochanteric Fxs Tx in Peds How are femoral shaft Fxs Tx?
Cast immobilization Spica casting or early splint/bed rest/cast

IPAP (212 decks)

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