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IPAP > Ortho: Block 3 > Flashcards

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
Q

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?

A

> 40mmHg

Pain out of proportion to exam
Main test= passive stretch of muscles in compartment

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26
Q

What is the limit indicating acute compartment pressure

What are the adverse outcomes if the syndrome is not Tx?

A

Within 30mmHg of diastolic BP
>30mm post-exercise
>20mm 5min post-exercise

Amputation
Kidney failure from rhabdo

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27
Q

What muscles are passively stretched to isolate which knee compartment is involved w/ compression?

A

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

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28
Q

What is the name of the tool used to measure compartment pressures?

How can chronic compartment syndrome be Tx w/out surgery?

A

Striker tool

Retrain how they run

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29
Q

How are compartment syndromes Tx w/ surgery?

What is the adverse outcome of this Tx?

A

Fasciotomy- surgical emergency

Scars

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30
Q

When are leg contusions red flagged for referral?

What two structures does the ITB connect to?

A

Coagulopathy
Compartment syndrome

Ileum
Tibia
Crosses both hip and knee joint, on outside of femoral condyle

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31
Q

What 2 PT populations develop ITB Syndrome?

What is the name of the tubercle that the ITB inserts on?

A

Distance runners
Cyclists

Gerdy’s tubercle

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32
Q

Where are gastrocnemius tears more likely to occur?

What are adverse outcomes of this injury?

A

Medial head in +30y/o

Shortened tendon
DVT

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33
Q

Where do knee meniscal tears occur?

What is an adverse outcome of this injury?

A

Anterior horn of medial meniscus

OA

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34
Q

What exams are done during PE for meniscal tears?

What type of tear is severe?

A

McMurray- audible/palpable click
Apley- pain test
Thessaly- pain test, specific

Bucket handle- posterior fragment flips anterior, causes locked leg and beyond rehab ability

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35
Q

How are meniscus tears managed non-operatively?

What types are Tx w/ surgery?

A

Rehab w/ early ROM goals

Peripheral- repair
Large- debridement

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36
Q

When are meniscus tears referred to Ortho?

Where does osteonecrosis of the femoral condyle occur?

What can cause this?

A

Mechanical Sxs
Peripheral tears

Weight bearing medial condyle

Systemic steroids
Systemic dzs- Gaucher
Renal transplant/Sickle cell
MC: female +60y/o

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37
Q

Since osteonecrosis of the femoral condyle can’t be fixed w/out surgery, what operative Txs can be done?

When are these PTs referred?

A

Arthroscopy
Osteomies
Arthroplasty

ALL PTs are referred

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38
Q

Patellar/Quad tendonitis is AKA ?

What do PTs complain of in clinic?

A

Jumper’s knee
Infer/Superior pole of patella

Pain w/ quad exercise inc w/ resisted extension

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39
Q

What is different about patellar/quad tendon ruptures?

What would be seen of an early case of this tendonitis?

A

No precursor of tendonitis is req’d

Spurs
If at tibial tuberosity- Hx of O-S

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40
Q

What are the 3 phases of non-surgical management of Patellar/Quad tendonitis?

What is the adverse outcome of this management?

A

Rest
Pain free ROM, flexibility and strengthening
Resume activities- heat before, ice after

Persistent functional impairment

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41
Q

How does the PT population differ between quad tendon and patellar tendon tears?

What is the clinical triad at presentation?

A

Quad: white male, 40-60y/o
Patella: black male, 40-60y/o

Palapable defect
Inability to extend
Change in patella height on x-ray

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42
Q

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?

A

Palpable defect
Effusion
No extension

Patella alta= patellar tendon rupture, patella is higher
Patella baja= quad tendon rupture, patella is lower
Quantify w/ MRI

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43
Q

What are the adverse outcomes of knee/quad tendon repair surgery?

All of these tears need to be surgically repaired w/in ? time frame?

A

Thromboembolism
Retearing of tendon

1wk

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44
Q

Patellofemoral maltracking usually occurs in ? direction but can be due to laxity of ?

How are these dislocations reduced?

A

Laterally
Medial patellofemoral ligament

Spontaneously w/ knee bending

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45
Q

What is seen on exam of PTs w/ patellofemoral maltracking?

What type of x-ray view is used to assess?

A

Retropatellar knee pain
J-sign: abnormal lateral tracking of knee
Apprehension test

Sunrise- Merchant or Laurin view

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46
Q

How are patellofemoral maltracking PTs managed non-operatively?

How are they repaired surgically?

What adverse event can occur even w/ treatment?

A 
Acute= Brace, NSAID
Chronic= quad exercise, brace

MPFL repair
Osteotomy

Recurrent Sxs

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47
Q

Patellofemoral pain is characterized by the ? sign and presents w/ pain during ?

How does PT pinpoint their pain?

A

Theater sign- pain w/ prolonged sitting
Quad activities

Circle around patella

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48
Q

How is patellofemoral pain Tx w/out surgery?

Which plica is more likely to be affected?

A

Hamstring/Quad strength
Full AROM

Medial

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49
Q

What is an adverse outcome of plica syndrome

How can this be Tx w/out surgery?

What surgical Tx option is available

A

Erosion of femoral condyle

Injection into plica

Arthroscopy

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50
Q

Popliteal cysts are AKA ?

PTs will pinpoint their pain to be between what two structures?

A

Baker cysts
Synovial cyst- similar to ganglion cyst

Medial gastrocnemius
Semimembranous

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51
Q

What imaging modality is preferred for popliteal cysts?

How can these be Tx w/ non-surgical and surgical methods?

A

US, also r/o DVT

Non: US guided aspiration
Surg: Tx

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52
Q

What is the function of the PCL?

What type of injury force causes a tear?

A

Keeps tibia from tracking back/behind femur

Forces applied to tibia and pushing it posterior (dashboard accidents)
Knee dislocation, posterior direction is MC

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53
Q

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?

A

Tibialis posterior muscle causing over pronation (pes planus) of ankle

Distal 1/3 of posterior medial crest, origin site of tibialis posterior

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54
Q

How are kids w/ anterior knee pain Tx w/out surgery

Which ones can be Tx w/ surgery but only when ?

A

Rest, Strength, Lengthen/Stretch

Plica/Bipartite- after 3-6mon of PT

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55
Q

What risk factors can lead to developmental hip dysplasia?

This deformity is associated w/ ? 3 issues

A 
FamHx
Breech birth
Oligohydramnios
First born
Swaddling
Female

Metatarsus adductus
Congenital muscular torticolis
Hyperextension of knee

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56
Q

What is the first inidcator a child has developmental dysplasia of the hip?

W/out Tx, this issue can develop into ?

A

Walking creates pain

Degenerative joint dz
Secondary OA
Pain w/ activity

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57
Q

Every child under 1yr old gets what two tests?

What two additional tests can be done for further info?

A

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

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58
Q

What is the preferred imaging modality for assessing developmental dysplasia of the hip in Peds?

How is this Tx w/out surgery?

A

US

Modified swaddling
Concentric reduction= normal acetabulum
Pavlik harness until 6mon

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59
Q

How is developmental hip dysplasia in Peds Tx w/ surgery?

What are adverse events that can occur in this d/o?

A

Closed reduction- cast
Surgical reduction

Femoral nerve palsy
Osteonecrosis

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60
Q

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?

A

+ 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

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61
Q

What degree of Genu Valgum in Peds is normal for their age

Most of these cases are ?

A

Birth: 10-15* varus
12-18mon: neutral
2-4yr: 10-15* valgus
11y/o: 5-7* valgus

ASx

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62
Q

What two angles are measured when assessing for Genu Valgum

What x-ray images are used for measurement?

A

Tibiofemoral angle
Intermalleolar distance

Full length hip to ankle film

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63
Q

Non-operative Tx is used for Genu Valgum if the PT is what age?

What surgical procedures are used for surgical Tx?

A

3-4y/o or,
ASx

Hemi-epiphysiodesis
Osteotomy

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64
Q

When are Peds w/ Genu Valgum referred to Ortho?

What two angles are used for measuring Genu Varum PTs?

A

Asymmetric
Short stature
After 12mon

Tibofemoral angle
Intercondylar distance

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65
Q

What 3 criteria indicate the need for x-rays in a PT w/ Genu Varum

What surgical procedure is done to correct this?

A

At 2y/o
<25th height percentile
Asymmetric

Osteotomy at 4y/o

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66
Q

When are Genu Varum cases referred to Ortho/

What are 3 causes of intoeing?

What are 2 causes of outtoeing?

A

> 5y/o
Worsening condition

Foot deformity
Inward tibial rotation
Inward femur rotation

Outward rotation of femur or Tibia

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67
Q

How to Pts w/ in/out toeing present?

What needs to be assessed on PE?

A

No pain
Tripping/inability to keep up

Assessment of femur, tibia, foot

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68
Q

How are in/out toeing Tx non-surgically or surgical?

When are they referred?

A

Non: reassurance
Op: osteotomy

Assymetric
No improvement
Complaints of other issues

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69
Q

Define Legg-Calve Perthes Dz

What PT population does this occur in?

A

Osteonecrosis of femoral head

Boys 4-8y/o

70
Q

What are the Sxs of Legg-Calve Perthese Dz

What are the adverse outcomes of this Dz?

A

Limp + groin pain

Secondary OA
Discrepancy in leg length

71
Q

What is seen on PE of Legg Calve Perthes Dz

What will be seen on x-ray

A

Dec abduction and internal rotation
Pelvic shift when standing on one leg

Crescent sign= subchondral Fx

72
Q

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?

A

Fragmentation stage

Reossification stage

73
Q

How is Legg Calve Perthes Dz Tx non-operative

What is the only surgical Tx when the femoral head is misshapen?

A

Bed rest
NSAID
ROM therapy

Joint replacement- means multiple surgeries through out life

74
Q

When do LCP Dx PT need to be referred?

Define Osgood Schlatter Dz

Define Sinding Larsen Johansen

A

<6y/o w/ great involvement or
<40* abduction
>6y/o

Apophysitis at tibia tubercle

Apophysitis at patella

75
Q

What causes Sxs in Peds w/ OS or SLJ Dz

What will be seen on x-rays

A

Quad activities
Theater sign
TTP at tibial tubercle OR distal patella pole

Heterotropic ossification
Unfused apophysis

76
Q

How is OS/SLJ Dz Tx non-surgically

When are they referred to ortho?

A

RICE Stretch

Inability to perform straight leg raise

77
Q

Slipped capital femoral epiphysis is AKA ?

What PT population does it occur in?

A

Saltar Harris Type 1 femur Fx

Over weight, black males 13-15y/o or girls 11-13y/o

78
Q

How do PTs w/ slipped capital femoral epiphysis present?

What body mechanic is changed due to these Sxs?

A

Pain and limp worse w/ activity

External rotation (unstable Fx, non-weight bearing)
Dec internal rotation
79
Q

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?

A

Klein line- superior femoral neck into joint

Stabilization of physis w/
screw fixation

All are referred

80
Q

What type of issue is transient synovitis of the hip in Peds?

What do these PTs present complaining of?

A

Sterile effusion

Groin pain

81
Q

What motions have dec ROM in transient synovitis?

What Labs/Rads are ordered?

A

Dec ROM w/ abduction or internal rotation

US*, x-ray
CBC w/ Diff- norm
ESR/CRP- elevated

82
Q

Hip dislocations usually occur in which direction?

What adverse outcome can occur after these injuries?

A

Posterior

Osteonecrosis

83
Q

Define Posterior/Anterior hip dislocations w/ words

A

Post: short, flexed, adducted/internal rotated w/ sciatic nerve palsy

Ant: flexed, aBducted and externally rotated; femoral nerve palsy

84
Q

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?

A

Ant: femoral head larger
Post: femoral head smaller

Acetabular Fx- CT

85
Q

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?

A 
NV exam
Rad
Sedate
Reduction
NV exam
Rad + CT

Weight bearing as tolerated x 4wks

86
Q

When are hip dislocations considered candidates for surgery?

What must be included when x-raying femurs after Fx?

A

Unable to reduce
Acetabulum Fx on posterior edge

Femoral neck

87
Q

What is the difference between a stable/unstable pelvis Fx?

What PE findings indicate immediate refferals?

A

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
Q

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?

A

Inlet/Outlet views

CT

89
Q

How are low energy pelvis Fxs treated w/out surgery?

What type of injuries are Tx w/ surgery

A

WBAT x 6wks

High energy

90
Q

Hip joint capsule attaches on what structures of the femur?

Proximal femur Fx includes Fxs where?

A

Ridge between trochanters

Inside joint capsule and disrupts blood supply leading to multiple complications

91
Q

What are the risk factors for a proximal femur Fx?

A 
White female
Dementia
>50y/o
Smoke/alcohol
Osteoporosis
Urban setting
Psychotropic use
Sedentary
92
Q

What is the mechanisms of injury in a proximal femur Fx?

What will be seen on PE?

A

Fall from standing height

Affected limb shorter
Externally rotated
Abducted leg
\+ log roll test
No straight leg raise
93
Q

What important x-ray image can NOT be taken for proximal femur Fxs?

When are these types of Fx Tx non-surgically?

A

Frog leg lateral- will displace Fx more

Non ambulatory,
transfer only PTs

94
Q

When are proximal femur Fx referred?

What are the two types of stress Fxs of the femoral neck?

A

Emergency when <60y/o

Tension- superior side in older PTs
Compression- young/active PT on inferior side of femur neck

95
Q

What type of stress Fx in the femur neck are pressed apart by weight bearing?

Which type is more likely to complete and displace?

A

Tension

Tension

96
Q

What are the adverse outcomes of femoral neck stress Fxs?

What will be seen on PE?

A

Only issues if it’s a complete Fx

Dec ROM w/ IR
Pain w/ straight leg raise

97
Q

What time frame are which images ordered for stress Fx of femoral neck?

What caution is needed when assessing these images?

A 
2-4wks= plain x-ray
24-48hrs= bone scan
72hrs= MRI* preferred

Radiographic healing lags behind true healing by 10-14 days

98
Q

How are compression Fx stress Fxs of the femoral neck Tx non-surgically?

How are tension Fxs Tx w/ surgery?

A

No training
NWB x 8wks w/ serial x-rays to monitor progression

All Tx surgically w/ internal fixation

99
Q

When are stress Fx of femur neck referred to Ortho?

Distal femur Fx are usually ?

A

Tesnsion
Compression >8 wks of compliance

Supracondylar
Intra-condylar
Periprosthetic

100
Q

What type of force usually causes a Fx at the tibial plateau?

What tests need to be done for Fxs about the knee?

A

Valgus force- lateral femur compresses weaker lateral tibial plateau

NV exam w/ ABI
<0.9 is bad

101
Q

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?

A

CT
W/ angiography if ABI <0.9
MRI if non-displaced

Non-displaced: toe touch x 6wks

Vascular/Compartment syndrome

102
Q

What is the difference between anterior/posterior stress Fxs?

How are these types of Fxs treated non-surgically?

A

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
Q

What type of surgery can be done for anterior stress Fxs as prophylaxis?

When are they referred to Ortho?

A

Prophylactic nail

All anterior
No improvement x 2wks

104
Q

How are peds femur Fxs Tx non-operative?

When are they Tx w/ surgery?

A

6mon-5yrs: casting if non-displaced Fx and intertrochanteric, shaft Fx

> 6y/o, displaced, trochanteric, distal femur

105
Q

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?

A

<36mon w/ abuse suspicion
Tibia is common site for abuse related Fxs

CT articular

Displaced <5*
Intra-articular/physeal
Open

106
Q

When are Peds tibia Fxs referred to ortho?

A

Angulation >10*
Physeal
Articular
Open

107
Q

Hip arthritis prevalence is highest in ? systemic Dz populations?

End stage arthritis is commonly seen in PTs w/ ? systemic dz

A

RA
Ankylosing spondylitis

Lupus

108
Q

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?

A

Antalgic- short step phase on affected side
Trendelenbur gait- develops w/ loss of articular cartilage

Restricted hip ROM w/ loss of internal rotation

109
Q

How is synovial inflammation detected in PTs w/ inflammatory arthritis of the hip?

What is seen on x-rays of early/late inflammatory arthritis?

A

PT prone, knee flexed, gentle “rolling pin”

Early: osteopenia, effusions
Late: symmetric loss of space, erosion

110
Q

Why are flexion contractures so problematic in hip OA PTs?

What two abnormalities can this problem be seen as?

A

Affected gait, compesation w/ inc lumbar extension

Antalgic- short stride on painful leg
Abductor lurch- swaying trunk over affected hip

111
Q

Why would a PT be a candidate for hip fusion due to OA?

Osteonecrosis of the femur usually presents at ? age and is often ?

A

Young PT who has to return to work as manual laborer or lives vigorously active life

3-5th decade
Bilateral

112
Q

When does the ITB sublux?

PTs w/ ITB syndrome will point to their pain being ?

A

Walking
Hip rotation

Trochanter region

113
Q

PTs w/ snapping iliopsoas usually feel pain ? when they do ? motion

How are these snapping movement replicated during a PE?

A

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
Q

Weakness of ? muscles is common in PTs w/ painful ITB syndrome

Hip strains can encompass what 5 muscles?

A

Hip abductors

Abdominals
Hip flexor- iliopsoas, sartorius, rectus femoris
Hip adductors

115
Q

What is the usual mechanism of injury for hip strains?

How is a strained abductor isolated on PE?

A

Vigorous muscle contraction while muscle is stretched- kicked ball and leg is blocked

Groin pain w/ passive abduction

116
Q

What are the 5 phases of hip strain rehab

A

1: 48-72hrs; RICE, crutches
2: 72hrs-7days; PROM, heat, electric stimulation, US
3: isometric exercises, sport related training to inc strength/flexibility

117
Q

Origin and insertion of hamstring?

Transient osteoporosis of the hip is AKA ?

A

Ischial tuberosity
Tibia/fibula

Bone marrow edema syndrome

118
Q

How long does it take for transient osteoporosis to self resolve?

What type of gait do they adopt?

A

6-12mon

Atalgic

119
Q

What non-leg sourced issues can lead to trochanteric bursitis?

Where can this pain radiate to?

A

Lumbar spine dz

Leg, butt, or knee, NOT to foot

120
Q

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?

A

Point tenderness over trochanter

Hip abduction
Adduction w/ internal rotation

Glutues medius tendon

121
Q

What PT movements are essential when Tx trochanter bursitis w/ physical rehab?

The main job of the ACL is prevention of knee ?

A

Hip abduction strengthening

Anterior translation

122
Q

What knee injury is most commonly from non-contact injuries?

This injury can be accompanied by other knee injuries but rarely w/ injuries to ?

A

ACL tears

LCL or PCL

123
Q

What PT population is more likely to have tibial eminence Fxs w/ an ACL tear?

How are older PTs Tx non-surgically?

A

PTs w/ open physes

PT w/ goal of controlling instability

124
Q

Most ACL repair surgeries are not actual repairs, but instead are ?

OA of medial or lateral compartments lead to ?

A

Grafts using patellar tendon, hamstring/quad tendon or cadaver tissue

Medial: Genu varum
Lateal: Genu valgum

125
Q

Isolated patellofemoral OA can exist, especially in ? PT population?

This is more frequently found in PTs w/ ?

A

Patellar subluxation
Patella baja

Tibiofemoral OA

126
Q

RA of the knee usually involves ? compartment

Gout causes knee destruction via ? while pseudogout causes destruction via?

A

Genu valgum, lateral

Uric acid
Calcium pyrophosphate

127
Q

OA usually affects what 3 PT populations?

It is not uncommon for knee OA PTs to present w/ ? bilateral knee malformity?

A

> 55y/o
Obese
FamHx of Dz

Windswept deformity- one knee valgus, one knee varus

128
Q

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?

A

Weight bearing AP w/ full extension

Knee sleeve/elastic bandage

129
Q

What is as effective as NSAIDs for OA Tx?

What type of management/Tx is NOT done in knee OA PTs?

A

PT w/ strength, gait and balance focused plans

Arthoscopic exams

130
Q

What do osteotomy do for knee OA issues?

Bursitis of the prepatellar bursa is AKA ?

A

Unloading tibial/femoral osteotomy can improve alignment, dec pain x 5-10yrs

House maid knee

131
Q

The pes anserinus burs lies between what structure landmarks?

This form of bursitis can occur from overuse but is usually due to ?

A

Beneat insertion of sartorius, gracilis and semitendinous muscle on medial flare of tibia

Early OA in medical compartment

132
Q

How is pes anserinus bursitis differentiated from medial meniscus pathology?

If this bursa swell, what neurological finding can be seen?

A

Pes anserine is distal to joint line

Saphenous nerve and infrapatellar branch compression, numbness distal to patella

133
Q

What therapeutic modalities can help w/ non-infected knee bursitis?

What is the underlying issue of neurogenic claudication?

A

US and Phonophoresis

Spinal stenosis causing Ischemia to clauda equina

134
Q

What is the underlying issue of vascular claudication?

Neurogenic claudication

A

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
Q

Vascular claudication

Neurogenic claudication may have a normal exam at rest, what can be done to cause Sxs?

A

Pain stops w/ stopping activity
Worse w/ bike riding
Pain starts distally, works proximal

Weakness/reflex changes after provocation exercises

136
Q

What findings may be seen on PE in PTs w/ arterial insufficiency induced claudication?

What two knee tendons are intra/extra articular?

A

Diminished pulses below waist
Extremities are cool
Ulcerations on toes
Inc erythema/pallor w/ elevation

Intra: ACL PCL
Extra: LCL, MCL

137
Q

What is the mechanism of injury in a MCL tear

What is the mechanism of the less common LCL tear

A

Valgus, abduction

Varus, adduction

138
Q

What additional findings when examining a MCL injury should increase suspicion of a lateral meniscus tear?

How is the LCL and MCL best examined?

A

Mechanical Sxs
Lateral joint line tenderness

MCL- knee in slight flexion
LCL- leg in figure 4 position

139
Q

What knee PE findings are considered knee dislocations w/ spontaneous reduction

What tests are done after this discovery?

A

Valgus/Varus laxity in full extension= ACL/PCL disruption and posterior capsule involvement

Neuro
ABI

140
Q

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?

A

Hyperflexion w/ elastic bandage

Anterior to LatFemCon
30*
Moves posterior to lateral femoral condyle

141
Q

Athletes w/ ? pre-existing risk factors can develop ITB syndrome?

What functional test can be done after an Ober test to confirm ITB syndrome?

A

Genu Varum
Internal tibia rotation
Excessive foot pronation

One legged hop causing lateral knee pain

142
Q

What 4 areas are focused on when PTs w/ ITB go to rehab?

What 3 activities usually precede a gastrocnemius tear in ? population

A

Hamstring
Tensor fasciae latate
Hip external rotator flexibility
Hip abductor weakness

Tennis
Hill running
Jumping
+30y/o

143
Q

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?

A
  • Thompson test- passive plantar flexion of the foot when calf is squeezed

CAM boot
0.5” hell lift
Calf sleeve/compression hose
Crutches

144
Q

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?

A

Obese PT w/ pop followed by pain at posterior knee

Weight bearing x-rays

145
Q

When are arthroscopic surgical debridement surgeries indicated for meniscal tears?

What x-ray findings indicate if femoral condyle osteonecrosis is early or late?

A

Young PT w/ substantial tear
Locked knee
Non-surgical Tx failure

Early: sclerosis, flattened condyle
Late: narrowing, osteophytes

146
Q

What is the hallmark Sx of Jumper’s Knee

When do PTs say the pain is most noticeable

A

Anterior knee pain

Right after exercise or,
While sitting down after exercise

147
Q

What adverse MSK issue can develop in long lasting Jumper knee?

What would be seen on x-ray

A

Atrophy of Vastus Medialis Obliques

Calcification at tendon insertions
Heterotopic ossification at upper/lower poles

148
Q

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

A

30* flexion to assess angle between inferior pole and Blumensaat line

Surgical lateral retinacular release

149
Q

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

A

ACL tear

Retropatellar pain

150
Q

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?

A

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
Q

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?

A

One quadrant medial
Two quadrants laterally

Lateral retinacular tightness

152
Q

What is the hallmark Tx of patellofemoral pain?

What type of mechanical assistance can be used during rehab?

A

PT rehab

McConnell taping

153
Q

What is a pilca and how many are there?

Which ones are more prominent and where are they located?

A

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
Q

Why do inflamed plica cause issues?

What complaint/Sx is rare w/ these inflammations?

Patholocial plicas may pop when bent to __*

A

Bowstring over femoral condyle

Locking, giving away, effusions

60*

155
Q

How are pathological plicas Tx?

What is the most common benign synovial cyst of the knee

A

Arthroscopic resection

Popliteal/Baker’s

156
Q

Popliteal cysts are associated w/ ? 2 underlying conditions?

What Sx may PTs complain of?

What PT population usually experience a burst cyst?

A

RA
Degenerative meniscus tears

Numb plantar surface

+40y/o w/ RA or degenerative joint dz

157
Q

What are the red flags of a popliteal cyst?

Where does the PCL originate and insert

A

CA like Sxs
Pulsatile cysts may be popliteal aneurysms

Medial intercondyle of femur, behind ACL inserts on posterior tibia below joint line

158
Q

What 4 clinical patterns suggest a torn PCL

What two nerves can be damaged by this injury if left un treated?

A

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
Q

What is the most common location for osteochondritis dissecans in the knee to occur?

What is required to make a Dx of chondromalacia

A

Lateral aspect of medial femoral condyle

Arthroscopy

160
Q

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?

A

Blount Dz

CT

Repetitive stress
MC= patellar maltracking

161
Q

Where is pain localized in Peds w/ painful plica or bipartite patella?

What other exam needs to be done in these PTs?

A

Plica: medial side
Bipart: superolateral pole

Hip- SCFE or Legg-Calve Dz

162
Q

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?

A

7-10 days in knee rest in extended position

3mon

Swaddling, avoid in new borns

163
Q

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?

A

Toddlers

Peds +4y/o

Foot angle progression

164
Q

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?

A

Great than 10-15*

Pes Planovalgus

Ober test

165
Q

If Peds PT requires surgery to correct in/out toeing, what ages can they have the surgery?

Tibial torsion usually presents ? while femoral presents /

A

Tibia: 6-8y/o
Femur: 10-12y/o

Tibial: asymmetric
Femur: symmetric

166
Q

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

A

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
Q

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 ?

A

Hypothyroid

OS: heterotopic ossification on tuberal tuberosity
SLJ: elongation of inferior pole of patella

2-3mon

168
Q

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

A

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
Q

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?

A

No weight bearing at all

Transient synovitis, b>g x3

Anti-strep O Ag test

170
Q

What are the 3 most significant adverse outcomes from femur Fxs?

PTs w/ open femur Fxs get what two things?

A

Fat embolism
ARDS
Multisystem organ failure

Tetanus
Systemic ABX

171
Q

What meds are given prophylactically for Fxs about the knee?

What is the draw back for taking x-rays to assess stress Fxs

A

Anticoags

Fx may not be visible for 3wks or more after injury

172
Q

How are non-displaced neck and intertrochanteric Fxs Tx in Peds

How are femoral shaft Fxs Tx?

A

Cast immobilization

Spica casting or early splint/bed rest/cast

IPAP (212 decks)

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