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SUMMED2 > ORTHO-HIP KNEE > Flashcards

ORTHO-HIP KNEE Flashcards

1
Q

Pt c/o of Hip pain what is systematic step?

A

Consider Anatomy- Proximal to Distal 1. Low back-DISC 2. Hip-SI Jt 3. Femur, Internal vs External: 1. Infx/Arthritis 1. Organ Referral Appendix 2. DVT, PAD 3. Labrum, Bursa 4. Ligament 5. MSK. EMErgent 1. INfx/Arthris 2. DVT 3. PAD

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2
Q

What Q/A is concerning?

A

Onset Location Duration C Associate sx Radiation Trauma Severity

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3
Q

This DDX is pain and tenderness over greater trochanteric bursa. Pain is worse with initial movement, better with ROM. Pt will state cannot lie on affected side.

A

Trochanteric Bursitis PE- TTP Pain w/ ER of hip DX- X Ray? TX- NSAIDs PT, Kenalog 40/0.5 Marcaine/1% Lidocaine- 1-2 ml cs+local anesthetic. Pt expectation will fill great, then wears off 2-3w Expectations

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4
Q

Where should CS be injected?

A

Local to Pt TTP- 1. Move needle around until Pt feels pain-$ 2. Slowly inject 3. Repeat in other hotspot. PT expec

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5
Q

What is this HIP ddx where Pt will hear snap over hips with walking and flexing?

A

Snapping Hips Syndrome. Likely IT/TFL irritated tight hip, weak glutes/rotators

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6
Q

What is the work up for Snapping Hip?

A

PE- Palpate has Pt ADD and Rotates hip DX- XR? TX- NSAIDS, PT, INJ?

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7
Q

What DDX is detrimental and is loss of articular cartilage in hip from trauma, overuse, infection, genetic?

A

Osteoarthritis

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8
Q

What is c/c of OA in the hip?

A

NIght pain. Gradual onset of groin pain. DEC ROM and Antalgic Gait, hard to put on shoes

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9
Q

What is the work up for OA?

A

PE- Early sign- DEC IR of hip, to loss of FLX and EXT. DX-XR- narrow space, osteophytes, cyst, sclerosis-white bone) TX- NSAIDs, PT, Ambulatory device, THR-10-15yr lifespan.

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10
Q

Is injection ideal for hip OA?

A

YES- But guided Arthrogram (under fluoroscopy). NOT FOR SEVERE cases

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11
Q

What is the DDX for hip when Medial circumflex artery acetabular branch of obturator aa. are compromised d/t narrow jt. Pain is gradual or acute.

A

Osteonecrosis AVN- Death of trabecular bone in femoral head- Idiopathic. WHO?-30-50y. RISK-trauma, alcohol abuse, corticosteroid use, rheumatoid arthritis or lupus

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12
Q

What is work up for Osteonecrosis of hip?

A

PE- Pain IR/ER and ABD. DX XR sclerosis, mothy, femur head is not smooth, TX- THR

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13
Q

This DDX of hips is classic pain radiate down leg from low back to glute?

A

LBP/Sciatica. Sciatic nerve irritation, glute stiff. TX- NSAIDs, PT

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14
Q

What are systematic approach for Knee pain?

A
  1. OLD CARTS and age, PMH 2. OA, Soft tissue, Fx, dislocation
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15
Q

What is MC form of knee arthritis?

A

Osteoarthritis- wear and tear cartilage WHO- >40y, FH, Obese, PMH trauma ACL

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16
Q

What is work up for Osteoarthritis of Knee?

A

CP- Joint line pain, unstable feeling, night pain, swelling, gradual PE-Alignment, Varus, Valgus, Crepitus w/ EXT PFP DX- XR-standing, sunrise merchant, AP, Lateral- MED, LAT, Patellofemoral compartments. JT space narrowed. MRI- if XR looks ok, meniscus ligament

17
Q

What is non op TX for OA of knee?

A

MAX 3200 600 TID,- Motrin, Naprosyn MAX 1250, Relafen, Indomethacin MAX 50 mg TID.
Cortisone Injection-check A1C
Can give months of pain relief QO3-4MO
Strict sterile technique
Depo Medrol, Kenalog mixed LIDo, marcaine. Hyaluronic Acid- avoid sulfa allergy, natural in synovial fluid, lubricant and shock absorb. From bacteria and rooster combs. Synvisc or Supartz
RICE

18
Q

What can PT and bracing do for OA?

A

Brace unload jt to create more space PT- Strength surround muscle, movement, wt loss, Re-education

19
Q

When is operation considered for OA?

A

When all other fail. Severe. Arthroscopy- cleaning frayed meniscus tissue. DO NOT TAKE OUT-cushion. FOR mild changes and pain not relieved with conservative TX

20
Q

Who get TKR?

A

Mod-Severe. Replace with metal prosthesis. Restore Pt QOL. Pt driven

21
Q

What DDX for knee pain is d/t jt line pain, catching, popping or locking of knee, swelling, pain w/ activity?

A

Meniscal Tears- Medial MC d/t limited mobility attached to MCL, larger, WB. Occurs with twisting mech w/ ACL, MCL. WHO- 13-40y. >50 2/2 d/t arthritis.

22
Q

Who get Degenerative meniscal injury?

A

30-50y OBese, Inactive

23
Q

What is work up for meniscus tears?

A

PE- TTP along jt line, +McMurray’s-pain and click, Deep squat pain limited-catch, EROM pain DX- XR obligues to r/o FX w/ trauma, >40 standing AP and sunrise/merchant joint space. MRI**- T1 H2O BLK.

24
Q

Why do meniscus tear hurt?

A

Meniscal tissue becomes caught or stuck in the joint- Bucket handle tear, flap tear, radial tear, complex tear, degenerative tear
1. Locked knee from meniscal tear- MAY knee same day/ week surgery.- Arthroscopy MC

25
Q

What is Non op TX for meniscus tears?

A

Small stable asymptomatic tears- NO arthroscopy degenerative tears
1. RICE- NSAIDs, +/- CSing and PT

SUMMED2 (38 decks)

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