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Clin med sem 2 > Ortho- lower extremity > Flashcards

Ortho- lower extremity Flashcards

1
Q

Anterior Cruciate Ligament Injury- pathophysiology

A

ACL connects posterior aspect of femoral condyle to anterior aspect of tibia
- controls anterior tibia on femur and rotational stability

Bones twist in opposite directions under full body weight

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2
Q

Anterior Cruciate Ligament Injury- cause

A

Non-contact deceleration -> valgus twisting
Hyperextension
Marked internal rotation
Pure deceleration

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3
Q

Anterior Cruciate Ligament Injury- epidemiology

A

F>M

Common - soccer, basketball, football, skiing

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4
Q

Anterior Cruciate Ligament Injury- S/S & PE

A

S/S:

  • pop
  • immediate effusion
  • Difficulty/Can’t weight bear
  • Unstable

Exam:

  • Lachmans
  • anterior drawer
  • Lever sigh
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5
Q

Anterior Cruciate Ligament Injury- diagnosis

A

MRI w/ out contrast

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6
Q

Anterior Cruciate Ligament Injury- labs & imaging

A

Xray - NOT diagnostic - will show effusion

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7
Q

Anterior Cruciate Ligament Injury- treatment

A

Young/active + complete tear - surgery

  • autograft - own patellar or hamstring tendon
  • allograph - cadaver

Older/sedentary OR partial tear - conservative

  • PT to strengthen hamstrings
  • bracing

Bracing? - debated - remain weight bearing if possible!!

  • to protect other structures - inc risk of 2nd meniscus injury
  • acute - knee immobilizer and crutches
  • Subacute/chronic - hinged brace

Rice
Pain control
Refer Orther

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8
Q

Posterior Cruciate Ligament Injury- pathophysiology

A

PCL - strongest ligament in knee

Sprains or partial tears more common

Associated w/ injuries - ACL and MCL tears

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9
Q

Posterior Cruciate Ligament Injury- cause

A

Blow to knee while flexed

  • striking knee against dashboard
  • falling on a bent knee
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10
Q

Posterior Cruciate Ligament Injury- S/S & PE

A

S/S:

  • swelling IMMEDIATE and PROFOUND
  • Severe pain
  • Limited ROM
  • instable - unable to move
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11
Q

Posterior Cruciate Ligament Injury- diagnosis

A

Sag sign - tibia posteriorly set off
Posterior draw test - positive
MRI

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12
Q

Posterior Cruciate Ligament Injury- treatment

A

Refer Ortho
RICE, pain control, immobilization w/ crutches
Isolated PCL tear - treated non-op w/ PT
W/ other injuries - surgery

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13
Q

Medial Collateral Ligament injury- pathophysiology

A

Most commonly injured

w/ ACL

Extra-articular - joint effusion LESS COMMON

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14
Q

Medial Collateral Ligament injury- cause

A

Valgus stress on partially flexed knee

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15
Q

Medial Collateral Ligament injury- S/S & PE

A

S/S:

  • Focal pain over ligament
  • Minor swelling
  • Limited ROM - improves w/in 2w
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16
Q

Medial Collateral Ligament injury- diagnosis

A

Valgus stress exam

MRI - doesn’t need to happen acutely

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17
Q

Medial Collateral Ligament injury- treatment

A 
Graduated weight bearing
Bracing
- minor -hinged
- sever -immobilizer
PT
6-8 weeks of healing
Isolated - Rarely need surgery
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18
Q

Meniscus injuries- pathophysiology

A

“Shock absorbers”
Very common injury
Acutely or degeneration

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19
Q

Meniscus injuries- cause

A

Internal rotation of femur on tibia w/ flexion knee
- posterior meniscus b/t femur and tibia

Sudden extension - external rotation
- lateral meniscus

Partial or complete tear
Posterior or anterior horn tear
Longitudinal or bucket handle tear

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20
Q

Meniscus injuries- S/S & PE

A 
S/S: 
- catching, locking, clicking
- Painful walking and squatting
- Mild to mod joint swelling 
- JOINT LINE TENDERNESS
- lock in extension - piece of menis obstructing joint
Exam - McMurray
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21
Q

Meniscus injuries- diagnosis

A

MRI w/ out contrast

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22
Q

Meniscus injuries- labs & imaging

A

Xray - nl, but may show joint space narrowing or effusion

- more helpful if hx or OA

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23
Q

Meniscus injuries- treatment

A

“Degenerative tears - PT

Acute tears - arthroscopic meniscus repair or debridement “

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24
Q

Knee Dislocation- pathophysiology

A

Dislocation of tibiofemoral joint of knee
ORTHO EMERGENCY
Many present already reduced!

To dislocate - at least 3, if not 4, major knee ligaments are torn

Anterior - most common
Posterior, lateral, medial

Popliteal artery - partial or complete disruption in 40%
Peroneal nerve - 23% injured

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25
Knee Dislocation- cause
Multi-trauma High-energy trauma - Hyperextension - anterior dislocation - anterior blow - posterior desolation: dashboard
26
Knee Dislocation- S/S & PE
Gross deformity - if not reduced LARGE effusion SIGNIFCANT pain- can't weight bear MUST EVAL FOR NEUROVASC - palpable distal pulses - DOES NOT exclude vascular injury - MUST DO ABI - assess sensation and strength ``` ABI - Systolic BP in LE - ankle - Systolic BP in UP - brachial - >.9 - monitor w/ serial exams - ```
27
Knee Dislocation- labs & imaging
Xray - AP and lateral - obtain even if reduced - tibial plateu fracture CT arteriogram - GOLD Arterial duplex US - both eval popliteal artery - not always indicated -> if ABI
28
Knee Dislocation- treatment
IV pain control Reduce - even if has vascular injury - then reassess Post reduction xray Splint - long leg w/ 20–30-degree flexion Admit for pain control - serial exams w/ortho consult
29
Knee Dislocation- prognosis
Require MRI after swelling reduced - will likely need surgery Complications are frequent Rarely go back to pre-injury state
30
Knee Dislocation- complications
Complications - limb ischemia, permanent nerve damage, compartment syndrome, arthrofibrosis (most common)
31
Knee Bursitis- pathophysiology
Bursa becomes irritated - produced too much fluid -> swelling and puts pressure on adjacent parts Pre-patellar - most common - Housemaid's knee
32
Knee Bursitis- S/S & PE
S/S: - swelling and tenderness over bursa - become infected -> erythema, warmth
33
Knee Bursitis- diagnosis
Clinical
34
Knee Bursitis- treatment
NSAIDs RICE No pressure over patella Refractory - prepatellar bursa injections - corticosteroids
35
Knee Osteoarthritis- pathophysiology
3x more common than hip Chronic progressive knee pain - medial more affected
36
Knee Osteoarthritis- epidemiology
>65
37
Knee Osteoarthritis- S/S & PE
S/S: - Morning stiffness <30min - Crepitus - Mild effusion - Pain relieved w/ rest - Severe - Genu Valgum or Genu Varum
38
Knee Osteoarthritis- diagnosis
Xray - joint space narrowing, osteophytes
39
Knee Osteoarthritis- treatment
Conservative - weight loss, graded exercise APAP and NSAIDs Intra-articular Corticosteroid - short term relief - doesn’t improve quality of life -> greater cartilage loss Synvisc - intra-articular viscosupplementionation - mixed date Platetet-Rich plasma injections - mixed Total or partial knee replacement
40
Patella Subluxation & Dislocation- pathophysiology
Very common | Medial or lateral - more common
41
Patella Subluxation & Dislocation- cause
Direct blow to side of knee
42
Patella Subluxation & Dislocation- S/S & PE
Pain, swelling, deformity | Limited ROM - locked in extension
43
Patella Subluxation & Dislocation- diagnosis
Xray - sunrise view
44
Patella Subluxation & Dislocation- treatment
``` Reduction - apply pressure while extending knee Immobilization short-term PT - quad strengthening 1st time - no surgery Recurrent - surgery ```
45
Patella Fracture- cause
Direct patellar impact - dashboards - fall onto flexed knee
46
Patella Fracture- S/S & PE
Significant swelling | Focal pain - will bruise
47
Patella Fracture- diagnosis
Xray - AP, Later, SUNRISE VIEW - multiple fracture types - important to examine and document - intact extensor mechanism
48
Patella Fracture- treatment
Refer Ortho RICE Pain Control No surgery - extensor mechanism intact, nondisplaced fx, vertical fracture - Extension bracing WITH WEIGHT BEARING Surgery - extensormechanism failur, open fx, displaced fx, comminuted fx - ORIF
49
Patella Fracture- Bipartite Patella
Bipartite Patella - patella composed of 2 bones, seen bilaterally - If separate while bending knee - pos for bipartite
50
Patellar Tendon Rupture- pathophysiology
Not common
51
Patellar Tendon Rupture- cause
Sudden quadriceps contraction with knee in a flexed position - jumping
52
Patellar Tendon Rupture- S/S & PE
Pain, swelling | ELEVATION OF PATELLA
53
Patellar Tendon Rupture- diagnosis
Xray - patella displacement | MRI
54
Patellar Tendon Rupture- treatment
Refer Ortho Complete tear - surgery Partial - splint and watch
55
Chondromalacia/Patellofemoral syndrome- pathophysiology
Runnes Knee Damage to undersurface cartilage of patella - sec to poor patellar tracking Risk for lateral patella subluxation
56
Chondromalacia/Patellofemoral syndrome- epidemiology
W>M | adolescents/YA
57
Chondromalacia/Patellofemoral syndrome- S/S & PE
``` Chronic, anterior knee pain - inc when going upstairs and/or squatting No effusion Grand test Apprehension test ``` This causes knee to be unstable - will come in because of dislocation
58
Chondromalacia/Patellofemoral syndrome- diagnosis
Xray - AP, lateral, SUNRISE (bilateral) - Patella alta/baja or lateral patella tilt MRI - cartilage damage
59
Chondromalacia/Patellofemoral syndrome- treatment
NO surgery - 1st line - NSAIDs - PT Surgery - persistent/progressive - PT failed after 1y - Arthroscopic debridement - Patellar realignment surgery
60
Tibial Plateau fracture- pathophysiology
Fracture of proximal tibia - intra-articular
61
Tibial Plateau fracture- cause
Higher energy injury - other ST injuries Valgus or vaus twist with axial loading Trauma
62
Tibial Plateau fracture- S/S & PE
Severe pain | Swelling
63
Tibial Plateau fracture- diagnosis
Xray - eval proximal and distal tibia - can miss this fracture CT - if high suspicion
64
Tibial Plateau fracture- treatment
Pain control Consult ortho No surgery - no to min displacement - hing brace, crutches Surgery - displaced, comminuted, open - ORIF
65
Tibial Plateau fracture- prognosis
Complications - Peroneal nerve injury - foot drop? - MRI for ST injury - ACL and meniscal tear - Compartment syndrome
66
Tibial Shaft fracture- pathophysiology
Common
67
Tibial Shaft fracture- cause
Torsional injury | Direct blow
68
Tibial Shaft fracture- diagnosis
Xray
69
Tibial Shaft fracture- treatment
No surgery - no to min displacement - hing brace, crutches -> watlking cast Surgery - displaced, comminuted, open - splint w/ crutches -> ORIF
70
Fibula Shaft Fracture- pathophysiology
Fibula - no weight bearing bone
71
Fibula Shaft Fracture- diagnosis
Xray - visualize entire bone
72
Fibula Shaft Fracture- treatment
Splint -> cast | Weight bear just fine
73
Ankle Sprain- pathophysiology
Most common reason to miss athletics Inversion - most common High ankle sprain - <10% - syndesmosis injury - tibiofibular and interosseous ligaments Low ankle sprain - >90% - anterior talofibular ligament (ATFL) - Calcaneofibular ligament (CFL)
74
Ankle Sprain- S/S & PE
Anterior draw | Talar tilt
75
Ankle Sprain- diagnosis
``` Should you xray? - way over ordered Ottawa Ankle rules: - inablitiy to bear weight - medial, lateral malleolus point, bony tenderness - 5MT base tenderness - Navicular tenderness ``` MRI - ligamentous injury
76
Ankle Sprain- treatment
RICE Immobilization - w/ weight bearing Early ROM and reture - 2w low, several w high Surgery - complete or recurrent sprain/instability
77
Malleoli Fracture- pathophysiology
Distal tibia fracture - can be inconjunction w/ fibula Bimalleolar - medial and lateral Trimalleolar - medial, lateral, posterior
78
Malleoli Fracture- treatment
Isolated <3mm displacement - ortho refer, walking boot 6-8w | Displaced, comminuted, open - surgery
79
Achilles Tendon Rupture- pathophysiology
Largest tendon in body
80
Achilles Tendon Rupture- cause
Trauma Abrupt Weekend warrior
81
Achilles Tendon Rupture- epidemiology
M | 30-40
82
Achilles Tendon Rupture- S/S & PE
Felt like shot in the foot, big pop Thompson test Achilles - feels soft
83
Achilles Tendon Rupture- diagnosis
Xray - eval for bony injury | MRI - TOC
84
Achilles Tendon Rupture- treatment
Refer ortho Surgery - sooner the better Splint, crutches, pain meds - may need hosp to control pain
85
Phalangeal Fractures- pathophysiology
very common
86
Phalangeal Fractures- treatment
Rarely surgery | Buddy tape + hard soled shoe
87
5th Metatarsal Fracture- pathophysiology
Very common | Dancer's fracture
88
5th Metatarsal Fracture- cause
Forced inversion during plantar flexion
89
5th Metatarsal Fracture- treatment
``` Stress fracture - distal - no weigth bearing Jones - middle - no weight bearing Avulsion (Pseudo Jones) - weight bearing ok ``` No surgery - stiff soled shoe - 1-4 Surgery - open fractures, displacement of 1st or multiple fractures
90
Plantar Fasciitis- pathophysiology
Inflammation of aponeurosis at origin on the calcaneus | - chronic overuse -> microtears
91
Plantar Fasciitis- epidemiology
Obesity Dec dorsiflexion in a non-athletic population Weight bearing endurance activity
92
Plantar Fasciitis- S/S & PE
Sharp heel pain - stepping out of bed - worse at end of day - bilateral
93
Plantar Fasciitis- diagnosis
Clinical - pinpoint tenderness - dorsiflexion of toes - foot inc tenderness w/ palpation
94
Plantar Fasciitis- treatment
Stretching NSAIDs arch support
95
Hammer Toe- pathophysiology
Flexion deformity of PIP w/ extension of DIP
96
Hammer Toe- cause
High heals
97
Hammer Toe- diagnosis
Clinical
98
Hammer Toe- treatment
No surgery - wide shoes, padding/splinting | Refer Podiatry
99
Corns and Calluses- pathophysiology
Toughened area of skin - relatively thick and hard due to repeated friction, pressure, other irritation
100
Corns and Calluses- S/S & PE
Corn - painful, small, hard center | Callus - larger, non-painful
101
Corns and Calluses- treatment
File | Padding
102
Bunions- pathophysiology
Hallux valgus | Pressure on lateral MCP joint - causes metatarsal head displaced medially -> bone deformity
103
Bunions- epidemiology
Genetic
104
Bunions- S/S & PE
Slow onset | Can be painful
105
Bunions- treatment
Wide shoe Pain control Refer podiatry - surgery?
106
Ingrown Toenail- pathophysiology
Nail grows - cutting into one or both sides of paronychium or nail bed
107
Ingrown Toenail- S/S & PE
Painful | Infected?
108
Ingrown Toenail- treatment
Warm water soaks Abx ointment well-fitting shoes Nail lifting or removal

Clin med sem 2 (30 decks)

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