Pathophysiology - LE Dysfunction Flashcards
test 2
1
Q
T or F?
The hip joint is an articulation between the head of femur and the acetabulum of pelvis (also called innominate - made up of ilium, ischium, and pubis)
A
True
2
Q
What is the most stable position of the hip joint?
A
Standing position: hip extension, slight abduction, slight IR
3
Q
What has to happen to bend forward at the waist?
A
Head and upper trunk flex, pelvis shifts posteriorly, and once stable, begins to rotate forward, being controlled by glute max and hamstrings
4
Q
What has to happen to return to uprights position form bent over?
A
Hip extensors rotate pelvis posteriorly and then back extensors work to bring spine upward
5
Q
What is the frontal plane angle called between the femoral shaft and the neck?
A
Collum/inclination angle
6
Q
How much is the collum/inclination angle usually but can vary with body type?
A
125 degrees
7
Q
What is an increase in collum angle of femoral head called that causes it to be more superiorly in the acetabulum?
A
Coxa Valga >125 degrees
8
Q
What is a decrease in the angle of femoral head called that causes it to be inferiorly placed in the acetabulum?
A
Coxa Vara <125 degrees
9
Q
Coxa Valga or Coxa Vara?
Shortens moment arm of hip abductors, placing them in a position of disadvantage causing them to contact more vigorously, increases overall length of leg, and changes orientation of the joint force from normal vertical to one that is almost parallel to the femoral shaft, reducing weight bearing surface and increases stress across joint
A
Coxa Valga
10
Q
Coxa valga or coxa vara?
More horizontal position of femoral head in acetabulum, increasing shear force on femoral neck, lengthens movement arm of hip abductors placing them in mechanical disadvantage, and decreases overall length of LE
A
Coxa Vara
11
Q
What is the term for femoral alignment in the transverse plane that is an anterior position of the axis through the femoral condyles?
A
Anteversion
12
Q
What is the term for femoral alignment in the transverse plane where the femoral neck axis is parallel or posterior to the condylar axis?
A
Retroversion
13
Q
What is a limitation of passive hip extension caused by lack of extensibility of mm or ligaments of the hip called?
A
Hip FLEXion contracture
14
Q
What people are hip flexion contractures common in?
A
People with compromised mobility - those who sit a lot
15
Q
What are some compensations of hip flexion contractures?
A
Lower spine compensates through overextension, trunk must flex, and knee joint must flex
16
Q
Strain of what mm group is the most common cause of groin pain? It could be b/c muscular imbalances that lead to fatigue or abduction overload.
Soccer players are vulnerable to this.
A
Adductors
17
Q
What is the strongest hip flexor mm and is often strained by forced extension of the hip while it is flexed?
A
Iliopsoas
18
Q
What mm of the quads is most commonly strained during sports like running, jumping, or kicking?
A
Rectus femoris
19
Q
What mm group is most commonly strained, especially in running sports, and during eccentric stages of usage?
A
Hamstrings, specifically biceps femoris
20
Q
What condition is characterized by the following:
- Repetitive stress injury as ITB creates friction when sliding over lateral femoral condyle at 30 degrees of knee flexion
- Causes reddish brown bursa
- Common in long distance runners and cyclists
A
Iliotibial Band Friction Syndrome
21
Q
What condition is characterized by the following:
- Often called trochanteric bursitis and is common cause of lateral hip pain
- Pts have a hard time lying on their side, standing, walking, sitting, etc
- Mostly in people 40+ and moreso in women
- Though to result from thickening and thinning of tears in glutes and changes in bursa structure
A
Gluteal tendinopathy
22
Q
What kind of bursitis is characterized by the following:
- Inflammation of one or the trochanteric bursa that are inflamed by friction b/c a short TFL
A
Trochanteric bursitis
23
Q
What kind of bursitis is characterized by the following:
- Located b/w anterior side of joint capsule of hip and muscle/tendon junction of iliopsoas
- Cause is from acute trauma or overuse from constant hip flexion
A
Iliopectineal bursitis
24
Q
What kind of bursitis is characterized by the following:
- Inflammation from chronic compression or trauma
- Pain with sitting in firm chair
- Affects thinner people more than obese people
- Affects women more than men
A
Ischial/gluteal bursitis
25
What kind of bursitis is characterized by the following:
- In pts 40-50 yo
- Pain in gluteal or trochanteric region
Gluteal bursitis
26
Fxs of the pelvis are common in what population?
Older people bc of falls. Has a high mortality rate.
27
Fx of what part of the pelvis is most common?
Pubic fracture
28
What is the intervention for a fx of the pelvis?
Get mobilized!
Do strength training and functional activities if the fx is stable.
If fx is unstable, limit weight bearing for up to 3 mo.
29
Fxs of the acetabulum occur primarily in what population and as a result of what?
Young adults as a result of high velocity trauma.
30
What is the intervention for a fx of the acetabulum?
ORIF - open reduction internal fixation
31
What is the 1 year mortality rate after a hip fx has been sustained?
14-58%
32
Which type of hip fx?
- From high energy trauma in young pts
- Often associated with multiple injuries and high rates of avascular necrosis and nonunion
Femoral neck hip fracture
32
Hip fx often result from what pre-existing pathology?
Osteoporosis
33
Which type of hip fx?
- Fx distal to femoral neck and proximal to femoral shaft
- Area where femur changes from vertical to angled bone
-Occurs bc a combo of bone fragility and decreased agility and mm tone of that area
- Surgical intervention
Intertrochanteric hip fracture
33
Which type of hip fx?
- Seen in older osteopenia pts after a low energy fall and in young people with high energy trauma
- 10-30% of all hip fxs
- Healing through cortical healing, so quite slow
- Surgical intervention
Subtrochanteric hip fracture
33
What are the 3 types of hip fxs?
Intertrochanteric
Subtrochanteric
Femoral neck fx
34
What condition is characterized by the femoral head temporarily loses its blood supply and starts to die?
The weakened bone gradually breaks apart and can lose its round shape. Lots of pain and stiffness
Legg-Calve-Perthes Disease
35
What condition is characterized by being a disorder of adolescent where the growth plate of the femoral head is damaged and slips with respect to the rest of the femur?
The head of the femur stays in the hip jt while the rest of the femur shifts. Affected leg is shortened and there is decreased IR.
Slipped capital femoral epiphysis
36
What is the term for insufficient containment of the femoral head by the acetabulum?
Acetabular dysplasia
37
T or F?
Hip preservation surgery is an aim to restore an optimal relationship between structure and joint kinematics and delaying a THA.
True - this is a cartilage restoration, arthroscopy, osteotomy
38
A THA is used in cases of severe joint damage from?
RA, OA, hip fx, avascular necrosis
39
What are common indications for a THA?
Pain, functional limitations, loss of mobility, post hip fx that has a high risk of vascular necrosis, or radiographic evidence of intra-articular disease
40
What is the approach to a THA called that is characterized by the following?
- Approach hip through the internal between the TFL and glut med.
- 1 or 2 small incisions
- Some portion of the hip abductor mm is released from greater trochanter and hip is dislocated ANTERIORLY
Anterolateral approach
41
What is the approach to a THA called that is characterized by the following?
- Most commonly used and gains access to the hip joint by splitting the glut max
- Femur is dislocated POSTERIORLY
Posterolateral approach
42
What is the approach to a THA called that is characterized by the following?
- Leaves the posterior portion of the glut med attached to the greater trochanter
- The preferred approach in noncompliant pts to prevent postsurgical dislocation
Direct lateral approach
43
Why is a minimally invasive approach to a THA the best?
Creates less damage, less incision, therefore less healing and less of a chance to mess up
44
What are some complications that can happen after a THA?
- DVT (risk up to 3 mo post op)
- Femoral fx
- Dislocation (in elderly women)
- Neurovascular injury (division of sciatic nerve leading to neutopathy)
- Heterotopic ossification
45
What are the standard precautions for a lateral or posterolateral THA approach?
- Do not cross legs (no hip ADD)
- Pillow between legs in sidelying
- No hip IR
- Do not flex hip over 90 degrees
- Use assistive device or reacher with ADLs as needed
- Combo of hip flexion, IR, and adduction are to be avoided for up to 4 mos after surgery or until physician clearance
46
What are the standard precautions for an anterior / anterior lateral / direct lateral THA approach?
- avoid hip flexion over 90 degrees
- avoid hip extension, adduction, and ER if a trochanteric osteotomy or glut med was incised, do not perform active, antigravity hip ABD for at least 6-8 wks or until approved by surgeon
47
What is the term for replacement of the articular surface of the femoral head without surgically altering the acetabular surface?
Hemiarthroplasty
48
In the knee, a lateral angle of fewer than 170 degrees indicates what?
Excessive genu valgum (knock-kneed)
49
In the knee, a lateral angle greater than 180 degrees indicates what?
Genu varum (bow-legged)
50
What mm is important for counteracting lateral pull by stabilizing the patella medially?
Vastus medialis
51
What mm are the primary dynamic mechanisms of the knee?
Quads
52
T or F?
Extension of the knee between 0-30 degrees produces lateral glide and lateral tilt of the patella
True
53
T or F?
Q angle is the angle created by drawing a line from the ASIS to the patella and the patella to the tibial tuberosity
True
54
T or F?
ACL tears are 2-8x higher in men than women
False - 2-8x greater in women than men.
This could be because the Q angle is larger, ACL is smaller, joints are more lax, hormone influence
55
What are some intrinsic factors that lead to an ACL tear?
narrow intercondylar arch, weak ACL, overall joint laxity, leg malalignment
56
What are some extrinsic factors that lead to an ACL tear?
Abnormal quad and hamstrings interactions, altered neuromuscular control, shoe to surface interface, surface you're playing on, athlete's playing style
57
T or F?
ACL tears are graded 1, 2
True
58
What is the mechanisms of injury for an ACL tear?
Sudden deceleration, abrupt change of direction with a fixed foot, and extreme hyperextension or flexion of knee.
This leads to a combo of ER, valves stress, and internal tibial rotation
59
What are the tests to determine an ACL tear?
Lachman test and anterior drawer test
60
In ACL tears, they rarely happen alone. What is the "terrible triad" of things that is normally injured as well?
ACL along with the MCL and medial meniscus
61
What is the contraindicated exercise for an ACL repair?
Open chain, active knee extension
62
In an ACL repair, there are 3 phases of intervention. How long do each of these phases last?
Phase 1 = 0-2 weeks
Phase 2 - 3-5 weeks
Phase 3 = 6 weeks
63
What causes PCL tears?
Significant trauma such as MVA, landing in hyper flexion from a jump, and hyperextension with foot planted
64
What are sx's of a PCL tear?
Pain in posterior knee that is aggravated with kneeling and there is minimal swelling. May or may not have instability
65
What is the most common ligamentous knee injury?
MCL
66
What is often injured with a severe MCL sprain?
Medial meniscus
67
What is the most common sx for an MCL injury?
Pain over the ligament
68
What are MCL injuries primarily caused by?
1. Valgus stress to the knee
2. Excessive ER of tibia
69
T or F?
MCL injuries can be from things like valgus stress and excessive ER of tibia as well as non-contact, indirect, and overuse things too
True
70
What are meniscus injuries from and cause pain, locking, catching, swelling and functional impairment?
Trauma (twisting/change of position in weight bearing knee) or angular stress of femur on tibia
71
T or F? Tears in the vascular potion of the meniscus "red zone" are far less likely to heal than tears in the middle portion, the "red-white zone"
False - tears in vascular portion "red zone" are far more likely to heal than tears in the middle portion of the meniscus, the "red-white zone"
The nonvascular central part of meniscus "white zone" cannot heal
72
T or F?
Articular cartilage defects often result in surgery to repair or transplant autogenous cartilage
True
73
What condition is this?
- Wear and tear degenerative condition
- Pain with weight bearing activities and some pain at rest
- Inflammation and joint locking of the knee can be from a loose body in the joint capsule
- People not appropriate for a TKA may be considered for high tibial osteotomy or a distal femoral osteotomy
Tibiofemoral Osteoarthritis
74
What are the primary reasons for a TKA (total knee arthroplasty)?
Pain and loss of function
75
TKA is a long term intervention for who?
Elderly to relieve pain, improve function, increase social interaction
76
What condition is this?
- Symptom characterized by pain in patella region that is worsened by positions of extreme flexion or increased/misdirected forces between the patella and femur
- Pain in front of knee from maltracking
Patellofemoral pain syndrome
77
What are the 2 major types of tendinopathy in the knee?
1. Patellar tendinopathy (just below patella)
2. Quadriceps tendinopathy (just above patella)
78
T or F?
Fractures of the tibia/femur can be displaced or non displaced and are from direct blows or sudden tensile force. Two types are supracondylar femur fractures and tibial plateau fractures
True
79
What condition is this?
- Traction apophysitis
- A knee condition that is one of the most common causes of knee pain in adolescents
- Often in active boys and girls age 11-13 with growth spurts
- From stress of repeated contraction of quads through the patellar tendon onto a partially developed tibial tuberosity
- visible and palpable bump over tibial tuberosity
Osgood-Schlatter disease
80
T or F?
Osgood-Schlatter disease can result in a partial avulsion fx
True
81
What are three sections of the foot?
- Rearfoot/hindfoot (talus and calcaneus)
- Midfoot (navicular, cuboid, 3 cuneiforms)
- Forefoot (14 bones of toes, 5 metatarsals, medial and lateral sesamoids)
82
Majority of support provided to the ankle and foot joint is by what?
Medial and lateral malleoli and ligaments
83
Temporary collapse of the ankle, rear foot, and midfoot can lead to what foot deformity?
Pronated foot
84
T or F?
A pronated foot leads lower limb overuse injuries and also excessive IR and ER of lower limb
True
85
What is flatfoot also called?
Pes planus
86
Is pes planus standard in infants and common in children up to 6 yo?
Yes
87
What is the most common cause of pes planus in adults?
Mismatch between active (posterior tibialis tendon) and passive arch (ligaments) stabilizers
88
What is the term for an abnormally supinated foot (pes cavus)?
Stiff foot
89
What is stiff foot (abnormally supinated, pes cavus) characterized by?
High arch, increased ER of tibia, increased forefoot varus, inability to pronate during stance phase --> lose shock absorption ability
90
60-70% of ankle sprains are from what?
Lateral/inversion sprain
91
What is the term for a sprain that is a disruption of the ligamentous structure between the distal fibula and tibia proximal to the ankle joint?
High ankle sprain or syndesmotic sprain
92
What are some risk factors for a lateral/inversion ankle sprain?
Obesity, ROM, mm strength, postural stability, and proprioception
93
The medial deltoid ligaments of the ankle prevent against what?
Eversion of ankle
94
Are medial/eversion ankle sprains more rare and often associated with a fx?
Yep!
95
T or F?
For recurrent ankle sprains, there is conservative intervention first, but then surgical repair which is 100% effective
False - yes conservative first, but surgery is not 100% effective
96
What is interchangeable with the term bunion?
Hallux valgus
97
What is this condition?
- describes a lateral or valves deformity of the big toe
- occurs in people that wear shoes
- women have a rate of 9:1 compared to men
hallux valgus or bunion
98
What is the term for a sprain of the MTP joint that primarily affects football, baseball, and soccer players due to dorsiflexed kicking?
Turf toe
99
What does turf toe present as?
red, swollen, and stiff big toe
100
What toe deformity is this?
Dorsiflexion of proximal phalanx of flexion of PiP
Claw toe
101
What toe deformity is this?
Flexion of PiP and hyperextension of MTP and DiP
Hammer toe
102
What toe deformity is this?
Flexion of DiP joint
Mallet toe
103
What condition is this?
- common in young dancers and ice skaters as well as runners
- is a repeated inversion strain causing inflammation at fibula's longus and brevis tendon
- there is instability between 4th and 5th metatarsals
Fibularis (peroneal) tendon tendinopathy
104
What is occurring in fibular tendon subluxation?
There is pain in the posterior distal fibula, swelling, inability to evert foot against resistance, and can look like ankle instability
105
Tibialis posterior tendinopathy produces pain in three locations, what are these?
Distal to medial malleoli, proximal to medial malleoli, and at anterior shin
106
Tibialis posterior tendinopathy is seen frequently in who?
Dancers, joggers, ice skaters, and running sports where there is rapid direction change
107
What can cause tibialis anterior tendinopathy?
Pain at the front of the shin
Walking, running up or down hills with uneven surfaces, excessively tight shoes, kneeling, kicking an object with toes pointed
108
Where is pain with flexor hallucis tendinopathy?
Posterior to medial malleolus and can be confused with posterior tibialis tendonopathy
109
What is one of the most commonly injured tendons, esp in athletes in running and jumping sports? Is the most common overuse syndrome of the lower limb
Achilles tendinopathy
110
T or F?
Achilles tendinopathy can be midportion or insertional
True
111
What are the three activities that ruptures the achilles tendon?
1. Pushing off ground with forefoot while extending knee
2. Sudden dorsiflexion with full weight bearing (slip or fall)
3. Violent dorsiflexion and landing on plantar flexed foot (jumping or falling from large height)
112
What condition is this?
Pain arising from the insertion of the planter fascia w or w/o heel spur as well as pain at aponeurosis along bottom of foot. Often referred to as plantar fasciitis and can be from obesity, prolonged standing, injury to heel, shoes, shortening of calf mm
Plantar heel pain
113
T or F?
In plantar heel pain, heel spur may or may not cause pain
True
114
What condition is this?
- Pain and tenderness on medial aspect of heel, especially during the morning but decreases during the day
- Heel pain worsens with increased activity
- 90% of pts improve within 1 year with a conservative approach
Plantar heel pain
115
What is the term for common overuse sx with pain at the forefoot associated with increased stress over metatarsal head region? From repetitive high-pressure loading on forefoot
Metatarsalgia
116
What condition is this?
- Entrapment neuropathy of the tibial nerve as it passes through the anatomic tunnel between flexor retinaculum and medial malleolus
- Can be acute or insidious
Tarsal tunnel syndrome
117
What is this condition?
- Enlargement of the interdigital nerve of the foot --> actually a thickening of the tissues around the nerve due to many things
- Sx's worsens with weight bearing and relieved by removing shoe and massaging forefoot
Interdigital neuroma/Morton's neuroma
118
What is this?
- Pain condition associated with sudden compression of nerves, blood vessels, and mm inside a closed space
- Small amount of bleeding or swelling of mm into compartment, causing pressure to rise
Acute compartment syndrome
119
Is acute compartment syndrome a medical emergency?
YES
120
What are some causes of acute compartment syndrome?
Hemorrhage, tibial fxs, casts, crush injuries, burns, prolonged limb compression, IV drug injection
121
What are the clinical signs/5 P's for acute compartment syndrome?
1. Pain
2. Paralysis
3. Paresthesia
4. Pallor
5. Pulses
122
What is the condition that is an exercise related leg pain along the middle of distal posteriomedial tibia? There is pain at the beginning of the run but resolves with exertion and can recur toward the end of the run
Medial tibial stress syndrome
123
What is the term for a break that develops in a bone after cyclical submaximal loading from running on hard surface, improper running shoes, sudden increases in jogging or running distance, or malalignment of the lower extremity (excessive pronation)
Stress fractures
124
What is the most common mid foot fracture, but still rare?
Navicular fxs
125
What is the largest and most frequently fractured in the foot?
Calcaneus fx
