Test 2 Review Topics Flashcards
What’s the mechanism of injury for an ACL rupture?
Non contact— Pivot injury—> slight flexion of knee + valgus force
Contact— Lateral blow to knee or hyperextension
Associated injuries: Meniscus tears, MCL/LCL sprain/tear
What are the S/sx of an ACL rupture?
Foot was planted and they heard/felt a “pop”
Pain and effusion
Limited weight bearing/limited ROM
Instability
(+/-) TTP if meniscus or collaterals are involved
What are the special tests for an ACL rupture?
(+) Lachman (highest sensitivity)= Patient lays supine on bed with knee in about 20-30 deg of flexion and slightly externally rotated. Examiner places one hand behind tibia and other on pts thigh, then pulls on the tibia anteriorly. An intact ACL should prevent forward translational movement of the tibia on the femur. A torn ACL feels soft or mushy when pulled.
(+) Pivot shift= pt lies supine with legs relaxed. Examiner grasps their heel of the involved leg and places opposite hand laterally on the proximal tibia just distal to the knee. Examiner applies valgus stress while internally rotating the tibia as the knee is moved into flexion from a fully extended position. A (+) test is indicated by subluxation of the tibia.
(+) Anterior Drawer test
What’s the mechanism of an MCL injury?
Typically due to a lateral blow to the knee and valgus stress.
Can have associated ACL and or meniscus pathology
What are the S/Sx of a MCL injury?
(+/-) “pop” at injury Medial joint line pain/TTP Sensation of instability Swelling Ecchymosis
What is the special test for an MCL injury?
Valgus stress test with leg bent at 30 degrees and then repeated in neutral 0 degrees. A positive test is when pain or gapping occurs
some gapping is normal at 30 degrees but there should be NO gapping at 0 deg
What is the mechanism of an LCL injury?
Due to a direct blow to the medial knee— varus force
Injury is rare in isolation; usually seen with concurrent injuries
What are the S/sx of an LCL injury?
Instability near full extension
Difficulty cutting/pivoting
Lateral knee swelling and pain
TTP at lateral joint and at origin/insertion
What is the special test for an LCL injury?
(+) Varus instability
Dial test=inspect the external rotation at the knee joint while the knees are in 30deg and 90deg of flexion. Test is (+) when there is more than 10deg of external rotation in the injured knee compared to the uninjured knee
Osteoarthritis
Cause= degenerative/mechanical
Joints= usually single, large
Pain= at nighttime
X rays show= joint space narrowing, sclerosis, subchondral cysts, and osteophytes
Inflammatory arthritis
Cause= autoimmune. Inflamed hypertrophic tissues
Joints= multiple/global degeneration
Pain= in the morning
X ray shows= Periarticular erosions and osteopenia
Imaging for Lumbar fractures
X ray does not help determine timing/age of fracture
—MRI is sensitive for acute vs old fractures
—Bone scan if pt cant have MRI
—CT in cases of trauma and/or to assess for canal compromise or posterior element (facet and lamina) involvement
Treatment for Cervical Myelopathy is?
Surgical in almost all cases.
Anterior approach= when there’s 2 levels of involvement
- ACDF (anterior cervical discectomy and fusion) if disc level is the primary issue
- Corpectomy (removing all or part of the vertebral body
Posterior Approach= for multiple level involvement or primarily posterior pathology
-laminectomy with or without fusion
What are the risk factors for compression neuropathy?
*Hypothyroidism
*DMII
*>50 years old
*Female
Smoking
Obesity Pregnancy Occupational exposure- repetitive activities Renal disease Inflammatory arthritis Amyloidosis Mucopolysaccharidosis Multiple myeloma Genetic predisposition
Adolescent idiopathic scoliosis treatment when they have 10-25degrees of curvature?
10-25 degrees= observe with serial x rays every 4-6 mos etc
