the lower extremity Flashcards
1
Q
what is femoroacetabular impingement (FAI)
A
- bone overgrowth or abnormality in bone development that changes function of hip joint
- can tear labrum
- destruct articular cartilage
2
Q
what are the two types of femoroacetabular impingement (FAI)
A
- pincer (acetabular involvement)
- Cam (femoral head involvement)
3
Q
clinical presentation
- groin pain and/or lateral hip pain
- pain may be described as sharp, stabbing, or deep dull ache
- pain aggravated with turning, twisting, prolonged standing or squatting
- FADIR test
A
femoroacetabular impingement (FAI)
4
Q
FADIR test
A
- impingement test
- knee/hip flexion with adduction and internal rotation of the hip
5
Q
FABER test
A
- flexion
- abduction
- external rotation
*figure of four test
note: place counter pressure on opposite hip
6
Q
Clinical presentation
- dull or sharp groin pain
- often radiates to lateral hip, anterior thigh, or buttock
- insidious onset vs acute trauma
- catching, clicking that may cause pain
A
Labral tear of the hip
7
Q
what causes snapping hip syndrome
A
muscle or tendon sliding over bony prominence, which can lead to bursitis
8
Q
what are the two main anatomical causes of snapping hip syndrome
A
- external: IT band over greater trochanter
- internal: iliopsoas tendon over iliopectineal eminence or femoral head
9
Q
clinical presentation
-
snapping or popping sensation in hip with walking, getting up from chair, or swinging leg
- may be painful or painless
- pseudosubluxation (sensation of hip subluxation or dislocation)
A
snapping hip syndrome
10
Q
physical exam for snapping hip syndrome
A
- do faber test (flex, abduct and externally rotate), then test snapping by extending hip
11
Q
what patient population is associated with snapping hip syndrome
A
- dancers
- adolescents
12
Q
what is the most common cause of lateral hip pain in adults
A
greater trochanteric pain syndrome
13
Q
what is greater trochanteric pain syndrome
A
- repetitive overload tendinopathy (gluteal medius and minimus)
- trouble with hip abduction and pelvic stability
- bursa may become inflamed
14
Q
clinical presentation
- Lateral hip pain with localized pain to greater trochanter
- pain increased with pressure over greater trochanter (lying on side)
- pain increases with walking, stairs, inclines, and prolonged standing
A
greater trochanteric pain syndrome
15
Q
physical exam for greater trochanteric pain syndrome
A
- TTP over greater trochanter
- pain with resisted abduction
- Trendelenburg sign (difficulty maintain standing on one foot)
16
Q
What is the Triad of O’Donoghue (unhappy triad)
A
- ACL
- MCL
- medial meniscus
17
Q
most common mechanism of injury for medial collateral ligament (MCL) sprain
A
- knee flexion + foot planted AND
- lateral impact causing vlagus stress + rotation
18
Q
mechanism of injury for lateral collateral ligament sprain
A
- rare
- tibial internal rotation
- medial impact
19
Q
valgus stress
A
- assess the integrity of the medial collateral ligament
- valgus = foot pulled laterally
20
Q
varus stress
A
- used to assess the lateral collateral ligament
- Varus = return foot to body
21
Q
what is the most common ligament in the knee to by injured
A
anterior cruciate ligament (ACL)
22
Q
function of anterior cruciate ligament (ACL)
A
prevents anterior translation of the tibia
23
Q
noncontact mechanism of injury: anterior cruciate ligament (ACL)
A
- quick position change with cutting/pivoting
- lateral bend (valgus stress)
24
Q
contact mechanism of injury: anterior cruciate ligament (ACL)
A
direct blow causing hyperextension or valgus deformity with lateral impact
25
is ACL injury more common in males or females
females
26
clinical presentation
* feeling or hearing a "pop"
* immediate pain and swelling
* report feeling of instability
* guarding
* often able to bear weight
* laxity
anterior cruciate ligament (ACL)
27
specialized tests for anterior cruciate ligament (ACL)
* **Lachman**
* anterior drawer
* pivot shift
\*pt needs to be cooperative and relaxed
28
treatment for anterior cruciate ligament (ACL)
* RICE
* refer to ortho
* surgery: younger patients and atheletes
29
function of posterior translation of tibia
prevents **posterior** translation of tibia
30
what is the largest and strongest ligament of the knee
posterior cruciate ligament
31
clinical presentation
* varies based on MOI (MVA, soccer..etc)
* mild to moderate knee effusion/hemarthrosis
* generalized knee pain, feeling "something isn't right"
* limp
posterior cruciate ligament
32
specialized testing for PCL injury
* posterior drawer sign
* posterior sag sign (pictured)
33
function of menisci
* increase contact area for articulation
* increase joint stability, facilitate lubrication and shock absorption
34
MOI: meniscus injury
excessive rotational force (femur on tibia)
35
which meniscus is more susceptible to injury
medial meniscus
* greater forces medially
* less mobile structure than lateral meniscus
36
clinical presentation
* joint line pain
* inability to fully extend knee, described as "locking" or "catching"
* walking up and down stairs and squatting is difficult and painful
meniscus injury
37
specialized testing for meniscus injury
* McMurray's
* Apley's compression/distraction
38
imaging for Meniscus injury
MRI (don't need arthrogram)
39
what is a Grade I knee sprain
mild stretch
40
treatment for a Grade I knee sprain
* RICE
* WB as tolerated
41
What is a Grade II knee sprain
partial tear
42
Treatment for a Grade II knee sprain
* RICE
* Brace immobilization
* +/- crutches
* PT
43
what is a Grade III knee sprain
complete tear
44
treatment for Grade III knee sprain
* REFER to ortho
* surgical repair
45
what is patellofemoral pain syndrome
* malalignment, patellar tracking concerns
* most common knee complaints in primary care medicine
46
clinical presentation
* anterior pain under the patella (involves retinaculum)
* pain worse with going up and down stairs
* positive theater sign or long car ride sign
* usually see crepitus, popping, feelings of joint instability
patellofemoral pain syndrome
47
specialized testing for patellofemoral pain syndrome
* patellar glide
* apprehension test
48
recovery/prevention for patellofemoral pain syndrome
* PT
* strengthen hip abductors and quads, stretch hamstrings, core stabilization
* taping or patellar stabilizing brace
49
what is a baker's cyst (popliteal cyst)
* accumulation of joint fluid in the popliteal fossa
50
treatment for baker's cyst
* NSAIDs
* aspiration/injection
* compressive neoprene brace
* surgery rarely indicated
51
What is patellar tendonitis (jumper's knee)
* patellar tendon inflammation from repetitive trauma
52
treatment for patellar tendonitis (jumper's knee)
* Ice, NSAIDs, bracing
* steroid injection is NOT recommended
53
clinical presentation
* pinpoint pain inferior to patella
* found in athletes involved in running, jumping, kicking sports
* age 16-40
* excessive foot pronation and running hills can exacerbate these symptoms
Patellar tendonitis
54
what patient population is iliotibial band syndrome (ITBS) most associated with
* runners
* cyclists
55
clinical presentation
* gradual onset of localized pain
* initially sharp/burning pain during activities
* may develop into constant deep ache
* PE: localized tenderness and reproducible with ROM and compression to iliotibial band region
iliotibial band syndrome (ITBS)
56
treatment for iliotibial band syndrome (ITBS)
* conservative
* RICE
* NSAIDs
* PT
57
in knee bursitis, what bursa are most commonly affected
* prepatellar
* pes anserine
58
a patient with knee bursitis will present with pain, swelling, and tenderness. what condition do you need to rule out?
infection
59
treatment for knee bursitis
* avoid precipitating factors
* NSAIDs
* aspiration/steroid injection
* bracing
60
what is osteochondritis Dissecans (OCD)
* lesion of cartilage and underlying bone that results in necrosis and possible displacement (stable vs unstable)
* unknown etiology
61
what are the most common locations affected by osteochondritis Dissecans (OCD)
* **knee**
* ankle
* elbow
62
treatment for osteochondritis Dissecans (OCD)
* long term bracing
* PT
* surgery?
63
if a patient presents with medial knee pain, what is your differential diagnosis
* MCL
* medial meniscus
* pes anserine bursitis
64
if a patient presents with lateral knee pain, what is your differential diagnosis?
* LCL
* IT band syndrome
* lateral meniscus
65
if a patient presents with posterior knee pain, what is your differential diagnosis?
* baker's cyst
* DVT
66
if a patient presents with anterior knee pain, what is your differential diagnosis?
* quadriceps/patellar tendons
* patellofemoral pain syndrome
* bursitis
* patellar fx or dislocation
* Osgood-schlatter disease
67
what ligaments are included in the lateral ligament complex
* anterior talofibular ligament
* calcaneofibular ligament (CFL)
* posterior talofibular ligament
68
what ankle injury is most common
lateral ankle: injury to the lateral ligament complex
* **inversion injury** with plantar flexion
69
what specialized test is for lateral ankle sprain
anterior drawer test
70
what ligaments are located on the medial aspect of the ankle
deltoid ligament complex
71
what is a syndesmotic ankle sprain
high ankle sprain
72
what ligaments are involved in a high ankle sprain (syndesmotic)
* anterior tibiofibular
* posterior tibiofibular
* transverse tibiofibular ligaments
* interosseous membrane
73
what specialized test is for high ankle sprain (syndesmotic)
* squeeze test
74
Grade I ankle sprain: typical findings
* minimal pain and swelling
* able to bear weight/stand
75
Grade 2 ankle sprain: typical findings
* moderate pain, swelling, and bruising
* difficulty weight bearing
76
grade 3 ankle sprain: typical findings
* severe pain, swelling, and bruising
* inability to bear weight w/o significant pain
77
Grade I ankle sprain: damage to ligament
* microscopic tears
* majority of ligament remains intact
78
Grade 2 ankle sprain: damage to ligament
* complete tear of some, but not all ligament fibers
79
Grade 3 ankle sprain: damage to ligament
* complete rupture of ligament, or avulsion fracture
80
treatment for ankle sprain
* RICE, NSAIDs
* +/- short immobilization for grade 2 and 3
* PT to prevent repeat injuries
* bracing, taping
81
what is the achilles tendon? function?
* common insertion of the gastrocnemius/soleus
* function: plantar flexion
82
if a pediatric patient c/o pain to the heel/inferior posterior leg, what condition must you exclude?
calcaneal apophysitis (Sever's disease)
83
clinical presentation
* recent increase in training regimen
* burning pain to heel/inferior posterior leg that increases with activity
achilles tendon tendinopathy
84
MOI of a achilles tendon rupture
* sudden pivoting or rapid acceleration
* sensation of violet hit or pop
85
physical exam for achilles tendon
* examine lying prone
* palpate along tendon for pain, edema, and/or defect
* palpate in both plantarflexion and dorsiflexion
86
specialized test for achilles tendon rupture
Thompson test
87
treatment for achilles tendon rupture
* ortho referral
* immobilization
* equinus splinting
* boot allowing for **continued plantar flexed position**
88
what is plantar fasciitis commonly due to
* activity
* heel spurs
* pes planus/cavus
* ankle pronation
* poor shoe wear
89
clinical presentation
* pain commonly on the plantar aspect of the heel
* pain with onset of walking (_first step_ in the morning)
* PE: point tenderness at insertion of fascia at calcaneus or along entire arch
* pain aggravated by ROM (dorsiflexion of toes or ankle)
plantar fasciitis
90
if a patient comes in c/o pain to the dorsum of their foot, what condition must you rule out
S1 radiculopathy
* weakness with dorsiflexion of great toe
* SLR and achilles tendon reflex
91
diagnostics of plantar fasciitis
* radiographs of foot: AP, lateral, and weight bearing
* assess for bony abnormalities
92
treatment for plantar fasciitis
* ice, NSAIDs, rest
* prevention
* improve shoe wear
* achilles stretching exercises
93
what is osteoporosis
progressive bone loss with increased risk of fracture
94
prevention of osteoporosis
* calcium
* vitamin D
* exercise
95
evaluation for osteoporosis
DEXA scan
96
treatment for osteoporosis
* estrogen replacement therapy
* calcitonin
* bisphosphonates
97
treatment for septic arthritis
* surgical emergency
* IV abx; I&D
98
evaluation of septic arthritis
* joint aspiration
* gram stain
* labs
* CBC, ESR, CRP, blood cultures
99
what is the most common benign tumor
unicameral bone cyst (simple bone cyst)
100
what is a unicameral bone cyst
* fluid filled cavity in the bone
* usually seen in long bones
* cortex is intact but thinned
101
treatment for unicameral bone cyst
* may resolve spontaneously: **OBSERVE**
* consider surgery for recurrent pathologic features
* in peds: avoid tx if near physis under older (high recurrence rate)
102
what is an Aneurysmal bone cyst (ABC)
* blood filled cyst in the bone
* seen in spine and extremities
* BENIGN but aggressive
103
treatment of Aneurysmal bone cyst
refer to ortho for surgery
104
what is a Non-ossifying Fibroma (NOF)
* benign lesion
* think **MES: M**etaphyseal, **E**ccentric, **S**clerotic border
* eccentric (on the edge of the bone)
* sclerotic: has a good border around it
105
clinical presentation of non-ossifying fibroma
asymptomatic or pain associated with pathologic fx
106
treatment for non-ossifying fibroma
* observe with serial radiographs
* ortho referral if lesion is greater than **50%** diameter of the bone
107
what is a giant cell tumor (GCT)
* Benign, aggressive tumor
* may develop as growth plate closes: metaphyseal/epiphyseal
* early adulthood
108
clinical presentation of giant cell tumor
* localized pain
* possible weakness
109
treatment for giant cell tumor
* refer to ortho
* **radiation** and surgery
* high reoccurrence rate
110
what is an Osteoid Osteoma
* small benign bone tumor
* seen in children and adults
* Nidus-center of growing cells surrounded by thickened bone
111
clinical presentation
* dull aching pain
* **severe night pain**
* **NSAIDs relieve pain**
Osteoid Osteoma
112
treatment of Osteoid Osteoma
* refer to ortho or interventional radiology
* CT guided radiofrequency ablation
113
what is osteochondroma (exostosis)
abnormal growth of bone and cartilage along surface of the bone
114
what is the most common benign bone tumor
osteochondroma
115
clinical presentation
* fixed, non-mobile mass near joints
* may be painful with activity
* tingling or numbness if near nerve
osteochondroma
116
if you see a osteochondroma, why should you check for more?
* multiple hereditary exostosis
* small malignant potential for an osteochondroma to become a chondrosarcoma
117
treatment for osteochondroma
* observation
* refer if painful
118
what is the most common bone tumor in children
osteosarcoma
119
what is an osteosarcoma
malignant primary bone tumor
120
what is chondrosarcoma
bone tumor composed of cartilage-producing cells
121
treatment for chondrosarcoma
* refer to ortho
* +/- radiation, chemotherapy
122
clinical presentation
* fatigue, fever, night sweats
* **diffuse bone tenderness**
* pathologic fractures
multiple myeloma
123
what is multiple myeloma
* malignant bone tumor
* involves entire skeleton
124
if considering multiple myeloma, what would you look for in the urine
bence-jones proteins
125
imaging: punched out appearance on radiographs
multiple myeloma
126
what cancers most frequently cause metastatic bone cancer
think **Lead Kettle (PB-KTL)**
* **prostate, breast, kidney, thyroid, lung**
