UE & LE INJURIES Flashcards
Direct Trauma: Shearing w/ twist, pivot, fall Pain: groin Clicking & catching Hypermobility, dysplasia (abno dvpt cells) Morphologic abnos 8-72yrs; F>M 22-55% Surg/Non: 6w Athletes: 2-6mos Hip arthroscopy Surg recover: 4-6mos Untreated = mech irritant PT, NSAIDs, rest
LABRAL INJURIES
Displacement frm disrup of physis Injury to physeal plate w/ med displ - acute or microtrauma MOI: Trauma = stress by WEIGHT Adols: Hip pain & diff walking Acute: hip, groin, thigh pain Loss IR & obligatory ER Most common among ADOLS; M>F Bilat: 50% Endo & renal Crutches: 6-8w Follow-up: 3-4mos Very Good No weight bear (Protected WB after surg: 6-8w) Surg: w/n 24-48hrs Goal: STABILIZE slip - avoid LT comp: avas nec, rotational deform, OA NO CLOSED REDUCTION ORTHOPEDIC EMERGENCY
SLIPPED CAPITAL FEMORAL EPIPHYSIS
MOI: Repetitive stress by FRICTION frm run/cycling Pain, inflam, SNAPPING sound Recov: 4-8w VG RICE
ITB SYNDROME
Injury to pt of hip: falling, bumping, lying, etc Infection: open wound Pain outside hip; lying affected side; worse during ax; SWELLING Both active or seden Unilat: 15; 8.5% Bilat: 6.6; 1.9% F>M: 80% 2-8w Stretching & strengthening Good Anti-inflam: a week Goal: pain, inflam, mobility, prevent recurrence Rest, splint, HOT & COLD Advanced: NSAID, cortico inj, surg
TROCHANTERIC BURSITIS
Ischemia = osteocytes death & marrow = microfx = collapse Trauma, corticos, alcohol, SYSTEMIC dse Similar to hip OA: GROIN pain increased w/ wb LOM: IR, F, ABD Core decomp - crutches Bone graft - conjunc w/ comp - LONGER Osteotomies - few mos Dep on stage; 50% - surg w/n 3yrs Weight off, pain meds Collapse: jt replace surg
AVASCULAR NECROSIS
Childhood: 4-10 UK cause Groin or thigh pain Antalgic gait LOM: ABD & IR Bilat: 10% Orthosis vs Osteotomy 18-24mos Revascularization & remodeling Good outcomes: age <6 nonsurg: brace (Scottish Rite Orthosis) Surg: Osteotomy
LEGG-CALVE-PERTHES DISEASE
Internal forces - overpowered by large energy Acute POST: pain & hold in F, IR, ADD ANT (less common): E, ER, ABD Obvious deform Not tolerate ROM or resist test d/t PAIN Risk: Acetabular fx Sports: high impact/contact 2-3mos Comps: Sciatic n injury, Posttrauma OA, Avas. Nec - 10% Orthopedic Emergency Closed reduc under anesth Non WB: 3-4w --> Protected: 3w
HIP DISLOCATION
Forceful contraction w/ foot planted Unstable knee MOI: Heavy load on leg w/ knee partial bent (BB-Athletes) Open K.C.: forceful KICK Result of: Injury, jt weakness, chronic cond Complete: rare Patellar: <40 Quads: >40 4mos Most: 6mos (or LONGER) Most return to ax Half: thigh weakness & soreness Brace & PT Immob Early repair: prevent scar & tighten
QUADS STRAIN/RUPTURE
Traumatic: sudden, acute
Acute course dep on: type, severity, rehab, sports
G1&2 MCL & LCL: 2-4w
Others: 4-12mos
KNEE LIG INJURIES (GEN.)
Med condyle –> Prox med tibia
Valgus w/ foot planted
Localize pain to med side
Aggressive ice & elevate
Immob: 1-2w - stab & repair scar tiss.
Early Gentle knee F&E: 1-2w
Gradual return to ax: 1-4w
G1: Firm EF; no tearing
G3: Jt line opens w/o restraint; complete disrup
RARELY req surgery
MCL INJURY
Fibular collat lig
Rare in isolation; torn in multilig injuries
Varus
Pain & tender on lat side
RICE, crutches, gradual walk w/ more weight
Brace, strengthen mms for more stab
Surg: REPLACE tiss rather than stitch - deceased donor or from back of thigh or heel
LCL INJURY
Most fxn devastating - bcs of dynamic stab (side-to-side or cutting)
Med wall of lat condyle –> Ant spine of tibial plateau
Tears: dynamic stab
Contact/non-con injuries
Restraints ANT displ & IR
MOI: Rotated/twisting on planted w/ knee F
“Pop”; knee instab
Aggressive I.C.E Immob or crutches Early Gentle knee F&E Quads inhib. Straight leg raises in immob LT treatment: desired ax lvl Lig reconstruction: Young, sporty Aggressive rehab: seden or straight ahead ax; when no instab Wait 2-3w before recons.
Impossible return to sports w/ repeated episodes of instab
Acute: pain not prominent
Pain = assoc injury (i.e. bone contusion, med menis tear)
ACL INJURY
Less common
Post & Inf intercon notch –> Post tib spine
MOI: Forceful blow to Prox Ant leg; SHIN (Dashboard injury)
Pain w/ swelling (quickly); Limp
Isolated = less sig fxn limits.
Can return to FULL ax
I.E. Pain control, Early gentle ROM
Immob: 1-2w
Rare: surg recon (if unstable)
PCL INJURY
Traumatic: Rotation/Twist w/ planted foot Acute trauma or Gradual degen Varus/valgus to F knee Slow onset of Swelling Pain w/ weight & twist Some clicking Locking - bucket handle I.E.NSAIDs, Bracing Arthroscopy Repair or debridement w/ meniscectomy ~3mos Meniscectomy: 3-4 weeks Simple = greater healing (Red zone) Vascular zone tears - younger; arthroscopic repair Older: 3-6w rest & rehab Arthroscopic repair: limited fxn, persistent mech, recurrent epis.
MENISCAL INJURIES (GEN)
Valgus f to F knee
MED M.T.
