Exam 4 Clinical

Question 1

• More common in female infants
• Majority of children w/ this condition have ligamentous laxity which causes the hip to become unstable & slip out of position
• Majority of infants w/ the condition were in a breech position during the birth process

Answer 1

Developmental Dysplasia (congenital dislocation)

Question 2

Long term effects from:

• Pain
• Abnormal gait
• unequal leg length
• osteoarthritis
• twisting of the femur (femoral anteversion)
• Contracture of the hip muscle

Answer 2

Developmental Dysplasia (congenital dislocation)

Question 3

• Most common, which allows the femoral head to pass through a tear in the capsular ligament & over the acetabulum, ending up on the ilium
• May compromise the sciatic nerve

Answer 3

Posterior dislocation of the hip joint

Question 4

• Dislocation which allows the head of the femur to end up in the obturator foramen
• May compromise the obturator nerve

Answer 4

Anterior dislocation of the hip joint

Question 5

• Caused by friction b/t the skin & the patella
• or direct blow or falling on a flexed knee
• If the condition becomes chronic, the bursae will become distended w/ fluid & form a swelling anterior to the knee

Answer 5

Prepatellar Bursitis (housemaid’s)

Question 6

• Casued by excessive friction b/t the skin & the tibial tubercle
• AKA. “clergyman’s knee” but is common in roofers & floor tillers (wear knee pads to avoid)

Answer 6

Subcutaneous Infrapatellar

Question 7

• Caused by bacteria from an abrasion or penetrating wound

- Infection may spread to the knee joint cavity, causing local redness & pain as well as enlarged lymph nodes

Answer 7

Suprapatellar Bursitis

Question 8

Unhappy Triad refers to a blow to the lateral aspect of the joint while it is weight bearing & cause damage to what ligaments?

Answer 8

Medial collateral
Anterior cruciate
Medial meniscus

Question 9

• Most commonly injured ligament of the joint

- Can occur not only by a lateral blow to the joint but also by rotational forces during trauma

Answer 9

Damage to the Medial Collateral ligament

Question 10

• More vulnerable than lateral ____
• pt.’s complain of knee “clicking”, locking up, pain when going up stairs
• Small tears can sometimes repair themselves (4-6 weeks PT)
• Larger tears need surgery
• If large parts of the menisci are removed, forces are now transmitted to the condyles of the tibia & can lead to damage of the articular cartilage & lead to osteoarthritis

Answer 10

Damage to the medial Meniscus

Question 11

• Damaged in sports that require twisting or jumping
• @ time of injury pt. may state they heard a popping sound, or say my knee gave out
• Knee becomes swollen, as the cavity fills with blood
• Will produce the tibia can be pulled excessively forward under the femur (positive anterior drawer test)

Answer 11

Damaged to the Anterior Cruciate lig.

Question 12

• injured less often than the anterior cruciate

- Tibia can be pulled excessively backward under the femur (positive posterior drawer test)

Answer 12

Damage to the Posterior Cruciate lig.

Question 13

• Used to replace diseased portions of the knee (both femoral & tibial portions)
• Can be total or partial

Answer 13

Knee replacements

Question 14

• Disruption of the epiphyseal plate of the tibial tuberosity that occurs around puberty in active teens
• Ex. of what is known as apophyseal injury or a traction apophysitis
• Apophyses is a secondary ossification center that develops w/ growth
• bilateral in half of those affected
• pt. will complain of pain in the area of the tibial tuberosity
• Avulsion fractures of the tubercle are common
• Can take 1-2 years to run its course

Answer 14

Osgood- Schlatter’s disease

Question 15

• Most commonly fractured bone of the lower leg
• Compound fractures are common from direct trauma
• Relatively poor blood supply, making fractures taking longer to heal

Answer 15

Fractures to the tibia

Question 16

• Usually fracture just proximal to the lateral malleolus or just distal to the head of the bone

Answer 16

Fracture to the fibula

Question 17

Fractures to the area below the head (neck) of the fibula may damage the ________ _______ nerve which can lead to atrophy & paralysis of the anterior & lateral leg musculature

Answer 17

Common fibular nerve

Question 18

• During ossification of the talus, under certain circumstances a secondary ossification center MAY develop for the lateral tubercle of the bone
• May be due to applied stress to the talus @ puberty
• Seen commonly in teenage soccer players or ballet dancers
• Mostly asymptomatic, but may be mistaken for a fracture on an x-ray

Answer 18

Os Trigonum

Question 19

• Fractures usually occur through the neck during serve dorsal flexion @ the ankle
• Blood supply may become compromised & lead to avascular necrosis of the head of the bone

Answer 19

Fracture of the Talus

Question 20

• Fractures may be comminuted

- These fractures are usually quite disabling & may disrupt the SUBTALAR JOINT

Answer 20

Fractures of the calcaneus

Question 21

• Fine hairline fracture that appear w/o evidence of soft tissue damage
• Fracture may become visible for several weeks
• These fractures are commonly found on the: shaft of the tibia, 2nd , 3rd, & 4th metatarsals, & navicular bone

Answer 21

Stress fractures

Question 22

What are the 2 types of stress fractures?

Answer 22

1. bone is normal, but is overloaded as a result of a sudden increase in activity
2. The bone is abnormal as a result of ostroporosis, drugs or some other metabolic disorder (pathological fracture)

Question 23

• Result from increased pressure w/in a myofascial compartment, resulting in ischemia & pain
• Muscles in the compartment will swell from overuse & the edema & muscle inflammation will reduce the blood flow to the muscles
• Maybe acute or chronic

Answer 23

Compartment syndrome

Question 24

• Most commonly occurs due to some trauma

Answer 24

Acute compartment syndrome

Question 25

• Also referred to as external compartment syndrome (ECS)
• Typically in runners & walkers
• Compartments mostly affected are the anterior & deep posterior

Answer 25

Chronic Compartment Syndrome

Question 26

Some precipitating factors for chronic compartment syndrome include:

Answer 26

1. Sudden increases in intensity & duration of exercise
2. More time spent on hard surfaces
3. Shoes

Question 27

• pain along the medial aspect of the tibia, usually involving the tibial anterior muscle
• AKA Medial tibial stress syndrome (MTSS)

Answer 27

Shin Splints

Question 28

Ski boot syndrome is the term used to indicate compression neuropathy to the:

Answer 28

Deep fibular nerve

Question 29

Motor damage to the deep fibular nerve:

Answer 29

Loss of dorsal flexion of the foot & extension of the toes along w/ diminished inversion of the foot

Question 30

Sensory damage to the deep fibular nerve:

Answer 30

Loss of sensation to the skin in the web space b/t digits 1 & 2

Question 31

• Due to microscopic tears in the collagen fibers of the tendons, usually just proximal to the attachment on the calcaneus
• Often occurs during repetitive activities & seen more commonly in baseball, tennis, runners, dancers

Answer 31

Achilles Tendonitis

Question 32

Heel lifts & stretching may help to decrease symptoms of:

Answer 32

Achilles Tendonitis

Question 33

• History of Achilles tendonitis
• ruptured during forceful plantar flexion (when the knee is extended)
• May hear a snap & feel intense pain
• ## Individual will have a hard time carrying out plantar flexion

Answer 33

Rupture of the tendon calcaneus

Question 34

• Calcaneal tendon reflex test is segmental innervation of:

Answer 34

S1 & S2