Lecture 9 - Lower Limb Soft Tissue And Bone Disorders Flashcards
1
Q
Dysplasia of the hip: Pathophysiology
A
- during childbirth
- abnormality in size, shape, orientation or organization of the femoral head or acetabulum
RISK FACTORS: breech, female, Family Hx, Firstborne
2
Q
Dysplasia of the hip: assessment
A
- ortolani and barlow maneuvers
- Galeazzi sign
- Hip abduction range
3
Q
Dysplasia of the hip: management
A
- subluxation often corrects spontaneously
- if subluxation persists: Pavlik harness
- if dislocation persists: closed reduction and Hip Spica casting
4
Q
Perthe’s disease pathophysiology
A
- osteochondrosis of capital epiphysis of femoral head: disruption of blood supplu
- cessatin of endochondral ossification
- Vascular invasion of cartilage
- necrosis of marrow space and trabecular bone
5
Q
Perthe’s disease: Assessment
A
- low grade ache, male 4-10 yo
- Limited abduction and internal rotation upon physical exam
- XRAY: increased density and flattening of femoral capital epiphysis
6
Q
Perthe’s disease: Management
A
Rest
- exercise for range of motion
- Brace
- surgery
7
Q
Avascular necrosis of the femoral head: pathophysiology
A
- damage to deep branch of medial femoral circumflex artery leading to necrosis of femoral head
- follows femoral fracture in high energy trauma
- can have non traumatic causes: anything that compromises blood supply in artery
8
Q
Avascular necrosis of the femoral head: clinical assessment
A
- history of hip pain progressively worse over time
- located in groin, proximal thigh, buttock
- aggravates with weight bearing and eases with rest
- antalgic gait
- passive movement elicits pain
- limitation in motion in capsular pattern
- MRI
9
Q
Avascular necrosis of the femoral head: management
A
- if non traumatic: non-weight bearing activities, alter risk factors
- older patient: hip replacement
- younger patient: reconstructive procedure
10
Q
Osgood Schlatter’s syndrome (aka: traction apophysitis)
A
- apophysis biomechanically weak during growth spurt: at danger in young athletes
- resultant traction causes irritation, inflammation, microtrauma
- Osgood Shlatters: tibial tuberosity
- Sinding Larsen Johansson: inferior angle of patella
11
Q
What is an apophysis
A
Secondary ossification centre, attachment of tendons
12
Q
Osgood Schlatters: clinical presentation
A
- in very active younf children aged 10-15 during growth spurt
- more often boys cause growth spurt later
- often unilateral
- inflammed, swollen and tender on palpation
- child may have poor lower limb alignment
13
Q
Osgood Schlatters management
A
PRICEM
- gentle strecth of rectus femoris
- orthotics
- patellar tendon taping
14
Q
Patellofemoral dislocation
A
- Patella moves laterally
- Predisposing factor: femoral anteversion, genu valgum, increased Q angle, Patella alta, ligament laxity, muscle weakness
15
Q
Patellofemoral dislocation assessment
A
Physical exam: tenderness over medial patella, patellar apprehension test
