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Clin Med - MSK > Lecture 10 - LE Disorders > Flashcards

Lecture 10 - LE Disorders Flashcards

1
Q

When does the acetabulum form?

A

by age 13 - 14
fuses by age 15 - 16
the acetabulum is the ball and socket joint of the hip

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2
Q

Labrum

A

“O-ring” of fibrocartilage that surrounds the acetabulum

increases depth of acetabular cacity; thus, increasing surface and strength of joint

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3
Q

What blood supplies the arterial head?

A

extra-capsular arterial ring at the base of the neck
ascending branches of the ring onto the neck surfaces
Obturator artery of the round ligament affixed to the neck (easily damaged)

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4
Q

What causes labral injury?

A

bone spurs
impingement syndrome
trauma
arthritis

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5
Q

How to pts with labral injury present?

A 
Groin pain (22%) 
Pain with twisting, sleeping on hip 
Mechanical sxs (66%) 
-popping, clicking, catching
-snapping hip syndrome (80%)
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6
Q

Which speciality tests do we do for labral tear?

A

for the hip always start distal (like the back) and then move into the hip

McCarthy Test
FABER Test
Anterior Impingement Test
Posterior Impingement Test

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7
Q

What is the treatment for labral tear?

A 
Conservative: 
NSAIDs
Corticosteroids
PT
Intra-articular cortisone injection done under fluoroscopy - kenalog

Surgery:

  • open labral surgery
  • arthroscopy
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8
Q

What is the aftercare from arthroscopic labral debridement/repair?

A

Crutches 1-4 weeks
PT early ROM - bike

IF CONTINUED PAIN, FURTHER SURGICAL HIP INTERVENTION MAY BE NECESSARY

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9
Q

What is the most common knee injury?

A

MCL - medial collateral ligament

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10
Q

What is the meniscus?

A

2 wedge shaped semilunar discs of fibrocartilage and collagen resting on top of the tibial plateau

medial meniscus attached on the periphery to MCL

these begin to lose blood supply naturally starting in 20s and 30s

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11
Q

What is the function of the meniscus?

A

increased distribution of load forces across the joint
dissipate compressive load “shock absorber”
protect articular cartilage
joint stability

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12
Q

What are common ways people injury the meniscus?

A

squatting and twisting the knee
direct blow
degenerative meniscus tears from weakened cartilage in elderly

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13
Q

Who gets meniscus injuries?

A

M > F
Males age 31-40yo
Females 11-20yo

degenerative tear 60% in >65 years

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14
Q

What are risk factors to meniscus injuries?

A 
sudden twist 
trauma 
repeated squatting
aging
previous ligamentous injury
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15
Q

What xrays do you do when a pt comes in with knee pain?

A

WEIGHTBEARING
AP
Lateral
Sunrise - bend to 90 degrees

torn meniscus on MRI

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16
Q

What is the management of meniscus tears?

A 
Medical: 
RICE 
NSAIDs
Analgesics (acetaminophen) 
Intra-articular steroid injection (kenalog/lidocaine) 
PT

Surgical:
Arthrosopy (repair (younger pts), debridement)
Human allograft meniscal transplantation

studies show no beneficial between operatively vs nonoperatively

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17
Q

What is the recovery period for meniscus tear?

A

following partial menisectomy: weight bearing as tolerated, may return to play/activity in 2-3 weeks

after meniscal repair: non weight bearing 4-6 weeks
return to play 6-8 weeks

PT is used to improve motion, strength, pain, and earlier return to activity

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18
Q

What are the different collateral and cruciate ligaments?

A

Collateral:
MCL
LCL
-resist valgus/varus forces

Cruciate:
ACL
PCL
-control anterior/posterior translation of the tibia
-secondary restraint for tibial rotation, varus/valgus stress

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19
Q

What causes ligament injuries?

A 
twisting of knee 
a blow to the knee
hyperextension of the knee
jumping and landing on a flexed knee 
stopped suddenly when running
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20
Q

How do you grade ligament injuries?

A

Sprains

Grade 1:
stretched, stable

Grade 2:
partial tear, lossening

Grade 3:
complete tear, unstable

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21
Q

What is the treatment and recovery for MCL and LCL injury?

A 
RICE 
bracing 
PT 
less common - open repair/reconstruction
usually non-operative

return to sport
MCL - Grade 1: 5-7 days; Grade 2: 2-4 weeks; Grade 3: 4-8 weeks
LCL: usually back to sport in 6-8 weeks

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22
Q

What speciality exams are used when assessing ACL injury?

A

anterior drawer
lachmans test (most sensitive)
pivot shift

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23
Q

What is the treatment for ACL injuries?

A

usually bracing, crutches, and PT

arthroscopic reconstruction, esp. in multi-ligament injury

76% go to surgery!

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24
Q

Tendon vs ligament injury terminology

A

Tendons = strains

Ligaments = sprains

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25
Q

How do you dx ACL injury?

A

Xray

AP, lateral, sunrise

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26
Q

Segond fracture

A

bony fragment from the lateral tibial condyle on the AP view

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27
Q

ACL Avulsion Fracture

A

avulsed bone fragment is seen anteriorly in the intercondylar region of the tibia due to avulsion of the tibial spine at the distal ACL attachment

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28
Q

What speciality tests will you do for PCL injury?

A

posterior drawer

posterior tibial sag test

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29
Q

What is the treatment for PCL injury?

A

hinged Abracing, crutches, and PT

Arthroscopic reconstruction, esp in multiligament injury

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30
Q

Arthroscopic surgery

A

ACL and PCL repair

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31
Q

Patellar femoral syndrome

A

aka chondromalacia patella

painful irritation of the cartilage on the underside of the patella. Common in young athletes

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32
Q

What are the medial ankle ligaments?

A 
deltoid ligament (2 sets of fibers:)
Superficial
-TCL (tibiocalcaneal ligament) 
-TSL (tibiospring ligament) 
-TNL (tibionavicular ligament)

Deep

  • PTTL
  • ATTL

Spring ligament

33
Q

What are the lateral ankle ligaments?

A

ATFL (anterior talofibular ligament)
PTFL (posterior talofibular ligament)
CFT (calcaneal fibular ligament)

34
Q

The Ottowa Rules for foot and ankle dx imaging

A

an ankle xray is required only if there is any pain in malleolar zone and any of these findings:

  • bone tenderness at posterior edge or tip of lateral malleolus
  • bone tenderness at posterior edge or tip of medial malleolus

a foot xray is required if there is any pain in the midfoot zone and any of these findings:

  • bone tenderness at base of 5th metatarsal
  • bone tenderness at navicular
  • inability to weight bear both immediately and in the casualty department
35
Q

What are risk factors for ankle sprains?

A 
hindfoot varus 
jumping and cutting sports
improper footwear
deconditioning
previous instability/recurrent sprains 
weakness
36
Q

Is the lateral or medial side more commonly involved in ankle sprains?

A

lateral

37
Q

What is the most common reason for missed athletic participation?

A

ankle sprains

38
Q

Which specialty tests are done for pts with ankle pain?

A 
talar tilt test 
anterior drawer 
external rotation/kleiger test 
Standing heel rise test
squeeze/compression test
39
Q

How do we grade low ankle sprain classification?

A 
Grade 1 (mild) 
-slight stretching and damage to the ligament fibers

Grade 2 (moderate)

  • partial tearing of the ligament
  • abnormal joint laxity

Grade 3 (severe)

  • complete tear of the ligament
  • significant instability
40
Q

Syndesmosis

A

high ankle sprain

complex ligamentous that maintains the integrity between tibia and fibula, resists axial, rotational, and translational forces

widening of mortise on Xray

41
Q

What are the non-operative treatments for ankle sprains?

A

RICE 48-72hr
NSAIDs
if painful weight bearing, brief period of immobilization in a walking boot

PT exercises/strengthening are vital to rehabilitation

42
Q

What are the operative treatments for ankle sprains?

A

indication:
chronic instability
multiple ligament injury

modality:
usually ligament reconstruction

43
Q

What are the non operative treatment for HIGH ankle sprains?

A

indication:
a syndesmotic sprain without diastasis or ankle instability

mechanism:
non-weight bearing CAM boot or cast for 2-3 weeks
delayed weight bearing until pain free

outcomes:
typically display a notoriously prolonged and highly variable recovery period
recovery may extend twice that of standard ankle sprain

44
Q

What are the operative treatments of HIGH ankle sprains?

A

indication:
a syndesmotic sprain with diastasis and/or ankle instability

syndesmotic screw
removal of screw at 9 weeks

outcomes:
improved stability
improved functionality and motion

45
Q

What are the return to play guidelines for ankle sprains?

A

Grade 1/2: 1-2 weeks
Grade 3: 3-6 weeks

high ankle
6+ weeks with immobilization
out for the season with screw fixation

46
Q

What are the different achilles tendon injuries?

A

tendonopathy

  • tendinosis
  • paratenonitis
  • paratenonitis with tendinosis

tendon rupture

47
Q

How does tendon rupture occur?

A

usually running, jumping, sudden acceleration/deceleration

high risk activities
-basketball, running, diving, tennis

48
Q

What are risk factors for achilles tendonopathy?

A 
intrinsic: 
Type O blood type 
family hx 
systemic dz (CKD, RA, SLE, Gout, thyroid, DM)

extrinsic:
drugs:
steroids, quinolones
overuse:
exercise, strain, improper footwear

49
Q

Who is more likely to have achilles tendonopathy?

A

M&raquo_space; F
30-50yo
80% of ruptures occur during recreational sports
Left > right

50
Q

How do pts with achilles tendonopathy present?

A

a sudden “snap” or “pop” in lower calf accompanied by severe pain
feeling of being “shot” or “kicked” in the back of the leg
swelling
difficult ambulation

51
Q

How do you definitively dx disrupted achilles tendon?

A

MRI but not always necessary

52
Q

What is the most commonly injured ligament in low ankle injuries?

A

ATFL - anterior talofibular ligament

53
Q

Pes Planus

A

congenital flat feet

54
Q

Pes Cavus

A

congenital super arched feet

55
Q

How do you manage chronic tendopathy?

A

RICE
Orthtoics (heel lifts)
PRP injections

56
Q

Who do you treat tendon rupture conservatively?

A

Elderly/inactive
Systemic illness

Serial casting
Heel lifts
NSAIDs
PT

57
Q

What is the surgical management for tendon rupture?

A

Open reconstruction with reapproximated ends

High risk of not healing well
4 months to heal

58
Q

Morton’s Neuroma

A

Nueropathic pain in the interdigital distribution of the metatarsal heads, resulting from repetitive irritation of the nerve from stretch or compression

59
Q

What causes morton’s neuroma?

A

Wearing tight shoes and high heels
Abnormal positioning of toes
Flat feet

60
Q

Who get morton’s neuronoma?

A

F > M.
15-50 yo
3rd - 4th and 2nd -3rd webspaces MC

61
Q

How do pts with Morton’s neuroma present?

A

I feel like im walking on a marble

Pain and dysesthesis in the forefoot and corresponding toes
Pain described as sharp and burning

62
Q

How do you dx Morton’s Neuroma?

A

Xray (evaluate bony structures)

This is a nerve issue but you want to make sure there aren’t any tumors, etc.

No labs necessary

63
Q

What are non-surgical treatment for mortons neuroma?

A 
Footwear modification (no high heels) 
PT 
Plantar metatarsal pad 
Steroid injection 
Shockwave therapy
64
Q

Morton’s Neuroma surgical treatment?

A

Neurectomy with nerve burial
Transverse intermetartsal ligament release

Basically trying to take the pressure off the nerve and rerouting the nerve

65
Q

What medications work for mortons neuroma?

A

TCA
Gabapentin
SSRI

NSAIDs are not helpful (this is not a inflammation problem but a nerve compression problem)

This are not highly liked by ortho people, because they need to be followed, so we let primary care do this

66
Q

Plantar Fasciitis

A

Inflammation and subsequent pain caused by irritation at the origin of the plantar fascia on the medial process of the calcaneal tuberosity

67
Q

What causes plantar fasciitis?

A

Repetative microtrauma
Obesity
Shoe wear
Overpronation

68
Q

Who gets plantar fasciitis?

A 
W > M 
Adults of all ages 
Runners
Athelets
Even general public
69
Q

How do pts with plantar fasciitis present?

A

When i get out of bed in the morning it feels awful

Startup pain (from sitting to standing) 
Or pain after long periods of exercise

Tight on dorsiflexion

WIndlass Test - passive dosriflexion of toes to reproduce the pain

70
Q

What imaging needed for plantar fasciitis?

A

Xray
AP, lateral, oblique
Calcaneal view

Heel spur not the cause!

MRI/US/bone scan only done in rare cases

71
Q

What is the treatment for plantar fasciitis?

A

Conservative treatment is the MC

Takes weeks to years for improvement

Massage and stretching
PT
Orthotics —hold in dosiflexion

72
Q

What is the last resort for plantar fasciitis?

A

Surgery

Plantar fasciitis release with plantar fasciotomy

73
Q

Bunion

A

Hallux valgus

A medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux, with or without medial soft tissue enlargement of the first metatarsal head

74
Q

What causes hallux valgus?

A

Joint and ligament laxity problem —instability

Trauma
Arthritis
Cerebral palsy

Shoes are not a cause

75
Q

Who gets hallux valgus?

A

F > M
70% with bunion have + family hx
Increased incidence with age

76
Q

How do pts with hallux valgus present?

A

Nonacute deep or sharp pain in the first MTP joint during ambulation

Feels better after they take off their shoes

77
Q

What imaging do you get for hallux valgus?

A 
Weightbearing Xrays 
AP 
Lateral 
Oblique
Seasmoid axial
78
Q

What is the conservative method of treatment for hallux valgus?

A

Most medical therapies are aimed at sxs relief

Footwear modification
Orthotics
NSAIDs if pain
Steroid injection of MTP joint

Clin Med - MSK (10 decks)

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