Ch 9 MDT Hip, Thigh, Knee Flashcards by Brandon Bazeluk

Occurs when the femoral head is displaced from the acetabulum

Hip dislocation

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Posterior hip dislocations are most common at ___%

90%

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Affected limb short, hip is fixed in adducted and internally rotated

Severe tenderness

Decreased ROM

Posterior Hip Dislocation

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Hip held in abduction and external rotation

Severe Tenderness

Decreased ROM

Anterior Hip dislocation

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Diagnostic tests for hip dislocations

Radiograph of hip, knee, pelvis

CT scan to evaluate for fracture pattern

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Treatment for hip dislocation

MEDEVAC

Reduction

SIQ until evaluated by Ortho

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Mostly caused by high energy trauma

Severe pain in thigh

Unable to bear weight

Obvious deformity and edema

Fracture of the femoral shaft

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Diagnostic tests for Femoral Shaft Fracture

Plain films of Hip, Knee, Pelvis, Femur

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Treatment for Femoral Shaft Fracture

Immediate splinting and traction

MEDEVAC

Surgery

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Occurs in patients who undergo repetitive impact
-Military recruits, athletes, runners

Vague pain in anterior groin or thigh, relieved with rest

Member increased their activity load

Stress Fracture of the Femoral Neck

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Physical Exam:

Antalgic gait
Tenderness to proximal thigh/groin
Limited ROM, particularly internal rotation
Pain to groin or thigh with straight leg raise

Stress Fracture of the Femoral Neck

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Diagnostic tests for Stress Fracture of the Femoral Neck

Bone scan/MRI

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Treatment for Stress Fracture of the Femoral Neck

Analgesics

Ortho Evaluation

Activity Modification
-Crutches/Non-weight bearing

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Pain in groin area with attempted weight bearing

Sensation of “coming apart” at the hip with bearing weight

High impact trauma

Fracture of the Pelvis

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Diagnostics for Fracture of the Pelvis

Radiographs: Pelvis, hip, head, cervical, chest

UA: Hematuria is common

Hematocrit to evaluate blood loss

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Treatment for Fracture of the Pelvis

MEDEVAC

Hemodynamic resuscitation

Activity modification, no weight bearing

Pain Management, Narcotics

PELVIC BINDER

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Strain to muscles around the hip
-Iliopsoas, Sartorius, Rectus Femoris

Vigorous muscle contraction while muscle is stretched causes the injury

Pain over muscle exacerbated by activity

Hip Strain

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Mild ecchymosis or edema

Tenderness to affected hip muscle

Increased pain while attempting to range the hip

Strength limited by pain, 4/5

Thomas test indicated for hip flexor tightness

Hip Strain

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Diagnostics for Hip Strain

Plain films of pelvis and hip considered

MRI for chronic pain/unclear diagnosis

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Treatment for Hip Strain

Light duty/Activity modification

NSAIDs

Pain free stretching and strengthening

Run-walk program

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Injury happens when actively contracted muscle is put on a stretch

More often hamstrings are injured vs. quadriceps

Thigh strain

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Hamstring strain typically reports a sudden onset of posterior or thigh pain that occurred while running, water skiing, or some other rapid movement

“Pop” perceived at the onset of pain

Quadriceps strains are associated with direct blows during contact sports resulting in a contusion

Thigh Strain

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Physical Exam:

Ecchymosis is common
Tenderness to palpation to affected muscle group
Pain while attempting to flex/extend at the knee

Thigh Strain

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Diagnostics for Thigh Strain

X-rays if suspicion of fractures

MRI or ultrasound can confirm but is rarely indicated

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Initial Treatment for Thigh Strain

Prevent further swelling and hemorrhage by having patient rest and elevate limb while applying ice and compressive wraps

Treatment for Thigh Strain

RICE Pain free stretching and strengthening NSAIDs

Inflammation and hypertrophy of the greater trochanteric bursa Lateral Hip pain

Trochanteric Bursitis

Trochanteric Bursitis can be associated with:

Lumbar spine disease Intraarticular hip pathology Significant limb-length inequalities Inflammatory arthritis Previous surgery around the hip

Pain and tenderness over the greater trochanter (lateral hip) Pain may radiate distally to the knee or ankle or buttocks Pain is worse when going from sitting to standing May decrease after warming up but return after 30-60 minutes of walking Unable to lay on affecting side

Trochanteric Bursitis

No deformities on exam with point tenderness on lateral hip Patient has increased pain with adduction or abduction with internal rotation Trendelenburg and Faber tests are positive

Trochanteric Bursitis

Diagnostics for Trochanteric Bursitis

Hip radiographs are not necessary | -Used to rule out bony abnormalities

Treatment for Trochanteric Bursitis

NSAIDs Light duty - Activity modification Hip Strengthening (focus on abduction) and stretching Refer to ortho if failed conservative management

Primary stabilizer of the knee

Anterior Cruciate Ligament (ACL)

Results from rotational (twisting) or hyperextension force Sudden pain and giving way of knee 1/3 report audible "pop" Had to stop playing sport because of instability/pain

ACL Tear

Generalized knee tenderness ROM limited by pain/effusion Locking/popping sensation Positive Anterior Drawer and Lachman test

ACL Tear

Diagnostics for ACL tear

MRI

Treatment for ACL Tear

RICE Light duty Ortho consult Physical therapy consult KNEE BRACE

Strongest ligament in the knee Less common than other ligamentous/meniscal injury

Posterior Cruciate Ligament (PCL)

Four Injury patterns for PCL tears

Dashboard injury Hyperflexion Hyperextension Fall onto flexed knee with foot in plantar flexion

Positive Special tests for PCL Tears

Posterior Drawer Test Positive Sag Test

Diagnostics for PCL Tears

MRI

Treatment for PCL Tears

RICE NSAIDs/Tylenol Light duty Ortho Consult Physical Therapy Consult

Stabilize the knee against valgus and varus stresses

Collateral ligaments

MCL tear results from _____ force

Valgus

LCL tear results from _____ force

Varus

24-48 hours, localized ecchymosis and small effusion Tenderness to medial or lateral knee Limited pain or effusion Valgus/Varus test positive

Collateral ligament tear (MCL/LCL)

Valgus/Varus stress testing is done with the knee at ___ degrees of flexion

25-30

Diagnostics for Collateral Ligament tear

MRI

Treatment for MCL Tear

Non-operation and heal in 4-6 weeks Contact MO Conservative management (NSAIDs, RICE, Hinged Brace)

Treatment for LCL tear

May be treated non surgically depending on grade Ortho consult Conservative Management (RICE, NSAIDs, Hinged brace)

What grade of LCL tear needs surgical treatment?

III

Chronic pressure or friction causes thickening of synovial lining and subsequent excessive fluid formation, thereby leading to swelling and pain of the knee

Bursitis of the Knee

Bursitis on the anterior aspect of the knee, superficial and lies between the skin and the bony patella

Prepatellar bursa (Housemaid's knee)

Bursa lies under the insertion site of the sartorius, gracilis, and semitendinosus muscles on the medial flare of the tibia just below the tibial plateau

Pes Anserine Bursitis

Dome shaped swelling over the anterior aspect of the knee Tenderness to fluid filled dome shaped over patella

Prepatellar bursitis

Mild swelling to medial aspect of the knee Tenderness focal medial flare of the tibia just below the tibial plateau

Pes Anserine Bursitis

Diagnostic tests for Bursitis of the knee

Radiographs to rule out bony pathologies Aspiration if septic bursitis is suspected

Treatment for Bursitis of the knee

RICE NSAIDs Light duty-activity modification Pain free stretching and strengthening Antibiotic treatment for septic bursitis

Dense, fibrous band of tissue that originates from the anterior superior iliac spine region, extends down the lateral portion of the thigh and inserts on the lateral tibia at the Gerdy tubercle

Iliotibial (IT) Band

IT Band Functions to:

Stabilize hip Limits tibial internal rotation Limits over pronation

Occurs with repetitive flexion and extension of the knee Only occurs in people who exercise, runners & cyclists Pain focal to the anterior lateral aspect of the knee that worsens with activity -Especially running downhill, heel striking

IT Band Syndrome

Positive tests with IT Band Syndrome

Obers Pain when jumping on flexed knee

Treatment for IT Band Syndrome

NSAIDs Foam rolling Light duty Modifications to training regimen (Proper running progression, stretching, hip abductor strengthening)

Fibrocartilaginous pads that function as shock absorbers between the femoral condyles and tibial plateaus

Menisci

Tears that disrupt the mechanics of the knee, leading to varying degrees of symptoms, and predisposing the knee to degenerative arthritis

Meniscal tears

Caused by a twisting injury to the knee Usually, can ambulate and may be able to continue to participate in activities Describe symptoms of mechanical locking, catching or popping

Meniscal Tear

Mechanical symptoms of locking, catching, or popping Moderate to severe effusion of knee Tenderness over medial or lateral joint lines Positive McMurray

Meniscal Tear

Diagnostic tests for Meniscal Tear

MRI

Treatment for Meniscal Tear

Mechanical or Traumatic effusion = Urgent Referral to Ortho No Mechanical Locking: -RICE, NSAIDs, ROM exercises, consult to ortho

Jumper's knee Seen in patients who increase physical training too quickly Anterior Knee Pain Pain exacerbated by exercise

Quadriceps/Patellar Tendinitis

Diagnostics for Quadriceps/Patellar Tendinitis

Clinically Radiographs/MRI if diagnosis remains in question

Treatment for Quadriceps/Patellar Tendinitis

NSAIDs Ice Light Duty Pain free stretching/strengthening PATELLAR TENDON STRAP

Overuse disorder characterized by pain around the patella aggravated by activities that load the patellofemoral joint Most common cause of knee pain in the primary care setting

Patellofemoral Pain

Common cited different Patellofemoral Pain causes

Overload Malalignment

Risk factors for Patellofemoral Pain

Fitness level Prior exercise behavior BMI over 25 Training load

Diffuse aching anterior knee pain Exacerbated by prolonged sitting, climbing stairs, jumping, or squatting No preexisting trauma No history of swelling

Patellofemoral Pain

Tenderness noted to medial and/or lateral subpatellar borders Crepitus maybe noted with patellar mobility Unremarkable muscle tests and ROM

Patellofemoral Pain

Special tests for Patellofemoral Pain

Patellar Apprehension Hamstring Flexibility via popliteal angle

Patellar Apprehension, Patellar movement should be:

One quadrant medially and two quadrants laterally

Treatment for Patellofemoral Pain

NSAIDs Ice Light duty - Active Rest Quadricep and hamstring flexibility and strengthening Weight loss Support biomechanical limitations (Taping, Brace, Shoe inserts)

Popliteal Cyst is also called:

Bakers cyst

Cysts in the popliteal fossa Inflammation in the joint space can cause these cysts

Popliteal Cyst

What differential must be considered in Popliteal Cyst?

DVT

Edema in the popliteal fossa Flexion limited by pain and excessive joint fluid

Popliteal Cyst

Diagnostic tests for Popliteal Cyst

U/S shows size and extent Radiographs if uncertain MRI if uncertain AFTER ultrasound

Treatment for Popliteal Cyst

NSAIDs and/or analgesics Ice Light duty Ortho consult if symptomatic

Common cause of anterior knee pain in younger population (14-18) -Active adolescents Pain and swelling at the tibial tubercle (insertion site of patellar tendon)

Osgood Schlatter Disease

Insertion site of patellar tendon Overuse causes chronic avulsion of the ossification center of the tibial tubercle Proximal patellar tendon separates from the tibial tubercle which causes elevation Causes callous over time as it heals, and the tibial tubercle becomes pronounced

Osgood Schlatter Disease

Anterior knee pain that increases gradually over time Exacerbated by direct trauma, kneeling, running, jumping -Relieved by rest Typically asymmetric, occasionally bilateral

Osgood Schlatter Disease

Bony prominence over tibial tubercle Tenderness to tibial tubercle Full ROM Pain with resisted extension of knee

Osgood Schlatter Disease

When are radiographs indicated in Osgood Schlatter Disease?

Pain at night Pain not related to activity Acute onset of pain Associated systemic complaints such as fever, chills

Treatment for Osgood Schlatter Disease

Usually benign and self-limited -Resolves when growth plate reaches skeletal maturity NSAIDs Protective pad over knee Avoid complete rest Home exercises

Ch 9 MDT Hip, Thigh, Knee Flashcards

(92 cards)