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SCS > Chapter 11 MSK LE > Flashcards

Chapter 11 MSK LE Flashcards

1
Q

what is the MOI of hip injuries

A

twisting, kicking, rapid acceleration adn decelleration

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2
Q

who is more at risk of hip injuries, males or females

A

males

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3
Q

what are some risk factors that increase the incidence of hip injury

A

-history of previous hip or groin injury
-age
-BMI inc or dec
-ecreased hip ABD and tROM loss,
-strength deficits between abd and add
-difference in hip ext strength bilaterally

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4
Q

according to the 2015 consensus statement on hip and groin pain what are the classifications

A

hip joint
adductor
public bone stress injry
iliopsoas/abdominal wall issue
**HIP/JOINTmost common

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5
Q

___% of athetes show findings of

A

FAI

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6
Q

7/10 young patients with hip fractures have had previous existing signs or symptoms of

A

osteoporosis

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7
Q

pediatric hip fractures are most often caused by

A

MVA

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8
Q

what are risks and possible bad things associated with pediatric hip fractures

A

failure of physeal plate to close, AVN, chondrolysis

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9
Q

what is the risk of acetabular fracture

A

AVN of femoral head

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10
Q

what kind of sports get pelvic fractures

A

high speed, such as motor sports

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11
Q

what are S+S of atraumatic bone stress injures

A

hip thigh groin pain, worse with activity relieved with rest

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12
Q

what are some risk factors or things that can lead to stress injuries

A

training intensity, surface changes, diet, female sex and triad, biomechanics with landing

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13
Q

how to best idenify a bone stress

A

MRI

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14
Q

what are tests to look for stress fractures in the hip and groin

A

FABER, flamingo and fulcrom test

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15
Q

femur stress fractures are likely associated with coxa ____, and happen at the _____ of the femur

A

vara,
neck of femur

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16
Q

what types and locations of stress fractures in the femur require surgical fixation

A

high stress at the head or the lateral side of the femoral neck (because this is the tension side)

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17
Q

what side of the femoral neck is the low risk femur fracture

A

the medial side of the femoral neck, and this can be NWB/PWB

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18
Q

what two things have been shown to speed up the bone healing

A

pulsed ultrasound and e-stim

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19
Q

what ages are chondral injuries common

A

14-25

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20
Q

where do apophyseal injuries happen

A

at the immature bone-tendon attachment

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21
Q

signs of apophyseal injury

A

pain and tenderness at apophysis, painful stretching and strengthening, and swelling.

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22
Q

RTP following apophyseal injury

A

~3 months

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23
Q

avulsion sites

A

ASIS (sartorius) , AIIS (RF), iliac crest (TFL, abdominals), ischial tuberosities (HS), LT (iliopsoas), pubis ramus (adductors)

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24
Q

management of acute avulsion fracture WB status

A

TTWB for 1-2 months

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25
Q

role of the labrum

A

absorption, joint stability and nutrition

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26
Q

what is the most common intra-articular hip pathology

A

labrum

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27
Q

labral tears are common in hips with coxa ___, femoral and acetabular _____, and ____ center edge angle

A

vara, retroversion, increased center edge angle

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28
Q

s+s of labral tear

A

anterior groin, hip pain or butt pain with clicking, locking or giving way

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29
Q

MOI of anterior vs posterior labral tearing

A

anterior: twisting or pivoting, posterior from a direct blow posteriorly, usually with dislocations.

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30
Q

traumatic vs atraumatic labral tears

A

traumatic, from a rapid twist, pivot or fall. atraumatic from cumulative microtrauma

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31
Q

tests for labral tears

A

FADIR, flex-IR test, posterior impingement test

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32
Q

difference between cam and pincer type

A

cam is a fat femoral neck, pincer is an overgrown acetabular rim

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33
Q

what is a pistol grip deformity

A

from a cam lesion where the femoral head and neck are fat at the junction

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34
Q

where are cam and pincer more common

A

cam in athletes due to repetitive stresses causing over growth
pincer in middle age active females

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35
Q

when to suspect FAI

A

painful clicking, locking, giving way, lateral/post hip pain, groin pain with pivoting, rotational movements, hip in flex/add/IR
pain worse with prolonged sitting, standing waking.
C sign

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36
Q

special tests for FAI

A

FADIR, FABER, modified Thomas test, Flex-IR test, resisted SLR and log roll

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37
Q

which test has sensitivity of 100% for FAI/labral tears

A

flexion IR test

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38
Q

dx of fai best done with

A

MRI

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39
Q

non-op FAI management

A

avoid aggravating positions, core strength, avoid end range movements

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40
Q

what things may cause structural instability in the hip

A

shallow acetabulum, excessive acetabular ante/retroversion, inferior acetabulum insufficiency, neck/shaft angle >140 degrees

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41
Q

focal rotary instability can be seen in

A

kicking repeated forceful rotation such as ballet, golf, martial arts,

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42
Q

which ligament is often involved in the abnormal loading of the anterosuperior labrum with focal rotary instability

A

iliofemoral

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43
Q

what is the most common position of hip dislocations

A

posteriorly, with a big posterior force in the flex/add position.

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44
Q

atraumatic instability signs and symptoms
coxa___

A

locking, giving way, clicking and c/o pan in the hip. hip dysplasia s+s on imaging and caxa valga.

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45
Q

tests for instability in the hip

A

pain with FABER, FADIR, AB-HEER (abd, ext and ER apprehension), hip IR less than 30 degrees at 90 degrees hip flexion

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46
Q

what ligament is affected in those with anterior capsule instability

A

ligamentum teres

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47
Q

what are the actions that cause a hip flexor tendinopathy

A

kicking or decelerations and eccentric contractions

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48
Q

severe injuries which lead to swelling can lead to what kind of palsy

A

femoral nerve palsy

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49
Q

most common muscles injured in the thigh

A

hamstrings

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50
Q

what are some things associated with prolonged recovery from a hamstring pull

A

ROM deficits with the hip flex to 90, over 1 day being unable to ambulate without pain, greater than 1 week from injury to consultation, stretching type injuries, participating in rec sports, and increased pain

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51
Q

what is the strongest predictor of adductor pain

A

previous adductor injury

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52
Q

adductor MOI

A

running, jumping twisting with hip ER,

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53
Q

which adductor most commonly involved

A

adductor longus

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54
Q

predictive things for adductor strains

A

add/abd weakness imbalance, hip/abd muscle imbalance,

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55
Q

how long for rehabb

A

4-8 weeks

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56
Q

what is the LSI of strength that they say you need

A

70%

57
Q

where does AP-sports hernia affect

A

Rectus abdominus and hip adductors

58
Q

in sports hernia ___ is strong and ___ is weak

A

strong adductors and weak abdominals

59
Q

s+s of sports hernia

A

twisting, kicking lateral movements and change direction pain, insidious onset of pain, deep groin/lower abdomen, worse with resisted sit ups, sprinting cutting pain with adductor testing,

60
Q

non-op PT for sports hernia

A

6-8 weeks, with strength, flexiblity, NM control…

61
Q

what is the surgical option for sports hernia

A

abdominal wall repair with bilateral adductor tenotomy.

62
Q

how long after sports hernia repair can PT start

A

4 weeks

63
Q

how does sports hernia rehab start

A

light PREs (progressive resistance exercises) adductor strengthening, propriocetion and coordination,

64
Q

when can add and abdominal pres be added after Sports hernia repair

A

6 weeks

65
Q

what is the difference between intra-articular and extra-artcular snapping hip

A

intra: labral tears, chondral injuries, ligamentum teres…
extra: have internal and external snapping hip

66
Q

internal snapping hip is AKA

A

coxa saltans interna
iliopsoas over the iliopectineal eminence or the femoral head

67
Q

tests for coxa saltans interna

A

Thomas test for tight iliopsoas, positive active iliopsoas snapping testing, glute med weakness

68
Q

external snapping hip AKA

A

coxa saltans externa from the ITB or Glute max over the greater trochanter.

69
Q

tests for external snapping hip

A

thightness in the ITB obers test, positive bike test

70
Q

what is overactive and what is underactive in external snapping hip

A

TFL overactive and glute max underactive

71
Q

what type of eccentric training is needed for external snapping hip

A

eccentric glute muscles

72
Q

what are the 3 stages and considerations for hip rehab

A

protective phase, rehabilitation phase and functional phase

73
Q

what is it about non contact injuries to the ACL

A

there is a strong quad contraction on the knee extended with some valgus, which created a IR of the femur on the tibia

74
Q

what are some criteria to be able to get surgery for your ACL

A

full ROM, walking ok, minimal swelling,

75
Q

what parts of the patellar tendon and hamstring are used for ACL

A

central third, or distal hamstring

76
Q

what is the avg return to running post ACl as per textbook

A

12 weeks

77
Q

RTP following ACL-R as per textbook

A

9-12 months

78
Q

what kind of tibial rotation can cause MCL injury

A

twisting and a tibial lateral rotation

79
Q

where are the different tissues (deep and superficial) layers of the MCL most often injured

A

in extension, the whole ligament is messed up
in 20+ degrees flexion, usually just the superficial tissue

80
Q

grades of MCL injury

A

grade I: pain with palpation to medial joint line, no instability, minimal swelling,
grade II 1+: 0-5 mm laxity, with an end feel
grade II 2+: 6-10 mm laxity, end feel harder to ID
grade III: no end feel

81
Q

grade II or more injuries should be managed how

A

in a locked slight flexion brace around 20-25 degrees

82
Q

RTP for MCL injuries grade I vs II

A

I: within 7-10 days
II: up to 3 weeks

83
Q

what is the PLC

A

the posterolateral complex made up of the posterior joint capsule, LCL, popliteus tendon and the popliteofibular ligament.

84
Q

what are some clinical findings/exams to clue into a PLC injury

A

-laxity posteriorly with varus testing
-laxity with dial test
-laxity with ER recurvatum test of Hughston test

85
Q

what is the dial test

A

increased ER of the tibia noted while prone with knee flex at 30 than 90 degrees flexion

86
Q

tests for PCL injury

A

posterior sag sign and posterior drawer test/clancy step off test

87
Q

what is the largest concern with PCL injury

A

tibial lag sign

88
Q

post op PCL… WB status and bracing

A

in full extension brace for 4-6 weeks, can WB if knee extended

89
Q

when can you do HS exercises following PCL-R

A

6-8 weeks

90
Q

what are risk factirs for Patellofemoral dislocation

A

-inc Q angle,
-female, wider pelvis,
-shallow femoral groove,
-flat lateral sulcus,
-high riding patella,
-ligamentous laxity,
-pronated feet and
-vastas medialis weakness

91
Q

do pronated or supinated feet leave you more prone to patellofemoral dislocation

A

pronated

92
Q

which way does a patella usually dislocate

A

laterally

93
Q

what way do you move the knee to relocate a dislocated patella

A

move it from flex to ext and that should reduce it.

94
Q

what is ruptured in most lateral patella dislocations

A

MPFL

95
Q

how long do you immobilize following dislocation of patella

A

3-4 weeks

96
Q

what kind of brace helps the knee after initial immobilization in patella dislocation

A

lateral buttress

97
Q

can you do QS right after patella dislocation

A

yes

98
Q

how many ligaments need to be disrupted to have a tibiofemoral disloaction

A

3+

99
Q

what are things to be mindful of with tibiofemoral dislocation

A

distal pulses, sensation, vascular supply due to popliteal artery, peroneal and tibial nerve

100
Q

how long do you immobilize after tibiofemoral dislocation

A

in full extension for 4 weeks

101
Q

what muscle is important to strengthen for tibiofemoral dislocation

A

vastas medialis oblique, as that is the only medial dynamic stabilizer.

102
Q

what provides blood supply to the meniscus

A

the medial and lateral genicular arteries

103
Q

where the is meniscus red zone

A

THE OUTER PORTION OF THE

104
Q

white zone is the _____1/3

A

inner

105
Q

s+s of meniscus tear

A

pain, twisting, giving way, locking, catching sensation,

106
Q

test for meniscus tear

A

joint line tenderness, McMurrays, Apleys

107
Q

partial meniscectomy WB status ?
RTP?

A

as soon as feel comfortable, and RTP in 6-8 weeks.

108
Q

meniscus repair WB? bracing? ROM limitations

A

either PWB or FWB, and first 6 weeks, ROM limited to 90 flexion.

109
Q

RTP following meniscus repair

A

16-20 weeks

110
Q

what are the grades of chondral injuries/lesions

A

grade 1: softening and swelling of cartilage
grade 2: fissuring and fragmentation of less than 1/2 inch in diameter
grade 3: fissuring and fragmentation greater than 1/2 inch in diameter
grade 4: cartilage eroded down to subchondral bone

111
Q

what location is the most common for OCD

A

the lateral portion of the medial femoral condyle

112
Q

what kind of view can you see an OCD lesion on

A

a notch view

113
Q

following OCD lesion surgery WB status? and early activities?

A

early quad sets, and usually WB status is restricted for first 4-6 weeks.

114
Q

patellofemoral pain is characterized by

A

pain int he anterior knee which is inc with compression of the patella against the femur.

115
Q

peak prevelance of PFPS

A

12-17 years old

116
Q

what are some anatomical risk factors of PFPS

A

anteversion of the hip and trochlear or patellar dysplasia

117
Q

when moving from ext to flexion, the patella has to translate…

A

has to translate medially as it enters the trochlear groove, around 20-30 degrees knee flexion, then will follow groove and translate laterally.

118
Q

what kind of things compound tracking issues

A

patella alta, baja, laterall pressure syndome

119
Q

PFPS is increased with what tasks

A

squatting, climbing stairs, kneeling.

120
Q

what could lateral PFPS mean

A

excessive lateral pressure syndrome or small nerve endings.

121
Q

what could medial PFPS mean

A

medial plica, stretchng of retunaculum.

122
Q

what could inferior pain with PFPS mean

A

patella tendinitis, fat pad

123
Q

what could retropatella PFPS mean

A

chondromalacia or articular cartilage

124
Q

what does a laterall tilted patella mean in full extension

A

tightness in the fibers of the retinaculum.

125
Q

how can you assess retinaculum with patella mobility

A

patella mobs in slight knee flexion.

126
Q

what is normal amount of tilting that should be able to occur medially at the patella

A

15 degrees past neutral, into medial position

127
Q

what kind of foot and tibia position can lead to tracking patella issues

A

pronated foot and tibial IR/MR

128
Q

who benefits more from orthotics

A

older folks, while younger do better with exercises

129
Q

taping and orthotics are good for those with what kind of structural things

A

excessive foot pronation

130
Q

what can inhibit quad firing which leads to atophy

A

pain

131
Q

why is intra-artcular swelling bad

A

becuse it can irritate the synovium and create articular cartilage issues

132
Q

whats better? ice alone or ice with compression

A

ice with compression for knee injruies

133
Q

cartilage procedures have what kind of WB restrictions

A

NWB for 6 weeks

134
Q

what is a fully extended knee gait pattern caled

A

quad avoidance gait pattern

135
Q

why is it a good idea to start balance exercises of 30 degrees knee flexion

A

becuase you get a co-contraction of quad to HS

136
Q

what kind of things do you need to do to get cleared for RTP

A

strngth within 10%, OKC testing (to isloate issues) CKC chain testing too
jump assessment

137
Q

which is the actual most important part of jump testing assessments

A

the landing ecentric phase tells us the most.

138
Q

what are jump height cut offs for men and women
(and single hop too)

A

jump men: 90-100% their height
women: 80-90% height
(single HOP: men: 80-90%, women 70-80%)

139
Q

what is a good LE test for RTP

A

LEFT lower extremity functional test with 15 conditions on a 30-10ft diamond.

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