Common Orthopedic Conditions/Sports Injuries Flashcards

1
Q

Legg-Calve-Perthes Disease

A
  • —Degeneration of femoral head from â blood supply (osteonecrosis of capital femoral epiphysis)
  • 2-4 year progression seen mainly in 4-8 yo
  • Affects one hip mainly in males
  • Limp
    • Pain in hip, groin, medial thigh, knee
  • ROM into hip Abd and IR
    • Trendelenburg
  • —Leg length discrepancy
  • —Tends to eventually heal but à degen. arthritis

—

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LCPD PT

A

—Hip ROM measurements in all planes taken and repeated often

—Emphasize ROM of hip in all directions especially IR and Abd

—Orthosis possible to maintain femoral head in contact with acetabulum

—Teach donning/doffing (“A” frame, Toronto brace)

—Gait train with orthosis

—

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LCPD Med Mgmt

A
  • —Pain management (medications)
  • —Decrease weight bearing
  • —Joint protection
  • —Natural course of revascularization
  • —If severe with destruction of femoral head à surgical intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SCFE

A

—Femoral head slides off the femoral neck due to slipping of femoral epiphysis

  • —Preadolescence and early teens (think growth spurt) boys > girls
  • —Limp
    • Pain in groin, buttock or thigh (acute onset follows trauma)
    • Also associated with obesity and weakness of growth plate
    • Trendelenburg
  • Dec ROM into hip Abd and IR
  • ***If patient is only able to flex the hip if also externally rotating
    • VERY characteristic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SCFE Med Mgmt

A
  • —Surgical pinning (stabilization) soon after diagnosis
  • Once diagnosis made, no weight bearing as it can lead to osteonecrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Congenital Dysplasia of Hip (CDH)
Developmental Dysplasia of Hip (DDH)

A

Acetabulum and femoral head not aligned normally—subluxed or dislocated

—Left hip > right hip (intrauterine positioning?)

—Girls > boys (maternal hormone?)

—Abnormal growth of hip

—Dec. ROM

—Leg length difference

—Uneven skin folds (thigh and gluteal)

—Antalgic gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Higher risk—so screen (if…)

A

Breech position (HF with KE)

—First born especially if large

—Torticollis

—Metatarsus adductus

—Oligohydramnios

—Family history

-Cultural differences in carrying infants: In a sling in hip flexion and wide abduction on mom’s hip or back vs swaddled for first few months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hip dysplasia Med Mgmt

A

Test for hip instability: at birth and infancy

— Barlow (stress test): adduction and compression

—Ortolani (reduction): distraction and abduction

—Conservative management—bracing (Pavlik)

  • —If optimal position of femoral head and acetabulum maintained, femoral head and femoral anteversion can remodel
  • —If bracing not successful, may need traction f/b closed reduction and spica cast

—After 2 years old—surgery (open reduction) if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hip Dysplasia PT Intervention

A
  • —Improve ROM of HF, HAbd, and IR
  • —ER to neutral only
  • Orthoses
    • Pavlik harness
      • —Infants 0-9 months
      • Promotes gradual, dynamic reduction
      • Requires reliable caregiving
      • Places child in HF, Abd and neutral rotation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

—If excessive genu valgum:

A

Anterior knee pain

—Patellofemoral instability

—Circumduction gait

—Difficulty running

—

*Staple medial femoral growth plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Flat foot

A
  • —“normal” for first 2 years
    • Arch not developed yet due to ligamentous laxity
    • —Fat pad under medial longitudinal arch (up to 5 years)
    • Lack of neuromuscular control
    • May take several years to develop arch
  • Weight bearing allows ligaments to stretch and allow mild subluxation of tarsal bones
    • Obesity plays a factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clubfoot:
Congenital talipes equinovarus

A
  • —Common congenital deformity
  • Forefoot adductus
  • Hindfoot varus
  • Ankle equinus
  • —Changes in talus, tarsal bones, navicular —— ligament and joint changes—–hypoplastic muscles with shortness of foot and small calf
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Other MS Abnormalities with idiopathic clubfoot

A

—Tibial shortening

—Internal tibial torsion

—Increased hip IR

—–—If due to merely intrauterine positioning, tend to be more mild and respond well to intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clubfoot PT Intervention

A
  • —Correct deformity
  • Retain mobility and strength
  • Plantigrade positioning with normal load-bearing area
  • Serial casting- if flexible
    • Correct cavus first, rotating foot from under talus, then correct equinus
    • May require achilles lengthening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Scoliosis

A
  • Lateral curvature of spine
    • Neuromuscular
    • Orthopedic
    • Congenital
    • Poor posture
    • Idiopathic—usually noted around time of adolescent growth spurt (girls > boys)
  • Named for:
    • direction of convexity
    • Type and number of curve (“s” or “c”, single or double)
    • Section of vertebral column
  • Postural asymmetries:
    • One shoulder higher than the other
    • Pelvic obliquity
    • Leg length difference
    • Prominent ribs/rib hump on one side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Scoliosis Medical Management

A
  • —Cobb angle
  • Brace (20-40°)
  • Surgery (>40°)
17
Q

Blount Disease

A
  • —Abnormal development of the tibial epiphyseal plate à altered growth of tibia (bowing)—-irreversible pathologic change
  • Tibia vara and torsion
  • Delayed ossification of medial epiphysis and metaphysis of proximal tibia
  • —Boys > girls
  • —Increases with obesity

—

18
Q

Blount disease Medical Management

A
  • Osteotomy to realign tibia
  • Disruption of growth plate
  • Limb lengthening
19
Q

Osteonecrosis:

A
  • —Group of diseases of kids in which localized tissue death (necrosis) occurs f/b regeneration of healthy bone tissue
  • During years of rapid growth, blood supply to epiphyses may be compromised à necrotic bone (typically near joints)
20
Q

Osgood Schlatter Disease

A

—Non-articular osteochondrosis at tibia

—Occurrence more frequent at times of rapid growth

—Activity related pain and inflammation at anterior knee

—Repetitive traction of patellar tendon on tibial tubercle on apophysis (ossification center)

—Tender to the touch at tibial tubercle

21
Q

OSD PT Intervention:

A

—Tends to be self limiting (related to growth)

—Ice, NSAIDs, modify activity

—Stretch hamstrings, quads

22
Q

Scheuermann Disease

A
  • —Physeal Osteochondrosis at intervertebral joints (endplates)
  • —Anterior vertebral body wedging— kyphosis during growth spurt
23
Q

Discoid Lateral Meniscus

A

—Snapping Knee

—Central area of lateral meniscus is filled in rather than “C” shape

—Possible limited ROM, locking, quad atrophy, pain, effusion

—May require arthroscopic surgery if ”symptomatic”

24
Q

Sever Disease

A

—Calcaneal apophysitis—heel pain

—Overuse syndrome caused by repetitive microtrauma at insertion of Achilles tendon at calcaneal apophysis

—Predisposing factors:

-—Gastroc/soleus tightness with tension at Achilles

—-Cavus or planus foot type à hard heel strike

—-Infection, trauma

—-obesity

25
Q

Sever Disease Intervention

A
  • —Typically self limiting (closure of growth plate)
  • Ice, heel cups, heel lifts, stretching
  • Reduce activity if necessary
  • —Proper foot wear for activity
26
Q

Sports Injuries

A

—Most common anatomic location is lower extremity (particularly knee and ankle)

—>50% of sports injuries are from overuse

—ACL injuries

—-In skeletally immature athletes, males> females

—-In skeletally mature athletes, females>males

27
Q

Growth Factors (and overuse)

A

Growing articular cartilage has low resistance to repetitive loading àmicrotrauma to cartilage or underlying growth plate

—Growing articular cartilage has low resistance to shear, particularly at elbow, knee, ankle

—Apophysitis is common– point of attachment of tendon to bone and represents an ossification center

—Increased tension at attachment sites à detachment of the structure at the apophysis (avulsion fracture)

—Longitudinal bone growth adds stress: musculotendinous structures tighten and lose flexibility (major at growth spurts)

—Biomechanical properties of bone: less cartilaginous and stiffer with growth à decrease in resistance to impactà buckling or bowing

—With growth spurt, ligaments stronger than growth plateà fx growth plate (Salter-Harris classification)

—Increased tension at attachment sites à detachment of the structure at the apophysis (avulsion fracture)

28
Q

Snapping Hip

A

—Overuse injury in athletes with a rotational component like gymnastics, dancing, sprinters

—Irritation of iliotibial band moving over the greater trochanter with hip movement

OR

—Tenosynovitis of the iliopsoas tendon near its femoral insertion

—Treat with rest, activity modification, stretching, strengthening, modalities

—

29
Q

Hip Pointer

A

—Iliac crest contusion mainly from a driving blow from a helmet

—Overlying muscle with subperiosteal hematoma

—RICE and padding

—Modalities, soft tissue work and stretching may be indicated if not resolved with above

30
Q

Avulsion Fractures

A
  • —Forceful contraction or excessive stretch of muscle originating from involved apophysis (sprinting, jumping, soccer, football, weight lifting)
  • Anterior-superior iliac spine
    • Origin of sartorius
  • Ischium
    • Origin of hamstrings
  • Lesser trochanteric spine
    • —Insertion of iliopsoas
  • Anterior-inferior iliac spine
    • Origin of rectus femoris
  • Iliac crest
    • Abdominal insertion

—

31
Q

Little League Shoulder

A

—Common in young pitchers and catchers

—Injury of proximal humeral growth plate secondary to a rotatory torque

—Limit throwing and rotational activities

—Strengthen parascapular and core muscles

—Don’t return to sports until all pain subsided

32
Q

Little League Elbow

A

—Extreme valgus stress placed on epicondyles during the acceleration of pitching

—Separation of of medial condyle with hypertrophy, irregularity, fragmentation, and avulsion

—Compressive load in lateral joint between radial head and capitellum àà

—–osteochondritis of capitellum

—–Avascular necrosis of radial head

—RICE to progression to full mobility/strength

—May have to alter throwing mechanism