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PH2001 MSK > Common Pathologies lower limb > Flashcards

Common Pathologies lower limb Flashcards

1
Q

Aim of physio intervention

A

differential diagnosis, determine appropriateness of physio/ other assessments (X-rays, scans, blood tests)/ interventions (injections/ surgery), to rehabilitate LL dysfunction conservatively

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2
Q

diagnosis and management

A

understand who gets it (typical patient), understand disease aetiology, understand typical presentation, understand why aetiology causes presentation, understand management

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3
Q

different groups of LL pathologies

A

tendinopathies (gluteal, achilleas, plantar fascia, rupture), OA (hip>knee»ankle), joint disorders (FAI, meniscal tears), sprains (ACL/PCL, MCL/LCL, ankle- LLS=ATFL, CFL), adolescents (OGS. SLJ)

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4
Q

LL MSK disorders- vascular, bone, muscle/tendon

A

Vascular= Venous (DVT) or arterial, bone= stress fracture or fracture, muscle/tendon= tendinopathies or muscle strains

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5
Q

LL MSK disorders- neural and joint

A 
neural= entrapment, peripheral, spinal 
joint= degenerative, inflammatory, traumatic
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6
Q

what causes insertional tendinopathy

A

due to calcaneal compression

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7
Q

typical GTPS patients and subjective

A

female/ postmenopausal/ increased BMI/ comorbidities

subjective= diffuse pain, sleep disturbance, standing on one leg, walking, hills/stairs

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8
Q

gluteal tendinopathy treatment

A

reduce compression, increase strength, increase functional strength and control. increase resilience to compression

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9
Q

physio main treatment for GTPS

A

education, load management, self- management strategies, strengthening exercises targeted to hip abductors

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10
Q

activity modification

A

reduce external loading- volume, intensity, frequency, duration, heel raises

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11
Q

MTU- functions as a shock absorber and spring- good

A

good muscle coordination, increased energy efficiency, greater elastic recoil- less hear production- -0tentional to improve or protect from tendinopathy

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12
Q

MTU- functions as a shock absorber and spring- bad

A

poor muscle coordination (ineffective function)- reduced energy efficiency and greater amplitude of tendon strain or greater cumulative load- greater energy absorption (More heat)- potential to trigger cellular response and tendinopathy

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13
Q

neuromuscular demanding exercise programme- achilleas (step up)

A

work away from patient preferred speed/ tempo, ensure full DF, stop movement at different positions, make patient aware of tremor- aim to smooth this, add external load early, different knee flexion angles, movement straight up (not leaning forward), change limb alignment

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14
Q

what happens with OA

A

breakdown of articular cartilage, fibrillation, fissures, gross ulcerations, disappearance of articular surface, osteophyte formation, thickening of subchondral bone, synovial membrane changes

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15
Q

clinical features of LL OA

A

high levels of activity (early OA), hip pain on movement/ walking, pain around joint, loss of ROM (on PROM R>P), antalgic or trendelenburg gait

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16
Q

treatment for OA

A

depends on severity of condition:
mobilisations for pain and stiffness, strengthening and ROM exercises, lifestyle/weight loss, surgery where pain and stiffness are severe= TJR or compartment replacement

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17
Q

what muscle groups are commonly injured

A

hamstrings>calf>groin>quads

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18
Q

groin strain- muscles and causes

A

muscles- adductors, iliopsoas, rectus femoris
cause- inflammation from overuse muscle/tendon direct trauma/biomechanics, inflammation/ pain on movement or contraction= loss of function/ weakness, visible/ palpable defect

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19
Q

hamstring strain rehab

A

POLICE, early load, length of muscle (ROM/ stretch), strengthen, pain relief if needed

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20
Q

collateral ligament injury- mechanisms of injury

A

usually varus/valgus contract force (i.e.direct blow to the knee can also occur as a result of a varus or valgus blow to the foot, MCl most commonly injured structure in knee> common than LCL, characteristic instability caused by MCL/ LCL injury is opening of medial/lateral joint space

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21
Q

signs and symptoms of lig injury

A

any age group but often early adulthood, focal joint pain, +/- h/o clicking/ popping, giving way, locking, swelling developing (24+ hours for extra articular lig, <24 for intra articular), positive test

22
Q

ACL- MOI

A

injury on external rotation, usually sudden deceleration and change of direction with fixed foot or hyperextension injury, often combined with valgus strain of MCL and medial meniscus

23
Q

ACL- signs and symptoms

A

knee buckles, unable to stand, immediate swelling- haemarthrosis (within 2 hours), inability to resume sport, locking/ loss of extension, positive lachmans test

24
Q

PCL- MOI and S+S

A

MOI- posterior force to proximal tibia, if combined with rotational force injury to P-L complex
S+S= mild to mod swelling, positive posterior draw test, often asymptomatic, pain on kneeling

25
Q

postero-lateral complex- structures involved

A

ITB/LCL/Popliteus/acurate ligament/ posterior horn lat meniscus/ lat coronary ligament/ posterior lat joint capsule/ bicep fem tendon

26
Q

postero-lateral complex- injury

A

rare but disabling and need specialist referral, associated with ACL/PCL injuries, poor outcome

27
Q

postero-lateral complex- mechanisms

A

direct blow to antero-medial tibia in an extended knee, fall onto a flexed knee, non-contact hyperextension

28
Q

S +S of postero-lat injury

A

pain in the postero-lateral corner, personal nerve symptoms, associated ligament pathology, positive posterolateral drawer

29
Q

S + S of meniscal tears

A

H/O loaded twisting/ squatting, catching, locking, acute block to extension, effusion developing over 24 hours, joint line tenderness, +ve clinical tests= McMurray’s/ Apley’s/ Joint line tenderness

30
Q

Patella-femoral disorders

A

patella femoral pain syndrome, Mal-tracking, dislocation, chondromalacia patella, patella tendinosis, prepatellar bursitis

31
Q

PFPS

A

pain at front of knee, worsened by prolonged sitting/ stair climbing or activities involved in bending, usually related to excessive mechanical loading/ chemical irritation of nerve endings

32
Q

PFPS- contributing factor

A

patella malalignment- abnormal biomechanics, muscle imbalance, overuse, direct trauma

33
Q

P/F dislocation / subluxation

A

dislocation- patella slipped out and had to be manually relocated, subluxation- patella slipped out and spontaneously relocated
S+S= localised tenderness around medial extensor retinaculum+ lateral knee pain, haemarthrosis,

34
Q

PFJ disorders- functional and structural

A

functional- muscle length/ strength, stability, proprioception
structural- bony alignment, patella shape, trochlear shae, foot position

35
Q

PFD treatment

A

pain/CMP/maltracking- patella mobilisation/ tape/ exercise

dislocation- reduction, tendon transposition, quadriceps strengthening

36
Q

meniscal management- depends on

A

clinical evaluation, associated lesions, type/location and extent of tear

37
Q

meniscal management- arthroscopic management

A

partial meniscectomy- preserve peripheral rim+ remove loose unstable fragment= increases incidence of degenerative changes, meniscal repair= poor success, rehab programme- depending on surgery

38
Q

meniscal management- conservative treatment

A

10% of patients with partial thick or short radial tears requires surgery after 4 years, mobilisations, exercise- quads and proprioception

39
Q

ligament rehab

A

unlikely to be isolated, consider Rx of other structures, rehab +/- reconstruction, functional bracing
MCL- aggressive conservative rehab 4-6 weeks return to sport, PCL or LCL= if isolated (unusual) then conservative, not isolated= surgery

40
Q

lateral ligament strain diagnosis- demographic and 24hr aggs

A

demographic- common teens to 40’s

24 hr: Aggs- walking or running over uneven ground, turning sharply, landing on inverted ankle

41
Q

lateral ligament strain diagnosis- symptoms and HPC

A

symptoms- pain+SWELLING local esp. ATFL

HPC- traumatic= specific injury involving ankle inversion, sudden onset, can be recurrent

42
Q

lateral ligament strain diagnosis- SQ and SH and assessment

A

SQ- giving way, swelling- onset or recurrent, walking over uneven ground
SH- sport involving rotation
assessment= ROM, lig tests, muscle strength tests, rehab target deficits

43
Q

lateral ligament strain diagnosis- management (functional vs Immobilisation)

A 
functional treatment (ankle exercises + external support) and proprioception
immobilisation= more effective in shor and long term than immobilisation (decreased swelling, increased stability)
44
Q

plantar fasciitis- demographic and 24 hour aggs

A

demo- late 50’s, obese women, athletes (long distance runnings)
24 hour= first few steps am, or after prolonged rest, running/dancing/jumping/prolonged standing/walking

45
Q

plantar fasciitis- subjective

A

symptom location- medial origin of medial band of plantar fascia, HPC- gradual onset over weeks/months, may be associated with traumatic incident
FSH- sport or job that involves weight bearing
SQ= P+Ns or Numbness

46
Q

plantar fasciitis- management- taping

A

medial arch support for the overpronated foot, correction of calcaneal valgus, effectiveness unknown,

47
Q

plantar fasciitis- management exericses

A

stretching of PF, hamstrings and calfs= improved with stretching alone, strengthening of tibialis posterior, intrinsics may be beneficial but lack of evidence

48
Q

perthes

A

AVN of femoral head, self limiting with revascularization occurring within 2-4 years, femoral head may remain deformed resulting in OA, most common in 6 year old males, want to reduce weight bearing and see if femoral head regrows

49
Q

LL disorder treatments

A

tendons= modify load, strengthen, progress, RTP
joint/OA- modify load/ ROM/ Strengthen/ progressive function
ligaments= modify load/ ROM/ balance/ strength/ neuromuscular control
fractures and joint replacement- ROM/ strengthen/ rehab function

50
Q

what do locking, swelling, subjective assessment at knee

A

locking= meniscus injury (tear can lead to flaps that can catch), swelling- constant? temp, how long? activity induced? knee giving away/locking- how many times over a period of time? painful?

51
Q

what is the unhappy triad an dhow to differentiate between them?

A

meniscus, ACL, LCL

meniscus= locking, ACL- giving way/ popping/ immediate swelling, MCL- pain and swelling medially

52
Q

test for PFJ pain

A

stairs and squats- anything where flex and ext under load

PH2001 MSK (14 decks)

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