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Exam 3 Flashcards

1
Q

what is subtalar joint arthritis

A

degenerative condition of articular cartilage of STJ

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2
Q

treatment of subtalar joint arthritis

A

conservative and surgical for pain relief and swelling reduction

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3
Q

subtalar joint anatomy

A

posterior, middle and anterior facets of calcaneous and talus articulate

medial, posterior, and lateral talocalcaneal ligaments, cervical ligaments

calcaneofibular ligaments limits execessive inversion
deltoid ligament limits eversion

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4
Q

causes of subtalar joint arthritis

A

post traumatic: intraarticular fracture of calcaneus or talus fracture
direct injury to plantar surface of talus or AVN of talus
STJ dislocation
STJ arthritis
flatfoot deformity
posterior tibial tendon tendinitis
RA

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5
Q

symptoms of subtalar joint arthritis

A

pain in medial or lateral hind foot
swelling over sinus tarsi
morning stiffness
gets better with activity
worsens in damp, cold weather
worse with WB
limping
limited ROM

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6
Q

Tests for subtalar joint arthritis

A

Xrays: STJ narrowing, osteophytes, sclerosis, cysts
CT scan: alignment, arthritis

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7
Q

treatment for subtalar joint arthritis

A

conservative: NSAIDS, corticosteroids, icing, US, LLLT, estim, iontophoresis, footwear mods, activity mods, orthotics and bracing if deformity, surgery

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8
Q

what is a STJ osteochondral injury

A

injury to the articular surface of taller dome in the ankle joint

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9
Q

causes of STJ osteocondral injury (OLT)

A

single traumatic event or repeat micro-trauma
inversion sprain w/ DF or w/ PF

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10
Q

symptoms of STJ OLT

A

pain, swelling, catching, stiffness, instability

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11
Q

STJ OLT classifications

A

stage 1: fracture
stage 2: partial detachment of osteochondral fragment
stage 3: completely detached fragment without displacement
stage 4: detached and displaced fragment
stage 5: subcentral cyst

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12
Q

testing for STJ OLT

A

xray of weight bearing
MRI

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13
Q

treatment of STJ OLT

A

immobilization
NWB 6 weeks –> progressive WB
icing
US
joint/ soft tissue mobilization
BAPS board
surgery to restore surface anatomy of talar dome

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14
Q

what is STJ tarsal coalitions

A

abnormal connection of 2+ bones in the foot
commonly occurs between calcaneus and navicular or between talus and calcaneus

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15
Q

symptoms of STJ tarsal coalitions

A

decreased motion in foot joints
stiffness
pain
rigid flat foot
recurrent ankle sprains
limp
tired legs
muscle spasms

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16
Q

causes of STJ tarsal coalitions

A

occurs during fetal development usually
infection
arthritis
previous injury to area

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17
Q

testing fot STJ tarsal coalitions

A

xrays
CT scan (gold standard)
MRI

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18
Q

treatment of STJ tarsal coalitions

A

only if causing symptoms
NSAIDS
massage
ROM exercises
US
steroid injections
orthotics
immobilization
resection surgery
fusion surgery

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19
Q

tarsal tunnel syndrome compartments

A

3 with muscles routed from leg to foot
1 with tibial nerve and posterior tibial artery surrounded by muscles

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20
Q

symptoms of tarsal tunnel syndrom

A

pain in proximal medial arch
parathesias
worse during day
burning and tingling

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21
Q

symptoms of tarsal tunnel syndrome

A

pain in proximal medial arch
parathesias
worse during day
burning and tingling

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22
Q

tests and signs for tarsal tunnel syndrome

A

NCV: posterior tibial nerve latency
tinel sign: sharp tap on posterior medial malleolus
pedal plantar sensation
longitudinal arch swelling
pes planus
weakness in posterior tibialis

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22
Q

tests and signs for tarsal tunnel syndrome

A

NCV: posterior tibial nerve latency
tinel sign: sharp tap on posterior medial malleolus
pedal plantar sensation
longitudinal arch swelling
pes planus
weakness in posterior tibialis

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23
Q

treatment of tarsal tunnel syndrome

A

icing
massage
taping
US
orthotics
wider shoes
NSAIDs
steroid injections
surgery
orthotics

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24
use of orthotics for tarsal tunnel syndrome
corrects excessive pronation to reduce pressure
25
Lis-Franc injury mechanisms
type 1: direct force to dorsal of foot, most common, forced hyper plantar flexion with medial/lateral component, MVA, crush injury, fall from high level type 2: indirect, low energy fall, sports related, twist of fall, twist of PF, forced ER of foot
26
evaluation of Lis-Franc
pain with palpation/ WB, swelling in mid region, widening of mid foot, bump on top of mid foot piano-key test mid foot squeeze single limp heel rise
27
hard castle classification for Lis-Franc
type A: injuries with an incongruity of whole joint Type B: injuries where a partial segment in displaced Type C: first metatarsal is displaced medially and other 4 are displaced laterally
28
Myserson classification for Lis-Franc
type A (total incongruity) type B (partial incongruity) type C (divergent)
29
Nunley and Vertullo classification for Lis-Franc
stage 1: no diaphysis stage 2: 2-5mm diaphysis, no arch height loss stage 3: 2-5mm diaphysis, arch height loss
30
fleck sign
small bony fragment in Lisfranc space associated with avulsion lisfranc ligament
30
fleck sign
small bony fragment in Lisfranc space associated with avulsion lisfranc ligament
31
treatment of Lisfranc fracture
stable: NWB 4-6 weeks, ambulation, rehab exercises displaced: surgery (open reduction)
32
injury management for Lisfrance fracture
NWB 2-3 weeks WB with specialized boot 1-2 months gradual WB with walking boot 4-8 weeks stiff sole show custom orthotic arch
33
rehab for Lisfranc fracture
ankle and foot ROM exercises toe and mid foot flexibility massage of mid foot calf stretching ankle and foot strengthening balance plyometrics icing laser estim
34
avulsion fractures of ankle and foot
bone pulled away from ligamentous or tendinous attachment in single impact or repetitive long term impact
35
avulsion fractures of ankle or foot mechanism
inversion sprain peroneus brevis
36
symptoms of avulsion fractures of ankle or midfoot
pain swelling bruising decreased ROM and strength gait and ambulation deviations balance problems
37
diagnosis of avulsion fracture of ankle or midfoot
x ray
38
rehab for avulsion fracture of ankle or midfoot
acute (2 weeks post op): PROM, icing, reduce edema and pain, massage, US recovery (0-6 weeks): boot first 3 weeks w/ PWB, AROM for toes and MT joints, strengthen, AROM/PROM for ankle and subtalar joint, proprioception, active resistive ROM, FWB functional (6-8 weeks post op): strengthening and conditioning of LE, increased neuromuscular control
39
what is plantar fascitis
over use injury with inflammatory reaction at insertion of plantar fascia to calcaneus heel spur in severe cases
40
plantar fascia anatomy
fibrous tissue that attaches to medial calcanea tubercle and extends to the forefoot
41
symptoms of plantar fasciitis
heel pain and plantar arch pain WB pain in morning and start of exercise that diminishes and then returns after ache/bruise at anteromedial regions of calcaneus and point tenderness persistent pain and inflammation
42
causes of plantar fasciitis
training errors improper footwear pes cavus (supinating) pes Plans (pronating) with heel eversion decreased PF strength reduced flexibility of PF muscles
43
plantar fasciitis treatment
taping rest ice boot, splint, cast night splint orthotics US laser injection
44
orthotics for plantar fasciitis
effective for plantar fasciitis w/ pes cavus, hyper pronation, increased stress, increased shearing forces
45
achilles tendon
connects heel to gastrocnemius and soles heads and inserts into posterior superior third of calcaneus
46
non insertional achilles tendinitis
mid portion of tendon in active, young people chronic micro tearing swelling, thickening, calcifying poor blood supply
47
insertional achilles tendinitis
lower portion of tendon calcifying of tendon bone spurs
48
insertional achilles tendinitis factors
varus deformity rear foot supination repetitive stress at heel strike cavus foot
49
causes of acute non insertional achilles tendinitis
recent changes to training pes cavus improper footwear
50
symptoms of acute non insertional achilles tendinitis
swelling edema crepitus TTP
51
symptoms of chronic non insertional achilles tendinitis
burning pain worse and beginning and end of workout prone to rupture
52
ROM achilles tendinitis
limited DF excessive rear foot inversion STJ supination rigid forefoot
52
ROM achilles tendinitis
limited DF excessive rear foot inversion STJ supination rigid forefoot
53
tests for achilles tendinitis
xrays US MRI
54
treatment of achilles tendinitis
ice taping heel lifts NSAIDs US BAPS board stretch posterior leg muscles orthotics surgery restore tendon length and flexibilty prevent and correct causing factors return to previous activity
55
factors for achilles rupture
men more than women sudden explosive movement jumping, running, throwing corticosteroids and antibiotics
56
signs of complete achilles rupture
popping 4-5cm gap sharp pain inability to walk
57
rehab for achilles tendon rupture
heel lift ice US Estim stretching massage balance strengthen gastrocsoleus
58
diagnosis achilles tendon rupture
thompson test xrays ultrasound MRI
59
open chain, tibia glides ___ with extension?
anteriorly
60
open chain, tibia glides ____ with flexion?
posteriorly
61
closed chain, femur glides ____ with extension?
posteriorly
62
closed chain, femur glides ____ with flexion?
anteriorly
63
what motion does tibia move during terminal extension in open chain? what causes this
external rotation because medial condyle is larger
64
what motion does tibia move during flexion in open chain? what causes this?
internal rotation because medial condyle is larger popliteus and semi membranous helps
65
what motion does femur move during terminal extension in closed chain?
internal rotation
66
what motion does femur move during flexion in closed chain?
external rotation
67
what direction does patella glide with flexion?
distally
68
location of knee pain
generally where patient is pointing to
69
pain extending above or below knee could be referred from?
lumbar spine
70
L3-S1 locations
L3: anterior thigh L4: knee L5: lateral thigh, knee, leg S1: posterior knee
71
what deformity typically occurs with knee OA?
genu varum because OA worse on medial side
72
symptoms of knee OA
pain, muscle weakness, medial joint laxity, joint stiffness, limited function, disability
73
knee OA risk factors
excess weight past trauma/ surgery developmental abnormality quad weakness abnormal tibia rotation
74
treatment for OA
pt. education taking rests/ breaks bed positioning bracing activity modification assistive device ROM exercises strengthening (quads, glutes, hip abductors) STM low impact cardio
75
indication for TKR
severe pain with WB loss of function extensive loss of cartilage gross instability failure of conservative treatment marked knee deformity
76
types of TKR
bicompartmental (tibia and femur replaced) unicompartmental (femur replaced ) tricompartmental (tibia, femur, and post. patellar replaced)
77
ligaments with TKR
meniscus, ACL, PCL removed MCL and LCL usually stay
78
factors for best outcome TKR
60-75yo healthy weeight active but not too active non smokeer strong uninvolved leg
79
TKR post op precautions
reduce swelling scar mobilization icing get to 90 degrees flexion to discharge from hospital stretching hamstrings, calves, ITB patellar mobilizations ankle pump, quad sets, OKC gait training and WBAT maintain full knee extension

Musculoskeletal (6 decks)

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