Exam and Treatment of Orthopedic Conditions Flashcards
(42 cards)
1
Q
3 types of foot deformities
A
- metatarsus adductus
- calcaneovalgus
- club foot
2
Q
Metatarsus Adductus
A
- Forefoot is curved medially;
- hindfoot is in a normal
amount of slight valgus, - full dorsiflexion range of
motion is present
3
Q
3 grades of metatarsus adductus
A
- Grade I = flexible with ability to correct beyond midline
- Grade II= moderately correctable with ability to correct to midline
- Grade III=severe with inability to achieve midline
4
Q
metatarsus adductus exam
A
- Tracing or photo of foot
- Stroke/tickle lateral border of
foot, watch for spontaneous correction - Evaluate PROM
5
Q
Metatarsus Adductus Treatment
A
- Grade I: Monitor – Usually
resolves on its own - Grade II: Corrective shoes
(Straight-last or Reversed-last) - Grade III: Manipulation,
casting/splinting, and corrective shoes
6
Q
When is orthopedic surgery considered for grade III metatarsus adductus
A
- when conservative treatment is ineffective
- older than 4 yo
7
Q
positional calcaneovalgus
A
- Excessive dorsiflexion, hindfoot valgus,
and forefoot abduction - no treatment needed
8
Q
congenital calcaneovalgus caused by vertical talus
A
- Talus is vertically oriented, navicular is displaced onto the dorsal surface of the talus – “rocker bottom foot”
- Requires surgical correction
9
Q
clubfoot
A
- Midfoot/forefoot CAVUS
- Midfoot ADDUCTUS
- Subtalar VARUS
- Ankle EQUINUS
10
Q
clubfoot treatment
A
- Ponseti serial casting
- comprehensive release
11
Q
femoral antetorsion causes
A
Structural, muscle imbalance, abnormal muscle tone
12
Q
femoral antetorsion exam
A
Ryders/Craig’s test, Trochanteric Prominence test
13
Q
Femoral antetorsion treatment
A
- May resolve naturally
- Discourage W-sitting
- Braces, twister cables, shoes (not typically effective if structural)
- Surgery after 10-14 y/o
14
Q
tibial torsion cause
A
Uterine positioning, muscle imbalance,
abnormal muscle tone
15
Q
tibial torsion exam
A
Thigh-foot angle, transmalleolar angle
16
Q
tibial torsion treatment
A
- Watch until after 18 m/o
- Denis-browne shoes and bar, Friedman counter splint
- Surgery after 8 y/o
17
Q
in-toeing/ out-toeing causes
A
- Femoral torsion
- Tibial torsion
- Metatarsus adductus/abductus
18
Q
developmental dysplasia of the hip - condition
A
- Seen at birth due to poor development
of the joint capsule, ligamentous laxity, intrauterine positioning - Generally posterior and superior
- Can lead to avascular necrosis
19
Q
developmental dysplasia of the hip screening
A
- asymmetric skin folds
- limited hip abduction (should be 75-80)
- Galeazzi test (greater than 1 yo)
- Ortolani test ( <2-3 mo)
- Barlow test (<2-3 mo)
20
Q
Ortolani Test
A
- Detects hip dislocation
- Distract and abduct leg with hip flexed to 90 degrees – feel “clunk as head of femur goes back into place
21
Q
Barlow Test
A
- Detects hip instability
- Apply downward pressure to a flexed
22
Q
conservative treatment of developmental dysplasia of the hip
A
pavlik harness
- abducted, ER, flexed
23
Q
acquired hip dislocation caused by
A
- Muscle imbalance * Spasticity * Positioning * Trauma
24
Q
screening for acquired hip dislocation
A
- Pain
- Galeazzi
- Skin fold asymmetry
- Gait
- Unilateral: Trendelenburg on involved side
- Bilateral: Waddling gait
25
Treatment for Aquired hip dislocation
* Pavlik Harness
* Abduction orthosis
* Orthopaedic surgery after 2 y/o
26
limp due to trendelenburg gait
* Lean toward involved side
* Usually related to hip problem
27
limp due to antalgic gait
* Decreased stance time on involved side
* Usually related to foot, ankle, or lower leg problem
28
Under 4 y/o with a limp
* Rule out trauma
* Most likely related to infection (osteomyelitis, septic arthritis)
29
Legg Calve Perthes Disease
* Typically 4-10 y/o but can occur up to 12 y/o
* Males: Females – 4:1
* Cause unknown but may be related to exposure to 2nd
hand smoke and poor nutrition
* Positively correlated with learning disabilities and ADD
* Positive Trendelenburg – hip pain or abductor weakness
* Limited abduction and IR ROM
* Pain in groin, hip or knee
30
4 stages of LCP
1. initial stage
2. feagmentation
3. re-ossification
4. healed
31
LCP Acute treatment
abduction brace,
decrease weight bearing
32
LCP gait training
after surgery or in residual stage
33
Sever's Disease was in sports injury lecture
not doing that again
34
slipped capital femoral epiphysis
* Posterior-inferior displacement of femoral head on femoral neck due to growth plate failure
- 60% bilateral
- Males > females
35
slipped capital femoral epiphysis symptoms
* Decreased hip ROM in flexion, abduction, IR – If hip is flexed, see increased ER
* Pain at groin, anteriomedial thigh and knee
- antalgic gait
- gonna need surgery
36
osgood schatter was also in sports injury
37
growing pains
- kids 3-12
- nonarticular, pain occurs late in the day or at night, lasts
minutes to hours, episodic
38
Physical therapy for mild curves
- the schroth method
- visual feedback, breathing, postural ed to re-establish where midline is
39
Spondylolisthesis
- seen in kids who participate in sports w/ repetitive lumbar hyperext (gymnastics)
40
spondylolisthesis symptoms
* Back pain
* L5 radiculitis
* Shortened trunk
* Palpable lumbosacral stepoff of a spinous
* Anterior pelvic tilt with increased lumbar lordosis
* Heart-shaped buttock appearance
* Hamstring tightness
41
spondylolisthesis treatment
* Activity modification
* Strengthening/Stretching
* Bracing
* Surgical stabilization/fusion if Grade 3
and above or if progressive
* Decompression if L5 radiculopathy is
persistent
* Surgical repair of pars interarticularis
42
