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TRI 2 - MSK > Final exam info > Flashcards

Final exam info Flashcards

1
Q

Describe hip capsular pattern

A
  • Hard to predict capsular pattern

- Flexion, abduction and medial rotation are most restricted

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2
Q

Describe Legg-Calve-perthes disease

A
  • Hip osteochondrosis
  • Disorder or deformation of the epiphysis of a bone
  • Interventions
    Relieve pain
    Restore ROM
    Conserative
    surgical
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3
Q

Describe Slipped Capital femoral epiphysis

A
  • Disorder of adolescent hip
  • Anterior displacement of the femoral neck from the capital femoral epiphysis
  • Etiology
    Weak epiphyseal growth plate
    Growth spurts
    Overweight for Hight
  • Interventions
    ROM restoration
    Relief symptoms
 - Complications
AVN
Chondrolysis
Long term DJD
Limb length discrepancy
  • To test draw klein’s line along the superior border of the femoral neck
    Normal - should cross at least a portion of the femoral epiphysis
    SCFE if line does not touch the femoral head
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4
Q

Describe Hip OA/DJD

A
  • Primary OA - no cause wear down with age
  • Secondary - predisposing factors

Sequelae - joint pain, stiffness, functional impairments

 - Risk factors
Family history
Obesity
Joint capsule mobility impairments
Biomechanical insults

ROM/Flexibility loss IR flexion
prolonged morning stiffness

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5
Q

Describe total hip arthroplasty and considerations for the various approaches

A

indications - severe joint damage, arthritis, displaced fractures, necrosis

  • THA precautions
  • Any anterior, posterior or lateral approach
    Avoid hip flexion >90, adduction past neutral
  • Posterior or posterolateral approach
    Avoid hip IR past neutral and combination of flexion/add/IR
  • anterior / anterior lateral or direct lateral approach
    Avoid hip EXT, ER past neutral and combination of FLEX/ABD/ER
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6
Q

Describe acetabular labral tear

A 
- Causes 
Impingement
Trauma
Sports
Twisting/torsional movements
Insidious
  • Location
    anterior / superior/ posterior
  • Etiology
    Degenerative, traumatic, idiopathic
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7
Q

Describe femoral acetabular impingement

A

Abnormal contact between femoral neck and acetabular rim

  • Types
    cam - femoral head
    pincer - acetabular rim
    mixed - both
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8
Q

Describe Acetabular labral tear

A

Could be caused by Femoral acetabular impingement
Imaging to confirm
Anterior, Anterior superior, posterior superior, posterior

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9
Q

Describe Chondral lesions

A

Acetabular labrum or cartilage tear
Acute or traumatic
Signs of impingement
Could become hip OA

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10
Q

What are some common types of hip tendinopathy

A

glutes, Adductors, iliopsoas, hamstrings, rectus femoris

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11
Q

Describe trochanteric bursitis

A

Lateral hip pain
Common in females 40-60 years of age
Caused by friction or direct trauma

  • Common bursa
    Subgluteus medius
    Subgluteus maximus
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12
Q

Describe femoral neck fractures

A

Intracapsular
geriatric populations
Displaced and nondisplaced

  • Complications
    Avascular necrosis
    Non-union
    DJD
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13
Q

Describe a posterior fracture

A
  • MOI - MVA/Dashboard injury/fall
    More common than anterior dislocations
    Accompanied by acetabular fractures
  • presentation
    Groin pain, lateral hip pain
    Leg shortness, flexed adducted IR
- Medical emergency/ complications
Blood vessel damage to femoral head
Sciatic nerve damage
Post traumatic DJD
Labral tears
Acetabular fractures
  • Interventions
    Closed reduction
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14
Q

Describe an anterior fracture

A

Anterior fracture
MOI - Forced abduction

  • Presentation
    Groin pain/ tenderness
    Superior/ anterior - leg held in extension, ER
    Inferior - anterior leg held in flexion, abduction, ER
  • Complications
    Nerve damage-Femoral
    Post traumatic DJD
    Labral tears
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15
Q

Describe femoral anteversion and retroversion

A

Anteversion
Normal 8-15 of IR
If excessive more IR and lack of full ER
Normal cartilage end feel

Retroversion
Relative retroversion 0-8 IR on craig
Absolute retroversion - less than 0 or any amount of ER
More ER lack of full internal rotation
Normal cartilage end feel with IR
Out-toeing gait pattern
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16
Q

Describe angle of inclination

A

Angle between the femoral neck and shaft of femur - 120-135
Coxa valga >135
Coxa Vara < 120
Coxa plana - flat femoral head

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17
Q

Describe synovitis and hemarthrosis

A
  • Synovitis
    excessive synovial fluid accumulation in the capsule due to synovial irritation
    Gradual effusion 6-12 hours
    dull/ achy pain
    Swelling end feel, may be empty in severe cases
    Rest/PRICE
 - Hemarthrosis
Blood in joint capsule due to severe trauma, blood needs to be removed immediately
Sudden effusion
Very painful, hot/inflamed
Very painful - no end feel
Aspiration of blood, rest/PRICE
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18
Q

Describe Osgood-Schlatter disease

A

osteochondrosis /apophysitis of tibial tubercle
Results in bigger tibial tuberosity
May result in avulsion fracture

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19
Q

What are some common tendinopathies of the knee

A

Patellar
Pes anserine
Popliteus
Semimembranosus

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20
Q

Describe patellar tendinopathy

A

Jumper’ knee - common in people who eccentrically load the patellar tendon
May be similar to osteochondrosis of the tibial tubercle

 - Presentation
Pain on to the inferior pole of the patella
Load related pain that increases with the demand of the knee extensors
Pain palpating patellar insertion
Pain with loading
Dose dependent pain
No pain when resting
Pain improves with warm up
Pain after energy storage exercise
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21
Q

Describe pes anserine tendinopathy

A

Proximal medial knee pain

All have different actions at the hip

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22
Q

Describe popliteus tendinopathy

A

Attaches to posterior capsule and lateral meniscus
IR of tibia flexes and unlocks the knee
Should be able to differentiate from semimembranosus due to location and actions that produce pain
Lateral side pain

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23
Q

Describe semimembranosus tendinopathy

A

Pain with hip extension

Medial side pain

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24
Q

Describe Iliotibial band friction syndrome

A

Not a TSI
Friction as the TFL passes over the lateral femoral condyle
Could be caused by TFJ or PFJ capsular issues, muscle imbalances, TFL tightness
Reduce stress, heat, ice, strengthen hip abductors, stretch ITB

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25
Q

Describe patello femoral pain syndrome

A

Most common injury of the LE
Anterior knee pain
Patellar mal alignment
Not TSI
With PFPS patella tracks laterally
Closed chain femoral ADD and IR overpower femoral ABD and ER, causing excessive IR and ADD of the femur
Lateral tracking is due to the femur rotating internally and adducting
Treat weak glutes, or hypertonic IR and ADD

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26
Q

What are some contributing factors to PFPS

A 
Anatomic structure
Gender
Q angle
Subtalar joint position
Muscle imbalances
Landing pattern
Altered core/ LE kinematics
Soft tissue restrictions
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27
Q

What are some interventions for PFPS

A 
NSAIDs
Minimize PFJ loading
Stretch lateral structures
Correct muscle imbalances
Tapping
Activity modification
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28
Q

Describe chondromalacia patella

A

May cause anterior or retro patella knee pain
Softening or wearing of posterior patellar articular cartilage cartilage

  • Types
    Age dependent - symptomatic
    Trauma dependent - symptomatic
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29
Q

Describe TKR

A 
- Indications
Pain and physical/functional limitations due to OA
Rheumatoid arthritis
Ligamentous instability
Infection
Avascular necrosis

The goal is to prevent these whenever we can
Treat OA before it gets to this point

3 parts of the replacement
Metal femur, metal tibia, plastic cap for patella

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30
Q

What are some TKR complications

A 
Embolism
Poor healing
Infection
Fractures
Neurological/ Vascular injuries
Extensor mechanism disruption
Restricted ROM
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31
Q

What variable predicts post operative knee ROM

A

pre-operative knee ROM

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32
Q

Describe symptomatic plica

A

Thickening of knee joint synovium
Hard to confirm, diagnosis of exclusion
Remnant of synovial folds in the developing knee
Anterior or medial knee pain

33
Q

Describe tibial plateau fractures

A
  • Crushing injury to the tibial plateau
  • MOI
    Valgus force in elders
    Blunt force trauma to plateau
  • Complications
    Intra articular adhesions/stiffness
    DJD
    Damage to popliteal structures
  • Treatment
    Closed reduction-external fixator
    Closed reduction-internal fixation
34
Q

Describe the concept of reflex inhibition

A

Joint effusion causes reflex inhibition in the surrounding muscles
Could lead to atrophy
Treat effusion before strengthening

35
Q

Describe patellar dislocation

A

Acute trauma or overuse injury
Subluxation - patella slides back into position normally

 - presentation 
Swollen knee with hemarthrosis
Patella laying on lateral side of knee
If suddenly returns its a subluxation
Guarding and apprehension
No weight bearing on involved leg
  • treatment
    Closed reduction with extended knee brace
    External support
  • Complications
    Repetitive dislocations
    Articular damage, chondromalacia patella, degeneration
36
Q

Describe the plica stutter test

A

Positive if patella jumps or stutters between 45 and 60 degrees of flexion
Only effective if there is no swelling
Not a great test

37
Q

Describe the knee joint capsule

A

3 compartments
Medial and lateral tibiofemoral
Patellar compartment

Cruciate ligaments - extracapsular
Popliteus - intracapsular
Gastroc - extracapsular

38
Q

Describe how the cruciate ligaments can affect the PROM A findings at the knee

A

Cruciate ligament position
Intra articular
Could lead to positive PROM A findings when injured

39
Q

Describe a healthy ACL

A

Extra capsular with fibers blending with joint capsule
Taut in full knee extension and tibial internal rotation
Limits anterior tibial translation and posterior femoral translation

40
Q

Describe injuries to the ACL

A
  • MOI
    non contact - valgus/ER force
    Contact - valgus/ hyperextension
  • Unhappy triad
    ACL, MCL, Medial meniscus injury
  • ACL injury examination
    Limit anterior tibial translation
    Avoid terminal open chain knee extension in early phases
    Closed chain knee extension to decrease shear forces
  • ACL intact Vs. Torn
    Patellar and hamstring graft commonly used to repair
41
Q

Describe a healthy PCL

A

Extra capsular
Taut in full knee flexion and tibial internal rotation
Limits posterior tibial translation in NWB and anterior femoral translation in WB

42
Q

Describe PCL injuries

A 
- MOI
Falling on flexed knees
Direct blow to anterior tibia
Forced hyperflexion/hyperextension
Fall onto tibia - where the tibia is forced posteriorly
  • PCL injury examination
    Limit posterior tibial translation
    Avoid terminal knee flexion in early phases
    Strengthen quads early to decrease posterior tibial translation
    Closed chain flexion before open chain
43
Q

Describe a healthy MCL

A

Medial epicondyle to shaft of tibia
Extracapsular but blends with capsule and medial meniscus
Taught in full extension and ER of Tibia
Restrains excessive valgus/ABD force
Prevents anterior displacement of tibia on femur

44
Q

Describe an injured MCL

A

MOI - valgus stress
Diagnosis - valgus test
Considerations - attaches to Med meniscus and SM

45
Q

Describe a the LCL

A

Lateral epicondyle to fibular head
MOI blow to medial knee
Varus test

46
Q

Describe meniscal tears

A

Function - lubrication, load distribution, shock absorption
Medial injuries are more common than lateral - less mobile
Medial meniscus attachments - tibia, MCL, capsule semimembranosus
Lateral meniscus attachments - tibia, capsule, popliteus

  • MOI
    Non-contact rotational/ twisting force with varus/valgus stress during weight bearing
    contact
    Presents with acute joint line tenderness
    clicking/popping is common
    Types of tears
  • TSI
    Medial or lateral tear
    Prognosis changes with central vs peripheral
    Peripheral may heal on their own
47
Q

Describe some meniscal tear interventions

A

meniscectomy/ excising the menisci
Meniscus repair-arthroscopy
To protect the sutures used in the repair WB is not allowed early in recovery
With meniscectomy WB is allowed and could happen, as they begin to weight bear they need to make sure not to overdo it in their early phase of healing
Look above and below the knee and see if there is anything that may cause stress to the meniscus repair

48
Q

Describe a lateral ankle sprain

A

77-83% anterior talofibular ligament
ATFL fibers blend with capsule
CLF is extracapsular

  • MOI
    ATFL/CFL - INversion and PF
    CF alone or along with ATFL - inversion and neutral df/pf
    Sequence of injury
    Anterior talofibular ligament sprain is the most common in the body
    Because of its capsular plend it may present with positive PRM a findings
    Rick factors
    intrinsic / extrinsic
  • Prognostic factors
    Grade of injury
    Age
    Recurrence
 - complications 
Chronic ankle instability
Clinical findings are based on age
Additional injuries
Peroneal tendons, nerves, other injuries
49
Q

Describe some uncommon ankle sprains

A

Medial/ eversion sprain to the deltoid ligament 5% occurrence
High ankle sprain - anterior/ posterior inferior tibiofibular ligament or interosseous membrane
MOI - dorsiflexion, eversion, external rotation or planted foot

50
Q

What are some differences between fractures and sprains in the structures of the ankle

A

Bone heals faster due to better vascular supply
Ligament collagen heals weaker than before
Ligament sprains can decrease proprioception increasing chances of recurrence
At the ankle stability is provided mostly by the ligaments rather than the muscles, placing more strain on other ligaments if one it torn

51
Q

What are some types of ankle fractures

A

Unimalleolar - one malleoli
Bimalleolar - two malleoli
Trimalleolar - bothe malleoli and posterior margin of the tibia
Pott’s fracture/ dislocation - any dislocation and fracture of malleoli

52
Q

What are some types of tibial fractures

A

Acute
Oblique
Stress

53
Q

What is the required great toe mobility

A

45-65 degrees to walk normally lack of this can affect the windlass effect
Limitations - muscular imbalances or joint pathology

54
Q

What are the differences between hallux limits and hallux rigidus

A

Hallux limitus: 1st MTP progressive degenerative disorder - less extension
Hallux rigidus: 1st MTP joint ankylosis - even les extension

- Presentation
1st ray DF stiffness
Pain, swelling, tenderness
Gait deviations
Difficulty running and stair walking
  • Interventions
Limitus
Rest/NSAID
Orthoses/shoe modification
Manual therapy
Therapeutic exercises

Rigidus - upward rotation blocked by bone spur
Surgical - cheilectomy

55
Q

Describe hallux valgus

A

1st MTP joint alignment deformity
Hallux and first 1st MT shift medially
More common women, could be hereditary
Bunion - overgrowth of bone and tissue on the medial side of the 1st MT head

  • Structural vs functional
    Functional - if big toe is brought into abduction and the bunion disappears it is functional
    Structural - if it stays it is structural
56
Q

Describe a tailors bunion

A

Bunion of the 5th MTP on lateral side of the foot
Irritation and pressure to the 5th metatarsal head
May have overlapping fifth toe or varus deformity of toe
Could be hereditary

57
Q

Describe hammer toes, claw toes and mallet toes

A
  • Hammer toes
    Extension of MTP and DIP
    Flexion of PIP

Claw toes
Hyperextension of MTP
Flexion of PIP and DIP

  • Mallet toes
    Flexion of DIP
58
Q

Describe an Achilles tendon rupture

A
  • Etiology
    Spontaneous
    microtrauma/tendon degeneration
    Steroid injections
  • MOI - sudden push off or DF
59
Q

Describe Metatarsalgia

A

Pain under plantar aspects of MT heads
Repetitive high loading under MT heads
Global diagnosis not TSI

60
Q

Describe Interdigital Neuroma

A

Interdigital Neuroma
Aka morton’s neuroma
Thickened tissue around the interdigital nerve
Causes chronic id nerve irritation and trauma

- Presentation
Tenderness b/w the metatarsal heads
Neurological symptoms
Imaging required to confirm the neuroma
Neuroma does not respond to neuroma and requires surgical excision
61
Q

What are the differences in presentation between Metatarsalgia and Interdigital Neuroma

A
  • Metatarsalgia
    Pain under MT heads
    No neurological symptoms
  • Morton’s neuroma
    Pain between MT heads
    Neurological symptoms present
62
Q

Describe Server’s disease

A

Calcaneal osteochondritis-calcaneal traction apophysitis

Heel pain in young and active children

63
Q

Describe compartment syndrome

A

Compartment Syndrome
Increased tissue pressure within a closed orofacial space
Compromised local blood flow- neurovascular compromise

 - Presentation
5 Ps
Pain
paralysis 
Paresthesia 
Pallor
Pulses
  • Acute/traumatic MOI
    Tight bandage / plaster cast
    Decreased arterial flow increased venous pressure
  • Chronic MOI
    Exertional, exercise induced
    Acute CS is a clinical emergency and needs to be treated by a physician
    PT’s treat chronic or exercise induced
64
Q

What are the regions of CS and what structures are at risk in each region

A
  • Anterior
    Deep peroneal nerve
    Anterior tibial artery and vein
    Dorsiflexors
  • Lateral compartment
    Superficial peroneal nerve
    Peroneal
  • Deep posterior compartment
    Tibial nerve
    Posterior tibial and peroneal artery and vein
    Tom dick and harry
65
Q

Describe medial tibial stress syndrome

A

Tibial periostitis/tibial stress syndrome/shin splints
Medial soleus or posterior tibialis
Exercise induced anterior and medial leg pain

  • presentation
    Anteromedial tibial tenderness
    Activity induced
    Resolves with rest
  • Causes
    Biomechanical imbalances
    Poor training
 - Interventions
Correct biomechanical impairments
Activity modification
Proper training
surgical
66
Q

Describe anterior tibial periostitis

A

Muscles - tibialis anterior, EHL
Exercise induced anterior and lateral leg pain

 - presentations 
Anterolateral tibial tenderness
Activity modification
Resolves with rest
Treatment similar to shin splints
67
Q

Describe plantar heel pain

A

Aka plantar fasciitis/ fasciopathy/ fascialgia

 - Contributing factors
Obesity 
occupational 
Acute injury
anatomical 
biomechanical 
Can be TSI
68
Q

What are the presentations and interventions that go along with plantar heel pain

A 
- presentation 
Plantar surface tenderness
Aggravating factors
swelling 
Positive windlass test
Limited TCJ mobility
Kinetic chain impairments
  • Interventions - treat the biomechanical impairment
    splinting / orthotics/ taping/shoe modification
    Therapeutic exercises - stretching/ strengthening
    Physical agents
    Patient education
    Activity modification
    Manual therapy-soft tissue and joint mobilizations
    Kinetic chain
69
Q

What is Homans sign

A

Special test that tests for deep vein thrombosis
Poor test
Positive if tenderness on the calf

70
Q

Describe a pronated foot

A

Increased angulation b/w hindfoot and forefoot
Some pronation during Gait is required
Weak and hypermobile flat foot

  • Causes
    congenital , developmental acquired
71
Q

Describe Flat foot

A

PES planus
Decreased medial longitudinal arch
Acquired/ rigid or flexible/ mobile flatfoot

72
Q

Describe high foot

A 
Pes cavus or high arch
Abnormally supinated / stiff foot, high longitudinal arch
Tibial external rotation
Rigid/mobile
Neurological and muscular causes
73
Q

Describe rearfoot varus and vallgus

A

Hindfoot/ rearfoot varus
Calcaneus varus/calcaneal inverted/ supinated rearfoot
Associated with tibia vara or pes cavus

Rearfoot valgus
Calcaneus valgus/ cancaneal everted, pronated rearfoot
Associated with tibia valga or pes planus

74
Q

Describe how rearfoot varus and valgus affect the kinetic chain

A

Forefoot varus - hindfoot valgus - Knee valgus/ tibial IR - Hip IR
Forefoot valgus - hindfoot varus - knee varus/ ER - Hip ER

75
Q

Describe the rays of the foot

A

1st - metatarsal, medial cuneiform
2nd - intermediate cuneiform
3rd ray - metatarsal, lateral cuneiform
4th and 5th

76
Q

Describe pronation and supination at the talocrural joint

A
  • Pronation
    Dorsiflexion and tibial IR
    Posterior talar glide and medial talar glide
  • Supination
    Plantarflexion and Tibial external rotation
    Anterior glide of the talus and lateral talar glide
77
Q

Describe pronation and supination at the subtalar joints

A
  • pronation
    Eversion
    Lateral arc glide
  • supination
    inversion
    Medial arc glide 2:1
78
Q

Describe pronation and supination in the forefoot

A
  • Forefoot pronation
    1-2 TMT - plantar glide
    3-4 TMT - dorsal glide
  • Forefoot supination
    1-2 TMT - dorsal glide
    3-4 TMT - plantar glide

TRI 2 - MSK (3 decks)

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