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Flashcards in LE Clinical Syndromes Deck (31):

Hip Osteoarthritis
-defn, symptoms & moi
-inclusion criteria

slowly progressive joint disease that causes articular cartilage breakdown and loss, capsular fibrosis & osteophyte formation

Symptoms: insidious onset of pain in anterolateral hip and groin region; decreased ROM
Inclusion Criteria:
1. hip pain AND IR 15 w/ pain AND morning stiffness less than 60 min and greater than 50 years old
2. Hip pain AND IR less than 15 AND hip flexion less than 115

MOI: aging, trauma, repetitive abnormal stress, obesity or systemic diseases


Kellgren & Lawrence Classification Scale of OA

Grade I = doubtful narrowing of joint space but symptoms are present

Grade II = definite osteophytes & joint space narrowing

Grade III = Moderate, multiple osteophytes, increased joint space narrowing, some sclerosis & possibly contour deformity

Grade IV = large osteophytes, marked narrowing, severe sclerosis & definite deformity


Hip Labral Tears
-defn, symptoms & MOI

tear in acetabular labrum due to excessive forces or pressure at the hip joint
-mainly females, atraumatic, hard to diagnose

Symptoms: anterior/groin pain (90%), clicking/catching, giving way, stiffness

1. Traumatic - MVA, falling, sports (frequent ER)
2. Atraumatic - repetitive microtrauma


Trochanteric Bursitis - Greater Trochanteric Pain Syndrome (GTPS)
defn, symptoms, special tests & MOI

chronic, intermittent pain w/ tenderness to palpation over lateral aspect of the hip
- usually affecting females

Symptoms: persistent pain tender to palpation
AGG - lying on affected side, prolonged standing, sit to stand, sitting w/affected leg crossed, climbing stairs, running or other high impact

Special tests: resisted ABD & IR, Ober's test

MOI - chronic microtrauma, regional muscle dysfunction, overuse, obesity or muscle fatigue


Hip Muscular Strains
defn, symptoms & MOI

pull or tear of a hip muscle; commonly the hamstring (bicep femoris esp), quads & adductors

Symptoms: pain over injured muscle, increased pain w/ palpation, swelling & loss in strength

MOI: stretched muscle forced to contract suddenly, overstertching, fall or direct blow, overuse, inadequate warm up, lack of flexibility


Classification/Grades of Muscle strains

Grade I - small tears in fibers, pain but MINIMAL loss in strength & ROM

Grade II - more amt of fibers torn but lesion incomplete; pain, swelling, bruising, compromised strength but not complete loss

Grade III - most fibers are torn & can be completely ruptured, movement is difficult or impossible & loss of function


Avascular Necrosis of the Femoral head
-defn, symptoms, MOI

progressive ischemia & death of bone cells of the femoral head due to disruption of circumflex arteries

Symptoms: pain (groin, prox thigh or gluteal region) that is increased w/ WB, limitations in ROM & antalgic gait

1. Traumatic - falls, fracture & dislocation
2. Atraumatic - long-term use of corticosteroids & excessive alcohol intake


Femoral Neck Stress Fracture
-defn, categories, symptoms, MOI

stress fracture of the neck (2in from joint)
- typically affects young & active OR old & frail

1. Compression fx - on inferior aspect of femoral neck
2. Tension fx - on superior aspect, more likely to progress & fx completely or dislocate

Symptoms: groin pain w/ activity, deep thigh pain, limping, rest relieves pain

MOI: sudden change in activity (athletes, military recruits) or falls (elderly)


Piriformis Syndrome
defn, symptoms, MOI

irritation or compression of sciatic nerve caused by spasm or contracture of the piriformis muscle

Symptoms: pain, N/T posterior leg, difficulty sitting, sore feeling & tenderness w/ palpation
-Special tests: piriformis test, femoral-acetabular impingement test

MOI: overuse, inadequate stretching, poor posture during walking/running or fall on buttocks

commonly seen in cyclists or rowers


defn, symptoms, MOI

groin pain in athletes w/o inguinal hernia that usually occurs where the adductor muscles & abdominal muscles meet at the pubic bone

Symptoms: unilateral insidious groin pain, acute hx of sudden tearing sensation
-relief w/ rest & aggravation when activity resumes

MOI: muscular imbalances that result in uneven distribution of forces, usually due to significant twisting & cutting

Difficult to diagnose, must rule out other possibilities


Grades/Classifications of Pubalgia

Grade I - single or multiple tears of rectus abdominus or adductor muscles

Grade II - partial avulsion from pubic symphysis

Grade III - complete avulsion w/ associated microtears


Femoral Condyle Injury
defn, symptoms, MOI & diagnosis

focal articular cartilage defects OR osteochondritis dissecans (OCD lesion)

defn - focal lesion in the articular cartilage; more common in males (12-35) & related to sports trauma

Symptoms - pain, swelling, catching, tenderness, limited ROM
- reproduce pain w/ palpation of joint line

MOI - unknown, may be heriditary

diagnosed by arthroscopic surgery: Grades I/II will have less swelling & may be able to perform some activitives whereas grade IV will have severe limitations & pain & swelling


Meniscal Injury
defn, symptoms, MOI & diagnostics

tear in the meniscus
- medial > lateral b/c medial more tightly bound

Symptoms: pain & limited motion especially w/ extension/compression, hard end feel, tenderness w/ palpation of joint line

1. traumatic: compression (WB) AND rotation; sudden acc/deceleration combined w/ change in direction
2. degenerative: stiff & less compliant

Diagnostics: Apleys compression, McMurrays test; gold standard = MRI


ACL Injury
defn & risk factors, symptoms, MOI

injury to the ACL
Risk factors: females (why?)
- smaller intercondylar notch
- female hormones
- increased valgus posture when landing/cutting
- delayed hamstring reflex when landing

Symptoms: knee giving out, acute hemarthrosis, immediate dysfunction, inability to walk unassisted, "pop"

1. Just ACL = hyperextension + anterior translation
- contact (valgus stress) or noncontact (sudden deceleration w/ massive quads contraction)

2. ACL + med meniscus = hyperext + rotation

3. ACL + med meniscus + MCL = extension + valgus force + rotation


PCL injury
defn, symptoms, MOI

injury of PCL - less common than ACL b/c 50% stronger

Symptoms: similar to ACL

MOI: hyperflexion + posterior translation
"dashboard injury"


MCL & LCL Injury
defn, symptoms, MOI

injury to medial or lateral collateral ligament

Symptoms: varus/valgus stress tests, Apley's distraction test, instability, pain

1. valgus stress w/ planted foot = MCL
2. Varus stress w/ planted foot = LCL


Patellofemoral Pain Syndrome
defn, symptoms, MOI (contributing factors)

patellar tracking problem or patellar dislocation

Symptoms: anterior, lateral, or retropatellar knee pain, dull achiness, clicking or popping, giving out
AGG w/ knee flexion

MOI/contributing factors:
- anatomical abnormalities: increased Q angle, patella alta or pes planus foot strike
- muscle weakness of hip abductors & quads (especially VMO)
- flexiblity: tight ITB or lateral retinaculum
- poor muscle control during sports/training errors


Patellar Tendinopathy
defn, symptoms, MOI & contributing factors

chronic degeneration of patellar tendon due to overuse and microtrauma; most commonly at proximal portion near inferior pole

Symptoms: pain over posterior aspect of tendon, mild stiffness in the AM or after sitting, pain worsens w/ activity

MOI: overuse leading to microtrauma, sudden changes in activity, repeated jumping & landing
Contributing factors:
- lack of flexibility or strength --> decreased ROM
- high riding patella
- postural alignment, reduced patellar glide or foot structure


Osgood-Schlatter's Disease
defn, symptoms, MOI

benign traction apophysitis to occurs at tibial tubercle
--> can lead to avulsion fractures or hetertrophic bone formation
--> occurs in children 11-18
--> males > females

Symptoms: unilateral acute pain w/ activities, often a visible lump over the site or pain reproduced w/ knee extension or stress of the quads

MOI: repetitive quad contraction onto partially developed apophysis (usually during periods of rapid growth)


Baker's Cyst
defn, symptoms, MOI

fluid filled cyst that causes a bulge & feeling of tightness behind the knee
--> excess synovial fluid in popliteal fossa
--> primary (idiopathic) or secondary (underlying knee problem)

Symptoms: swelling or lump distal to popliteal crease on medial side; general pain, stiffness & clicking

MOI: inflammation of the joint resulting in excess of synovial fluid
- due to gout, OA/RA, injury, lupus, etc


IT Band Syndrome
defn, symptoms, MOI

irritation & inflammation of distal IT band usually due to repeated friction between ITB & lateral femoral condyle
- knee flexed its behind, and as you extend it moves in front of the condyle
- most common in runners or bicyclists

Symptoms: local ache/pain on outer knee or gr. troch., repitus or popping along lateral knee
AGG - walking, climbing stairs, running, cycling

MOI: overuse, poor training habits, poor flexiblity, mehcanical imbalances, leg-length discrepency, abnormal pelvic tilt, bowed legs


Ankle Sprain
defn, symptoms (by grade), MOI

stretching or tear of lateral/medial ligaments of the ankle joints

Grade I - minimal pain & swelling, no difficulty w/ WB
Grade II - moderate pain & swelling, frequently bruising w/ some difficulty w/ WB
Grade III - severe pain & swelling w/ definite bruising & difficulty WB

MOI: inversion or eversion
- Inversion most common due to excessive load on a supinated foot (inverted, PF & IR)


Grading of Ankle Sprains

Grade I: PF & Inversion = anterior talofibular
--> PF, Inversion & IR = anterior talofib & tibfib*****

Grade II: 26-75% tear, moderate pain & swelling, loss of ROM & slight instability
--> PF & inversion (& IR) = + calcaneofibular

Grade III: total tear, severe pain & swelling, loss of ROM & instability, unable to WB w/ loss of function 4-26 weeks
--> PF & inversion (& IR) = + posterior talofibular


Functional Ankle Instability (FAI)
defn, symptoms, MOI/possible contributing factors

chronic instability that leads to recurrent sprains and or feeling of the ankle "giving way"

Symptoms: recurrent ankle sprain & sensation of instability

MOI: previous ankle sprain
Possible factors related to teh cause of chronic instability
- increased joint flexibility or stiffness
- muscular weakness
- proprioceptive impairments
- balance control impairments
- delayed peroneal activation time


Achilles Tendinopathy
defn (types), symptoms, MOI/contributing factors

tendonitis/tendinosis of Achilles tendon

1. Non-insertional: fibers near the middle of the tendon have tears, swell & thicken
2. Insertional: involves the insertion point into the calcaneus

Symptoms: pain, stiffness, thickening, swelling, increases w/ activity

MOI: overuse (most common overuse injury of LE)
Contributing factors:
1. biomechanics: quick/repetitive movements from pronation to supination
2. rapid loading forces (eccentric contraction)
3. Over-pronation
4. Lack of stretching, training variables


Classification of Achilles Tendinopathy

Non-insertional vs. Insertional

Type I - pain only after activity
Type II - pain during & after activity but doesnt affect performance
Type III - pain during & after that DOES affect performance


Medial Tibial Stress Syndrome
defn, symptoms, MOI/Risk factors

increased pressure w/n small fascial compartment due to edema causing ischemia of tissues --> atrophy of muscles

Acute vs. Chronic
- most common musle affected in MTSS = posterior tib, soleus or flexor digitorum longus

Symptoms: pain in mid-bottom 1/3 of shin, pain w/ palpation, ache during or after exercise

MOI: due to hypertrophy or overuse of muscles

Risk factors: flat arch (over-pronation), athlete, female, excessive hip ROM, high BMI


Heel Spurs
defn, symptoms, MOI

bony exotosis (new bone on bone formation) usually found on medial-plantar aspect of calcaneal tubercle

Symptoms: similar pain as plantar fasciitis due to bone affecting the soft tissue in the plantar area
- pain w/ WB, heel strike & palpation
- inflammation around Achilles tendon

MOI: chronic & repetitive stress to the heel, inadequate footwear, prolonged standing, poor gait mechanics & athletes
- age & pes planus/cavus increases risk


Plantar Fasciitis
defn, symptoms, MOI/Risk factors

inflammation or degenerative changes of the plantar fascia

Symptoms: pain just anterior to calcaneus on plantar side that increases in the morning, w/ stairs, long day of standing/walking or intense activity

MOI: overstretch or strain causing microtears which leads to inflammation & pain

Risk factors = age (40-60), women, overpronation, high arches or flat feet, posterior tightness, obesity or poor footwear


Cuboid Syndrome
-defn, symptoms, MOI

cuboid subluxation/plantar neuritis - disruption of the arthrokinematics or structural congruity of calcaneocuboid joint due to displacement or tearing of soft tissues

Symptoms: pain along lateral side of foot greatest during push-off or side to side movements, restricted ROM, inflammation & discoloration, tenderness along peroneus tendon, cuboid and/or dorsolateral foot

MOI: trauma (sprained ankle) or repetitive use
- excessive traction by peroneus longus
- repetitive micro-trauma to surrounding ligaments


Calcaneus Fracture
defn, symptoms, MOI

fracture of the calcaneus (most frequently fractured tarsal bone)

Symptoms: sudden onset of heel pain & tenderness, edema, bruising, deformity, pain w/ palpation, inability to WB, occasional N/T, positive x-ray

MOI: high impact or traumatic events
- requires a large force to fracture so often involves fracture of the hip or L spine as well