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Flashcards in LE Clinical Syndromes Deck (31):
1

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

2

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

3

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

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

4

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

5

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

6

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

7

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

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

8

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

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

Categories:
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)

9

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

10

Pubalgia
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

11

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

12

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

13

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

MOI -
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

14

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"

MOI -
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

15

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"

16

MCL & LCL Injury
defn, symptoms, MOI

injury to medial or lateral collateral ligament

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

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

17

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

18

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

19

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)

20

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

21

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

22

Ankle Sprain
defn, symptoms (by grade), MOI

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

Symptoms:
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)

23

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

24

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

25

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

tendonitis/tendinosis of Achilles tendon

Types:
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

26

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

27

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

28

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

29

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

30

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

31

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