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Flashcards in Lower Extremity Deck (40):
1

Aseptic Necrosis (hip) Characteristics

1. loss of blood supply to trabecular bone which causes collapse of femoral head (cresent sign)
2. children: Legg-Calve-Perthes disease

2

Aseptic Necrosis Clinical Features

1. dull/throbbing ache localized to groin, lateral hip, butt
2. pain with WB, alleviated with rest
3. loss of rotation or ABDuction

3

Aseptic Necrosis adverse outcomes

1. secondary OA
2. femoral head collapse
3. disability

4

Aseptic Necrosis Imaging

1. MRI for early detection
2. xray (cresent sign later in disease)

5

Aseptic Necrosis Treatment

1. alendronate to prevent collapse
2. surgery: decompression, THA
3. protected weight-bearing

6

Slipped Capital Femoral Epiphysis (SCFE) Characteristics

1. weakening of epiphyseal plate of femur, results in displacement of femoral head
2. 10-16yo
3. boys more than girls, African-Americans more
4. younger children: metabolic cause (hypothyroid, hypopituitary)

7

SCFE Clinical Features

1. insidious hip, thigh, knee pain
2. limp

8

SCFE Imaging

lateral xray (frog-leg lateral view)

9

SCFE Treatment

1. pinning in situ
2. crutches, avoid WB after surgery

10

Meniscal Injury Characteristics

1. excessive rotational force of femur on tibia
2. medial meninscus torn more than lateral

11

Meniscal Injury Clinical Feature

1. joint line pain on side of injury
2. unable to fully extend knee (LOCKING)
3. knee "giving way"
4. swelling
5. difficulty stairs/squatting
6. Mcmurry, Apley

12

Meniscal Injury Imaging

MRI

13

Meniscal Injury Treatment

1. activity modification
2. NSAIDs
3. quad strengthening
4. Indications for arthroscopy: persistant sxs unresponsive to treatment

14

Osgood-Schlatter Characteristics

1. apophysitis of tibial tubercle
2. 8-15 yo
3. males more than females
4. self-limited

15

Osgood-Schlatter Clinical Features

1. anterior knee pain
2. localized pain and swelling over tibial tuberosity
3. pain when active, relieved with rest

16

Osgood-Schlatter Imaging

lateral xray may show fragmentation of tibial tuberosity

17

Osgood-Schlatter Treatment

1. rest for several months
2. stretching, ice, NSAIDs after exercising

18

Cruciate Ligament Injury Characteristics

1. ACL injured more than PCL
2. ACL injury associated with pivot
3. women more than men

19

Cruciate Ligament Injury Clinical Features

1. hear POP
2. feel instability in knee
3. Hemarthrosis (bleeding into joint space) within 3-4 hours
4. Lachman test for ACL

20

Cruciate Ligament Injury Imaging

1. MRI
2. xray to r/o fracture

21

Cruciate Ligament Injury Treatment

1. PT/bracing for non-athletes
2. surgical reconstruction with autograft/allograft for patients under 40 and athletes

22

Ankle Sprain/Strain Characteristics

1. Inversion injury
2. most often associated with lateral ligaments
3. ATL (anterior tibulocalcaneal ligament)

23

Ankle Sprain/Strain Clinical Features

1. report hearing "pop"
2. ecchymosis, tenderness
3. stability tested with anterior drawed test

24

Ankle Sprain/Strain Imaging

xray to r/o fracture

25

Ankle Sprain/Strain Treatment

1. RICE
2. crutches 48-72 hours
3. PT

26

Achilles Tendonitis Characteristics

1. common in runners and patients who increased fitness
2. overuse injury, result of improper stretching/training
3. if untreated: results in achilles rupture

27

Achilles Tendonitis Clinical Feature

1. pain during/after activity
2. pain on posterior calf (2-6cm above insertion of Achilles tendon)
3. normal ankle ROM
4. Thompson squeeze test to r/o rupture

28

Achilles Tendonitis Imaging

1. xray (shows calcification)
2. MRI (r/o rupture, shows hypertrophy)

29

Achilles Tendonitis Treatment

1. NSAIDs
2. PT
3. Cortisone injection

30

Bunions (Hallux Valgus) Characteristics

1. most common deformity of metatarsalphalangeal (MTP) joint
2. result of lateral deviation of proximal phalanx
3. more common in women

31

Bunion Clinical Feature

1. medial eminence pain, metatarsal head pain, deformities of the toes, and inablilty of shoes to fit

32

Bunion Imaging

1. weight-bearing xray of foot (valgus deformity an angle greater than 15 degrees)

33

Bunion Treatment

1. buy shoes with wide toe box
2. pads on medial eminence
3. surgery for serve deformity

34

Morton Neuroma Characteristics

1. result of traction of interdigital nerve against the transverse metatarsal ligament causing degeneration of nerve and chronic inflammation
2. affects 3rd web space

35

Morton Neuroma Clinical Features

1. pain and localized numbness with activity, relieved with rest
2. pain localized to web space, mass often palpable
3. squeezing forefoot will often reproduce sxs

36

Morton Neuroma Diagnosis

clinical

37

Morton Neuroma Treatment

1. soft metatarsal pad and shoes with wide toe box
2. cortisone injection
3. surgical removal of neuroma

38

Plantar Fasciitis Characteristics

1. common in runners and overweight patients
2. cause by microscopic tears in plantar fascia

39

Plantar Fasciitis Clinical Features

1. pain with first few steps in the morning
2. heel pain at night
3. inflexible achilles tendon

40

Plantar Fasciitis Treatment

1. 6-12 months conservative treatment (PT)
2. steroid injections
3. surgery for severe cases