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Clin Med II MHM - FINAL > Lower Extremity Disorders > Flashcards

Lower Extremity Disorders Flashcards

(72 cards)

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1
Q

What makes the hip a more stable joint than the shoulder?

A

Acetabulum is a deep socket with much more coverage of femoral head

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2
Q

How is the hip joint different than the shoulder joint?

A

Weight bearing

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3
Q

Where is the sciatic nerve most vulnerable to pelvic fractures?

A

Sciatic notch

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4
Q

Where is the sciatic nerve most vulnerable to posterior dislocations?

A

Distal to sciatic notch

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5
Q

How does hip pain present?

A

Groin and anterior thigh

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6
Q

Describe avascular necrosis of the hip

A
  • Aseptic necrosis of hip
  • Results from loss of blood supply to femoral head
  • Males
  • 20-40 yo
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7
Q

Treatment of AVN of the hip

A
  • Restrict weight bearing and activity to prevent collapse

- Long term prognosis is poor usually requires total hip arthroplasty as OA progresses

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8
Q

Who is affected by OA of the hip?

A
  • Under 45 yo, MC in men

- Over 55 yo, MC in women

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9
Q

What is the sign of end stage OA of the hip?

A

Pain at rest

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10
Q

Post-op care of total hip arthroplasty

A
  • Rapid mobilization, wt bearing as tolerated w/crutches or a walker
  • Anticoag
  • Alternating compression sleeve and stocking
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11
Q

What is the MC approach to total hip arthroplasty?

A

Posterior - less risk of infection, quicker recovery

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12
Q

Describe trochanteric bursitis

A
  • Bursa overlies greater trochanter and can get irritated

- Pain over GT aggravated by lying on the affected side

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13
Q

What is the most likely cause of snapping hip?

A

Tight IT band that catches over greater trochanter with movement

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14
Q

What makes the knee inherently unstable? What keeps it stable?

A
  • Intrinsic bony configuration

- Surrounding network of soft tissue

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15
Q

What is the bony anchor of the extensor mechanism in the knee?

A

Patella

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16
Q

What is the largest sesamoid bone in the body?

A

Patella

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17
Q

What are the extrinsic ligaments of the knee?

A

MCL (femur and tibia)

LCL (femur and fibula)

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18
Q

What are the intrinsic ligaments of the knee?

A

ACL (resists anterior translation on tibia)

PCL (resists posterior translation on tibia)

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19
Q

MOI for ACL injury?

A
  • Valgus force to ER knee w/foot planted

- Hyperextension in IR

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20
Q

MOI for PCL injury?

A
  • Knee flexed

- Anterior to posterior translation of joint

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21
Q

What is the extensor apparatus of the knee and what does it do?

A

Straightens knee, prevents buckling

  • Quad muscle and tendon
  • Patella and tendon
  • Tibial tubercle
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22
Q

When ordering x-rays of the knee, what views should be obtained?

A

AP, lateral, tunnel view

Sunrise if tracking patella

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23
Q

What x-ray view is best if you suspect OA in a patient over 40?

A
  • AP view in standing position

- Lets you see joint space narrowing better

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24
Q

Describe MCL fibers

A
  • Posterior fibers are taut in extension

- Anterior fibers are taut in flexion

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25
MCL is primary stabilizer to what type of stress?
Valgus (lateral) stress
26
MOI of MCL injury?
Lateral or valgus stress (often w/foot planted)
27
MCL injury grading
Grade I: 1-5 mm laxity Grade II: 5-10 mm laxity Grade III: Over 10 mm laxity
28
MOI of LCL injury?
Varus stress to medial aspect of knee
29
What is the most important single ligamentous stabilizer in the knee?
ACL
30
ACL can be reconstructed with what type of grafts?
Patellar, semitendinosis, gracilis
31
What is the strongest ligament of the knee?
PCL
32
MOI of knee meniscal injuries
- Usually a twisting injury | - In older patients may be as simple as squatting down
33
Patients don't like to have their knees touching in which knee injuries?
Meniscal
34
PE of meniscal injuries shows:
- Positive McMurray's sign | - Positive Apley grind test
35
Subtotal menisectomy may predispose patients to what?
OA
36
How does a meniscal cyst of the knee present?
- Similar to meniscal tear but usually with a painful lump along joint line - Requires a more extensive surgery
37
What is a discoid meniscus? How does it present and how is it treated?
- Congenitally abnormal meniscus (too big and not C shaped) - Can cause a painful click - Arthroscopy to remove excess meniscus
38
What is chondrocalcinosis? How is it treated?
- Pseudogout - Calcium pyrophosphate dihydrate deposition in mensicus - Arthroscopic partial or complete menisectomy
39
What is a plica? Definitive treatment?
- Silky membrane of tissues within the fetus's knee - Usually dissolves at birth - 30% of people keep it (medial side of knee) - Some thicken and present similar to torn meniscus - Arthroscopic debridement
40
What is a Baker's cyst?
- Not truly a cyst but a collection of fluid in a normally occurring bursa behind knee - Pts w/pain usually have torn meniscus due to synovial fluid being pumped out of the knee into the bursa
41
What is osteochondritis dissecans? Who is affected?
- Subchondral bone develops AVN - Mostly males, young adults - X-ray shows a lucency over medial femoral condyle
42
AVN of the knee
- Presents much like osteochondritis dissecans - X ray shows radiolucent defect - If no response to conservative tx, patient may need TKR
43
Chondromalacia of the knee
- Extensor apparatus dysfunction | - Softening of articular cartilage
44
All patellofemoral disorders influence what?
Q angle (indicator of how patella tracks)
45
Q angle in males vs. females
Males usually small angle | Females usually large angle
46
Patellofemoral disorders affect who?
Young females usually athletes or those who ride horses
47
PE of patellofemoral disorders
- Crepitus - Large Q angle - Apprehension sign w/lateral displacement of patella - Positive squeeze test
48
Describe patella tendinitis
- Jumpers knee (bball players) | - Pain over tendon worse w/stairs and jumping
49
Where does bursitis in the knee occur MC?
Pre-patellar (traumatic injury) | Pes anserine
50
Compartments of the knee
1. Medial 2. Lateral 3. Patellofemoral
51
Septic arthritis of knee
- Direct invasion of joint space by bacteria - MC S aureus - Young pts MC N. gonorrheae
52
Early prosthetic joint infection (within 3 months) is MC caused by which bacteria?
S aureus
53
Delayed prosthetic joint infections (3-24 months) are MC caused by which bacteria?
CoNs and gram negative aerobes
54
Septic arthritis presenting triad
Fever, pain, impaired ROM
55
Hallux valgus deformity
- Bunion | - Enlarged bursa is the bump
56
What is Tailor's bunion?
Bunion on 5th MT
57
What is pes planus? Treatment?
- Overpronation of foot (flat feet) | - Orthotics to correct flat foot deformity
58
Treatment of plantar fasciitis?
- Orthotics (heel pads or cups do NOT work) | - Avoid walking barefoot
59
What is Morton's neuroma?
Fibrosis of interdigital nerve between 3rd and 4th toes
60
Hammer toes
- Deformity of 2nd, 3rd, 4th toes - Toe is bent at middle joint so it resembles hammer - If left untreated, can become fixed and require surgery
61
What causes hammer toes?
Shoes that don't fit properly and/or muscle imbalance
62
Ankle sprain MOI
Inversion type injury
63
High ankle sprain MOI
Twisting or rotational injury
64
How does posterior tibial tendon injury occur?
Excessive pronation
65
Cortisone injections of achilles tendinitis
NEVER (increases incidence of rupture)
66
MOI achilles rupture
- Explosive plantar flexion | - Forced dorsiflexion
67
PE of achilles rupture
Positive Thompson test
68
Positive Thompson test?
Achilles tendon rupture
69
Plantaris tendon rupture
- Long thin muscle that traverses through calf | - Same presentation as Achilles rupture
70
What is retrocalcaneal bursitis?
- Pump bump (Haglund's deformity) | - Positive 2 finger squeeze test
71
Who is affected by achilles rupture?
- 40 yo or older males - Weekend warrior types - Basketball, racquet sports
72
Presentation of Achilles rupture?
Feels like someone hit it with a baseball bat

Clin Med II MHM - FINAL (16 decks)

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