Lower Extremity Disorders Flashcards Preview

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

Flashcards in Lower Extremity Disorders Deck (72):
1

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

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

2

How is the hip joint different than the shoulder joint?

Weight bearing

3

Where is the sciatic nerve most vulnerable to pelvic fractures?

Sciatic notch

4

Where is the sciatic nerve most vulnerable to posterior dislocations?

Distal to sciatic notch

5

How does hip pain present?

Groin and anterior thigh

6

Describe avascular necrosis of the hip

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

7

Treatment of AVN of the hip

-Restrict weight bearing and activity to prevent collapse
-Long term prognosis is poor usually requires total hip arthroplasty as OA progresses

8

Who is affected by OA of the hip?

-Under 45 yo, MC in men
-Over 55 yo, MC in women

9

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

Pain at rest

10

Post-op care of total hip arthroplasty

-Rapid mobilization, wt bearing as tolerated w/crutches or a walker
-Anticoag
-Alternating compression sleeve and stocking

11

What is the MC approach to total hip arthroplasty?

Posterior - less risk of infection, quicker recovery

12

Describe trochanteric bursitis

-Bursa overlies greater trochanter and can get irritated
-Pain over GT aggravated by lying on the affected side

13

What is the most likely cause of snapping hip?

Tight IT band that catches over greater trochanter with movement

14

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

-Intrinsic bony configuration
-Surrounding network of soft tissue

15

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

Patella

16

What is the largest sesamoid bone in the body?

Patella

17

What are the extrinsic ligaments of the knee?

MCL (femur and tibia)
LCL (femur and fibula)

18

What are the intrinsic ligaments of the knee?

ACL (resists anterior translation on tibia)
PCL (resists posterior translation on tibia)

19

MOI for ACL injury?

-Valgus force to ER knee w/foot planted
-Hyperextension in IR

20

MOI for PCL injury?

-Knee flexed
-Anterior to posterior translation of joint

21

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

Straightens knee, prevents buckling
-Quad muscle and tendon
-Patella and tendon
-Tibial tubercle

22

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

AP, lateral, tunnel view
Sunrise if tracking patella

23

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

-AP view in standing position
-Lets you see joint space narrowing better

24

Describe MCL fibers

-Posterior fibers are taut in extension
-Anterior fibers are taut in flexion

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