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Lower Extremity Disorders Flashcards

1
Q

Which nerves create the sciatic nerve?

A

L4-S3

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2
Q

Which nerves create the femoral nerve?

A

L2-4

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3
Q

Which nerve create the lateral femoral cutaneous nerve?

A

L3-4

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4
Q

Blood Supply to the Hip

A

Circumflex
Profunda femoris
Posterior division of the obturator artery
Femoral head

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5
Q

Possible Reasons for AVN

A 
Fracture
Dislocation
Slipped capital femoral epiphysis
Steroids
ETOH
Perthes
Coagulopathy
Sickle cell
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6
Q

Hip Imaging

A 
X-rays: weight bearing if possible
Bone scan
CT
MRI
MRI arthrogram
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7
Q

Differential Diagnosis for Anterior Hip Pain

A 
Osteoarthritis
Inflammatory arthritis
Muscle/tendon strain
Tendinitis
Femoral neck stress fracture
Obturator/ilioinguinal nerve entrapment
Osteitis pubis
Acetabular labral tear
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8
Q

Differential for Pre-Pubescent Individuals

A

Legg Calve Perthes disease

Slipped capital femoral epiphysis (SCFE)

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9
Q

Differential for Hip Pain of Adolescence

A 
Avulsion fracture
Hip pointer
Contusion
Myositis ossificans
Femoral neck stress fracture
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10
Q

Differential of Hip Pain for Older Individuals

A 
Femoracetabular impingement (FAI)
Osteoid osteoma
ITB syndrome
Trochanteric bursitis
Piriformis syndrome
Iliopsoas bursitis
Meralgia paresthetica
Osteoarthritis
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11
Q

Clinical Presentation of Iliopsoas Bursitis or Tendinosis

A

Pain & snapping in groin & anterior hip with hip flexion & crunches

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12
Q

Evaluation of Iliopsoas Bursitis or Tendinosis

A

H&P
X-ray
MRI
R/o other diseases

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13
Q

Treatment of Iliopsoas Bursitis or Tendinosis

A 
Relative rest
Stretch
NSAIDs
PT
Injection, surgery??
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14
Q

Clinical Presentation of Acetabular Labrum Tear

A 
Hip pain
Deep click
Catching sensation
Worse with deep flexion & raising from seated position
Decreased ROM
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15
Q

Evaluation of an Acetabular Labrum Tear

A

H&P
Pain with hip flexion, add, and axial load
X-rays
MRI arthrogram

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16
Q

Treatment for Acetabular Labrum Tear

A

PT to maximize ROM & strength
Corticosteroid injection?
Surgery?

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17
Q

Clinical Presentation of Trochanteric Bursitis

A

Lateral hip pain
Gradual onset
Can’t lie on side

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18
Q

Evaluation of Trochanteric Bursitis

A

H&P
Tender to palpation over lateral thigh
Pain with Ober test
X-ray??

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19
Q

Treatment of Trochanteric Bursitis

A 
Ice
NSAIDs briefly
PT: stretch IT band, strengthen hip muscles
Evaluate biomechanics
Corticosteroid injection
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20
Q

Clinical Presentation of Osteoarthritis of the Hip

A

Progressive hip & groin pain

Decreased ROM

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21
Q

Evaluation of Osteoarthritis of the Hip

A

H&P

Weight bearing x-rays

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22
Q

Treatment of Osteoarthritis of the Hip

A

PT
Tylenol > NSAIDs
US guided hip injection
Surgery

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23
Q

Clinical Presentation of Pubic Ramus Stress Fracture

A

Pain with jumping, running, stretching, & landing

Increased pain with activity

24
Q

Evaluation of Pubic Ramus Stress Fracture

A 
Point-tender superior pubic ramus
Non-tender adductors
Normal physical exam
X-ray
Bone scan
MRI
25
Treatment of Pubic Ramus Stress Fracture
Relative rest Non-painful activity Slowly increase Address other fractures
26
Other Problems Associated with Stress Fractures Besides Overuse
Estrogen deficiency Hormonal abnormalities Nutritional deficiencies Metabolic disorders
27
Presentation of a Stress Fracture
Gradual onset Increased intensity/duration of activity Change in footwear Change in surface
28
Evaluation of Stress Fractures
H&P X-rays Bone scan MRI
29
Key to Treatment of Stress Fractures
Pain free activity
30
Treatment of Inferior Hip, Pelvis, or Thigh Stress Fractures
Non-painful activity | Gradual return to activity
31
Treatment of Superior Hip, Pelvis, or Thigh Stress Fractures
Refer to ortho
32
Address Causation of Hip, Pelvis, or Thigh Stress Fractures
Diet Activity level Maturity
33
Clinical Presentation of Adductor Tendonopathy
Chronic groin pain Increased training Worse with resisted adduction
34
Evaluation of Adductor Tendonopathy
H&P Pain with resisted adduction Tender to palpation medial groin at tendon insertion
35
Treatment of Adductor Tendonopathy
Relative rest Ice Isometric & eccentric strengthening PT
36
Clinical Presentation of Athletic Pubalgia or Sports Hernia
Groin pain Progressive symptoms Worse with hip motion
37
Evaluation of Athletic Pubalgia or Sports Hernia
Pain in hernia region without hernia | Possible dilated superficial ring
38
Etiology of Athletic Pubalgia or Sports Hernia
Injury to conjoined tendon, internal oblique, external oblique, transversalis fascia, inguinal ligament, etc.
39
Treatment of Athletic Pubalgia or Sports Hernia
Surgery | Only some surgeons do these
40
Clinical Presentation of Piriformis Strain or Syndrome
``` Buttocks pain Insidious onset Pain to sit Increase after a run Annoying ```
41
Evaluation of Piriformis Strain or Syndrome
Painful resisted external rotation | Painful passive internal rotation
42
Difference Between Piriformis Strain & Syndrome
Strain: no sciatica Syndrome: sciatica
43
Treatment of Piriformis Strain/Syndrome
Rule out other things NSAIDs Stretch/strengthen PT: core strength program
44
Evaluation of Femur Fractures
H&P R/O other injuries Shortened & external rotated Internal rotation elicits pain
45
Treatment of Femur Fracture
Pins ORIF Total hip Hemi hip
46
Things to Consider with Femur Fractures
DVT | Young: AVN
47
Etiology of Femur Shaft Fractures
High energy
48
Treatment of Femur Shaft Fractures
Surgery
49
Something to Consider with Femur Shaft Fractures
Compartment syndrome
50
Causes of Compartment Syndrome
``` Fractures Crush Envenomation Immobilization Constrictive dressing Infection Burns Tourniquets Chronic exertional compartment syndrome (CECS) ```
51
Treatment of Compartment Syndrome
Release of pressure
52
Anterior Hip Dislocation
Dashboard with thigh abducted | Externally rotated position
53
Posterior Hip Dislocation
Internally rotated position
54
Treatment of Hip Dislocations
Reduction ASAP | Watch for s/s of AVN & sciatica
55
What should one always think of with hip fracture or dislocation?
Concomitant injuries

Ortho (22 decks)

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