Lower Extremity MSK Flashcards
(117 cards)
1
Q
What is an Apophysis?
A
Normal development
- an outgrowth of a bone which arises from a separate ossification center, and fuses to the bone later in development.
2
Q
Apophysis after forms an important insertion portion for what?
A
A tendon or ligament
3
Q
Apophysis is most often mistaken for what?
A
Fractures
4
Q
Are fractures generally perpendicular or parallel to diaphysis?
A
Perpendicular
5
Q
Are apophysis generally perpendicular or parallel to diaphysis?
A
Parallel
6
Q
What are the 2 MC locations for an apophysis?
A
Knee and Foot
7
Q
Apophysis usually occurs at what age range?
A
14-18
8
Q
How do you distingush a Jones fracture from other foot fractures?
A
More distal on diaphysis
9
Q
What is the diaphysis?
A
- Shaft of long bone
- elongation occurs toward epiphysis
10
Q
What is the epiphyseal?
A
- Growth plate
- Site of elongation of long bones
11
Q
What is the epiphysis?
A
- Terminal end of long bone
- Ultimately forms articular cartilage
12
Q
What is a Sesamoid?
A
A bone that ossifies within a tendon
13
Q
What is the largest sesamoid in the body?
A
Patella
14
Q
Sesamoids are MC found where?
A
- 1st MTP and 1st MCP
15
Q
Sesamoid(s) are commonly referred to as what?
A
- Mouse or Mice
16
Q
History should include what characteristics?
A
- Pain
- Mechanical sxs
- Joint effusion
- Mechanism of injury
17
Q
What is one of the MC causes of knee pain in active adolescents?
A
Osgood-Schlatter disease
18
Q
Osgood-Schlatter disease affects what?
A
Apophasis of proximal tibia
19
Q
What is the age range and MC gender of Osgood-Schlatter disease?
A
- 11-15
- M>F (males older at initial presentation)
(bilateral 25-50%)
20
Q
What is the etiology of Osgood-Schlatter disease?
A
Micro avulsions caused by repeat reaction on the anterior portion of developing ossification center of the tibial tuberosity
21
Q
What are S/Sx of Osgood-Schlatter disease?
A
- Discomfort with resisted knee extension
- stair-walking/climbing and squatting
- pain over tibial tuberosity
22
Q
Sunrise view/skyline view XR looks at what?
A
Area under patella
23
Q
What are the angles of Sunrise view/skyline view XR?
A
- XR device is at 15 degrees
- Knee is at 115 degrees
24
Q
What are the general tx options?
A
- Conservative
- decrease activities
- RICE
- NSAIDs
- PT
- surgery: rarely indicated
- Othro referral: dx uncertain and persistent sxs
25
Ankle sprains are Mc'ly d/t what?
Inversion during plantar flexion involving lateral ligaments
26
Are isolated injuries to the medial ligaments common or uncommon and involve what?
- Uncommon
| - Involve a medial malleolar fracture
27
Thomsons test is used to assess Achilles rupture but can be misleading, why?
- Partial tear may be present which means ankle can still move slightly
28
A high index of a talar dome fx is warranted when the pt presents with what sxs?
Chronic swelling and/or locking of ankles 4-5 wks post-injury
29
Do kids often sprain a joint?
NO- they fracture
30
Is fibular a weight bearing bone?
No- not weight bearing
31
A buckle or torus fracture is often d/t what?
FOOSH
32
An open growth plate is indicative of what?
A younger pt
33
What is a sprain?
Stretch and/or tear of a ligament
34
Ligaments connect what?
Fibrous bands of connective tissue that connect bone to bone
35
What is a strain?
Injury of a muscle and/or tendon
36
Tendons connect what?
Fibrous structures attaching muscles to bone
37
High ankle sprain often involves what?
Soft tissue ligament tears not seen on XR
38
What are the lateral ligaments?
- Anterior talofibular ligament (ATL)
- Calceneoufibular ligement (CL)
- Posterior talofibular ligament (PTL)
39
What is the medial ligaments?
Deltoid ligament
40
The pt will often hear what when they fracture of fifth metatarsal?
Hear a pop
41
What are some special maneuvers for ankle injuries?
- Anterior drawer test
- Tilt test
- Thompson test
42
Osteomyelitis is commonly seen in what?
Open injuries or recent surgeries
43
Reiters is often caused by what?
STD- Chlamydia
44
What are the specific sites for traumatic fractures?
- Calcaneal
- Tibia
- Fibular
- Metatarsal
- Tarsals
45
What are some common traumatic fractures?
- Stress Fx
- Avulsion Fx
- Interosseous Fx
46
A mortise view is used to identify what?
Uniformities in talar dome (able to see dislocation better)
47
What are the routine ankle views?
- Lateral
- AP
- Mortise
48
What are the routine foot views?
- AP
- Oblique
- Lateral
49
Lateral malleolus fracture involves what bone?
Distal Fibula
50
Medial malleolus fracture involves what bone?
Distal Tibia
51
Posterior malleolus fracture involves what bone?
Posterior prominence of Tibia
52
Bimalleolar fractures involve what bones?
- Both distal Tibia and Fibula
| - Unstable ankle fx's
53
Trimalleolar fractures involve what bones?
- Three fx involving both Tibia and Fibula
| - Unstable ankle fx's
54
What are some signs of Trimalleolar fractures?
Cold to the touch, no cap refill, and decreases pulses.
55
A fifth metatarsal fx is usually located where?
The base of 5th MT
56
Lisfrancs fx is located where and usually caused by what?
- Mid-Foot fx
| - Kickball or kicking walls
57
Syndesmotic injury are also called what?
High ankle sprain
58
Syndesmotic injury are usually a result of what?
Ankle eversion and step and twist
59
Syndesmotic injury involves ligaments attaching to what?
Ligaments attaching distal tibia and fibula
60
Syndesmotic injury may or may not be associated with what?
Actual fracture, but is treated as a fracture
61
On an XR of a Syndesmotic injury what is often seen?
Widening between fibular and tibula
62
On an XR for a Lisfranc fx what is often seen?
- Bones are pushed sideways and displaced laterally
| - widening between big toe and 2nd toe
63
What is a type 1 injury?
Ligament stretched or minor tear
64
When can someone return to play with a type 1 injury?
1-10 days
65
What is a type 2 injury?
Partial ligament tear
66
When can someone return to play with a type 2 injury?
2-4 wks
67
What is a type 3 injury?
Complete ligament tear
68
When can someone return to play with a type 3 injury?
5-8 wks (ortho call is needed)
69
What is a do not miss diagnosis in adolescents with hip pain?
Slipped capital femoral epiphysis: d/t risk for AVN
70
What are historical findings of Trochanteric Bursitis?
- Single blow or friction from IT band.
- Predisposing factor: hx of training changes or increased Q angle.
- MC bursitis.
- "snapping hip" syndrome
71
What are PE findings for Trochanteric Bursitis?
- Pain to lateral aspect of the hip that is made worse w/ direct pressure over the bursa.
- Well localized.
72
What is the largest sesamoid bone in the human body?
Patella w/ quadriceps tendon
73
What does PRICE stand for?
```
P: protect the joint
R: Rest
I: Ice
C: Compression
E: Elevate
```
74
AP view of the knee is helpful in diagnosing what?
- Arthritis in the knee joint between the thigh and shin bones.
- It can also show whether there is arthritis in the inside or outside of the knee
75
Lateral view of the knee is helpful in diagnosing what?
Most useful for diagnosing arthritis between the kneecap and the thigh bone.
76
Skyline view of the knee is helpful in diagnosing what?
Looks between the kneecap and helpful for diagnosing arthritis
77
What are the radiologic characteristics of a Jones fracture?
Transverse orientation, involves the inter-metatarsal articulation
- Fracture of the proximal diaphysis of the 5th metatarsal
78
What are the radiologic characteristics of a 5th metatarsal fx?
Transverse or oblique orientation, shaft of the bone-distal to inter-metatarsal joint,
79
What structures are involved in a Lisfranc injury?
Midfoot and tarsometatarsal joint
80
What are the 3 common Lisfranc injury patterns?
1. Homolateral
2. Isolated
3. Divergent
81
Homolateral (Lisfranc injruy) involves what structures?
All 5 MT (or 2-5)
| - displaces laterally
82
Isolated (Lisfranc injruy) involves what structures?
1 or 2 MT displaced
83
Divergent (Lisfranc injruy) involves what structures?
-2-5 displaced laterally while the 1st MT is displaced medically
84
What is the workup for a Lisfranc injury?
- FWB: XR w/ comparison view = CRITICAL
| - If XR normal but high suspicion: MRI or CT
85
What are the 6 Ps for compartment syndrome?
1. Pain
2. Pallor
3. Paresthesia
4. Paralysis
5. Pulslessness
6. Pain out of proportion
86
What are the clinical findings of compartment syndrome?
Increased pressure in closed muscle compartment
- 3 compartments in thigh
- 4 in lower leg
87
What is the tx for compartment syndrome?
- Orthopedic emergency (>40 mmHg)
| - Surgical fasciotomy within 4-6 hrs
88
What causes Slipped capital femoral epiphysis?
- Weakened epiphyseal plate of femur
| - displaced femoral head
89
What is the classic patient of Slipped capital femoral epiphysis?
- Male
- 10-16
- Obese
90
What is the workup for Slipped capital femoral epiphysis?
Frog leg lateral pelvis or lateral hip view
91
What is the treatment for Slipped capital femoral epiphysis?
Pinning and non weight bearing
92
What are some risk factors for nonunion?
- Fracture stability
- Blood supply (inherent soft tissue damage, smoking, DM, vascular disease)
- Nutrition
93
AVN of the femoral head is also known as what?
"Leg Calve Perthes" in children
94
What are S/Sxs of Leg Calve Perthes?
Dull ache and limp (x3-6 wks)
| - aching pain in groin or proximal thigh
95
What is seen on the hip XR in a pt with Leg Calve Perthes?
Crescent sign - resembles a subchondral fracture
96
What is the tx for Leg Calve Perthes?
- Long leg casts with spreader par (petrie casts) x 6 wks
| - surgical: osteotomy
97
When do strains occur?
Occur secondary to dynamic overload during eccentric muscle contraction
98
What are the 2 types of hip fractures?
Intracapsular and Extracapsular
99
Intracapsular hip fractures involved what structures?
Femoral head and neck
100
Extracapsular hip fractures involved what structures?
Intertrochanteric/subtrochanteric
101
What are characteristics of Intracapsular hip fractures?
- Higher rates of nonunion, malunion, AVN
- Common in older adults
- Occurs 1-2 inches from joint
- Risk to blood supply
102
What are characteristics of extracapsular hip fractures?
- Occurs 3-5 inches from joint
| - Does not interrupt blood supply
103
What are the weber classifications of a fibular fracture?
- A: below syndesmosis
- B: level of syndesmosis
- C: above level of syndesmosis
104
Hip fractures are more common in who?
- Women > men
| - White females > black or Hispanic females
105
What are some causes of a hip fracture?
Falls
- Direct blow
- Osteoporosis (stand and twist)
106
How will a pt with a hip dislocation be laying?
- Leg internally rotated and adduction
107
How will a pt with a hip fracture be laying?
- Leg externally rotated and abduction
108
Is a hip dislocation a medical emergency or no?
- Medical emergency
| - very rare
109
What are PE findings of a hip disclocation?
- Limp when walking
- Shortening of leg
- AROM is impossible
- No attempt to reduce to prevent affecting vasculature, sensory and vascular check
110
What is Piriformis syndrome?
Impingement of the sciatic nerve from spasm of piriformis muscles
- 6x more common in women
111
In Piriformis syndrome where does the sciatic nerve pass under?
- Passes under or through the piriformis muslces
112
Piriformis syndrome mimics what?
Lumbar nerve root impairment and intervertebral disk disease
113
What are the causes of Degenerative hip changes?
- Age
- Repetitive trauma
- Acute trauma
- Improper arrangement of hip
114
What are the risks for Degenerative hip changes?
- Degeneration of articular surfaces of femur or acetabulum
- Arthritis
- Osteochondrosis dissecans
- Acetabular labrum tears
- AVN
115
What are S/Sx of Degenerative hip changes?
- Pain
- Referred to low back
- Anterior thigh
- Knee LOM in all planes
- Decreased strength
116
What are S/Sx of Ischial tuberosity bursitis?
- Movement of buttocks while pt is weight bearing in seated position can irritate the bursa
- Irritated by prolonged sitting
117
What do you need to r/o before diagnosing Ischial tuberosity bursitis?
R/o hamstring strain or avulsion of its attachment
