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Master the boards: Orthopedics > Lower Extremity: The Hip, Knee and Foot > Flashcards

Lower Extremity: The Hip, Knee and Foot Flashcards

(100 cards)

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1
Q

How does Avascular necrosis of the Femoral Head present?

A

insidious onset of hip and groin pain worse with activity and weight-bearing and relieved by rest

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2
Q

What are risk factors for Avascular necrosis of the Femoral Head?

A

Steroid use
sickle cell disease
alcohol abuse
osteomyelitis
SLE
Previous fx, dislocation or surgical fixation
Younger patient <40

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3
Q

What is the most sensitive test for Avascular necrosis of the Femoral Head?

A

MRI
X-rays are normal in first few months

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4
Q

How do you treat Avascular necrosis of the Femoral Head?

A

Total hip arthroplasty replacement

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5
Q

How does OA of the Hip present?

A

Progressive hip and groin pain worse with movement in patients >50

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6
Q

What causes OA of the Hip?

A

Overuse, trauma and chronic degeneration of the articular cartilage

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7
Q

How do you diagnose OA of the Hip?

A

X-ray

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8
Q

How does OA of the Hip present on physical exam?

A

Limites ROM and (+) FABER/Patrick test

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9
Q

How do you treat OA of the HIP?

A

Conservative until pain is intolerable then total hip arthroplasty replacement

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10
Q

What is the most common ligament injury of the knee?

A

ACL Tear

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11
Q

What is the usual cause of an ACL tear?

A

Noncontact: darmatic cutting, deceleration and hyperenxtion of the knee

Valgus stress on a flexed, planted and rotated knee

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12
Q

What to look for in question to suggest ACL tear?

A

Audible pop with anterior knee pain, instability and effusion

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13
Q

What is seen on physical exam with an ACL tear?

A

Decreased knee flexion secondary to effusion/hemarthrosis
Joint line tenderness common due to secondary pathology (Meniscus)

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14
Q

What is seen in the Anterior Drawer test for an ACL tear?

A

patient supine and knee flexed to 90: pull anteriorly on the tibia: if it slides easily in relation to the femur it is a (+) Test

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15
Q

What is seen on the Lachman test for an ACL tear?

A

Patient supine and knee flexed to 30: pull anteriorly on the tibia: if it slides easily in relation to the femur it is a (+) test

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16
Q

Which is more sensitive for an ACL tear Anterior drawer test or Lachman test?

A

Lachman

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17
Q

What is the best initial test to diagnose an ACL tear?

A

MRI

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18
Q

What is the most accurate test to diagnose an ACL tear?

A

Arthroscopy

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19
Q

What do most ACL tears require for treatment?

A

Surgery

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20
Q

How does a PCL test present?

A

Hyperflexion, posterior force on a planter leg: car accident with knees hitting dashboard

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21
Q

How do you diagnose a PCL tear?

A

MRI

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22
Q

How do you treat a PCL tear?

A

Surgery

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23
Q

What special test is used for PCL tear?

A

Posterior drawer

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24
Q

How does and MCL tear present?

A

Valgus force from a blow on a planted leg

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25
What special tests evaluate for MCL/LCL tear?
Valgus and varus stress test
26
How do you diagnose an MCL tear?
MRI
27
How do you treat an MCL tear?
often Conservative Surgery
28
How does an LCL tear present?
Rare; devastating injury associated with multiple pathologies and neurovascular injury
29
How do you diagnose an LCL Tear?
MRI
30
How do you treat and LCL tear?
Surgery
31
How does a Meniscus tear present?
Join-line knee pain and clicking, popping or locking with movement results from cutting maneuvers that cause tibial rotation on a flexed and fixed knee
32
What special tests evaluate for a Meniscus tear?
McMurray Thessaly Apley Grind
33
How do you diagnose a Meniscus tear?
MRI
34
How do you treat a Meniscus tear?
Conservative Arthroscopic Reconstructive surgery
35
How does Iliotibial Band Syndrome (ITBS) present?
Lateral knee pain over Gerdy Tubercle where the IT band inserts
36
What special test is used for Iliotibial Band Syndrome (ITBS)?
Ober
37
How do you diagnose Iliotibial Band Syndrome (ITBS)?
Clinical
38
How do you treat Iliotibial Band Syndrome (ITBS)?
Conservative Physical Therapy
39
How does Patellofemoral Syndrome (Runner's Knee) present?
Anterior knee pain under the patella overuse/muscular imbalance or quads and poor biomechanics (bowlegged) Prolonged sitting and excessive activity are exacerbating factors
40
What special test is used for Patellofemoral Syndrome (Runner's Knee)?
Patellar grind test
41
How do you diagnose Patellofemoral Syndrome (Runner's Knee)?
Clinical
42
How do you manage Patellofemoral Syndrome (Runner's Knee)?
Conservative Physical Therapy
43
How does Patellar Tendinitis (Jumper's knee) present?
Inferior patellar knee pain: episodic common in athletes where a lot of jumping occurs (basketball, volleyball) Overuse injury from repetitive overload of quads on patellar tendon
44
What special test i used for Patellar Tendinitis (Jumper's knee) ?
Pain with palpation over the inferior pole of the patella
45
How do you diagnose Patellar Tendinitis (Jumper's knee) ?
Clinical
46
How do you manage Patellar Tendinitis (Jumper's knee) ?
Conservative Physical Therapy
47
How does OA of the Knee present?
Medial> lateral joint-line pain: age >50, obese, limited ROM, crepitus with ROM, small effusion , varus of valgus angulation, pain with weight bearing or activity
48
What special tests are used for OA of the knee?
Limited AROM and PROM
49
How do you diagnose OA of the knee?
X-ray
50
how do you manage OA of the knee?
Conservative Arthroplasty: replacement
51
What is the anterior/posterior draw test?
Hip flexed 45, knee flexed 90 Anterior pull on tibia; laxity = ACL pathology/tear Posterior push on tibia: laxity = PCL pathology/tear
52
What is the lachman test?
Hip slightly flexed: knee flexed to 30 Anterior pull on tibia: laxity = ACL pathology/tear
53
What is the valgus stress test?
Hip flexed to 30: knee extended to 190 Valgus/Lateral force: laxity = MCL pathology/taer Valgus/Lateral force means force applied lateral to medial
54
What is the varus stress test?
Hip flexed to 30: knee extended to 180 Varus/medial force: laxity = LCL pathology/tear Varus/medial force: applied medial to lateral
55
What is the O'Donoghue Unhappy Triad?
Triple injury to the ACL, MCL and Medial Meniscus
56
What is commonly seen in Meniscal tears?
Younger patients experience a "pop" followed by pain
57
What do medial Meniscus tears usually result from?
cutting maneuvers that cause tibial rotation on a partially flexed and fixed knee (think soccer and football)
58
What do lateral meniscus tears usually result from?
Squatting with full flexion of knee and rotation (Think wrestling , squatting)
59
How do meniscal tears present?
Joint feels stiff, decreased ROM especially with flexion, will pop, catch and lock with ambulation and stair-climbing
60
What special test is used for Meniscal tears?
McMurray Test
61
What is the McMurray Test?
Patient supine, hip and knee flexed: palpate joint line of the knee bilaterally: externally rotate the tibia and apply valgus force while extending the knee to examine Medial Mensicus Internally rotate the tibia and apply varus force while extending the knee to examine lateral meniscus
62
How do you perform a McMurray test to evaluate the Medial Meniscus?
externally rotate the tibia and apply valgus force while extending the knee
63
How do you performa McMurray test to evaluate the lateral Meniscus?
Internally rotate the tibia and apply varus force while extending the knee
64
What indicated a positive McMurray Test?
Popping, clicking and pain
65
What is the Thessaly Test?
Evaluates Meniscal tear: patient stands on the affected limb and rotates the femur on the tibia
66
What is the Apply grind test?
Evaluates Meniscal Injury: patient prone with knee flexed to 90: compression through the heel while internally and externally rotating the tibia to grind the meniscus
67
What is the gold standard to diagnose a meniscal tear?
MRI
68
How do you manage meniscal tear with mild symptoms and age >40?
Conservative: rest, modify activity, NSAIDs
69
How do you manage Meniscal tear in younger patient with >3-4 weeks of symptoms?
Arthroscopic surgical repair
70
How does Plantar Fasciitis present?
Heel pain focal to rear foot: greatest with first steps in the morning then improves Prolonged daily activity leads to return of pain at night
71
How do you diagnose Plantar Fasciitis?
Clinical: point tenderness distal to heel
72
How do you manage Plantar Fasciitis?
Conservative: stretching of plantar fascia Steroid injection in refractory cases
73
How does Stress Fracture of the foot present?
2nd metatarsal most common: pain in the midfoot due to repeated tension can occur with poor nutriton: Vit D, Ca deficiency Female athlete triad; low calorie, low bone density, amenorrhea
74
How do you diagnose Stress Fracture of the foot?
Clinical X-ray normal for 3-6 weeks MRI/CT/bone scan: more sensitive early on
75
How do you treat Stress Fracture of the foot?
Conservative: rest, wide hard-soled footwear CAM boot if more aggressive for 5th metatarsal
76
How does a Jones fracture present?
5th metatarsal fracture at junction of metaphysis and diaphysis: common with ankle sprain and when heel is off the ground but forefoot is planted Risk of delayed healing if untreated
77
How do you diagnose Jones fracture?
x-ray
78
How do you manage Jones fracture?
Nondisplaced: 6-8 weeks in case and non-weight bearing
79
How does a Morton Neuroma Present?
Numbness and burning pain between 3rd and 4th digits Caused by interdigital Neuroma Happens to both athletes and nonathletes
80
How do you diagnose Morton Neuroma?
Clinical Mulder Sign US or MRI to confirm
81
What is the Mulder sign?
Squeezing metatarsal joins causes pain and crepitus at 3rd/4th digits
82
How do you treat Morton Neuroma?
Conservative; support pads or hard-soled footwear : 1st line Injections and surgery if refractory
83
How does Tarsal Tunnel Syndrome Present?
Medial side of the sole of the foot: pain, tingling, and burning with activity or at rest entrapment of tibial nerve under flexor retinaculum by -Tibialis posterior -Flexor Digitorum Longus -Flexor Hallicus Longus
84
How do you diagnose Tarsal Tunnel Syndrome?
EMG to confirm Clinical exam + Tinel sign at the tarsal tunnel
85
How do you manage Tarsal Tunnel Syndrome?
NSAIDs Steroid injection Tunnel release for Progressive nerve damage
86
What Bursitis are located at the posterior knee?
Baker Cyst and Popliteal Cyst
87
What are risk factors for posterior knee Bursitis?
OR, RA, meniscal tear
88
What is the best initial test for posterior knee bursitis?
US to r/o DVT
89
What bursitis is located at the medial knee?
Pes Anserine
90
How does medial knee bursitis present?
pain with palpation just inferior or distal to the medial joint line of the knee: insertion of 3 muscles and associated with overuse
91
What 3 muscles insert at the Pes Anserine tendon?
Sartorius Gracilis Semitendinosus
92
What bursitis is located at the superior knee?
Suprapatellar
93
How does Suprapatellar bursitis present?
Becomes inflammed and enlarged with OA because it communicates with the joint space of the knee
94
What bursitis are associated with the inferior knee?
Prepatellar, housemaid's knee
95
how does inferior knee bursitis present?
Superficial to the patella; easily exposed to trauma: repetitive kneeling
96
What buristis is at the lateral hip?
Greater Trochanter
97
How does Greater Trochanteric Bursitis present?
lateral hip pain over the greater trochanter where the gluteus medius inserts Pain with sleeping on side or with External Rotation and resisted Abduction Associated with ITBS
98
What bursitis is located at the Olecranon?
Student's elbow, Craftsmans's elbow, miner's elbow
99
How does Olecranon bursitis present?
Posterior elbow pain: most common from recurrent gout exacerbations
100
How to treat Bursitis?
Avoid behavior that exacerbate Conservative therapy: Rest, NSAIDs, Ice, Corticosteroid injection Abx for 7-10 days in septic bursitis

Master the boards: Orthopedics (3 decks)

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