Lower Extremity X3

Question 1

Femoroacetabular impigement

Answer 1

Bown overgrowth of abnormailty in development whcih changes function of the hip joint
- can cause secndary problems > labral tear or OA
Pincer (acetabulum) and Cam(neck of femur) type

Question 2

Femoroacetabular impigement present

Answer 2

Groin pain +- lat hip pain

• described as sharp stabbing or deep dull ache
• aggravate with turning, teisting, prolonged standing or squatting

Question 3

Femoroacetabular impigement tests

Answer 3

FADIR- impingment specifcally
FABER- “figure four”
- also can show SI disfunction so ask where do you have pain
Imaging: X ray and CT if needed

Question 4

Femoroacetabular impigement tx

Answer 4

• Decreaseing aggrvating activities
• NSAIDs
• PT
• surgery maybe

Question 5

Trochanteric Pain syndrome

Answer 5

repetitive overload tendinopath

• lateral hip pain with localized pain to greater tochanter
• pain increase with prresure and increase with repetative motion

Question 6

Trochanteric pain syndrome dx

Answer 6

TTP over greater trochanter
- pain with resisted abduction
Trendelenburg sign

Question 7

Trochanteric pain synrome Tx

Answer 7

NSAIDs
heat
adjust positioning
injection

Question 8

Labral Tear Present

Answer 8

Dull or ahrp groin pain

• may radiate to lat hip or ant thigh or but
• insidious onset vs. acute trauma
• catching or clicking that causes pain

Question 9

Labral Tear Dx

Answer 9

ROM and strength testing
-FADIR and FABER
Imaging: X ray MRI or ***MR arthrogram- test of choice

Question 10

Snapping Hip Syndrome

Answer 10

Snapping or poppin sensation in hip with walking, getting up
Cause: muscle or tendom sliding over bony prominence
External: IT band over greater troch
Internal: Iliopsoas over iliopectineal eminence

Question 11

Snappin Hip Syndrome pres

Answer 11

Snapping or popping sensation

• may or may not be painful
• Pseudosubluxation
• difficulty with stairs, running

Question 12

Snapping Hip Syndrome Dx

Answer 12

Physical exam: snapping is reproducible
external: passive IR ER rotation of hip while laying on side
Interal: FABER then extend hip

Question 13

Snapping hip

Answer 13

NSAID, avoidance of specific activities +/- corticosteroid inj
PT
surgery rarely indicated

Question 14

MCL sprain MOI

Answer 14

knee flexion and foot planted and a lateral inpact causing valgus and rotation
- usually in combo with triad of Donnoghue

Question 15

Unhappy triad

Answer 15

ACL, MCL, Medical meniscus

Question 16

ACL injury MOI

Answer 16

• quick position change with cutting/pivoting

c- contact: direct blow causing hyperextention

Question 17

ACL present

Answer 17

feeling pop + immediate pain and swelling+ report feeling very very unstable
Present: joint effusion, gaurding, often able to bear weight , laxity

Question 18

ACL test/ Dx

Answer 18

Lachman, ANterior drawer, Pivot shift

MRI! but X ray may be considered for bony involvment

Question 19

ACL Tx

Answer 19

RICE
refer to ortho 
conservative vs surgical 
- surgery for younger pt or athletes 
- brace or PT rehabilitation

Question 20

PCL MOI

Answer 20

Prevents post translation
MOI
- high evergy trauma MVA
- can be in sports but least likely in athlets

Question 21

PCL presentation

Special test

Answer 21

variable
- grossly instable 
- may be very subtle finding 
- mild to moderate knee effusion/hemarthrosis 
Test: posterior testing

Question 22

Menisci MOI

Answer 22

Increases stability and shock absorption

• during rotational force
• medial is more suspecptible to injury

Question 23

Meniscus Present

Answer 23

joint line pain
inability to full etend knee and described as locking or catching
- walking down stairs and squatting is diff or painful

Question 24

Meniscu Dx

Answer 24

McMurray, Apley Gring
Image: MRI
Tx: conservative vs surgical

Question 25

Knee sprain grade c tx

Answer 25

I- rice WB as tolerated II- patrial tear rice, brace immobilixation +/- crutches maybe surgery III: complete tear surgical repair, crutches, brace, aggressive PT

Question 26

Patellofemoral Pain Syndrome cause/pres

Answer 26

"runner knee" Anterior pain under patella - pain worse with going up and down stairs - postive theatre sign or long car ride - common crepitus, popping, feeling of joint instability

Question 27

Runners knee test

Answer 27

Patellar glide and apprehension test Dx: history and physical exam Tx: Ice, NSAIDs, PT - strengthen hip abductors and quads, stretching, core stability

Question 28

Bakers Cyst

Answer 28

Accumulation of joint fluid of the popliteal fossa | Clin present: often asymptomatic or found incidentaly, pain and swelling with prolonged standing or activity

Question 29

Bakers cysts tx

Answer 29

NSAID aspiration/injection compressive neoprene brace surgery rarely indicated

Question 30

Patellar tendonitis

Answer 30

jumpers knee tendon inflamattion typically involved in running often after skeletal maturity - seen with pronation or running hills

Question 31

Patellar tendonitis tx

Answer 31

Conserv: Ice, NSAID, bracing, strapping, act modification and PT

Question 32

Iliotibial band syndrome present

Answer 32

Overuse injury Gradual onset of localized pain - initially sharp burning and will develope a deep ache Exam: localized tenderness evaluate LLD Tx: RICE, NSAIDS, PT

Question 33

Knee Bursitis

Answer 33

Inflam or the bursa | prepattelar, suprpatellar,infrapatellar, pes anserine

Question 34

Knee bursitis pres/tx

Answer 34

pain swelling R/O infection Tx: avoid preipitating factors, NSAID, asapiration/steroid injection

Question 35

Osterochondritis Dissecans

Answer 35

``` Presentation gradual onset of poorly localized deep pain - decrease ROM in elbow but not knee may have sweeling, popping locking need X ray or MRI ```

Question 36

Osterochondritis Dissecans tx

Answer 36

1-III avoidance of activitu and immobilication may be required +- pt IV- surgery

Question 37

Ankle Sprain lateral

Answer 37

Lateral- most common lateral ligament complex anterior talofibular ligament, calcaeofibular ligament and post talofibular lig Dx: anterior draw

Question 38

Ankle sprain dx

Answer 38

radiographs to rule out fracture tx: RICE and NSAIDs +/- short immobilize grade 2/3 PT to prevent future injuries

Question 39

Achilled Tendon issues present

Answer 39

tedinopathy- maybe new repative training or buring pain | Rupture: sudden pivoting or rapid acceleration sunden pop with severe pain

Question 40

Achilles tendon exam

Answer 40

``` palpate along tendon for pain edenma palpate both plantar and dorsal flexon Special: thompon test Tx: ortho referal immobilization, equinus splinting , boot to keep in felxed position ```