Lower Quarter Flashcards
(148 cards)
1
Q
3 tests for appendicitis
A
Rebound tenderness
Precussion tenderness
Rigidity
2
Q
+ LR of appendicitis tests
A
Rebound tenderness = 1.99
Percussion tenderness = 2.86
Rigidity = 2.96
3
Q
Characteristics of SCFE
A
Obese adolescent males
Gradual onset of thigh or knee pain
painful limp
limited hip motion especially IR
Physis of the femur is distal to the femoral neck
4
Q
Legg Cale Perthes Disease
A
Children 2-15
Pain in the hip, knee or groin
pain typically mild
painless limp
limited hip AROM, especially IR and abduction
Increased pain with hip movement
5
Q
Sulcus angle and the reason
A
Depth of the groove
Norms are 132 - 144 with shallower meaning an increased risk of subluxation/dislocation of the patella
6
Q
What is a congruence angle of the knee
A
Patella position in the trochlear groove with midpoint of the sulcus angle compared to the lowest portion of the patellar ridge
7
Q
Medial tilt of the patella
A
6 degrees
8
Q
lateral tilt of the patella
A
16 degrees or larger is associated with lateral patellar subluxation
9
Q
Femoral tibia angle should be?
A
180-185 for slight valgus
10
Q
what is the above and below angles for femoral tibia angle?
A
> 185 is genu valgum
< 175 degrees is genus varum
11
Q
what portion of the menisci is avascular
A
Lateral side that is seperated by the popliteus tendon
12
Q
Which part of Menisci is most likely involved when the ACL is torn
A
ACL for anterior and PCL for posterior
13
Q
Posterior menisci is reinforced by? and what force does it resist
A
Posterior oblique ligament and the semimembranosus. valgus force resistors
14
Q
Posterior capsule of the knee is supported by?
A
POL for medial side, arcuate popliteal ligament, LCL and popliteofibular ligament
15
Q
ACL anteromedial bundle characteristics
A
Taut in knee flexion or tibia IR
Tested in knee flexion
If injuried could bring a false positive for Anterior drawer since posterolateral bundle is intact
16
Q
ACL posterolateral bundle characteristics
A
Taut in extension
Provides greatest restraint to anterior translation in 20 degrees of knee flexion
17
Q
ACL characteristics
A
Resists 85% of anterior translation at 30 degrees
18
Q
Common injury of the ACL
A
Deceleration in a slight knee flexion position w/ medial or lateral tibial rotation.
19
Q
ER or IR of the tibia will involve ACL how?
A
Tibial IR will cause ACL to wind around the PCL.
Tibial ER will cause ACL to stretch over the lateral condyle
20
Q
PCL anterolateral and posteromedial bundle
A
Anterolateral is taut in flexion and priority for surgery if torn
posteromedial bundle is taut in extension.
21
Q
CKC biomechanics of the knee flexion
A
Flexion results in posterior rolling of the femoral condyles and anterior glide of tibia
22
Q
CKC biomechanics of the knee extension
A
Femoral condyles roll anteriorly and glide posteriorly on a fixed tibia
23
Q
Tibial rotation with TKE
A
ER of the tibia to achieve screw home mechanism with extension
IR of the tibia to unlock and initiate flexion
24
Q
Ottawa knee rules
A
> 55 years old
Inability to bear weight both immediately and in the ED
Isolated tenderness of the patella
Tenderness at head of fibula
Inability to flex to 90
** unable to bear weight twice onto each limb regardless of limping
25
Pittsburgh criteria
Age < 12 or > 50 will need an x-ray
Inability to walk 4 steps weight bearing in the ED
26
Side effects of paracetamol (acetaminophen) w/ panadol
GI ulceration and bleeding with dose of 3g/day
27
What is diclofenac?
NSAID
28
What is Etoricoxib used for?
inhibitor of COX - 2 for pain and inflammation with OA
29
OA routes for medicine
Cortisone or glucocorticoid injection
Hyaluronans
Platelet rich plasma
Autologous conditioning serum
30
Reason for cortisone or glucocorticoid injection
1-4 week of symptom relief
Increases rate of articular cartilage loss over 2 years
Useful in a severe symptomatic knee
31
Reason for Hyaluronans
Small effect for OA and is < 500$
Used for grease/oil change
32
Reason for platelet rich plasma
Groth factor transplant
Better for youthful patients
300-600$
33
Autologous conditioning serum
More effective that HA
1000$
Combined actions of cortisone and platelet rich plasma
34
Time for injections and exercise
5 days off exercise then after 7 days to resume progressive strengthening
Post 6-8 weeks with no improvement warrants a surgical opinion
35
Meniscectomy results
No benefit over sham surgery and potentially harmful
36
What are a few signs of compartment syndromes
Pain
acute or chronic
Cramping with exercises
numbness - permanent tissue damage
37
Hypermobility Beighton score
> or equal to 5/9
38
Beighton tests
Pull little finger back beyond 90
Pull thumb to touch forearm
Bend elbow backwards beyond 10 degrees
Bend knee backwards beyond 10 degrees
Lie hand flat on the floor with knees straight.
39
Peripheral arterial dysfunction symptoms and tests
Pain with activity
Loss of color, temperature and pulse
Seated bicycle will make PAD worse
Treadmill will make spinal stenosis worse
40
WOMAC
Sn 77%
Sp 78%
MDC 26%
41
Victorian institute of sport assessment questionnaire
MDC 11.1
MCID > 13
42
Lysholm knee score for meniscus and ligamentous injury
95-100 excellent
84-94 good
65-83 fair
< 65 poor
MDC is 10
43
Cincinnati knee rating system
2.45 pain MDC
2.86 swelling
2.82 partial giving away
2.3 full getting away
44
KOS
8.87 MDC
45
LEFS
9 for LE and new joints
10 for OA of the hip and knee
8 for anterior knee pain
46
Global rating of change
-5 very much worse
0 no change
+5 completely recovered
15 point scale
47
Patient specific functional scale
3 MDC for knee
2 MDC for single activity
48
Patella action with knee flexion
glides inferiorly
49
How do you measure the Q angle?
line from ASIS to the midpoint of the patella to the tibial tuberosity
50
Q angle norms
10-15 for men
15-20 for women
If greater then a increase of lateral patella force and displacement
51
For Patella femoral pain syndrome what angles should you avoid
0-30 degrees with OKC
52
Patella joint forces
Walking is 50% body weight force on the knee
Jogging is 3-4x body weight on knee
Rising from a chair is 6.7x body weight on knee
53
Ottawa foot and ankle rules
Inability to bear weight immediately and in the ED
Tenderness 6 cm posterior edge of the lateral malleolus
Tenderness 6cm posterior edge of the medial malleolus
Navicular tenderness
Base of 5th metatarsal tenderness
54
Wells criteria for DVT ( 9 )
Active cancer
Paralysis, paresis, or recent plaster immobilization of the lower extremities
recently bedridden for 3 days or major surgery in the last 12 weeks
Localized tenderness along the deep venous system
Entire leg swollen
Calf swelling > or equal to 3cm compared to asymptomatic side
Pitting edema confined to symptomatic leg
Collateral superficial veins
Previously documented DVT
55
Lumbar myelopathy CPR
> 40 years old
+ babinski
+ hoffmans
+ inverted supinator sign
Gait deviations
56
lumbar myelopathy CPR (SN/SP)
3/5 = Sp .99/ LR+ 30.9
1/5 = Sn .94/ LR- 1.8
57
Hip OA CPG
> 50 years old
Morning stiffness < 1 hour
Moderate anterior or lateral hip pain with WB activities
Hip IR < 24 and < 15 flexion compared to opposite side
58
Signs and symptoms of hip labrum
C-sign pain
clicking locking, catching stiffness, instability, or giving way
Anterior pinching pain with sitting hip rotation and morning stiffness
59
ACR knee OA guidelines altman criteria
Crepitus
morning stiffness > 30 mins and bony enlargement
60
Achilles Tendon dysfunction and comobidities
Diabetes, HTN, Hyperlipidemia
61
Achilles tendinopathy intrinsic risk factors
Decreased DF
Decreased subtalar ROM
Decreased plantar flexion strength
Excessive pronation/decreased pronation control
62
Achilles tendinopathy extrinsic risk factors
Obesity, HTN, Diabetes
Quick change in training regime
63
Objective data for Achilles tendinopathy
Tenderness to palpation 2-6 cm proximal to achilles insertion
decreased plantar flexion strength on affected side
Decreased ankle DF ROM on affected side
64
Interventions for Achilles Tendinopathy
heavy load eccentrics of SL calf raise
3x15 with knee straight and extended 2x a day for better effect.
65
Poor interventions for Achilles tendinopathy
manual therapy, taping, and DN on < 3 months AT.
66
Functional requirements of the hip AORM
Up stairs = 40-70 degrees
down stairs = 40 degrees
gait = 20 - 40 degrees
67
Functional requirements for knee and ankle AROM
11-21 DF for up and down stairs
80-100 knee flexion for stairs
68
Lunge requirements of LE AROM
Ankle 10 DF degrees
Knee 95 flexion degrees
Hip 85 degrees
69
Squat AROM requirements
Ankle 16 DF
Knee 100 Flexion for DL / 75 for SL
Hip 100 flexion
70
Angle of inclination
> 135 coxa valga with instability
< 120 coxa vara with leg length discrepancy and weak hip ABD
71
Torsion/version angle of the femoral neck
angle b/w the femoral neck and a line bisecting the femoral condyles
72
Norms for torsion/version angle
8-20 degrees
73
Anteversion traits
Significant anterior placement of the femoral neck in relation to the transcondylar axis
higher version angle
in-toeing
decreased loading of anterior joint
74
Retroversion traits
Excessive posterior placement in the transverse plane and results in a lower than normal version angle
Out-toeing
Excessive ER with limited IR
75
Alpha angle of the hip
Line through femoral head and neck
Line through femoral head and border of acetabulum
> 60 degrees indicated cam type deformity
76
Lateral center edge angle
Vertical line from the middle of the femoral head and line from middle of femoral head to the edge of the acetabulum
77
LCEA norms
25-39 = normal
< 25 = undercoverage
> 39 = overcoverage results in pincer FAI
78
Iliofemoral ligament
Limits EXT/ABD/ADD/ER
Sits anteriorly
79
Pubofemoral ligament
Limits ABD and EXT
Sits Anteriorly and inferior
80
ischiofemoral ligament
Limits IR and EXT
Sits posteriorly
81
Loose packed position of the hip
30 flexion
30 ABD
Slight ER
82
Closed packed position of the hip
90 flexion
Slight ABD and ER
83
Iliohypogastric nerve
T12-L1
S) Lateral gluteal
M) Internal Oblique, TrA
84
ilioinguinial nerve
L1
S) Anterior and medial thigh, Scrotum and labia
M) Internal Oblique TrA
85
Gentiofemoral Nerve
L1-2
S) Anterior and medial thigh, Scrotum and labia
M) Cremaster
86
Lateral femoral cutaneous Nerve
L2-3
S) Lateral Thigh
87
Obturator Nerve
L2-4
M) Adductors
88
Femoral Nerve
L2-4
S) Anterior thigh w/ branch into saphenous Nerve for patella sensation
M) Quad, sartorius, articularis genu
89
Lumbar plexus mnemonic
I
Irregularly
Get
Lunch
On
Fridays
90
Ligamentum teres
Pediatrics seen with blood supply
Adult population seen with stability of the hip
91
OKC arthrokinematics of the hip
Flexion/IR of the femur
Rolls anterior and glides posteriorly
92
OKC arthrokinematics of the hip
Extension/ER of the femur
Rolls posterior and glides anteriorly
93
OKC arthrokinematics of the hip
ABD of the femur
Rolls laterally and glides medially
94
OKC arthrokinematics of the hip
ADD of the femur
Rolls medially and glides laterally
95
CKC arthrokinematics of the hip
Forward flexion of the pelvis on the femur
Rolls anteriorly and glides anteriorly
96
CKC arthrokinematics of the hip
Backward extension of pelvis on femur
Rolls posteriorly and glides posteriorly
97
SLS Trendelenburg sign
Pelvic drop of > 2 cm to the opposite side of the stance leg
98
Gait and hip mechanics
Initial contact
Flexed approximately 30 with slight ADD
99
Gait and hip mechanics
Mid stance
Neutral moving into flexion
100
Gait and hip mechanics
Pre swing
Extended approximately 10 with slight ABD
101
Gait and hip mechanics
Early swing
Extended and moving into flexion with slight ABD
102
Gait and hip mechanics
Mid swing
Flexed with slight ABD
103
Gait and hip mechanics
Terminal swing
Flexed 30 with slight ABD
104
FAI CPG
Anterior/lateral hip pain
Aggravated by sitting
+ FADIR
Hip IR < 20 in 90 degrees of hip flexion
AROM/PROM may be limited
Often popping, locking, or snapping of the hip are present
105
Labral Tear CPG
Typically 30+ y/o
Anterior/groin or generalized hip pain
+FADIR and/or +FABER
Often popping, locking or snapping of the hip are present
May have sensation of instability with squatting
106
CAM FAI
Sphericity of the femoral head and/or widening of the femoral neck
Doesn't allow for the femoral head to glide smoothly in the acetabulum
107
Pincher FAI
Over-coverage of the anterosuperior acetabular wall, and abnormal version of the femur or acetabulum
Rim is abnormally shaped
108
Patella pubic percussion test
Stethoscope placed on the pubic tubercle and then you tap on the same side patella
Lack of sound indicate a femoral neck or pubic rami Fx
109
CPG for inflammatory back pain
< 40 y/o
Insidious onset of pain
Improvement in pain with exercise
No improvement in pain at rest
Pain during the second half of the night that improves upon waking
110
4/5 on CPG for inflammatory back pain
77% for ruling out
92% for ruling in
111
FAI surgery ROM precautions for 1-2 weeks
Flexion 90
Extension 0
ABD 25-30
IR 90 with hip flexion at 0
ER at 90 with hip flexion at 30
ER 20 in prone
112
FAI surgery avoid week 1
SLR and S/L hip ABD
113
Week 4-8 avoidance
Hip flexor tendinitis
114
CPG for hip pain mobility deficits and OA
1-5 times per week for 6-12 weeks
Ms stretching of the joint with hip flexor and ER stretch
Strengthening of the hip abductors/ER/Extensors
115
4 phases of wound healing
Day 1-3 homeostasis
Day 3-20 inflammation with blood vessel growth
Week 1-6 Granulation with wound closure
Week 6-2 years remodeling
116
When are hip precautions lifted?
Usually by week 6
117
ROM to achieve by week 4-8 THA
Hip flexion 90-115
Hip ABD 15-25
Hip IR/ER 10-20
118
ROM to achieve by week 6-8 TKA
Knee flexion 110-125
Knee extension 0
119
ACL inflammatory phase 0-3 weeks
Patella mobs
PROM manual for knee flexion to 90
stretch depending on graft location
120
ACL week 3
Full WB (depending on MD)
Recumbent bike
Knee flexion to 115
Shuttle 0-60 degrees
121
ACL week 4-8
PROM 0-130
Graft is weakest at week 6
CKC stability
wall squats and lateral walking
122
ACL week 7-12 weeks Criteria for phase
AROM 0-125
No PFPS
Minimal effusion
123
ACL 12-16 weeks
Plyometrics
Running program
Sports specific training
124
ACL month 3.5 - 4.5 test
Single leg hop test
6m timed hop
Triple hop for distance
Crossover hop for distance
125
What is a hop test
Done for distance with either SL or DL and should be < 10% difference in distance of legs
126
Plyometric progression
Maintain proximal control
Shuttle with TB (DL - SL)
Mini jump then controlled squat to a box line jump
Jump down for technique
127
Meniscus Maximum protection week 1-4
WBAT
D/C crutches when safe gait is established
128
Meniscus week 1-2 PROM
0-90 degrees for week 1
100-105 for week 2
115 - 120 week 3
125-135 week 4
129
Meniscus repair week 3 exercises
Mini wall squats 0-45
Tandem
recumbent bike
130
Meniscus repair week 9-16 components
Hamstring curls begun lightly
cardio
SL activities
leg press
131
Meniscus repair week 4-6 months
4 months = straight plane running and deep squat
5 months = high speed agility and pivoting drills
132
Achilles Sx week 0-4
usually casted in PF for 2 weeks
NWB 2 weeks then PWB at 3 weeks
Heel lift reduced weekly
Bike with boot on week 2
*No calf stretch
133
Achilles Sx week 4-8
Seated BAPS
AROM Inv/Ev
134
Achilles Sx week 8-12
PROM
Contract/relax
Seated HR
Weight shifts
135
Achilles Sx week 12-20
PA glides
MWMs
Strengthening
DL - SL
136
Achilles Sx week 18-20
Return to running
Repeated HR at an incline
Pool running and SL HR
Plyometrics
137
Collateral ligaments of the lateral ankle
Anterior talo-fibular ligament
Calcaneo-fibular ligament
Posterior talo-fibular ligament
138
what are the two common techniques for lateral ankle repair
Brostrom and tendon reconstruction
139
Brostrom lateral ankle repair
reattach the ligaments to the fibular through small holes drilled into the bone
140
Tendon reconstruction
Replace the lateral ligaments by using either an allograft from cadaver or autograft with the patient's hamstring
141
Lateral ankle reconstruction wks 0-6
Immobolized 10-14 days
NWB until CAM boot
PROM, edema
AROM (DF,PF,INV,EVER) if approved by MD
142
Lateral ankle reconstruction wks 6-10 weeks
Discharge boot and ADs
Full ROM
Flexibility
Proximal strength
143
Lateral ankle reconstruction wks 8-12
DL to SL
Slideboard and ladder drills
TM slow walk
plyometrics only if able to complete 25 SL HR
144
Lateral ankle reconstruction wks 12-4 months
Pain free jogging
Y balance test and hop test
figure 8s
145
Abnormal pronated foot posture
FPI 6 > 4
Midfoot hypermobility
decreased tibialis posterior ms strength
medially rotated lower extremity position
146
Absolute contraindications for taping
Decreased sensation
Fx
Infectious disease
Malignancy
Osteoporotic changes
147
Sinding-larsen Johansson syndrome
Repeated irritation of the patella growth plate resulting in swelling and pain on the inferior border of the patella
148
Osgood schlatter disease
Traction apophysitis of the patella tendon on the tibial tubercle usually fixed with conservative care
