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Flashcards in MSK App Deck (76)
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1
Q

OA of hip tx

young pts

A

femoral head resurfacing

2
Q

OA of hip tx

old pts

A

THA or bipolar arthroplasty

avoid narcotics

3
Q

Hip impingement syndrome

A

abnormal wear and tear of ball and socket joint due to increased friction

2/2 abnormal formation of hip during childhood (athletes notice sooner but NOT caused by exercise)

4
Q

Cam and Pincer lesions

A

associated with FAI

cam = lesion on femur 
pincer = lesion on hip
5
Q

cross over sign

A

acetabular retroversion seen on XR

indicates a pincer lesion on femur

6
Q

blood supply to hip

A

obturator (head of femur)
medial and lateral circumflex arteries

compromise of these = osteonecrosis

7
Q

systemic diseases that may cause osteonecrosis

A
sickle cell 
SLE 
RA
EtOH abuse
steroid
8
Q

radiographic finding osteonecrosis

A

crescent sign

indicates head of the femur is about to collapse

9
Q

imaging in osteonecrosis

A

if radiograph normal but still suspect get MRI

10
Q

tx of osteonecrosis prior to collapse

A

core decompression w/wo graft

avoid of steroids

11
Q

tx of osteonecrosis after collapse

A

bipolar hemiarthroplasty or head resurfacing

avoid steroids

12
Q

ITB snapping hip

A

over greater trochanter

occurs w/walking or rotation, reproducible

LATERAL hip pain

13
Q

iliopsoas tendon snap

A

over pectineal eminence
rising from seated position
more annoying than painful

Not often palpable snap

14
Q

labrum or femoral head tear

A

shocking, catch pt off guard - must brace to prevent fall

pain occurs RIGHT in groin

15
Q

diagnostic work up of snapping hip

A

AP Pelvis and frog let

MR Arthrogram = labral tear

16
Q

strained hip/thigh muscle recovery phases (1-5) long *

A
  1. RICE 48-72 hrs
  2. PROM exercise, heat 72hrs - 1 week
  3. isometrics 1-3 weeks
  4. increased strengthening 3-4 weeks
  5. sport specific training
17
Q

strain imaging work up

A

XR to r/o avulsion fx to ASIS/AIIS

MRI if torn muscle/tendon (athlete)

18
Q

hx of hamstring tear

A

sudden onset of pain

“pop” while running

19
Q

hx of quads tear

A

direct blow to area (soccer or football)

20
Q

trochanteric bursitis presentation

A

pain over lateral hip when standing from seated position or lying down

also pain with lying on that side

21
Q

PE trochanteric bursitis

A

focal tenderness over greater trochanter

get XR to r//o boney pathology

22
Q

tx trochanteric bursitis

A

don’t lay on side

NSAIDS –> steroid injection

23
Q

hip dislocation presentation

A

following MVA

posterior dislocation MC

24
Q

posterior hip dislocation on PE

A

hold thigh flexed, ADducted, INTERNALLY/MEDIALLY rotated

check NV status

25
Q

anterior hip dislocation PE

A

ABducted, EXTERNALLY/LATERALLY rotated

less NV injury

26
Q

Hip dislocation imaging

A
posterior = head of femur is smaller 
anterior = head of femur larger 

CT done to check acetabulum

27
Q

hip dislocation tx

A

ortho emergency

reduction W/IN 3 HRS

28
Q

femur shaft fx

A

high energy trauma

PE look at entire extremity

29
Q

tx of femoral shaft fx

if open fracture but pt has no pulses

A

traction splint

+ Ancef, TIG

30
Q

pelvis fracture work up

A

worry about shock

XR AP pelvis, inlet, Judet and oblique –> CT

31
Q

complications of pelvis fracture

A

shock, organ damage, injury to entire body

pelvic girdle for hemodynamic stability or bed sheets over GREATER TROCHANTER

32
Q

osteoporosis and femur fx

A

MC in femoral neck

especially in older women

33
Q

RF for femur neck fracture

A
smoking 
sedentary lifestyle 
alcohol abuse 
dementia 
psych medication
34
Q

hx of a femoral neck fx

A

fall on affected side, land on hip

unable to stand or ambulate

35
Q

femoral neck fx will appear

A

displaced and shortened in ER

36
Q

what do we used to classify femoral neck fx

A

Garden classification

37
Q

OA of hip XR

A

narrowing of articular space

38
Q

OA of hip tx (Rx)

A

NSAIDS, steroids, avoid narcotics

Mobic is good option

39
Q

OA of knee

A

progressive pain (activity –> constant)

aging, obesity, repetitive wear and tear, previous trauma

40
Q

OA of knee XR

A

AP and lateral weight bearing

loss of joint space, sclerosis, subchondral cysts, osteophytes

41
Q

bursa of knee

A

pre patellar
infrapatellar
pes anserine

42
Q

prepatellar bursitis

A

located b/t skin and patella

swell to size of tennis ball

found in carpet layers or wrestlers

43
Q

pes anserine bursitis

A

medial knee, under SGT

over use or obese patients (warning of medial joint DJD)

44
Q

hx bursitis of knee

A

pain present with active or direct pressure

relieved after resting then worse when resuming activity

45
Q

aspiration of bursa

A

is suspicion of infection (redness, swelling)

46
Q

tx of bursitis

A

ice, decreased activity, preventative measures (I.e. knee pads)

NSAIDs, steroid injections

47
Q

patellofemoral pain hx

A

insidious onset

aching knee, worse with prolonged sitting, climbing stairs, jumping or squatting

48
Q

patellofemoral pain PE

A

increased Q angle (esp. women)

malt racking of patella

49
Q

patellofemoral pain tx

A

NSAIDs, quad strengthening, referral

50
Q

meniscus tear - which one MC? why?

A

medial meniscus

fixed to tibial plateau

51
Q

cause of meniscus tear

A

Degenerative (OA cascade)

Trauma (twisting motion)

52
Q

meniscus tear hx

A

worse with forced flexion (squatting)

buckling or catching sensation

53
Q

bucket handle

A

meniscus tear flips over and blocks knee from full extension

54
Q

meniscus tear PE

A

McMurray test positive

MRI (2-3 days after injury to help visibility)

55
Q

tx of meniscus tear

A

PT then sx

PT improves post op outcomes by strengthening muscles around the knee

56
Q

ACL tear test +

A

lachman’s test

MRI

57
Q

MoI ACL tear

A

twisting on bent or hyperextended knee

58
Q

testing MCL tear

A

valgus stress testing

59
Q

testing LCL tear

A

varus stress testing

60
Q

conservative tx of ACL tear

A

PT with ROM strengthening and bracing

sx following MRI

always check contralateral extremity

61
Q

two spots that rupture patellar quad tendon tear (age)

A

< 55: distal

>55: proximal

62
Q

hx patellar quad tendon tear

A

fall on partially flexed knee

63
Q

PE patellar quad tendon tear

A

inability to fully extend against gravity

64
Q

patellar quad tendon tear tx

A

EARLY sx repair

avoid NSAIDS

65
Q

hx tibial plateau fx (medial)

A

MVC hit from side

66
Q

tibial plateau fx (lateral)

A

direct blow to distal lateral thigh w/foot planted

67
Q

tibial plateau fx diagnostic tests

A

CT recon (surgical planning)

MUST also asses for meniscal or ligamentous injury

68
Q

tibial plateau fx tx

A

ORIF and referral

69
Q

patella fx

A

direct blow (by fall or object)

inability to extend knee

70
Q

patella fx dx studies

A

AP and lateral XR of knee

71
Q

tx patella fx

A

complete/extensor mechanism not intact = SX

otherwise long leg cylinder cast or long leg hinged brace in full extension

72
Q

osgood schlatter dz

A

receptive stress on quad groups pulls on apophysis of tibial tuberosity

boys 11-13

prominence of tibial tuberosity

73
Q

management osgood schlatter dz

A

if pain is UNILATERAL = XR to r/o tumor

ice pack and stretching exercise

74
Q

Sinding larsen Johansson

A

injury at the junction of PATELLAR tendon and distal pole of patella

pain is INFERIOR patella

75
Q

S-L-J v. Osgood

A
OS= tibial pain 
SLJ= patellar pain
76
Q

meniscus tear confirmed with

A

MRI (get XR first)