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Semester 3 > Orthopedic Pathology 300 (Lower Extremity Pathologies) > Flashcards

Orthopedic Pathology 300 (Lower Extremity Pathologies) Flashcards

1
Q

Hip Dislocation

A

Normal adult hip one of the most stable joints in body

Ball and socket joint

Stability depends on shape of articulating surfaces

Severe violence required to dislocate a hip

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2
Q

TYPES of hip dislocation

A

Posterior dislocation

Anterior dislocation

Central dislocation

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3
Q

Posterior dislocation (hip)

A

most common,

can be associated with fracture,

present shortened and internally rotated

MOI
E.g.
leg flexed – posterior force hits knee and drives femur backward out of AF socket
I.e.
sitting in a car (without seatbelt?)

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4
Q

Anterior dislocation (hip)

A

least common,

can be associated with fracture,

will present externally rotated

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5
Q

note posterior/anterior dislocation vs glide/slide

A

posterior glide
= flexion, IR

anterior glide
= extension, ER

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6
Q

Central dislocation (hip)

A

due to severe blow to lateral hip;

ALWAYS associated with FRACTURE

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7
Q

treatment hip dislocaiton

A

Emergency

Surgery

Casting

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8
Q

hip dislocation complications

A

Avascular necrosis

Severe post-traumatic DJD

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9
Q

recall which other bone (dislocation?) carried risk of avascular necrosis?

A

scaphoid mainly

also lunate

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10
Q

trochanteric bursitis

A

Bursa

Between gluteus max and trochanter

also b/w gluterus medius and GT

(also minimus)

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11
Q

three trochanteric bursae

A

Trochanteric Bursa of Gluteus Maximus Muscle

Trochanteric Bursae of Gluteus Medius Muscle

Trochanteric Bursa of Gluteus Minimus Muscle

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12
Q

which aspect of hip affected? (trochanteric bursitis)

A

Affects the lateral aspect of the hip

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13
Q

which demographic affected?

A

Middle age/older

WOMEN > men

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14
Q

trochanteric bursitis causes

A

Poor stretching and warm up

Occupations: cashiers, wallpaper hangers

Bucket seats and tight fitting chairs

Overuse

Post surgery

Direct trauma

Lying on one side for extended periods of time

Ice skaters/dancers

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15
Q

trochanteric bursitis – SSx

A

Difficulty walking

Walk with limp

Aching over trochanter

Walking with legs apart helps discomfort (?)

Radiating pain

Worse with climbing stairs and getting out of a car

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16
Q

trochanteric bursitis – Tx

A

US

Acupuncture

NSAIDs

Stretching/Strengthening

Massage

Ice / Hydrotherapy

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17
Q

Iliotibial Band Syndrome (ITBS)

what are the two types

A

IT Band Contracture

IT band Friction Syndrome

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18
Q

which ITBS is more common

A

IT band Friction Syndrome

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19
Q

IT Band contracture

A

Contracture or thickening of IT band

The thickening alters biomechanics of the knee and hip with compensation occurring in the SI joint or ankle

May be TrPs in TFL or glut max.

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20
Q

ITB contracture – what movements common?

A

APT

& Internal hip rotation (?)

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21
Q

IT band Friction Syndrome

A

Inflammation and pain where the iliotibial band crosses the lateral femoral condyle

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22
Q

causes of ITBS

A

Overuse of flexion of knee and hip

Prolonged repetitive hip and knee flexion
—> Running or cycling

Postural imbalance
—> Anterior pelvic tilt or hyperlordosis

Prolonged wheelchair/bedrest

Weakness in hip abductors and lateral rotators.

*** NOT ENOUGH STRETCHING? (TFL/ITB contracture?)

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23
Q

shortened TFL

A

“A shortened TFL can lead to an anterior tilt of the pelvis and/or medial rotation of the femur”

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24
Q

ITBS pain

A

Pain

Gradual onset and worse with activity

Along lateral thigh (IT band contracture)

Lateral aspect of knee (IT band friction syndrome)

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25
Q

what kind of pain with ITB contracture

A

Along lateral thigh (IT band contracture)

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26
Q

what kind of pain with ITB friction syndrome

A

Lateral aspect of knee (IT band friction syndrome)

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27
Q

where is inflammation? (ITBS)

A

Inflammation at lateral femoral condyle

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28
Q

where HT/TrP (ITBS)

A

TFL, gluteals, hip flexors

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29
Q

what about lower back Sx (ITBS)

A

L-spine and SI joint symptoms

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30
Q

what other condition can it go hand in hand with?

A

Trochanteric bursitis

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31
Q

ITBS – Tx

A

Activity modification
—> Decrease training, rest

Hydrotherapy/cryotherapy

Modalities
—> Ultrasound, cold laser, shockwave therapy

Soft tissue/massage

Stretching/strengthening

Corticosteroid injections

Surgery
—> Rarely performed

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32
Q

Knee Pathologies

A

..

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33
Q

Bursitis (types in/around knee)

A

Prepatellar Bursitis**
Aka gardeners

Suprapatellar Bursitis (FYI)
Aka chambermaids

Infrapatellar Bursitis Bursitis (FYI)
Aka preachers

WHY?
From prolonged kneeling or recurrent trauma to ant. knee

Pain and swelling and restricted ROM

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34
Q

Patellofemoral pain syndrome

A

aka patellofemoral syndrome, patellofemoral tracking syndrome

General term used for pain around patellofemoral joint

Usually refers to anterior knee pain.

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35
Q

patellofemoral syndrome (general term for Sx when more specific pathology not determined) – diagnosis of exclusion

A

Does not include…

a) Patellar Tendinopathy

b) or Chondromalacia Patellae

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36
Q

patellofemoral syndrome – feature

A

Problem with patellofemoral contact and/or tracking of the patella in the femoral groove

Mechanism is not fully understood

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37
Q

chondromalacia patella

A

the breakdown of cartilage on the underside of the kneecap (patella).

When the kneecap rubs against the thigh bone, it hurts and swells.

It is common among runners and other athletes and has been given the nickname “runner’s knee.”

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38
Q

malacia

A

Malacia is abnormal softening of a biological tissue, most often cartilage.

The word is derived from Greek μαλακός, malakos = soft.

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39
Q

patellar tendinitis – aka

A

jumper’s knee

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40
Q

patellar tendinitis vs tendinopathy

A

tendinopathy includes either tendinitis or tendinosis

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41
Q

patellofemoral pain syndrome —> contributing factors

A

Abnormal biomechanics

Increased internal tibial or femoral rotation.

Increased foot pronation (collapsed arch?)

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42
Q

tracking of patella vs PF pain syndrome (contributing factor)

A

Abnormal shape, tracking and stability of patella

E.g.
—> Patella alta

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43
Q

PF pain syndrome other contributing factors

A

Tight muscles/stuctures
—> Vastus lateralus, ITB, lateral retinaculum
—> Rectus femoris, hamstrings

Weak muscles
—> VMO, glut med, piriformis

Knee injury
—> Patellar subluxation/dislocation,
—> knee surgery

Knee stress/overuse

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44
Q

It places excessive lateral force on the patella and can also externally rotate the tibia, upsetting the balance of the PF mechanism.

This can lead to excessive lateral tracking of the patella.

A

Weak muscles
—> VMO

Tight muscles/stuctures
—> Vastus lateralus

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45
Q

PF pain syndrome – clinical manifestation

A

Anterior knee pain

Crepitus

Grating/grinding sensation

Swelling

Atrophy
quads

DJD

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46
Q

PF pain syndrome – when pain worse

A

Typically worsens with:

Sitting for long periods of time (Movie Theatre Sign)

Walking up and down stairs

Squatting/kneeling

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47
Q

Cinema Sign (also known as Theatre sign, Movie-goers sign, Movie sign)

A

Pain during prolonged sitting is sometimes termed the “movie sign” or “theatre sign” because individuals might experience pain while sitting to watch a film

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48
Q

PF pain syndrome – Tx

A

NSAIDs

Braces/Taping

Manual Therapy
–> Massage
–> Mobilization

Orthotics

Strengthening
–> VMO, quads, hip

Proprioceptive training

Surgery (uncommon)
–> Lateral release

49
Q

Chondromalacia Patella (associated condition)

A

Softening of the cartilage of the patella

Can be asymptomatic

Thought to be secondary to patellar tracking issues

50
Q

Leg, Ankle and Foot Pathologies

A

..

51
Q

Shin Splints

A

Defined as “pain and discomfort in the leg from repetitive activity on hard surfaces, or due to forceable, excessive use of the foot flexors”

52
Q

shin splints aka

A

Aka medial tibial stress syndrome

53
Q

shin splints – why poorly defined?

A

Poorly defined; sometimes grouped together as …

periostitis,

tibialis posterior tendonitis,

tibial stress fractures

and compartment syndrome

54
Q

shin splints causes

A

Overuse

Overtraining
—> increase in distance, intensity and duration

Running on hard or uneven surfaces

Poor footwear

Poor shock absorption or support

55
Q

shin splints — risk factors

A

Poor biomechanics:

—> Excessive pronation (collapsed arch?)

—> unequal leg length

Overweight

56
Q

shin splints – clinical presentation

A

Most commonly the pain is on the posteromedial border of the tibia.

Usually middle or lower tibia

Often bilateral

Similar to tendonitis, where it initially gets better with “warm up”, but as condition progresses pain will be present through exercise and continue during activities of daily living.

57
Q

shin splints – foot movement?

A

Excessive foot pronation is often present

58
Q

shin splint – if untreated?

A

If untreated, it may progress to a stress fracture

59
Q

shint splint – tx

A

Rest; 2-6 weeks
Avoid running or standing long periods

Ice, NSAIDs

Gradual return to activity/training
Low impact, cross-training

Stretching/strengthening

Massage, chiro, physio

New shoes/orthotics

Surgery (rare)

60
Q

compartment syndrome

A

A critical pressure increase within a confined compartmental space

Most commonly occurs in the anterior leg compartment

Can also occur in many areas of the body, including foot, thigh, forearm, hand, gluteal area.

61
Q

two types of compartment syndrome

A

Two types:

Acute

and
Chronic (aka, chronic exertional compartment syndrome, CECS)

62
Q

compartment syndrome – MOI

A

Connective tissue that forms compartment is rigid, therefore any swelling or bleeding that occurs can increase intra-compartmental pressure.

Increased pressure will cause the vessels to be compressed leading to decreased blood flow and ischemia.

—> Causing pain, nerve damage and possible tissue death

63
Q

muscle and nerve anoxia

—> muscle and nerve necrosis

—> ?

A

leaky basement membranes

—> transudate (edema)

64
Q

acute compartment syndrome

A

Most commonly due to trauma

—> E.g. Tibial fracture

—> Rarely will it be due to overuse or progress from CECS1,5

65
Q

acute compartment syndrome — clinical presentation

A

Severe pain

Skin is taut and shiny from swelling

Paresthesia/anesthesia may be present from nerve compression

66
Q

acute compartment syndrome – Dx

A

Intra-compartmental pressure monitoring

—> with needle?

67
Q

Acute compartment syndrome – Tx

A

Emergency fasciotomy

Best results within 6 hours. If later than 12 hours, high likelihood of long-term disability/amputation

Usually will release all four compartments

Wound may be left open for up to 5 days post surgery to allow swelling to decrease.

68
Q

Chronic Exertional Compartment Syndrome

A

Etiology:

Exercise induced/overuse

—> Overtraining, poor technique, impact

—> During strenuous exercise, there can be a 20% increase in muscle weight and volume d/t to blood flow and edema

69
Q

Chronic Exertional Compartment Syndrome

—> predisposing factors

/ risk factors

A

Anatomical configuration

Muscle imbalances

Improper footwear

70
Q

Chronic Exertional Compartment Syndrome

—> clinical presentation

A

Achy/cramping pain and swelling over the compartment area

May have paresthesia/anaesthesia over compartment and foot

Pain will come on at the same time, distance and intensity of exercise

71
Q

what happens to pain (CECS)

A

Pain will continue and worsen through activity, but will subside with rest

The pressure may remain high in the compartment for more than 20 minutes post exercise

72
Q

CECS – muscle herniation (?)

A

Muscle herniations may be palpated

—> May only be apparent after exercise

73
Q

CECS –> Dx

A

Intra-compartmental monitoring

—> Can be done before, during and after exercising

74
Q

CECS – Tx

A

Rest (4-8 weeks)

Activity modification

Massage/physio/chiro

Orthotics

Stretching/strengthening

Surgery; Fasciotomy
—> Non-operative treatments are generally unsuccessful (???)

75
Q

Achilles Tendinitis

A

Common overuse injury

Can be seen in athletes, recreational athletes and inactive individuals

Pain due to microtears and inflammation

Develops at mid point of tendon

76
Q

Achille’s Tendinitis – causes

A

Overuse

—> Stop and go sports

Running on hills or hard surface

Direct trauma

Poor stretching

Tight and/or weak calf muscles
—> Ballet dancers, high heels

Worn out shoes or footwear that inhibits movement
Over pronation syndrome (collapsed arch?)

Poor biomechanics

77
Q

Achille’s tendinitis – clinical manifestation

A

Pain is usually located at mid-tendon
—> Can also be at bone/tendon junction

Redness and swelling over tendon
—> Tendon can appear and feel thicker

Crepitus with touching or moving tendon

Morning pain

Pain when pushing off during walking

Pain with raising toes

Muscle atrophy
—> chronic

Can lead to rupture if not treated

78
Q

what can happen if achille’s tendinitis not treated ??

A

Can lead to rupture if not treated

79
Q

note risk factor

A

WEAK CALVES

80
Q

achille’s tendinitis – Tx

A

Rest

Activity modification

Isometric and eccentric loading exercises

Calf stretches

Massage

Joint mobilization/manipulation

Night splint

Orthotics
—> Overpronation

Steroid injections

Modalities
—> Shockwave, cold laser, ultrasound

Surgery
—> rare

81
Q

Achille’s tendon rupture

A

Can be a partial rupture or full rupture

Largest tendon in the body

Most commonly ruptured tendon

82
Q

AT rupture why

A

Sudden overstretch of the tendon

Forceful dorsiflexion

Fall

83
Q

AT rupture – Dx

A

Ultrasound

MRI

84
Q

AT rupture – Tx

A

Surgery

Casted

85
Q

Plantar Fasciitis

A

Overuse condition of resulting in inflammation of the plantar fascia

m/c cause of foot pain in athletes

Overuse and stress on the plantar fascia cause tissue fatigue and microtearing

86
Q

MOST COMMON CAUSE OF FOOT PAIN

A

plantar fasciitis

87
Q

plantar fascia

A

Attaches to calcaneal tuberosity (medial),MTP joints and flexor tendon sheaths

88
Q

plantar fascia function

A

Functions as a passive bowstring during … (??), which shortens and raises the medial longitudinal arch

Windlass mechanism; adds stability to a loaded foot with minimal muscle activity.

89
Q

windlass mechanism

A

TOE DORSIFLEXION = CALCANEUS moves ANTERIOR

—> ACCENTUATES ARCH

90
Q

plantar fasciitis – WHICH DEMOGRAPHIC ?

A

Occurs at any age, but most commonly experienced in middle age.

Occurs more commonly in athletic populations and accounts for 8-10% of all running related injuries

91
Q

plantar fasciitis – ETIOLOGY

over-pronation and over-supination

A

May be caused by over pronation or supination:

Pronation causes a stretching effect and leads to a repetitive tension overload

Supination causes a poor dissipation of forces. The rigidity of the foot leads to more shock absorption into the plantar fascia, which would normally be dissipated through the leg

92
Q

plantar fasciitis – RISK FACTORS

A

Overuse
—> Overtraining, poor technique (running/dancing)

Poor biomechanics/muscle imbalances
—> Pronation/supination, hip mechanics (int/ext rotation)

Impact/weight bearing activities
—> Prolonged standing, running on hard surface

Improper foot wear

Weight gain

93
Q

plantar fasciitis –> SSX / clinical presentaiton

A

Sharp heel pain

Often worse with getting out of bed in the morning

Can be unilateral or bilateral

Symptoms range from mild to severe

Limited dorsiflexion and tight calcaneal tendon

Worse with stair climbing and activity

Heel spur

94
Q

what can heel pain do? (plantar fasciitis)

A

Can radiate along bottom of inside of foot

Pain can be reproduced with palpation of medal calcaneal tuberosity or extension of 1st digit (toe)

95
Q

heel spur (plantar fasciitis)

A

Seen in up to 50% of patients

Not an indication of severity

Not causative for plantar fasciitis, but the reaction to chronic fascial tension

96
Q

plantar fasciitis – Tx

A

NSAIDs

Rest

Corticosteroid injections

Orthotics

Taping (athletic or kinesio)
Ankle mobilization

Correcting imbalances

Stretching/strengthening

Massage/physio/chiro

Night splints

Surgery
—> Plantar fasciotomy w/ or w/o heel spur removal

97
Q

when surgery (plantar fascitiis)

A

Surgery should be considered a last resort as 95% of patients respond to conservative care

—> Other sources reports 70-90%

—> More than 80% of patients improve within 12 months regardless of type of care

98
Q

Calcaneal Spurs (HEEL SPURS)

A

Bony outgrowth that forms on calcaneus

—> Can be on the back of the heel or under the sole

99
Q

HEEL SPURS — WHY

A

May result from continuous pulling on attachment sites
—> Back of heel: calcaneal tendon
—>Under the sole: plantar fascia

May be associated with plantar fasciitis or calcaneal tendonitis, but not considered to be the pain generator.

May be found in 10 to 27% of asymptomatic individuals

100
Q

varus/valgus types in FOOT

A

Hindfoot varus – inversion of calcaneus

Hindfoot valgus – eversion of calcaneus

Forefoot varus – inversion of forefoot on the hindfoot at the midtarsal joint

Forefoot valgus – eversion of forefoot on hindfoot at midtarsal joint

101
Q

Pes Planus

A

AKA pes planovagus, flat feet, pronation of feet, fallen arches

Decreased, flattened medial longitudinal arch leads to sole of foot coming into complete contact with ground

Pronated hindfoot

Unilateral or bilateral

Common

102
Q

functional vs structural Pes Planus

A

Functional
—> Due to ligamentous laxity and muscle weakness
—> Reversible; arch can be recreated

Structural
—> Due to bony malformation
—> Irreversible; arch can’t be recreated

103
Q

pes planus causes

A

Hypermobility

Poor biomechanics

Shortened or weak muscles

Congenital

Poor posture

Nerve lesions/trauma

Footwear

Pregnancy; weight gain

104
Q

pes planus – SSx / clinical manifestations

A

Flattened medial arch

Pain (maybe)

Weak muscles

Trigger points

Other conditions (knee, hip, ankle, SI, etc.)

105
Q

pes planus – Tx

A

Orthotics

Surgery

Massage, chiropractic

Strengthening/stretching

Exercises/modify ADLs

Mobilization

Proper arch support

Weight loss

106
Q

Pes Cavus

A

Aka claw foot

Increased arches

Toes appear clawed

Forefoot will drop below rearfoot when non-weight bearing

107
Q

pes cavus – causes

A

Possible normal variant

Hereditary

Neurological (MD)

108
Q

pes cavus – Sx

A

Calluses

Unable to properly fit shoes

Stiffness and immobility

Inversion ankle sprains (think of fibularis longus)

Pressure sores

Pain (maybe)

109
Q

pes cavus – tx

A

Depends on severity

Foot orthotics

Pads

surgery

110
Q

Hallux valgus

A

Aka hallux abducto valgus (HAV)

Valgus orientation of big toe

Most commonly associated with medial deviation of 1st MT and bunion at 1st MTP joint

Symptoms can include pain, redness, swelling and drift of other digits

Can be due to poor footwear, injuries, neuromuscular problems

Always progressive

Treatment – surgery, orthotics, relief of pressure

111
Q

toe pathologies

A

..

112
Q

Hammer toe

A

MTP hyper extension, PIP flexion and DIP hyperextension

113
Q

Claw toe

A

MTP hyperextension and PIP & DIP flexion

114
Q

Mallet toe

A

Mallet toe – DIP flexion

115
Q

toe deformities – clinical manifestations

A

Pressure

Pain

Corns

Calluses

Altered biomechanics

Tight tendons, ligaments

116
Q

toe deformities – etiology

A

Muscle imbalances

Arthritis

Genetics

Shoes

117
Q

toe deformities – Tx

A

Proper shoes/splints

Gel toe shields/caps

Surgery

118
Q
A

Semester 3 (32 decks)

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