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LE Orthopedic DOs

NPTE Musculoskeletal

QuestionAnswer
Impaired blood supply to femoral head with osteonecrosis AVN of hip
Sx of hip AVN groin or thigh pain, TTP at hip joint, decr ROM in FLEX, IR, ABD
Rx contraindicated in AVN Corticosteroids
MRI with bony crescent sign –collaps of subchondral bone at fem neck/head indicates Legg Calve Perthe’s disease
Signalment of LCP disease average age 6yr, males 4x more than girls
Sx of LCP disease psoatic limp (ER, FLEX, ADD), gradual onset of aching pain at hip/thigh/knee, ABD & EXT ROM loss
Most common hip DO in adolescents Slipped capital femoral epiphysis
Onset of slipped capital femoral epiphysis 11yr girls, 13yr boys. Males 2x greater incidence
Sx of Slipped capital femoral epiphysis AROM decr ABD/FLEX/IR, vague knee/thigh/hip pain, Trendelenburg gait (chronic)
Excessive femoral anteversion or torsion leads to squinting patellae & in-toeing
Angle of femoral neck with shaft of femur <120d Coxa Vara
Angle of femoral neck with shaft of femur >135d Coxa Valga
Coxa Vara usually results from defect in ossification of head of femur
Coxa Vara and Valga may result from necrosis of femoral head 2/2 septic arthritis
Inflammation of deep trochanteric bursa Trochanteric bursitis
MOI of Trochanteric bursitis direct blow, irritation by ITB, gait abnormalities
Trochanteric bursitis common in pt with RA
ITB Friction caused by Tight ITB, abnormal gait
ITB friction leads to trochanteric bursitis
MOI of Piriformis syndrome piriformis is ER and can be overworked with excess PRON of foot with resulting femoral IR. Active with motion of SIJ
Sx of Piriformis syndrome decr IR, TTP, pain referred to posterior thigh, weak ER, + Piriformis test, uneven sacral base
ACL laxity results in anterior instability
PCL laxity results in posterior instability
ACL & MCL laxity results in anteromedial rotary instability
ACL & LCL laxity results in anterolateral rotary instability
PCL & MCL laxity results in posteromedial rotary instability
PCL & LCL laxity results in posterolateral rotary instability
Unhappy triad consists of injury to MCL, ACL, medial meniscus
MOI of unhappy triad Valgum, flexion, and ER forces to knee on planted foot
MOI of meniscal injury TibFem flexion, compression and rotation forces
Sx of meniscal injury lateral or medial joint pain, effusion, popping, giving way, decreased flexibility of knee, joint locking
Camel back sign two bumps over anterior knee due to patella alta
Patella baja results in restricted knee EXT, abnormal cartilage wear with DJD
Lateral patellar tracking often 2/2 increased Q angle
Dx test for abnormal patellar positions XR with ‘sunrise’ view
Pes anserine bursitis often caused by oversue or contusion
Traction apophysitis of tibial tubercle at patellar tendon insertion Osgood-Schlatter’s /jumper’s knee
Dx test for OSD XR with irregularities of the epiphyseal line
Normal tibiofemoral shaft angle is 6d of valgum
Genu varum excess medial tibial torsion “bowlegs”
Genu varum results in excessive medial patellar positioning and pigeon toeing
Genu valgum excessive lateral tibial torsion, knock knees
Genu valgum results in excessive lateral patellar tracking
Femoral condyle fx usually occur on medial condyle
Tibial plateau Fx MOI valgum and compression with knee flexed
Tibial plateau Fx often occurs with MCL injury
Epiphyseal plate Fx MOI WB torsional stress
Epiphyseal plate Fx occur in adolescents where an ACL injury woud occur in an adult
Increased LE compartmental pressure resulting in a local ischemic condition Anterior compartment syndrome
MOI of ACS direct trauma, fracture, overuse, muscle hypertrophy
Sx of ACS exercise induced and described as deep cramping
Acute ACS medical emergency that requires immediate surgical intervention with fasciotomy.
Anterior tibial periostitis shin splints, musculotendinous overuse
3 common etiologies of shin splints abn alignment, poor conditioning, improper training
Muscles involved in anterior tibial periostitis anterior tibialis, extensor hallucis longus
Overuse injury of the posterior tibialis or medial soleus with periosteal inflammation at muscular attachments Medial tibial stress syndrome
Pain with palpation of distal posteromedial tibial border medial tibial stress syndrome
LE Stress fractures most commonly involve tibia
MOI of lateral ankle sprain plantar flexed and inverted roll of ankle
Grade 1 ankle sprain no loss of function, minimal tearing of ATFL
Grade 2 ankle sprain some loss of function, partial disruption of ATFL and CFL
Grade 3 ankle sprain complete loss of function, complete tearing of ATFL and CFL, partial tear of PTFL
Trimalleolar Fx medial & lateral malleoli & posterior tubercle of distal tibia
Entrapment of posterior tibial nerve or one of its branches within the tarsal tunnel Tarsal tunnel syndrome
MOI of Tarsal tunnel syndrome pronation, overuse with tendonitis of long flexor & posterior tibialis, trauma that compromises space
Sx of Tarsal Tunnel syndrome pain, numb, paresthesias at medial ankle to plantar aspect
Tendonopathy common in ballet dancers Flexor hallucis tendonopathy
Pes cavus deformity incr longitudinal arch, dropping of anterior arch, met heads lower than hindfoot, plantar flexion, splaying of forefoot, claw toes
Pes cavus etiologies genetics, neuro DO’s with muscle imbalances, soft tissue contractures
Pes Planus deformity reduced meidal longitudinal arch
Etiologies of Pes Planus genetic, muscle weakness, lig laxity, paralysis, pronation, trauma, disease such as RA
Gait results of Pes Planus decreased ability of foot to provide rigid lever for push off in gait
Postural equinovarus clubfoot due to intrauterine malposition
Talipes equinovarus clubfoot due to abnormal devel of head/neck of talus 2/2 heredity or NM disorder
Postural equinovarus deformity seen plantar flexed, adducted, inverted
Talipes equinovarus deformity seen PF of talocrural, INV of subtalar & talocalcaneal & talonavicular & calcaneocuboid, SUP in midtarsals
Plantar flexed foot equinus
Equinus etiology congentical, neuro disorders like CP, calf contractures, trauma, inflamm Dz
Compensation in Equinus Subtalar or midtarsal pronation
Medial deviation of head of 1st met, Distal phalanx moves laterally Hallux Valgus
Etiology of Hallux valgus pronation, lig laxity, heredity, weak muscles, tight footwear
Mechanical Metatarsalgia caused by tight trceps surae or Achilles, collapse of transverse arch, short first ray, forefoot pronation
Pain in 1st & 2nd met heads Metatarsalgia
Rigid Metatarsus adductus medial subluxation of tarsometatarsal joints. Hind foot slightly valgus with navicular lateral to head of talus
Flexible Metatarsus Adductus adduction of all 5 metatarsals at the tarsometatarsal joints
Etiology of Metatarsus Adductus congenital, muscle imbalance, NMD (polio)
Peroneal muscular atrophy that affects motor & sensory nerves Charcot-Marie-Tooth disease
Etiology of plantar Fasciitis pronation, 1st MTP limited ROM, tight calves, rigid cavus foot.
PT Tx for Plantar Fasciitis modalities, flexibility for calves, night splints, invertor strengthening
Rigid inversion of calcaneus when subtalar neutral Rearfoot Varus
Rearfoot Varus etiology abnormal tibial alignment, shortened rearfoot soft tissues, malunion o calcaneus
Eversion of calcaneus when subtalar neutral Rearfoot Valgus
Rearfoot Valgus etiology genu valgum, tibial valgus
Inversion of forefoot at sutalar neutral Forefoot varus
Forefoot varus etiology congenital
Eversion of forefoot at subtalar neutral congenital
Created by: Jenwithonen on 2009-07-24



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