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LE Orthopedic DOs
NPTE Musculoskeletal
| Question | Answer |
|---|---|
| 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
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