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