Orthopedics- lower extremity

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