NPTE Musculoskeletal Flashcards

capital femoral epiphysis
Terms Definitions
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
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