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615 Cards in this Set
- Front
- Back
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Indications for splinting
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Fractures
Sprains Joint infections Tenosynovitis Acute arthritis/gout Lacerations over joint Puncture wounds and animal bites Pain control |
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Long Arm Posterior Splint
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- Elbow and forearm injuries
- Distal humerus fx - Both bones forearm fx - Unstable proximal radius/ulna fx Doesnt completely eliminate supination/pronation - either add anterior splint or use double sugar-tong if complex or unstable distal forearm fx |
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Double sugar tong
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Elbow and forearm fx -prox/mid/distal radius and ulnar fx
Better for most distal forearm and elbow fx - limits supination/pronation and flexion/extension |
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Cockup splint
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- Soft tissue hand/wrist injuries - sprain, carpal tunnel night splints
- Most wrist fx, 2nd-5th metacarpals - Some add dorsal splint for increased stability - Not used for distal radius or ulnar fx - can still supinate or pronate |
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Forearm sugar tong
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- Distal radius or ulnar fx
- Prevents supination/pronation and immobilizes elbow |
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Radial and Ulnar gutter
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Fractures, phalangeal and metacarpal and soft tissue injuries of the little and ring fingers
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Thumb spica
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Scaphoid fx - seen or suspected (check snuffbox tenderness)
- Lunate fx - All thumb fx - De Quervain tenosynovitis |
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Finger splints
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Sprains - dynamic splinting
Dorsal/volar splints - phalangeal fractures, gutters better for proximal fractures |
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Jones compression dressing
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- Short term immobilization of soft tissue and ligamentous injuries to knee or calf
- Pain relief - Allow slight flexion and extension, can add posterior knee splint to further immobilize knee |
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Posterior ankle splint
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- Distal tibia/fibula fx
- Reduced dislocations - Severe sprains - Tarsal/metatarsal fx Use coaptation splint to posterior splint - eliminates inversion/eversion especially useful for unstable fractures and sprains |
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Stirrup splint
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Similar to posterior splint, less inversion/eversion and plantar flexion, great for ankle sprains
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Complications for casting
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BURNS - thermal injury as plaster dries, increased number of layers, extra fast drying, poor padding - increase risk
ISCHEMIA PRESSURE SORES INFECTION |
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Why do you do ophtalmologic examination when suspect child abuse
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Shaken baby syndrome or retinal hemorrhages
|
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Skeletal survey includes :
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Skull - frontal and lateral
Spine - frontal and lateral Chest Extremities Additional views as needed |
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Multiple rib fractures healing on xray is pathognomonic for _
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CHILD ABUSE - ESPECIALLY POSTERIOR PART
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Bruises - abuse vs accidental
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ABUSE - on padded areas, pattern injuries, many lesions
ACCIDENTAL - on poorly padded areas, non-specific patterns, few lesions |
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Differential diagnosis for bruises
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CHILD ABUSE
Bleeding disorders Mongolian spots Henlich-Shonlein purpura Cupping, coining |
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Which lesion is virtually pathognomonic for child abuse
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Metaphyseal fracture - results from tearing and shearing forces
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Most vulnerable part of bone in infant
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Distal metaphysis (no chondrocytes - makes it weaker then physis, fewer organized cells and less calcification makes it weaker then proximal metaphysis or any other part of the bone)
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what is central to radiologic diagnosis of abuse
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RIB FRACTURES - posterior rib fractures are highly suggestive of abuse
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Which parts of ribs are most commonly fractured in abuse
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Head and neck - only in abuse and MVA
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High specifity injuries suggesting abuse
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- Classic metaphyseal lesions
- Rib fractures - head+ neck, posterior - Scapular fractures - Spinous process fractures - Sternal fractures |
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Compartment syndrome definition
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Elevation of interstitial pressure in closed fascial compartment that results in microvascular compromise
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Tissue threshold to ischemia - muscle _ , nerve _
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Muscle 4 hours
Nerve 8 hours |
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Causes of compartment syndrome
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Fractures of long bones
CRUSH INJURIES Burns Pneumatic tourniquette High injury trauma/blunt trauma Ischemia/reperfusion Penetrating injuries (snake spider bites) Chronic overuse |
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Which compartment is most commonly involved in compartment syndrome in lower extremity
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Anterior compartment (stronger fascia, lower compliance, less subcutaneous fat for shock absorption)
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6 P's of compartment syndrome
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Pain (out of proportion)
Paresthesias Pulselessness Passive movement pain Pallor Paralysis |
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You should consider diagnosis of compartment if pressure within compartment is equal to or exceeds _
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30 mm Hg
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Treatment of compartment syndrome
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Fasciotomy
Debridement of necrotic muscle Jelonet dressing IV heparin |
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Most common symptoms of PE
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Dyspnea
Pleuritic chest pain Cough Hemoptysis |
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Signs of PE
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Tachypnea
Rales Tachycardia 4th heart sound Accentuated pulmonic compound of 2nd heart sound Circulatory collapse |
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In PE EKG will often show
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Sinus tachycardia
T wave and ST segment changes - S1Q3T3 |
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What does chest x ray show in patient with PE
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Non specific changes (12% normal)
- Hamptons hump - wedge shaped formation in lower part of the lung from occlusion of the vessel Westmark sign - changes distal to occlusion of pulmonary artery Also atelectasis, small pleural effusion, infiltrate, elevated hemidiaphragm |
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Which tests are don to diagnose PE
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- PULMONARY ANGIOGRAPHY - gold standard
- CT - Ventilation-perfusion scanning - D dimer |
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In diagnosis of PE 2 algorithms are used -
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- Clinical suspicion + ventilation-perfusion scanning
- Clinical suspicion + CT scan/D-dimer |
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Wells criteria assess
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Likelihood of patient having PE
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What has become a modality of choice for diagnosis PE
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CT SCAN (pulmonary angiography is a gold standard but it is less available and more invasive)
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Mortality rate for patients with PE
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30% w/out treatment
2-8% with prompt intervention |
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65-90% of PE arise from _
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DVT in lower extremities
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Virchow triad
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Vascular intimal injury
Hypercoagulability Venous stasis |
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Risk factors for PE
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SURGERY
- Immobilization - Stroke - Smoking - History of DVT - Malignancy - Chronic heart diseases - Fractures - Oral contraceptives |
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What should be INR in patients on Coumadin
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2-3
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SYmptoms for flexor tenosynovitis
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- Pain with passive stretching
- FUsiform swelling (sausage fingers) - Erythema - Intact sensation |
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Normal extension of the hip is _
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20-30 degrees
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Normal flexion of the hip is
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135 degrees
|
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Normal abduction of the hip is _
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45-50 degrees
|
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Normal adduction of the hip is _
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20-30 degrees
|
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What is a weight bearing portion of the hip ( would decrease in OA)
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Superior portion of acetabulum
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Causes of hip pain
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Hip fracture
Hip dislocations OA Osteonecrosis Iliotibial band tendonitis Intraarticular pathology Trochanteric bursitis Pediatric causes - unique to children - growth plate problems, infections Inguinal hernia |
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Intraarticular pathology
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Labral tears
Ossified loose bodies Synovitis (pigmented villonodular) Septic arthritis - pediatric patients and post joint replacement |
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How would typical patient with septic arthritis present
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- Pain in anterior aspect of the hip
- Pseudoparalysis - patients are not paralyzed but it is very painful so they are trying to limit use of the extremity - Fever - Possible trauma history - if patient is bacteremic even small trauma can cause septic arthritis - Patient is usually 4 years old with no underlying illnesses |
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What is a common positioning of the hip in patients with septic arthritis and why
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Hip is in: external rotation, abduction and mild flexion - in this position capsule holds most fluid - most comfortable position
|
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Which blood tests should you do in patient with septic arthritis
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CBC
CRP ESR CRP and ESR are both acute phase reactants, CRP is more acut and ESR is more chronic - both used to evaluate progress in patients with septic arthritis |
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Blood cultures in patients with septic arthritis are always positive - T/F
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FALSE - 40-50% are positive
|
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If you see x ray changes in patients with septic arthritis what does it mean
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Long standing infection
|
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Is ultrasound useful as diagnostic tool in patients with septic arthritis
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It looks for echogenecity - very sensitive for effusion but not infection, effusion can be normal (synovial fluid) or can be infectious (pus)
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What procedure is used to determine organism in septic arthritis
|
Large bore needle aspiration - if you think joint is infected but nothing is coming out, inject sterile saline solution to give volume and suck it back out and bacteria will follow the fluid, dont inject anything bactericidal - will kill causative organism before determination
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Describe WBC levels in patients with septic arthritis
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Over 50000 and 90% PMN
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Glucose levels in synovial fluid of patients with septic arthritis are _
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40 mg/dL less then serum levels (also do blood glucose levels to compare)
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How do you confirm diagnosis in patients with septic arthritis
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Gram stain - can confirm diagnosis in 50% of cases
Cultures - positive in 50-80% of patients |
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How do you treat septic arthritis of the hip
|
Early diagnosis is very important. Also get cultures of synovial fluid as soon as possible to determine appropriate antibiotic, and do hip arthrotomy to drain surgically.
|
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In high risk low birth weight neonates causative organisms of septic arthritis of the hip are _
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S. aureus followed by group B strep
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In kids 3 months- 3 years old causative organisms of septic arthritis of the hip _
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H.influenza type B, followed by Staph and Strep, declined drastically with H. flu vaccine
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In kids older then 3 years old causative organisms for septic arthritis of the hip are_
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S aureus (50%) , strep (25%)
|
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What are the possible causes of Legg-Perthes-Calve disease
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- Clotting factors/blood viscosity
- Endocrine abnormalities (thyroid disorders, higher T3/T4 levels) |
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Usual age of presentation for LCP disease/sex
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4-10 years old boys (often small for age)
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WHat is common presentation of child with LCP disease
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Limping (antalgic gait)- can present for weeks or months, usually no pain but if it does exist its mild and affects knee
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What motions are limited in child with LCP disease
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Internal rotation and abduction, internal rotation is best tested in extension
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Which test is positive for LCP disease
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Trendelenburg test - test for gluteus medius strength, opposite side drops
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Pain is referred from hip to suprapatellar region - what nerve is involved
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Femoral
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Pain is referred from hip to medial thigh - what nerve is involved
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Obturator
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Pain is referred from hip to buttock - what nerve is involved
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Sciatic nerve
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What is a recommended treatment and goals for management of LCP disease
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- Relief of weight bearing
- Bedrest, traction, spica, slings, frames - Present goals- maintenance of hip motion and containment of involved femoral head from bases for treatment, inital goals are to restore mobility and to reduce pain - Operative and non-operative containment - if femoral head is not covered completely by acetabulum can do pelvic osteotomy and manipulate to get full coverage |
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What is prognosis for patients with LCP disease
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Majority of patients will do well in 5th decade, 50% of untreated patients will develop arthritis by age of 55
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How do patients with OA of the hip usually present
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Groin, buttock, and or thigh and knee pain
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Conservative measures for treatment of OA of hip
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Activities modification
NSAIDS Weight control Tylenol Injections Assistive devices |
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2 types of hip fractures
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Intracapsular
Extracapsular |
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Hip fracture patients typically present with what deformity
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Limb is shortened and externally rotated
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Hip fractures cause pain where
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Usually groin pain , can also have thigh or knee pain - may not be weight bearing, both passive and active motion cause pain
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Which imaging tests do you order when you suspect hip fracture
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AP pelvis
AP hip Shoot through lateral of hip MRI Bone scan |
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4 types of intracapsular hip fractures
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Capital
Subcapital Transcervical Basicervical |
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2 types of extracapsular fractures
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Intertrochanteric
Subtrochanteric |
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Anterior hip dislocations occur as result of _
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Abduction and external rotation forces
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If hip is flexed at the time of injury anterior hip dislocation is _
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Anterior and inferior
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If hip is extended at the time of injury anterior hip dislocation is _
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Anterior pubic
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Posterior dislocations of the hip occur when _
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Longitudinal force is applied in line with femur and acting on adducted hip
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Which posterior dislocation is worse when hip is more abducted or adducted
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When hip abducted - worse dislocation, more adducted - cleaner dislocation
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How do posterior dislocations present
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Will be flexed at the hip, adducted and internally rotated
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How do anterior dislocations present
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Externally rotated with various degrees of flexion and abduction
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How do you treat hip dislocations
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- Emergent reduction
- Closed reduction is attempted first unless there is associated hip or femoral neck fracture (ipsilateral) - Complete paralysis should be obtained prior to attempt reduction |
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Which tests do you order when child presents with limping
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ESR
CBC Metabolic profile |
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Which anatomical cause of cervical region can result in limping
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Cervical instability C1-C2
|
|
Joint diseases of hip that can cause limping
|
- Septic arthritis (toddler-adult)
- Dislocated hip - Developmental dysplasia of hip - LCP disease (AVN of femoral head) - Slipped capital femoral epiphysis - Benign tumors - fibrous dysplasia, unicameral bone cyst - Stress fracture of the hip - Snapping hip - iliotibial band |
|
Joint diseases of knee that cause limping
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- Osteochondritis dissecans - AVN of femoral condyle
- Tumor - benign or malignant |
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What can cause leg length discrepancy
|
- Growth arrest (infection, fracture, burn, JRA)
- Fracture (physeal fracture) - Septic joint - Knee trauma - fracture, ligamentous injury - RA - Discoid meniscus (congenital abnormality of lateral meniscus - prone to tearing) - Osgood Schlatter - Patellar instability (can shear off femoral condyle) - Pathologic fractures - Brodies abscess (infection) |
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Which fractures of the knee are more common in little children vs older children
|
Little children - avulsion fracture, older children - ACL tear
|
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What is Kohler disease
|
AVN of navicular bone
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What is Sever disease
|
Apophysitis of tendo-achilles insertion
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Which problems in feet can cause limping
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- Clubfoot
- Tarsal coalition - Tight shoes - Foreign body |
|
Neurologic causes of limping
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Cerebral palsy (diplegia, hemiplegia)
Spinal cord pathology Tumors |
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In acute hematogenous osteomyeilitis infection begins where
|
Metaphyseal venous sinusoids
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Describe cellulitic phase of acute hematogenous osteomyelitis
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Infection begins in metaphysis and as it spreads metaphyseal vessels thrombose and prohibit inflow of WBC which must slowly migrate there from medullary cavity
- Pus has not been produced yet - At this age antibiotics alone can be sufficient |
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Subperiosteal stage of acute hematogenous osteomyelitis
|
Once pus forms, to lessen interosteal pressure it will exit through porous metaphyseal cortex - this elevates periosteum and forms subperiosteal abscess
|
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How do you diagnose acute hematogenous osteomyelitis
|
- Half of patients have history of recent or concurrent infection
- May refuse to move limb - Tenderness over involved bone - Decreased range of motion over adjacent joints - Swelling, erythema and warmth over bone later |
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In acute hematogenous osteomyelitis ESR and CRP are _ EXCEPT in _
WBC are _ |
ELEVATED (90%)
EXCEPT sickle cell anemia patients, kids on steroid medications, and neonates ELEVATED |
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Organisms causing acute osteomyelitis in neonates
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S aureus
Group B strep Gram negative coliforms |
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Organisms causing acute osteomyelitis in infants and children
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S aureus
|
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Organisms causing acute osteomyelitis in patients with sickle cell anemia
|
Salmonella
|
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Organisms causing acute osteomyelitis in adolescents
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S. aureus, gonorrhea
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In acute osteomyelitis blood cultures are ALWAYS positive - T/F
|
FALSE - in 40-50%
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Are there any x ray changes in acute osteomyelitis
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Little change except soft tissue swelling for 7-10 days
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How is definitive diagnosis of acute osteomyelitis made
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By bone and subperiosteal aspiration
|
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Antibiotics for treatment of acute hematogenous osteomyelitis in neonates
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Oxacillin with cefotaxime or gentamicin
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Antibiotics for treatment of acute hematogenous osteomyelitis in infants and children
|
Oxacillin or Cefazolin
Clindamycin or vancomycin if allergic to penicillin or cephalosporins |
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In neonates why does infection spread fast to joint
Why not in older kids? |
Metaphyseal vessels communicate with epiphyseal in cartilaginous precursor of ossific nucleus permitting a route to spread to joints
As child matures epiphysis develops separate blood supply and there is no longer communication with metaphyseal vessels |
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Which areas are intraarticular in neonates and why is this important
|
Metaphysis of hip, proximal humerus, proximal radius and distal lateral tibia are intraarticular - provide tracks under the capsule into joint
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How does infection affect growth plate in neonates
|
Thrombosis of vessels can cause ischemia of growth plate and infection can cause subsequent lysis of growth plate - complete ischemia and lysis of physis before ossification can lead to necrosis and reabsorption of femoral neck and head
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Why do neonates get infections by microorganisms typically not seen in older children
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Immune system is immature making inflammatory response compromised
|
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Why is detection of osteomyelitis in neonates is often delayed
|
Minimal symptoms - malaise, failure to gain weight, no fever, ESR and WBC can be normal
|
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Long term complications of osteomyelitis in neonates
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Osteonecrosis of epiphyses, joint dislocation and premature physeal arrest
|
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SUBACUTE HEMATOGENOUS OSTEOMYELITIS
Pain _ Fever _ Loss of function _ Prior antibiotic therapy _ Elevated WBC count _ Blood cultures _ + bone cultures _ initial radiographs _ Site _ |
Pain MILD
Fever FEW PATIENTS Loss of function MINIMAL Prior antibiotic therapy OFTEN (30-40%) Elevated WBC count FEW Elevated ESR MAJORITY Blood cultures FEW POSITIVE + Bone cultures POSITIVE IN 60% Initial radiographs FREQUENTLY ABNORMAL Site ANY LOCATION (CAN CROSS PHYSIS) |
|
Assesment of open fractures in children should include _
|
ABC's
Patient disease Size of wound Degree of contamination Crush (myoglobinuria) Bone loss Vascular and nerve injury Degree of periosteal slipping |
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If wound is contaminated with soil or barnyard , which organisms should you suspect
|
Tetanus
Clostridium (gas gangrene) |
|
If wound is contaminated in fresh water ponds which organisms should you suspect
|
Pseudomonas aeruginosa
Aeromonas hydrophilia |
|
Which pathogenic contaminates of the wound are hospital acquired
|
MRSA
Pseudomonas aeruginosa |
|
Which pathogenic contaminates of wound can be received from patient to patient
|
HIV
Hepatitis |
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If patients presents with open wound (fracture) and is not immunized up to date which immunizations should be given
|
Tetanus for clean or minor wounds and tetanus + immunoglobulin for under immunized
|
|
What is a treatment plan for open fractures in pediatric patients
|
Assess and document
Splint fracture Give antibiotics Debridement within 5-6 hours if at all possible Do not close initially Repeat debridement as needed |
|
What is the most important prognostic factor in kids with septic arthritis for outcome and prevention of growth anomalies
|
Duration of symptoms prior to treatment - requires urgent treatment, delay can cause destruction of articular cartilage
|
|
Signs and symptoms of septic arthritis in kids
|
Fever (38-40 C)
Pain Effusion and joint warmth Loss of motion Tenderness In infants - limited spontaneous motion and assymmetric posture of extremity |
|
In septic arthritis in kids WBC are _
|
Elevated in 30-60% of patients with left shift in 60% of those with elevated count
|
|
Which blood test in kids with septic arthritis is more sensitive then others
|
ESR - higher in patients with septic arthritis then in patients with osteomyelitis
|
|
What is differential diagnosis of septic arthritis in kids
|
JRA
Hemarthrosis Cellulitis Osteomyelitis Henoch-Shonlein purpura Rheumatic fever Slipped capital femoral epiphysis Lyme disease Sickle cell crisis Transient synovitis (hip) Crystalline arthropathies (rare in children) LCP disease |
|
What would x rays show in septic arthritis
|
Soft tissue swelling, adjacent bone destruction, joint narrowing (late)
|
|
When assessing for septic arthritis of hip in kid what other things should you consider
|
Appendicitis
Psoas abscess Pelvic osteomyelitis |
|
Aspiration of effusion in septic arthritis will show fluid that is _
|
Cloudy
|
|
Most joint with early treatment in septic arthritis respond well to _
|
Aspiration and antibiotics
|
|
In septic arthritis of the hip there is risk of _ so its best treated with _
|
AVN
Surgical drainage |
|
When should surgery be considered in kids with septic arthritis
|
If aspiration fails once or twice
|
|
When should antibiotic therapy be started in septic arthritis patients
|
After you have all cultures - including joint aspirations
Infants and young children also need LP to look for meningitis |
|
In neonates antibiotics used for treatment of septic arthritis are _
|
Oxacillin + cefotaxime or gentamicin
|
|
In child younger then 4 years old antibiotics used for treatment of septic arthritis are _
|
Oxacillin + cefotaxime or cefuroxime
|
|
In child over 4 years old antibiotic used for treatment of septic arthritis is _
|
OXACILLIN
|
|
In immunocompromised kids antibiotics used for treatment of septic arthritis are -
|
Oxacillin + ceftriaxone
|
|
Initial treatments of nail puncture wounds are _
|
Tetanys prophylaxis
Excision of devascularized skin flaps Irrigation of puncture tract |
|
Should antibiotic coverage for gram positive organisms be given in kids with nail puncture wounds
|
Only if there is evidence of cellulitis or soft tissue infection
|
|
Possible complications of nail puncture wounds
|
Cellulitis
Osteochondritis Osteomyelitis Soft tissue abscess Pyarthrosis (Psedomonas osteomyelitis-osteochondritis 0.6-1.8 %) |
|
Which organism is found in 93% of all nail pucture wounds osteomyelitis
|
Pseudomonas aeruginosa
|
|
Pseudomonas species have propensity for which part of the foot
|
Cartilaginous structures
|
|
What is a treatment for pseudomonas osteochondritis
|
Surgery to careful exploration for foreign bodies, debridement of dead tissue and extensive lavage
7 day treatment of parenteral antibiotics |
|
What are the main steps in treating any infection
|
- Identify organism
- Arrest tissue destructions (antibiotics or surgery if antibiotics cannot reach site) - Use surgery to prevent long term complications (AVN) or chronic joint changes |
|
Adolescent idiopathic scoliosis definition
|
Structural lateral curvature of the spine occuring at or near onset of puberty for which no cause could be determined
|
|
Factors well known to predict curve progression
|
Lesser maturity and larger curve magnitude
|
|
Which curves tend to progress more
|
Over 50 degrees with more rotation
|
|
Which patients with scoliosis are at increased risk of cor pulmonale
|
High angle thoracic curves of more then 100 degrees
|
|
In patients with scoliosis (nonsmokers) significant FVC limitations start to occur _
|
after 100-120 degrees curve
|
|
Which x ray view is taken in patients with scoliosis
|
Standing x ray of spine - requires special grid for entire spine on one grid
If patient has structural leg length discrepancy put block under short limb until iliac crests are at level |
|
What are you looking for on xrays in patients with scoliosis
|
Interpedicular widening
Congenital abnormallities Rib pencilling Skeletal maturity |
|
Typical idiopathic curves in scoliosis
|
Left lumbar and right thoracic
|
|
Juvenile idiopathic scoliosis presents with high incidence of _
|
Neuroaxis abnormalities
|
|
Which imaging test needs to be ordered in patients with juvenile idiopathic scoliosis
|
MRI - over 10 degrees deviation indicates progression
|
|
Diastemotomyelia
|
Boney or fibrous defect that splits spinal cord, as child grows and spine elongates traction occurs on the cord - can cause neuromuscular scoliosis
|
|
Diplomyelia
|
Split cord - can cause neuromuscular scoliosis
|
|
Tethered cord
|
Traction on end of cord - thickened filum terminale, lipoma
|
|
Myelomeningocele
|
Neural tube defect - can cause neuromuscular scoliosis
|
|
Hydrosyrinx
|
Expansion of spinal cord with CSF, scoliosis improves and sometimes resolves when hydrosyrinx is treated
|
|
Lower motor neuron diseases that can cause neuromuscular scoliosis
|
Polio
SMA Dysautonomia |
|
Myopathic causes of neuromuscular scoliosis
|
Muscular dystrophies
Arthrogryposis |
|
Patient with congenital scoliosis should also be evaluated for _
|
Heart problems
GU - need renal evaluation Spinal cord Klippel feil syndrome |
|
Congenital scoliosis treatment
|
- Bracing - only for compensatory curves
- Hemiepiphyseodesis (under 7 years old) - Fusion - fuse early |
|
Which infection is responsible for torticollis
|
Retropharyngeal abscess - erodes alar ligaments that connect C1 and C2 and you get cervical instability - need fusion
|
|
Congenital muscular torticollis
|
Head side bent and rotated - contracted SCM, packaging defect
|
|
What else do you need to check in kids with congenital muscular torticollis
|
HIPS
|
|
What is Klippel Feil syndrome
|
Congenital cervical spine fusions
|
|
Possible etiology of Klippel Feil syndrome
|
Homox gene
|
|
Problems associated with Klippel Feil
|
Sprengel's
Deafness GU anomalies - get renal ultrasound Synkinesis (mirror movements) Pulmonary problems Congenital heart disease Spinal cord Other congenital problems (syringomyelia, neuroschisis, etc) |
|
Sprengel deformity
|
Check shoulder height - retract shoulders
Scapula starts forming along cervical vertebrae, migrates distally with the limb, fibrous tether, shortening of the muscle |
|
Which orthopedic problems are common in patients with Down Syndrome
|
Ligamentous laxity
C1-C2 instability Occipital cervical instability |
|
Which diseases are associated with cervical kyphosis
|
Diastrophic dysplasia
Larson syndrome - multiple joint dislocations, foot deformities, etx |
|
Spondylolysis and spondylolisthesis in kids
|
Defect of posterior elements with fracture or slippage, not always painful
|
|
Treatments for spondylolysis and spondylolisthesis in kids
|
Activity limitations
Bracing if recent Surgery if recalcitrant symptoms |
|
Scheuermann disease (definition, common site, x ray findings)
|
Inflammation of growth plates of vertebral bodies
- increased thoracic kyphosis In thoracolumbar kyphosis + pain, in lumbar no deformity + pain X rays- Cobb angle >45 degrees, wedging of 5 consecutive vertebrae |
|
Discitis
|
Inflammatory lesion of interverebral disc, narrowing disk space, self limiting inflammation, disc space infections (S. aureus)
|
|
Differential diagnosis for back pain in children
|
Trauma - compression fx, physeal fx
Vertebral infection - S.aureus, TB Muscle spasm Psoas abscess Tumor |
|
Diagnosis of DDH includes _
|
Typical neonatal hip dislocation
Hip instability Late presentation hip dislocation Teratologic hip dislocation Acetabular dysplasia |
|
Which DDH is hardest to identify
|
Bilateral
|
|
DDH is more prevalent in _
|
girls
|
|
Etiology of DDH
|
Remains uncertain
Possible causes: Position in utero - very important Hereditary Postnatal positioning Intrinsic dysplasia vs ligamentous laxity |
|
Periods at risk for DDH
|
Impossible before 12th week of gestation
Muscles are formed by 18 weeks Last 4 weeks from positioning Early postnatal period |
|
What is most common position in utero that causes DDH
|
Single breech + genu recurvatum (butt first + hyperextended knees)
|
|
What are risk factors for packaging defects
|
Women
Large babies First pregnancy |
|
Effect of post natal positioning on DDH
|
Increased with swaddling
More frequent during winter and spring Hip can dislocate with forced positioning |
|
Which tests should be included in newborn exam to test for DDH
|
Ortolani
Barlow |
|
What is necessary requirement for correct performance of Barlow and Ortolani tests
|
Baby need to be completely relaxed (this includes crying)
|
|
How do you diagnose DDH in older child
|
- Limited abduction
- Galeazzi sign - looks at femoral lengths - Leg length discrepancy - Asymmetric skin folds - Increased lumbar lordosis - muscles of hip are contracted and pulling which increases lordosis in order to stay straight |
|
X ray findings in patients with DDH
|
Acetabular dysplasia
Shallow acetabulum Absent ossific nucleus Femoral head displaced laterally |
|
Pavlik harness is treatment for _
|
Hip instability
|
|
Treatment of DDH in older children
|
- Reduce hip
- Avoid AVN by excessive pressure - Casting and surgery depend on age |
|
Do children with DDH need regular follow up
|
X rays until child is walking - then once a year, recheck in adolescence for late subluxation
|
|
Which pediatric hip condition is an orthopedic emergency
|
Slipped Capital Femoral Epiphysis
|
|
What is common age group for SCFE
|
12-15 year old
|
|
Patient with SCFE commonly presents with _ pain
|
KNEE
|
|
Risk factors for SCFE
|
Overweight
Endocrinopathies - especially hypothyroidism Delayed skeletal maturation |
|
Triad of symptoms for SCFE
|
Knee pain
Limping External rotation of the extremity |
|
Untreated SCFE leads to _
|
Progressive slippage and early arthritis - onset of OA directly depends on degree of slippage
|
|
Which treatment is reliable in patients with SCFE
|
Early treatment with screw fixation (EARLY DIAGNOSIS IMPORTANT !!!!!!!)
|
|
If the slip in SCFE becomes unstable what complication is likely
|
AVN
|
|
In patients with _ due to ligamentous laxity and collagen problems slipped capital femoral epiphysis can persist even after treatment
|
DOWN SYNDROME
|
|
Age group for children with LCP disease
|
3-9
|
|
In LCP disease pain is at _
|
hip
|
|
When LCP disease is bilateral you need to consider _
|
Hypothyroidism or skeletal dysplasia
|
|
LCP disease =
|
AVN of femoral head
|
|
Which processes occur in bone in LCP disease
|
Collapse and fragmentation
|
|
Children with LCP disease aged 6-9 statistically benefit from _
|
Surgery to redirect femoral head into acetabulum
|
|
Best outcome of treatment in LCP disease occurs in children
|
Younger then 6 at time of onset
|
|
Which treatments are used to preserve motion and reduce symptoms in LCP disease
|
Bracing, casting, traction and bed rest
|
|
What are consequences of leg length discrepancy
|
Increased energy expenditure of gait
Functional scoliosis (insignificant) Pelvic obliquity causing increased center-edge angle of hip of long leg |
|
Neurologically intact children with leg length discrepancy will compensate by _
|
toe walking
|
|
Which conditions should you beware of when diagnosing leg length discrepancy
|
Wilms tumor
Hemihypertrophy (look at size of hands and face) |
|
Name things that can cause functional leg length discrepancy
|
Flexion contractures of hip or knee
Abduction or adduction contractures of hip Pelvic torsion |
|
Treatment of leg length discrepancy of 0-2 cm
|
No treatment necessary
|
|
Treatment of leg length discrepancy of 2-6 cm
|
Shoe lift, epiphysiodesis, shortening or leg lengthening
|
|
Treatment of leg length discrepancy of 6-20 cm
|
Lengthening (possible combined with other procedures)
|
|
Treatment of leg length discrepancy of over 20 cm
|
Prosthetic lifting
|
|
Which imaging test is used to assess leg length discrepancy
|
Scanogram - x ray with ruler to measure lenght of long bones
|
|
When adolescent patient presents with knee pain what are the things you should be concerned about
|
HIP PATHOLOGY - especially slipped capital femoral epiphysis
Physeal fractures Tumors - night pain is very concerning |
|
Patellofemoral syndrome is also called _
|
patellar chondromalacia
|
|
Patellofemoral syndrome is most common in _
|
Adolescent girls
|
|
In patellofemoral syndrome pain is localized to _
|
anterior knee
|
|
In patellofemoral syndrome patient experiences locking and feeling of knee giving way - T/F
|
FALSE - no locking and giving way
|
|
In patients with patellofemoral syndrome pain gets worse with _
|
Stairs, walking hills and weather changes
|
|
Which test is positive in patellofemoral syndrome
|
Patellar grinding test
|
|
In patellofemoral syndrome you need to strengthen _ and stretch _ (muscles)
|
Strengthen quads
Stretch hamstrings |
|
Which exercises are best in patients with patellofemoral syndrome
|
Exercises with knee in nearly full extension - shallow squats, terminal extension weights, bike riding with seat fairly high
|
|
What are recommendations for patients with patellofemoral syndrome
|
Avoid deep knee bends and stairs
Decrease force across patella NSAIDS for symptoms |
|
Osgood Schlatters disease is a childhood equivalent of _
|
Patellar tendonitis
|
|
Describe Osgood Schlatters disease
|
In growing adolescents proximal tibial apophysis is weak and susceptible to overuse injuries - microfractures with elevation of tubercle and bursitis
|
|
Treatments for Osgood Schlatters
|
-Decrease activity during periods of severe pain
- Severe pain improves with rest - Ice knees after vigorous activity - Hamstring stretching - NSAIDS periodically |
|
Patients with Osgood Schlatters have slight predisposition toward
|
Tibial tubercle fractures
|
|
Why can small avulsions occur in Osgood Schlatters
|
Quadriceps pulls on tibial apophysis
|
|
Osgood Schlatters is most common in _
|
11-14 year old boys
|
|
Triad of symptoms for diagnosis of patellar subluxation
|
Hurts anteriorly
Gives way Positive apprehension test |
|
Osteochondritis dessicans is AVN of _
|
Medial femoral condyle
|
|
Osteochondritis dessicans can lead to _
|
Osteochondral fractures
Chondral flaps Chondral separation Loose joint bodies |
|
Common cause for meniscal surgery in children
|
Discoid lateral meniscus
|
|
With discoid lateral meniscus patients experiences
|
Snapping in lateral aspect of knee and occassional blocking of extension
|
|
Children are more likely to have _ then ligamentous injuries
|
Physeal injuries
|
|
When patient presents with bowed legs always keep in mind _
|
Dwarfism and metabolic disorders
|
|
Tibia vara is also called _
Treatment - Diagnosis - |
Blounts disease
Treatment - surgery and bracing Diagnosis - x rays |
|
Difference between tibia vara and physiological genu varum
|
Genu varum is normal, tibia vara only gets worse and leads to early DJD
|
|
Patient present with pain out of proportion to injury and pain on passive stretch, it is a surgical emergency - what is the diagnosis
|
COMPARTMENT SYNDROME
|
|
If child isnt walking independently by 24 months what do you need to do
|
Refer for evaluation of significant developmental delay to orthopedic surgeon or neurologist
|
|
Child should be able to do reciprocal crawling by what age?
|
6-9 months
|
|
If primitive reflexes persist in child what can it indicate
|
Cerebral palsy
|
|
Hand grasp reflex tests _
Extuinguishes by_ |
Tone of upper extremity flexors
2-4 months |
|
Plantar grasp reflex - describe
Extuinguishes by _ If persists indicate _ |
Tonic flexion and adduction of toes when stroked on bottom of foot
Extuinguishes by end of 1st year If persists - developmental delay, birth injury |
|
In Moro reflex baby _ when startled
|
Extends all 4 extremities
|
|
Persistence of Moro reflex after 6 months indicates _
|
Cerebral palsy
|
|
Moro reflex is decreased or absent in _
|
Floppy baby syndrome
|
|
Asymetry of Moro reflex indicates _
|
Peripheral nerve injury or cerebral palsy
|
|
Stepping reflex in baby should disappear by _
|
1-2 months
|
|
Placing reaction (baby lift foot and steps when brought to edge) persists until _ and its absence indicates _
|
12 months
Brain damage |
|
In crossed extension reflex pressure is applied to _ and opposite leg _ and toes _
|
Inguinal area
Flexes, adducts, extends Fan |
|
Crossed extension reflex should disappear by _ and if it persists it indicates _
|
1 month
partial spinal lesion |
|
In asymmetric tonic neck reflex, baby is lying on the side and head is rotated to the side , arm and leg on chin side should _ , and on occiput side should _
|
Extend
Flex |
|
Asymmetric tonic neck reflex should persist until _ and if it persists after that indicates _
|
4-6 months
Cerebral palsy - contributes to neuromuscular scoliosis in those kids |
|
Which reflex appears at 6 months and persists throughout life and its absence indicates brain damage
|
Parachute reaction - when held at stomach extends arms as if to break fall (diminished response indicates hypertonicity in upper extremities)
|
|
In plain films in kids _ and _ is not visible
|
Non ossified bone and cartilage
|
|
Characteristics of toddlers gait
|
- Wide base
- Little arm swing - Short stride length - Higher center of gravity - Little ground clearance - Mild foot drop |
|
Center of gravity in gait of adult is _
|
Anterior to S2
|
|
Requirements of gait
|
Stability in stance
Clearance in swing phase Appropriate swing phase repositioning Adequate step length Conservation of energy |
|
Toeing out during walking can indicate _
|
External hip rotation
External tibial torsion Calcaneovalgus Vertical talus Pes planus |
|
Toeing in during walking can indicate
|
- Internal femoral torsion
- Internal tibia toria - Metatarsus adductus - Equinovarus deformities |
|
Multiple epiphyseal dysplasia presents with progressive _ deformity, DJD, pain and altered mechanical axis
|
VALGUS
|
|
Differential diagnosis for valgus
|
- Post traumatic/post infection partial growth arrest
- Salter II fracture of proximal tibia - fibular hemimela - Genu recurvatum - Physiological genu valgum in adolescents |
|
Achondroplasia causes varus/valgus deformity
|
VARUS
|
|
Differential diagnosis for varus
|
- Blounts disease
- Skeletal dysplasia - Fibrocartilaginous dysplasia - Fibrous cortical tether of distal femur - Rickets - Post traumatic/post infection partial growth arrest - Combination of external femoral rotation and internal tibial torsion - Tibial bowing |
|
In positive Trendelenburg test which muscle is weak
|
Gluteus medius
|
|
What happens to knee when patient has weak quadriceps femoris
|
It locks
|
|
During walking patient is unable to push off with toes which results in calcaneus gait and tibia shifts posteriorly over talus in last portion of stance phase - which muscle is weak in this patient
|
Gastrocnemius - soleus
|
|
Patient has steppage gait to clear foot through swing phase, patients externally rotates foot and lifts foot higher - which muscles are weak
|
Dorsiflexors of the foot
|
|
Patients weightbearing is shortened during stance on affected side to relieve or lessen pain - this gait is called _
|
Antalgic
|
|
Most common form of polydactyly
|
Small nubbin on lateral border of foot (postaxial), may have a nail
|
|
What treatment is indicated in polydactyly
|
Surgical to ensure comfortable foot wear
|
|
Syndactyly is caused by _
|
Failure of programmed cell death
|
|
Syndactyly usually occurs _ where
|
Between 3d and 4th toes - skin only, partial webbing
|
|
Surgical intervention is medically necessary in syndactyly
|
no, cosmetic - shoe fit generally not a problem
|
|
4 types of syndactyly
|
Complete - webbing entire length of digit
Incomplete - webbing partial length of digit Simple - soft tissue union Complex - boney union |
|
In metatarus varus (adductus) medial border of the foot curves _
|
Inward
|
|
With any packaging defect you should also check _
|
hips
|
|
Etiology of clubfoot deformity
|
Idiopathic
Packaging defect Arthrogryposis Myelodisplasia Hereditary |
|
With clubfoot deformity you also check _ and _
|
Hips for dysplasia or instability
Spine for sacral cleft, dimples and hairy patches |
|
Signs of clubfoot
|
- Adductus of forefoot
- Varus of hindfoot - Posterior and medial creases - Supination of mid and forefoot - Empty heel pad |
|
Vertical talus is also known as _
|
Rockerbottom foot - rigid foot, cannot plantarflex, can palpate head of talus on plantar foot
|
|
Cleft foot is caused by _
|
Central failure of formation
|
|
Goal of treatment of cleft foot is _
|
Comfortable shoe wear
|
|
Flat foot is called
|
Pes planus
|
|
Which arch is flattened in pes planus - what else is abnormal
|
Longitudinal
Hindfoot valgus Subluxation of talonavicular joint |
|
Which type of pes planus is painful and should be refered to orthopedic surgeon
|
Rigid
|
|
3 types of tarsal coalitions
|
Syndostosis - bone coalition
Synchondrosis - cartilage coalition Syndesmosis - fibrous coalition |
|
Increased height of longitudinal arch is called _
|
Cavus/cavovarus
|
|
X rays are high/low energy
|
HIGH - only gamma rays are higher
|
|
X rays are measured in _
|
Roentgens
|
|
Radiopacity is dependent on 3 factors - what are they
|
Atomic number
Physical density Thickness |
|
With any packaging defect you should also check _
|
hips
|
|
Etiology of clubfoot deformity
|
Idiopathic
Packaging defect Arthrogryposis Myelodisplasia Hereditary |
|
With clubfoot deformity you also check _ and _
|
Hips for dysplasia or instability
Spine for sacral cleft, dimples and hairy patches |
|
Signs of clubfoot
|
- Adductus of forefoot
- Varus of hindfoot - Posterior and medial creases - Supination of mid and forefoot - Empty heel pad |
|
Vertical talus is also known as _
|
Rockerbottom foot - rigid foot, cannot plantarflex, can palpate head of talus on plantar foot
|
|
Cleft foot is caused by _
|
Central failure of formation
|
|
Goal of treatment of cleft foot is _
|
Comfortable shoe wear
|
|
Flat foot is called
|
Pes planus
|
|
Which arch is flattened in pes planus - what else is abnormal
|
Longitudinal
Hindfoot valgus Subluxation of talonavicular joint |
|
Which type of pes planus is painful and should be refered to orthopedic surgeon
|
Rigid
|
|
3 types of tarsal coalitions
|
Syndostosis - bone coalition
Synchondrosis - cartilage coalition Syndesmosis - fibrous coalition |
|
Increased height of longitudinal arch is called _
|
Cavus/cavovarus
|
|
X rays are high/low energy
|
HIGH - only gamma rays are higher
|
|
X rays are measured in _
|
Roentgens
|
|
Radiopacity is dependent on 3 factors - what are they
|
Atomic number
Physical density Thickness |
|
Higher atomic number more/less radiopaque?
|
More radiopaque
|
|
Air less dense so it appears _
|
Black - radioluscent
|
|
Fluid and soft tissue is more dense so it appears _
|
Grey/radiopaque
|
|
Thicker substance is more/less radiopque
|
More radiopaque
|
|
When two tissues/objects overlap, how do they appear on film
|
Additive - appear more white
|
|
Which tissues have same radiopacity
|
Soft tissue and fluid
|
|
Fat is more lucent then _ but more opaque then _
|
Bone/soft tissue
Gas |
|
Most radioluscent material visible on film
|
GAS
|
|
Most opaque shadow seen on radiographs
|
Metal
|
|
In x ray machine there is electrode pair - cathode and anode, cathode is _ , anode is _
|
Cathode - heated element
Anode - tungsten plate or beam |
|
How x ray works - free electrons from _ collide with _ - knocking an electron out of _ . A _ fills gap releasing energy as x ray photon.
|
Heated cathode
Tungsten atom Lower orbit Higher orbit electron |
|
95% of electron energy is deposited as _ , 5 % generates _
|
Heat on anode
x rays |
|
1 gray equals _
|
100 rads
|
|
How do you protect from radiation
|
Reduce time of exposure
Increase distance from radiation source Provide radiation shielding |
|
Where should you view radiographs
|
Darkened quiet room with at least two viewing boxes and good illuminator
|
|
You always need two orthogonal projections when viewing x rays - T/F
|
TRUE
|
|
Radiographic views are named according to _
|
Direction primary beam enters and leaves tissues and body part being examined
|
|
Digital radiography uses _
|
photostimulable phosphor plate and image reader-writer
|
|
Computed tomography is _ rotated around patient
|
Fanned x ray beam
|
|
Compute tomography uses _ to display as image
|
Mathematical measurements of transmissions at various angles
|
|
How does ultrasound work
|
Sound waves are sent through patient and returning echo is recorded as image
|
|
Resolution of images in ultrasound depends on _
|
Wavelength and frequency of waves
|
|
Low frequency ultrasound has _ wavelength, _ resolution, _ depth of penetration
|
Longer
Less Greater |
|
High frequency ultrasound has _ wavelength, _ image detail and superior for _
|
shorter
greater orthopedic views of ligaments and tendons |
|
What is the origin of signal used in generation of MRI images
|
Proton (hydrogen nucleus)
|
|
What is the feature exploited in detecting NMR signal in MRI
|
Magnetic moment (spin) of H nucleus when placed in strong external magnetic field
|
|
In MRI response of excited proton is measured when _
|
Second (RF) signal is applied to small slice of scan
|
|
T1 MRI image measures energy released as _
|
Proton exposed to RF signal realigns to magnetic orientation
|
|
T2 MRI image measures energy transmitted by _
|
Wobbling effect of protons that have been exposed to RF signal (they are out of phase and release energy as they become in phase)
|
|
Every tissue has same T1 and T2 property on MRI - T/F
|
FALSE - every tissue has unique T1 and T2 property (can have same T1 but different T2, or same T2 but different T1)
|
|
Normal and strained muscle have same appearance on _ , but different on _ (T1, T2)
|
Same T1
Different T2 |
|
Fat and muscle have same appearance on _, but different on _ (T1, T2)
|
Same T2
Different T1 |
|
When radioisotope localizes in skeleton, _ is measured and recorded
|
Gamma radiation
|
|
First isotope used clinically for bone scannin
|
Strontium 85
|
|
Which isotope has shorter half life then Strontium 85 but poor soft tissue clearance
|
Strontium 87
|
|
Which isotope has short half life (excreted in urine after 4 hours) and binds to _ in bone
|
Technetium - binds to Ca in bone
|
|
Which isotope used to tag WBC's
|
Indium
|
|
Which isotope impregnates into Ca hydroxyapatite crystals uptake in neutrophils and bacteria
|
Gallium 67
|
|
Which isotope doesnt require in vivo use
|
IgG labeled
|
|
Factors affecting uptake of isotopes
|
Bone turn over rate
Blood flow to area Trauma Time isotope is in system |
|
Example of metabolic imaging is _
|
PET scan
|
|
PET scan is best to use for detection of _
|
Soft tissue neoplasms or osseous metastases
|
|
What is the name of tracer used in PET scans
|
2-deoxy-2-fluoro-D-glucose
|
|
What does PET scan measure
|
Glucose utilization by tissue
|
|
PET scans can be combined with _ for precise imaging
|
CT scans
|
|
DEXA scan stands for _
|
Dual energy x ray absorption
|
|
DEXA scan measures absorption of _ and compares to _
|
2 beams of radiation into hip and spine
standard |
|
DEXA scan calculates _ and uses them to identify if patient has _
|
T scores
Osteopenia or osteoporosis |
|
If you need cross sectional capability which imaging modality would you choose
|
CT scan
|
|
For early detection of fracture or infection and degree of involvement, imaging modality that you would choose would be _
|
Bone scan
|
|
For identification of bone contusions, articular cartilages, relationships of neurovascular structures to other anatomy which imaging modality would you choose
|
MRI
|
|
For identification of fluid filled tissue and vascular supply imaging modality of choice is _
|
Ultrasound
|
|
What is the best therapy of ankle sprain
|
PT with emphasis on proprioceptive training
|
|
How do you diagnose Achilles tendon rupture
|
Local tenderness/swelling
Palpable defect MRI/ultrasound Inability to plantar flex foot |
|
Thompson test detects _
|
Achilles tendon rupture
|
|
Describe Thompson test
|
When you squeeze calf - foot will normally plantar flex - in Achilles tendon rupture that doesnt happen
|
|
With medial gastrocnemius/plantaris muscle tear pain is more _
|
proximal, mid to upper medial calf
|
|
Will Thompson test be negative in plantaris muscle tear as well
|
NO - positive - squeeze calf and foot plantar flexes
|
|
Which orthopedic condition of foot is most underdiagnosed and unrecognized
|
Posterior tibial tendon insufficiency = "acquired flatfoot"
|
|
"Too many toes" sign is sign of _
|
Posterior tibial tendon insufficiency
|
|
Patient presents with pain in medial malleolus, unable to stand on toes Diagnosis?
|
Posterior tibial tendon insufficiency
|
|
Patient complains of morning pain in foot (1st few steps extremely painful) - what should you immediately consider
|
Plantar fasciitis
|
|
What is main treatment of plantar fasciitis
|
Participation to tolerance
|
|
Jones fracture is a fracture of _
|
Base of 5th metatarsal - at metaphyseal-diaphyseal junction
|
|
Acute Jones fracture shows _ on x ray
|
sharp margins
|
|
Non unions are very common with Jones fracture - T/F
|
TRUE
|
|
Patient presents with compression, pain between fingers - what should you immediately be considering
|
Mortons neuroma
|
|
What is key distinction of claw toes
|
Marked hyperextension of MTP joints
|
|
Knee swelling within 4-6 hours of injury indicates _
|
Hemarthrosis
|
|
Fat globules in the blood on aspiration indicate _
|
Fracture
|
|
If aspirate has cloudy appearance you should think about _
|
Infection
|
|
String sign means _
|
Viscosity of aspirate - indicates infections
|
|
Patient presents with knee effusion with joint pain, warmth, erythema and swelling, what should be you first suspicion
|
Infection
|
|
What is the location for aspiration of the knee
|
Superior lateral pole of patella
|
|
Patient presents with pain, snapping, swelling, stiffness, decreased ROM, feeling of instability and locking of the knee- diagnosis
|
Torn meniscus
|
|
Patient presents with acute meniscal tear - what is the probable mechanism of injury
|
Twisting injury with foot planted
|
|
Which symptom is not present in chronic meniscal tear
|
Knee locking
|
|
You examine patient with torn meniscus - what would you find
|
Pain at joint line
Positive McMurrays test Popping or catching of knee Knee locking Swelling and stiffness |
|
Differential diagnosis for meniscal tear
|
Ligamentous injury
Loose bodies Osteochondritis dissecans |
|
How would you treat torn meniscus
|
Arthrotomy
PT Meds |
|
Patient presents with post traumatic pain and swelling, knee feels unstable and there is immediate effusion - what does this patient have?
|
ACL rupture
|
|
Over 70% of patients presenting with immediate effusion have _
|
ACL rupture
|
|
Patient presents with ACL tear - what is possible mechanism of injury
|
Hyperextension or deceleration injury
|
|
Patient presents with chronic knee instability after old injury - what should you be thinking
|
ACL with posterior medial meniscal horn tear
|
|
Which test is most sensitive for ACL tear
|
LACHMANS
|
|
You suspect patient has ACL rupture what test would you do ?
|
Anterior drawer test
Pivot shift test Lachmanns test |
|
Differential diagnosis for ACL tear
|
PCL, MCL, meniscal injury or combination
|
|
Which procedure usually fail in treatment of ACL rupture
|
Primary repair
|
|
Which surgical procedures are used in treatment of ACL tear
|
Grafts (auto/allografts)
Radiofrequency heat Simple debridement |
|
Patient presents with PCL tear - what is probable mechanisms of injury
|
High energy trauma - dashboard, posterior force on anterior tibia
|
|
Patient presents with palpable deformity of the knee and the knee is flexed - what is possible diagnosis
|
Patellar dislocation
|
|
Over 90% of patellar dislocations occur _
|
Laterally
|
|
You evaluate patient for patellar dislocation - which test is positive?
|
Apprehension
|
|
Patient has patellar dislocation what is your treatment plan
|
Reduction
Immobilization Braces Arthroscopic procedure Open procedures (realignment) |
|
Patient presents with pain around knee cap,no history of injury, crepitance and increased pain when going up the stairs - what is most likely diagnosis
|
Patellofemoral syndrome (chondromalacia)
|
|
You examine patient with patellofemoral syndrome - which tests would you perform
|
Patellofemoral grind test
Clarks test - compression of patella with contraction of quads Lateral J sign - lateral movement of patella in extension above trochlear groove |
|
Differential diagnosis of patellofemoral syndrome
|
Patellar malalignment
Osteoarthritis Osteochondritis dissecans Plica syndrome |
|
Patient presents with patellofemoral syndrome - what are surgical options of treatment
|
Chondroplasty
Lateral release Open realignment Patellectomy |
|
Patient presents with painful and swollen prepatellar bursa and increased temperature - diagnosis?
|
Prepatellar bursitis
|
|
Patient presents with collateral ligament tear - what do you find on exam
|
Pain
Instability Effusion Locking |
|
You evaluate patient for collateral ligament damage and see calcifications on x rays due to old MCL tear - what is your diagnosis
|
Pellegrini-Stieda disease
|
|
What is differential diagnosis for collateral ligament rupture
|
ACL rupture
Meniscal injury Tibial plateau fracture |
|
Patient presents with pain and swelling, popping and locking of the knee - further tests find necrosis of subchondral bone - diagnosis
|
Osteochondritis dissecans
|
|
Which x ray do you order in evaluating patient with osteochondritis dissecans and what would you commonly see
|
Tunnel view - lesion on lateral aspect of medial femoral condyle
|
|
Differential diagnosis for osteochondritis dissecans
|
ACL rupture
Meniscal injury |
|
Most common cause of loose bodies in the knee
|
Osteochondritis dissecans
|
|
The conservative treatment of osteochondritis dissecans would include
|
long leg casting
|
|
What are the surgical treatments of osteochondritis dissecans
|
In situ pinning
Debridement OATES Drilling/microfracture Removal of free fragment Autologous cartilage transfer |
|
What is the best surgical procedure for treatment of osteochondritis dissecans
|
OATES - take pieces of HA and implant
|
|
Patient presents with knee pain and states that it only hurts with weight bearing and doesnt with rest, he also has deformity, decreased ROM, swelling and crepitance/catching of the knee - most likely diagnosis is _
|
OA of the knee
|
|
Most common location of OA of knee is _
|
Medial femoral condyle
|
|
You order weight bearing x ray on patient with OA of knee - what would you see
|
Density changes on xray - sclerotic bone due to OA, medial femoral condyle space is collapsed, lateral widened
|
|
Differential dx for OA of knee
|
Torn meniscus
Hip pathology Chondromalacia |
|
Conservative treatment of OA of knee would include
|
PT
Meds Injections Assistive devices |
|
Surgical options for treatment of OA of knee
|
High tibial osteotomy
Unicompartmental knee replacement Total knee replacement |
|
Sport with highest percent of reportable and high severity injuries
|
Female gymnastics
|
|
Most common site of injuries in sports in both men and women
|
Knee and ankle
|
|
Patient is taking a banned drug which was banned because it causes liver damage, it significantly increases androgenic plasma serum levels, however patient reports increased psychological and physical well being, you advise patient that drug increases risk of uterine and prostate cancer and also can cause hirsutism, gynecomastia, liver disease and virilization
What is the name of the drug patient is taking |
DHEA
DEHYDROEPIANDROSTERONE |
|
Patient is taking a banned drug, his endogenous testosterone is increased (300 mg/day) - what is the name of drug he is taking
|
Androstendione
|
|
Patient is taking banned drug, he reports increase in muscle mass and delay in fatigue - name of drug and mechanism of action
|
CREATINE - increases formation of ATP
|
|
Patient is taking a nutritional supplement that is banned in sports - he reports increased muscle mass and increased rate of recovery after strenuous exercise -what is the name of supplement and what is is a metabolite of
|
Beta-hydroxy or beta-methylbutyrate - metabolite of leucine
|
|
Human growth hormone is restricted in sports because it _
|
Increases type II fast acting muscle fibers and decreases fat
|
|
Which drugs are restricted in sports
|
Diuretics
beta blockers Human growth hormone |
|
Why is EPO banned in sports
|
Increases RBC mass (natural hormone produced by kidney)
|
|
Men have higher RBC counts - T?F
|
T
|
|
Women have significantly higher rates of injury of _
|
Knee (ACL, collateral ligament, meniscus)
|
|
Stress fractures are more common in men/women?
|
Women - poor nutrition,menstrual irregularities
|
|
Your female patient is young athlete, she refuses to maintain normal weight, has intense fear of weight gain, disturbed body image and 3 consecutive months of amenorrhea - diagnosis
|
Anorexia nervosa
|
|
Patient has anorexia nervosa - what would you find on exam
|
Amenorrhea
Fat and muscle loss Dry hair and skin Lanugo Cold discolored extremities Decreased body temp Dizziness Bradycardia |
|
Young female athlete presents with complain of recurrent binge eating, over eating and sense of loss of control, she has recurrent compensatory vomitting and abuses laxatives, she also engages in fasting and over exercise and has negative self image - diagnosis?
|
Bulimia nervosa
|
|
Female athlete triad
|
Amenorrhea
Eating disorder Osteoporosis |
|
Pregnant patient asks you if she can continue exercising with pregnancy You give following advice
maternal heart rate should not exceed _ , strenuous activities should not exceed _ minutes, she should avoid _ maneuver and _ exercise after 4th month, she needs to increase _ and maternal core temp should not exceed _ |
140 beats per min
15 min valsalva supine caloric intake 38 degrees C |
|
In young athletes under 12 which shoulder injuries are more common
|
Fractures (dislocations are rare)
|
|
Little league shoulder is stress reaction to _
|
Proximal humeral epiphysis (widening and microfracture)
|
|
Microinstability in pediatric shoulder leads to _
|
Labral tears
|
|
Little league elbow includes _
|
Medial epicondylar apophysitis
Lateral joint compression OCD of capitulum Ulnohumeral chondromalacia |
|
Madelungs deformity is _
|
Shortened and deformed distal radius
|
|
Pediatric wrist injuries in sports are common among
|
Weight lifters and gymnasts
|
|
47% of all low back pain in young athlete is due to _
|
Spondylolysis
|
|
Spondylolysis occurs due to excessive repetitive _
|
hyperextension
|
|
Young athlete presents with snapping pain in hip with external rotation - what are the possible causes of his condition
|
Tight iliopsoas, bursitis, inflammation
|
|
Young athlete presents with painful snapping at greater trochanter - diagnosis
|
Snapping iliotibial band
|
|
Young athlete presents with posterior heel pain - differential diagnosis?
|
Severs apophysitis
Achilles tendonitis Plantar fasciitis |
|
AVN of navicular bone is called _
|
Kohlers disease
|
|
AVN of 2nd metatarsal head is called _
|
Friebergs disease
|
|
Patient presents with acute onset of muscle soreness which occured during unaccustomed exercise, its accompanied by weakness and easy fatiguebility - diagnosis and probable location
|
Muscle strain - muscle tendon junctions
|
|
Treatment of muscle strains
|
RICE + NSAIDS
|
|
Patient complains of pain in lower leg that is brought by exercise and relieved with rest - what is diagnosis, why occurs and possible complication
|
Chronic exertional compartment syndrome - fascia does not accomodate increased swelling and blood flow, can progress to typical compartment syndrome (watch for 6 P)
|
|
In tendon overuse injuries type _ collagen is replaced by type _
|
Type I by type II
|
|
Physical therapy modalities that both use cortisone cream and bring into tissue by electrical stim or sound waves
|
Iontophoresis
Phonophoresis |
|
Patient presents with loss of consciousness after trauma on field, he also experiences retrograde amnesia, tinnitis, blurred vision. He has headache and has trouble concentrating. He complains of nausea, vomitting, disturbed balance, excessive sleep and depression- diagnosis
|
CONCUSSION
|
|
In concussion _ is disrupted which causes stretching of _ . This results in opening of _ channels. Extracellular increase of _ leads to release of _ amino acids which leads to influx of _ to cell which causes neuron injury and death - cerebral blood flow _
|
Neuronal cell membrane
Axons Potassium Potassium Excitatory Ca Decreases |
|
Football player presents 2 days post concussion with headache, slower reflexes, impaired memory and concentration, depression and excessive sleep - diagnosis
|
Post concussion syndrome
|
|
Post concussion syndrome is caused by _
|
Continued NT dysfunctions
|
|
Patient is an athlete who has sustained initial head injury, returned to play while still symptomatic and sustained second head injury.Second head injury resulted in loss of cerebral autoregulation, cerebral vascular congestion, increased intracranial pressure and brain herniation - diagnosis
|
Second impact syndrome
|
|
Patient presents after trauma - he didnt lose conscioussnes and had post traumatic amnesia for less then 30 minutes - he has concussion grade _
When can he return to play |
I
Can return if asymptomatic for one week (if completely asymptomatic can return same day) |
|
Patient sustained trauma, lost consciousness for less then 5 minutes and had post traumatic amnesia for more then 30 minutes, he has concussion grade _
When can he return to play |
II
Can return to play when asymptomatic for one week |
|
Patient has sustained trauma during play, he was unconscious for more then 5 minutes and had post traumatic amnesia for more then 24 hours. He has concussion grade _
When can he return to play |
III
He may not return to play for at least one month - can return then if asymptomatic for one week |
|
Mildest form of heat injury
|
Heat cramps
|
|
Patient presents with painful muscle cramps and spasms that occured after intense exercise in high heat, he has mild fever (less then 102) - diagnosis and how would you manage it
|
Heat cramps - move to cold place and rest, fan patient, give cool sports drinks and stretch cramped muscles
|
|
Patient presents with muscle cramps, nausea and vomitting and high fever (over 102), you diagnose patient with heat exhaustion - what is management?
|
This occured due to loss of electrolytes and water due to excessive sweating - move to cool place and rest, remove excessive clothing, give cool sports drinks, if no improvement give IV fluids
|
|
After being several hours in heat patient presents with high fever over 104, warm dry skin, he is confused, lethargic - diagnosis, is condition serious and how do you treat it
|
LIFE THREATENING - HEAT STROKE - patient can progress to stupor, seizures, coma and death, bodys heat regulation system is overwhelmed - need to move to cool place, call 911, remove excessive clothing, fan, drench skin with cool water, place ice bags in armpits and groin, give cool fluids if alert or IV fluids if not, and monitor urine output
|
|
Landmarks for hip PE
|
Greater trochanter
ASIS Iliotibial band Ischial tuberosity Gluteal muscle mass Hip adductors |
|
Ober test evaluates _
|
Contraction of iliotibial band and fascia lata
|
|
Thomas test test for _
|
flexion contractures
|
|
How do you measure true leg length
|
Measure from ASIS to medial malleoli, then while supine flex knees and place feet together, judge knee discrepancies for tibial vs femoral length discrepancies
|
|
Flexion of knee
|
120 degrees
|
|
Extension of knee
|
180 degrees
|
|
External rotation of knee
|
507 degrees
|
|
Landmarks for evaluation of knee
|
Patella
Tibial tubercle Patellar tendon Adduction tubercle Fibular head Popliteal space Popliteal artery Suprapatellar pouch Medial and lateral femoral condyles VMO |
|
Apprehension sign checks to see if patella is prone to _
|
Lateral subluxation or dislocation
|
|
Drawer test evaluates _
|
ACL and PCL
|
|
How is Lachman test different from anterior drawer
|
Leg flexed approximately 20 degrees
|
|
Clark maneuver tests for _
|
Patellar grind
|
|
Apley compression test - patient is _ (prone/supine) with one leg _ to _ degrees - perform downward compression and _ - elicits pain
|
Prone
Flexed to 90 degrees Internal/external rotation |
|
Mcmurray test includes _
|
Valgus stress and external rotation - take from flexion to extension
|
|
Varus and valgus stress tests are done at _ degrees of flexion and check for _
|
30 degrees
MCL, LCL |
|
Ankle plantar fkexion _ degrees
dorsal flexion _ degrees |
50
20 |
|
Which pulses do you measure on foot
|
Dorsalis pedis
Posterior tibial |
|
To perform Ober test you place patient in _ position, _ knee, let knee drop - if knee stays abducted it demonstrates tight _
|
Lateral position
Abduct knee Iliotibial band or fascia lata |
|
In Thomas test you place patient _ , _ hip to 90 degrees and try to _ opposite extremity
|
Supine
Flex Extend |
|
Internal/External rotation of knee
|
10 degrees
|
|
Q angle
|
Line from ASIS to center of patella, then second line from patella to tibial tubercle
|
|
Anterior drawer test of the ankle assesses
|
stability of anterior talofibular ligament
|
|
How do you test for pes planovalgus
|
Look from behind for "too many toes", also look at arch height, compare both sides
|
|
Finkelstein tests for what disease
|
deQuervains disease - active and passive ulnar deviation of wrist
|
|
Thumb grind test tests for _
|
OA at base of thumb
|
|
When testing for Froment sign you ask patient to _
|
hold paper between thumb and index finger
|
|
Adsons test should show what_
|
Radial pulse and tingling with shoulder abduction
|
|
Spurling test
|
Head tilted and rotated then downward pressure - facet and nerve root impinges
|
|
Biceps reflex level
|
C5
|
|
Brachioradialis reflex level
|
C6
|
|
Triceps reflex level
|
C7
|
|
Biceps innervation level
|
C5-C6
|
|
Triceps innervation level
|
C7
|
|
Wrist flexion innervation evel
|
C7
|
|
Wrist extension innervation level
|
C6
|
|
Shoulder abduction (deltoid)innervation level
|
C5
|
|
Patellar tendon reflex level
|
L4
|
|
Achilles tendon reflex level
|
S1
|
|
Which root has no reflex
|
L5
|
|
Toe extension innervation level (extensor digitorum longus)
|
L5
|
|
Foot eversion (fibular tendons) innervation level
|
S1
|
|
Anterior tibialis muscle innervation level
|
L4
|
|
Sensory level for medial side of leg
|
L4
|
|
Sensory level for lateral leg to dorsum of foot
|
L5
|
|
Sensory level of lateral foot
|
S1
|
|
When you ask patient to toe walk what root are you testing
|
S1
|
|
When you ask patient to heel walk what root are you testing
|
L4-L5
|
|
Lasegues straight lef lifting test suggests _
|
Nerve root irritation (pain shoots down leg)
|
|
Contralateral Lasegues tests _
|
hip
|
|
Straight leg drop test tests _
|
pull of iliopsoas (hip pain)
|
|
Patrick test differentiates hip disorders from _
|
SI pain
|
|
Gaenslens sign is indicative of _
How is it done |
SI pain - done by droping leg off table
|
|
Mennel sign is done in what position
|
PRONE (extended leg)
|
|
Patient presents with loss of sensation on medial leg, EMG showed fibrillation of sharp waves in tibialis anterior, myelogram shows bulge in spinal cord adjacent to disc L3-L4
What is the root involved? Reflex? |
Root L4
Reflex Patellar Muscle - tibialis anterior |
|
Patient presents with loss of sensation in lateral leg and dorsum of foot, EMG shows fibrillation of sharp waves in extensor hallucis longus,myelogram shows bulge in spinal cord adjacent to disk L4-L5
Root ? Muscles? Reflex? |
Root L5
Muscle - extensor hallucis longus (also extensor digitorum longus and brevis, medial hamstring, gluteus medius) No reflex (tibialis posterior) |
|
Patient presents with loss of sensation in lateral foot, EMG shows fibrillation of sharp waves in peroneus longus and brevis, myelogram shows bulge in spinal cord adjacent to disc L5-S1
Root? Reflex? Other muscles involved |
Root S1
Reflex Achilles tendon Other muscles - flexor hallucus longus, gastrocnemius, lateral hamstringm gluteus maximus |
|
Most common level of herniation
|
L5-S1
|
|
Drop arm sign tests for _
how is it done |
Patient unable to hold arm abduction 90 degrees against gravity - tests for rotator cuff injury or tear
|
|
Lift off test tests for _ how is it done
|
Tests for rotator cuff tear - put patients dorsum of hand on back - unable to lift off against resistance
|
|
In Apley scratch test you ask patient to _
Indicates _ |
touch contralateral superior medial corner of scapula
Indicates rotator cuff pathology particularly superspinatus |
|
In Neer impingement sign examiner _
|
stands behind patient and immobilizes scapula then jerks arm into forward and upward position
|
|
Yergasons test evaluates function of _
How is it done |
long head of biceps
Arm beside trunk and flexed 90 degrees at elbow, patient supinates against resistance |
|
Anterior apprehension sign is done _ while posterior apprehension sign is done _
|
Anterior - seated
Posterior - supine |
|
Anterior and posterior drawer tests of shoulder test for _
|
Instability
|
|
Thompsons test of elbow indicates _
How is it done |
Lateral epicondylitis
Dorsiflex wrist with elbow and wrist on extension |
|
In Golfers elbow sign you ask patient to _
|
Extend flexed elbow against resistance
|
|
Reverse Cozen test tests for _
How is it done |
Medial epicondylitis
With arm supinated patient flexes and extends elbow against resistance |
|
Hip joint type
|
Synovial ball and socket
|
|
Hip joint involves articulation between _ and _
|
Head of femur and acetabulum of os coxa
|
|
Hip socket is deepened by _ ligament and _
|
Transverse acetabular ligament (spans opend end of acetabulum) and acetabular labrum (fbrocartilaginous rim attached to bony rim of acetabulum and transverse acetabular ligament)
|
|
Capsule of hip joint has 2 attachments _
|
superior and inferior
Superior - brim of acetabulum near labrum and transverse acetabular ligament Inferior - anteriorly to intertrochanteric line and junction of neck of femur with trochanters, posteriorly posseses free (unattached) border that covers approximatley 2/3 of proximal femoral neck |
|
Hip capsule is constructed of two laminae of fibers _
|
Superficial lamina - longitudinally oriented fibers which limit movement of limb in specific direction
Deep lamina - "zona orbicularis" - provides "screw home" effec between head of femur and acetabulum - greatly enhances hip joint stability |
|
Hip ligament that assumes position of inverted Y, attaches superiorly to AIIS and inferiorly to intertrochanteric line - name of ligament and which way is it tightest in?
|
ILIOFEMORAL LIGAMENT - tightest in extension
|
|
Ligament that forms medial inferior portion of hip capsule, attaches medially to brim of pubic portion of acetabulum and obturator crest of superior pubic ramus and laterally to neck of femur near lesser trochanter - name of ligament - it becomes tight in _ and limits _
|
PUBOFEMORAL LIGAMENT - becomes tight in extension and limits abduction
|
|
A gap between _ and _ ligaments anteriorly and inferiorly, covered by _ and its bursa - (iliopectineal bursa)
|
Iliofemoral and pubofemoral
Psoas major |
|
This ligament is attached posteriorly to ischial portion of acetabulum, laterally to neck of femur medial to root of greater trochanter, fibers are spiral and form posterior free margin of capsule
This ligament becomes tight in _ |
Ischiofemoral ligament
Becomes tight in extension |
|
Ligamentum teres capitis femoris is _ ligament
This ligament limits _ |
Intracapsular
Adduction |
|
Blood supply to hip joint
|
Lateral and medial femoral circumflex arteries
Superior and inferior gluteal arteries Obturator artery provides branch to head of femur via ligamentum teres capitis femoris |
|
Which rotation of hip is greater - lateral or medial
|
Lateral
|
|
Knee joint type
|
Synovial, modified hinge joint (modified because it does allow some rotation)
|
|
Knee joint is joint between _ and _
|
Femoral and tibial condyles and femur with patella
|
|
How is knee joint supported
|
Muscular attachments
Capsular ligaments that cross joint Intracapsular ligaments Strong collateral ligaments |
|
Knee capsule is thickest _ where it reinforced with ligaments
|
Posteriorly
|
|
Knee capsule is buttressed laterally by _ and anteriorly by _
|
Laterally - iliotibial tract
Anteriorly - expansions of fascia lata |
|
Lateral and medial patellar retinacula is expansion of _ muscles
|
Vastus lateralis and medialis
|
|
Oblique popliteal ligament is the expansion of _ muscle
|
semimebranosus tendon
|
|
Arcuate popliteal ligament is an expansion of _ muscle
|
attachment of biceps femoris to fibular head
|
|
2 extracapsular ligaments of knee are _
|
Ligamentum patellae + collateral ligaments (medial and lateral)
|
|
Ligamentum patellae is an extension of _
|
quadriceps tendon across patella to tibial tuberosity
|
|
This knee ligament is broad and thin but tough, it passes from medial femoral epicondyle to upper medial portion of tibia below condyle and attaches to medial meniscus
|
Medial (tibial) collateral ligament
|
|
This knee ligament is "pencil like" cord from lateral femoral epicondyle to head of fibula, it is not attached to lateral meniscus because tendon of popliteus muscle passes between it and capsule of the knee
|
Lateral (fibular) collateral ligament
|
|
Name two intracapsular ligaments of the knee
|
ACL, PCL
|
|
Shape of lateral meniscus is _ , medial _
|
Lateral - lunar, medial - semi-lunar
|
|
_ ligaments attach lateral margins of menisci to margins of tibial plateau
|
Coronary
|
|
Menisci are attached to one another anteriorly via _
|
Transverse geniculate ligament
|
|
Function of menisci
|
Help cushion joint and stabilize articulation by deepening the articular surfaces
|
|
ACL prevents _ when foot is _
|
Posterior displacement of femur
Firmly fixed |
|
PCL prevents _ when foot is _
|
Forward displacement of femur
Firmly fixed |
|
Proximal tibiofibular joint is what kind ?
|
Synovial plane glidng joint
|
|
Distal tibiofibular joint is what kind of joint
|
Fibrous (tibiofibular syndesmosis)
|
|
In proximal tibiofibular joint capsule is strengthened by _
|
anterior and posterior ligaments of head of fibula
|
|
In distal tibiofibular joint which ligaments maintain integrity of joint
|
Interosseous ligament - thickened inferior portin of interosseous membrane
Anterior, posterior and transverse tibiofibular ligaments |
|
Which ligament helps to form "tenon" of talocrural joint (ankle) by extending below the inferior margin of distal talofibular joint
|
Transverse talofibular ligament
|
|
Talocrural joint (ankle) type
|
Synovial hinge joint
|
|
Which motions are possible at ankle joint
|
Flexion and extension (dorsiflexion and plantar flexion)
|
|
Medial ligament of ankle consists of __
|
Deltoid ligament - anterior tibiotalar, tibionavicular, tibicalcaneal, posterior tibiotalar
|
|
Lateral ligament of ankle consists of _
|
Anterior talofibular
Calcaneofibular Posterior talofibular |
|
Motions allowed at subtalar joint
|
Inversion and eversion of posterior portion of foot
|
|
Forms highest portion of medial longitudinal arch
|
Talocalcaneonavicular joint
|
|
Talocalcaneonavicular joint is supported by strong _
|
Plantar calcaneonavicular ligament (spring ligament)
|
|
Forms highest portion of lateral longitudinal arch
|
Calcaneocuboid joint
|
|
Calcaneocuboid joint is supported by _
|
long and short plantar ligaments
|
|
This joint identifies line of division between forefoot and hindfoot which allows foot to function securely on uneven (slanting and irregular) surfaces, allowing forefoot to move on hindfoot in plantar flexion and dorsiflexion, inversion and adduction and eversion and abduction
|
MIDTARSAL JOINT
|
|
Tarsometatarsal and intermetatarsal joints are what type
|
Plane synovial
|
|
Metatarsophalangeal and interphalangeal joints are what types of joints
|
synovial hinge
|
|
Which joints increase joint capsule stability in metatarsophalangeal and interphalangeal joints
|
Plantar and collateral ligaments
|
|
3 arches of feet
|
lateral, medial and transverse
|
|
Which foot arch composes a flat rigid component which provides a stable base for upright posture
|
Lateral arch
|
|
Which foot arch composes a higher more resilient curvature that lateral longitudinal arch
|
Medial arch
|
|
Which foot arch includes bases of all metatarsals
|
Transverse arch
|
|
Which ligaments support lateral longitudinal arch
|
Long and short plantar ligaments
|
|
Which ligament supports medial longitudinal arch
|
Plantar calcaneonavicular ligament
|
|
What ties together proximal and distal ends of longitudinal arches
|
Plantar aponeurosis
|
|
Which two muscles provide tendinous attachments to inferior surface of most of tarsal and metatarsal bones thereby forming tendinous sling for support of both longitudinal arches
|
TIbialis posterior and fibularis longus
|
|
Which two muscles provide tendinous attachments to superior portion of longitudinal arches much like cables of suspension bridge
|
Tibialis anterior and peroneus brevis
|
|
When considering support of arches of foot _ support is more important during static balance while _ is greater during active movement
|
Ligamentous support
Muscular support |
|
Which muscle provides means of feeling or "grasping" surfaces as we stand/walk/run
|
Flexor digitorum longus
|
|
Which muscle provides impetus for each step we take
|
Flexor hallucis longus
|
|
Muscles that extend thigh and flexes leg
|
Hamstrings
|
|
Muscle that extends leg
|
Quadriceps femoris
|
|
Specific muscle that holds patella in place
|
Vastus medialis
|
|
Chief invertors of foot
|
tibialis anterior and posterior
|
|
Chief evertors of foot
|
Fibularis longus and brevs
|
|
Major injury triad with lateral impact to knee
|
ACL
MCL Medial meniscus |
