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152 Cards in this Set

  • Front
  • Back
Open fx surgical treatment
irrigation & debridement
what are the 3 important things to look for in restoring fxs?
length
alignment
rotation
what is important in the outcome of a tibial plateau fixation?
restoration of the articular surface using medial and lateral plate fixations
what is the management of an orthopedic trauma?
perform secondary survey
Prior to elbow surgery, its important to obtain a __________
traction film
3 causes of a single hot joint
trauma
infxn
crystals
Patello-Femoral Sydrome (PFS)
______ knee pain
worse on stairs and jumping
pain after being ________ for a while
pain prior to ________
anterior

seated

instability
PFS Exam:
knee _______
patellar facet tnederness, shrug, grind, tilt
________ mobility
_________ tightness
___ angle - b/w femer & tibia when knee is flexed 90 degrees
foot architecture - look for _________
hip motion - look for _________
quad strength (iliopsoas strength)
extension

patellar

hamstring

Q

pes planus (flat foot)

anteversion
PFS Tx:
________ & ________ stretch
work in terminal extension
?______
?______
?McConnell taping
hamstring & quad

NSAIDs

Brace
Meniscal injury:
usually a _______ injury
_______ related pain & swelling
possible locking, w/ firm block to motion and easily identifiable unlocking
either at free edge or bucket handle

*meniscus can only be repaired _________ b/c of blood supply (otherwise remove)*
can remove 1/2 of meniscus before pt has problems
twisting

activity

peripherally
Meniscus injury Exam:
________ tenderness (seated)
_______ (supine)
meniscal compression - combo of flexion & tibial rotation looking to stress a particular part of a particular meniscus
not random ___________
joint line

effusion

circumduction
Meniscus injury Tx:
_____
______
? injections (elderly)
Patience
Surgery (not always needed)
RICE

NSAIDs
"I planted my left foot & twisted to the right. I felt a pop, shift, & pain. I fell to the ground & could not walk away. My knee swelled in a hour. Since that time, I have had pain, swelling, locking, popping and giving way"
ACL tear
ACL tear exam:
________
_________, not anterior drawer
if cant examine, RICE & NSAIDs and come back in a wk

Xray: Std series
_________
lateral plateau avulsion (________ fx)
effusion

Lachman

hemarthrosis

Segond
ACL tear Tx:
______ rehab
+/- brace
not all need surgery
in young people - reconstruction to preserve meniscus
surgery - reconstruct w/ BTB (bone-tendon-bone), HS, quad tendon, allograft
quad
MCL injury:
usually valgus
Grade 1 - ________
Grade 2 - ________
Grade 3 - ________

Tx: brace, motion, NSAIDs
strain
partial tear
complete tear
Arthritis:
activity related pain & swelling
night pain, weather pain
ask how far the pt can walk
effusion
_________ tenderness
loss of _______

TX:
NSAIDs, cane in the _________ hand
injection (__________), arthroscopy
TKA
joint line

motion

contralateral

cortisol
Ilio-tibial Band Syndrome:
activity related _______ knee pain
no _________ or _________
pain is usually at 30 degrees flexion, coming from flexion

Tx:
stretch, rest NSAIDs
rarely surgery
lateral

effusion or locking
change in training routine
excessive downhill work
worn out shoes
always running the same direction on a cambered road or track
crossover gait
ITB triggers
Patellar tendonitis:
pain during or after activity
________ pole tenderness

Tx:
RICE
quad, HS, achilles stretch modalities
quad strength
sleeve or strap
progression to activity
most important is ________
inferior

rest
Baker's cyst:
swelling _______ the knee
changes in size
pain, fullness/stiffness

Tx:
treat the source of intra-articular irritation and cyst should go away
________ in young pts
________ in elderly pts
behind

meniscal tear

arthritis
Loose Body:
________ or bony pieces that have broken off
may have mechanical sx - _________
needs to be removed if causes sx
cartilage

locking
Osteochondritis Dissecans:
________ of the lateral aspect of the medial __________
pain and swelling
Xray (cant make dx w/o it) - ______ view
MRI

Tx:
age dependent
AVN

femoral condyle

Tunnel
Degenerative Arthritis:
common in middle aged & elderly
articular cartilage ________
pain is often located in _______
decreased ROM of hip
Xrays

Tx:
NSAIDs, ____
______ loss
total _________
thinning

groin

GCS (glucosamine condroitin sulfate)

weight

hip replacement
Avascular Necrosis (AVN):
occurs in 3rd to 5th decade
chronic _______ use
prior hip injury
bone necrosis in wt bearing portion of ________
pain often located in groin w/ wt bearing
Xrays

Tx:
NWB
vascularized graft
hip replacement
steriod

femoral head
Trochanteric Bursitis:
pt complains of pain and cant sleep on their ______
pain located over ___________ during int rotation & abduction

Tx:
NSAIDs, ice, heat, stretching
injections, PT
side

greater trochanter
Hip Dislocation:
always from a __________
must reduce hip quickly to prevent _____ (<6 hrs)
high energy trauma

AVN
Slipped capital femoral epiphysis:
________ w/ activity related groin pain
sudden onset or acute increase in pain
always need _______
overweight teenagers

surgery
Hip Fractures:
very common
tx w/ surgery
________ fractures - can be replaced if displaced
fractures below neck are tx w/ ____
femoral neck

pins
Femoral neck fractures:
activity related _____ pain
most stress fractures are on ______ side of femoral neck
groin

dorsal
During the inflammatory phase of a fracture, do not give _______

Growth around the metaphysis occurs at the _________

Children don't sprain, they break at the ___________
Always Xray the underside of the bone
NSAIDs

Ring of LaCroix

Growth plate
Adults cannot have incomplete fractures
_________ is most common
_________ & plastic deformation are very uncommon
torus/buckle

Greenstick
Zone of Calcification - ________ injury
Distal ________ fx is the worst
physeal

tibial
Distal _______ Torus - very common
shows as a little bubble on Xray
Point tenderness at fx site only
clinically healed = ________ in 6 wks
radiographically healed = ____________
Radial

non-tender

bridging calcifications
fat pad - _______ densities on Xray
blood accumulates under pad & pushes it out
anterior pad in ________ is normal
black

flexion
Bone ossification
female - _____
male - ____
1 yr

2 yr
Lateral elbow Xray:
lines through humerus & capitellum is _____
ant humeral line should go straight thru ________ (middle 1/3)
line thru ant humerus should sweep smoothly with ______ (coronoid process)

*________ should always point at capitellum in every view*
30 degrees

capitellum

ulna

Radial head
post fat pad on elbow film is ______ in kids
in adults is a ________ fx
Supracondylar Fx of Humerus

radial head
Both Bone Forearem (BBFA) fx - xray joint ______ & _______
adults should not be put in a ________ cast
above & below

forearm
evaluating reductions:
same ______ = good reduction
bones are oval so different sizes means _______ = bad
size

rotation
Corner/Buckethandle fx - usual fx is _______ & _______
torsion & compression
Clubfoot:

______ - high arch
______ - forefoot
______ - foot is swong over
______ - foot hangs like a hoof
cavus
adductus
varus
equinus
Metatarsus adductus:
usually ______
no ______ or ______
put pt in special shoes
Last shoes - medial contour
use straight or reverse Last shoes for tx
flexible

cavus or varus
Flatfoot:
_____ is by bony anomalies
no ______
hindfoot is ______

Intoeing: Etiology
metatarsus adductus
internal _______ torsion
excessive _______ anteversion (points forward)
rigid
arch
valgus

tibial
femoral
Knee:
cross from bow-legged to knock-kneed at age ____
adult alignment by age ____

_______ dz:
problem w/ medial tibial physis
needs surgery
2

6-7

Blounts dz
Osgood-Schlatter dz:
point tenderness at _______ (apophysitis)

Always look at ______

Tx of Shin Splints: _____
tibial tubercle

hips

none
Congenital Dysplasia of Hip:
now thought to be a __________ problem
hip exam - always have pt ______
int/ext rotation is usually ____ degrees total
dysplasia can produce _________

*_______ line* - curve along femoral neck & obturator line
_______ line - transverse
_______ line - vertical
look at where all lines cross

*________ sign* - pt is supine, knees flexed, if at different heights the femur is pushed posterior
extra skin folds in thighs?
development
lie flat
110 degrees
dislocation

*Shenton's*
Hilgerener's
Perkin's

*Galeazzi's*
______ Dz:
vascular insult - toxic synovitis ~ septic hip from _____ infxn
head dies but will come back & remodel in children
short neck, fat trochanter
Perthes

viral
Slipped Capital Femoral Epiphysis (SCFE):
usually _______ in ________ pts
head slips off the neck
put pin in to stop physis from growing
bilateral
African American
ER Hands:
dont take of dressing
do __________ in fingers on each side laterally
____ mm is normal

_____ in the hand is where tendons run together in the sheath

____ side - back of hand
____ side - palm
fingertip injury goes to the OR next day
2 pt discrimination
5-6

Zone 2

ER
OR
Carpal Tunnel:
> 35 yrs
_______ women
women > ___
______ > 40 yrs

ichemia from ________
9 tendons, 1 nerve - tendons get bigger as person ages
NO numbness in _______

________ is early sign
_______ is late sign (means regeneration)
TX: injections
pregnant
50
smokers

compression
small finger

Median nerve compression test
Tinnel's sign
CTS Tx:
nerve studies - dependent of wt, BMI, sweat
______ should be worn at night
surgery - carpal tunnel release with local anesthetic, not ________
splints

endoscopy
Cubital Tunnel:
_____ stretches & squeezes
*_______ sign* - flexion of thumb when squeezing
wrap hand towel around arm at night
ulnar nerve

*Fromont's sign*
most movement in spine is from _______ areas
lumbar/cervical
Anatomy
50% of Flex/ext and rotation comes from C1-C2
______ responsible for largest % motion
Little motion in T-Spine
C5-6 HNP likely compresses C6
L4-5 HNP compresses ____
L4-5
L5
Low Back Pain
Benign Symptom
Self-Limiting Disease
Very Common ___% of Adults
15% of all Patient Visits
80% of Acute LBP Resolves Within 4 Weeks
84
Cervical Degenerative Disc Disease
Not related to ______
Most people develop to some degree
No good classification system
________of the disc
________- bone spur, disc space narrowing
pain
Dehydration
Spondylosis
Herniated Nucleous Pulposus (HNP) is disc herniation > __mm

(a BULDGE is less than this)
> 3mm
SPINAL STENOSIS
From the Greek word “Choking”
Can be produced by a combination of changes
Cervical Myelopathy
-decrease in _______ skills
-spastic ________
-hyperreflexia
fine motor
gait
Cervical Strain (>3 wks pain)
________injury
________ injury
Ligament, tendons, muscles
Self-limiting
Conservative care: (_____, muscle relaxants, physical therapy )
Whiplash
Soft tissue

NSAIDS
Cervical Dislocation/Subluxation
Spinal Cord Injury
42% **____
24% Violence
22% Falling
8% Sports

Most often treated with closed reduction
**MVA
Rheumatiod Arthritis
Affects 2 million Americans
_________Disorder
_____ and Facet joints affected
________ C-Spine
Seropositive
C1-2
Step-ladder
Rheumatoid Arthritis
________Key
Labs
____with Diff, ANA, ____, CRP, Sed Rate
Treatment
Medication, Low impact ______
Early treatment improves long term outcome
Early Diagnosis
CBC
RF
exercise
Thoracic Spine
Thoracic discs protected by ______
_______motion
DDD/HNP not as common
HNP may have mixed presentation
ribs/cage
Little
ANKYLOSING SPONDYLITIS
______
Sero______
________4 times more likely
“_________”
HLA-B27
Hereditary
Seronegative
Males
Bamboo Spine
ANKYLOSING SPONDYLITIS
Treatment
Symptomatic relief
________
NSAIDs
Surgery
Fusion
Higher probability of _______ injury in fractures
Physical Therapy
cord
Thoracic Kyphosis
Scheuermann’s
________thoracic kyphosis
Anterior wedging of __ degrees involving ____consecutive bodies
Treatment with NSAIDs, ______, exercise, surgery
Juvenile
5
3
Bracing
Thoracic Kyphosis
Other Causes
-Congenital
-Neuromuscular Disorders
-Trauma, tumor, infection
________
Surgery
-Progressive Deformity
-_________symptoms
Cobb Angle

Neurological
Scoliosis
Types
-___________,idiopathic(F>M), De Novo
Early Dx again key
-Cobb angle
-________ classification (III-most common)

Thorough exam important
Congenital

King
Idiopathic Scoliosis
Defined as curve >____degrees
Most common in ________
Must R/O other causes; Tethered cord
Time of most concern before ______
Brace at ____or > degree
10
girls
menses
20
Idiopathic Scoliosis
Bracing to limit degree of progression
Surgery indicated at >__degree curve
Correction after puberty to avoid ________ effect
40
crank-shaft
Congenital Scoliosis
Result of abnormal vertebral formation
Must assess ________ function
Treatment depends on type of vertebral malformation
kidney
Lumbar Degenerative Disc Disease
Classification?
___% of Americans experience LBP
Early return to normal activity key
Watch for red flags
Treatment
80
DDD - Treatment
Be patient, symptoms are likely to improve
________and Muscle Relaxants
PT - _________ Exercises
Surgery indicated for intractable pain or progressive neurological weakness
NSAIDs
Williams Flex
Lumbar Strain
Similar treatment to ____
Early activity again key
R/O other causes
Red Flags
Self-limiting
DDD
Discogenic Pain
________Pain
Malfunction of the disc
Dehydration on MRI, _______
Diagnosed by ________
Mechanical
Annular tear
Discography
Discogenic Pain
Treatment
-Conservative Care
-Surgery:
1 Fusion
2 ____
3 ____
4 Dynamic Stabilization
5 Satellite
ADR (art. disc replacement)
IDET (intradiscal electrothermal therapy)
____________
Anterior slip of one vertebral body onto another
Two main types
_________
_________
Symptoms related to mechanical pain, leg pain due to foraminal narrowing
Spondylolisthesis
Isthmic
Degenerative
Isthmic Spondylolisthesis
Fracture of vertebrae causing it to slip
Result of defect in _______
Most common at _____
Occurs in 7% population
Seen in football lineman and _______
pars interarticularis
L5-S1
gymnast
Degenerative Spondylolisthesis
Due in large part to _________ failure
Most common at _____
Frequently causes L5 radiculopathy
Conservative treatment with ________, flexion exercises
Surgery to decompress and stabilize
facet
L4-5
NSAIDs
__________
__________ patients
Intractable LBP
CBC, CRP, Sed rate
MRI, Bx
Treatment with 6 wks IV abx
Discitis
Immunocompromised
Fractures
_________Fx most common
Trauma in young pt
w/wo trauma in elderly
_______ exam
______, X-rays, bone scan
Conservative Tx with _____
Vertebroplasty/ Kyphoplasty
Compression
Neuro
MRI
TLSO (Thoracic Lumbar Sacral Orthosis)
_______Fracture
Compression fracture with retropulsion of posterior elements
50% patients develop ________
Better prognosis with surgical decompression and stabilization within 1st __hrs
Burst
neurological deficits
48
________ DYSFUNCTION
Very small joint
Does not move much
Dx difficult to make
Make Dx by H&P, imaging studies
Tx with PT, SI mobility, injections
SACROILIAC
LBP Treatment in Primary Care
Complete H&P
Self-limiting
Treatment with ________, NSAIDs, Muscle Relaxants
Watch for Red Flags
exercise
LOW BACK PAIN
Red Flags
Age <__, >__
Pain
-_________
-Radiating pain:
1 Leg
2 Abdomen
3 ______
<18, >55
Nocturnal
Testicular
Low Back Pain
Red Flags
History
-______
-Weight _____
-Morning stiffness
-________
-HIV
-Drug Abuse
-Systemic Illness
Fever
loss
Cancer
Low Back Pain
PHYSICAL EXAM
-________DEFICIT
-SEVERE LIMITATION OF MOTION
-STRUCTURAL DEFORMITY
-________DISTURBANCES
-EDEMA, , POOR PULSES
NEUROLOGICAL
GAIT
What bone is involved
Location of the fracture
Pattern of the fracture
Amount of anatomic disruption
Fracture Classification
______ - shaft of long bones
______ - flared end of a long bone b/w diaphysis & physis
______ - cartilaginous growth plate, only in growing bone
______ - end of a long bone
diaphysis

metaphysis

physis

epiphysis
closed/open - goes to OR
simple/comminuted
intra/extra articular
transverse
oblique
spiral
impacted - usually humoral/femoral
pathologic
stress - needs MRI (can't see on xray)
greenstick
torus - buckle
avulsion - Jersey finger
pattern of fractures
Anatomic Disruption (3)
displacement
angulation
rotation
Salter-Harris Fxs:

SH 1 - fx thru ______
SH 2 - fx thru physis & ______
SH 3 - fx thru physis & ______
SH 4 - fx thru _______
SH 5 - _______ injury
physis
metaphysis
epiphysis
P/E/M
crush
Fracture Healing:

1.________ - bleeding, hematoma, osteoblasts/fibroblasts
2.________ - callus w/in 2 wks
3.________ of union
4.________ - begins in middles of repair phase & continues after clinically healed
inflammatory phase
repair
restoration
remodeling
________ fx - fell of outstretched hand, tender in anatomical snuff box (could also be a sprain)
immobilize for 7-10d only

_______ fx - thumb is adducted

_______ fx - 5th knuckle is depressed

_______ fx - radial mid-shaft fx that disrupts radial/ulnar joint
distal radial fx

Bennentt's fx

Boxer's fx

Galeazzo's fx
_______ fx - distal humerus fx

_______ fx - abducted arm is dislocated ant, back of humerus drags across glenoid causes shoulder instability

_______ fx - proximal ulnar fx

_______ fx - buckle fx in peds
Holstein Lewis fx

Hill-Sachs fx

Montaggis's fx

Torus fx
Hip Fractures Locations:

Grade 1
Grade 2
Grade 3
femoral neck
trochanteric
subtrochanteric
_______ fx - 5th metatarsal fx, common in overweight women

_______ fx - ankle inversion

_______ fx - medial collateral ligament of knee is displaced
Jones fx

Maisonneuve's fx

Stieda's fx
Femoral Neck Fx TX:
displaced-
nondisplaced-
replacement
sugical screws
_________ - more common in tibial fx but also in radial fx
increase in pressure in compartments causing nerve compression & death
pain w/ passive range of motion
>40 is diagnostic
compartment sydnrome
Fx Mnemonic:
"Break the forearm of the MUGR (mugger)"

5 Ps
Monteggia=Ulna
Galeazzi=Radius

pain
pallor
paralysis
parasthesias
pulselessness
work, sport, MVA
onset (trauma, insidious)
location
aggravating/alleviating factors
night pain
others (cardiac, metastaic dz...)
fx history
inspection
palpation
range of motion (active & passive)
rotator cuff
provocative tests
instability
physical exam
*SITS muscles* of Rotator Cuff

________ on xray is a tear
supraspinatus
infraspinatus
teres minor
subscapularis

lucency
_______ - pain at night & w/ overhead activity

_______ - also w/ bursitis, presents same as calcific tendonitis

_______ - weakness

_______ - subacromial impingement
1. flat
2. curve
3. beak curve
Calcific tendonitis

Tendonitis

Tears

Impingement
Adhesive Capsulitis (________):
idiopathic or cuff tendonitis initially
gradual or sudden onset
usually in *_______ women*
S/S - pain, decreased ______
TX - no steroids if diabetic, PT, pain meds
may take 6 months to get back ROM
frozen shoulder

diabetic

ROM
Shoulder Instability:

Traumatic - _______
acute or chronic
TX ~ ________, rehab to strengthen cuff muscles
after 2nd dislocation there is a _____ chance of redislocation

Multidirectional Instability
TX ~ focus on cuff strengthening, ____
dislocation

conservative

90%

PT
Acromioclavicular Joint Separation:

Grades
I - ligaments b/w acromion & _______ is torn, xrays are negative, base dx on hx
II - small amount of ______ on xray in distal clavicle
III - all ligaments are _____, sits up high, if asx then no sx
IV - always requires _______

*most are non-surgical except for symptomatic grades _____*
clavicle

elevation

torn

surgery

III & IV
Clavicle fx: is there _____ of the skin?

*abduction & ext rotation is common for ____ dislocation*

_____ fx - part of gleniod is torn off
tenting - mid-shaft fx pokes up making a tent

anterior

Bankart fx
_______ pathology:
adult hallux valgus
hallux rigidis
hammer toes
Morton's neuroma
stress fracture

_______ pathology:
Lis Franc injuries
forefoot

midfoot
_______ pathology:
plantar fasciitis
Achiles pathology

_______ pathology:
PTT dysfunction
peroneal tendon pathology
sprain
fracture
arthritis
hindfoot

ankle
____________:
forefoot deformity characterized by lateral deviation (valgus) of the great toe (hallux)

Etiology:
shoes
hindfoot ________
herecitary
_____ instability
Hallux Valgus (bunion)

pronation

MTC (metatarsocuneiform)
Hallux Valgus:
+/- _____
deformity
difficulty w/ shoes
2nd toe pain (transfer lesion)

Surgical correction is indicated in _______ pts only
pain

symptomatic (pain)
Hallux Valgus:

Non-operative tx -
_______ modification
shoe stretching
toe ______

Operative tx -
proximal/distal osteotmies
soft-tissue procedures
arthrodesis
shoewear

spacers
_________:
degenerative arthritis of the 1st MP joint characterized by restricted dorsiflexion

Etiology -
unclear
______
1st metatarsal elevation
Hallux Rigidus

trauma
Hallux Rigidus:
1st MP pain
_______ (restricted dorsiflexion)
dorsal ____ (synovitis, osteophytes)
+/- swelling

Diagnostic Studies - ______
stiffness

mass

xray
Hallux Rigidus:

Non-operative tx -
______ & activity modification
_______ shoes
orthotics with rigid shand
injections in early dz

Operative tx:
1st MTP _______
NSAIDs

stiff-soled

fusion
_________:
acquired deformity characterized by flexion contracture of the PIP joint

Etiology-
shoewear
long ______
trauma
neuropathic
______ imbalance
idiopathic
Hammertoes

metatarsal

muscle
Hammertoes:

Conservative tx-
elastic toe sleeves
wide/deep toe box

Surgical tx-
PIP resection arthroplasty
refer for surgery only if:
_______ pts
rigid hammertoes in _______ impaired pts

no tx if ______
rigid symptomatic

sensory

flexible
_________:
inability of boen to withstand repetitive physiologic forces

Etiology-
increased _______
decreased _____ stock
Metatarsal Stress Fracture

activity

bone
Metatarsal Stress Fracture:
insidious onset
aching, burning
sharper w/ ______
anticedent increase in activity

DDX-
metatarsalgia
midfoot ______
neoplasm
MP pathology
weight

OA/RA
Metatarsal Stress Fracture: diagnostic studies

_______-
all suspected cases
+ only in reparative stage

____-
if xray is neg & dx is in doubt

with stress fractures in middle-aged & elderly women ~
check bone mineral density w/ a _____ scan
Radiographs

MRI

DEXA
Metatarsal Stress Fracture: tx

walking ____
protected weight bearing crutches
hard-soled shoes
______ modification with gradual resumption
boot

activity
__________:
an entrapment neuropathy of an interdigital nerve underneath the transverse metatarsal ligament

Etiology-
_______ nerve
increased ______ of the nerve
______ formation
trauma
Interdigital Neuroma

thickened
mobility
bursa
Morton's Neuroma:
sharp/radiating plantar _______ pain
worse w/ walking, alleviated w/ rest
_______ numbness and paresthesias
______ onset
forefoot

Webspace

Insidious
Mortons neuroma: Diagnosis
___ Webspace tenderness
Mulder’s _____

Diagnostic/Therapeutic-__________- injection

If the pathology isn’t in the ________ webspace, it’s probably not a Neuroma
3rd

click

lidocaine/steriod

second or third
Morton’s neuroma:

Non-operative tx-
First Line ~ ______ & accommodative orthotics with proximal metatarsal pad under involved two metatarsals
Second Line ~ _______ Injection
Third Line ~ Time & ______
NSAIDs

Steroid

surgery
Midfoot Sprains/LisFranc Injuries: radiographs
look for _______

AP - Lateral border of 1st metatarsal and Lateral border of medial cuneiform
1st intermetatarsal Space and
1st Intercuneiform space

Internal Oblique-
Medial border of 4th metatarsal and Medial border
of cuboid
Lateral border of 3rd metatarsal and Lateral border of lateral cuneiform

If any question obtain
______________
separation

COMPARISON WEIGHTBEARING VIEWS
__________:
inflammation and probable microscopic tearing of the origin of the plantar fascia (medial)

Etiology-
Soft tissue _________
Overuse
_______
old age
Trauma
Plantar Fasciits

contractures

overweight
Plantar Fasciitis:
_______ heel pain
First-step / ________ pain
Worsens as day progresses

____-
Entrapment neuropathy
Tarsal tunnel syndrome
Calcaneal stress fracture (squeeze heel, elicits pain)
Achilles Pathology
Fat pad atrophy
Neoplasm
Plantar fibroma
Plantar fascia rupture
Inferior

morning

DDX
Plantar Fasciitis: Non-operative tx

First Line-
Shoewear modification (soft over the counter inserts)
Home achilles / plantar fascia ________
Home ________ stretching
_______

Second Line-
Night ______
Formal ___ ~ Iontophoresis (deep tissue massage)Strapping/taping

Third Line-
______ cast/boot
______ injection(s)???????

Refer for Re-evaluation if
symptoms persists after _____ of treatment
stretching
hamstring
NSAID’s

splint
PT

Walking
Steroid

3 months
Heel Spurs:
Heel spurs are in the _____ muscle, not the plantar fascia
Present in many (80-88%) ________ individuals
Heel spur ______ in conjunction with fasciotomy
is controversial

can do ________ therapy but 44% have unsuccessful treatment
FHB (flexor hallicus brevis)

asymptomatic

excision

shockwave
________: largest tendon in the body
terminal gastrocs/soleus muscles
fibers internally rotate
hypovascular zone is 4 cm proximal to insertion
Achilles tendon
Achilles tendon rupture:

History-
acute, sharp pain in back of leg or ankle
immediate difficulty with _______
audible ____
"i turned around to see if someone had kicked me"

PE-
_____ can be almost normal
palpable ____
diminished but not absent ______
_________ test is positive
walking
pop

gait
gap
strength
Thompson
Achilles tendon rupture: tx

______ - significant rise of re-rupture
acceptable in select pts - elderly, sedentary, informed

______ - risk of wound complications & infection (smaller yet potentially catastrophic)
casting

surgical repair
________:
tendonopathy and/or pertendonitis of the Achilles tendon

Etiology:
hypovascularity
tendon rotation
overuse/age
constrictive shoes
inflammatory arthropathy
Achilles Tendonitis
Achilles Tendonitis:
the term "________" is used loosely but generally applies to a Haglund's process or swelling associated with insertional achilles tendonitis

Clinical Presentation-
_______ heel pain & swelling
______ stiffness
posterior prominence
pump bump

posterior

ankle
Achillies Tendonitis: TX

Non-operative - ___________ measures
heel lift (1/4 in)
Achilles stretching
night splint

When considering _______ injections - DONT DO IT
Biomechanical

steriod
____________:
inflammatory tendinopathy secondary to chronic degeneration of the posterior tibial tendon

Etiology-
age
hindfoot pronation
hypovascularity
__________ arthropathy in young males
Posterior Tibial Tendon (PTT) Dysfunction

seronegative
PTT Dysfunction: exam

_______ hindfoot inflammation/edema

_______ deformity-
“pes planovalgus”
hindfoot valgus/eversion
forefoot abduction

Medial/lateral hindfoot ______
medial

flat foot

pain
PTT Dysfunction: staging

Stage I - _________ w/ deformity
Stage II - ________ hindfoot valgus
Stage III - _______ hindfoot valgus
inflammation
flexible
rigid
PTT dysfunction: diagnostic studies

Radiographs-
Make sure to order _________ views
_______ view ~ collapse of longitudinal arch & negative talar neck-first metatarsal angle
AP view ~ talar head uncoverage
Check for arthrosis/coalition

_____-
Confirm diagnosis
Check for arthrosis/coalition
Rule out other pathology
weight-bearing

Lateral

MRI
PTT dysfunction: tx

Non-operative Treatment-
_______
Air stirrup
Arizona brace, Articulated AFO
_______ with medial hindfoot posting
NSAID’s

Orthotics
_________:
traumatic injury of the stabilizing ligaments of the tibiotalar joint

*__________ is the most common ligament torn*
Ankle Sprains

*Ant talofibular ligament*
Ankle Sprains: presentation

Acute pain/sensation of “______”
Audible “____”
May be able to bear weight initially
Immediate or delayed _________

_____:
Ankle fracture
Lateral process of talus fracture
Anterior process of calcaneus fx
Fifth metatarsal fracture
Peroneal tendon dislocation
Osteochondral defect (OCD)
Superficial peroneal neuralgia
giving way

pop

swelling
Ankle Sprains: dx

Tenderness directly over the ________, not the bone
______ if the patient has bony tenderness or is unable to bear weight
______ ankle sprain - do an External Rotation Test & a Squeeze Test
ligament

X-rays

High
Ankle Sprains: tx

Non-operative Treatment-
_____
Bracing
Protected weight-bearing as dictated by symptoms
Early functional ______ ~
peroneal strengthening
proprioceptive exercises
conditioning
range-of-motion (avoid inversion)
RICE

rehab
Ankle Sprain

Top Reason for Persistent Pain Following Ankle Sprains is *__________*
*inadequate rehab*
Ankle Fractures: types
________ - fracture fragments are out of place and don’t line up anymore
_________ - fracture fragments remain in place and stay in line
_____ - fracture fragments come through the skin and become contaminated with bacteria (“compound fracture”)
________ - fracture fragments remain inside the body
__________ - non-displaced fractures caused by repetitive stress, weak bone, or a combination of the two
displaced

non-displaced

open

closed

stress fractures
Ankle Fractures: Diagnosis

Tenderness directly over the _____, not the ligament

______ are essential
bone

X-rays
*Ankle Fractures: tx*

Weber A - fx _____ the ankle joint, no surgery unless ________

Weber B - fx at level of ankle joint, probably needs _______

Weber C - fx ______ ankle joint, always needs surgery
below
displaced

surgery

above
Ankle replacements will come loose in _____ years
7-11