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60 Cards in this Set
- Front
- Back
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Osteochondrosis
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disease causing degenerative change to epiphyseal ossification centers of long bones
AKA "aseptic necrosis, ischemic necrosis, avascular necrosis" |
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Disease Examples of Osteochondrosis
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Legg-Calve-Perthes - hip
Osgood-Schlatter's - tib tub Kohler's - navicular Panner's - capitellum Freiberg's - 1st MTP Scheuermann's - Spine Kienbock's - Lunate |
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Osteochondrosis Etiology and Predisposing Factors
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-idiopathic
-may have genetically determined vascular configuration causing susceptibility -may be related to trauma -m>f; 3-10 y.o. |
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Osteochondrosis - Phase 1
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"necrosis phase"
-dec. blood supply -osteocyte/marrow die -negative xray - QUIET phase |
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Osteochondrosis - Phase 2
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"revasularization"
-symptoms become evident -inc. blood supply -"head within a head" xray -biological plasticity -path fx to subchondral bone of original ossification ctr. -synovial thickening, px, ROM loss -rx: splinting |
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Osteochondrosis - Phase 3
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"bone healing"
-bone resorption stops -deposition continues -biological plasticity remains |
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Osteochondrosis - Phase 4
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"residual deformity"
-bone healing complete -epiphysis shape fixed -jt fxn remains due to healthy articular cartilage -DJD likely to result from wt bearing and deformity of bone underlying articular cartilage |
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Legg-Calve-Perthes Disease
"AKA" |
coxa plana
pseudocoxalgia osteochondritis deformans coxae juvenalis |
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Legg-Calve-Perthes Disease Etiology
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-avascular necrosis of the femoral head in boys>girls age 3-11.
-caused by synovial effusion which may have inflammatory disease or traumatic origin -hereditary predisposition to susceptible vascular arrangement and possibly thrombophilia |
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Coxa Plana Complications
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-subchondral fx
-hip jt incongruity leading to instability/sublux, dec. ROM (ABD/IR) and eventual DJD -leg length discrepancy -disuse atrophy to calf and upper thigh |
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Legg-Calve-Perthes Disease Treatment and Prognosis
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-bracing, bed rest and avoid compensation
-good prognosis if found <5 y.o. -fair between 5-7 y.o. -poor >7 y.o. |
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Chandler's Disease
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-affects adults
-non-traumatic associated with alcoholism, systemic adrenocorticosteroids, path fx, fat emboli and thrombophilia -may be long span and never heal, art. cart destroyed -poor prognosis, requires surgery |
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Panner's Disease
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Osteochondrosis of the capitellum
-px/swell at elbow -deformity unlikely 2* non-wt bearing |
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Freiberg's Disease
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Osteochondrosis of the MTP (1st or 2nd)
-girls>boys -forefoot px in wt bearing activity -synovial thickening, tender, pxful dec MTP ROM |
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Scheuermann's Disease
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Osteochondrosis of the Spine
-adolescent onset of kyphotic posture -moderate back px, local tender -excess l-spine lordosis, tight hamstrings |
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Kohler's Disease
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Osteochondrosis of the Navicular
-midfoot px -limp during movement analysis |
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Kienbock's Disease
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Osteochondrosis of the Lunate
-wrist px and tender local to the lunate -dec wrist ROM, weak grip |
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Calve's Disease
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Osteochondrosis of 1 Vertebral Body
-children 2-8 y.o. -mild back px -slight kyphosis, muscle spasm may be present |
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Cyriax Capsular Pattern of the Hip
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"FAME"
Flexion Abduction Medial Rotation Extension +slight lateral rotation |
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Kaltenborn Capsular Pattern of the Hip
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"MEAL"
Medial Rotation Extension Abduction fLexion +slight lateral rotation |
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Trochanteric Bursitis Etiology
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-gradual, insidious onset
-lat hip/thigh px, may refer to knee -presents similarly to L5 nerve root lesion->check for LS px -px with run, stairs, squatting, pressure during sidelying |
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Trochanteric Bursitis Examination Findings
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- + palp tend over bursa*
- + palp cond over bursa* - + MSTT str/px with ABD&IR - + CPROM px w/ IR, ADD - + CAROM px w/ ABD |
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Trochanteric Bursitis Rx
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pa - cryo, heat
pr - same or none co - rx SOURCE of irritation (gluts, IT band, leg length) non-thermal US, pt education -> cross legs, sleep pattern, leg pillow w/ sleep, AD for gait Su - rest, try corrective rx at home |
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Trochanteric Fx Clinical Features
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-extracapsular fx, ecchymosis, swelling, LE rests in ER and appears shorter at first
-most common in elderly osteoporotic females -TWIST -> then FX -> then FALL |
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Trochanteric Fx Radiographic Features
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-often severely comminuted
-abudant blood flow, so nearly all fx unite |
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Trochanteric Fx Rx
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-ORIF most common, THA better for severe osteoporosis
-ok for pt to move in bed s/p ORIF, usually seated w/in few days -WB defer until fx healed for more active pts |
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Femoral Neck Fx Clinical Features
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-intracapsular, hemarthrosis = no observable swelling
-LE in ER and appears short -most common in elderly osteoporotic females -TWIST -> then FX -> then FALL |
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Femoral Neck Fx Radiographic Features
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-distal fragment ER and shifted proximal=>neck appears short
-vertical fx line = poor prognosis |
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Femoral Neck Fx Rx
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ORIF, hemiarthroplasty if severe osteoporosis
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Femoral Neck Fx Complications
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-long lever arm distal to fx site increases instability of fx
-possible DJD, avascular necrosis, and jt adhesions 2* to effusion |
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Trochanteric Fx Complications
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-few 2* to extracapsular fx
-may develop non-union fx => coxa vara |
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Posterior Hip Fx-Dislocation Clinical Features
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mechanism = excess FL, ADD, IR as in car accidents
-may involve acetabular fx -may involve post labral tear (50%) |
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Posterior Hip Fx-Dislocation Complications
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-sciatic n. dmg
-potential blood supply dmg and subsequent avascular necrosis of femoral head and eventual DJD |
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Posterior Hip Fx-Dislocation Rx
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CRIF w/o fx
ORIF if fx present |
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Anterior Hip Fx-Dislocation Clinical Features
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Uncommon
mechanism = violent EXT, ABD, ER -possible acetabular fx |
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Anterior Hip Fx-Dislocation Rx
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closed reduction
-hip spica to limit FL, IR, ADD |
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Anterior Hip Fx-Dislocation Complications
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-possible femoral triangle dmg
-less chance of avascular necrosis than posterior fx-disl. -may contribute to DJD if residual deformity develops |
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Developmental Dysplasia of the Hip
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-abnormal changes/growth resulting in shallow acetabulum or femoral deformation
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Developmental Dysplasia of the Hip Clinical Features
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-8X more common in Females
-birth to 10 mo old -dislocation or subluxations of the hip -may see ADD/IR contractures or hypertrophy |
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Developmental Dysplasia of the Hip Rx
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Splinting!!
-3rd world countries may use multiple diapers to support hip |
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Developmental Dysplasia of the Hip Complications
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-early DJD changes
-antalgic gait=>limp, shortened stride/step length, -femoral anteversion |
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Developmental Dysplasia of the Hip Special Tests
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Ortolani's Sign - dislocation present
Barlow's Test - instability Galeazzi's Sign - unilateral |
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Shiba Shoe Inserts
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polymeric foam rubber best material, reduces shock absorption of LE by 11%
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Hip OA/DJD Etiology
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Pt is usually 60 y.o. or older, pain, dysfunction, limited ROM
-review 10 causes of 2ndary DJD |
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Hip OA/DJD Examination Findings
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- + Scouring/Quadrant Test
- + FABER test (patrick's) - pt Hx =>px post activity, inc morning px/stiffness - Movement Analysis => pt may have difficulty with fxnal activity such as sit-stand; also ABD/antalgic gait - dec ACCPROM in capsular pattern |
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Early Hip OA/DJD Rx
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-long axis distraction
-encourage high rep low load exercise strengthening -address contributing factors such as obesity or leg length discrepancey |
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Moderate/Advanced Hip OA/DJD Rx
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-treat capsular tightness
-suggest AD, inserts to reduce jt compression during WB activity, raised toilet seat -low load CKC exercise |
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Hip Joint Forces and the Gait Cycle
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-capsular tightness leads to premature force increase at HO, adding to the already high force
-force increases after HS, then decreases at MS |
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5 Complications of THA that may necessitate a Revision
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-Loosening of one or both components
-Fatigue fracture of metallic stem -Dislocation* -Wear of plastic acetabulum -Infection* -Blood clots*(acute phlebitis/DVT) *= acute concerns |
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Cemented THA and WB precautions
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with methyl methacrylate – liquidy powder, thicker; WBAT/PWB 50% of body weight, elderly
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Uncemented THA and WB precautions
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press fit or biological fixation - allows growth of bone into porous coated prosthesis; NWB to TDWB with only the wt of the leg (about 20 pounds), younger
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Patient Instructions S/P THA
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-No bending forward
-sit only on raised commodes -No leg/ankle crossing -No twisting on operated leg in standing or sitting -Keep pillow between knees (sleep) -Sit for short periods only on elevated chair |
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Benefits of Minimally Invasive THA
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-less invasive
-dec hospital stay by 1 1/2 days -less anesthesia -> less disorientation during PT -dec surgery time-> dec blood loss -less muscle dmg -10cm incision vs 24 cm |
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S/P THA HEP
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-ankle pumps/ circles
-Quad/Glut Sets -SAQ/TKE -heel slides -hip abd/add (neutral to 15-20) -LAQ -AROM full ER to neutral |
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S/P THA ADL Restriction Timeline
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All 8 weeks except:
-Left driving an automatic 4-6 -Right drive automatic 8-10 -Stick 10-12 -F stop using commode 3-4 mo -stationery bike 6-8 -bike 8-10 -swim 6 weeks |
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Anterolateral THA
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Prob: BV and Sup. Gluteal N
Adv: almost bloodless, quick CI: EXT, ADD, ER |
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Anterior THA
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Adv: good view of acetabulum
CI: EXT ABD ER |
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Transtrochanteric THA
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Adv: old favorite, good femur and acetabular view
Prob: trochanteric non-union |
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Posterior THA
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Advantage: good view of femur, well known to orthopods
Problem: sciatic nerve exposed Contraind: FL, ADD, IR (~8-12 weeks) |
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Posterolateral THA
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Gaining popularity with surgeons
Contraind: EXT, ADD, ER, active ABD |
