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131 Cards in this Set

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What are five disorders that cause forefoot pain?

(1)Degenerative Joint Disease, (2)Hallux Valgus, (3)Stress Fracture, (4)Gout—1st MTP, (5)Morton’s Neuroma

What are two disorders that cause midfoot pain?

(1)Avascular Necrosis (Navicular), (2)Tendonitis (Tibialis Posterior, FHL, FDL)

What is one disorder that causes heal pain at the bottom of the heal?

Plantar Fasciitis

What are two disorders that cause heal pain at the back of the heal?

(1)Retrocalcaneal Bursitis, (2)Achilles Rupture or Tendonitis

What is another name for degenerative joint disease in the forefoot?

Hallux Rigidus because it often occurs at the 1st MTP joint

Are men or women more affected by DJD in the forefoot?

Men

*Is Hallux Rigidus bilateral or unilateral?

Bilateral

How will Hallux Rigidus present?

Pain and tenderness over MTP joint. Decreased ROM (extension) which affects walking.

What are four treatment options for Hallux Rigidus?

(1)Mobilizations to 1st MTP joint, (2)Metatarsal bar in shoes (Rocker bar), (3)Correct other biomechanical factors above the MTP joint, (4)Surgery indicated rarely

What is hallux valgus?

Medial deviation of the first metatarsal bone

What is the progression of symptoms of hallux valgus?

(1)Initially a callus develops over the medial side of the head of the metatarsal bone, (2)As the condition progresses, the bursa becomes thickened and inflamed, (3)The chronic inflammation results in excessive bone growth (exostosis), (4)Results in a bunion

What is a common cause of hallux valgus?

Shoes with a narrow toe box

What are four treatment options for hallux valgus?

(1)Education and advice regarding footwear (no high heels and adequate toe box room), (2)Exercises to strengthen muscles, (3)Toe spacer, (4)Surgery is very common and quite successful

What is another name for a stress fracture in the forefoot?

March fracture (often seen in soldiers)

Where does a forefoot stress fracture occur?

Occurs at metatarsals (Mainly 2nd and3rd)

What can cause a forefoot stress fracture?

Prolonged stress on bone leads to small cracks in the bone. Weight-bearing activities painful and if left undiagnosed--Disruption of fracture

What is the treatment for a forefoot stress fracture?

Treatment is normally to decrease weight-bearing activities until healed. Metatarsal support in orthotic, taping, exercises (ROM & rotation - 8 sets, 40 reps), boot cast.

What is the clinical name for Morton's Neuroma?

Metatarsalgia

What is Morton's Neuroma/Metatarsalgia?

A fibrous tissue formation around the digital nerve. Usually between 2-3rd and 3-4th MT space.

Is Morton's Neuroma/Metatarsalgia more common at the 2-3rd MT or 3-4th MT?

3-4th MT

Is Morton's Neuroma/Metatarsalgia more common in men or women?

Women

How does Morton's Neuroma/Metatarsalgia present?

Walking is very painful. Pain at outer border of forefoot to tip of toe (intermittent pain), paresthesia is possible.

How is Morton's Neuroma/Metatarsalgia treated?

Orthotics, coritosteroid injection, alcohol injection, neuroectomy, cryogenic, neuroblasi

What is another name for avascular necrosis of the navicular?

Kohler’sDisease

*Who is the most common patient of avascular necrosis of the navicular?

More common in boys (3-8 years)

What is a cause of avascular necrosis of the navicular?

Abnormal strain on an un-ossified navicular

How does avascular necrosis of the navicular present?

Foot pain with weight-bearing is main symptom. Mild swelling. Pain may persist for 6-9 months.

What is a treatment for avascular necrosis of the navicular and how long can it take to heal?

May require a walking cast or orthotics while healing. Resolves in approximately 2 years.

What is a common misdiagnosis for Tibialis Posterior/FHL/FDLTendonitis?

Plantar fasciitis

How would you determine if a patient had tendonitis?

Differentiate each muscle with specific muscle testing and localization of tenderness. Check joints above and below.

What is the treatment for tendonitis?

May require orthotics to control supination or pronation. RICE, education and progressive return to activity.

What are four functions of the plantar fascia?

(1)Supports longitudinal arch of foot (with gait), (2)Creates a more rigid foot for propulsion/push-off, (3)Originates off the medial process of calcaneal tuberosity, (4)Divides into five bands and inserts into plantar aspects of the bases of the proximal phalanges

What is plantar fasciitis?

Inflammation of the plantar fascia at its origin on medial calcaneal tuberosity. Chronic inflammation may progress to global thickening of fascia with nodule formation or traction spurring of calcaneus (heel spur).

*What are five causes of plantar fasciitis?

(1)increased standing, (2)walking, (3)running, (4)hill climbing, (5)improper or worn-out footwear

How should normal heal wear present?

Equal, bilateral, lateral

What are five abnormal lower extremity biomechanics associated with plantar fasciitis?

(1)Pes planus (over pronation), (2)Internal tibial torsion (over pronation), (3)Tight Achilles tendon (over pronation), (4)Pes cavus (lack of pronation), (5)External tibial tibial torsion (lack of pronation)

How does the pain of plantar fasciitis typically present?

(1)Usually unilateral, (2)Worse when initially getting out of bed in morning, (3)Pain typically on bottom of heel, (4)Pain may subside with activity only to return with time

What are eight treatments for plantar fasciitis?

(1)Correct biomechanical dysfunction, (2)RICE, (3)NSAID’s, (4)Taping, (5)Footwear modifications, (6)Orthotics-common and helpful, (7)Surgery-rarely, (8)Foot core exercises

What can a chronic retrocalcaneal bursitis result in?

Chronic conditions can cause increased bone growth in area--Bony Spur or “Pump Bump”

What is the treatment for retrocalcaneal bursitis?

Treatment includes RICE, footwear modifications (padding) and NSAID’s

Describe achilles tendonitis.

Inflammation of the AT or its insertion. May progress to thickening, nodule formation or partial rupture.

Where does achilles tendonitis commonly occur?

Occurs commonly 2-6 cm proximal to tendon insertion (least vascularity)

What are four causes of achilles tendonitis?

(1)Frequent overuse syndrome, (2)External irritation from shoe, (3)Common in runners or sports involving repetitive jumping, (4)Abnormal biomechanics in L/E

How does achilles tendonitis present?

(1)Local tenderness on palpation +/- palpable thickening, nodule or gap, (2)+/- swelling/redness, (3)Pain on resisted PF, (4)Pain on stretch

How is achilles tendonitis treated?

RICE, frictions, heel lift, gentle stretching, progress to strength

What do patients report when they experience an achilles rupture?

Client may report hearing a pop or snap after landing on foot or pushing off of foot.

How would a patient with an achilles rupture present?

May have increased passive dorsiflexionon examination. Weak and painless plantarflexion (grade 3 strain). Positive Thompson Test.

Which ankle sprain is more common: inversion or eversion?

Inversion sprains are much more common

*Which ligaments are injured in ankle inversion sprains?

Lateral ligaments are injured with inversion sprains (anterior talofibular ligament most common). Calcaneal fibular ligament is affected in 20-40% of cases.

How is an ankle sprain treated?

RICE, Frictions, Rehabilitation program (ROM, strength, balance, functional retraining)

Why are ankle sprains slow to heal?

Ligaments have low blood supply

What can happen to ligaments with a more severe sprain?

Chronic laxity can occur with more severe sprains. May require ankle brace or taping for activities. Surgery indicated in rare situations (Evan’s Repair {(Peroneus Brevis})

What is a high ankle sprain?

A tear of the IOM between the tibia and fibula

What are three conditions that can be referred to as shin splints?

(1)Medial tibial stress syndrome (tib ant), (2)Stress fractures, (3)Compartment syndromes

What are four conditions classified as medial tibial stress syndrome?

(1)Musculotendinous strains, (2)Tendinitis, (3)Interosseous membrane pain, (4)Periostitis

What is another name for compartment syndrome?

Exercise-induced ischemia

What is compartment syndrome?

Increased intramuscular pressure impedes blood flow and function of the tissues within that compartment.

What is the cause of compartment syndrome?

Exact cause is not known. Most common factor is a high level of physical activity with repetitive DF/PF. Frequently found in runners and cyclists.

*What are four ways that the pain of compartment syndrome present?

(1)Pain induced only by activity (differentiates from vascular claudication), (2)Pain located along specific muscular group, (3)Numbness or tingling may occur (deep peroneal or tibial nerve , (4)Symptoms normally disappear quickly with stopping activity.

Which leg compartments frequently suffer from compartment syndrome?

Anterior and Deep posterior compartments most frequently involved.

How would the leg pulses present with compartment syndrome?

The pulses will be normal.

What five muscles, nerve, and artery are in the anterior compartment?

(1)Tibialis anterior, (2)Extensor digitorum longus, (3)Extensor hallucis, (4)Deep peroneal nerve, (5)Anterior tibial artery & vein

What two muscles and nerve are in the lateral compartment?

(1)Peroneus longus, (2)Peroneus brevis, (3)Superficial peroneal nerve

What three muscles, two arteries, and one nerve are in the deep posterior compartment?

(1)Tibialis posterior, (2)Flexor digitorum longus, (3)Flexor hallucis longus, (4)Tibial nerve, (5)Peroneal artery & vein, (6)Posterior tibial artery & vein

What three muscles are in the superficial posterior compartment?

(1)Soleus, (2)Gastrocnemius, (3)Plantaris

*What is Charcot-Marie-Tooth disease?

Hereditary peripheral motor and sensory neuropathy. The most common inherited neuro disorder (1 in 3000).

When does Charcot-Marie-Tooth disease usually present?

Usually manifests late childhood-early adulthood in lower extremity.

*How does Charcot-Marie-Tooth disease usually present?

Muscle atrophy, loss of touch, vibration, proprioception senses; *pain is intact. ”stork leg”: peroneal and calf muscle atrophy; B/L pes cavus, hammer toes.

What are two early signs of Charcot-Marie-Tooth disease?

(1)Painful muscle spasm or affected muscles, (2)Distal muscle weakness (falls often)

What are three treatments for Charcot-Marie-Tooth disease?

(1)PT and moderate exercise, (2)bracing for foot deformities and to control foot-drop, (3)surgery: straightening and pinning toes, fuse arch bones

What were the nine pediatric orthopaedic conditions discussed?

(1)Fractures—Salter-Harris, (2)Osgood-Schlatters, (3)Congenital Hip Dysplasia, (4)Legg-Perthes’ Disease, (5)Slipped Capital Femoral Epiphysis(SCFE), (6)Severs Disease, (7)Volkmann’s Ischemic Contracture, (8)Pulled Elbow, (9)Sprengel’s Deformity

*What fracture is unique to childhood?

Fracture of the *growth plate* is an injury unique to childhood

How do Salter-Harris fractures heal?

Most such fractures heal without permanent deformity. A small percentage, however, are complicated by growth arrest and subsequent deformity.

What is the Salter-Harris classification system?

The Salter-Harris classification of growth plate injuries aids in estimating both the prognosis and the potential for “growth arrest".

What is the acronym for the Salter-Harris classification system?

SALTR

What is a type I Salter-Harris fracture and what percentage of incidence?

Straight across (separated); 5%

What is a type II Salter-Harris fracture and what percentage of incidence?

Above (proximal); 75%

What is a type III Salter-Harris fracture and what percentage of incidence?

Lower; 10%

What is a type IV Salter-Harris fracture and what percentage of incidence?

Through (growth plate & above and below); 10%

What is a type V Salter-Harris fracture and what percentage of incidence?

Rammed (compression); 1%

Which Salter-Harris types are the most severe fractures?

Types IV and V. The often result in a shortened limb.

Describe a Salter-Harris Type I fracture.

Displaced, or widened at the growth(epiphyseal) plate. These injuries are associated with a favourable prognosis regardless of region.

What would lead a practitioner to suspect a Salter-Harris Type I fracture?

Point tenderness at the growth plate should lead the practitioner to suspect Type I Salter-Harris fracture even if radiographs are normal.

Describe a Salter-Harris Type II fracture.

Fracture through growth plate and metaphysis. Rarely do these injuries result in functional limitations, except at the knee and ankle

Does a Salter-Harris Type II fracture result in limb shortening?

These injuries may produce minimal shortening.

Describe a Salter-Harris Type III fracture.

Fracture through the growth plate and the epiphysis.

Do Salter-Harris Type III fractures result in longterm disabilities?

Yes, this type of fracture is prone to chronic disability because it typically involves the articular surface of the joint.

Describe a Salter-Harris Type IV fracture.

Fracture through the metaphysis, growth plate and epiphysis.

Do Salter-Harris Type IV fractures result in longterm disabilities?

Yes, like the type III fracture the articular cartilage can be damage in this type of fracture resulting in chronic disability. These injuries can produce joint deformity with angulation more likely at the knee and ankle.

Describe a Salter-Harris Type V fracture.

Compression or crush injury of the epiphyseal plate with no associated epiphyseal or metaphyseal fracture. Most occur in the lower extremities and are associated with a diaphyseal fracture.

How are Salter-Harris Type V fractures diagnosed and what is the prognosis?

In type V injuries, initial plain film x-rays are normal. The diagnosis is more often made in retrospect as premature closing is observed. These injuries have a poor prognosis because angulation and/or shortening are 100%.

What is congenital hip dysplasia?

Femoral head and acetabulum are not formed properly.

What is the incidence of congenital hip dysplasia?

Incidence is 1.5 in 1000 births. Abnormality is bilateral in > 50%. Girls 8 times more than boys.

How is congenital hip dysplasia diagnosed and treated?

Barlow maneuver (dislocate hip), Ortolani click test (reset hip). Treated with brace for 23-24 hours/day for 6-8 weeks.

What is Slipped Capital Femoral Epiphysis (SCFE)?

A Type I Salter-Harris epiphyseal injury. Most common adolescent hip disorder.

What is the etiology of Slipped Capital Femoral Epiphysis (SCFE)?

Genetic (African American > Caucasians). Mechanical (growth spurt, overweight).

*Who is Slipped Capital Femoral Epiphysis (SCFE) more common in?

More common in obese males (tends to be preteens - teens)

*What are three symptoms a patient with Slipped Capital Femoral Epiphysis (SCFE) may present with?

(1)Present with a limp, (2)hip laterally rotated and reports of knee, (3)hip or anterior thigh pain

How is Slipped Capital Femoral Epiphysis (SCFE) misdiagnosed?

(1)Suspected hip referral pain, (2)20 - 50% report knee pain only and are written off as growing pains

Upon physical examination of a patient with Slipped Capital Femoral Epiphysis (SCFE) what two findings would you expect?

(1)Loss of internal rotation, abduction, flexion (metaphysis moves anterior and externally rotates), (2)Increased hip extension

What is the treatment for Slipped Capital Femoral Epiphysis (SCFE)?

Gently reduce with traction, ORIF with pins to avoid necrosis

*What are three potential complications of Slipped Capital Femoral Epiphysis (SCFE)?

(1)Avascular Necrosis, (2)Chondrolysis, (3)Premature OA

What is Legg-Perthe's disease?

Avascular necrosis of femoral head. Cause is unknown.

*What is the incidence of Legg-Perthe's disease?

Occurs between ages 3-11. 5 times more common in boys (particularly active boys).

Is Legg-Perthe's disease bilateral or unilateral?

Bilateral in 15% of affected children

What is the prognosis if Legg-Perthe's disease is diagnosed before 6 years of age? After 10 years of age?

6yo: Good prognosis


10yo: High risk for early OA

*Where can the pain of Legg-Perthe's disease present?

Pain may be in the hip or knee.

What three symptoms will a patient with Legg-Perthe's disease present with?

(1)Loss of abduction and internal rotation, (2)Atrophy of the upper thigh muscles, (3)Ambulates with a limp

What is the treatment for Legg-Perthe's disease and how is it diagnosed?

Treatment: Traction, leg braces (~8 months)


Diagnosis: Confirmed with x-ray

What is Osgood-Schlatter disease?

Osteochondritis of the tibial tubercle. Is thought to be due to continuous traction of the immature epiphyseal insertion by the patellar tendon. Athletic activity +/- a recent growth spurt may lead to cartilage detachment.

What are the signs and symptoms of Osgood-Schlatter disease?

Pain, swelling and tenderness occur at the site of the patellar tendon insertion. Self-limiting disease.

How is Osgood-Schlatter disease diagnosed?

X-ray may show fragmentation of the tibial tubercle. Localizing the maximal point of tenderness over the tibial tuberosity.

What are two treatments of Osgood-Schlatter disease?

(1)Avoid excessive activity (particularly deep knee bends), (2)Excision of the ossicle may eventually be required

When is Osgood-Schlatter disease "healed"?

Complete remission when there is fusion of the tibial tubercle to the diaphysis. Resolution occurs over a period of several weeks to months.

What is Sever's disease?

Achilles tendon pulls on the epiphysis of the calcaneus. This can disrupt the plate and cause pain and swelling. Self-limiting disease. X-rays are often normal.

What is the incidence of Sever's disease?

Boys 8-15 most commonly affected

How is Sever's disease treated?

Rest, support, education

What is osteochondritis dissecans?

Condition characterized by subchondral bone necrosis and sometimes by complete or partial separation of the articular fragments. Articular cartilage remains intact until subchondral bone breaks down. Unlikely cause of knee locking.

*What is the most common site for osteochondritis dissecans?

Lateral aspect of the Medial femoral condyle of the femur

What is the incidence of osteochondritis dissecans?

Males, 10 - 30yo, athletes, result of shearing forces with low blood supply.

What are three treatments for osteochondritis dissecans?

In most cases the treatment is conservative. (1)Limitation of activities, (2)Isometric quadriceps exercises, (3)Open arthrotomy or arthroscopic surgery is only indicated when the fragments are greater than 1 cm in diameter

What is Sprengel's deformity?

Scapula does not descend. Often associated with abnormalities of the cervical spine (Klippel-feil & cervical rib). Can have a ligamentous connection between the medial border of the scapula and the lower cervical spinous processes. Scapula is not only high and small but also rotated downward.

What ROM is decreased with Sprengel's deformity?

Shoulder abduction

What is the treatment for Sprengel's deformity?

Surgery but function is seldom improved

What is Volkmann’s Ischemic Contracture?

Associated with supracondylar fractures of the distal humerus. The brachial artery may be caught and kinked in the fracture site. Similar to a compartment syndrome affecting nerves within the compartment. Not specific to children.

What are symptoms of Volkmann’s Ischemic Contracture?

Numbness, swelling, discoloration of the fingers with increasing arm pain. If left alone, can result in contractures of the muscles of the forearm.

What is another name for a pulled elbow?

Nursemaids elbow

What structures are affected with a pulled elbow?

Radial head is pulled through the annular ligament as the ligament is still thin and weak.

Which age group is most susceptible to a pulled elbow?

Preschool age children vulnerable to a sudden longitudinal pull or jerk on their arms

What are the symptoms of a pulled elbow?

Decreased supination and ++pain are the only significant findings.

Do x-rays show any significant results for a pulled elbow?

X-rays are usually negative