What a pain in the ____________!
What........ is going on with this patient?
This'll make you feel better... I hope.
If it's not this... it could be that!
Back to basics
100
Name 4 common causes of hip pain.
a. Adductor muscle strain b. Adductor muscle tendinopathy c. Hip joint synovitis d. Hip labral tear e. Hip Chondral lesion
100
What is the most common hip disorder affecting adolescents?
What is a SCFE (Slipped Capital Femoral Epiphysis)
100
True or False: When executing diamond box taping for the hip, you should tape along the dermatomal distribution to offload the inflamed tissue.
True
100
What 3 conditions are considered most often with Patellar Pain Syndrome?
Patellar tendonitis, Chondromalacia patellae, and Patellar malalignment
100
What is open packed position of the hip?
30 degrees flexion, 30 degrees abduction, and slight ER
200
Name 3 factors that contribute to the miserable malalignment.
Increased femoral anteversion, excessive lateral joint compression, excessive Q-angle, patellar subluxation, lateral tibial torsion, and/or STJ pronation
200
Name the four types of equinus.
Ankle equinus --> normal dorsiflexion is limited due to an osseous block between the tibia and talus Gastrocnemius-Soleus equinus --> acquired or congenitally shortened triceps surae Forefoot equinus --> the foot is plantarflexed at the midtarsal joint Metatarsal --> the foot is plantarflexed at the tarsometatarsal joint
200
Imaging is often used in the diagnosis of knee pathology. In determining if your patient may need imaging, what are at least 3 principles of the Ottawa Knee Rule?
ONLY x-ray after trauma if one of the following is present: >55 yrs of age, tenderness (fibular head, patella, unable to flex knee >90), inability to WB both immediately and in ED
200
How can you differentiate between the presentation of OA of the hip and inflammatory arthritis of the hip?
OA: groin pain with activity, gradual worsening of pain, limp Inflammatory arthritis: pain in the morning, activity limitations, systemic involvement Note: These are the definitions/ways to differentiate based on Dr. Watson's powerpoints. Check the charts for more ways to differentiate!
200
What is the origin and insertion of the tibialis posterior?
O: Posterior surfaces of interosseous membrane and adjacent regions of tibia and fibula I: Mainly to tuberosity of navicular and adjacent region of medial cuneiform
300
What are 2 signs and symptoms of an aggravated synovial plicae?
medial knee pain, swelling, clicking, locking sensation, inability to sit for long periods
300
When performing Thessaly's test, what are you diagnosing with medial rotation as opposed to lateral rotation?
Medial rotation tests the lateral meniscus, whereas lateral rotation tests the medial meniscus
300
Describe the importance of proprioceptive training for an individual who has a history of ankle sprains.
Proprioceptive training can help maintain joint stability through the feedback of position and movement sense. In a healthy ankle, proprioceptive feedback is provided by mechanoreceptors in the ankle. After an ankle sprain, however, mechanoreceptors may not be able to detect joint position and motion around the joint, thus increasing the likelihood that the patient will sustain another ankle sprain in the future.
300
This condition begins when bleeding from a deep muscle contusion contacts the periosteum of bone. HINT: most commonly seen in the quads.
Myositis ossificans
300
Describe ROM requirements of the knee (in degrees) for walking, stairs, sitting, or donning/doffing shoes.
a. 65° walking b. 83°stairs c. 93° sitting d. 106° donn/doffing shoes
400
When examining a 46 year old, female patient who presents to you with hip pain, you should be sure to screen for.....
Intra-abdominal abnormality including: appendicitis, prostatitis, UTI, GYN conditions
400
When performing the talar tilt test, what structures are you testing in eversion versus inversion?
Eversion: deltoid ligament Inversion: lateral calcaneonavicular ligament
400
Name a manual technique you can do to improve knee flexion. (Be ready to demonstrate)
A) posterior tibial glide at 0 degrees: the patient is in supine with a block under the distal femur. The PT stands with the proximal hand stabilizing the femur while the distal hand stabilizes the proximal tibia. A POSTERIOR force is applied to the proximal tibia. B) posterior tibial glide at 90 degrees: the patient is in supine with the hip flexed to 45 degrees and then knee flexed to 70-90 degrees. The PT sits on the patient's foot to stabilize the leg, while applying a posterior force to both sides of the proximal tibia. C) posterior tibial glide at 30 degrees: the patient is PRONE with a block under the middle thigh and proximal tibia. The PT stabilizes the distal femur and proximal tibia while applying an ANTERIOR force to the distal femur.
400
This condition presents with proximal flexion of the interphalangeal joint accompanied by hyperextension of the distal interphalangeal and metatarsophalangeal joints. You may also see a painful callus on the tip of the toe.
Hammer toes!
400
Describe normal talocrural ROM in.
Plantarflexion: 50 degrees Dorsiflexion: 20 degrees
500
What are the most common sites for fracture in the talus?
Neck, body, or lateral facet of the talus
500
Name 3 of the nerves (and their innervations) you are screening during a neurovascular assessment of the hip.
Superior Gluteal Nerve (L4-S1) Sciatic Nerve (L4-S3) Femoral Nerve (L2-L4) Lateral Femoral Cutaneous Nerve (L2-3) Ilioinguinal Nerve (L1-L2) Obturator Nerve (L2-L4)
500
Grafts from which two muscles have been used successfully for ACL repair? Which is more successful?
Grafts from the patellar tendon and hamstring tendon The hamstring tendon coupled with gracilis graft has been down to be stronger in ACL reconstruction.
500
How can you differentiate between a mild, moderate, or severe ankle sprain based on clinical presentation?
Grade I: minimal loss of function, little swelling, localized tenderness and mild pain in response to stress Grade II: moderate loss of function, difficulty on toe raise and walking, diffuse tenderness, and swelling Grade III: functional disability, marked tenderness and swelling, marked loss of ROM, a need for crutches
500
Selecting the appropriate manual technique for your patient with limitations in knee ROM requires understanding of basic knee kinematics. Fortunately, you know how the knee works (because you're a boss). Describe what happens in the knee joint with open chain flexion as opposed to closed.
Open: tibial condyles roll and slide posteriorly on the femur Closed: femur rolls posteriorly while gliding anteriorly on the tibia
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