Applied Anatomy
What type of joint is the hip?
Ball and Socket
This type of hip pain involves pathology of structures inside the hip joint such as the labrum, articular surfaces, and synovium.
Intra-articular hip pain
What test is better to assess for ACL tears: Anterior drawer or Lauchman's?
Lauchman's (Sp= 94%, Sn=85%)
[Anterior Drawer (Sp=58%, Sn=49%)]
Describe the difference between gene varus and valgum
Varum: excessive space between the knees
Valgum: excessive space between feet when knees are touching.
What is the Beighton Scale Used for?
General Laxity
What is the closed pack position of the Knee?
Full extension AND lateral rotation of the tibia
Entrapment of the sciatic nerve in the buttock region, often by the piriformis or gemelli muscles, is known as this syndrome.
Deep Gluteal Syndrome
What are the two main tests to utilize if you suspect a PCL tear?
Posterior Sag Sign (perhaps the easiest special test of this class)
Posterior Drawer test
What is Knee OA?
Degeneration of articular cartilage
Factors: age >/= 45, weight, genetics
Clinical Exam: dx on imaging, structural deformities
What are the 3 special tests for diagnosing lateral epicondylitis?
Cozens, Medleys, Mills
What is the closed pack position of the hip and is it the point with the most boney congruency?
Full EXT, IR, And
No, it't the point of the most muscular support
This childhood condition is characterized by avascular necrosis of the femoral head and typically affects boys ages 3–12.
Legg-Calvé-Perthes Disease
What is the lateral pivot shift test aiming to do?
Medial rotation and anterior translation of the tibia: subluxation of the tibia in absence of ACL
more to come...
How would you TEST the difference between an MCL versus LCL tear?
Varus stress test
Valgus stress test
TEST AT FULL EXT AND 30 DEGREES FLEXION
This is the PRIMARY difference between back pain with mobility deficits versus movement coordination impairments.
Mobility deficits: hypo mobility, pain at end range
Movement Coordination Impairments: Hypermobility, challenge in midrange and muscle weakness.
What is the alpha angle measuring?
line from the center of the femoral head through the center of the neck
Normal: <60°
This condition is diagnosed with the following exam findings: IR > 30 degrees when hip is at 90 degrees of flexion, + FADIR and/or FABER, + micro instability tests, hx of clicking and popping, lateral center edge angle <25 degrees
Hip Instability
What is the terrible triad knee injury?
the medial collateral ligament (MCL), the anterior cruciate ligament (ACL), and the medial meniscus
What is the cluster for meniscal pathology?
h/o of mechanical catching/locking, joint line tenderness, pain with forced knee hyper extension, pain with maximum passive knee flexion, + McMurray's.
This is the cluster for neck pain with radiating pain
+: General ULTT, Spurling's A, Distraction, <60 rotation ipsilateral
At what degrees does the IT band act as a knee Extensor versus knee Flexor?
Knee Extensor <30 degrees
Knee Flexor >30 degrees
In the lateral pivot shift test, you are using the IT band to REDUCE the tibia once you flex the knee past 30 degrees.
This is the Cluster for Hip OA
Age >50
Hip Pain
Morning stiffness for <1 hr>/= 24 degrees less of hip IR or >/= 15 degrees difference side to side with FLEX AND IR of the affected hip (Seated)
Increased pain with passive IR of hip
This is hard to do!:
Insidious onset, aggravated by increased PF joint compressive forces. Underlying factors: overuse, muscle strength deficits, movement coordination impairments, mobility impairments.
You MUST rule out other dx. Alsop evaluate the hip.
What does a score of 2+ mean for the brush-stroke test?
0:no discernable fluid
1+: fluid returns after lateral sweep
2+:Fluid returns spontaneously after medial sweep
3+: can't sweep fluid out of medial pouch
List the following actions associated with the myotome C1-T1 and L1-S2 (ALL)
C1/C2 - Neck flexion, C3 - Neck side bend, C4 - Scapular elevation "shrug'' C5 - Shoulder abduction, C6 - Elbow flexion, wrist extension, C7 Elbow extension, wrist flexion, C8 - Thumb CMC ext, finger flexion, T1 - Finger abduction/adduction, L1/L2 - Hip Flexion, L3/L4 - Knee Ext, L5 - Big Toe Ext, S1/2 - Heel Raises (single leg x 10 ea)