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Flashcards in Lower Extremity Deck (91)
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1
Q

Dextroscoliosis

A
  • Inspect from several angles and with patient bending forward
  • curve is convex (toward) the right
2
Q

Levoscoliosis

A
  • Inspect from several angles and with patient bending forward
  • curve is convex (toward) to the left
3
Q

What could you see as a result from Dextroscoliosis/Levoscoliosis

A

May see falsely apparent leg length “discrepancy”, with “shortening” on the concave side

4
Q

Sciatica

A

Pain, numbness, or tingling in the leg – caused by injury to or pressure on lumbar nerves L3-L5, sacral nerves S1-3 or compression of the sciatic nerve itself

Weakness is a red flag

5
Q

Radiculopathy

A

Sciatica caused by injury/pressure on a particular nerve root (e.g. L4), is considered a radiculopathy (e.g. lumbar radiculopathy); another term – lumbosacral radiculopathy

Weakness is a red flag

6
Q

How do you Tests for impingement of spinal nerves / sciatic nerve?

A

-Straight leg raise (SLR)

  • Elevate leg, dorsiflex foot Pain into ipsilateral leg is a positive test – suggests a lumbosacral radiculopathy
  • Assess degree of elevation at which pain occurs (e.g. 60 degrees) – “Positive SLR – pain down to mid-calf with elevation of leg to 600”
  • Pain in the contralateral leg is a positive crossed SLR
  • Tightness / discomfort in the buttocks or hamstring is not a positive test
7
Q

Describe the Seated SLR test (“flip sign”)

A
  • Patient seated with his/her hands on table
  • Extend leg
  • Watch for pt to “flip back” when leg extended
8
Q

Valgus/valgum

A

Inward

9
Q

Varum

A

bowed out

10
Q

FAbER Test

A
  • Flex –> Abduct –> Externally Rotate
  • Assesses SI Joint Dysfunction
  • Assesses Adductors
11
Q

Antalgic gait

A
  • Limp adopted to avoid pain on weight-bearing structures, characterized by a very short stance phase
  • Patient remains on painful leg for as short a time as possible
  • “Limp” / Trendelenburg lurch –> No dorseflexion
12
Q

Describe a normal plum ling

A

neck, AC joint, hip, and knee aligned when you look at a person from the side

13
Q

Trendelenburg sign

A
  • Identifies weak hip abductor muscles on side that is bearing weight (side we are testing)
  • If contralateral hip (not bearing weight) drops, the hip abductors on the weight bearing side are weak
14
Q

Ottawa Knee Rules Level 1

A
  • Helps determine if patient needs to get an xray or not
  • Age >55
  • Isolated tenderness at the patella
  • Tenderness at the fibular head
  • unable to flex knee at 90 degrees
  • UNAble to bear weight immediately after the ER for 4 steps
15
Q

Baker’s cyst (popliteal cyst)

A
  • A synovial fluid cyst located in the popliteal space
  • Palpable as fluctuant fullness
  • May be painful &/or, if they leak, result in calf swelling
  • Best to palpate with knee extended
16
Q

Popliteal artery aneurysm

A
  • Usually due to atherosclerotic vascular disease
  • Males&raquo_space;females
  • Usually > 65 years old
  • The most common aneurysm of the peripheral vascular system
  • Bilateral > 50% of the time
  • Diagnosis: pulsatile swelling behind the knee
  • Best to palpate with knee extended
17
Q

Meniscal Tears

A
  • Wight bearing with rotation
  • Pain / Swelling localized at joint line.
  • Won’t see much swelling – why?
  • -> Depends on the location of the tear… if you tear at an a-vascular zone… no swelling … needs surgery (gets chopped out)… increases your risk for osteo-arthritis
  • -> Outer zone –> vascular zona … it will get sewn down and it will heel itself “Buckethandle tear”
  • Maximum amount of swelling is frequently seen the day after injury.
  • May report popping, clicking, locking (gets in the intercondilar notch)
  • May report “feels like knee is going to give out” – very specific complaint to meniscal injury
  • Surgery – repair or menisectomy
18
Q

Patellar dislocations

A
  • knee flexed between 20-45˚ w/valgus load – then max contraction of quads
  • Will almost always go laterally
19
Q

Describe the Slump Test

A
  • Seated –> Slump –> tuck chin –> extend knee –> Dorsiflex
  • For sciatica or herniated disk
20
Q

Patellar fractures

A
  • Significant direct blow/force
  • not common in athletics
  • extremely painful – unable to SLR
21
Q

Chondromalacia patellae

A
  • degenerative process that results in a softening (degeneration) of the articular surface (hyaline cartilage) of the patella
  • MOI – overuse w/poor tracking
  • Commonly large Q-angle
  • The more knock-kneed you are, the greater the Q-angle.
  • Women naturally have greater Q-angles (wider hips for child-bearing).
  • Thus, women experience chondromalacia patella more frequently than men.
  • Normal = <15°
22
Q

Patellar Tendonitis

A

“Jumper’s knee”

  • MOI – overuse w/heavy quad loads & poor quad flex.
  • S/S - Pain increased with activity, aches after exercise, possible swelling, pt tenderness at inf pole, increased pain with resisted knee extension
  • Risk of tendon rupture!
23
Q

MCL Sprains MOI and S/S

A
  • Most frequently injured lig in the knee
  • MOI: Blow to lateral side of the knee forcing valgus
  • S/S: pain, mild to mod swelling exterior to jt, discoloration, and point tenderness along length, valgus instability, may report feeling a “pop”
24
Q

LCL Sprains MOI and S/S

A
  • MOI: Foot planted, medial side impact/varus force
  • S/S: pain, lateral knee swelling, ecchymosis, point tenderness over the length of the LCL, varus instability, may feel “pop” with complete rupture
25
Q

Anterior Cruciate Ligament Sprains

A
  • MOI: A twisting maneuver during weight bearing – such as changing directions or landing from a jump while twisting
  • Forced hyperextension
  • Landing w/bent knee with center of gravity too far posterior – ex: skiing in deep powder
  • A direct blow to the back of the tibia that drives the tibia forward (very rare!)
  • S/S: Immediate pain & feeling of instability
  • Audible “pop”
  • Joint effusion and loss of motion usually result within 24 hours
  • Athlete will be unwilling to bear weight or will have a sense of significant instability with weight bearing
26
Q

ACL Tear Test

A

Lachman’s Test

27
Q

PCL Sprains MOI and S/S

A
  • MOI: injured by a direct force against the ant. tibia, driving it posteriorly
  • S/S: pain, joint effusion, and limited range of motion into full flexion & extension, may have audible “pop”
  • Athletes who have good quadriceps and hamstring muscle strength may not complain of a feeling of instability with weight bearing. So this type of injury is sometimes missed.
28
Q

Describe the Hip Scour Test

A
  • Tests Acetabular Labrum

- Apply axial load and “grind” the Femur into the acetabulum to try to catch a part of the torn labrum

29
Q

Ober’s Test

A
  • Tests the IT band
  • Roll over to your side –> knee flexion –> Tibal IR –> hip ABD –> extension –> Drop Leg to table
  • Positive test is if leg will not lower to the table
30
Q

Noble’s Test

A
  • Tests the IT band
  • Patient is supine, palpate IT band and passively flex and extend knee
  • Subjective —> “do you feel pain when I do this?”
31
Q

Thomas Test

A

-Laying on back kind of in fetal position with legs hanging off the table … as he drops one leg down it should just droop down… UNLESS

  • Illiopsoas (B)
  • Positive is if femur raises off table

or

  • Rectus femoris (A)
  • Positive if unable to have 90 degree flexion of the knee
32
Q

Unhappy Triad”

A
  • Sprain of the MCL, ACL, and tear of the medial meniscus.
  • Athlete receives a lateral blow to the knee with the foot fixed. Combination of valgus force and rotation of the leg places stress on the medial collateral ligament first.
33
Q

Antiversion of the hip

A

-Femoral head has to rotate anteriorly for the toes to face forward
“pigeon foot”

34
Q

Retroversion of the hip

A

Femoral head has to rotate posteriorly for the toes to face forward
“Cartoon feet” AKA “duck foot”

35
Q

Clarks test

A

To test for antiversion or retroversion of the hip

  • Feel for the greater trocanter
  • Take a gonio___ measurement
  • 8-15 degrees is acceptable = Neutral
  • Outside of the range = anti/retroversion… look it up
36
Q

What is effusion?

A

Swelling IN the joint space

-Edema is swelling OUTSIDE of the joint space

37
Q

Iliotibial Band

A
  • Origin - Tensor fascia latae M. & 2/3 glut max M.
  • Insertion - Gurdy’s tubercle
  • MOI: overuse w/tight TFL and glut max
  • S/S: Pain over lateral epicondyle; Pain going DOWN stairs; Pain when leg is swinging forward during gait
  • Treatment: Must stretch glut max and TFL; Arch supports commonly help
38
Q

Popliteus Tendonitis

A
  • MOI: Overuse injury if hamstrings get tired and popliteus has to carry more than its regular load in knee flexion
  • S/S: nothing unique; pain w/resisted knee flexion; pain w/palpation
39
Q

Osgood-Schlatter’s Disease

A
  • MOI: repetitive traction on the tibial tuberosity apophysis via the patellar tendon and quadriceps group
  • Occurs in young athletes when the growth plate of the tibial tuberosity is still fluid
  • S/S: aggravated by running, jumping, or kneeling in youth athletes; pain & swelling around tuberosity
40
Q

Sinding-Larsen-Johansson Disease

A
  • resembles Osgood-Schlatter’s disease except that the pathology involves the proximal rather than the distal end of the patellar tendon
  • caused by repetitive traction forces on the inferior pole of the patella
41
Q

Peroneal nerve contusion

A
  • nerve passes just below the proximal head of the fibula, where it lies subcutaneously
  • localized pain from the contusion and a radiating pain to the anterior lateral leg musculature and dorsum (back) of the foot
42
Q

Prepatellar bursitis

A

-most commonly injured, direct trauma, large amounts of fluid between skin and patella; looks like golf ball hanging

43
Q

Infrapatellar bursitis

A

-result of repetitive kneeling or repeated trauma over the distal patellar tendon.

44
Q

Suprapatellar bursitis

A

-fills whole knee jt capsule – common after ACL tear

45
Q

Pes Anserinusbursitis

A

-related to cycling or running, constant friction or external blow

46
Q

Baker’s Cyst

A
  • Posterior aspect of knee
  • Often palpable (red arrow)
  • Common after ACLr
  • Painful with full extension and full flexion
  • Surgical if necessary for pain relief
  • Playable as tolerated
47
Q

Plica or ‘Medial Shelf’

A
  • Plica is an unusual fold of the synovium
  • MOI: Plica gets pinched under the patella if the quads fatigue and can’t pull it out of the way soon enough before the patella compresses
  • S/S: pain, popping, snapping, or just aching at rest under medial edge of patella
48
Q

Fat Pad Impingement or Bruise

A
  • MOI: bottom of the patella pinches, or impinges on, the fat pad on top of the tibia
  • S/S: will report a sensation of pinching, bruise feeling in full extension
49
Q

Sweep Test

A
  • Testing for knee effusion (fluid accumulation around the joint usu. assoc. with trauma or overuse)
  • With leg straight, “milk” knee joint fluid down one side & up the other - observe for bulge
50
Q

Ballottement of patella

A
  • Testing for knee effusion
  • Apply downward pressure from above the knee to milk fluid down
  • Push patella into the joint space, feel for fluid / boggy sensation
51
Q

Genu valgus

A

“knock knees”

52
Q

Genu varus

A

“bow legs”

53
Q

Valgus stress test

A
  • Testing for medial collateral ligament (MCL) laxity &/or pain
  • With leg slightly flexed, stabilize the knee & abduct the distal leg
  • Note any ligament laxity or pain
54
Q

Varus stress test

A
  • Testing for lateral collateral ligament laxity &/or pain
  • Like valgus stress test, except adduct the distal leg
  • Note any ligament laxity or pain
55
Q

Lachman’s test

A
  • Testing for ACL tear
  • Patient’s knee is flexed ~ 15-20º
  • You stabilize thigh with one hand, with other hand, pull upper tibia forward
  • Compare sides
  • More sensitive sign of ACL tear than drawer test
56
Q

Anterior drawer sign

A
  • Testing for anterior cruciate ligament tear (ACL tear)
  • Patient’s knee is flexed 90º; foot & hips stable
  • Pull upper tibia forward assessing for excessive forward movement
  • Compare sides
57
Q

Posterior drawer sign

A
  • Testing for posterior cruciate ligament tear (PCL tear)
  • Similar to anterior drawer sign, except tibia is pushed back (rather than pulled forward)
  • Excessive laxity suggest PCL tear
58
Q

McMurray’s test

A
  • Testing for meniscal tear
  • Flex knee, place thumb & index finger on joint space
  • To test for medical meniscal tear
  • Rotate foot laterally and extend leg
  • Palpable click or pain at joint line indicates medial meniscal tear
  • To test for lateral meniscal tear
  • Same procedure done except – rotate foot medially, and extend leg
  • Palpable click or pain at joint line indicates lateral meniscal tear

NOW THERE IS A NEW TEST… thessaly’s test

59
Q

Palpation – for pitting edema

A

-Press downward with thumb for a few seconds, observe for indentation:
-Indicate how high edema rises up leg
-Dorsum of foot
-Behind medial malleolus
-Pretibial (shins)
-Grade from 0 to 4+ edema
“2+ pitting edema to mid-calf”

60
Q

Posterior tibial pulse

A

Behind and slightly below medial malleolus

61
Q

Dorsalis pedis pulse

A

Dorsum of the foot Over 1st-2nd metatarsals

62
Q

Grade the amplitude of the pulse:

A
0	Absent, unable to palpate 
1+	Diminished, weaker than expected
2+	Brisk, normal
3+	Increased
4+	Bounding
63
Q

Ottawa Ankle Rules

A

See picture

64
Q

Ankle sprain vs Strain

A

Sprain – tear or stretch of a ligament (bone to bone)

Strain – tear of stretch of a tendon / muscle structure (tendon is muscle to bone)

65
Q

Anterior drawer sign

A
  • Testing for anterior talofibular ligament tear
  • Stabilize the distal tibia
  • Grasp & pull calcaneus forward assessing for excessive forward movement
66
Q

Anterior tibialis tendonitis

A
  • Tends to be more acute

- Isolate to confirm with MMT

67
Q

Achilles’ tendonosis

A
  • Tends to be more chronic
  • Obvious swelling
  • Long rehab w/ many set-backs
  • Risk of rupture – age group?
68
Q

Achilles’ Rupture

A
  • MOI – big bang!; usually age related; “weekend warrior”
  • Surgery
  • Suture mop ends together = LOTS of scar tissue!
  • Long, slow rehab
69
Q

Neuropathic ulcer

A

-Commonly assoc. with diabetes

70
Q

“Pes planus”

A

Flat foot

71
Q

Inversion Sprains

A
  • Most common MOI:
  • Plantarflexion with hindfoot inversion
  • 1st degree = ATF lig torn, little laxity, pain
  • 2nd degree = ATF lig torn & some CF lig damage, clear laxity but end pt, pain
  • 3rd degree = all three lateral ligs torn, laxity w/no end pt, pain, unable to bear weight
72
Q

Eversion Sprains

A
  • MOI: Land in plantar-flexion and rotation into eversion

- If excessive eversion may fracture the fibula (lateral Malleolus)

73
Q

Syndesmosis Sprains

A
  • MOI: Plantarflexion with hindfoot inversion and rotation of talus in mortise
  • Damage to ATF lig, CF lig, distal tib-fib lig (ant &/or post)
  • Often referred to as a HIGH ANKLE SPRAIN

-Takes longer to heal because every time the individual steps, the tib-fib lig is stressed

74
Q

Plantar Fascitis:

A
  • MOI: overuse; acute or chronic
  • S/S: Pain most severe when first getting out of bed in the morning
  • Pain generally diminishes during activity & increases when activity stops
  • Pt tender at the origin on the ant./medial calcaneous & distally to mid-fascia

-Predisposing factors: excessive pronation, obesity, abnormally high arch (pes cavus)

75
Q

Different types of Plantar Fascitis:

A

1) Tarsal Tunnel Syndrome
- Use Ankle DF with Foot Eversion

2) Tinel’s Sign
- Sever Disease (calcaneal apophysitis)
- If patient is 13 years old or younger
- Indicated if pain elicited when squeezing heel

3) Heel Spur
- get x-ray to confirm

76
Q

Turf Toe

A

-MOI: sprain of 1st MP jt from hyperextension

S/S: moderate pain in ball of foot under the big toe with gait

  • Swelling and signif pt tenderness on inferior jt
  • Incr pain w/toe extension

Treatment:

  • Turf toe tape
  • Steel inserts – very helpful!
  • Differential diagnosis with seasmoiditis or fracture
77
Q

Fracture to the base of the 5th metatarsal

A

-MOI: inversion moment commonly combined with landing from a jump

S/S: Very pt tender at head of 5th

  • Bone may even feel mobile
  • Cannot bear wt on that foot
  • Pain w/resisted eversion

Treatment:
-Refer on crutches for x-rays

78
Q

Lisfranc Injury:

A
  • Injury to any side of the 2nd metat head articulations; dislocations or fracture
  • MOI – varied; signif impact from something
  • S/S – painful wt bearing – inability to go into terminal stance of gait; pt tender in dorsal apex of mid-foot around head of 2nd metat
  • Treatment – refer immediately for x-rays
79
Q

Different types of foot pathologies (Part 1)

A

1) Spring Ligament Sprain

2) Heel Contusion
= Fat Pad Contusion

3) Morton’s Neuroma:
- compression of a nerve bundle betwn the metatarsal heads in ball of foot; most commonly betwn 3-4 or 2-3;
- MOI - shoes with narrow toe box
- S/S - tingling, burning, pain in the ball of their foot AND DISTALLY into assoc toes.
- Treatment – ditch the tight shoes permanently; may place felt pad directly under neuroma

80
Q

Different types of foot pathologies (Part 2)

A

1) Blisters
2) Bunion- inflammation and thickening of the bursa of the MTP joint of the big toe – with valgus deformity

3) Metatarsalgia
- Pain and tenderness under the metatarsal heads
- Unable to progress through terminal stance during walking because cannot load forefoot

81
Q

Describe type of toe pathologies (Part 3)

A

1) Claw Toes
- Hyperextension of MP jt. and flexion of PIP & DIPs
- Assoc. with pes cavus, fallen metatarsal arch, or problems with intrinsic musculature

2) Hammer Toes
- Extension contracture at MP jt. Flexion contracture at PIP, DIP may be in any position
- Can be congenital, poor fitting shoes, hallux valgus or muscular imbalance

82
Q

Describe Pes Cavas

A
  • Rigid foot, High Arch
  • Plantar soft tissues are shortened
  • Often leads to claw toes
  • Difficult to absorb shock
83
Q

Describe Pes Planus

A
  • Flat, mobile foot
  • MOI: Congenital, trauma, muscle weakness
  • All infants have flat feet until ~ 2 y.o.

Two types:

1) Rigid or congenital: Rare
- Calcaneous in valgus & midtarsal in pronation
- Visible in NWB position
2) Flexible or acquired
- Due to tibial torsion or subtalar jt. dysfunction
- Apparent in WB position, but if stand on tiptoes, arch re-appears

84
Q

Pes cavus

A

High Instep

85
Q

Signs of peripheral artery insufficiency

A
  • Palpation: Pulses Femoral, popliteal, posterior tibial, dorsalis pedis
  • Skin temperature: Cool
  • Capillary refill: Delayed (> 2 sec)

-Auscultation for bruits: Abdominal aorta, Femoral & popliteal arteries

86
Q

Venous insufficiency [varicose veins (varicosities) ]

A

-Dilated, tortuous superficial veins - result from defective structure & function of the valves of the saphenous system

Symptoms include:

  • Dull ache or pressure sensation after prolonged standing; relieved with elevation
  • Dependent ankle edema may develop
  • Ankle ulcerations may develop
  • Superficial thrombosis / thrombophlebitis may occur
  • Support hose if prolonged sitting –> Flight to Australia
87
Q

Stasis dermatitis

A
  • Due to chronic venous insufficiency with incompetent valves & higher pressure in capillary bed.
  • Tissue is damaged & inflamed
  • “Brawny,” non-pitting edema
88
Q

Lymphedema

A

-Results from blockage of the lymph vessels that drain fluid from tissues throughout the body (& transport immune cells to where they’re needed)

89
Q

Homan’s sign

A
  • Testing for deep venous thrombosis
  • In a patient with calf pain, tenderness, &/or swelling
  • Passivel dorsiflex the foot
  • Calf pain with dorsiflexion suggests DVT
  • Questionable reliability & validity.
  • Calf pain may be due to some other cause
  • Negative test does NOT rule out DVT
90
Q

Evaluation of ???? IDK

A

Specific Structure Tests:

  • Homan’s Sign (DVT)
  • Thompson’s Test (Achilles’ rupture)
  • Compression Test (fx)
91
Q

Describe thessaly’s test

A
  • Its to evaluate Medial and lateral menisci
  • Person will hold on to something (on both sides)
  • They will swivel at the knee
  • Now bend the knee and swivel
  • WEIGHT BEARING