20. Clinical Correlations of Lower Extremity

Question 1

Young little chubbster comes in with history of groin and knee pain in the area of the anteromedial thigh. Pain is bilateral, but doesn’t necessarily hurt at the same time. Hurts worse with activity. Dx?

Answer 1

Slipped capital femoral epiphysis (SCFE)

Question 2

Causes of SCFE

Answer 2

repetitive overload

Question 3

Expected exam findings of SCFE

Answer 3

Limitation of internal rotation

Question 4

Test ordered for expected SCFE

Answer 4

Tests – plain x-rays.

Question 5

Tx for SCFE

Answer 5

surgical fixation

Question 6

Synovitis of hip exam findings

Answer 6

holding hip slightly flexed & ER Resistance to abduction and internal rotation

Question 7

5 yo child comes in with mom, she was at her PC last wek for her vaccine updates. Any motion caused pain; child refuses to bear weight; otherwise looks okay

Answer 7

Synovitis of hip

Question 8

Test findings in Synovitis of the hip

Answer 8

Sed rate 35-60mm/hr & CBC

- mild leukocytosis

Question 9

Tx for synovitis of the hip

Answer 9

NSAIDs for 1-3 weeks

Question 10

Swollen, extremely painful knee that is red and hot.
Passive & active ROM very painful
Expected Dx?

Answer 10

Septic joint

Question 11

Septic Joint in these two types of patients may present different

Answer 11

Usually has systemic signs, but may be absent in diabetic

patient or immunosuppressed patient

Question 12

Causes of septic knee joint?

Answer 12

typically Gonorrhea or skin flora

Question 13

Treatment of septic joints:

Answer 13

often requires surgical incision and drainage followed by IV antibiotics;

Question 14

articular surface destruction is a complication of what?

Answer 14

septic knee joint

Question 15

Patellar dislocation is usually a _____ dislocation

Answer 15

lateral

Question 16

Patient comes in with acute pain and swelling around her knee and feels a cutting sensation with active quadriceps contraction
Expected Dx?

Answer 16

Patellar dislocation

Question 17

Exam findings you would expect in patient with patellar dislocation

Answer 17

ecchymosis, effusion with a Positive apprehension test – feeling of instability with stressing of the joint

Question 18

Treatment for patient with patellar dislocation?

Answer 18

physical therapy– If recurrent may eventually need

surgery

Question 19

High school football player comes to your office the day after a football game. The night before he stated he quick changed directions when running a route and heard a ‘pop’ in his knee. He knee started swelling right away. What exam should we perform on this patient and why?

Answer 19

Perform a Lachmann exam; flex knee at 20-30 degrees, and flex; keep femur stabalized and check for anterior translation and endpoint of tibia.
–Expected ACL sprain

Question 20

Causes for ACL sprains:
Acute
Chronic

Answer 20

twisting non-contact, deceleration or hyperextension
injury
Acute - pop and rapid effusion
Chronic - instability

Question 21

Young lady was skiing and twisted her knee. She now experiences swelling in the joint as well as locking. Expected Dx?

Answer 21

Meniscal tear
usually occur with twisting on a loaded (weight-bearing)
knee in athletes; Degenerative tears are common in older patients

Question 22

What exam findings are we expecting with a suspected meniscal tear?
Treatment
a) Locked - needs reduction; referral to orthopaedic surgeon
b) No locking - physical therapy and relative rest

Answer 22

pain over joint line; pain with circumduction tests

McMurray is best known

Question 23

Pathology of Compartment syndromes

Answer 23

elevation of pressures in a muscular compartment high

enough to interfere with perfusion

Question 24

Two causes of compartment syndrome

Answer 24

a) Acute – severe bleed – usually caused by fracture
b) Chronic exertional – from hypertrophied muscle in tight
compartment with exercise (which increases muscle bulk up to 20%)
c) Common locations – leg»forearm

Question 25

Patient presents with diffuse pain over leg and weird tingly sensation. Leg is cool to the touch. Excpected Dx?

Answer 25

Compartment syndrome–early findings

Question 26

What are the late findings of compartment syndrome

Answer 26

Paralysis (late)
Pallor (late)
Pulselessness (late & rare)

Question 27

Acute compartment syndrome injury pressures

0 - 10 mm Hg =

Answer 27

normal

Question 28

Acute compartment syndrome of 10-30 mm Hg =

Answer 28

elevated, not dangerous

Question 29

Acute compartment syndrome of 30-40 mm Hg =

Answer 29

in acute compartment syndrome potentially

dangerous

Question 30

Compartment syndrome of ______ is usually dangerous, usually requires compartment release

Answer 30

40-60 mm Hg

Question 31

Compartment syndrome of ______ is consistently dangerous, requires urgent release

Answer 31

> 60 mm Hg

Question 32

Most ankle sprains are due to:

Answer 32

forced ankle inversion

Question 33

How do you perform an anterior drawer test and what is it for?

Answer 33

2. Exam
   a) Anterior drawer test – abnormal is 3-5 mm more than
   uninjured side; may also fell softer end point on injured side

Question 34

Positive squeeze test with pain at the ankle; suspicious for

Answer 34

high ankle sprain

Question 35

Positive squeeze test with pain at knee suspicious for:

Answer 35

Maisonneuve fracture – fracture of the proximal fibula associated with ankle injury

Question 36

What two tests would be positive for a high ankle sprain

Answer 36

External rotation test (+) suspicious for high ankle sprains

Question 37

45 yr old pt was playing basketball and heard a pop and felt like some asshole kicked him in the back of the right ankle. He now has difficulty walking. Dx?

Answer 37

Achilles tendon rupture

Question 38

What do we expect to see in exam findings in patient with achilles tendon rupture?

Answer 38

Defect in Achilles: Pain & weakness with plantar flexion

Question 39

Recommendation for tx of achilles tendon rupture

Answer 39

either acute immobilization or surgery