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Family Medicine > Ankle + knee pain > Flashcards

Ankle + knee pain Flashcards

1
Q

ligament stretched or torn

-don’t hear or feel a “pop” but swollen

A

sprain

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2
Q

tendon or muscle stretched or torn

- tender, tight muscle

A

strain

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3
Q

lateral (fibula) ligaments of ankle joint (ant to post)

A 
#1 anterior talofibular ligament (most susceptible to acute injury)
#2 calcaneal fibular ligament
posterior talofibular ligament
peroneus longus
brevis tendons
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4
Q

medial (tibia) ligaments of ankle joint

A

deltoid ligament

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5
Q

primary plantar flexor

A

achilles tendon: attaches at posterior portion of calcaneus

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6
Q

primary everters of ankle

A 
inferior to lateral malleolus:
peroneus brevis (attaches to distal 5th metatarsal, can cause avulsion fracture)
peroneus longus
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7
Q

primary inverter of ankle

A

posterior tibialis tendon: inferior to medial malleolus

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8
Q

high ankle sprain ligaments

A

anterior tibiofibular ligament
posterior tibiofibular ligament
syndesmosis: sheet of interosseous membrane

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9
Q

ankle injury grades

A

grade I: minimal swelling + pain, ATFL stretch, no instability, able to bear weight with some pain
grade II: partial tear of ATFL, stretched CFL, > pain + swelling, mild-mod joint instability, lots pain with weight bearing, loss of ROM
grade III: complete tear of ATFL and CFL, partial tear of PTFL, > joint instability, can’t bear weight, loss of function

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10
Q

most common ankle injury

A

forced inversion with ankle in plantar flexion (tear anterior talofibular ligament)

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11
Q

causes of tendinosis (usually chronic ankle pain, d/t overuse causing inflammation, partial tendon rupture)

A

achilles tendon
peroneal tendon
posterior tibialis tendon

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12
Q

cause of achilles tendon rupture

A

jumping sports
steroid injection complication
FQ antibiotics

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13
Q

hemarthrosis think

A

hemophilia

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14
Q

knee pain + limp, think

A

hip disorder:
legg-perthes
slipped capital femoral epiphysis

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15
Q

ankle/knee pain + poor response to treatment

A

malignancy

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16
Q

bony swelling + ankle/knee pain

A

tumor

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17
Q

fever + ankle/knee pain

A

osteomyelitis

septic arthritis

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18
Q

if “snap” or “pop” felt

A

ligament rupture

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19
Q

inability to bear weight after injury think

A

fracture (not sprain)

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20
Q

PE for joint

A 
ROM
strength
palpation
stability
gait
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21
Q

ottowa ankle rules to determine need for xray with ACUTE ankle injury: sensitive for ankle and midfoot fractures
must be > 6yo

A

pain in malleolar or midfoot zone and one of following:
bony tenderness at posterior edge or tip of either malleoli
bony tenderness over navicular(medial)
bony tenderness at base of 5th metatarsal (lateral)
inability to bear weight both immediately and in ED (4 steps)
if negative: probably not a fracture

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22
Q

talar tilt test

A

lateral ankle pain
anterior talofibular + calcaneofibular ligament
grasp each side of foot at talus and apply varus stress (bow out)
+ if asymmetric ROM between ankles

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23
Q

anterior drawer test

A

lateral ankle pain
anterior talofibular ligament
grasp calcaneus and try to slide heel forward
+ if at least 3 mm difference between ankles

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24
Q

squeeze test

A

anterior/lateral ankle pain
compress tibia and fibula above midpoint of calf
+ pain: syndesmosis sprain (high ankle)

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25
Q

cotton test/rocker test

A

anterior/lateral ankle pain

like talar tilt test - mediolateral force applied and any ROM > 3 mm is abnormal

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26
Q

eversion + dorsiflexion trauma (rare) causes

A

medial ankle pain:
deltoid ligament sprain (very strong)
often associated with fracture or posterior tibialis tendon injury

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27
Q

medial ankle pain think

A

deltoid liagment

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28
Q

posterior ankle pain think

A

achilles tendon:

crepitus, tenderness, swelling, gap

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29
Q

thompson (mildcalf compression) test

A 
assess if achilles tendon is intact
lie prone with feet over edge of table
squeeze gastrocnemius and soleus
normal: plantar flexion
positive: no foot movement (complete or near complete rupture of tendon)
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30
Q

if ankle bone pain at night, bone pain without injury, or don’t respond to tx get

A

xray

31
Q

imaging for achilles tendinosis or achilles tendon rupture

A

no gold standard: U/S or MRI (good if young athlete - help with prognosis)

32
Q

early mobilization of ankle sprain

A 
more likely to return to sport vs brace
improve functioning
reduce pain + swelling
return sooner
less instability
33
Q

lace up brace for ankle sprain

A

less likely to cause disabling swelling vs semirigid brace

34
Q

semirigid brace for ankle sprain

A

return sooner vs elastic bandage

prevent ankle sprain during high risk sport if previous grade II or III tear

35
Q

PT for ankle sprain

A

prevents subsequent sprains

36
Q

acute grade I ankle sprain tx

A

RICE symptomatically
early mobilization: bear weight as tolerated
NSAID or acetaminophen for pain

37
Q

acute grade II ankle sprain tx

A

RICE for 2-3 days
NSAIDS
immobilization in lace up splint 2-7 days, crutches

38
Q

acute grade III ankle sprain tx

A

same as grade II - but longer recovery
immobilization in air-stirrup splint or below knee cast for up to 3 mo
PT afterward
if still functionally impaired or separation of tibia and fibular: need surgery

39
Q

syndesmosis sprain tx

A

body weight can increase stress, pain, instability
removable splint or casting to allow for progressive weight bearing as tolerated
passive ROM - esp dorsiflexion within week of injury

40
Q

if avulsion fragment > 2mm

A

immobilize in cast or splint and refer to surgeon

41
Q

avulsion of peroneus brevis on 5th metatarsal head

A

heals without treatment

immobilize until weight bearing tolerated

42
Q

refer to surgeon if

A

fracture of base of 5th metatarsal (jones fracture)
proximal 2nd, 3rd, 4th (Lis Franc)
growth plate (salter-harris fracture)

43
Q

treatment of achilles tendinosis

A

rest, ice, heel lifts
rehab of gastroc and soleus: stretching, ROM, then strength
NSAIDS

44
Q

treatment of achilles tendon rupture or if very active with achilles tendinosis

A

surgery (prevent re-rupture)

45
Q

all patients with ankle injuries should undergo

A

rehab

46
Q

knee joint

A

patella
tibia
femur

47
Q

primary stabilizers of knee

A

ACL (insertion), PCL, MCL, LCL
menisci
joint capsule
medial and lateral retinacula attach to patella

48
Q

knee actions

A

during flexion: forward translation, internal rotation of tibia
extension: rearward translation, external rotation

49
Q

ACL role

A

prevent anterior movement of tibia on femur

helps MCL stabilize knee during lateral stress when knee is flexed

50
Q

menisci role

A

stabilize knee during pivoting

51
Q

popliteus m. role

A

attached to lateral meniscus
prevents lateral meniscus from sliding forward and getting crushed during flexion
locks knee in full extension and unlocks

52
Q

flexed knee hits dashboard in MVA

A

PCL injury

53
Q

causes of anterior knee pain: pain climbing up/down stairs, squatting, pronged sitting, snap/pop/click/catching of knee

A

patellar tendonitis
patellofemoral dysfunction
chondromalacia patellae

54
Q

sudden swelling of knee

A

hemarthrosis (most commonly associated with ACL tear, osteochondral fracture in 10%)

55
Q

hear or feel pop think

A

ACL tear

56
Q

knee gets “stuck” during ROM

A

meniscus injury or loose joint body (cartilage)

57
Q

stiffness with inactivity - improves after few minutes (vs RA), pain with weight bearing activity

A

DJD

58
Q

lachman test

A

ACL Tear
knee flexed at 20-30 deg
stabilize femur, other hand on proximal tibia - try to slide tibia forward
+ if: >3 mm difference or no endpoint

59
Q

posterior drawer test

A

PCL tear
flex knee to 90 degrees and push tibia posterior
-do this before lachman test to ensure integrity

60
Q

posterolateral or posteromedial pain at extreme of flexion or extension is a

A

meniscal injury

61
Q

anterior joint line tenderness and pain with squatting suggests

A

chondromalacia

62
Q

McMurray test

A

meniscal damage
medial meniscus: extension + valgus + internal rotation
lateral: extension + varus + external rotation
+ if: palpable click, pain

63
Q

MCL or LCL test

A

varus or vagus stress

determine laxity

64
Q

pathophys of anterior knee pain

A

quadricep atrophy

crepitus with manipulation of patella

65
Q

patellar apprehension test

patellar compression test

A

anterior knee pain
press inferiorly on superior patella: pain
hold patella and contract quad: pain

66
Q

ottawa knee rules if 18 yo or older to determine if acute knee injury has fracture

A 
get xray if any of following:
>55yo
tenderness at head of fibula
isolated patella tenderness
inability to flex to 90 deg
inability to bear weight immediately and in ED
67
Q

confirmatory test for meniscal tear

A

MRI

68
Q

refer for additional evaluation or surgery if:

A 
hemarthrosis
ACL or meniscal tear
third degree collateral ligament injuries
severe functional impairment
poor response to conservative tx
69
Q

treatment of knee pain

A

exercise

70
Q

treatment of ACL

A

immobilization and then, surgery

71
Q

treatment of meniscus tear

A

protected weight bearing + PT

if continues, surgery

72
Q

treatment of DJD

A

glucosamine
CS injections
NOT NSAIDS - not inflammatory (unless acute flare)

73
Q

treatment of collateral ligament tear

A

knee immobilizer, crutches until can tolerate walking

74
Q

-focal area of bony tenderness

A

fracture

Family Medicine (21 decks)

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