B6-101 MSK Exam: Lower Limb Flashcards
when would you expect to see swelling from a meniscal tear?
next day
worst pain in the first few steps after getting out of bed
plantar fasciitis
pathogen associated with causing septic hip in kids
H. flu
AROM means
patient moves joint under own power
PROM means
practitioner moves joint
it is important in cervical spin injury to allow […] before checking […]
AROM before PROM
examine [injured/uninjured] side first
uninjured
active movement against full resistances
5
active movement with gravity only
3
no active movement but detectable flicker or trace of muscle contraction
1
mass that fluctuates in size is likely
ganglion cyst
patients with discogenic back pain will want to remain in what posture?
standing
intervertebral disc pressure is highest in what position?
sitting
pain radiating down posterior thigh and past knee on straight leg test can indicate
sciatic nerve pain
**lower lumbar root
pain radiating down anterior thigh with passive hip hyperextension or knee flexion can indicate
femoral nerve pain
**upper lumbar root
right scapula elevated on Adams Forward Bending test indicates
adolescent idiopathic scoliosis
hip arthritis typically presents as pain where?
front of hip
trochanteric bursitis typically presents as pain where?
side of hip
pain in the back of the buttock indicates an issue with what area?
lumbar spine/facet
kid with loss of abduction of hip may be
Legg-Calves-Perthes
referred pain from the obturator nerve can go to the
knee
it is common for hip pathology to present as isolated […] pain
knee
**evaluated hip ROM for knee pain
pain with loss of hip internal rotation can indicate
arthritis
fracture
slipped capital femoral epiphysis (kid)
how would a patient with a hip fracture present?
hip and leg externally rotated
how would a patient with hip dislocation present?
“position of modesty”
adducted, flexed, internally rotated
positive trendelenburg sign indicates weak [2]
gluteus medius and minimus
normal hip drops and torso swings over to weak hip to maintain balance
positive trendelenburg sign
in a positive “apprehension” test the patient will
guard against lateral displacement of the patella
apprehension tests checks for
instability/dislocation/subluxation of patella
anterior drawer tests for
ACL integrity
positive Lachman’s indicates
ACL injury
best imaging for suspected ACL/PCL tear
MRI
valgus stress applied at the ankle that illicits pain and laxity indicates damage to
MCL
MCL and LCL tests should be performed at what degrees of extension?
0 and 30
**in full extension, the posterior capsule may cause false negative
varus stress applied at the ankle that illicits pain and laxity indicates damage to
LCL
all meniscus exam tests will be positive in patients with
arthritis
describe the McMurray test
- flex knee
- rotate and extend knee while palpating medial or lateral side
**clicking or pain is considered positive
“click” in medial compartment on McMurray indicates
medial meniscus tear
**same for lateral
what way do you rotate the foot in McMurray to evaluate for medial meniscus tear?
externally
what way do you rotate the foot in McMurray to evaluate for lateral meniscus tear?
internally
apley grind tests evaluates for
meniscus tear
thessaly test evaluates for
meniscus tear
widely considered to be the most sensitive exam for meniscus tear
thessaly test
[…] syndrome occurs frequently in runners and cyclers
IT band
tenderness over the lateral aspect of the knee about 2 cm above the joint line
IT band syndrome
tenderness over the lateral aspect of the knee 1 cm below the joint line over Gerdy’s tubercle
IT bursitis
pain is illicited on palpation of the anterior tibial tuberosity
Osgood-Schlatter
anterior knee pain below the patellar tendon in a patient 12-14
Osgood-Schlatter
plantar bruising suggests
lisfranc fracture
if a patient with flat foot is able to form an arch on toe rise, that indicates
flexible flatfoot (benign finding)
if a patient with flat foot is not able to form an arch on toe rise, that indicates
rigid flat foot
**structural issue, usually talocalcaneal coalition
most common cause of rigid flatfoot
talocalcaneal coalition
pain anterior to the distal fibula
anterior talofibular ligament sprain
why are medial ankle sprains less common than lateral?
deltoid ligament is much stronger
tests for the integrity of the achilles
Thompson’s
**squeezing calf normally illicits plantar flexion, but when achilles is gone this response is absent
tests the integrity of the anterior talofibular ligament
anterior drawer test
tests the integrity of the calcaneofibular ligament
talar tilt test
no movement illicited upon squeezing calf (thompson’s)
achillies tendon rupture
pain worse first steps out of bed but improves with standing
plantar fasciitis
1st MTP joint arthritis/bone spur
hallux rigidus
pain and limited 1st MTP joint AROM/PROM in extension
hallux rigidus
tibia glides anteriorly to femur when knee is at a 90 degree angle
positive anterior drawer
**ACL tear
tibia glides posterior to femur when knee is at a 90 degree angle
positive posterior drawer sign
**PCL tear
medial widening in valgus stress test
MCL injury
lateral widening in varus stress test
LCL injury
during flexion/extension, pain/popping on internal rotation of knee
lateral meniscus tear
**LIME = Lateral Internal, Medial External
during flexion/extension, pain/popping on external rotation of knee
medial meniscus tear
**LIME = Lateral Internal, Medial External
subchondral bone resorption and collapse of wedge shaped portion of femoral head
leads to severe joint space collapse
AVN
causes of AVN
alcoholism
steroids
trauma
irradiation
sickle cell
the bends
gauchers
repeated aspirations of aseptic bursitis can cause
septic bursitis
ligament inferior to lateral malleolus
calcaneofibular
ligament posterior to lateral malleolus
posterior talofibular
most commonly injured ligament from inversion injuries
ATFL
an intact achilles tendon will […] with calf squeezing
plantar flex
L1-L3 disc herniation would typically give […] nerve symptoms in the […] region
femoral
hip/thigh
L3-L4 disc herniation would result in
diminished patellar reflex
L4-L5 herniation would result in
loss of sensory to dorsum of foot, no reflex deficits
S1 nerve root gives sensory to […] and motor to […]
lateral foot
motor to ankle plantar flexors, achilles
