Back and LE (pitcher-10) Flashcards
with an MSK CC, what other system should be check in ROS?
neuro
inspect back/LE for
posture position deformity edema erythema lesions symmetry
palpation for back/LE for
tissue texture
warmth
tenderness
ROM of back/LE
each jt has own motion with hard/soft end feel
restricted ROM compared with other side
neuro exam for
sensation (soft, sharp, vibration)
reflexes
strength
what type of joint is the foot?
hinge
what type of jt is the knee?
synovial condylar
what type of jt is the hip?
synovial spheroidal
lumbar spine exam: inspection of posture
posture: pelvic and iliac crest positions, spinal curves from posterior and lateral views
sacral base: sulcus dimples at SI joint
lat: eat in line
lumbar spine exam: inspection of gait
gait: smooth, stance and swing, reflects issues related to spine, pelvis, knee, feet
lumbar spine exam: palpation
TART skin changes paraspinal mm TPs SPs**
landmarks of Sps
t3-scapular spine
t7-inf scapula
l4-iliac crest
neuro exam of Lspine
reflexes
sensation
strength (use scale 5/5)
L4 dermatome
medial malleolus and some of tibia
L5 dermatome
big toe, 2nd toe, outside fibula
S1 dermatome
last few toes and heel
viscerosomatic reflex of small intestine and ovaries/testes?
T10-11
viscerosomatic reflex of colon, rectum, bladder, uterus, prostate?
T12-L2
cause of LBP
sprain, strain, m. spasm, deconditioning herniated/bulging discs, spinal stenosis, facet syndrome OA scoliosis spondylolisthesis sacroilitis, sciatica infection osteoporosis, vert fxx metastasis/malignancy referred pain from hip
what level(S) is/are most common area of injury/pain from Lspine?
L5-S1
why? PLSL narrows as it descends; herniation made easier
what is scoliosis
lateral curvature of spine
measure leg length (ASIS to med mall)
what is ankylosing spondylitis
chronic, inflammatory disease (B27)
pronounced lumbar lordosis
SI tenderness source of LBP
what is OA
degen disc dz
common in Lspine esp at L5-S1
**deterioration and loss of cartilage and normal bone
what is osteoporosis?
thinning of bone
affects Lspine ad hips commonly (DEXA scan)
**compression fxx cause pain
what increases risk of osteoporosis?
steroids
thin bones
what is sciatica?
pain radiates BELOW knee
pain u/l from l5
often shooting
worse w/sitting and Valsalva
possible causes of sciatica
herniated disc spinal stenosis lumbar facet pain SI jt or mass lession -OR- peripheral compression
sciatic n. levels
L4, 5, S1, 2, 3
straight leg raise technique
raise leg, any pain?
lower leg to no pain, dorsiflex to produce pain
B/W 40-60 EXT
straight leg raise tests for
sciatica
hamstrings problem
synovial joints
bone ends covered with cartilage
synovial membrane secretes fluid lube
capsule and lig join bones together
strengthened by muscles
history of hip dislocation?
investigate for necrosis of femoral head
palpate pelvis upright
iliac crests
SI w/ forward flexion/ext
trochanteric bursa
palpate pelvis supine
ASIS pubic symphysis trochanteric bursa pelvic rock inguinal ligament
palpate pelvis prone
SI joint
PSIS
ischial bursa
hip ROM
flex: 135
ext: 30
abd: 45
add: 20
rot: 90
rotation of lower leg at flexed position
medial: ext rot of hip 50
lateral: int rot of hip 30
structures at inguinal lig
NAVEL:
n, a, v, empty, LN
true hip pain
deep inguinal
NOT LATERAL
lateral hip pain?
check trochanteric bursa
trendelenburg
checks gluterus medius intake
pt stands on 1 leg which should contract gluteus medius on that side
gluteus medius action
keeps hips stable during gait
weak on standing leg side
ober test
evaluates ITB syndrome
pt flexes knee and abducts at hip
if leg released and stuck, (+) and abnml
thomas test
evaluates for flexion contractures due to tight psoas
pull knee to chest, other leg should remain flat
FABER test
Flex, ABduct, ExtRot
reproduces pain or SI tenderness
leg length
from ASIS to medial malleolus causes: short femur short tibia scoliosis add/flex deformity of hip
psoas strength test
raise knee, resist pressure
piriformis exam
knees to chest
hold heels
rotate knee L and R
compare ROM
pelvic unit dysfunctions
OA inguinal hernia bursitis (troch, ischial) sciatica lumbar spasms fxx (trauma, osteoporosis) scoliosis/leg length discrp infxns (bone, bursa, tissue)
palpation of knee/lower leg
bursa
patella
ligaments in knee/lower leg provide?
passive stability
menisci in knee/lower leg provide?
walking stability
structures examined in knee
ACL, PCL, LCL, MCL
medial/lateral menisci
pes anserine
bursa: prepatellar, suprapatellar, pes
bulge signq
minor effusion
ballon sign
bigger effusion
balloting sign
biggest effusion, push patella and fluid returns back into suprapatellar pouch
palpation of knee
femoral condyles
tibial plateau
patellar tendon and patella
tibial tubercle
knee ROM
flex: 135
ext: 10-15
int rot: 10-30
ext rot: 10-40
prepatellar bursitis
from excessive kneeling
anserine bursitis
excessive running
from valgus knee, arthritis
mixed up w/ anserine tendonitis
baker’s cyst
cyst in popliteal fossa
check for swelling, tenderness
patellofemoral grind test
compress patella against femur
tighten quads
feel for roughness, crepitus, pain
complaints of going up stairs/rising from chair?
chondromalacia
patellofemoral syndrome
apprehension test
tests for d/l, subluxation
manually d/l patella and observe facial expression
anterior drawer sign
flex knee and hip
pull tibia anterior
checks ACL tear
lachman test
ONLY FOR ACL TEST knee flexed 15, ext rot grasp femur and tibia move in opp directions any snapping=(+)
most important finding for lachman?
asymmetry
posterior drawer test
hip and knee flexed to 90
tibia post against femur
PCL tear
mcmurray test
rotate heel int and ext and then extend to hear pop/click
UNSPECIFIC test
checks menisci
apley’s compression test
prone with knee flexed
lean into heel compressing menisci
meniscal tear
locking/giving out
unable to trust knee
catching sensation
cannot extend leg fully
thessaly test
stand, rotate on bent knee of 5, 10, 20 degrees
SENSITIVE to meniscal tear
valgus stress test
flex knee, one hand on knee, push leg out
tests MCL
varus stress test
flex knee, one hand on knee, push leg in
tests LCL
PALPATE GASTROC AND SOLEUS
CHECK FOR PAIN AND SWELLING
homan’s sign
for DVT
dorsiflex ankle with leg extended
thompson test
for achilles rupture
prone, leg bent, squeeze calf and observe passive plantar flexion
principal joints of hinge foot jt
tibiotalar
subtalar
lateral malleolus ligaments
post TF, ATF, calcaneofib
medial malleolus ligamen
deltoid
ankle ROM
dorsiflex/plantar flex
inversion/eversion
anterior ankle drawer test
checks lig stability
grip calcaneus in hand and lower tibia with other
pull calc forward and push tibia posterior
testing subtalar jt
hold calcaneus and tibia,
evert and invert
testing transverse tarsal jt
hold lower tibia and move whole foot to R and L
morton’s neuroma
pain b/w 3 and 4 toes and ball of foot
check by compressing forefoot
talar tilt test
pt sits with legs dangling
doc inverts calcaneus
if gapping occurs, ATF or calcaneofib lig are torn
ankle/foot ROM
dorsiflex: 20 plantar flex: 50 subtalar inversion: 35 eversion: 25 add: 20 abd: 10 flex big toe: 30 ext big toe: 80
ankle sprain
stretch/tear lig
third deg: full tear
ATF, calcaneofib lig
commonly injured
from inversion
high ankle sprain
syndesmosis b/w fib and tib
Ottawa rules
over 18
unable to bear weight after 4 steps
tenderness over post malleoli
SUSPECT FX
why ottawa rules?
to avoid unnecessary radiography in anke injury
bone spurs
bottom of calcaneus, point tenderness
plantar fascitis
heel and arch pain
bad w/ initial weight bearing in morning
pes planus
loss of longitudinal arch of foot (flat feet)
hallux valgus
abnml abd of bigtoe (bunion)
gout
red/sweeling/pain of great toe d/t uric acid crystal deposition
pesudogout
like gout, from calcium pyrophos crystal desposition
RA
compressive tenderness
onychomycosis
fungally infected nails
plantar warts
viral, plantar aspect of foot, thickening of skin w/ dark stippling spots
corns
thickening of skin from abnml pressure over bony prominence (5th toe)
hammertoes
hyperextension of MTP joint and flexion of IP jt (2nd toe common)
ingrown toenails
red, bleeding, purulent d/c from edges of nails (great toe common)
