Back and LE (pitcher-10) Flashcards
1
Q
with an MSK CC, what other system should be check in ROS?
A
neuro
2
Q
inspect back/LE for
A
posture position deformity edema erythema lesions symmetry
3
Q
palpation for back/LE for
A
tissue texture
warmth
tenderness
4
Q
ROM of back/LE
A
each jt has own motion with hard/soft end feel
restricted ROM compared with other side
5
Q
neuro exam for
A
sensation (soft, sharp, vibration)
reflexes
strength
6
Q
what type of joint is the foot?
A
hinge
7
Q
what type of jt is the knee?
A
synovial condylar
8
Q
what type of jt is the hip?
A
synovial spheroidal
9
Q
lumbar spine exam: inspection of posture
A
posture: pelvic and iliac crest positions, spinal curves from posterior and lateral views
sacral base: sulcus dimples at SI joint
lat: eat in line
10
Q
lumbar spine exam: inspection of gait
A
gait: smooth, stance and swing, reflects issues related to spine, pelvis, knee, feet
11
Q
lumbar spine exam: palpation
A
TART skin changes paraspinal mm TPs SPs**
12
Q
landmarks of Sps
A
t3-scapular spine
t7-inf scapula
l4-iliac crest
13
Q
neuro exam of Lspine
A
reflexes
sensation
strength (use scale 5/5)
14
Q
L4 dermatome
A
medial malleolus and some of tibia
15
Q
L5 dermatome
A
big toe, 2nd toe, outside fibula
16
Q
S1 dermatome
A
last few toes and heel
17
Q
viscerosomatic reflex of small intestine and ovaries/testes?
A
T10-11
18
Q
viscerosomatic reflex of colon, rectum, bladder, uterus, prostate?
A
T12-L2
19
Q
cause of LBP
A
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
20
Q
what level(S) is/are most common area of injury/pain from Lspine?
A
L5-S1
why? PLSL narrows as it descends; herniation made easier
21
Q
what is scoliosis
A
lateral curvature of spine
measure leg length (ASIS to med mall)
22
Q
what is ankylosing spondylitis
A
chronic, inflammatory disease (B27)
pronounced lumbar lordosis
SI tenderness source of LBP
23
Q
what is OA
A
degen disc dz
common in Lspine esp at L5-S1
**deterioration and loss of cartilage and normal bone
24
Q
what is osteoporosis?
A
thinning of bone
affects Lspine ad hips commonly (DEXA scan)
**compression fxx cause pain
25
what increases risk of osteoporosis?
steroids
| thin bones
26
what is sciatica?
pain radiates BELOW knee
pain u/l from l5
often shooting
worse w/sitting and Valsalva
27
possible causes of sciatica
```
herniated disc
spinal stenosis
lumbar facet pain
SI jt or mass lession
-OR- peripheral compression
```
28
sciatic n. levels
L4, 5, S1, 2, 3
29
straight leg raise technique
raise leg, any pain?
lower leg to no pain, dorsiflex to produce pain
B/W 40-60 EXT
30
straight leg raise tests for
sciatica
| hamstrings problem
31
synovial joints
bone ends covered with cartilage
synovial membrane secretes fluid lube
capsule and lig join bones together
strengthened by muscles
32
history of hip dislocation?
investigate for necrosis of femoral head
33
palpate pelvis upright
iliac crests
SI w/ forward flexion/ext
trochanteric bursa
34
palpate pelvis supine
```
ASIS
pubic symphysis
trochanteric bursa
pelvic rock
inguinal ligament
```
35
palpate pelvis prone
SI joint
PSIS
ischial bursa
36
hip ROM
flex: 135
ext: 30
abd: 45
add: 20
rot: 90
37
rotation of lower leg at flexed position
medial: ext rot of hip 50
lateral: int rot of hip 30
38
structures at inguinal lig
NAVEL:
| n, a, v, empty, LN
39
true hip pain
deep inguinal
| NOT LATERAL
40
lateral hip pain?
check trochanteric bursa
41
trendelenburg
checks gluterus medius intake
| pt stands on 1 leg which should contract gluteus medius on that side
42
gluteus medius action
keeps hips stable during gait
| weak on standing leg side
43
ober test
evaluates ITB syndrome
pt flexes knee and abducts at hip
if leg released and stuck, (+) and abnml
44
thomas test
evaluates for flexion contractures due to tight psoas
| pull knee to chest, other leg should remain flat
45
FABER test
Flex, ABduct, ExtRot
| reproduces pain or SI tenderness
46
leg length
```
from ASIS to medial malleolus
causes:
short femur
short tibia
scoliosis
add/flex deformity of hip
```
47
psoas strength test
raise knee, resist pressure
48
piriformis exam
knees to chest
hold heels
rotate knee L and R
compare ROM
49
pelvic unit dysfunctions
```
OA
inguinal hernia
bursitis (troch, ischial)
sciatica
lumbar spasms
fxx (trauma, osteoporosis)
scoliosis/leg length discrp
infxns (bone, bursa, tissue)
```
50
palpation of knee/lower leg
bursa
| patella
51
ligaments in knee/lower leg provide?
passive stability
52
menisci in knee/lower leg provide?
walking stability
53
structures examined in knee
ACL, PCL, LCL, MCL
medial/lateral menisci
pes anserine
bursa: prepatellar, suprapatellar, pes
54
bulge signq
minor effusion
55
ballon sign
bigger effusion
56
balloting sign
biggest effusion, push patella and fluid returns back into suprapatellar pouch
57
palpation of knee
femoral condyles
tibial plateau
patellar tendon and patella
tibial tubercle
58
knee ROM
flex: 135
ext: 10-15
int rot: 10-30
ext rot: 10-40
59
prepatellar bursitis
from excessive kneeling
60
anserine bursitis
excessive running
from valgus knee, arthritis
mixed up w/ anserine tendonitis
61
baker's cyst
cyst in popliteal fossa
| check for swelling, tenderness
62
patellofemoral grind test
compress patella against femur
tighten quads
feel for roughness, crepitus, pain
63
complaints of going up stairs/rising from chair?
chondromalacia
| patellofemoral syndrome
64
apprehension test
tests for d/l, subluxation
| manually d/l patella and observe facial expression
65
anterior drawer sign
flex knee and hip
pull tibia anterior
checks ACL tear
66
lachman test
```
ONLY FOR ACL TEST
knee flexed 15, ext rot
grasp femur and tibia
move in opp directions
any snapping=(+)
```
67
most important finding for lachman?
asymmetry
68
posterior drawer test
hip and knee flexed to 90
tibia post against femur
PCL tear
69
mcmurray test
rotate heel int and ext and then extend to hear pop/click
UNSPECIFIC test
checks menisci
70
apley's compression test
prone with knee flexed
| lean into heel compressing menisci
71
meniscal tear
locking/giving out
unable to trust knee
catching sensation
cannot extend leg fully
72
thessaly test
stand, rotate on bent knee of 5, 10, 20 degrees
| SENSITIVE to meniscal tear
73
valgus stress test
flex knee, one hand on knee, push leg out
| tests MCL
74
varus stress test
flex knee, one hand on knee, push leg in
| tests LCL
75
PALPATE GASTROC AND SOLEUS
CHECK FOR PAIN AND SWELLING
76
homan's sign
for DVT
| dorsiflex ankle with leg extended
77
thompson test
for achilles rupture
| prone, leg bent, squeeze calf and observe passive plantar flexion
78
principal joints of hinge foot jt
tibiotalar
| subtalar
79
lateral malleolus ligaments
post TF, ATF, calcaneofib
80
medial malleolus ligamen
deltoid
81
ankle ROM
dorsiflex/plantar flex
| inversion/eversion
82
anterior ankle drawer test
checks lig stability
grip calcaneus in hand and lower tibia with other
pull calc forward and push tibia posterior
83
testing subtalar jt
hold calcaneus and tibia,
| evert and invert
84
testing transverse tarsal jt
hold lower tibia and move whole foot to R and L
85
morton's neuroma
pain b/w 3 and 4 toes and ball of foot
| check by compressing forefoot
86
talar tilt test
pt sits with legs dangling
doc inverts calcaneus
if gapping occurs, ATF or calcaneofib lig are torn
87
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
```
88
ankle sprain
stretch/tear lig
| third deg: full tear
89
ATF, calcaneofib lig
commonly injured
| from inversion
90
high ankle sprain
syndesmosis b/w fib and tib
91
Ottawa rules
over 18
unable to bear weight after 4 steps
tenderness over post malleoli
SUSPECT FX
92
why ottawa rules?
to avoid unnecessary radiography in anke injury
93
bone spurs
bottom of calcaneus, point tenderness
94
plantar fascitis
heel and arch pain
| bad w/ initial weight bearing in morning
95
pes planus
loss of longitudinal arch of foot (flat feet)
96
hallux valgus
abnml abd of bigtoe (bunion)
97
gout
red/sweeling/pain of great toe d/t uric acid crystal deposition
98
pesudogout
like gout, from calcium pyrophos crystal desposition
99
RA
compressive tenderness
100
onychomycosis
fungally infected nails
101
plantar warts
viral, plantar aspect of foot, thickening of skin w/ dark stippling spots
102
corns
thickening of skin from abnml pressure over bony prominence (5th toe)
103
hammertoes
hyperextension of MTP joint and flexion of IP jt (2nd toe common)
104
ingrown toenails
red, bleeding, purulent d/c from edges of nails (great toe common)
