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PCM 2.1 > Back + LE > Flashcards

Back + LE Flashcards

1
Q

cartilaginous joint

A
  1. vertebral disc
  2. symphysis pubis
  3. SI joint
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2
Q

snyovial joint

A
  1. spheroidal - hip

2. condylar - knee

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3
Q

hinge joint

A

foot

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4
Q

3 components of neurologic exam

A
  1. reflexes - reinforcement
  2. sensation
  3. strength
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5
Q

L4 lumbar neuro exam

A
  1. motor - anterior tibialis
  2. reflex - patellar tendon
  3. sensation - lateral strip from ankle to large toe
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6
Q

L5 lumbar neuro exam

A
  1. motor - extensor hallucis longus
  2. reflex - none
  3. sensation - mid top of foot and most of plantar surface
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7
Q

S1 lumbar neuro exam

A
  1. motor - gastroc-soleus (repetitive toe raises)
  2. reflex - achilles tendon
  3. sensation - lateral strip of foot
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8
Q

V-S reflexes

A
  1. small intestine - T10-T11
  2. colon and rectum - T12-L2
  3. bladder - T12-L2
  4. ovaries/testes - T10-T11
  5. uterus - T12-L2
  6. prostate - T12-L2
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9
Q

most common area of injury or source of pain from lumbar spine

A

L5-S1

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10
Q

scoliosis

A
  • lateral curvature of the spine
  • evaluate the extent and level of curvature
  • measure the leg lengths in conjunction with scoliosis
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11
Q

ankylosing spondylitis

A
  • hereditary, chronic inflamm disease
  • pronounced lumbar lordosis
  • sacroiliac tenderness (sacroilitis)
  • other body systems affected as well
    1. uveitis - photophobia, pain
    2. general synovial arthritis - hip/shoulder most common
    3. enthesopathathies - inflamm at tendon insertion
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12
Q

osteoarthritis

A
  • degenerative disc disease
  • common in lumbar spine, esp L5-S1
  • deterioration and loss of cartilage and normal bone
  • low grade inflamm issue
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13
Q

osteoporosis

A
  • thinning of bone
  • affects lumbar spine and hips commonly
  • steroids increase risk
  • loss of height, Dowager’s hump
  • compression fractures cause the pain
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14
Q

sciatica

A
  • lumbar radiculopathy vs peripheral nerve compression
  • includes nerve L4-S3 nerve roots
  • consider herniated disc, spinal stenosis, lumbar facet pain, SI joint or mass lesions vs. peripheral compression
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15
Q

how to find sciatica

A
  • patient lying on side opp of pain
  • pain unilateral from L5 through buttock, down lateral leg to lateral foot
  • often shooting
  • worse with sitting of valsalva
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16
Q

straight leg raise

A
  • sciatica vs. hamstrings
  • raise leg to reproduce leg pain radiation
  • lower leg just to point of no pain then dorsiflex foot
  • stretches sciatic nerve, so if dermatomal pain reproduced again, more likely is sciatica
  • most commonly pos. for sciatic if pain found b/w 40-60 degrees of extension
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17
Q

sacrum/pelvis/hip unit

A
  • system of joints involved with strength, stability, weight bearing, and ambulation
  • very strong anterior longitudinal ligament
  • bursae: psoas (iliopsoas), trochanteric, ischial
  • joints - cartilagenous, spheroidal synovial
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18
Q

hx of hip dislocation

A

investigate for necrosis of femoral head

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19
Q

hip ROM

A
  • flexion - supine, pull knee to chest (135 degrees)
  • extension - prone, extend leg at hip (30 degrees)
  • abduction - stabilize opposite hip, 45 degrees
  • adduction - 20 degrees
  • rotation
    1. move lower leg medial = ext rotation (50 degrees)
    2. move lower leg lateral = int rotation (30 degrees)
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20
Q

which ROM best indicators of true hip pathology?

A

internal and external rotation

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21
Q

inguinal ligament

A
  • patient supine, place heel on opposite knee to inspect inguinal ligament
  • palpate ASIS to pubic tubercle
  • NAVEL
  • true hip pain is deep inguinal, not lateral
  • check trochanteric bursa with complaint of lateral hip pain
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22
Q

trendelenburg test

A
  • evaluates gluteus medius mm
  • observe PSIS dimples standing on both legs
  • next have patient stand on one leg
  • gluteus medius on the standing leg should contract keeping the pelvis level
  • pos: pelvis can’t remain level - gluteus medius is weak on the standing leg side
  • gluteus medius keeps hips stable during gait
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23
Q

ober test

A
  • evaluates IT band syndrome
  • patient lies on side opp side being tested
  • flex knee to 90 degrees and abduct leg at hip
  • release leg
  • pos: leg remain abducted = ITB syndrome
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24
Q

thomas test

A
  • for flexion contractures of the hip due to tight psoas
  • flex hips with patient supine so thigh touches abdomen
  • upon extending, one hip should lie flat on the table
  • pos: hip does not fully extend
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25
Q

faber test

A
  • most specific for hip joint
  • trying to reproduce their pain
  • may elicit SI tenderness
  • flexion, abduction, external rotation
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26
Q

leg length

A
  • measure distance from ASIS to media malleolus

- consider shortened femur, tibia, scoliosis, or from adduction and/or flexion deformity of hip

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27
Q

psoas strength test

A
  • seated, raise knee, resist pressure down
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28
Q

piriformis exam

A
  • supine, knees to chest and hold heels, rotate knees left L and R comparing ROM
  • primarily by palpation
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29
Q

pelvic unit dysfunction

A
  1. osteoarthritis (limitation to motion, esp abduction)
  2. inguinal hernia
  3. bursitis - trochanteric, ischial
  4. sciatica
  5. lumbar spasms
  6. fractures - trauma, osteoporosis
  7. scoliosis/leg length discrepancies
  8. infections - bone, bursa, tissue
30
Q

bursae

A
  1. prepatellar - pes anserine (sartorius, gracilis, semitendinosus)
  2. suprapatellar pouch
31
Q

bursa signs

A
  1. bulge sign - minor effusions
  2. balloon sign - large effusion
  3. balloting - large effusions
32
Q

knee ROM

A
  • flexion - 135 degrees
  • extension - 10-15 degrees
  • internal rotation - 10-30 degrees
  • external rotation - 10-40 degrees
33
Q

prepatellar bursitis

A
  • anterior
  • dome swelling over patella assoc with tenderness
  • from excessive kneeling
  • Housemaid’s knee
34
Q
  • anserine burisitis
A
  • medial aspect of knee - tibial plateau
  • excessive running
  • also from valgus knee deformity and arthritis
  • hard to tell from pes anserine tendonitis
35
Q

baker’s cyst

A
  • posterior
  • cyst in the popliteal fossa, most often medial
  • leg extended, check posterior/medial aspect of knee for swelling or fullness, sometimes tenderness
36
Q

tendonitis vs bursitis tenderness

A
  • tendonitis tenderness occurs with active ROM

- bursitis tenderness equal with active or passive ROM

37
Q

patellofemoral grind test

A
  • patient supine with knee extended
  • compress patella against femur
  • instruct patient to tighten quads
  • assess for roughness of motion, crepitus, pain
  • pain assoc with going up stairs or rising from chair consider chondromalacia or patellofemoral syndrome
38
Q

apprenhension test

A
  • tests for dislocation or subluxation of patella
  • attempt to manually dislocate patella laterally
  • observe patient’s facial expressions
39
Q

anterior drawer sign

A
  • patient supine flex knee and hips 90 degrees
  • pull tibia forward to check for mvmt anteriorly
  • compare to opp side
  • pos: move anteriorly = ACL tear
40
Q

Lachman test

A
  • only good for ACL
  • knee flexed 15 degrees and externally rotated
  • grasp femur with one hand and tibia with other
  • move femur and tibia in opp directions
  • pos: asymmetric, forward mvmt of tibia against femur = ACL tear
41
Q

posterior drawer sign

A
  • patient supine with hip and knee flexed to 90 degrees
  • push tibia posteriorly checking for mvmt against femus
  • compare to opp side
  • pos: posterior mvmt = PCL tear
42
Q

McMurray test

A
  • heel points the direction of the meniscus getting tested
  • patient supine grasp heel and fully flex the knee
  • hold knee joint with other hand palpating along joint line
  • rotate the lower leg internally to engage lateral meniscus and extend leg. Note pain, pop or click during the motion
  • repeat using external rotation for medial meniscus
  • not a very specific test
43
Q

Apley’s compression test

A
  • patient prone with knee flexed to 90 degrees
  • stabilize thigh with one hand while leaning onto heel compressing medial and lateral menisci
  • rotate heel during compression noting any pain
44
Q

key features of patient presentation for a meniscal tear

A
  1. locking or giving out - sensation or of actual occurrence
  2. not feeling they can trust the knee when walking or stepping off a curb
  3. a catching sensation or true catching of the knee - sudden pain stops ROM
45
Q

Thessaly test

A
  • standing, rotator motion on one leg at 5-10 degrees and against at 20 degrees
  • more sensitive and specific for mensical injury or tear than McMurray, bent knee position best
46
Q

valgus stress test (abduction stress test)

A
  • patient supine and flex knee slightly
  • one hand against lateral knee, the other around medial ankle
  • push medially against knee while laterally against ankle
  • tests MCL
47
Q

varus stress test (adduction stress test)

A
  • position patient same as for valgus
  • hands against medial knee and lateral ankle
  • push laterally against knee while medially against ankle
  • tests LCL
48
Q

Homan’s sign

A
  • evaluates DVT
  • dorsiflex patient’s ankle with leg extended at knee
  • pos: pain in calf
49
Q

Thompson test

A
  • evaluates achilles integrity
  • patient prone, leg bent 90 degrees, squeeze calf and observe for normal passive plantar flexion
  • best to determine achilles rupture if done in 48 hrs
50
Q

which ligaments most commonly injured?

A

lateral ankle

  1. anterior talofibular
  2. calcaneofibular
51
Q

ankle ROM

A
  • dorsiflex/plantar flex - tibiotalar joint

- inversion/eversion - talocalcaneal joint = subtalar joint

52
Q

foot ROM

A
  • inversion/eversion - transverse tarsal joint
53
Q

anterior drawers

A
  • evaluate general ligament stability of subtalar joint
  • grip calcaneus in palm of one hand and lower tibia with other
  • pull calcaneus foward while pushing tibia posterior
  • should not move or feel lax
54
Q

talar tilt test

A
  • patient is sitting with legs dangling off table
  • doctor inverts the calcaneus
  • pos: talus gaps or rocks in the ankle mortise = the ATF and calcaneofibular ligaments are torn
55
Q

ankle/foot ROM

A
  • plantarflexion > dorsiflexion
  • subtalar inversion > eversion
  • forefoot adduction > abduction
  • MTP joint great toe extension > flexion
56
Q

ankle sprains

A
  • abnormal stretching or tearing of ligaments (1st - 3rd degrees, 3rd = full tear)
  • caused by inversion force
  • high ankle sprain - syndesmosis b/w fibular and tibia
57
Q

Ottawa Rules

A
  • developed to avoid unnecessary radiography in ankle injury
    1. pain around malleolus and tenderness in posterior malleolar area or tip of fibula
    2. pain around malleolus and unable to weight bear immediately and more than 4 steps
    3. pain in mid-foot and either
  • tenderness at base of 5th metatarsal or navicular
  • unability to weight bear or more than 4 steps
58
Q

Kleiger’s test

A
  • high ankle sprain

- deltoid ligaments

59
Q

bone spurs

A
  • bottom of calcaneus

- causes point tenderness

60
Q

plantar fascitis

A
  • heel and arch pain, esp with initial weight bearing in morning
61
Q

pes planus

A
  • loss of longitudinal arch of foot (flat foot)
62
Q

hallux valgus

A
  • abnormal abduction of great toe (bunion)
63
Q

gout

A
  • redness/swelling/pain at MTP of great toe

- uric acid crystal deposition

64
Q

pseudogout

A
  • looks the same

- from calcium pyrophosphate crystal deposition

65
Q

rheumatoid arthritis

A

compressive tenderness

66
Q

ingrown toenails

A
  • redness, bleeding, purulent discharge from edges of nail

- great toe most common

67
Q

hammertoes

A
  • hyperextension of MTP joint and flexion if IP joint

- 2nd toe most common

68
Q

corns

A
  • painful thickening of skin from abnormal pressure over bony prominence
  • 5th toe most commone
69
Q

plantar warts

A
  • viral
  • plantar aspect of foot
  • thickening of skin with dark stippling spots
70
Q

onychomycosis

A

fungus infected nails

PCM 2.1 (5 decks)

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