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MSK > Ch 10 MDT Lower Extremity > Flashcards

Ch 10 MDT Lower Extremity Flashcards

1
Q

Secondary to a reaction of the periosteum in response to increased stress, as seen in runners

A

Shin Splints

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2
Q

Gradual onset of pain with prolonged walking or running activity

Pain is localized to distal third of the medial tibia

Patient may have increased training, intensity, pace, or distance

A

Shin Splints

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3
Q

Physical Exam:

  • Visal: Unremarkable
  • Tenderness along posterior medial crest of tibia
  • ROM: Unremarkable
  • Pain with resisted plantar flexion
A

Shin Splints

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4
Q

Diagnostics for Shin Splints

A

Radiographs if concerned for stress fracture

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5
Q

Treatment for Shin Splints

A

NSAIDs

Ice

Light duty

Gradual pain free return to running

Weight loss

Proper running shoes

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6
Q

Shin splints not healing with conservative management should be further investigated with:

A

Plain films/MRI

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7
Q

Should be on the differential of every patient with shin pain

A

Suspected Tibial Stress Fracture

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8
Q

Symptoms similar to shin splints

Pain becomes more focal and time course to recovery is much longer

May increase over the course of weeks or months

Pain worsens and begins to hurt AT REST

A

Suspected Tibial Stress Fracture

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9
Q

Unremarkable visual exam

Point tenderness in the tibia

ROM is unremarkable

Pain with resisted plantar flexion

Patient complains they have PAIN AT REST

A

Suspected Tibial Stress Fracture

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10
Q

Diagnostics for Suspected Tibial Stress Fracture

A

Plain film X-ray

MRI/CT/Bone scan is better to detect stress fractures

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11
Q

Treatment for Suspected Tibial Stress Fracture

A

Duty modification for 12 weeks

NSAID/Tylenol

RICE

Cross training for runners (cycling/swimming)

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12
Q

Elevation of intra-compartmental pressure to a degree that compromises blood flow to the involved muscles and nerves

A

Compartment Syndrome

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13
Q

Muscles of the lower leg are divided into ____ compartments by fibrous septa

A

Four

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14
Q

Acute Compartment Syndrome can result from:

A

Crush injury

Muscle strain

Closed fracture

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15
Q

Type of Compartment Syndrome:

  • Chronic in nature and followed by exercise
  • Associated with prolonged walking or running with gradual onset of pain
  • Do not experience pain at rest
  • Anterior compartment is most commonly involved
A

Exertional compartment syndrome

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16
Q

Severe leg pain out of proportion to apparent injury
-Deep ache or burning

Symptoms progress over few hours

Pain, pallor, parasthesias, paresis, poikothermia, pressure, pulselessness

Pale, Shiny skin

A

Compartment Syndrome

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17
Q

Diagnostics tests for Compartment Syndrome

A

During Surgery

Intercompartmental pressure monitoring for chronic exertional Compartment Syndrome

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18
Q

Treatment for Compartment Syndrome

A

Fasciotomy

  • Prior to transport: Remove tight fitting items, place limb in neutral position
  • Analgesics and Supplemental O2
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19
Q

Largest tendon in the body

A

Achilles

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20
Q

Achilles Tendon Rupture

___ per 100,000 general population

A

5-10

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21
Q

Achilles Tendon Rupture occurs in ___% of competitive athletes

A

8.3%

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22
Q

__% of military recruits develop Achilles tendinopathy

A

6.8%

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23
Q

What muscles converge to form the Achilles tendon?

A

Gastrocnemius and Soleus

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24
Q

Achilles inserts posteriorly on the:

A

Calcaneus

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25
Risk factors for Achilles Tendon Rupture
Athletes Age 30-40 y/o Male Obesity Running mechanic issues Fluoroquinolone antibiotic use Rheumatologic disease
26
Sensation of being struck violently in back of ankle -"Pop" Ecchymosis, edema, foot malalignment ROM/Strength: Impaired plantarflexion Positive Thompson test
Achilles Tendon Rupture
27
Exam Achilles Tendon Rupture patient in what position?
Prone, feet hanging off table
28
Diagnostics for Achilles Tendon Rupture
MRI (Gold Standard) U/S
29
Treatment for Achilles Tendon Rupture
Light duty Ice NSAID Achilles tendon support Physical therapy Complete tear: Ortho Consult in 1-2 Days
30
Ligament that connects Talus and anterior fibula
Anterior talofibular ligament (ATFL)
31
Ligament that connects Talus and posterior fibular
Posterior talofibular ligament (PTFL)
32
Ligament that connects calcaneus and fibula
Calcaneofibular ligament (CFL)
33
Majority of ankle sprains involve _____ only
ATFL
34
Results from "high ankle sprain" Disruption of interosseous membrane
Eversion injury with dorsiflexion
35
Results in medial ankle sprain Syndesmosis injury
Eversion injury
36
Repeat ankle injury is almost ____ times as likely as primary injury
Five
37
Ankle sprain Edema is measured with what method?
Figure 8
38
Ankle sprain Check areas required for the Ottawa ankle rules:
Posterior edge/tip of Lateral Malleolus Posterior edge/tip of Medial Malleolus Base of fifth metatarsal (Navicular bone)
39
Swelling, ecchymosis of ankle Eversion/Inversion limited due to pain Positive Anterior Drawer = ATFL Positive Talar Tilt = CFL Positive tib/fib squeeze (syndesmosis sprain)
Ankle Sprain
40
Ottawa Ankle Rules catches __% of fractures
98%
41
Ankle sprain MRI for patients without relief after ___ weeks
6-8
42
Treatment for Ankle Sprain
RICE NSAIDs Light duty Pain free stretching/strengthening Brace
43
Critical injury involves the second tarsometatarsal joint Second metatarsal "keys" into a slot in the cuneiforms and is the stabilizing apex for the other tarsometatarsal joints
Lisfranc Fracture
44
Patients report a sprain Pain is localized to the dorsum of the midfoot Swelling may be relatively mild Ecchymosis in plantar arch Edema in the tarsometatarsal joint Maximum tenderness and swelling over the tarsometatarsal joint rather than ankle ligaments
Lisfranc Fracture
45
Special test to differentiate Lisfranc Fracture from an ankle sprain
Stabilize the calcaneus with one hand and rotate and/or abduct the forefoot with the other hand
46
Diagnostics for Lisfranc Fracture
Radiographs
47
When AP radiographs shows _____________, even by only a few millimeters, a Lisfranc Fracture has occurred
Second metatarsal base has shifted laterally
48
Treatment for Non-displaced Lisfranc Fracture
Ortho consult 6-8 weeks in non-weight bearing cast immobilization Analgesics
49
Treatment for displaced Lisfranc Fracture
Ortho consult SURGERY Analgesics
50
Creates hallux valgus with lateral deviation of the great toe at the MTP Joint Prominence of the medial aspect of the first metatarsal head
Bunion
51
Bunions are much more common in females at a ratio of:
10:1
52
Pain and swelling, aggravated by shoe wear Great toe pronates with resulting callus on the medial aspect
Bunion
53
Valgus stress at the MTP joint of the great toe Hypertrophic bursa Great toe is pronated (rotated inward) Tenderness over joint MTP valgus greater than 15 degrees
Bunion
54
The severity of a bunion deformity is graded by measuring:
Forefoot angles on weight-bearing AP radiographs of the foot
55
Normal hallux valgus angle is ___ Normal intermetatarsal angle is ____
< 15 degrees < 10 degrees
56
Treatment for Bunion
Patient education and shoe modification Light duty Ice
57
Perineural fibrosis of the common digital nerve as it passes between the metatarsal heads Most common between the third and fourth toes (third web space)
Morton neuroma
58
Most common symptom of Morton neuroma
Plantar pain in the forefoot
59
Plantar pain of forefoot Dysesthesias or burning plantar pain that is aggravated by activity Numbness in the adjacent toes "Walking on a marble" or "Wrinkle in my socks"
Morton neuroma
60
Positive Special tests for Morton neuroma
Metatarsal squeeze test
61
Diagnostic tests for Morton neuroma
Diagnosed clinically MRI/US if diagnosis is unclear
62
Treatment for Morton neuroma
Wear low-healed, soft-soled shoe with a wide toe box Metatarsal pads (take pressure off of the metatarsal heads)
63
Long fibrous band like tissue that arises from the medial tuberosity of the calcaneus and extends to the proximal phalanges
Plantar fascia
64
Most common cause of heal pain in adults Due to degeneration Occurs twice as much in woman as in men More common in over weight patients
Plantar Fasciitis
65
Pain is most severe on awakening or when rising from a resting position Prolonged standing and walking increases pain Focal pain directly over the medial calcaneal tuberosity and 1-2 cm distally along the plantar fascia
Plantar Fasciitis
66
Diagnosis for Plantar Fasciitis
Clinically Pain in the inferior heel that is worse when starting to walk plus finding of local point tenderness
67
Treatment for Plantar Fasciitis
NSAIDs Ice massage Light duty OTC heel pads Night splints
68
Plantar Fasciitis Surgical release should be considered only after _____ months of intense non-operative management
6-12 months
69
Pain in the posterior heel may originate from one or more of the following structures:
Achilles Tendinosis Retrocalcaneal bursitis Haglund syndrome Pre-Achilles bursitis
70
"Pump bump" that is irritated by shoe wear Start-up pain in heel Pain after activity Antalgic gait
Posterior heel pain
71
Calcaneal prominence may be present with edema Superficial bursa (pump bump) Tenderness over heel or Achilles tendon Dorsiflexion limited Positive Thompson test
Posterior heel pain
72
Diagnostic tests for posterior heel pain
Clinically diagnosed - Lateral radiographs may show calcification - Prominent posterosuperior process of the calcaneus
73
Treatment for Posterior heel pain
Light duty Heel lift or open back shoes Ice massage Achilles stretch Casting for 6 weeks in extreme cases
74
Hyperextension injury of the first metatarsal
Turf Toe
75
Swelling, tenderness, and limited motion of first MP joint
Turf Toe
76
Diagnostic tests for Turf Toe
Radiographs are useful for ruling out fractures Bone scan or MRI when diagnosis is in question
77
Treatment for Turf Toe
RICE NSAIDs Stiff shoe inserts
78
Treatment for severe Turf Toe
Immobilization for 1-2 weeks and 4-6 week period of rest from sports

MSK (14 decks)

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