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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
Q

Risk factors for Achilles Tendon Rupture

A

Athletes

Age 30-40 y/o

Male

Obesity

Running mechanic issues

Fluoroquinolone antibiotic use

Rheumatologic disease

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26
Q

Sensation of being struck violently in back of ankle
-“Pop”

Ecchymosis, edema, foot malalignment

ROM/Strength: Impaired plantarflexion

Positive Thompson test

A

Achilles Tendon Rupture

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27
Q

Exam Achilles Tendon Rupture patient in what position?

A

Prone, feet hanging off table

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28
Q

Diagnostics for Achilles Tendon Rupture

A

MRI (Gold Standard)

U/S

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29
Q

Treatment for Achilles Tendon Rupture

A

Light duty

Ice

NSAID

Achilles tendon support

Physical therapy

Complete tear: Ortho Consult in 1-2 Days

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30
Q

Ligament that connects Talus and anterior fibula

A

Anterior talofibular ligament (ATFL)

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31
Q

Ligament that connects Talus and posterior fibular

A

Posterior talofibular ligament (PTFL)

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32
Q

Ligament that connects calcaneus and fibula

A

Calcaneofibular ligament (CFL)

33
Q

Majority of ankle sprains involve _____ only

A

ATFL

34
Q

Results from “high ankle sprain”

Disruption of interosseous membrane

A

Eversion injury with dorsiflexion

35
Q

Results in medial ankle sprain

Syndesmosis injury

A

Eversion injury

36
Q

Repeat ankle injury is almost ____ times as likely as primary injury

A

Five

37
Q

Ankle sprain

Edema is measured with what method?

A

Figure 8

38
Q

Ankle sprain

Check areas required for the Ottawa ankle rules:

A

Posterior edge/tip of Lateral Malleolus

Posterior edge/tip of Medial Malleolus

Base of fifth metatarsal (Navicular bone)

39
Q

Swelling, ecchymosis of ankle

Eversion/Inversion limited due to pain

Positive Anterior Drawer = ATFL

Positive Talar Tilt = CFL

Positive tib/fib squeeze (syndesmosis sprain)

A

Ankle Sprain

40
Q

Ottawa Ankle Rules catches __% of fractures

A

98%

41
Q

Ankle sprain

MRI for patients without relief after ___ weeks

A

6-8

42
Q

Treatment for Ankle Sprain

A

RICE

NSAIDs

Light duty

Pain free stretching/strengthening

Brace

43
Q

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

A

Lisfranc Fracture

44
Q

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

A

Lisfranc Fracture

45
Q

Special test to differentiate Lisfranc Fracture from an ankle sprain

A

Stabilize the calcaneus with one hand and rotate and/or abduct the forefoot with the other hand

46
Q

Diagnostics for Lisfranc Fracture

A

Radiographs

47
Q

When AP radiographs shows _____________, even by only a few millimeters, a Lisfranc Fracture has occurred

A

Second metatarsal base has shifted laterally

48
Q

Treatment for Non-displaced Lisfranc Fracture

A

Ortho consult

6-8 weeks in non-weight bearing cast immobilization

Analgesics

49
Q

Treatment for displaced Lisfranc Fracture

A

Ortho consult

SURGERY

Analgesics

50
Q

Creates hallux valgus with lateral deviation of the great toe at the MTP Joint

Prominence of the medial aspect of the first metatarsal head

A

Bunion

51
Q

Bunions are much more common in females at a ratio of:

A

10:1

52
Q

Pain and swelling, aggravated by shoe wear

Great toe pronates with resulting callus on the medial aspect

A

Bunion

53
Q

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

A

Bunion

54
Q

The severity of a bunion deformity is graded by measuring:

A

Forefoot angles on weight-bearing AP radiographs of the foot

55
Q

Normal hallux valgus angle is ___

Normal intermetatarsal angle is ____

A

< 15 degrees

< 10 degrees

56
Q

Treatment for Bunion

A

Patient education and shoe modification

Light duty

Ice

57
Q

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)

A

Morton neuroma

58
Q

Most common symptom of Morton neuroma

A

Plantar pain in the forefoot

59
Q

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”

A

Morton neuroma

60
Q

Positive Special tests for Morton neuroma

A

Metatarsal squeeze test

61
Q

Diagnostic tests for Morton neuroma

A

Diagnosed clinically

MRI/US if diagnosis is unclear

62
Q

Treatment for Morton neuroma

A

Wear low-healed, soft-soled shoe with a wide toe box

Metatarsal pads (take pressure off of the metatarsal heads)

63
Q

Long fibrous band like tissue that arises from the medial tuberosity of the calcaneus and extends to the proximal phalanges

A

Plantar fascia

64
Q

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

A

Plantar Fasciitis

65
Q

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

A

Plantar Fasciitis

66
Q

Diagnosis for Plantar Fasciitis

A

Clinically

Pain in the inferior heel that is worse when starting to walk plus finding of local point tenderness

67
Q

Treatment for Plantar Fasciitis

A

NSAIDs

Ice massage

Light duty

OTC heel pads

Night splints

68
Q

Plantar Fasciitis

Surgical release should be considered only after _____ months of intense non-operative management

A

6-12 months

69
Q

Pain in the posterior heel may originate from one or more of the following structures:

A

Achilles Tendinosis

Retrocalcaneal bursitis

Haglund syndrome

Pre-Achilles bursitis

70
Q

“Pump bump” that is irritated by shoe wear

Start-up pain in heel

Pain after activity

Antalgic gait

A

Posterior heel pain

71
Q

Calcaneal prominence may be present with edema

Superficial bursa (pump bump)

Tenderness over heel or Achilles tendon

Dorsiflexion limited

Positive Thompson test

A

Posterior heel pain

72
Q

Diagnostic tests for posterior heel pain

A

Clinically diagnosed

  • Lateral radiographs may show calcification
  • Prominent posterosuperior process of the calcaneus
73
Q

Treatment for Posterior heel pain

A

Light duty

Heel lift or open back shoes

Ice massage

Achilles stretch

Casting for 6 weeks in extreme cases

74
Q

Hyperextension injury of the first metatarsal

A

Turf Toe

75
Q

Swelling, tenderness, and limited motion of first MP joint

A

Turf Toe

76
Q

Diagnostic tests for Turf Toe

A

Radiographs are useful for ruling out fractures

Bone scan or MRI when diagnosis is in question

77
Q

Treatment for Turf Toe

A

RICE

NSAIDs

Stiff shoe inserts

78
Q

Treatment for severe Turf Toe

A

Immobilization for 1-2 weeks and 4-6 week period of rest from sports

MSK (14 decks)

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