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CLASS 22010 MSK > CLINICAL CARE OF THE LOWER EXTREMITY MUSCULOSKELETAL SYSTEM > Flashcards

CLINICAL CARE OF THE LOWER EXTREMITY MUSCULOSKELETAL SYSTEM Flashcards

1
Q

What is thought to be 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

True or False

Shin splints must be differentiated from a tibial stress fracture

A

True

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3
Q

A patient presents with a history of gradual onset of pain with prolonged walking or running that is localized to the distal third of the medial tibia, what is the most likely diagnosis?

A

Shin splints

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4
Q

Patients with what will have tenderness along the posterior medial crest of the tibia in the middle to distal third of the leg?

A

Shin splints

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5
Q

True or False

Patients with shin splints with have pain with resisted plantar flexion

A

True

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6
Q

What is the treatment for stress fractures?

A
  1. NSAIDS
  2. Ice
  3. LLD activity mod
  4. Gradual return to pain free running
  5. Weight loss if needed
  6. Proper running shoes
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7
Q

Shin splints not responding to conservative management should be further investigated with plain films and/or ____ or bone scan

A

MRI

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8
Q

What should be a differential diagnosis for any patient with shin pain?

A

Tibial stress fractures

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9
Q

Typically tibial stress fractures occur in runners who do what?

A

Ramp up mileage to quickly

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10
Q

What presents very similarly to shin splints but becomes more focal and recovery time is much longer?

A

Tibial stress fractures

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11
Q

What are some clues that a patient presenting with shin splints may have a tibial stress fracture?

A
  1. Pain at rest

2. Pain that suddenly increases in intensity around site of more mild symptoms

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12
Q

Patients with what will have point tenderness in the tibia upon palpation?

A

Tibial stress fracture

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13
Q

True or False

All patients with a suspected tibial stress fracture need imaging to confirm the diagnosis

A

True

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14
Q

True or False

All patients with suspected stress fractures require X-rays but a negative X-ray cannot rule out a stress fracture

A

True

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15
Q

What imaging is better at detecting stress fractures of the tibia?

A

MRI/CT

*MRI is mostly used

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16
Q

What is the treatment for a tibial stress fracture?

A
  1. Rest/duty mod
  2. Weight bearing modification and training
  3. NSAID/Tylenol/ice
  4. Duty mod for roughly 12 weeks
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17
Q

Muscles of the lower legs are divided into four compartments by what?

A

Fibrous septa

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18
Q

What is characterized by an 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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19
Q

What syndrome can be acute resulting from crushing injury, muscle strains, or closed fractures?

A

Acute compartment syndrome

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20
Q

What raises pressure in the fibrous septa?

A

Inflammation

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21
Q

What form of compartment syndrome is chronic in nature and followed by exercise; usually associated with prolonged walking or running with gradual onset of pain symptoms?

A

Exertional compartment syndrome

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22
Q

The following symptoms are associated with what?

  1. Severe leg pain out of proportion to apparent injury
  2. Persistent deep ache or burning pain
  3. Paresthesias
  4. Symptoms progress over few hours
A

Compartment syndrome

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23
Q

What are the Seven “P’s” when concerned for compartment syndrome?

A
  1. Pain
  2. Pallor
  3. Parasthesias
  4. Paresis
  5. Poikilothermia
  6. Pressure
  7. Pulselessness
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24
Q

True or False

Compartment syndrome

Measurement of compartment pressures are not required for diagnosis but are often done by surgical team

A

True

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25
Q

True or False

Acute compartment syndrome is a medical emergency and requires a fasciotomy by a surgeon

A

True

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26
Q

What is the treatment for chronic exertional compartment syndrome?

A
  1. Rest from aggravating activities
  2. NSAIDS
  3. Possible surgery
  4. Ice is contraindicated
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27
Q

True or False

Achilles tendinopathy is common

A

True

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28
Q

How many cases of Achilles tendinopathy happen per 100,000 cases in the general population?

A

5-10

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29
Q

Achilles tendinopathy is more common amongst who?

A

Athletes

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30
Q

Achilles tendinopathy occurs in what percentage of competitive athletes?

A

8.3%

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31
Q

What percentage of military recruits develop Achilles tendinopathy?

A

6.8%

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32
Q

What is the largest tendon in the body?

A

Achilles tendon

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33
Q

The gastrocnemius and soleus muscles converge to form the what?

A

Achilles tendon

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34
Q

What tendon inserts posteriorly on the calcaneus?

A

Achilles

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35
Q

These are all risk factors for what?

  1. athletes
  2. age (30-40)
  3. males
  4. obesity
  5. running mechanic issues
  6. fluoroquinolone antibiotic use
  7. rheumatologic disease
A

Achilles tendon rupture

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36
Q

What special test should be used for a possible Achilles tendon rupture?

A

Thompson test

** can still miss about 10% of ruptures**

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37
Q

If an Achilles tendon rupture is suspected what is the gold standard imaging to be used to confirm the diagnosis?

A

MRI

UT is an alternative

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38
Q

What is the treatment for an Achilles tendon rupture?

A
  1. LLD
  2. Ice
  3. NSAIDS
  4. Achilles tendon support
    a. heel lift
    b. elastic bandage
    c. taping
  5. PT
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39
Q

True or False

All complete tears of the Achilles tendon require an ortho consult and a MEDEVAC

A

True

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40
Q

What ankle ligament connects the Talus and anterior fibula?

A

Anterior talofibular ligament (ATFL)

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41
Q

What ankle ligament connects the talus and posterior fibula?

A

Posterior talofibular ligament (PTFL)

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42
Q

What ankle ligament connects the calcaneus and fibula?

A

Calcaneofibular ligament (CFL)

43
Q

What is the large, strong, and less commonly injured medial ankle ligament?

A

Deltoid ligament

44
Q

What injury of the ankle is most common?

A

Inversion

45
Q

Inversion ankle injuries result is what kind of ankle sprain?

A

Lateral ankle sprain

46
Q

The majority of ankle sprains involve what lateral ankle ligament?

A

ATFL

47
Q

What kind of ankle injury results in a medial ankle sprain?

A

Eversion

less common

48
Q

What ankle injury results in a “high ankle sprain”, a disruption of the interosseous membrane?

A

Eversion injury with dorsiflexion

49
Q

Repeat ankle injuries are how many more times likely as the primary injury?

A

five times

50
Q

How is edema measured with ankle injuries?

A

Figure of 8 method

51
Q

True or False

With ankle sprains you should palpate the entire fibula, distal tibia, foot, and Achilles tendon

A

True

52
Q

For ankle sprains you should use what rules?

A

Ottawa ankle rules

53
Q

What special test should be done for an ankle sprain?

A
  1. Anterior Drawer - ATFL
  2. Talar Tilt - CFL
  3. Tib/fib squeeze
54
Q

Ottawa ankle rules help catch about what percentage of fractures?

A

98%

55
Q

An MRI should be ordered for a patient with an ankle sprain if they have no relief after how many weeks?

A

6-8

56
Q

What is the treatment for an ankle sprain?

A
  1. RICE
  2. NSAIDS
  3. LLD/activity mod
  4. Pain free calf stretching and strengthening
  5. Bracing as needed
57
Q

The critical injury of a Lisfranc fracture involves the second what?

A

tarsometatarsal joint

58
Q

True or False

Lisfranc fracture

The second metatarsal “keys” into a slot in the cuneiforms and is the stabilizing apex for the other tarsometatarsal joints

A

True

59
Q

These are symptoms associated with what fracture?

  1. Patients often report a sprain
  2. pain is localized to the dorsum of the midfoot
  3. swelling may be relatively mild
A

Lisfranc fracture

60
Q

Patients with what will have maximum tenderness to palpation and swelling over the tarsometatarsal joint rather than the ankle ligaments?

A

Lisfranc fracture

61
Q

This is a special test associated with what?

During examination, stabilize the hindfoot (calcaneus) with one hand and rotate
and/or abduct the forefoot with the other hand

A

Lisfranc fracture

This maneuver produces severe pain with a Lisfranc injury but only minimal
pain with an ankle sprain

62
Q

AP radiographs that show that the second metatarsal base has shifted laterally, even by only a few millimeters, what kind of fracture has occurred?

A

Lisfranc

63
Q

True or False

Lisfranc fractures

If there is confusion about the diagnosis, a CT or MRI is helpful in confirmation

A

True

64
Q

What is the treatment for a Lisfranc fracture?

A
  1. Ortho consult
  2. Non displaced injuries are treated with 6-8 weeks of non-weight bearing cast
    immobilization
  3. Fractures or dislocations that are displaced require surgery
  4. Non-weight bearing (NWTB)
  5. Analgesics
  6. MEDEVAC
65
Q

True or False

Even a minimally displaced Lisfranc fracture requires surgical reduction

A

True

66
Q

What creates hallux valgus, which is lateral deviation of the great toe at the MTP joint?

A

Bunion

67
Q

What may lead to prominence of the medial aspect of the first metatarsal head (bunion)?

A

Hallux valgus

68
Q

Are bunions more common in men or women?

A

Women 10:1

69
Q

Pain and swelling, aggravated by shoe wear are the principal complaints of what?

A

Bunions

70
Q

The great toe pronates with resulting callous on the medial aspect in what?

A

Bunion

71
Q

You will see the following in visual exam of what?

  1. Valgus stress at the MTP with hypertrophic changes over joint
  2. A hypertrophic bursa is evident over the medial eminence of the first metatarsal
  3. The great toe is pronated (rotated inward) with subsequent callus on its medial aspect
A

Bunion

72
Q

True or False

The severity of a bunion deformity is graded by measuring forefoot angles on weightbearing AP radiographs of the foot

A

True

73
Q

True or False

Bunion

The normal hallux valgus angle is < 15°, and a normal intermetatarsal (IM) angle is <10°

A

True

74
Q

What is the initial treatment for a bunion?

A
  1. PT education and shoe wear modifications
  2. LLD
  3. Ice
75
Q

True or False

Bunion

Patients with persistent pain may benefit from surgical correction

A

True

76
Q

What neuroma is not a true neuroma but rather a perineural fibrosis of the common digital nerve as it passes between the metatarsal heads?

A

Morton Neuroma

77
Q

What condition is most common between the third and fourth toes (third web space)?

A

Morton neuroma

78
Q

Plantar pain in the forefoot is the most common presenting symptom in what?

A

Morton Neuroma

79
Q

Dysesthesias into the affected two toes or burning plantar pain that is aggravated by activity is common in what? Patients also report numbness in the adjacent toes of the involved web space.

A

Morton neuroma

80
Q

Many patients with what state they feel as though they are “walking on a marble” or that there is a “wrinkle in my socks”, removing the shoe and rubbing the ball of the foot often help obtain relief?

A

Morton neuroma

81
Q

True or False

Isolated pain on the plantar aspect of the web space is consistent with an intermetatarsal neuroma

A

True

82
Q

What special test is indicated with a Morton Neuroma?

A

Metatarsal squeeze test

Apply upward pressure between adjacent metatarsal heads and then compress
the metatarsals from side to side with the free hand

The upward pressure places the neuroma between the metatarsal heads, allowing it to be compressed during side-to-side compression

83
Q

What is the treatment for a Morton Neuroma?

A
  1. Low heeled, soft soled shoe with a wide toe box

2. Metatarsal pads

84
Q

What is a long fibrous band like tissue that arises from the medial tuberosity of the calcaneus and extends to the proximal phalanges?

A

Plantar fascia

85
Q

What provides support to the foot and toes by tightening thus elevating the longitudinal arch, inversion of the hindfoot and external rotation?

A

Plantar fascia

86
Q

What is the most common cause of heel pain in adults due to the degeneration of the plantar fascia, occurring twice as much in woman as in men, and is more common in over weight patients?

A

Plantar fasciitis

87
Q

The following are clinical symptoms associated with what?

  1. Pain is often most severe on awakening, or when rising from a resting position because the first few steps irritate the foot
  2. Prolonged standing and walking also increase the pain; sitting relieves symptoms
  3. Focal pain directly over the medial calcaneal tuberosity and 1-2 cm distally along the plantar fascia
A

Plantar fasciitis

88
Q

True or False

Patients with plantar fasciitis will be TTP directly over the plantar medial calcaneal tuberosity and 1-2 cm distally along the plantar fascia

A

True

89
Q

What is the treatment for plantar fasciitis?

A
  1. NSAIDS
  2. Ice massage
  3. LLD/activity mod
  4. OTC heel pads
  5. Night splints may be helpful
90
Q

True or False

Plantar fasciitis

Patients whose symptoms do not respond to non-operative treatment need further evaluation, Surgical release should be considered only after 6 to 12 months of intense nonoperative management

A

True

91
Q

The following structures may be associated with pain originating from where?

  1. Insertion of the Achilles tendon at the calcaneus (Achilles tendinosis)
  2. Retrocalcaneal bursa (retrocalcaneal bursitis)
  3. Prominent process of the calcaneus impinging on the retrocalcaneal bursae and/or Achilles tendon (haglund syndrome)
  4. Inflammation of the bursa between the skin and the Achilles tendon (pre-achilles bursitis)
A

Posterior Heel pain

92
Q

The following clinical symptoms are associated with what?

  1. “pump bump”
  2. Start up pain
  3. Pain after activity
  4. Antalgic gait
A

Posterior heel pain

93
Q

A calcaneal prominence may be present with associated edema and superficial bursa may be present (pump bump) in what?

A

Posterior heel pain

94
Q

True or False

You may have a positive thompson test for Achilles tendon rupture in a patient with posterior heel pain

A

True

95
Q

True or False

Posterior heel pain

Lateral radiographs of the heel may show calcification of the Achilles tendon and spur formation, a prominent posterosuperior process of the calcaneus also may be present

A

True

96
Q

What is the treatment for posterior heel pain?

A
  1. LLD/ activity mod
  2. Heel lift or open back shoes
  3. Ice massage
  4. Achilles stretch
  5. Casting for 6 weeks in extreme cases
97
Q

What is known as a hyperextension injury of the first metatarsal?

A

Turf toe

98
Q

True or False

Turf toe is called such because of the increased incidence of hyperextension injury associated with playing on artificial turf

A

True

99
Q

Patients with what usually report swelling, tenderness, and limited motion of the first MP joint?

A

Turf toe

100
Q

True or False

Turf toe

Radiographs are useful to detect associated avulsion fractures, evaluate joint congruity, and rule out preexisting arthritic changes and when the diagnosis is in question, a bone scan or MRI can help exclude other possibilities such as sesamoid or metatarsal fractures

A

True

101
Q

What is the treatment of turf toe?

A
  1. RICE
  2. NSAIDS
  3. Stiff shoe inserts
  4. Severe injury requires protective weight bearing or immobilization for 1-2 weeks and with 4-6 week period of rest from sports
102
Q

True or False

Turf toe

Intra-articular fractures can require open reduction or excision

A

True

103
Q

True or False

Turf toe

Urgent surgical intervention is necessary for an irreducible dislocation

A

True

104
Q

True or False

Turf toe

Osteochondral lesions or loose bodies also require further evaluation

A

True

CLASS 22010 MSK (12 decks)

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