Examination Flashcards
When is there generally a need to refer out?
if the injury is acute (after determining seriousness of injury)
When may a full biomechanical exam NOT be necessary?
post surgery or post injury
What are Dutton’s key points on history taking?
- Mechanism of injury
- severity of condition
- when symptoms began
- location, nature and behavior of symptoms
- structure at fault
- other systemic conditions (collagen disease, neuropathy, vascular, radiculopathy, other pathology)
Immediate and continuous inability to bear weight may indicate what?
Fracture
Nocturnal pain may indicate what?
Malignancy
Hemarthrosis
Fracture
Infection
Gross pain with ankle valgus stress and tenderness with pressure on the distal fibula may indicate what?
Fractured fibula
Pain and weakness during resisted eversion may indicate what?
Fracture of the 5th metatarsal base
Calf pain and/or tenderness, swelling with pitting edema, increased skin temperature, superficial vein dialation, or cyanosis may indicate what?
Deep vein thrombosis
REQUIRES IMMEDIATE MEDICAL!
An abnormally warm foot may indicate what?
Local inflammation, but can also originate from a tumor in the pelvic or lumbar region.
An abnormally cold foot may indicate what?
Vascular problem
What are the 8 special questions?
1) Do symptoms change with movements of LOW BACK? Do you have BACK PAIN if you feel it is unrelated?
2) Does your foot ankle PAIN EXTEND up into your knee, thigh, hip or back? Do you experience NUMBNESS OR TINGLING into the hip, thigh, leg, or ankle?
3) Have you INCREASED your PHYSICAL ACTIVITY, especially running?
4) Do you have ankle pain or STIFFNESS that EASES AFTER A FEW HOURS in the MORNING?
5) Do you have pain in the bottom of your foot that is WORSE when you INITIALLY BEAR WEIGHT (especially in the AM) and WORSENS with INCREASED TIME ON YOUR FEET?
6) Is your leg/ankle or foot pain a RESULT OF TRAUMA, such as injury with JUMPING, LANDING, TWISTING, etc?
7) Have you ever had or do you have ACTIVE CANCER, PARALYSIS, PLASTER IMMOBILIZATION, RECENT PERIOD OF BED REST, LOWER LEG SWELLING, PITTING EDEMA?
8) Do you or have you had sudden episodes of REDNESS, HEAT, SWELLING, and PAIN? Have you recently consumed GREATER THAN NORMAL PORTIONS OF MEATS, SEAFOODS, BEANS, or other foods high in PURINES? INCREASED intake of ALCOHOL?
What do you do if pt has symptoms that change with movements of low back / low back pain.
Examine lumbopelvic region and back.
What do you do if pt has ankle pain extending up into knee/thigh/back and experiences numbness/tingling into hip/thigh/leg/ankle?
Neurological exam
Low back exam
What do you do if pt has pain in posterior calf and/thigh but no numbness?
Consider:
Hamstring strain
Ischial bursitis
Piriformis syndrome
What do you do if pt has recently increased physical activity, especially running.
Be suspicious of a stress fracture.
What do you do if pt has ankle pain of stiffness that eases after a few hours in the morning?
Be suspicious of osteoarthritis .
What do you do if pt has pain in the bottom of foot that is worse when initially bearing weight (especially in the AM) and worsens with increased time on his feet?
Be suspicious of plantar fascitis?
What do you do if pt’s leg/ankle/foot pain is a result of trauma (i.e. jumping, landing, twisting, etc.)?
Be suspicious of: Ligamentous injury talar dome osteochondral defect fracture ankle sprain sydesmosis injury
What do you do if pt has/had paralysis, plaster immobilization or recent period of bed rest?
Be suspicious of DVT.
What do you do if pt has/had sudden episodes of redness, heat, swelling, and pain?
Be suspicious of gout.
What do you do if pt recently consumed a greater than normal portion of meat, seafood, beans, or other foods high in purines?
Be suspicious of gout.
What do you do if pt had increased intake of alcohol?
Be suspicious of gout.
What do you do if pt has/had active cancer?
Be suspicious of DVT.
