fifi Flashcards
- Patient presents w/ lateral pain, radiating down lower leg from recent forced dorsiflexion injury with tingling sensation
Tib-Fib Subluxation
- You test popliteal muscle
test tibial rotation first
13 year old boy had pain and is overweight; has posterior-inferior rotation in hip
SCFE (adolescent coxa vara
- Patients who present with peripatellar pain with clicking and high riding patella with a fibrotic feel
Synovial plica
- PFTS caused by
Quad imbalance, patella alta/baja, synovial plica syndrome (ALL)
- Movie theater sign-
pain on prolonged sitting
housemades knee
pre-patellar bursitis
segond’s sign
lateral tibial avulsion Fx- ACL and MM
sindig larsen/ johansson disease
- inferior patellar apophysisitis
- proximal pole of patellar tendon inserting into the inferior pole of the patella. represents a chronic tratcion injury related to osgood schlatter disease
- Osgood-Schalters
- tibial tuberosity apophysitis
pelligrini steati
calcified MCL
godfrey sag
PCL tear/instability
45 male had sudden pain; reports a painful sense of giving way (mechanical); anterio-medial joint line pain; sharp pain and catching; pain increased with activities; irritation of synovium
-Orthopedic test: McMurray’s
Most likely clinical impression:
-Medial Meniscus Tear
Management avenues
-Obtain x-ray based on Ottawa Rules (couldn’t bend knee)
-Recommend crutches and co-manage with orthopedist
45 year old female, insidious Right Lateral knee pain; pain aggravated by running downhill training for marathon; no pain with walking; pain with stair climbing; crepitus over lateral knee
-Orthopedic + Tests: Noble Test, Modified Ober’s
-Clinical Impression
a. IT Band syndrome
Management:
a. Stretch IT band, hamstrings and quad
b. Adjust for fibular head subluxation
c. Adjust for internal hip rotation
d. Adjust talus and calcaneus bones if needed
- X-ray of 14 year old, codman’s triangle with onion skinned appearance
OsteoSARCOMA
adult patient with relatively painless activity, has a feeling of giving way
ACL instability
athletes who experience sudden pain and inability to plantarflex toes to push off
tennis leg
ottawa rules:
- 55+
- isolated pain over fib head
- isolated pain over patella
- cant bend knee to 90o
- cant weight bear
high ankle sprain characterized by:
syndesmosis of tib-fib lig
osteochondrosis, navicular pain, may lead to AVN
kohler’s
not considered an ottowa rule
excuisite pain at 2nd met head
21 male, diffuse heal pain, bohler’s angle 4o
calcaneal fx
typically affecting juveniles, posterior heel and calf pain, can lead to AVN
severs
west pont ankle pain, ATFL and CFL instability
grade 2
common cause of fasciitis overlooked
tightened tricep surae and achilles
grade 1 sprain, 2 appropriate answers:
RICE
adjust the cuboid bone if subluxated
appropriate exercises excluded:
immobilized completely for 7 weeks
pain from traction apophysitis, 5th met base
Islen’s disease
calcific bump on calcaneus
haglans deformity
majority of foot complaints in souza
inappropriate footwear
improper support
lisfranc fracture
Fx of tarsal- metatarsal joints
pain at bottom of foot, specifically forefoot; pes cavus, callus at 2nd met head, no pain in big toe dorsiflexion least likely?
plantar fasciitis
tapping dorsum of foot negative, tapping bottom of foot
metatarsalgia
management of patient to exclude
cast and crutches
fracture of 5th met base
jones
podagra, associated where:
1st metatarsal-phalangeal joint
peroneal nerve foot stepped on in max dorsiflexion, radiating into foot
proximal tib/fib subluxation (medical)
popliteus blows out, what to address first?
rotated tibia
13 year old bilateral knee pain, overweight, trauma, posterior-inferior of proxiaml femoral epiphysis; Dx?
9-17 years old
-adolescent coxa vara (SCFE)
knee pain, push patella medial, describes what test?
test for synovial plica/ patellar bowstring
movie- goes sign
retropatellar ache
housemaids knee
prepatellar bursitis
bakers’s cyst
popliteus fossa mass
jumpers knee
patellar tendonitis
pellegrini stieda
calcified collateral ligament- post traumatic, medial femoral collateral ligament, avulsion fx, then calcification of ligament
Right knee pain, felt it twist, painful giving way, loose body, anterior medial joint pain in knee worse with bending, decreased active flexing
- meniscus, mcmurray
- management: xray, crutches and co-management with orthopedist
severely swollen knee, one year ago, limping, whole region is painful, kid, hair on end xray
osteosarcoma
43 year old collapses after leg gave way, painless
ACL, ligament instability
male walking in woods, drops to ground, feels pop, postero-medial knee pain, ecchymosis
tennis leg (rupture of the gastroc)
pain over shin, weak dorsiflexion, dorsalis pedis is weak
- anterior compartment
- deep peroneal/ fibular nerve
21 yoa athlete, pain at bottom of foot, pes cavus, taut fibers on plantar
aspect, callus at 2nd met head, forced dorsiflexion of big toe is unremarkable (plantar fasciitis out)
- Passively flexion toes rules out metatarsalgia, extending aggravates Mortons
- Tap plantar aspect = pain, tap dorsal aspect = no pain; rules out fracture
- management excludes foot cast and crtches
leg cramps relieved by rest, 70 year old
- interittent claudication
- ischemic arteritis
ballet dancer w/ pain in middle of shin, shin splint treatment isnt working, “dreaded black line”
- tibial stress fx
- tibial stress fx syndrome is shin splints
36 year old no trauma, working out, lower leg swelling, blushing, management?
- refer out
- anterior compartment swelling
- intermittent claudication aka ischemic arteritis
wells pre test probabiblity
DVT test
burning sensation in both legs, LBP, walking in pain worsens, stopping doesnt make it better, but flexing does
claudication and spinal stenosis
soccer, left sided medial shin pain ( posterior), cramping on medial aspect of lower leg, intermittent pins and needles, into bottom of foot (plantar nerves), loses muscle control (paresis), different from shin splints, no low back pain, skin is shiny (indicates swelling)
- clinical impression: deep posterior compartment syndrome
- chiro care and refer to manage
6 P’s
- pain
- pallor
- paresthesia
- pulselessness
- paresis
- poikilothermia
intrinsic factor for ITB syndrome
decreased Q angle
lateral proximal thigh pain
coxa varus
2 hour drive with painless give away w/ previous slip
ACL injury w/ quad inhibition
patella alta & weak VMO
PFTS
64 yo ale w/pain relieved at rest
advanced atherosclerosis
shin pain, gradually progresses, relief is not immediate upon stopping
medail stress fx
56 yo male, leg discomfort, denies truama
refer patient for doppler ultrasound
pain in distal calf to heel, posterior-lateral distal heel, runs 40 miles, not likely dx:
- deep posterior compartment syndrome
- it is sural N
- 28 y.o female, R sided shin pain aching and tingling w/ burning, constant, “loss of control”, normal stats, tenderness, median shin; “woody feeling”, erythmateous, (-) Mortons, (-) Drawer Sign, (-) Thompson, (-) Tarsal Tunnel, (+) Tineal Ankle, loss of 2 point discrimination, able to toe walk
- Possible sequela: diministed posterior tibial pulse, inability to plantarflex & invert, DVT
- Possible ddx: Tarsal Tunnel Syndrome, Deep Posterior Compartment Syndrome, Posterior Tibial Stress Syndrome (Medial Shin Splints)
- Mangement to exclude: Ice, compression, elevevation; Splint w/ dorsiflexion at night; air cast for 4-6 weeks
Wells Pre-Test probably scale resulting in 2 points being taken off?
a. Patient has malignancy in leg
b. Next step if patient had a high score on test
- Obtain a D-Dimer assay .
- Regarding lower leg swelling, what would have a strep or staph infection
Cellulitis
stress fx locations of the tibia best match
runners- middle or distal 3rd
patient has pain over the distal part of shin, dorsalis pedis is weak, what nerve
deep peroneal
weakness when testing the popliteus muscle/ hilton law
posterior tib
increased q angle genu ____
valgus
primary functions of ACL, which is not true
does not assist the biceps
lateral knee pain 23 year old foot stepped on
tib fib sublux
15 yo with bilateral knee pain, antalgic lean, mild osteoporosis
slipped capital epiphysis kliens
55 yo cant take more than 4 steps exquisite patella pain
xray the patient
55 yo walking in the wilderness, feels like he was fhot in the leg or snake bite
tennis leg/ refer to orthopedist
medial jnt space narrowing and subchondral cysts
DJD/ adj exercise, PNF, swimming
prime movers in flexion after 30 degree
IT band
high school athlete w/ med pain and swelling - patello-femoral tracking syndrome (not chondramalascia patella)
+ obers, clarks, tight ITB, inc Q angle
according to souza-
restricted leg extension do not do during stage stage 1 ACL tear
origin of IT
lateral iliac crest, inserts to the IT band?
PCL
shorter structure less prone to injury
movie goes sign
retro patellar ache
