Knee, Ankle, and Foot Joint Pain Flashcards
How do you perform a varus test?
Pt supine w/ knee flexed to 30 degrees
lateral force to proximal tibia while adducting leg
(do test at 30 degree flexion and fully extended)
+ test = increased laxity, soft or absent endpoint, pain
indication: LCL disruption
(+ at fully extended indicates more serious injury)
What is morton’s neuroma?
inflammation and thickening of tissue that surrounds the nerve btw toes. Most commonly btw 3rd and 4th toes
pt reports feeling like they’re walking on a marble
palpation –> burning pain
What are ottawa ankle rules?
ankle x rays only indicated for pts who have pain in the malleolar zone AND
- have bone tenderness at posterior edge or tip of lateral or medial malleolus
OR
- are unable to bear weight both immediately after the injury and for four steps in ER/ clinic
What is genu valgum?
knock knees
Q angle increased
What is the rule for weight-bearing in ottawa ankle rules?
If pt can transfer weight twice to each foot (four steps) = weight bearing, even if they limp
What are ottawa foot rules?
Foot x-rays only indicated for pts who have pain in the midfoot zone AND
- have bone tenderness at base of 5th metatarsal or navicular
OR
- are unable to bear weight both immediately after the injury and for four steps in ER/clinic
How do you perform Homan’s sign?
pt laying or setting w/ knee exended. Dorsiflex pt’s foot. can apply lateral compression to calf
+ test = pain w/ dorsiflexion
indication: thrombophlebitis or acute DVT
(not always performed due to potential risk of embolus)
What is normal capillary refill time?
2 seconds or less
How do you perform patellar laxity and apprehension tests?
laxity: push patella laterally, assessing ROM
apprehension: when testing laxity, ask pt if the maneuver provokes any discomfort or sense of instability
+ test = sense of apprehension or instability
indicates: possible previous patellar dislocation or severe instability
How do you perform a posterior drawer test?
pt supine w/ knee flexed to 90 degrees. Sit on pt’s foot and translate tibia posteriorly
+ test = excessive translation
indication: PCL insufficiency, posterior capsular injury or disruption (injury/tear)
How do you perform a talar tilt test?
grasp distal tib/fib and inferior calcaneous; block motion of calcaneus on talus –> invert talus to evaluate ROM
+ test = laxity, increased ROM, or pain
Indication: calcaneofibular L pathology/tear, also tests some ATF (lateral ankle sprain)
What is turf toe?
inflammation and pain at base of 1st MTP
caused by hyperextension of great toe causing tamage to the joint capsule
What percentage of ankle sprains are high ankle sprains?
What is the mechanism of injury?
10%
ankle eversion and rotation (some dorsiflexion)
What are the two tests for a high ankle sprain?
squeeze test
cross leg test
What is mulder’s sign?
clicking sensation upon palpating w/ one hand 3rd web toe space and other hand compressing transverse arch together
Indication: Morton’s neuroma
How does achilles tendonitis present?
sharp heel pain and stiffness at mid-achilles tendon to insertion; worse w/ strenuous exercising, better w/ walking
When performing a monofilament test, where do you test?
base of first, third, and 5th plantar MTP joints
How do you perform a knee anterior drawer test?
pt supine w/ knee flexed to 90 degrees
sit on pts foot and pull prox tibia anteriorly
+ test = excessive translation
Indication: ACL insufficiency
What should a complete diabetic foot test include?
examining pulses, checking for skin lesions, and monofilament testing
How do you perform a patellar glide test?
pt slowly extends and flexes the knee while dr notes quality of motion. Placing hand lightly over patella can increase sensitivity
+ test = palpable or audible crepitus, pain, or catching
indication: possible damage to the articular surface
How do you perform a patella-femoral grinding test?
compress patella caudally into trochlear groove and instruct pt to tighten quad against resistance
+ test = crepitus or pain
indicates: roughness or articulating surfaces (chondromalacia)
How do you perform a thompson test?
pt prone w/ foot off the table. Squeeze pt’s calf. Observe for plantarflexion.
+ test = absence of plantar flexion
indication: achilles tendon rupture
How do you perform a patellar compression test?
pt supine and knee extended
compress patella w/ one hand while moving it medial and lateral
+ test = pain w/ compression
indicates: possible inflammation, chondromalacia, or injury to patellofemoral articular surfaces
How do you perform an eversion ankle test?
grasp distal tib/fib w/ one hand and plantar surface of mid-foot w/ other hand –> evert foot to evaluate ROM
+ test = laxity, increased ROM or pair
indication: deltoid L pathology
