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PCM-1 > Knee, Ankle, and Foot Joint Pain > Flashcards

Knee, Ankle, and Foot Joint Pain Flashcards

1
Q

How do you perform a varus test?

A

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)

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2
Q

What is morton’s neuroma?

A

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

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3
Q

What are ottawa ankle rules?

A

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

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4
Q

What is genu valgum?

A

knock knees

Q angle increased

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5
Q

What is the rule for weight-bearing in ottawa ankle rules?

A

If pt can transfer weight twice to each foot (four steps) = weight bearing, even if they limp

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6
Q

What are ottawa foot rules?

A

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

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7
Q

How do you perform Homan’s sign?

A

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)

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8
Q

What is normal capillary refill time?

A

2 seconds or less

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9
Q

How do you perform patellar laxity and apprehension tests?

A

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

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10
Q

How do you perform a posterior drawer test?

A

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)

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11
Q

How do you perform a talar tilt test?

A

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)

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12
Q

What is turf toe?

A

inflammation and pain at base of 1st MTP

caused by hyperextension of great toe causing tamage to the joint capsule

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13
Q

What percentage of ankle sprains are high ankle sprains?

What is the mechanism of injury?

A

10%

ankle eversion and rotation (some dorsiflexion)

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14
Q

What are the two tests for a high ankle sprain?

A

squeeze test

cross leg test

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15
Q

What is mulder’s sign?

A

clicking sensation upon palpating w/ one hand 3rd web toe space and other hand compressing transverse arch together
Indication: Morton’s neuroma

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16
Q

How does achilles tendonitis present?

A

sharp heel pain and stiffness at mid-achilles tendon to insertion; worse w/ strenuous exercising, better w/ walking

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17
Q

When performing a monofilament test, where do you test?

A

base of first, third, and 5th plantar MTP joints

18
Q

How do you perform a knee anterior drawer test?

A

pt supine w/ knee flexed to 90 degrees
sit on pts foot and pull prox tibia anteriorly
+ test = excessive translation
Indication: ACL insufficiency

19
Q

What should a complete diabetic foot test include?

A

examining pulses, checking for skin lesions, and monofilament testing

20
Q

How do you perform a patellar glide test?

A

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

21
Q

How do you perform a patella-femoral grinding test?

A

compress patella caudally into trochlear groove and instruct pt to tighten quad against resistance
+ test = crepitus or pain
indicates: roughness or articulating surfaces (chondromalacia)

22
Q

How do you perform a thompson test?

A

pt prone w/ foot off the table. Squeeze pt’s calf. Observe for plantarflexion.
+ test = absence of plantar flexion
indication: achilles tendon rupture

23
Q

How do you perform a patellar compression test?

A

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

24
Q

How do you perform an eversion ankle test?

A

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

25
Q

How do you perform a cross leg test?

A

pt crosses affected ankle over opposite knee –> apply pressure to distal fibula of affected leg
+ test = pain at distal ankle
indication: syndesmosis pathology (high ankle sprain)

26
Q

How do you perform a moses sign?

A

pt subine w/ knee slightly flexed or extended –> anterior compression on gastrocnemius m.
+ test = pain w/ anterior compression
indication: deep vein thrombosis of posterior tibial veins

27
Q

How do you perform a squeeze test?

A

wrap hands around leg proximal to ankle, contacting distal tib/fib w/ both thenar eminences –> squeeze for 2-3 sec, then rapidly release
+ test = pain at syndesmosis
indication: syndesmosis pathology (high ankle sprain)

28
Q

How do you perform mcmurray’s test for medial meniscus?

A

external rotation and valgus stress

+ = pain or palpable click during extension

29
Q

How do you perform mcmurray’s for lateral meniscus?

A

internal rotation and varus stress

+ = pain or palpable click during extension

30
Q

Where do you palpate for bone tenderness in Ottawa ankle rules?

A

distal 6 cm of the posterior edge of fibula

31
Q

What is genu varus

A

bowlegged

decreased Q angle

32
Q

How do you perform an ankle anterior drawer test

A

grab posterior calcaneous and distal tibia/fibula –> provide anterior force on calcaneus; normal springing should occur
+ test: pain, no springing, or excessive motion/laxity
indication: ATF ligament pathology/tear (lateral ankle sprain)

33
Q

How do you perform a valgus knee test?

A

pt supine w/ knee flexed to 30 degrees; apply medial force to proximal tibia while abducting lower leg
+ test = increased laxity, soft or absent endpoint, pain
indication: MCL disruption
(if + at 0 degrees, more serious injury)

34
Q

How do you perform an Apley’s grind distraction test?

A

pt prone w/ knee flexed to 90
pull up while stabilizing thigh; rotate leg
+ test = pain w/ distraction and rotation
indication: possible collateral ligament damage

35
Q

How do you perform an Apley’s grind compression test?

A

pt prone w/ knee flexed to 90
push down and rotate foot internally and externally
+ test = pain w/ rotation or compression
indicates: possible meniscal injury

36
Q

What does a reverse lachman’s test evaluate?

A

PCL insufficiency/posterior capsule injury or disruption

37
Q

How do you perform a lachman’s test?

A

Pt supine w/ knee flexed to 10-30 degrees
push femur posteriorly while pulling tibia anteriorly
+ test = increased laxity
indication: ACL insufficiency (injury/tear)

38
Q

What are the Ottawa knee rules?

A 
age 55 or older
tenderness at head of fibula
isolated tenderness of patella
can't flex knee to 90 degrees
can't do 4 weight bearing steps
39
Q

What are the pittsburgh decision rules for the knee?

A

blunt trauma or fall as mechanism of injury plus either of the following:

  • age less than 12 or greater than 50
  • can’t weight bear 4 steps
40
Q

Which rule, pittsburgh or ottawa is more sensitive for an isolated knee injury?

A

Pittsburgh

PCM-1 (11 decks)

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