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SFM2 > Knee, Ankle, and Foot Pathology > Flashcards

Knee, Ankle, and Foot Pathology Flashcards

1
Q

osgood schlatter disease

A

repetitive pulling of patellar tendon over tibial tubercle –> pain and swelling

adolescents age 10-15

anterior over tibial tubercle

gradually worsens

prominence of tibial tubercle w/ mild effusion, local tenderness, warmth

jumping, sports

tx: nsaids, quads and hams stretching and strengthening; avoid activities that cause pain; ice

usually resolves within a year or so w/ conservative treatment, surgery rarely indicated

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2
Q

peroneal compression

A

common peroneal nerve entrapment

most common peripheral nerve injury in LE

can be injured at any level down thigh and into leg, but usually at fibular head

habitual leg crossing, compression against bed railing or hard mattress, prolonged immobility

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3
Q

patellofemoral syndrome

defn and causes

A

poor tracking of patella over femoral condyles –> grinding

d/t wear and tear, overuse, overload, muscular/biomechanical problems

runners

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4
Q

patellofemoral syndrome

clinical presentation and PE

A

gradual onset of anterior knee pain d/t repetitive movement

dull, aching, possible swelling, clicking

worse with stairs, walking, running, extended sitting, standing from seated

weak quads (vastus medialis atrophy), offset patella, swollen knee

limited knee flexion d/t pain

crepitus, lateral patellar tenderness on passive or active movement

special testing: tracking of patella over femoral groove on knee flexion and extension; patella grind

XR may be normal or misaligned

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5
Q

patellofemoral syndrome

tx and prognosis

A

RICE

bracing and taping for patellar alignment

quads (esp vastus medialis) stretch and strengthen

surgery last resort

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6
Q

knee OA

A

gradual cartilage wear and tear

repetitive trauma over 15-20 years

pain intermittent –> constant

stiffness esp after inactivity

worse with weight-bearing

limp, limited flexion and extension, pain at end of ROM, joint line tenderness, crepitus

risk factors: obesity, trauma, knee instability

XR: osteophytes, sclerosis, non-uniform joint space narrowing

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7
Q
A

knee OA

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8
Q
A

patellofemoral syndrome

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9
Q

meniscal tear

defn and causes

A

foot plant on twisted knee

usually basketball, football, skiing, aging d/t degeneration

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10
Q

meniscal tear

dx: clinical presentation and PE

A

acute injury –> mild swelling and pain >24h

tears d/t chronic degeneration = gradual worsening over time

mild to moderate, dull, aching

with twisting or bending –> worse, sharp

popping, clicking, catching, joint effusion

possible vastus medialis atrophy

limited extension, full flexion d/t pain and catching

joint line effusion and tenderness

special testing: mcmurray test = knee flexion, internal or external rotation w/ valgus or varus stress –> clicking or pain

definitive: MRI

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11
Q
A

meniscal tear (medial)

note fluid in substance of meniscus

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12
Q

meniscal tear

tx and prognosis

A

nsaids

RICE, activity restriction, crutches if needed

quad and hamstring strengthening

consider surgery if locking or concurrent ACL tear

prognosis depends on extent of injury, may predispose to accelerated degeneration

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13
Q

mcmurray’s test

A

meniscal tears, mcl, lcl

valgus and varus stress with knee flexion –> clicking or pain

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14
Q

knee ligment tear

defn and causes

A

ACL = most common

high-impact jumping, twisting, lateral impact while foot is planted

basketball, ski, football

“pop” + immediate swelling

PCL: impact to tibia when knee is bent, e.g. dashboard MVA

LCL: excessive varus movement

MCL: excessive valgus movement

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15
Q

“unhappy triad”

A

MCL + ACL + meniscus tear

“blown knee”

lateral impact + foot planted = football, rugby, motocross …

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16
Q

knee ligament tear

dx: clinical presentation and PE

A

immediate sharp, severe pain after high-impact twisting, often with “pop”

“giving out”

gradually lessens to dull ache

worse with climbing, jumping running

bruising, effusion, tenderness

limited flexion and extension

special testing: Lachman and Anterior Drawer for ACL; posterior drawer for PCL; valgus and varus stretch for LCL and MCL

definitive: MRI

17
Q

lachman’s test

A

ACL tear

knee at 15 degree flexion

pull shin anteriorly while putting back-pressure on thigh

no movement = good

laxity = ACL tear

18
Q

anterior and posterior drawer test

A

anterior: ACL tear
posterior: PCL tear

lay on table, knees bent 90 degrees, pull tibia anteriorly (ACL) and push back (PCL)

no movement = good

laxity and pain = tear

19
Q
A

ACL tear

note disruption of ACL integrity

20
Q

knee ligament tear

tx and prognosis

A

nsaids

RICE, hard braces

PT: proprioception, ROM, quad+ham strengthening for knee stability

consider surgical reconstruction for young adults, athletes, or severe instability

PCL, MCL, LCL: good px; usually responds well to conservative tx

ACL: fair px; if not treated early at risk for prolonged instability, accelerated joint degeneration

21
Q

compartment syndrome

defn and causes

A

limb and life threatening: necrosis, permanent fx impairment, rhabdo(–> kidney failure)

perfusion pressure < tissue pressure in closed space eg muscles, nerves, vessels surrounded by tight fascia

d/t extreme swelling or bleeding

trauma, tigh casts, etc.

usually acute

may be chronic in cases of repeated low-intensity trauma

22
Q

compartment syndrome

dx: clinical presentation and PE

A

6 “P’s” - pain (out of proportion), paresthesia, paralysis, pallor (+/-), pulselessness, pressure

severe pain and pressure esp. following an injury

consider in any case of severe pain following injury esp when significant swelling present

nothing relieves pain

pain on passive muscle stretching is an early clinical indicator

palpation: may be warm or cold. when severe, feels tense or hard

23
Q

compartment syndrome

tx and prognosis

A

fasciotomy

IV hydration

O2 administration d/t hypoxic limb, hyperbaric is best

elevation is contraindicated (decreases arterial flow –> worse ischemia)

good prognosis if fasciotomy w/in 6 hours, necrosis will occur after that (w/ compromise to life and limb)

24
Q

metatarsal frx

A

most common: 5th metatarsal frx at base of bone (nearest tarsal)

forceful INversion

pain and tendernaess at base of 5th metatarsal +/- swelling, bruising, addtl injuries

high risk of delayed healing and nonunion

nondisplaced –> conservative tx (e.g. boot)

if displaced or non-union, surgery

25
Q

malleolar frx

A

lateral malleolar (fibular) is most common

frx of distal fibula

direct trauma or twisting

usually accompanied by medial ligament injuries or another frx

joint widening indicates ruptured ligament

local tenderness, inability to bear weight

26
Q

MTP joint pain

A

metatarsal-phalangeal pain, most often of 1st and 2nd MTP joints

d/t abnormal mechanics e.g. flatfoot (pes planus), high arch (pes cavus), overpronation, poor muscle balance d/t tight gastrocs and dorsiflexors, improper footwear

worse w/ weight-bearing, walking, running, etc.

+/- swelling, redness, tenderness at 1st and 2nd MTP

DD: OA, gout, RA, interdigital neuritis

tx: RICE, nsaids, good footwear, correction of foot mechanics, corticosteriods if severe, surgery if refractory

27
Q

ankle sprain

defn and causes

A

inversion, eversion, twisting planted foot

most common: lateral sprain d/t eversion = anterior talofibular ligament (ATFL)

28
Q

ankle sprain

dx: clinical presentation and PE

A

diffuse initially then localized to medial or lateral w/ reduced swelling

initial sharp pang –> constant deep aching

worse w/ weight-bearing or ROM

bruising if severe

limited active and passive ROM

DDx: medial or lateral malleolar frx, 5th metatarsal frx, midfoot frx; palpate all for bony tenderness, deformity, or crepitus. XR can r/o.

29
Q

ankle sprain

tx and prognosis

A

RICE + bracing

PT (rehab)

if severe, consider surgery (e.g. high-level athletes, chronic instability)

severe lateral, medial, and high ankle sprains may take 4-6 weeks to fully recover, mild sprains usually much more quickly

30
Q

plantar fasciitis

A

pain d/t inflammation along plantar fascia esp at insertion on heel or arch

most common cause of heel pain

repetitive trauma, poor mechanics, poor footwear, overpronation, flat feet, prolonged standing or weight bearing

gradual onset, usually after change in amount or intensity of running or walking, change in footwear, change of surface

burning feeling

usually accompanies tight achilles

point tenderness at medial process of calcaneous, tight plantar fascia

common complication: heel spurs

31
Q

achilles tendon rupture

A

torn tendon usually 4-5 cm proximal to calcaneous, where blood supply is weakest

sudden strain or direct blow to contracted tendon

acute, sharp pain

inability to ambulate

obvious swelling, possible bruising

often a palpable defect

special testing: Thompson test: lying prone with knee passively flexed or standing/kneeling on chair, squeeze calf. no plantarflexion = rupture.

tx: casting +/- surgery

good prognosis but usually some loss of ROM

32
Q

thompson test

A

achille’s tendon rupture

lie prone or stand while kneeling on chair

squeeze gastroc

plantar flexion = normal

no plantarflexion = achille’s tendon rupture

33
Q

tarsal tunnel syndrome

A

entrapment of tibial nerve as it moves under retinaculum of tarsal tunnel (posterior to medial malleolus)

34
Q

Tinel’s test

A

tapping over affected nerve to reproduce sx

e.g. tapping over median nerve in carpal tunnel, ulnar nerve in cubital tunnel, or tibial nerve in tarsal tunnel

35
Q

medial tibial stress syndrome

A

aka shin splints

overuse/repetitive stress –> repetitive pulling of muscle on periosteum –> microtears in muscle and bone

pain with activity

posterior tibialis, flexor digitorum, soleus, tibialis anterior insertions

could progress to stress frx (felt at rest)

RICE + nsaids

ddx stress frx, compartment syndrome

SFM2 (11 decks)

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