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PCMI Exam 2 > Knee, Ankle, Foot > Flashcards

Knee, Ankle, Foot Flashcards

1
Q
  • What are some of the key anatomical features to identify when examining the knee?
A
  • Patella
  • Medial and lateral tibial plateau
  • Medial and lateral femoral condyle
  • Medial and lateral meniscus
  • MCL and LCL
  • ACL and PCL
  • Tibial tuberosity
  • Proximal fibular head
  • Popliteal fossa
  • Anserine and prepatellar bursa
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2
Q
  • What are some of the key anatomical features to identify when examining the ankle/foot?
A
  • Medial and lateral malleolus
  • Tendons (Ligaments)
    • Deltoid, Anterior and Posterior Talofibular Ligaments, Calcaneofibular ligaments, anterior and posterior tibualis, flexor and extensor halluces longus, peroneous (fibularis), flexor digitorum longus
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3
Q
  • What are normal ROM for knee?
A
  • Flexion: 145-150
  • Extension: 0
  • Internal and External Rotation: 10
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4
Q
  • What are the normal ROM values for the ankle and foot?
A
  • Plantar flexion: 55-65
  • Dorsiflexion: 15-20
  • Inversion: 20
  • Eversion: 10-20
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5
Q
  • What are the two DTRs to check on the lower extremity? Which nerve roots are associated with each?
A
  • Patellar tendon (L2-L4)
  • Achilles (S1)
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6
Q
  • How do you test capillary refill?
A

Press on nail bed of finger until blanching

Release and note time to regain color

Normal <2 sec

Tests digital perfusion (arterial occlusion, hypovolemic shock, hypothermia)

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7
Q
  • In which areas do you examine for edema in the lower extremity?
  • How is edema documented
A
  • Dorsum of foot
  • Anterior tibia
  • Behind medial malleolus
  • 1+ (slight pitting disappears rapidly)
  • 2+ (slight indentation, 10-15 sec)
  • 3+ (deep indentation >1 min)
  • 4+ (Very marked indentation, 2-5 min)
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8
Q
  • How do you perform a Valgus specialty test?
  • What are you testing for?
A
  • Patient is supine with knee flexed to 30 deg
  • Doc holds lateral knee with cephalad hand and lower leg with caudad hand
  • Medial force is applied to the knee while the lower leg is aBducted (basically applying a lateral force pulling out the lower leg)
  • Testing for MCL disruption
  • If this test is + at 0 deg, indicative of potential capsular injury
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9
Q
  • How do you perform a Varus specialty test?
  • What are you testing for?
A
  • Patient is supine with knee flexed to 30 degrees
  • Doc has cephalad hand monitoring medial aspect of knee and caudad hand monitoring lateral aspect of lower leg
  • Doc applies lateral force on knee while ADducting the lower leg
  • Testing for LCL disruption
  • If test is positive at 0 deg, indicative of potential capsular injury
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10
Q
  • How do you perform an Anterior Drawer Test?
  • What is this testing for?
A
  • Patient is supine with knee flexed to 90 deg
  • Doc sits on patient’s foot and graps proximal tibia with both hands and applies an anterior force
  • Testing for Excessive translation of the tibia
  • Positive test indicative of ACL insufficiency (injury/tear)
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11
Q
  • How do you perform a Posterior Drawer Test?
  • What are you testing for?
A
  • Patient is supine with knee flexed to 90 deg
  • Doc sits on patient’s foot, graps proximal tibia with both hands and applies a posterior translating force
  • Excessive translation indicative of PCL insufficiency, capsular injury or disruption
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12
Q
  • How do you perform a Lachman’s test?
  • What are you testing for?
A
  • Patient is supine w knee flexed to 20-30 deg
  • Doc has cephalad hand on distal thigh and caudad hand on proximal tibia
  • Caudad hand pulls tibia anteriorly while the cephalad hand stabilizes the thigh
  • + test indicative of ACL insufficiency (injury/tear)
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13
Q
  • How do you perform a reverse Lachman’s test?
  • What are you testing for?
A
  • Patient is supine with knee flexed 20-30 deg
  • Doc uses cephalad hand to stabilize distal thigh and uses caudad hand to contact the proximal tibia
  • Doc applies posterior force on proximal tibia while the cephalad hand monitors the distal thigh
  • Testing for PCL insufficiency, capsular injury, or disruption (injury/tear)
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14
Q
  • How do you perform a McMurray’s test?****
  • What are you testing for?
A
  • Patient is supine with hip and knee flexed
  • Doc has caudad hand on ankle and cephalad hand on tistal femur
  • Medial meniscus: Rotate tibia into internal rotation and apply a varus stress and continue leg into extension
  • Lateral meniscus: Rotate tibia into external rotation and apply a valgus stress and continue leg into extension
  • Testing for MCL or LCL tear
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15
Q
  • How do you perform an Apley Grind Compression Test?
  • What are you testing for?
A
  • Patient is prone with knee flexed to 90 degrees
  • Doc applies downward force on foot using caudad hand while rotating internally and externally
  • Positive test with pain during rotation and/or compression indicative of possible meniscal injury, collateral ligament injury, or both
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16
Q
  • How do you perform an Apley Grind Distraction Test?
  • What are you testing for?
A
  • Patient is prone with knee flexed to 90 deg
  • Doc has caudad hand on foot and stabilizes thigh with cephalad hand
  • Upward traction is applied to the leg while rotating it (reduces meniscal pressure and increases ligamentous strain)
  • Positive test is indicative of a possible collateral ligament injury
17
Q
  • How do you perform a patellar laxity and apprehension test?
  • What are you testing for?
A
  • Laxity: One hand above and below joint, thumbs against medial side of patella, push patella laterally and assess ROM
  • Apprehension: When testing laxity to point of restriction, ask if maneuver provokes discomfort
  • Positive indicative of previous patellar dislocation or severe instability
18
Q
  • How do you perform the patellar compression (grind) test?
  • What are you testing for?
A
  • Patient supine with knee extended
  • Compressive force applied to patella while moving it medially and laterally
  • Positive test when there is pain with compression
  • Indicative of Possible inflammation, chondromalacia, or injury to the patellofemoral articular surfaces
19
Q
  • How do you perform the patella-femoral grinding test?
  • What are you testing for?
A
  • Patient supine with knee extended
  • Doc compresses patella into trochlear groove and patient is instructed to tighten quads
  • Positive test with crepitus or pain
  • Positive test indicative of Chondromalacia
20
Q
  • How do you perform a patellar glide test?
  • What are you testing for?
A
  • Patient sitting or supine
  • Doc will monitor patient while they flex and extend the knee
  • Positive test with crepitus, pain, or catching of the patella
  • Positive test indicative of possible damage to the articular surface
21
Q
  • How do you perform an ankle anterior drawer test?
  • What are you testing for?
A
  • Doc grabs posterior calcaneus with caudal hand and distal tib/fib with cephalad hand
  • Anterior force applied to calcaneous (normal springing should occur)
  • Positive test with no springing or excessive laxity, indicative of ATF ligament pathology/tear or a lateral ankle sprain
22
Q
  • How do you perform a Talar Tilt Test?
  • What are you testing for?
A
  • Doc grabs distal tib/fib with one hand and inferior calcaneus with the other
  • Talus is inverted to evaluate ROM
  • Positive test with laxity, increased ROM or pain
  • Indicative of Calcaneofibular ligament pathology/tear and some ATF injuries (lateral ankle sprain)
23
Q
  • How do you perform an eversion test?
  • What are you testing for?
A
  • Doc grabs distal tib/fib with one hand and plantar surface of mid-foot with the other
  • Doc everts foor to evaluate ROM
  • Positive test with laxity, increased ROM, or pain
  • Indicative of deltoid ligament pathology
24
Q
  • How do you perform a squeeze test?
  • What are you testing for?
A
  • Wrap hands around legs proximal to ankle; squeeze 2-3 sec then release
  • Positive test with pain at the syndesmosis
  • Indicative of syndesmosis pathology (high ankle sprain)
25
Q
  • How do you perform a Cross Leg Test?
  • What are you testing for?
A
  • Patient will be seated and cross affected ankle over opposite knee
  • Doc applies pressure to distal tib/fib of affected leg
  • Positive test when there is pain at the distal ankle
  • Indicative of syndesmosis pathology (high ankle sprain)
26
Q
  • How do you perform a Thompson test?
  • What are you testing for?
A
  • Patient is supine and doc squeezes calf
  • Observe for plantar flexion
  • Positive test with ABSENCE of plantar flexion
  • Indicative of achilles tendon rupture
27
Q
  • How do you perform Homan’s sign test?
  • What are you testing for?
A
  • Patient is lying or seated with knee extended
  • Doc dorsiflexes patient’s foot
  • Positive test when there is pain with dorsiflexion
  • Indicative of thrombophlebitis or acute DVT
28
Q
  • How do you perform the Moses sign test?
  • What are you testing for?
A
  • Patient is seated or supine with knee slightly flexed or extended
  • Doc applies anterior compressive force on the gastrocnemius muscle
  • Positive test if there is pain with anterior compression
  • Indicative of DVT of the posterior tibial veins
29
Q
  • When someone sprains an ankle, what is the most common type of sprain?
  • What ligaments are involved?
A
  • Inversion sprain
  • ATF (Always tears first)
  • Calcaneofibular
  • Posterior talofibular
30
Q
  • What is the mechanism of injury for a high ankle sprain?
  • What ligaments are involved?
A
  • Ankle eversion sprain with dorsiflexion
  • Anterior inferior tibiofibular
  • Syndesmosis
  • Usually more painful on medial surface and there is minimal swelling
31
Q
  • Plantar fasciitis is inflammation of origin of the _
A

Plantar aponeurosis

Worse in morning, improves throughout day ***

Point tenderness of calcaneous

Commonly associated with tight calves, repetitive impact activities, obesity, etc

32
Q
  • What is Morton’s neuroma?
  • How do you test for it?
A
  • Inflammation and thickening of tissue surrounding the nerve between the toes (typically 3-4th toes affected)
    • Patient will note that they feel as if they are walking on a marble (they aren’t walking on sunshine and it don’t feel good)
  • Mudler’s Sign Test (Mudler, Morton)
    • Clicking senesation upon palpating with one hand in the third web space and other hand compressing the transverse arch together
33
Q
  • What is turf toe?
    *
A
  • Inflammation and pain @ base of first MTP
  • Pain and bruising at base of first toe
  • Caused by hyperextension of toe
34
Q
  • How do patients with diabetic neuropathy present?
  • How do you test for diabetic neuropathy?
A
  • Loss of vibratory sensation along foot and pain with light touch and temperature changes
  • Monofilament test (pressure sensation)
  • Vibration sensation test with tuning fork
  • Superficial pain test with pinprick
35
Q
  • How do patient’s with gout present?
A
  • Swollen, tender, erythematous and painful metatarsophalangeal joint (most commonly of the big toe)
  • Urate crystal deposits
36
Q
  • What is Osgood-Schlatter Disease?
  • How do patients present?
  • What causes it?
A
  • Osteochondritis of tibial tubercle
  • Swelling of tibial tubercle with anterior knee pain that worsens over time (usually in kiddos)
  • Repetitive strain and avulsion of ossification center of tibiual tubercle
37
Q
  • What are the Ottowa Ankle Rules?
A
  • An ankle series is only indicated for patients who have pain in the malleolar zone AND have bone tenderness at posterior edge or tip of the lateral or medial malleolus OR are unable to bear weight immediately after injury and for four steps in ED or Doctor’s office
  • A foot series is only inicated for patients who have pain in midfoot zone AND have bone tenderness at the base of the fifth metatarsal or at the navicular OR are unable to bear weight immediately after injury and for four steps in the ED or doctor’s office

PCMI Exam 2 (11 decks)

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