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CLET > Knee Pain Wk 2 > Flashcards

Knee Pain Wk 2 Flashcards

1
Q

Bony palpation of knee

A

patella
medial tibial plateau (ext rotation tibia)
tibial tubercle
medial femoral condyle (flex knee)
lateral tibial plateau (int rotation of tibia)
lateral femoral condyle (flex knee)
fibula head (dorsi/plantar flex)

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2
Q

soft tissue palpation of knee

A 
quadriceps (as unit and individual)
     vastus lateralis
     vastus medialis
     vastus intermedius
     rectus femoris
infrapatellar tendon
bursae
      prepatellar
      superficial infrapatellar
medial meniscus
lateral meniscus
pes anserine area (3 tendons come together)
     sartorius
      gracilis
      semitendinosus
popliteal fossa
lateral collateral ligament
medial collateral ligament
gastrocnemius
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3
Q

Knee range of motion

A

flexion 135
extension 0
internal and external rotation

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4
Q

McMurray Sign

A

supine, flex hip to 90, knee to 90. hold heel apply external rotation. place hand on lateral knee and apply valgus stress. maintain these while extending knee

positive: clicking sound or pain by knee joint
indicates:
- tear of medial meniscus is positive on external rotation
- tear of lateral meniscus if positive on internal rotation

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5
Q

Medial Collateral Ligament tests & AKAs

A

aka Abduction stress test, valgus stress test

supine, stabilze lateral thigh, grasp above medial ankle and apply abduction of knee pressure

positive: gapping and/or elicited pain above/at/below joint line
indicates: torn medial collateral ligament

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6
Q

Lateral collateral ligament test and AKAs

A

aka Adduction stress test, Varus stress test

supine, stabilze medial thigh, grasp lateral ankle and push medial to open lateral side of joint

positive: gapping and/or elicited pain above/at/below the joint line
indicates: torn lateral collateral ligament

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7
Q

bounce home test

A

supine, flex knee and grasp heel and posterior knee. glently pull knee into extension

positive: knee does not go into extension, slight flexion remains
indicates: diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus

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8
Q

Drawer Test

A

supine, knee bent. sit on patients foot. pull tibia toward you, then push away

  • gapping greater than 6mm, tibia moves anterior, when the leg is pulled indicates torn anterior cruciate ligament
  • gapping greater than 6mm, tibia moves posterior, when the leg is pushed indicates tear of posterior cruciate ligament
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9
Q

Lachman test

A

supine, knee flexed to 30. grasp proximal tibia and distal femur. attempt to pull tibia forward to feel joint play

-gapping with the tibia moving away from femur indicates anterior cruciate ligament or posterior oblique ligament instability

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10
Q

Apprehension test of patella

A

supine, push patella laterally while looking at patients FACE!

positive: apprehension, distressed facial expression, or contraction of the quadriceps to bring patella back in line
indicates: chronic patella dislocation, or predisposition to dislocation

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11
Q

patella femoral grinding test

A

aka Clarke sign
supine, use web on hand to trap patella against femur. ask pt to contract quadriceps for while holding for a few seconds

  • retropatellar pain and the patient is unable to hold the quadriceps contraction
  • degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)
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12
Q

Patella Ballottment test

A

pt supine, knee extended. A-P pressure on medial patella

  • a floating sensation of the patella
  • a large amount of swelling in knee
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13
Q

Apley Compression test

A

pt prone, flex knee to 90. stabilize thigh with your knee. downward pressure on patients heel while internally and externally rotating

  • patient points to side of pain
  • pain on medial side is medial meniscus tear, pain on the lateral side is lateral meniscus tear
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14
Q

Apley Distraction Test

A

prone, knee at 90. stabilze thigh with your knee. grab ankle just below malleolus. pull up, then pull up while internally and externally rotating.

  • patient will point to side of pain
  • pain on medial side indicates medial collateral ligament tear. pain on the lateral side indicates lateral collateral ligament tear
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15
Q

Heart exam where to palpate for pulsations and thrills

A

pulsations=finger pads
Aortic
Pulmonic
Erb’s point
tricuspid
mitral(apical impulse for location and amplitude)
epigastic (flat hand toward left shoudler)
-pulsations coming superior to inferior may indicate right ventricular enlargement
-pulsations coming inferior to superior, or P-A may indicate abdominal aortic aneurysm

Thrills=ball of hand
turbulent blood flow causing vibrations

aortic
pulmonic
erb's point
tricuspid
mitral (knife edge)
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16
Q

percuss the heart for size and location

A

percuss down the right side of sternum until you hit liver

percuss 3rd 4th and 5th intercostal space on men, skip 4th on girls

17
Q

ascultate for high pitched cardiac sounds

A

use diaphragm for high pitch

  • aortic
  • pulmonic (S2 is best heard, listening for accentuated, diminished, or splitting)
  • Erbs
  • tricuspid
  • mitral (S1 is best heard, listen for accentuated, diminished, or splitting, pair with carotid pulse after patient inhales and exhales and holds while you asses for pairing)
  • Epigastic
18
Q

APETME locations

A 
A-  right 2nd ICS at sternal border
P- left 2nd ICS at sternal border
E- left 3rd ICS at sternal border
T- left 4th ICS at sternal border
M- left 5th ICS mid clavicular line
E- inferior to tip of xyphoid
19
Q

Ascultate for low pitched sounds

A
  • Aortic
  • Pulmonic (listen for accentuated, diminished, or splitting)
  • Erbs
  • Tricuspic
  • Mitral (accentuated, diminished or splitting)
  • Epigastric (deep breath and hold, listen for low pitched sounds)
20
Q

special maneuver for mitral murmuers

A
  • listen at mitral with bell supine first
  • then patient in left lateral laying position
  • use bell (low pitch) at apical impulse area
  • ask pt to take in deep breath and hold
21
Q

special maneuver for aortic murmers

A
  • patient in seated postion
  • listen at erbs point using diaphragm (high pitch)
  • ask pt to take deep breath in and lean forward while exhaling
22
Q

Venous hum

A
  • use bell
  • epigastric
  • base of neck bilateral (place bell anterior SCM, turn and extend head, breath and hold)
23
Q

ascultate for bruits of head and neck

A

-use bell

  • temporal arteries
  • carotid
  • subclavian
24
Q

Periphreal pulses of head, neck, upper extremity

A

-rate, rhythem, amplitude, contour

  • carotid
  • subclavian
  • brachial
  • radial
  • ulnar

CLET (9 decks)

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