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Lower Extremity > LE Lecture Midterm > Flashcards

LE Lecture Midterm Flashcards

1
Q

4 knee injury clues

A

Swelling

Pop @ injury

Gives way

Locking

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2
Q

Immediate swelling of knee may indicate

A

*Blood

ACL tear

Fracture (Femur, Tib, Patella)

ICE

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3
Q

Delayed swelling of knee may indicate

A

*Synovial fluid

Meniscus tear

Other joint irritation

Ice won’t help

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4
Q

Knee: pop @ injury w/ immediate swelling?

A

ACL tear

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5
Q

Knee: pop @ injury? (2)

A

+/- Meniscus tear

Patellar dislocation

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6
Q

Knee gives way with pain may indicate

A

Reflex inhibition of quads

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7
Q

Knee gives way, NO pain may indicate

A

Instability “Chronic ACL”

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8
Q

Sequence of “On-field” Evaluation of KNEE (6)

A
  1. External injury/deformity?

Status of

  1. *Neurovascular
  2. *Collateral ligs
  3. *Cruciate ligs
  4. Can they stand/walk
  5. Challenge w/ progressively harder mvmt
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9
Q

Ottawa Rules for the KNEE. Take x-rays if: (4)

A

55+ yo

Isolated tenderness @ patellar/fib head

Can’t flex knee 90*

Can’t bear weight right after injury

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10
Q

“Return to Play” criteria for KNEE (5)

A

Full ROM

Good patellar mobility

Norm stability on manual testing (ACL/PCL/MCL/LCL)

Quad + hamstring strength = 80% of opposite side

Can complete RTP functional requirements for specific sport (E.g. swing a bat)

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11
Q

Grades for PAIN SENSITIVE structure of the KNEE

A

Moderate-Severe Pain (Localized)

Minimal Pain (Poorly Local)

Moderate-Severe Pain (Poorly Local)

No pain

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12
Q

Moderate-Severe, LOCALIZED pain may suggest (2)

A

Supra patellar pouch

Med/Lat Retinaculum

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13
Q

Minimal, POORLY LOCALIZED pain may suggest (4)

A

Articular cartilage of femoral condyles

Trochlea

Tib plateaus

Odd facet of patella

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14
Q

Moderate-Severe, POORLY LOCALIZED pain may suggest (1)

A

Tib/femoral origin for ACL/PCL

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15
Q

Medial column bones of foot

A

Talus

Navicular

Cuneiforms

MT 1-3

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16
Q

Lateral column bones of foot

A

Calcaneus

Cuboid

MT 4-5

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17
Q

Rearfoot bones

A

Calcaneus

Talus

Navicular

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18
Q

Forefoot bones

A

MT

Phalanges

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19
Q

Ankle joints (3)

A

Talocrural

Subtalar

Transverse tarsal (“Midtarsal”)

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20
Q

Bones of TALOCRURAL JOINT

A

Talus

Tib

FIb

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21
Q

Bones of SUBTALAR JOINT

A

Talus

Calcaneus

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22
Q

Bones of TRANSVERSE TARSAL JOINT (Midtarsal)

A

Medial = Talus/Navicular

Lateral = Calcanus/cuboid

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23
Q

Movement of Talocrural joint

A

Dorsiflexion

Plantarflexion

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24
Q

Movement of Subtalar joint

A

Inversion

Eversion

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25
Q

Movement of Transverse Tarsal joint (Midtarsal)

A

Forefoot

*Supination/ADDuction

*Pronatoin/ABduction

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26
Q

Muscles for dorsiflexion

A

Anterior leg muscles

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27
Q

Muscles for plantarflexion

A

Posterior leg muscles

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28
Q

Muscles for inversion

A

Tib Anterior/Posterior

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29
Q

Muscles for eversion

A

Peroneal muscles

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30
Q

Muscles for forefoot supination/ADDuction

A

TIb Anterior/Posterior

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31
Q

Muscles for forefoot pronation/ABduction

A

Peroneal muscles

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32
Q

Plane for Dorsiflexion

A

Sagittal

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33
Q

Plane for Plantarflexion

A

Sagittal

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34
Q

Plane for Eversion

A

Frontal

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35
Q

Plane for Inversion

A

Frontal

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36
Q

Plane for ABduction

A

Transverse

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37
Q

Plane for ADDuction

A

Transverse

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38
Q

How is the foot situated for forefoot VARUS?

A

Looks like inversion

Lateral column towards floor

Big toe up

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39
Q

How is the foot situated for forefoot VALGUS?

A

Foot looks everted

Medial column towards the floor

Little toe up

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40
Q

Equinas (Static)

A

Plantarflexion -> dorsiflexion limited

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41
Q

Calcaneus (Static)

A

Dorsiflexion -> plantarfelxion limited *Patient walks on heel

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42
Q

Medial ankle ligaments

A

Deltoid/MCL

Spring Ligament (Plantar CalcaneoNavicular)

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43
Q

O/I of Spring Ligament

A

Sustentaculum Tali to Navicular Tuberosity

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44
Q

Lateral ankle ligaments

A

LCL

Bifurcate

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45
Q

Lateral Collateral Ligaments of the ankle

A

A/P TaloFibular

CalcaneoFibular

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46
Q

Bifurcate Ligaments of the ankle

A

CalcaneoNavicular

CalcaneoCuboid

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47
Q

Medial ankle ligaments

A

Deltoid lig or MCL

Spring Ligament

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48
Q

Deltoid Ligaments /MCL

A

A/P TibioTalar

TibioNavicular

TibioCalcaneal

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49
Q

Triplanar movement for PRONATION

A

Dorsiflexion

Abduction

Eversion

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50
Q

Triplanar movement for SUPINATION

A

Plantarflexion

Adduction

Inversion

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51
Q

List the general foot conditions (11)

A

Hyper PRO/SUPination

Morton’s Neuroma

Tarsal Tunnel Syndrome

Stress Fractures

1st Toe Disorders

Heel Disorders

Ankle sprains

Lower Leg Disorders

Proximal Tib-Fib Subluxation

ITB Syndrome

Popliteus Tendinitis

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52
Q

List 1st Toe Disorders

A

Turf toe

Hallux valgus

Hallux rigidus

Gout

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53
Q

List Heel Disorders

A

Achilles Tendinitis/Rupture

Fat Pad Syndrome

Plantar Fascitis

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54
Q

List Lower Leg Disorders

A

Deep V. Thrombosis

Tennis Leg

Compartment Syndrome

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55
Q

Define “Metatarsalgia”

A

Generic term for metatarsal pain

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56
Q

Causes of metatarsalgia

A

Chronic stretching of transverse ligaments

Overuse/repetitive actions (jumping)

Over weight

Hammer toes

Pes planus/cavus

Dropped metatarsals

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57
Q

Metatarsalgia treatment

A

Proper support (Rocker bottom shoes)

Manipulation

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58
Q
A

Hammer Toe

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59
Q

Freiber’s Infarction

A

Avascular necrosis

Most common @ head of MT2

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60
Q

Freiberg’s Infarction is MC in

A

Teen girls 14-18 yo

Physically active

(Female to male = 4:1)

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61
Q

Cause of Freiberg’s Infarction

(Freiberg = A pimp for hookers)

A

High heels

Gymnastics

Dancing

Direct trauma

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62
Q

Freiberg’s Infarction ssx

A

May precede xray changes by 6 mos.

T2P

Decreased ROM

Crepitus

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63
Q

Freiberg’s Infarction tx

A

Orthotic protection

Surgery (for fragmentation)

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64
Q
A

Hammer Toe

Mallet Toe = Plantar contracture of DIP

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65
Q
A

Claw Toe - DIP + PIP = flexed

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66
Q

Morton’s Neuroma

A

Benign tumor

Entrapment or irritation of Digital Nerve

(Follows Tibial N. distribution)

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67
Q

Morton’s Neuroma ssx

A

+/- palpable mass between 2-4 INTERmetatarsal space

Pain

Numbness

Tingling

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68
Q

What makes Morton’s Neuroma pain/numb/tingle worse?

A

Dorsiflexion

Transverse Compression

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69
Q

What makes Morton’s Neuroma pain/numbness/tingling better?

A

Plantarflexion of MTP joint

“Wave your toes closed”

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70
Q

Morton’s Neuroma tx

A

Metatarsal pads

Orthotics

Surgery maybe

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71
Q

Tarsal Tunnel Syndrome

A

Posterior Tibial Nerve entrapped/compressed in Tarsal Tunnel

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72
Q

Tarsal Tunnel Syn ssx

A

Insidious onset of NUMBNESS/TINGLING across bottom of foot

No associated LBP

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73
Q

Cause of Tarsal Tunnel Syn (4)

A

Hyperpronation

Swelling

Ganglion

Subluxation

74
Q

How do you test for Tarsal Tunnel Syndrome?

A

Tinnel’s Test (Percuss behind Med Malleolus - reproduce sx)

Neuro tests - rarely (+)

Sensory findings = MC than motor

75
Q

Tarsal Tunnel Syndrome Tx

A

Trial orthotics

Adjust foot

*If due to GANGLION or other pathology = REFER out

76
Q

What are the components of the TARSAL TUNNEL?

A

Flexor Retinaculum

Sustentaculum Tali

Medial Malleolus

77
Q

Tarsal Coalition

A

When tarsals fuse together.

Osseous/cartilage fuse into a bridge.

78
Q

What are 2 kinda common anomalies that may be the source of foot pain?

A

Tarsal Coalition

Accessory Ossicles

79
Q

2 developmental problems that might cause foot pain?

A

Osteochondrosis

Osteophytic reactions

80
Q
A

Os Tarsal

Os Navicular

Os Vers-something

Os Peroneum

81
Q

What do accessory ossicles look like on x-ray?

A

Oblique

Smooth

82
Q

What do Avulsion Fractures look like on X-ray?

A

Transverse

Jagged

(Jones Fracture)

83
Q

Metatarsal Stress Fractures

A

Constant FOREFOOT PAIN

d/t prolonged walking or running

esp. when unaccustomed or menstrual irregularities

84
Q

Metatarsal Stress Fractures occur when

A

Resorptive process is faster than OSTEOBLASTIC activity

85
Q

MC spot for Metatarsal Stress Fractures

A

2nd MT

(d/t length + biomechanical axis)

86
Q

What makes Metatarsal Stress Fracture pain worse?

A

Weightbearing

Transverse presure

+/- tuning fork

87
Q

How to detect Metatarsal Stress Fractures

A

1 BONE SCAN = definitive

X-Ray maybe

88
Q

Metatarsal Stress Fracture tx

A

1 Rest

Stiff-soled shoes

Increase Ca++

Avoid activity for several weeks

89
Q

Stress Fracture = ___ pain at rest.

Weight bearing = ___

A

NO

pain at rest

90
Q

MC site of stress fracture in LE?

A

Tibia

91
Q

5th Metatarsal Fractures

A

Pull of the Peroneous Brevis muscle

+/- cause avulsion fracture

92
Q

5th Metatarsal Fractures must be differentiated from

A

accessory ossicles

93
Q

5th MT Fractures may be SECONDARY to ____ or a PRIMARY fracture

A

ankle sprain

94
Q

A TRANSVERSE FRACTURE is called a ______ found mainly in DANCERS

A

Jone’s Fracture

(Stop Jonesin’ for that dancer)

95
Q

Hallux Valgus

A

Lateral deviation of PROXIMAL PHALANX

96
Q

Cause of Hallux Valgus

A

Hereditary

Morton’s Deformity

Tight shoes

High heels

Arthritis

Forefoot varus

97
Q

Hallux valgus ssx

A

Callous formation

Inflammation

Corns

Pain @ medial 1st MTP joint

98
Q

Hallux Valgus tx

A

Taping

Pad the bunion

Shoes w/ larger toe box

Don’t wear heels, man

99
Q

Hallux Rigidus

A

Pain on DORSAL surface of 1st toe

Dorsal ring of osteophytes

100
Q

Who gets Hallux Rigidus?

A

Old ppl

Athletes w/ recurrent capsular sprains

(Usually d/t turf toe)

101
Q

Hallux Rigidus ssx

A

Pain w/ dorsiflexion

+/- bunion

102
Q

Hallux Rigidus tx

A

Mobilization

Stiff-soled shoe

Rocker bottom shoe

+/- Surgery

Bucket, warm water, salt

103
Q

Turf Toe

A

Hyperextension of 1st toe

Capsular sprain

104
Q

Turf Toe tx

A

Tape to prevent extension

Stiff-soled shoe

Rocker bottom shoe

Rest, Ice, Support

105
Q

Turf Toe’s evil cousin

A

“Sand Toe”

Kicking into the ground - playing soccer in the sand

106
Q

Sesamoiditis

A

Sudden onset

Pain at PLANTAR surface of first toe

(Medial sesamoid MC)

107
Q

Cause of Sesamoiditis

A

Direct trauma

Overpull of FLEXOR HALLICUS BREVIS

Hallux Valgus

Super flexible footwear

Repetitive running/walking on hard surfaces

108
Q

Sesamoiditis tx

A

Tape toe into neutral

w/ pad

(Do xray to R/O fracture)

109
Q

Gout

A

Disorder of PURINE METABOLISM.

Allows accumulation of SODIUM-URATE crystals in joints

110
Q

Gout ssx

A

Pain/swelling - abruptly

111
Q

Gout MC occurs where (4)

A

1st toe

knee

elbow

behind ear

112
Q

How do you DIAGNOSE Gout?

A

X-RAY:

Tophi (radiolucent)

Joint destruction

LAB:

Elevated serum URIC ACID levels

113
Q

Gout tx

A

Don’t eat meat, alcohol

Meds = Alopurinal, Colchicine

114
Q

Avascular Necrosis examples w/ location (5)

A

Freiberg’s - 2nd MT

Kohler’s - Tarsal, Navicular

Iselin’s - 5th MT head

Sever’s Phenomenon - Calcaneus (heel pain)

Osteochondritis Dessicans - Talus

115
Q

Point to the location of each AVASCULAR NECROSIS condition (5)

A
116
Q

Achilles Tendinitis/Rupture

A

Pain, swelling usually 2 cm proximal to CALCANEAL TUBEROSITY

117
Q

Cause of Achillies Tendinitis and who is it most commonly found in?

A

Overuse

Runners + Jumpers

118
Q

Achillies Tendinitis ssx

A

Chronic degeneration +/- = knotty swelling

Palpable defects +/- with impending rupture

TENDERNESS OVER THE TENDON

+/- swelling

119
Q

Evaluate for Achilles Tendinitis

A

Check tightness of Triceps Surae

w/ the knee FLEXED + EXTENDED

Thompson Test

MRI, Ultrasound

120
Q

Achilles Tendinitis tx

A

Rest, Ice

Modify activity

Heel lift (propulses you forwarded)

Elastic Taping

Rupture = Surgical reattachment

121
Q

What can irritate the Achilles Tendon?

A

Uphill running - in rigid shoes, strains it @ toe off

Downhill running - forceful impact transmitted

Pes Cavus = predisposes problems

Hyperpronation - causes torsion

122
Q

Retrocalcaneal Bursitis

A

Irritation of the BURSA directly behind Achilles Tendon by insertion

leads to BURSITIS

123
Q

Pinch in front of Achilles for tenderness

A

Haglund’s Deformity

d/t Retrocalcaneal Bursitis

124
Q

Fat Pad Syndrome

A

Fat pad degenerates or someone doesn’t have a lot of fat under their heel

*MC in old people

125
Q

DDx Fat Pad Syndrome + Plantar Fascitis

A

Fat Pad Syn = Pain in the middle of the heel

Plantar fascitis wouldn’t cause this

126
Q

Fat Pad Syndrome: pain decreased when

A

Squeezing heel together or increasing padding

127
Q

Fat Pad Syndrome tx

A

Better heel support - “Tuli Cups”

Firm heel counter in shoe

128
Q

What does a LOOSE HEEL COUNTER do to the fat pad when running?

A

Lets calcaneal fat pad spread out during HEEL STRIKE.

This means INCREASED impact to the heel.

*Firm, well-fitted heel counter = maintains fat pad = buffers impact of running

129
Q

Plantar Fascitis

A

Burning/sharp pain at medial, plantar surface of the foot

130
Q

Cause of Plantar Fascitis

A

Hyperpronation

Hypersupination

131
Q

Plantar Fascitis ssx

A

Pain worse with 1st toe dorsiflexion

Or coupled w/ ANKLE dorsiflexion

Tenderness @ Medial tubercle of Calcaneus

132
Q

Plantar Fascitis tx

A

Low-Dye Taping

Gradual stretching

Orthotics

133
Q

Protocol for an ankle sprain injury?

A

Anterior Drawer Test

Talar Tilt (Inversion/Eversion)

Talar Rock

Tib-Fib Squeeze

Ottawa Rules for X-Rays

134
Q

Ottawa Rules for X-Ray: Ankle

A

Can’t bear weight after injury or at time of eval

Tender at a specific spot (bony: malleoli, navicular, 5th MT head)

Do this so you don’t miss significant fractures

*Significant = 3+ mm in breadth

135
Q

Most common ankle sprain?

A

Inversion, plantarflexion

136
Q

What view would you want to include for an ankle x-ray?

A

Mortise View

137
Q

High ankle injury: external rotation ONLY

What ligments are involved?

A

Anterior TibioFibular

Anterior TibioTalar

TibioNavicular

138
Q

Ankle Sprain tx

A

Air-Stirrup brace @ first

Open-Gibney Taping

Crutches (2nd/3rd degree tears)

Prophylactic taping (chronic sprains)

Train: Peroneals, Tib anterior, Hip abductor

139
Q

ACSM Return-to-Play Criteria for Ankle Sprains (4)

A

Full ROM

No pain

Hop - 80% well side (full weight bearing, as far as pos)

Final RTP = Successful running, cutting, jumping, twisting (appropriate for sport)

140
Q

Deep Vein Thrombosis Facts

A

D/t minor trauma, prolonged sitting, immobilization, birth control pills

Pain in ISOLATED portion of CALF muscles

Sudden onset w/o prior warning

141
Q

How do you test for DVT?

A

Homan’s Test coupled with

RESISTED MUSCLE TESTING

Doppler-Ultrasound to DX (old school = venography)

142
Q

Why is a DVT dangerous?

A

Can emobolize to lungs = INFARCT or DEATH

143
Q

DVT tx?

A

Warfarrin

Coumadin

(Anti-coagulant drugs)

3-6 months

144
Q

Homan’s Test (+)

A

[Knee extended, ankle passively dorsiflexed]

Pain in calf

T2P calf

+/- pallor, swelling in leg

+/- loss of dorsal pedis pulse

145
Q

Tennis Leg

A

Tearing of MEDIAL GASTROC head

Occurs w/ sudden extension of knee + foot dorsiflexed

146
Q

Tennis Leg ssx

A

Sudden, SHARP pain @ upper, medial calf

Pain worse w/ plantarflexion

147
Q

Tennis Leg tx

A

Crutch-walking (1* or 2*)

Heel-lift (temporary)

Serious injury? Long leg cast for many weeks

Surgery (3*)

148
Q

2 Types of Shin Spints and related muscles

A

Anterior = Tib anterior, extensors

Posterior = Tib posterior, flexors

149
Q

Cause of Anterior Shin Splints?

A

Poor shock absorption (shoes)

Run/walk on hard surface

150
Q

Cause of Posterior Shin Spints

A

Hyperpronation

151
Q

What other foot condition would you expect to co-occur with shin splints?

A

Forefoot valgus

152
Q

Shin Splints tx

A

Acute: Ice, support, elastic tape (spiral upward toward area of tenderness)

Orthotics (esp. for posterior for posterior ss)

New, more shock absorbant shoes (anterior ss)

Increase calcium

153
Q

Cause of Stress Fractures of Tibia

A

Weak muscles

allows more bone loading/forceful repetitive contraction of muscles

…pulls on origins

154
Q

AKA for early stage Tibial Stress Fracture

A

Medial Tibial Stress Syndrome

155
Q

Tibial Stress Fractures account for ___ of all stress fractures in all athletes.

A

HALF

156
Q

Tibial Stress Fractures: Who + Where

A

Runners - Distal & middle 1/3

Dancers - Middle 1/3 (Might progress to full fracture = “Dreaded Black Line” on xray)

Military Recruits - proximal

157
Q

Tibial Stress Fracture tx for athletes + non-athletes

A

Athletes - Immobilization, increase calcium

Non-athletes - Restric impact

158
Q

Compartment Syndrome

A

Increased pressure in compartment

d/t blood or fluid build up (acute)

exercise (chronic)

159
Q

Contents of Anterior Compartment

A

Tibialis Anterior

Extensors

Tibial Artery/Vein

Deep Peroneal Nerve

160
Q

Contents of Lateral Compartment

A

Peroneal muscles

Superficial Peroneal Nerve

161
Q

Contents of Deep Posterior Compartment

A

Posterior Tibialis

Toe Flexors

Posterior Tibial Artery/Vein

Tibial Nerve

162
Q

Contents of Superficial Posterior Compartment

A

Triceps Surae

(Gastroc heads, Soleus)

163
Q

Compartment Syndrome ssx

A

Athletes - Sx 10-30 minutes after exercise, pain goes away mins-hours after stopping activity

Pain/swelling in compartment

Normal pulse

Sensory deficit

Slit-catheter compartment pressure ABNORMALLY HIGH

164
Q

Compartment Syndrome tx

A

ICE DOES NOT HELP

Stretching

Proper warm-up

Soft tissue work

Fasciotomy (Partial cut of fascia to relieve pressure)

165
Q

Compartment Syndrome Pressures in mmHg

A

Normal: Rest (8), Activity (80), 5 mins after ceasing activity (<30)

Compartment Syndrome: Rest (>30), Activity (>100)

166
Q

Lateral (Valgus) force damages

A

MCL

167
Q

Rotation with foot fixed on the ground damages

A

Meniscus

(With lateral/valgus force = ACL & MCL)

168
Q

Hyperextension or sudden deceleration damages

A

ACL

169
Q

A blow to Anterior Tibia (knee flexed) damages

A

PCL

170
Q

ACL Injury video

A

http://www.youtube.com/watch?v=lpIOMuqXWrE

171
Q

ITB Syndrome history

A

Lateral knee pain

Repetitive activity (running)

Gradually worsens

Occasionally squeaks

172
Q

ITB Exam Findings (5)

A

Pain @ lateral epicondyle - 30* knee flexion

(+) Modified Ober’s - Leg kept in extension, doesn’t drop below table

(+) Noble Compression Test

(+) Rinne’s - pain with unilateral weightbearing @ 30* knee flexion

+/- foot pronation

173
Q

Popliteus Tendinitis History

A

Pain after downhill running/walking

Lateral knee pain

174
Q

Popliteus Tendinitis Exam Findings

A

Pain w/ resisted internal rotation

Tenderness in front/behind LCL insertion

Pain w/ weight bearing @ 30* + internally rotated femur

175
Q

Proximal Tib-Fib Subluxation History

A

Ankle Injury w/ forced dorsiflexion/plantarflexion

Pain @ fib head (+/- radiate down leg)

*Common Peroneal nerve wraps around fib neck

176
Q

Proximal Tib-Fib Subluxation

A

Decreased ROM at Fib head on dorsi/plantarflexion

Decreased A-P glide of Fib head

Instability on full weight bearing at 30*

(Do “Rinne’s”, then do “Modified Moossavi” to see if pain is eliminated)

177
Q

Freiberg’s Infarction description + tx: Category I

A

No DJD, Articular intact, Self-limits

Low heel shoe, orthotics, no sports, NSAIDS

178
Q

Freiberg’s Infarction description + tx: Category 2

A

Periarticular spurs, Articular intact

Cheilectomy, low-heel shoe, orthotics, no sports, NSAIDS

179
Q

Freiberg’s Infarction description + tx: Category 3

A

Severe degeneration, Joint disesase, Loss of articulation

Surgery: arthoplasty, MT head resection

180
Q

Freiberg’s Infarction description + tx: Category 4

A

Epiphyseal dysplasia, multiple heads

Same treatment as Category 1-3

Lower Extremity (1 decks)

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