Lecture 11: Knee, Ankle, and Foot Complaint Flashcards
What does a “locking” sensation of the knee suggest?
Meniscal Tear
What does a “popping” sensation of the knee suggest?
Ligamentous tear or rupture
What does a “giving out” sensation of the knee suggest?
Ligamentous rupture or patellar subluxation
What does a rapid onset of large, tense knee effusion suggest?
ACL rupture or tibial plateau fracture
What does a slower onset of moderate knee effusion suggest?
Meniscal tear or ligamentous sprain
What does a recurrent knee effusion suggest?
Meniscal tear
What are different techniques to palpate for effusions?
Milking Techniques: Stroke down knee
Medial Pressure: Apply pressure to medial aspect of knee to look for lateral bulging
Fluid Wave Technique: Tap lateral knee and feel for fluid wave
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What does a Valgus knee stress test for?
What does a Varus knee stress test for?
Valgus: MCL injury
Varus: LCL injury
What does an Anterior Drawer test indiacte?
What does an Posterior Drawer test indiacte?
ACL and PCL Injury
What does a McMurray’s test indicate?
Medial or lateral meniscal tear
What does the Ottawa Knee Rule encompass?
- Age is 55 years or over
- Inability to bear weight for four steps immediately after injury or in emergency setting
- Inability to flex knee to 90o
- Tenderness over head of fibular or isolated to patella
When should you obtain a knee x-ray after an acute knee injury?
If the patient fits one of the Ottawa Knee Rule criteria
What is a meniscal injury?
Medial or lateral joint line tenderness
-can treat with RICE
What is Patellofemoral Pain Syndrome?
Anterior Knee Pain
- Pain under patella
- Worsens when climbing up or down the stairs and prolonged sitting
- Pain with squatting
- Treat hip and quadriceps
What is Osgood-Schlatter Disease?
Tibial Apophysitis
- Anterior knee pain seen often in children ages 9-14 with a rapid growth spurt
- Tenderness of bony prominence over tibial tuberosity
- Chronic avulsion of tibial tuberosity
What is Pes Anserinus Pain Syndrome?
Medial Knee Pain
- Worsened with repetive flexion and extension
- Risk Factors: Diabetes, Female, Obesity
- Pain worse at night
What is Iliotibial Band Syndrome?
Knee Pain
- Common knee pain, especially in runners or cyclists
- Intermittent sharp pain that can progress to constant, deep pain
- Noble Test can detect
What is Popliteal Cyst (Baker’s Cyst)?
Bursa
- Mostly asymptomatic and an incidental finding
- Can present with posterior knee pain, knee stiffness, or mass behind knee
- Foucher’s Sign: cyst softens or disappears with knees flexed to 45o
What does a Talar Tilt test indicate?
Lateral Ankle Sprain
Calcaneofibular Ligament Sprian
Anterior Tabofibular Ligament Injury
What does an ankle Anterior Drawer Test for?
Lateral Ankle sprain
What does an eversion ankle test for?
Medial Ankle Sprain
Deltoid Ligament Injury
What does a squeeze test indicate?
High Ankle Sprain
Distal Tibiofibular Syndesmosis Injury
What does Homan’s Sign test for?
DVT
What is Plantar Fasciitis?
Foot Pain
- Very common foot pain in adults
- Overuse can cause microtears in plantar fascia, resuliting in degeneration of fibrous tissue or acute inflammation
- Presents as sharp, stabbing, medial, plantar heel pain
- Risk Factors: Running, obesity, flat feet, high-arched feet
- Tenderness to palpation over medial plantar calcaneal region
- Pain worse with passive dorsiflexion
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What is the most common ankle sprain?
Lateral Ankle Sprain
What other injuries do you see with lateral ankle sprain?
Is the foot everted or inverted?
Is it plantar flexed or dorsi flexed?
Lateral ankle ligaments (e.g. anterior talofibular and calcaneofibular ligaments) injury secondary to foot inversion and plantar flexion
What other injuries do you see with medial ankle sprain?
Is the foot everted or inverted?
Medial ankle ligaments (e.g. deltoid ligament complex) injury secondary to eversion
What other injuries do you see with syndesmotic (high ankle) sprain?
Is the foot everted or inverted?
Is it plantar flexed or dorsi flexed?
Distal Tibiofibular Syndesmosis Injury
Foot eversion and Dorsiflexion
How does the Ottawa Rules apply to the ankle?
X-rays Performed if:
- Tenderness over medial or lateral malleolus
- Inability to bear weight immediately after injury
- Tenderness over base of 5th metatarsal or navicular
What joint is most likely to experience a gout flare?
1st metatarsophalangeal joint