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PCM_MIDTERM 01 > Lecture 11: Knee, Ankle, and Foot Complaint > Flashcards

Lecture 11: Knee, Ankle, and Foot Complaint Flashcards

1
Q

What does a “locking” sensation of the knee suggest?

A

Meniscal Tear

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2
Q

What does a “popping” sensation of the knee suggest?

A

Ligamentous tear or rupture

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3
Q

What does a “giving out” sensation of the knee suggest?

A

Ligamentous rupture or patellar subluxation

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4
Q

What does a rapid onset of large, tense knee effusion suggest?

A

-within two hours of injury

ACL rupture or tibial platear fracture

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5
Q

What does a slower onset of moderate knee effusion suggest?

A

24-36 hours of injury

Meniscal tear or ligamentous sprain

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6
Q

What does a recurrent knee effusion suggest?

A

Meniscal tear

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7
Q

What are different techniques to palpate for effusions?

A

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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8
Q

What does a Valgus knee stress test for?

What does a Varus knee stress test for?

A

Valgus: MCL injury

Varus: LCL injury

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9
Q

What does an Anterior Drawer test indiacte?

What does an Posterior Drawer test indiacte?

A

ACL and PCL Injury

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10
Q

What does a McMurray’s test indicate?

A

Medial or lateral meniscal tear

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11
Q

What does the Ottawa Knee Rule encompass?

A
  • IT IS SHOULD YOU DO AN XRAY OR NOT: IF YOU HAVE ONE OF THESE THEN YOU SHOULD DO IT
  • 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
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12
Q

When should you obtain a knee x-ray after an acute knee injury?

A

If the patient fits one of the Ottawa Knee Rule criteria

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13
Q

ACL injury:

contact vs non contact injury

presentation

A
  • contact: fixed lower leg with a direct blow causing hypereexension or valgus deformation
  • non contact injur: sudden decelleration with change of direction
  • presents with: LARGE EFFUSION and has popping seanstion/ giving out
  • can lead to OA in 10-20 years after the inital injury
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14
Q

What is a meniscal injury?

Acute vs chronic

presentation:

A

Dx: Medial or lateral joint line tenderness

Acute: •Results from a sudden change of direction in which the knee is twisted or rotated while the corresponding foot is planted

Chronic: degenerative changes seen in older patients with minimal twisting injury history

Presentaiton:

–Patients with untreated meniscal tears for weeks can report “locking” or “catching” of knee during extension

-can treat with RICE

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15
Q

What is Patellofemoral Pain Syndrome?

A

Anterior Knee Pain: most common reason why people come in for knee pain for ppl under 60 years

  • ​Pain under patella
  • Worsens when climbing up or down the stairs and prolonged sitting (movie gower sign)
  • Dx: Pain with squatting
  • Treat hip and quadriceps with PT
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16
Q

What is Osgood-Schlatter Disease?

A

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 the secondary ossification center (apophysis) of the tibial tuberosity
  • -kids describe it as a low grade ache to a pain that causes a limp
17
Q

What is Pes Anserinus Pain Syndrome?

A

Medial Knee Pain

  • Worsened with repetive flexion and extension
  • Risk Factors: Diabetes, Female, Obesity
  • Pain worse at night
  • usually from reffered mechanical knee pain or true bursisits
18
Q

What is Iliotibial Band Syndrome?

A

Knee Pain

  • Common knee pain, especially in runners or cyclists
    • Intermittent sharp pain that can progress to constant, deep pain
  • Noble Test can detect
  • Tx: IT band strenching
19
Q

What is Popliteal Cyst (Baker’s Cyst)?

A

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
20
Q

What does a Talar Tilt test indicate?

A

Lateral Ankle Sprain

Calcaneofibular Ligament Sprian

Anterior Tabofibular Ligament Injury

21
Q

What does an ankle Anterior Drawer Test for?

A

Lateral Ankle sprain

22
Q

What does an eversion ankle test for?

A

Medial Ankle Sprain

Deltoid Ligament Injury

23
Q

What does a squeeze test indicate?

A

High Ankle Sprain

Distal Tibiofibular Syndesmosis Injury

24
Q

What does Homan’s Sign test for?

A

DVT

25
Q

What is Plantar Fasciitis?

A

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
26
Q

What is the most common ankle sprain?

A

Lateral Ankle Sprain

27
Q

What other injuries do you see with lateral ankle sprain?

A

Lateral ankle ligaments (e.g. anterior talofibular and calcaneofibular ligaments) injury secondary to foot inversion and plantar flexion

-dx by: anterior drawer test or talar tilt test

28
Q

What other injuries do you see with medial ankle sprain?

Is the foot everted or inverted?

A

Medial ankle ligaments (e.g. deltoid ligament complex) injury secondary to forced eversion

-dx by eversion test

29
Q

What other injuries do you see with syndesmotic sprain?

A

Distal Tibiofibular Syndesmosis Injury: high ankle sprain

Foot eversion with external rotation and/ or Dorsiflexion

-dx by squeeze test

30
Q

How does the Ottawa Rules apply to the ankle?

A

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
31
Q

What joint is most likely to experience a gout flare?

What is a gout flare?

How is it dx?

A

1st metatarsophalangeal joint

  • precipitation of MSU crystals
  • athrosentesis: and negative bifrigent needle shaped cyrstals on polarized light
32
Q

What is a nobel test?

A

patient in lateral decubitis position with knee passivley flexed to 60 degreee

-positive test if TTP over the latearl femroal epicondyle during the maneuver

PCM_MIDTERM 01 (13 decks)

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