Lower extremities exam 2 Flashcards
1
Q
genu varum aka
A
bowed legs
2
Q
what is genu varum caused by
A
increased stretching force on lateral joint structures
3
Q
genu valgum aka
A
knock knees
4
Q
genu valgum caused by
A
increased stretching force on medial joint structures which can cause degeneration of lateral meniscus
5
Q
genu recurvatum aka
A
hyperextended knees
6
Q
genu recurvatum is often seen in which athletes
A
swimmers
7
Q
genu recurvatum is at risk for what
A
ACL and PCL injury b/c contact b/w patella and femur can cause hyperextension
8
Q
what does normal patellar alignment look like
A
the patella is aligned within the trochlea with the center of the femur
9
Q
patella alta def
A
high riding patella, aka long patella tendon
10
Q
patella baja
A
low riding patella, short patella tendon
11
Q
squinting patella
A
medially positioned patella, creates problems with tracking
12
Q
squinting patella caused by what
A
femoral anteversion and tibial internal rotation
13
Q
what can be used to treat squinting patella
A
j-brace or patella tape
14
Q
frog eyed patella def
A
lateral and high riding, creates tracking problem
15
Q
frog eyed patella may be caused by
A
femoral retroeversion and tibial external rotation
16
Q
what is the largest seasmoid bone
A
patella
17
Q
what 3 purposes of patella
A
increased mechanical efficiency for quads, protect anterior portion of knee, absorb and transmit joint’s reaction forces
18
Q
what are the 4 main anterior muscles acting on the knee
A
vastus lateralis, vastus intermedius, vastus medialis, rectus femoris
19
Q
where does sartorius cross
A
at the hip to the knee
20
Q
where does the IT band cross
A
at the lateral part of the knee
21
Q
which hamstring muscle inserts at the fibula
A
biceps femoris
22
Q
3 hamstring (posterior) muscle groups
A
semiteninosis: medial, semimembranosus, bicep femoris: lateral
23
Q
what are the 3 medial adductors acting on the knee
A
adductor longus, adductor brevis, adductor magnus
24
Q
what makes up the pes anserine muscle group
A
gracilis, sartorius, semitendinosus
25
what are 6 functions of the meniscus
deepen articulation and fill gaps when increase in load, improve lubrication for surfaces, provide shock absorption, increase passive joint stability, limit extremes of flexion and extension, serve as proprioceptive organ
26
what shape is the medial meniscus
c shape
27
what shape is lateral meniscus
o shape more round
28
if there is a tear in the red zone is the tissue more or less likely to heal on its own
more likely to heal on its own b/c more vascularization
29
MCL anatomy
medial epicondyle of femur connects to medial condyle of the tibia
30
LCL anatomy
lateral epicondyle of femur connects to head of fibula
31
posterolateral corner palpation
yes, you can find it; important for providing stability against forces throughout the knee
32
what is included in the posterolateral corner
popliofibular ligament, popliteus complex, arcuate ligament, fabella
33
where is suprapatella bursa located
b/w quad tendon and femur
34
where is prepatella bursa located
b/w patella and skin
35
what is the most commonly injured bursa of knee
prepatella bursa
36
deep infrapatella bursa
b/w patella tendon and tibia
37
superficial/subcutaneus intrapatella bursa
b/w patella tendon and skin
38
pes anserine bursa
b/w pes anserine group tendons and tibia
39
medial plica def
fold in synovial membrane, feels like a ridge, found medially kn knee
40
what is
ideal ROM of knee extension
0 deg
41
what is ideal ROM of hip flexion
135 deg
42
what is ideal ROM hip extension
30 deg
43
what is ideal ROM knee flexion
135 deg
44
what muscles are involved in knee flexion
quads, sartorius, gracilis, plantaris, popliteus, grastroc
45
what muscles are involved in knee extension
rectus femoris, vastus medialis, vastus intermedialis, vastus lateralis
46
4 pulses of lower leg
popliteal, posterior tibial, dorsal pedal
47
DTR of knee
L4= patella
48
where does LCL insert
fibular head
49
when doing girth measurements where does the 0 deg mark go
right on the joint line
50
what measurements should be done above joint line
5, 10, 15 cm
51
what is Q angle
b/w ASIS, midpoint of patella, tibial tuberosity
52
what is Q angle used for
quantify line of pull of quads and patellar tendon
53
normal Q angle for men and women
13 men, 18 women
54
what does a high Q angle create a risk factor for
ACL injury, especially in women
55
2 tests used for swelling of knee
sweep and ballotable patella test
56
sweep test+ test
reformation of edema on MEDIAL side
57
sweep test perform
apply pressure to knee on one side to get the fluid to move and bulge
58
what does sweep test indicate
swelling of knee
59
ballottable patella perform
one hand pushes fluid inferiorly towards the patella and the other hand pushes fluid superiorly towards the patella
60
+ test ballottable patella
bouncing, bobbing, floating of patella
61
what does ballottable patella test indicate
joint effusion
62
4 tests for patellofemoral dysfunction
clark's sign, patella apprehesion, patellar tilt, medial and lateral patella glide
63
clark sign aka
c-sign
64
clark's sign perform
one hand cups patella and other hand applies gentle downward pressure while patient is contracting quads
65
+ clark's sign
pain and inability to hold quad contraction
66
what does clark's sign indicate
patella femoral dysfunction or chondromalacia patella
67
is clark's test usually reliable
sort of, can produce false positive
68
patellar apprehension test which direction does patella slide
laterally
69
+ patellar apprehension test
guarding of quads during contraction
70
patellar apprehension test indicates
laxity of medial retinaculum
71
+ patellar apprehension test may indicate
predisposition to subluxation/dislocation of patella
72
patellar tilt test description
grasp patella w/ index finger and thumb elevating lateral border
73
+ patellar tilt test
more than 15 deg = hypermobile and less than 0 deg hypomobile
74
what does 0 deg patellar tilt indicate
tightness of lateral restraints, more than 15 deg may predispose to anterior knee pain
75
medial and lateral patellar guide test description
supine with bolster under the knee and flexed 30 deg
76
how to perform medial and lateral patellar glide
move patella medial and laterally
77
+ medial and lateral glide test
medial: movement of 1-2 quadrants
lateral: movement of 0.5-2 quadrants
78
medial hypo and hypermobile of knee means
tightness of lateral retinaculum, laxity of lateral restriants
79
lateral hypo and hypermobile of knee means
tightness of medial restraints and patellofemoral ligaments, laxity of medial restraints
80
plica tests
medial plica test and stutter test
81
medial plica test description
flex knee 90 deg, internal rotate tibia, move patella medially and palpate capsule
82
+ medial plica test
reproduction of symptoms
83
when may clinican feel plica during medial plica test
around 45-60 deg flexion
84
stutter test description
cup hand over patella and patient extend knee
85
+ stutter test
irregular motion b/w 40-60 deg as plica passes medial condyle
86
what does stutter test look for symptoms of
irregular motion/stutter NOT pain increase
87
collateral ligament tests
valgus and varus stress tests
88
valgus stress test description
one hand supports medial tibia and then other grasps the knee laterally
89
+ valgus stress test
laxity, increase quality at end point, pain compared w/ uninvolved limb
90
what is the best position for testing valgus test
flex knee 25 deg to isolate MCL
91
varus stress test description
one hand on lateral portion of tibia and other hand grasps knee and applies varus force
92
varus stress test +
laxity, decrease quality of endpoint, pain increases
93
what ligament does varus stress test
LCL
94
what is best position for varus stress test
25 deg flexion
95
3 ACL tests
Lachman's, modified lachman's, anterior drawer
96
2 rotary ACL tests
slocum, pivot shift
97
what is best test for ACL
Lachman's
98
what is position for knee to be in for Lachman's
20-25 deg flexion
99
how is lachman's test performed
draw tibia anteriorly while posterior pressure is applied to stabilize femur
100
+ Lachman's test
increase amount of anterior tibial translation compared w/ opposite limb or lack of firm endpoint
101
lachman's test indicative of
ACL sprain/tear
102
modified lachman's test description
place bolster like towel under knee to assist in stabilizing femur
103
anterior drawer test description
hip flex 45 deg, knee extend 90 deg, tests ACL
104
anterior drawer test perform
draw tibia anteriorly, index finger used to palpate hamstring tendons and ensure they're relaxed
105
+ anterior drawer test
increased amt anterior tibial translation compared w/ opposite limb or lack of firm endpoint
106
compare lachman's and anterior drawer test
both for ACL. Lachman's better clinical values. Anterior drawer= easier to perfrom
107
slocum test set up
knee flexed 90 deg, tibia internally rotated 25 deg to test lateral capsule and tibia externally rotated to test medial capsule
108
slocum test +
increased anterior translation or lack of firm endpoint
109
anteriolateral instability= damage to
ACL, LCL, IT band, politeus, lateral meniscus
110
anteriomedial instability=damage to
MCL
111
pivot shift test description
patient supine w/ hip passively flexed to 30 deg, maintain 20 deg internal tibial rotation, increases force of internal rotation when knee is flexed
112
pivot shift test +
tibia reduces or subluxes as the leg is flexed in 30-40 deg
113
what does pivot shift test indicate
anterolateral rotary instability or ACL tear
114
what are 2 PCL tests
posterior drawer and godfrey's/posterior sag test
115
+ posterior drawer test mean
increased posterior tibial translation and lack of firm endpoint
116
posterior drawer test indicates
PCL sprain
117
how to perform posterior drawer test
grasp tibia and put thumbs on both sides of patellar tendon, palpate hamstring tendons to make sure they are relaxed, push tibia posteriorly
118
what will posterior drawer test feel like if PCL is sprained
it will feel empty
119
posterior sag test/ godfrey's test + test
unilateral displacement of tibial tuberosity
120
posterior sag test perform
lift lower legs and hold them parallel to the table so the knees are flexed at 90 deg, observe tibial tuberosities
121
what does posterior sag test indicate
PCL sprain
122
external rotation/dial test positioning of pateint
patient should be prone
123
dial test set up
knee flexed 30 deg then 90 deg and externally rotate the lower leg
124
+ dial test
increase in external rotation greater than 10 deg compared w/ opposite side
125
what does a difference of knee flexionat 30 deg but not at 90 deg for dial test indicate
injury of posterolateral corner of knee
126
what does a difference of knee flexion at 30 and 90 deg for dial test indicate
trauma to PCL and related structures
127
what does a difference in knee flexion at 90 deg but not 30 deg indicate for dial test
PCL sprain
128
3 miniscal tests
McMurray's, Apley's compression/distraction, Thessaly test
129
which meniscal test has the best clinical values
thessaly
130
positioning of patient for McMurray's test
patient supine
131
set up for McMurray's test
one hand supports lower leg, thumb and index finger are posteromedial and posterolateral on joint line, valgus stress applied when knee is flexed its available ROM
132
+ McMuray's test
pop, click, lock knee
133
McMurray's test indicates
meniscal tear
134
apley's compression/distraction test positioning
patient prone w/ knee flexed at 90 deg
135
how is apley's compression/distraction test performed
apply axial load to tibia w/ IR and ER of tibia, distract tibia away from femur while rotation is happening
136
+ apley's compression/distraction test
pain during compression that is eliminated during distraction
137
what does apley's test for
meniscal tear
138
thessaly test set up
patient stand on one leg at a time, flex knee to 5 deg and rotate body to internally and externally rotate femur on the tibia, repeat at 20 deg
139
+ thessaly test
joint line pain, clicking or locking
140
2 IT band tests
noble's compression and ober;s
141
noble's compression test set up
patient laying on side, 90 deg flexion, 45 deg hip flexion, knee supported and pressure applied while flexing and extending knee
142
+ noble's compression test
pain under thumb, common at 30 deg
143
what does + noble's compression test indicate
IT band friction syndrome
144
ober's test set up
patient side lying w/ knee flexed to 90 deg, one hand stabilizes pelvis and other supports lower leg, abduct and extend hip
145
+ ober's test
thighs remain abducted
146
ober's test indicates
IT band tightness: predisposing patient to IT band friction syndrome and/or lateral patellar malalignment
147
wilson test set up
patient seated w/ knee flexed 90, actively extends knee w/ tibial IR for a few seconds, do ER of tibia after pain is felt
148
wilson test + test
pain during extension w/ IR that is relived by ER
149
what does wilson test indicate
osteochondral defect or osteochondritis dissecans on medial femoral condyle
150
myositis ossificans def
calcification of bone deposits in muscle
151
what causes myositis ossificans
inflammatory response to quad contusion
152
tx myositis ossificans
ROM exercises, NSAIDs, refer for imaging
153
s/s myositis ossificans
decreased ROM, pain, swelling, tender
154
quad strain most common muscle
rectus femoris
155
MOI quad strain
muscle overload, sprinting, kicking, improper warm up
156
s/s quad strain
immediate pain, discoloration, pain w/ extension, pain w/ flexion, swelling
157
tx quad strain
avoid stretching in early stages especially for 48 hours post-injury
158
hamstring strain MOI
usually rounding curve or muscle overload
159
s/s hamstring strain
immediate pain, grabbing back of leg, swelling, pain w/ extension
160
tx hamstring strain
avoid stretching in early stages, RICE, NSAID
161
popliteal strain MOI
hyperextension
162
popliteal strain s/s
pain w/ hyperextension, pain w/ initiation of knee flexion, IR, behind knee
163
popliteal strain tx
modify activity, RICE, NSAID
164
hamstring tendonitis location on leg
can be proximal or distal
165
MOI hamstring tendonitis
insidious, overuse, repetitive activity
166
s/s hamstring tendonitis proximal
pain in gluteal fold, tender, pain w/ long strides
167
s/s hamstring tendonitis distal
clicking behind knee, pain w/ knee flexion
168
popliteus teninitis MOI
insidious onset, overuse
169
risk factors politeus tendinitis
excessive pronation, posterior knee instability
170
s/s popliteus tendinitis
pain in fossa radiating to LCL, pain when running downhill, swelling, crepitus, pain w/ knee flexion
171
tx popliteus tendinitis
strengthening hip musculature, RICE, NSAID
172
pes anserine tendinitis MOI
run, cycling, insidious, overuse, knee flexion
173
s/s pes anserine tendinitis
pain at medial tibial plateau, anterior inferior medial knee pain, crepitus, swelling, pain w/ knee flexion
174
pes anserine tendinitis tx
ratio of stretching and strengthening, RICE, NSAIDS
175
def fat pad contusion/impingement
pad is impinged b/w femur and tibia
176
MOI fat pad contusion
hyperextension, direct blow
177
s/s fat pad contusion
pain on side of patella tendon, swelling
178
most commonly injured bursa
prepatella bursa= housmaid's knee
179
MOI bursitis
direct contact, falling on knee, kneeling for increased duration
180
s/s bursitis
pain, swelling, redness
181
medial plica syndrome def
inflammation of medial plica, friction caused by rubbing medial femoral condyle
182
MOI medial plica
trauma to knee, overuse, insidious
183
s/s medial plica
anteromedial knee pain, click, pop, lock
184
+ test medial plica
medial synovial plica, stutter
185
what does medial plica sometimes look like
meniscal tear
186
tx medial plica syndrome
ultrasound, laser, injection
187
popliteal/baker's cyst description
fluid filled cyst behind knee
188
MOI popliteal/baker's cyst
meniscal tear, arthritis, accumulation of fluid
189
s/s popliteal cyst
bulge behind knee, tightness, inability to fully flex
190
IT band friction syndrome def
friction b/w IT band and lateral femoral condyle
191
MOI IT band
insidious, overuse, downhill running
192
risk factors IT band syndrome
IT band tightness, genu varum, excessive pronation
193
s/s IT band syndrome
pain lateral femoral condyle, pain w/ stairs, radiate to IT band
194
+ tests for IT band
noble compression, ober
195
who is IT band friction syndrome most common in
runners, cyclists
196
patella tendonitis MOI
insidious, overuse, excessive jump/run
197
risk factors patella tendonitis
patellar maltracking
198
s/s patella tendonitis
pain inferior of patella w/ knee extension, tight quad, tight IT band
199
tx patella tendonitis
improvement of jump/landing, good ratio of stretching and strengthening
200
patella tendon rupture
overload of extensor mechanism, rapid quad contractions
201
risk factors for patella tendon rupture
previous tendonitis, tendon degeneration, steroid injections
202
s/s patella tendon rupture
immediate pain, displacement of patella, swelling, pop
203
treatment patella tendon rupture
immobilize, reffer
204
which knee condition should you use diagnosis of exclusion
patellofemoral pain syndrome
205
MOI patellafemoral pain syndrome
change in surface, activity level or intensity
206
risk factors patellafemoral pain syndrome
increased Q angle, patella alta or baja, female
207
s/s patellafemoral pain syndrome
anterior pain, clicking, giving out, pain w/ glide
208
+ patellafemoral pain syndrome tests
clarke's sign, ober's, patellar tilt
209
tx patellfemoral pain syndrome
strengthening hip and knee muscles
210
chondramalacia patella condition def
softening, roughening, degeneration of articular surface of patella
211
MOI chondramalacia patella
patellar misalignment, direct or repetitive trauma
212
s/s chondramalacia patella
anterior knee pain, crepitus
213
+ chondramalacia patella test
clarke's
214
tx chondramalacia patella test
modify activity, strengthen hip and knee muscles
215
patellofemoral instability/subluxation MOI
direct trauma, knee extension
216
risk factors patellofemoral instability
shallow groove, excessive Q angle, hypermobile patella, female
217
s/s patellofemoral instability
sharp pain, knee gives out, deformity, swelling
218
+ test patellofemoral instability
patella tilt test, patellar apprehension
219
tx patellofemoral insability
reduce, immobilize, refer, brace
220
patellar dislocation MOI
lateral blow, rapid change of direction w/ foot
221
risk factors patellar dislocation
patella alta, history of previous problems
222
s/s patellar dislocation
immediate and sharp pain, deformity, swelling, pain
223
tx patellar dislocation
immobilize, reduce, refer
224
patellar fracture MOI
direct blow, hyperflexion
225
s/s patellar fracture
immediate pain, unable to bear weight, deformity, swelling
226
+ test patellar fracture
tap test
227
tx patellar fracture
immediate referral, x-ray
228
osgood-schlatter disease description
apophysitis at tibial tuberosity, usually adolescents
229
MOI osgood-schlatter
stress on growth plate
230
MCL sprain MOI
valgus force, ER of tibia
231
MCL s/s
pain, decreased flexion/extension
232
tx MCL sprain
brace, RICE, NSAID
233
LCL sprain MOI
varus force
234
LCL sprain s/s
pain, swelling, decreased flexion/extension
235
tx LCL sprain
refer, RICE
236
ACL sprain MOI
rotation of knee, valgus force, hyperextension
237
risk factors ACL sprain
female, menstral cycle, increased Q angle
238
s/s ACL sprain
feeling pop, buckling, pain w/ joint, ACL clutch
239
allograft vs autograft ACL repair
donor ACL (less common), use piece of body for repair
240
PCL sprain MOI
direct blow to anterior tibia that drives tibia posteriorly, hyperflexion, hyperextension
241
PCL sprain usually happens
car accident or falling on knee
242
s/s PCL sprain
pain w/i knee joint, may not pop
243
is PCL usually surgical
no, usually not surgical
244
rotary insability
multiple major structures involved
245
straight insability
one major structure involved
246
what test is used to differentiate b/w rotary and straight instability
slocum test
247
knee dislocation def
rupture of at least 3 of major ligaments: ACL, PCL and at least one more
248
MOI knee dislocation
hyperextension, rotation, varus force
249
s/s knee dislocation
pain, deformity, popping, non-weight bearing, swelling
250
tx knee dislocation
immobilize and immediate transportation to hospital
251
risk of knee dislocation
neurovascular injury
252
meniscus tears MOI
tibial rotation, hyperflexion, degeneration
253
s/s meniscus tear
pain along medial or lateral joint, click, lock, pop, pain w/ flexion/extension
254
OCD description
fracture of articular cartilage and underlying bone
255
MOI OCD
repetitive trauma, compressive force, rotational force
256
s/s OCD
increased pain w/ weight bearing, pain decreased w/ rest, joint line tenderness
257
tx OCD
modify activity, unload brace, surgery
258
osteoarthritis MOI
repetitive stress, poor mechanics, injury history, gradual onset
259
osteoarthritis risk factors
female, obesity, FH
260
s/s osteoarthritis
pain in morning, baker's cyst, compensatory gait
261
tx osteoarthritis
injection for lubrication, knee replacement surgery
262
femur fracture MOI
direct blow
263
femur fracture s/s
immediate and severe pain, muscle spasm, deformity
264
tx femur fracture
immobilize and transport to hospital
