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H & P > Lower extremity > Flashcards

Lower extremity Flashcards

1
Q

ROM of spine

A
  1. Flexion
  2. Extension
  3. Lateral bending
  4. Rotation (seated position)
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2
Q

Dextroscoliosis

A

Curve is convex (toward) the right

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3
Q

Levoscoliosis

A

Curve is convex (toward) the left

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4
Q

Straight leg raise (SLR)

A
  • Tests for impingement of spinal nn/ sciatic n
  • Elevate leg, dorsiflex foot
  • Pain into ipsilateral leg = + = lumbosacral radiculopathy
  • Pain in contralateral leg = + crossed SLR
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5
Q

Seated SLR

A
  • Pt has hands on table
  • Extend leg
  • Watch for pt to “flip back”
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6
Q

FAbEr test

A
  • F = flexion, A = abduction, E = external rotation
  • Supine figure 4
  • Checks SI joint dysfunction
  • Checks adductors
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7
Q

Slump test

A
  • Seated
  • Slump
  • Tuck chin
  • Knee extension
  • Dorsiflexion
  • Checks sciatica or a herniated disc
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8
Q

Antalgic gait

A
  • Limp adopted to avoid pain on weight-bearing structures
  • Short stance phase
  • Trendelenburg lurch
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9
Q

Trendelenburg sign

A
  • Identifies weak hip abductor on side that is bearing weight
  • If contralateral hip drops = +
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10
Q

Hip scour test

A
  • Acetabular labrum

- Apply axial load to femur as you rotate hip internally & externally

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11
Q

Ober’s test

A
  • IT band
  • Tibial IR & hip ABD & extension
  • Then lower leg to table
  • If leg will not lower = +
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12
Q

Noble’s test

A
  • IT band
  • Pt supine, palpate IT band & passively flex & extend knee
  • subjective test for pain
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13
Q

Thomas test

A
  • Iliopsoas (B)
  • If femur raises off table = +
    OR
  • Rectus femoris (A)
  • Unable to have 90˚ flexion of knee = +
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14
Q

Ottawa knee rules

A
  • 55 or older
  • Isolated tenderness at patella
  • Tenderness at fibular head
  • Unable to flex knee to 90
  • Unable to bear weight immediately after & ER for 4 steps
  • If any above are + = X-ray needed
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15
Q

Baker’s cyst

A
  • Synovial fluid cyst in popliteal region
  • Palpable as fluctuant fullness
  • May be painful (can leak –> calf swelling)
  • Best to palpate w/ knee extended
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16
Q

Popliteal artery aneurysm

A
  • Due to atherosclerotic vascular disease
  • Male > female
  • Usually > 65yo
  • Bilateral >50%
  • Best to palpate w/ knee extended
  • Most common aneurysm of peripheral vascular system
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17
Q

Popliteal artery aneurysm dx

A

Pulsatile swelling behind knee

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18
Q

Meniscal tears s/s & tx

A
  • Pain/swelling at joint line
  • Max swelling is seen day after injury
  • May report popping, clicking, locking
  • “Feel like knee is going to give out”
  • Surgery (repair or menisectomy)
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19
Q

Meniscal tear MOI

A

Weight bearing w/ rotation

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20
Q

Patellar dislocations MOI

A
  • Knee flexed btwn 20-45˚ w/ valgus load
  • Then max contraction of quads
  • Will almost always go laterally
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21
Q

Patellar fractures MOI

A
  • Direct blow/force

- Extremely painful (unable to SLR)

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22
Q

Chondromalacia patellae

A
  • Degenerative process –> softening of articular surface of patella
  • More frequent in women
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23
Q

Chondromalacia patellae MOI

A
  • Overuse w/ poor tracking

- Large Q-angle

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24
Q

Q-angle

A
  • Women have greater Q-angles

- Normal = <15˚

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25
Q

Patellar tendonitis MOI

A
  • “Jumper’s knee”

- Overuse w/ heavy quad loads & poor quad flex

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26
Q

Patellar tendonitis s/s

A
  • Increased pain w/ activity
  • Increased pain w/ resisted knee extension
  • Aches after exercise
  • Swelling
  • Tenderness at inferior pole
  • Risk of tendon rupture
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27
Q

MCL sprains MOI

A
  • Most frequently injured ligament in knee

- Blow to lateral side of knee forcing valgus

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28
Q

MCL s/s

A
  • Pain
  • Mild to moderate swelling exterior to joint
  • Discoloration
  • Point tenderness along length
  • Valgus instability
  • May feel “pop”
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29
Q

LCL sprains MOI

A

Foot planted, medial side impact/varus force

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30
Q

LCL s/s

A
  • Pain
  • Lateral knee swelling
  • Ecchymosis
  • Point tenderness over length of LCL
  • Varus instability
  • May feel “pop” w/ complete rupture
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31
Q

ACL sprain MOI

A

Twisting maneuver during weight bearing

  • Hyperextension
  • Rotation w/ change of direction
  • Jump stop w/ weight posterior
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32
Q

ACL fxn

A

Stops anterior translation of tibia on femur

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33
Q

ACL sprain s/s

A
  • Immediate pain & feeling of instability
  • Audible “pop”
  • Joint effusion & loss of motion within 24hrs
  • Unwilling to bear weight
  • Sense of instability w/ weight bearing
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34
Q

PCL sprains MOI

A

Direct force against anterior tibia, driving it posteriorly

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35
Q

PCL s/s

A
  • Pain
  • Joint effusion
  • Limited range of motion into full flexion & extension
  • May have audible “pop”
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36
Q

Unhappy triad

A

Sprain of:

  • MCL
  • ACL
  • Medial meniscus
  • Receives lateral blow to knee w/ foot fixed
  • Combo of valgus force
  • Rotation of leg –> stress on medial collateral ligament 1st
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37
Q

Iliotibial band MOI

A

Overuse w/ tight TFL & gluteus maximus

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38
Q

Iliotibial s/s

A
  • Pain over lateral epicondyle
  • Pain going downstairs *
  • Pain when leg is swinging forward during gait
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39
Q

Iliotibial tx

A
  • Stretch gluteus maximus & TFL

- Arch supports

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40
Q

Popliteus tendonitis MOI

A

Overuse injury if hamstrings get tired & popliteus has to carry more than its regular load

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41
Q

Popliteus tendonitis s/s

A
  • Pain w/ resisted knee flexion

- Pain w/ palpation

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42
Q

Knee bulge sign/ Sweep test

A
  • Testing for knee effusion

- With leg straight, “milk” knee joint fluid down 1 side & up other - observe for bulge

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43
Q

Ballottement of patella

A
  • Testing for knee effusion
  • Apply downward pressure from above the knee to milk fluid down
  • Push patella into the joint space, feel for fluid / boggy sensation
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44
Q

Osgood-Schlatter’s disease MOI

A
  • Repetitive traction on tibial tuberosity apophysis via patella tendon & quads
  • Young athletes
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45
Q

Osgood-Sclatter’s disease s/s, what actions aggravate it?

A
  • Aggravated by running, jumping, or kneeling

- Pain & swelling around tuberosity

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46
Q

Sinding-Larsen-Johansson disease

A
  • Resembles Osgood-Schlatter’s disease except involves proximal rather than distal end of the patellar tendon
  • Caused by repetitive traction forces on the inferior pole of the patella
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47
Q

Peroneal nerve contusion

A
  • Nerve passes below proximal head of the fibula, where it lies subcutaneously
  • Localized pain from the contusion & radiating pain to anterior lateral leg musculature & dorsum of foot
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48
Q

Prepatellar bursa

A
  • Most commonly injured
  • Direct trauma
  • Fluid btwn skin & patella
  • Looks like golf ball hanging
49
Q

Infrapatellar bursa

A

Result of repetitive kneeling or repeated trauma over the distal patellar tendon

50
Q

Suprapatellar bursa

A
  • Fills whole knee joint capsule

- Common after ACL tear

51
Q

Pes anserinus bursa

A
  • Related to cycling or running

- Constant friction or external blow

52
Q

Plica or “Medial Shelf” MOI

A
  • Plica: unusual fold of synovium
  • Plica gets pinched under patella if the quads fatigue & can’t pull it out of the way soon enough before patella compresses
53
Q

Plica s/s

A
  • Pain
  • Popping
  • Snapping
  • Aching at rest under medial edge of patella
54
Q

Fat pad impingement MOI

A

Bottom of the patella pinches, or impinges on, the fat pad on top of the tibia

55
Q

Fat pad impingement s/s

A
  • Sensation of pinching

- Bruise feeling in full extension

56
Q

Genu valgus vs genu varus

A 
Valgus = knock knees
Varus = bow legs
57
Q

Valgus stress test

A
  • Testing for medial collateral ligament (MCL) laxity &/or pain
  • W/ leg slightly flexed, stabilize knee laterally & abduct distal leg
  • Note any ligament laxity or pain
58
Q

Varus stress test

A
  • Testing for lateral collateral ligament laxity &/or pain
  • W/ leg slightly flexed, stabilize knee medially, & adduct distal leg
  • Note any ligament laxity or pain
59
Q

Lachman’s test

A
  • Testing for ACL tear
  • Knee is flexed 15-20º
  • Stabilize thigh w/ 1 hand, pull upper tibia forward w/ other hand
  • Compare sides
60
Q

Anterior drawer test

A
  • Testing for ACL tear
  • Knee is flexed 90º; foot & hips stable
  • Pull upper tibia forward assessing for excessive forward movement
  • Compare sides
61
Q

Posterior drawer test

A
  • Testing for PCL tear
  • Similar to anterior drawer sign, except tibia is pushed back (rather than pulled forward)
  • Excessive laxity suggest PCL tear
62
Q

McMurray’s test

A

Testing for meniscal tear

63
Q

McMurray’s test - medial meniscal tear

A

To test for medical meniscal tear:

  • Flex knee, place thumb & index finger on joint space
  • Rotate foot laterally & extend leg
  • Palpable click or pain at joint line = medial meniscal tear
64
Q

McMurray’s test - lateral meniscal tear

A

To test for lateral meniscal tear:

  • Same procedure done except – rotate foot medially, & extend leg
  • Palpable click or pain at joint line = lateral meniscal tear
65
Q

Calf pain w/ dorsiflexion suggests what?

A

DVT

66
Q

Which test is used to assess for achilles rupture?

A

Thompson’s test

67
Q

Which test is used to assess for DVT?

A

Homan’s sign

68
Q

What does a compression test assess?

A

Fx

69
Q

Lymphedema

A

Blockage of the lymph vessels that drain fluid from tissues throughout the body

70
Q

LE stasis dermatitis

A
  • Chronic venous insufficiency w/ incompetent valves & higher pressure in capillary bed
  • Tissue damaged & inflamed
  • “Brawny,” non-pitting edema
71
Q

Sx of venous insufficiency (varicose vv)

A
  • Dull ache or pressure sensation after prolonged standing; relieved w/ elevation
  • Dependent ankle edema
  • Ankle ulcerations
  • SF thrombosis / thrombophlebitis
72
Q

Signs of peripheral artery insufficiency

A
  • Dependent rubor
  • Pallor w/ raised extremity )
  • Hair loss on leg/foot
  • Atrophic skin; nail changes
  • Ulcers
  • Necrosis/gangrene
73
Q

Consequences of peripheral artery insufficiency

A
  • Gangrene

- Amputation

74
Q

Pes cavus

A
  • Rigid foot, High Arch/instep
  • Plantar soft tissues shortened
  • Leads to claw toes
  • Difficult to absorb shock
75
Q

Pes planus

A

Flat, mobile foot

76
Q

Pes planus MOI

A
  • Congenital
  • Trauma
  • Muscle weakness
77
Q

2 types of pes planus

A
  1. Rigid or congenital
    - Rare
    - Calcaneous in valgus & midtarsal in pronation
    - Visible in NWB position
  2. Flexible or acquired
    - Due to tibial torsion or subtalar jt. dysfunction
    - Apparent in WB position, but arch re-appears on tiptoes
78
Q

Claw toes

A

Hyperextension of MP jt. & flexion of PIP & DIPs

79
Q

What are claw toes associated w/ ?

A
  • Pes cavus
  • Fallen metatarsal arch
  • Problems w/ intrinsic musculature
80
Q

Hammer toes

A
  • Extension contracture at MP jt.
  • Flexion contracture at PIP
  • DIP (any position)
81
Q

Causes of hammer toes

A
  • Congenital
  • Poor fitting shoes
  • Hallux valgus
  • Muscular imbalance
82
Q

Bunion

A

Inflammation & thickening of the bursa of the MTP joint of the big toe – w/ valgus deformity

83
Q

Metatarsalgia

A
  • Pain & tenderness under metatarsal heads

- Unable to progress through terminal stance during walking bc cannot load forefoot

84
Q

Morton’s neuroma

A
  • Compression of a nerve bundle btwn metatarsal heads in ball of foot
  • Commonly btwn 3-4 or 2-3
85
Q

Morton’s neuroma MOI

A

Shoes w/ narrow toe box

86
Q

Morton’s neuroma s/s

A
  • Tingling
  • Burning
  • Pain in the ball of foot AND DISTALLY into assoc toes
87
Q

Morton’s neuroma tx

A
  • Ditch tight shoes permanently

- Place felt pad directly under neuroma

88
Q

Lisfranc injury

A
  • Injury to any side of the 2nd metat head

- Dislocations or fx

89
Q

Lisfranc s/s

A
  • Painful wt bearing, inability to go into terminal stance of gait
  • Tender in dorsal apex of mid-foot around head of 2nd metat
90
Q

Lisfranc MOI

A

Significant impact

91
Q

Lisfranc tx

A

Refer immediately for x-rays

92
Q

Fx to base of 5th MT MOI

A

Inversion combined w/ landing from a jump

93
Q

Fx to base of 5th MT s/s

A
  • Tender at head of 5th
  • Bone may even feel mobile
  • Cannot bear wt on foot
  • Pain w/resisted eversion
94
Q

Tx for fx at base of 5th MT

A

Refer on crutches for x-ray

95
Q

Turf toe MOI

A

Sprain of 1st MP jt from hyperextension

96
Q

Turf toe s/s

A
  • Moderate pain in ball of foot under big toe w/ gait
  • Swelling & tenderness on inferior jt
  • Incr pain w/toe extension
97
Q

Tx of turf toe

A
  • Tape

- Steel inserts

98
Q

DDx of turf toe

A

Seasmoiditis or fx

99
Q

Plantar fascitis MOI

A

Overuse, acute or chronic

100
Q

Plantar fascitis s/s

A
  • Pain most severe when 1st getting out of bed
  • Pain diminishes during activity & increases when activity stops
  • Tender at origin on the ant./medial calcaneous & distally to mid-fascia
101
Q

Predisposing factors for plantar fascitis

A
  • Excessive pronation
  • Obesity
  • Abnormally high arch
102
Q

DDx for plantar fascitis

A
  • Tarsal tunnel syndrome (Tinel’s sign)
  • Sever disease (pain when squeezing heel, 13yo or younger)
  • Heel spur
103
Q

Inversion sprains MOI

A

Plantarflexion w/ hindfoot inversion

104
Q

Types of inversion sprains

A
  • 1st degree = ATF lig torn, little laxity, pain
  • 2nd degree = ATF lig torn & some CF lig damage, clear laxity w/ end pt, pain
  • 3rd degree = all 3 lateral ligs torn, laxity w/ no end pt, pain, unable to bear weight
105
Q

Eversion sprains MOI

A

Land in plantar-flexion & rotation into eversion

106
Q

Excessive eversion can cause fx of what?

A

Fibula

107
Q

Syndesmosis sprain MOI

A
  • Plantarflexion w/ hindfoot inversion & rotation of talus in mortise
  • Damage to ATF lig, CF lig, distal tib-fib lig (ant &/or post) *HIGH ANKLE SPRAIN
108
Q

Why do syndesmosis sprains take longer to heal?

A

Bc every time he/she steps, the tib-fib lig is stressed

109
Q

What kind of ulcer is commonly associated w/ diabetes?

A

Neuropathic

110
Q

Achilles Rupture MOI

A
  • Big bang!
  • Age related
  • “weekend warrior”
111
Q

Tx of achilles rupture

A

Surgery

  • Suture ends together = LOTS of scar tissue!
  • Long, slow rehab
112
Q

Anterior tibialis tendonitis

A
  • More acute

- Isolate to confirm w/ MMT

113
Q

Achilles tendonitis

A
  • More chronic
  • Obvious swelling
  • Long rehab w/ many set-backs
114
Q

Difference btwn sprain & strain

A 
Sprain = ligament 
Strain = tendon
115
Q

Pulse grading (amplitude)

A 
0	Absent, unable to palpate 
1+	Diminished, weaker than expected
2+	Brisk, normal
3+	Increased
4+	Bounding
116
Q

Callus

A
  • Skin thickening found on bottom of foot

- Generally SF & doesn’t cause pain

117
Q

Corns

A
  • Found on top of toes
  • Specially shaped callus of dead skin
  • Smaller than calluses but deeper & painful
118
Q

Anterior drawer sign

A
  • Testing for anterior talofibular ligament tear
  • Stabilize distal tibia
  • Grasp & pull calcaneus forward assessing for excessive forward movement

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