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History & Physical > Lower Extremity > Flashcards

Lower Extremity Flashcards

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1
Q

How can you evaluate for scoliosis?

A

inspect from several angles and with pt bending forward

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2
Q

Dextroscoliosis

A

curve is convex (toward) R

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3
Q

levoscoliosis

A

curve is convex (toward) L

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4
Q

What does SLR test for?

A

impingement of spinal nerves/sciatic nerve

Elevate leg and dorsiflex foot- pain on ipsilateral leg is a positive test- suggests a lumbosacral radiculopathy

(tightness/discomfort in the buttocks or hamstrings is not a positive test)

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5
Q

Seated SLR test

A

pt seated with hands on table, extend leg

watch for pt to “flip back” when leg extended

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6
Q

Slump test*

A

seated, slump, tuck chin, knee extension, dorsiflex

perform bilaterally, check for sciatica/herniated disk

ask if pt has any pain with any of those movements

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7
Q

FAbER test

A

Supine “figure 4”
Flexion, Abduction, External Rotation

assesses SI joint dysfunction

assess adductors

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8
Q

Antalgic gait

A

lump adopted to avoid pain on weight bearing structures, characterized by a very short stance phase

can also be due to loss of dorsiflexion

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9
Q

Trendelenburg sign

A

see if pt can keep hips even when weight is placed on side

Positive if it causes opposite side to drop

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10
Q

Thomas Test*

A

iliopsoas

Positive if femur raises off table

Or

Rectus femoris

positive if unable to have 90 flexion of knee

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11
Q

Ottowa knee rules

A

If any are positive > x-ray

  • Age > or = 55
  • isolated tenderness at the patella
  • tenderness at the fibular head
  • unable to flex knee to 90 deg
  • unable to bear weight immediately after and in ER for 4 steps

100% sensitive, 50% specific

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12
Q

Baker’s cyst (popliteal cyst)

A

a synovial fluid cyst located located in the popliteal space

palpable as fluctuant fullness, best to palpate with knee extended

may be painful or (if they leak) result in calf swelling

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13
Q

Popliteal artery aneurysm

A

usually due to atherosclerotic vascular disease

Males > females, usually >65yo

the most common aneurysm of the peripheral vascular system

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14
Q

How do you dx popliteal artery aneurysm?

A

pulsatile swelling behind the knee

best to palpate with knee extended

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15
Q

mechanism of injury (MOI) of meniscal tear

A

weight bearing with rotation

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16
Q

Sxs of meniscal tears

A

pain/swelling localized at jt line

max swelling is freq. seen the day after injury

may report popping, clicking, locking

“feels like knee is going to give out”

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17
Q

Treatment for meniscal tears

A

repair or menisectomy

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18
Q

MOI for patellar dislocation

A

knee flexed between 20 -45deg with valgus load, then max contraction of quads

will almost always go laterally

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19
Q

MOI for patellar fractures

A

significant direct blow/force, not common in athletics, extremely painful, unable to SLR

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20
Q

Chondromalacia patellae

A

degenerative process that results in a softening (degeneration) of the articular surface of the patella

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21
Q

MOI for chondromalacia

A

overuse with poor tracking (patella doesn’t slide nicely in groove)

commonly have large Q angle

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22
Q

Q angle

A

Normal <15deg

women naturally have greater Q angles (wider hips)

thus, women experience chondromalacia patella more freq. than men

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23
Q

Patellar tendonitis

A

“jumper’s knee”

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24
Q

MOI for patellar tendonitis

A

overuse w/ heay quad loads & poor quad flex

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25
Q

Sxs of Patellar tendonitis

A

pain increased w/ activity, aches after exercise, possible swelling, tenderness at inferior pole, increased pain with resisted knee extension

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26
Q

MCL sprain

A

most freq. injured ligament in the knee

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27
Q

MOI for MCL sprain

A

blow to lateral side of the knee, forcing valgus

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28
Q

Sxs of MCL sprain

A

pain, mild to mod swelling exterior to jt, discoloration and tenderness, valgus instability, may report feeling a “pop”

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29
Q

LCL sprain MOI

A

foot planted, medial side impact/varus force

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30
Q

LCL sprain Sxs

A

pain, lateral knee swelling, ecchymosis, point tenderness, varus instability, may feel “pop” with complete rupture

31
Q

ACL sprain MOI

A

twisting maneuver during weight bearing, such as changing directions or landing from a jump while twisting.

landing with bent knee with center of gravity too far posterior

direct blow to the back of the tibia that drives the tibia forward (rare)

32
Q

SXs of ACL sprain

A

immediate pain & feeling of instability

audible pop

joint effusion and loss of motion usually result within 24hrs

unable to bear weight

33
Q

PCL sprain MOI

A

injured by a direct force against the anterior tibia, driving it posteriorly

(fall, MVC)

34
Q

SXS of PCL sprain

A

pain, joint effusion, limited ROM into full flexion & extension, may have audible “pop”

35
Q

Unhappy tried

A

MCL, medial meniscus and ACL tear

36
Q

Osgood-Schlatter’s disease MOI

A

repetitive traction on the tibial tuberosity apophysis via the patellar tendon and quadriceps group

37
Q

In what population does osgood-schlatter disease typically occur?

A

young athletes when the growth plate of the tibial tuberosity is still fluid

38
Q

Sxs of osgood-schlatter disease

A

aggravated by running, jumping or kneeling in young athletes, pain and swelling around tuberosity

39
Q

Ankle sprain v. strain

A

sprain- tear or stretch of a ligament (bone to bone)

strain- tear or stretch of a tendon/muscle structure

40
Q

Ankle anterior drawer sign

A

testing for anterior talofibular ligament tear

  • stabilize distal tibia
  • grasp and pull calcaneus forward assessing for excessive forward movement
41
Q

Anterior tibialis tendonitis

A

tends to be more acute

42
Q

Achilles’ tendonosis

A

tends to be more chronic

obvious swelling, long rehab

43
Q

Achilles’ rupture MOI

treatment

A

“big bang” sudden forced plantar flexion

surgery- suture mop ends together, long slow rehab

44
Q

neuropathic ulcer

A

commonly associated with diabetes

45
Q

pes planus

A

flat foot

46
Q

Inversion ankle sprains MOI

types

A

plantarflexion with hindfoot inversion

1deg: ATF lig torn, little laxity, pain
2deg: ATF lig torn and some CF lig damage, clear laxity, pain
3deg: all 3 lateral ligaments torn, laxity, unable to bear weight

47
Q

eversion ankle sprain MOI

A

land in plantarflexion and rotation into eversion

if excess eversion may fracture the fibula

48
Q

Syndesmosis sprains MOI

A

plantarflexion with hindfoot inversion and rotation of talus in mortise

damage to ATF ligament, CF ligament, distal tib/fib

often referred to as high ankle sprain

takes longer to heal

49
Q

Plantar fascitis MOI

A

overuse, acute or chronic

50
Q

Plantar fascitis sxs

A

pain most severe when first getting out of bed, pain generally diminishes during activity and increases when activity stops, ttp at anterior/medial calcaneus and distally to mid fascia

51
Q

plantar fascitis predisposing factors

A

excessive pronation, obesity, abn. high arches

52
Q

plantar fasciitis dif dx.

A

tarsal tunnel syndrome-tinel’s sign

sever disease (calcaneal apophyitis) -if pt <13yrs, pain with squeezing heel

heel spur - xray to confirm

53
Q

turf toe MOI

A

sprain of 1st MP jt from hyperextension

54
Q

turf toe sxs

tx

A

pain in ball of foot under the big tow with gait, swelling and sig ttp on inferior jt, increased pain with toe extension

turf toe tape, steel inserts

55
Q

fx to the base of 5th MT MOI

A

inversion moment commonly combined with landing from a jump

56
Q

fx to base of 5th MT sxs, treatment?

A

point tender at head of 5th MT, bone may feel mobile, cannot bear wt on foot, pain with resisted eversion

x-ray, crutches

57
Q

lisfranc injury MOI

A

injury to any side of the 2nd MT head articulations;dislocations or fractures

varied, significant impact from something

58
Q

lisfranc injury sxs, treatment?

A

pain with weight bearing, inability to go into terminal stance of gait, pt tender in dorsal aspex of mid foot around head of 2nd MT

x-ray

59
Q

Morton’s neuroma MOI

A

compression of a nerve bundle between the MT heads in ball of foot

shoes with narrow toe box

60
Q

morton’s neuroma sxs, treatment?

A

tingling, burning pain in the ball of foot and distally into associated toes

wider shoes, may place felt pad under neuroma

61
Q

bunion

A

inflammation and thickening of the bursa of the MTP joint of the big toe with valgus deformity

62
Q

metatarsalgia

A

pain and tenderness under the metatarsal heads, unable to progress through terminal stance during walking because cannot load forefoot

63
Q

claw toes

A

hyperextension of MP joint and flexion of PIP and DIPs, associated with pes cavus, fallen metatarsal arch or problems with intrinsic musculature

64
Q

hammer toes

A

extension contracture at MP joint, flexion contracture at PIP, DIP may be in any position

can be congenital, poor fitting shoes, hallux valgus or muscular imbalance

65
Q

pes cavas

A

rigid foot, high arch, plantar soft tissues are shortened

often leads to claw toes, difficult to absorb shock

66
Q

pes planus MOI

A

flat mobile foot

congenital, trauma, muscle weakness

all infants have flat feet until ~2yrs

67
Q

What are the 2 types of pes planus?

A

rigid/congenital: rare, calcaneous in valgus and midtarsal in pronation, visible in non weight bearing position

Flexible or acquired: due to tibial torsion or subtalar jt dysfunction, apparent in WB position, but if stand on tiptoes, arch reappears

68
Q

signs of LE peripheral artery insufficiency

A

dependent rubor, pallor with raised extremity, hair loss on leg/foot atrophic skin/nail changes, ulcers, necrosis/gangrene

69
Q

LE varicose veins

A

dilated, tortuous SF veins-result from defective structure &function of the valves of the saphenous system

70
Q

Sxs of varicose veins

A

dull ache or pressure sensation after prolonged standing, relieved with elevation, dependent ankle edema may develop, ankle ulcerations ad SF thrombosis may occur

71
Q

stasis dermatitis

A

due to chronic venous insufficiency with incompetent valves and higher pressure in capillary bed

tissue is damaged and inflamed, “brawny” non pitting edema

72
Q

lymphedema

A

results from blockage of the lymph vessels that drain fluid from tissues throughout the body

73
Q

Homan’s sign

A

testing for DVT in pt with calf pain, tenderness or swelling

passively dorsiflex foot, calf pain with dorsiflexion suggests DVT

negative test does not rule out DVT

History & Physical (8 decks)

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