Lower Extremity Flashcards
How can you evaluate for scoliosis?
inspect from several angles and with pt bending forward
Dextroscoliosis
curve is convex (toward) R
levoscoliosis
curve is convex (toward) L
What does SLR test for?
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)
Seated SLR test
pt seated with hands on table, extend leg
watch for pt to “flip back” when leg extended
Slump test*
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
FAbER test
Supine “figure 4”
Flexion, Abduction, External Rotation
assesses SI joint dysfunction
assess adductors
Antalgic gait
lump adopted to avoid pain on weight bearing structures, characterized by a very short stance phase
can also be due to loss of dorsiflexion
Trendelenburg sign
see if pt can keep hips even when weight is placed on side
Positive if it causes opposite side to drop
Thomas Test*
iliopsoas
Positive if femur raises off table
Or
Rectus femoris
positive if unable to have 90 flexion of knee
Ottowa knee rules
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
Baker’s cyst (popliteal cyst)
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
Popliteal artery aneurysm
usually due to atherosclerotic vascular disease
Males > females, usually >65yo
the most common aneurysm of the peripheral vascular system
How do you dx popliteal artery aneurysm?
pulsatile swelling behind the knee
best to palpate with knee extended
mechanism of injury (MOI) of meniscal tear
weight bearing with rotation
Sxs of meniscal tears
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”
Treatment for meniscal tears
repair or menisectomy
MOI for patellar dislocation
knee flexed between 20 -45deg with valgus load, then max contraction of quads
will almost always go laterally
MOI for patellar fractures
significant direct blow/force, not common in athletics, extremely painful, unable to SLR
Chondromalacia patellae
degenerative process that results in a softening (degeneration) of the articular surface of the patella
MOI for chondromalacia
overuse with poor tracking (patella doesn’t slide nicely in groove)
commonly have large Q angle
Q angle
Normal <15deg
women naturally have greater Q angles (wider hips)
thus, women experience chondromalacia patella more freq. than men
Patellar tendonitis
“jumper’s knee”
MOI for patellar tendonitis
overuse w/ heay quad loads & poor quad flex
Sxs of Patellar tendonitis
pain increased w/ activity, aches after exercise, possible swelling, tenderness at inferior pole, increased pain with resisted knee extension
MCL sprain
most freq. injured ligament in the knee
MOI for MCL sprain
blow to lateral side of the knee, forcing valgus
Sxs of MCL sprain
pain, mild to mod swelling exterior to jt, discoloration and tenderness, valgus instability, may report feeling a “pop”
LCL sprain MOI
foot planted, medial side impact/varus force
LCL sprain Sxs
pain, lateral knee swelling, ecchymosis, point tenderness, varus instability, may feel “pop” with complete rupture
ACL sprain MOI
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)
SXs of ACL sprain
immediate pain & feeling of instability
audible pop
joint effusion and loss of motion usually result within 24hrs
unable to bear weight
PCL sprain MOI
injured by a direct force against the anterior tibia, driving it posteriorly
(fall, MVC)
SXS of PCL sprain
pain, joint effusion, limited ROM into full flexion & extension, may have audible “pop”
Unhappy tried
MCL, medial meniscus and ACL tear
Osgood-Schlatter’s disease MOI
repetitive traction on the tibial tuberosity apophysis via the patellar tendon and quadriceps group
In what population does osgood-schlatter disease typically occur?
young athletes when the growth plate of the tibial tuberosity is still fluid
Sxs of osgood-schlatter disease
aggravated by running, jumping or kneeling in young athletes, pain and swelling around tuberosity
Ankle sprain v. strain
sprain- tear or stretch of a ligament (bone to bone)
strain- tear or stretch of a tendon/muscle structure
Ankle anterior drawer sign
testing for anterior talofibular ligament tear
- stabilize distal tibia
- grasp and pull calcaneus forward assessing for excessive forward movement
Anterior tibialis tendonitis
tends to be more acute
Achilles’ tendonosis
tends to be more chronic
obvious swelling, long rehab
Achilles’ rupture MOI
treatment
“big bang” sudden forced plantar flexion
surgery- suture mop ends together, long slow rehab
neuropathic ulcer
commonly associated with diabetes
pes planus
flat foot
Inversion ankle sprains MOI
types
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
eversion ankle sprain MOI
land in plantarflexion and rotation into eversion
if excess eversion may fracture the fibula
Syndesmosis sprains MOI
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
Plantar fascitis MOI
overuse, acute or chronic
Plantar fascitis sxs
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
plantar fascitis predisposing factors
excessive pronation, obesity, abn. high arches
plantar fasciitis dif dx.
tarsal tunnel syndrome-tinel’s sign
sever disease (calcaneal apophyitis) -if pt <13yrs, pain with squeezing heel
heel spur - xray to confirm
turf toe MOI
sprain of 1st MP jt from hyperextension
turf toe sxs
tx
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
fx to the base of 5th MT MOI
inversion moment commonly combined with landing from a jump
fx to base of 5th MT sxs, treatment?
point tender at head of 5th MT, bone may feel mobile, cannot bear wt on foot, pain with resisted eversion
x-ray, crutches
lisfranc injury MOI
injury to any side of the 2nd MT head articulations;dislocations or fractures
varied, significant impact from something
lisfranc injury sxs, treatment?
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
Morton’s neuroma MOI
compression of a nerve bundle between the MT heads in ball of foot
shoes with narrow toe box
morton’s neuroma sxs, treatment?
tingling, burning pain in the ball of foot and distally into associated toes
wider shoes, may place felt pad under neuroma
bunion
inflammation and thickening of the bursa of the MTP joint of the big toe with valgus deformity
metatarsalgia
pain and tenderness under the metatarsal heads, unable to progress through terminal stance during walking because cannot load forefoot
claw toes
hyperextension of MP joint and flexion of PIP and DIPs, associated with pes cavus, fallen metatarsal arch or problems with intrinsic musculature
hammer toes
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
pes cavas
rigid foot, high arch, plantar soft tissues are shortened
often leads to claw toes, difficult to absorb shock
pes planus MOI
flat mobile foot
congenital, trauma, muscle weakness
all infants have flat feet until ~2yrs
What are the 2 types of pes planus?
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
signs of LE peripheral artery insufficiency
dependent rubor, pallor with raised extremity, hair loss on leg/foot atrophic skin/nail changes, ulcers, necrosis/gangrene
LE varicose veins
dilated, tortuous SF veins-result from defective structure &function of the valves of the saphenous system
Sxs of varicose veins
dull ache or pressure sensation after prolonged standing, relieved with elevation, dependent ankle edema may develop, ankle ulcerations ad SF thrombosis may occur
stasis dermatitis
due to chronic venous insufficiency with incompetent valves and higher pressure in capillary bed
tissue is damaged and inflamed, “brawny” non pitting edema
lymphedema
results from blockage of the lymph vessels that drain fluid from tissues throughout the body
Homan’s sign
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
