Lower extremity complaint Flashcards
pt has patellofemoral arthralgia and/or patellar tracking disorders
athlete with anterior knee pain
knee pain in elderly pts
osteoarthritis
young athlete with tibial tuberosity pain
Osgood Schlatter’s disease
pt with complaint of knee instability
chronic ACL damage
pt with painful locking of knee
meniscus tear
history of hyperextension injury at the knee
ACL tear or patellar dislocation
history of hyperflexion injury at the knee
PCL tear and/or ACL tear
history of sudden deceleration in knee
ACL tear
history of Valgus force injury in knee
MCL tear
history of Valgus force with rotation in knee
ACL, MCL, and menisci
history of blow to a flexed knee
contusion, patellar fracture, or PCL tear
tests for ACL
Lachman’s, anterior drawer, pivot shift test
tests for meniscus
McMurray’s, Apley’s compression and distraction
collateral ligament tests
varus and valgus stress tests
tests for patellofemoral disorders
compression, stability, and tracking
Ottawa knee rules for acute trauma
pt is over 55 isolated tenderness at patella isolated tenderness at fibula head pt is unable to flex the knee 90 degrees pt is unable to bear weight immediately after injury
pt reports sudden onset of knee pain following hyperextension injury, or sudden stopping or cutting, or after being hit from the side of the knee; may hear pop, joint swelling may appear, and pt is unable to bear weight
ACL tear
usually consists of anterior cruciate ligament tear, medial collateral ligament tear, and medial meniscal tear
O’Donoghue’s triad
xrays may show Segond’s fracture, potential tibial spine fracture, or head of fibula fracture
ACL tear
ACL should be this color on MRI
black
young athlete complains of knee pain following a blow to the front of his tibia with the knee in a flexed position or by forced hyperflexion
PCL injury
tests for PCL
posterior drawer test
SAG sign
refers to a characteristic linear fragment arising from the lateral margin of the lateral tibial plateau
Segond’s fracture
Segond’s fracture is associated with the disruption of
ACL
knee pain following a rotational injury and involves flexion and internal rotation of the tibia; swelling in the knee over a few hours; episodes of knee locking; knee gives away
meniscus tears
most meniscus injuries are due to
compression and rotation
on MRI the defect extends to the articular surface of the posterior horn
meniscus tear
young athlete complains of pain and swelling at the tibial tuberosity
osgood-schlatter’s disease
with osgood-schlatter’s disease, the apophysis may undergo an inflammatory reaction that is called
a traction apophysis
stiffness and knee pain that is worse with prolonged sitting or walking; varus deformity may be apparent
DJD
on xray may show decreased joint space predominantly involving the medial compartment with osteophytes, cystic changes, subchondral sclerosis and misalignment
DJD
young pt with insidious onset of anterior knee pain with a limp, occasionally the knee locks and swells, is a defect in the osteochondral bone and articular cartilage that usually affects the lateral portion of the medial femoral condyle
osteochondritis desiccans
occurs only on the convex surfaces of bone and is the most common cause of an intra-articular loose body
osteochondritis desiccans
FBI sign means
fracture
in older pts, calf pain should always suggest possibility of
deep vein thrombosis
pt has complaints of leg pain that occurs with walking and relief with rest
claudication
type of claudication that is secondary to spinal stenosis with compression of nerves and/or blood supply to the nerves causing leg symptoms that are related to exertion
neurogenic claudication
distinction between vascular and neurogenic claudication is due to
posture
pts with this claudication are more likely to be able to walk or ride a bicycle further before the onset of leg pain in a flexed position
neurogenic
claudication that involves stenosis of peripheral blood vessels compromising the blood supply to the muscles
vascular
smoking is a major risk factor for this type of claudication
vascular
older pts complain of leg pain after walking for a few minutes then must stop and rest before continuing; relief from rest is almost immediate
intermittent claudication
possible issues with the first toe
Hallux valgus/rigidus, gout, sesamoiditis
possible issues with metatarsals
Morton’s neuroma, netatarsalgia, stress fractures
possible issues with ankle
inversion and eversion sprains
possible issues with achilles tendon/heel
tendinitis, bursitis
pain on bottom of foot, dropped metatarsal heads, could be from direct trauma after jumping and landing on toes
metatarsalgia
pain on bottom of foot, insidious onset, pt may have less pain when barefoot, transverse compression may increase the pain, occasionally a mass may be palpated
Morton’s neuroma
constant pain of the forefoot especially with weight bearing, history of prolonged walking or running, tender to touch and pain with transverse compression
stress fracture
ankle pain and swelling following a twisting injury
ankle sprain
most ankle sprains involve these ligaments in sequence:
anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament
eversion ankle sprains often damage this ligament
deltoid ligament
type of ankle sprain that has pain in malleolar region and tenderness at either malleolus or inability to bear weight immediately after
plantar flexion inversion
tests for ankle sprains
anterior drawer test, varus and valgus stress test
one of the impingement syndromes involving the ankle, classically described in ballet dancers
Os trigonum syndrome or PAI
when measured, the angle of the calcaneus should not be less than this many degrees
28 degrees
transverse fracture at the base of the 5th metatarsal
Jones/Dancer’s fracture
