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H & P Exam 3 > Lower Extremity Exam > Flashcards

Lower Extremity Exam Flashcards

1
Q

seated leg raise evaluates

A

sciatica nerve irritation or lumbar nerve root irritation

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2
Q

Seated straight leg raise test

A

patient is seated

have them passively extend the knee

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3
Q

what does passive extension of the knee do?

A

causes tensions the sciatic nerve and lumbar nerve roots

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4
Q

Seated straight leg raise test positive test

A

-patient not tolerating full knee extension on the involved side

Typically demonstrated by the patient reflexively leaning back, shown as the flip sign

or they may just complain of reproduction or an increase in radicular pain

Reproduction of lumbar pain or radicular pain with contralateral knee extension is also considered a positive test.

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5
Q

flip sign

A

patient reflexively leaning back during seated straight leg raise

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6
Q

straight leg raise evaluates

A

sciatic nerve irritation or lumbar nerve root irritation

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7
Q

straight leg raise test

A

patients is supine passively flex the hip while maintaining knee extension.
If radicular symptoms are produced, slowly lower the leg until pain is relieved and then dorsiflex the foot

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8
Q

straight leg raise positive test

A

Reproduction of radicular pain with dorsiflexion

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9
Q

what is not considered a positive straight leg raise

A

Tightness / discomfort in the buttocks or hamstring

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10
Q

radicular pain in contralateral leg during straight leg raise

A

highly specific for lumbar nerve root entrapment/irritation

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11
Q

Passive flexion of the hip while the knee is maintained in full extension tenses

A

the sciatic nerve and lumbar nerve roots

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12
Q

slump test steps

A

patient is seated, slumps, tuck chin, pressed on occipital bone, extend knee , and then passively extend the knee

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13
Q

what dos the pelvic spring test assess

A

pelvic instability and fracture

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14
Q

steps of the FabER

A

have the patient be supine and create a figure four

abduction, external rotation and apply pressure

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15
Q

what does FAbER test assess

A

SI Joint dysfunction

assesses adductors

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16
Q

Antalgic gait

A

Limp adopted to avoid pain on weight-bearing structures, characterized by a very short stance phase
Patient remains on painful leg for as short a time as possible

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17
Q

Lower Extremity Palpation anterior landmarks

A

iliac crest
anterior superior iliac spine
pubic symphysis

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18
Q

Lower Extremity Palpation posterior lateral landmarks

A

grater trocater

ischial tuberosity

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19
Q

Hip Extension

A

best if prone or on one side

extend thigh or patient is standing

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20
Q

passive abduction and adduction

A

grasp ankle and move leg either medically across body or extend out
you are moving the patients leg

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21
Q

lower extremity inspection

A

inspect the skin and subcutaneous tissue over the muscles and joints for color, skin folds swelling and masses

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22
Q

where else should you inspect the color during lower extremity inspection

A

the nails

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23
Q

palpation landmarks of the knee

A 
patella 
patelar ligament 
medial and lateral epicondyles of the tibia 
medial and lateral condyles of tibia 
medial and lateral joint line 
tibial tuberosity
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24
Q

palpation of the popliteal fossa

A

look for pulse, cyst and aneurysm

knee should be flexed

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25
Q

ottowa knee rules level 1 criteria

A 
age over 55 
isolated tenderness at the patella 
tenderness at the fibula head 
unable to flex the knee 90 degrees 
able to bear weight immediately after and in the ER for 4 steps limping counts

need one of these to be positive and there must be an appropriate MOI

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26
Q

if we have a positive Ottawa knee what else do we need in order to appropriately give an X-ray

A

appropriate MOI

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27
Q

what is a baker’s cyst

A

a synovial fluid cyst located in the popliteal space

Palpable as fluctuant fullness

May be painful
may leak fluid into the calk causing calf swelling

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28
Q

how is a baker’s cyst best palpated

A

with the knee extended

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29
Q

what is a popliteal artery aneurysm usually due to

A

atherosclerotic vascular disease

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30
Q

popliteal artery aneurysm general population

A

more likely to occur in males than females

and with those 65 years old and older

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31
Q

what is the most common aneurysm of the peripheral vascular system

A

popliteal artery aneurysm

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32
Q

a popliteal artery aneurysm is _____ more than 50 % of the time

A

bilateral

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33
Q

how to diagnosis popliteal artery aneurysm

A

there is a pulsatile swelling behind the knee

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34
Q

it is best to palpate a popliteal artery aneurysm when

A

the knee is extended

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35
Q

bulge sign evaluates for

A

a small to significant knee joint effusion

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36
Q

how to look for bulge sign

A

Place your left hand above the patella and apply pressure on the suprapatellar pouch, “milking” the fluid downward. Stroke downward on the medial aspect of the knee.

then tap the knee just behind the lateral margin of the patella with the right hand

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37
Q

positive bulge sign

A

A fluid wave or bulge felt along the medial aspect of the knee is indicative of a knee effusion

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38
Q

ballottement of patella evaluates

A

large effusion of the knee joint

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39
Q

ballottement of patella test

A

Compress the suprapatellar pouch and apply downward pressure to the patella by tapping it

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40
Q

ballottement of patella positive test

A

A sensation that the patella is boggy like it is floating on a cushion of fluid is indicative of a knee joint effusion

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41
Q

is MCL or LCL more common

and in which sex is it more common

A

MCL and men

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42
Q

valgus

A

medial/ inward rotation

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43
Q

varus

A

bowed out

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44
Q

how do we rate valgus and varus stress test

A

grade 1 2 and 3

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45
Q

MCL mechanism of injury

A

forced direction to there lateral aspect of the knee

cause injury to the medical collateral ligament

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46
Q

MCL injury is

how do was test for this

A

instability caused by medial joint space

valgus stress test

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47
Q

valgus test assess

A

medial collateral ligament stability

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48
Q

valgus stress test

A

patient is supine
one hand on lateral aspect of knee and one medial distal tibia
apply abduction stress to the knee
repeat the test with the knee flexed to 30 degrees

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49
Q

Opening of the medial joint line at 0° during valgus stress test

A

is indicative of complete MCL tear and dependent upon the degree of knee laxity also indicative of possible ACL/PCL involvement

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50
Q

Opening of the medial joint line at 30° during valgus stress test

A

Opening of the medial joint line at 30° is indicative of partial to complete MCL tear

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51
Q

unhappy triad

A

ACL, MCL, Medial meniscal tear

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52
Q

LCL injury

A

Force directed to the medial aspect of the knee (Rare)

Injury to the lateral collateral ligament

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53
Q

LCL injury causes

and clinical evaluation

A

Instability caused by abnormal opening of lateral joint space
use varus stress test

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54
Q

with LCL injury also check for

A

neurological function

55
Q

varus stress test asses

A

lateral collateral ligament stability

56
Q

varus stress test

A

With patient supine and knee extended place one hand on the lateral side of the knee and grasp the medial distal tibia with the other hand. Apply a adduction stress to the knee
Repeat the test with the knee flexed to 30°.

57
Q

Opening of the lateral joint line at 0° during varus stress test

A

Opening of the lateral joint line at 0° is indicative of complete LCL tear and dependent upon the degree of knee laxity also indicative of possible ACL/PCL involvement

58
Q

Opening of the lateral joint line at 30° during varus stress test

A

Opening of the lateral joint line at 30° is indicative of partial to complete LCL tear

59
Q

ACL Tear mechanism of injury

A

rotational (twisting) or hyperextension force
Sudden pain and giving way
about 1/3 of patients hear a pop

60
Q

ACL tear joint effusion

A

Rapid development of joint effusion and associated stiffness

61
Q

ACL tear

A

Majority involve a complete tear

Associated meniscal tears are common

62
Q

ACL Non contact MOI

A

planting and pivoting

Valgus loading in combination with internal rotation of the femur and external tibial of the tibia rotation

63
Q

ACL contact MOI

A

Hyperextension force applied to the anterior aspect of the knee while the foot is planted on the ground

64
Q

ACL Signs and symptoms

A

Rapid effusion
Significant ROM limitation due to effusion
Pain and feeling of instability w/ weight bearing

65
Q

Postive test for ACL tear

A

Positive Lachman test

Positive anterior drawer test

66
Q

Lachman’s test asses

A

anterior cruciate ligament stability

67
Q

Lachman’s test

A

With patient supine, flex the knee to 30° and grasp the distal femur from the lateral side with one hand and the proximal tibia from the medial side with the other hand. Pull anteriorly on the tibia while stabilizing the femur

68
Q

Lachman’s test increased anterior translation of tibia when compressed when compared bilaterally or lack of.a firm end

A

indicative of an ACL injury

69
Q

kne anterior drawer test

A

With patient supine and the knee flexed to 90°, stabilize the leg by sitting on the patient’s foot. Grasp the proximal tibia with both hands and attempt to anteriorly translate the tibia.

Increased anterior translation of the tibia when compared bilaterally and/or a lack of a firm end is indicative of an ACL injury and considered a positive test.

70
Q

PCL Tear

A

Less common than ACL injuries

Combined ligament injuries > isolated PCL injuries

71
Q

PCL MOI

A

Dashboard injury

Fall onto flexed knee with foot in plantar flexion

Hyperextension injury to knee
Direct load on anteromedial proximal tibia w/ knee in extension
ACL ruptures first followed by PCL rupture
Frequently results in knee dislocation

72
Q

dashboard injury

A

posteriorly directed force to anterior knee with knee in flexion

73
Q

PCL signs and symptoms

A

Effusion within first 24 hours
Active and passive ROM limited due to effusion
Pain and feeling of instability w/ weight bearing

74
Q

PCL postive test

A

positive posterior drawer test

75
Q

posterior drawer sign

A

Assess for posterior cruciate instability

With the patient supine and foot supported on the table, flex the knee to 90°. Grasp the proximal tibia with both hands and push the tibia posteriorly.

Excessive posterior translation of the tibia and/or lack of end feel is indicative of injury to the PCL and is considered a positive test

This should be performed in unison with the anterior drawer test.

76
Q

types of meniscus tears

A

cross section, flap, radial, degenerative, bucket handle, longitudinal
look at pictures

77
Q

meniscal tears clinical presentation

A

Specific incident
Onset of moderate swelling and stiffness over 1-2 days
Locking, catching, popping may develop
Joint line pain w/ twisting or squatting
Tenderness over medial or lateral joint line
Motion limited secondary to pain, effusion and/or mechanical block

78
Q

degenerative tears

A

Insidious onset typically associated with increase activity level
Onset of mild swelling and stiffness over several months
Catching or popping may develop
Joint line pain w/ twisting or squatting
Tenderness over medial or lateral joint line
Motion limited secondary to pain and effusion

79
Q

mcmurray’s test assess for

A

meniscal pathology

80
Q

how to do the mcmurrary’s test

A

Flex the knee to maximum pain-free range. Hold the leg in that position and externally rotate the foot, then gradually extend the knee while applying a varus load to the knee as well. Pain, clicking and/or locking along the medial joint line is indicative of medial meniscal pathology.

To test the lateral meniscal internally rotate the foot, then gradually extend the knee while applying a valgus load the knee. Pain clicking and/or locking along the lateral joint line is indicative of lateral meniscal pathology.

81
Q

Thessaly Test assess

A

meniscal pathology

82
Q

Thessaly Test

A

Support the patient by holding their outstretched hands while the patient stands flatfooted on the floor
Internally and externally rotating 3 times with their knee flexed at 20 degrees. Provider should assist the patient in performing this movement pattern by walking in a arc like pattern to guide the patients movement.

83
Q

positive Thessaly test

A

Joint line pain, clicking and/or locking is indicative of possible meniscal pathology and considered a positive test

84
Q

during palpation take note of

A 
muscle tone
edema 
warmth 
crepitus 
and tendereness
85
Q

palate known tender areas ___

A

last

86
Q

palpating the calf for

A

tenderness
swelling
palpate for firm cord
end with palpation of the achilles tendon

87
Q

whaat does a firm cord suggest in the calf

A

suggest thromboses vein (aka blood clot)

88
Q

inspecting the ankle and foot for

A

deformities
nodules / masses
swelling

89
Q

wha is a callus

A

skin thickening found on the bottom of the foot

usually superficial and not cause pain

90
Q

what are corns

A

they are usually found on the top of toes

callus of dead skin but smaller than calluses and deeper and typically painful

91
Q

ankle and foot caption landmarks

A 
achilles tenon 
medial malleolus lateral malleolus 
heel, calcaneus, plantar fascia 
heads of the 5 metatarsals 
metatrosophalangeal joints
92
Q

where is the posterior tibial pulse typically found

A

behind and slightly below the medial malleolus

93
Q

where is the dorsalis pedis pulse typically found

A

on the dorsal of the foot

over 1st and 2nd metatarsals

94
Q

1+ pulse

A

diminished weaker than expected

95
Q

2 + pulse

A

brisk, normal

96
Q

3+ pulse

A

increasing pulse

97
Q

4+ pulse

A

bounding pulse

98
Q

an ankle x ray series is required only if there is any pain in malleolar zone and any of which findings

A

Bone tenderness at posterior edge of lateral malleolus
or
Bone tenderness posterior edge or tip of medial malleolus
inability to bear weight both immediately and in emergency department

99
Q

an foot x ray series is required only if there is any pain in misfit zone zone and any of which findings

A

Bone tenderness at the base of the 5th metatarsal
or
Bone tenderness at navicular
inability to bear weight both immediately and in emergency department

100
Q

ankle sprain inversion to eversion ratio

A

8 to 1

101
Q

lateral ankle sprain mechanism

A

inversion

combined inversion and plantarflexion

102
Q

lateral ankle sprain ligament injury

A

stretch, partial tear or complete tear of
ATFL
CFL
PTFL (uncommon)

103
Q

anterior drawer test ankle assess

A

the stability of the anterior talofibular ligament (ATFL)

104
Q

anterior drawer test ankle

A

With patient seated and knee flexed to 90°, place the ankle in approx. 20° PF, Stabilize the tibia with one hand, cup the palm of your other hand around the posterior aspect of the calcaneus and attempt to anteriorly translate the ankle

105
Q

anterior drawer test ankle positive

A

Increased translation when compared bilaterally, pain and/or lack of end feel are indicative of injury to the ATFL

106
Q

ATFL

A

anterior talofibular ligament

107
Q

talar tilt test asses

A

for laxity of the calcanofibular ligament

108
Q

talar tilt test

A

Patient seated with knee flexed to 90°. Ankle is relaxed. Use one hand to stabilize the medial aspect just above the medial malleolus. Utilizing your other hand grasp the inferolateral calcaneus and invert the hind foot

109
Q

talar tilt postive test

A

Increased inversion talar tilt, pain and/or lack of end feel are indicative of injury to the CFL

110
Q

cfl

A

calcanofibular ligament

111
Q

eversion talar tilt assess

A

laxity of the deltoid ligament

112
Q

eversion talar tilt test

A

Patient seated with knee flexed to 90°. Ankle is relaxed. Use one hand to stabilize the lateral aspect just above the lateral malleolus. Utilizing your other hand grasp the inferomedial calcaneus and evert the hind foot.

113
Q

eversion talar tilt positive test

A

Increased inversion talar tilt, pain and/or lack of end feel are indicative of injury to the deltoid ligament

114
Q

common causes of achilles rupture

A

Explosive / rapid contraction
Change in direction
Rapid eccentric load

115
Q

signs and symptoms of achilles tendon

A 
“Kicked in the calf”
Audible “snap”
Observable / palpable gap
Severe swelling / ecchymosis
Pain / “weakness” on resisted plantar flexion
116
Q

which test is positive in achilles tendon

A

Thompson test

117
Q

how is Thompson test performed

A

knee is flexed and squeeze calf

if pain is produced then the test is positive

118
Q

what is neuropathic ulcer associated with

A

diabetes

119
Q

pes planus commonly referred to as

A

flat foot

120
Q

pes cavus

A

a rigid foot with a high arch

often leads to claw toes

121
Q

plantar soft tissues are shorted in which foot finding

A

Pes Cavus

122
Q

it is difficult to absorb ____ with Pes Cavus

A

shock

123
Q

claw toes hyperextension at

A

MP joints

124
Q

claw toe flexion

A

at PIP and DIP joints

125
Q

claw toes problems with

A

intrinsic musculature

126
Q

hammer toes can be due to

A

congenital, poor fitting shoes, hallux valgus or muscular imbalance

127
Q

hammer toe extension contracture

A

at MP joint

128
Q

hammer toe flexion contracture

A

PIP

129
Q

hammer toes DIP

A

may be in any position

130
Q

hallux valgus is ____ ar _____ joint

A

lateral deviation at the MTP joint

131
Q

hallux valgus may leas to

A

painful prominence of medial aspect of 1st meta teal head

a bunion

132
Q

hallux valgus female to male ratio

A

10 to 1

133
Q

hallux valgus causes

A

pain and swelling aggrieved by show wear

2nd toe overrides the laterally deviated great toe

134
Q

normal valgus at MTP

A

less than 20 degrees

H & P Exam 3 (2 decks)

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