Lower Extremity Exam Flashcards
1
Q
seated leg raise evaluates
A
sciatica nerve irritation or lumbar nerve root irritation
2
Q
Seated straight leg raise test
A
patient is seated
have them passively extend the knee
3
Q
what does passive extension of the knee do?
A
causes tensions the sciatic nerve and lumbar nerve roots
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.
5
Q
flip sign
A
patient reflexively leaning back during seated straight leg raise
6
Q
straight leg raise evaluates
A
sciatic nerve irritation or lumbar nerve root irritation
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
8
Q
straight leg raise positive test
A
Reproduction of radicular pain with dorsiflexion
9
Q
what is not considered a positive straight leg raise
A
Tightness / discomfort in the buttocks or hamstring
10
Q
radicular pain in contralateral leg during straight leg raise
A
highly specific for lumbar nerve root entrapment/irritation
11
Q
Passive flexion of the hip while the knee is maintained in full extension tenses
A
the sciatic nerve and lumbar nerve roots
12
Q
slump test steps
A
patient is seated, slumps, tuck chin, pressed on occipital bone, extend knee , and then passively extend the knee
13
Q
what dos the pelvic spring test assess
A
pelvic instability and fracture
14
Q
steps of the FabER
A
have the patient be supine and create a figure four
abduction, external rotation and apply pressure
15
Q
what does FAbER test assess
A
SI Joint dysfunction
assesses adductors
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
17
Q
Lower Extremity Palpation anterior landmarks
A
iliac crest
anterior superior iliac spine
pubic symphysis
18
Q
Lower Extremity Palpation posterior lateral landmarks
A
grater trocater
ischial tuberosity
19
Q
Hip Extension
A
best if prone or on one side
extend thigh or patient is standing
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
21
Q
lower extremity inspection
A
inspect the skin and subcutaneous tissue over the muscles and joints for color, skin folds swelling and masses
22
Q
where else should you inspect the color during lower extremity inspection
A
the nails
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
24
Q
palpation of the popliteal fossa
A
look for pulse, cyst and aneurysm
knee should be flexed
25
ottowa knee rules level 1 criteria
```
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
26
if we have a positive Ottawa knee what else do we need in order to appropriately give an X-ray
appropriate MOI
27
what is a baker's cyst
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
28
how is a baker's cyst best palpated
with the knee extended
29
what is a popliteal artery aneurysm usually due to
atherosclerotic vascular disease
30
popliteal artery aneurysm general population
more likely to occur in males than females
| and with those 65 years old and older
31
what is the most common aneurysm of the peripheral vascular system
popliteal artery aneurysm
32
a popliteal artery aneurysm is _____ more than 50 % of the time
bilateral
33
how to diagnosis popliteal artery aneurysm
there is a pulsatile swelling behind the knee
34
it is best to palpate a popliteal artery aneurysm when
the knee is extended
35
bulge sign evaluates for
a small to significant knee joint effusion
36
how to look for bulge sign
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
37
positive bulge sign
A fluid wave or bulge felt along the medial aspect of the knee is indicative of a knee effusion
38
ballottement of patella evaluates
large effusion of the knee joint
39
ballottement of patella test
Compress the suprapatellar pouch and apply downward pressure to the patella by tapping it
40
ballottement of patella positive test
A sensation that the patella is boggy like it is floating on a cushion of fluid is indicative of a knee joint effusion
41
is MCL or LCL more common
| and in which sex is it more common
MCL and men
42
valgus
medial/ inward rotation
43
varus
bowed out
44
how do we rate valgus and varus stress test
grade 1 2 and 3
45
MCL mechanism of injury
forced direction to there lateral aspect of the knee
| cause injury to the medical collateral ligament
46
MCL injury is
| how do was test for this
instability caused by medial joint space
| valgus stress test
47
valgus test assess
medial collateral ligament stability
48
valgus stress test
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
49
Opening of the medial joint line at 0° during valgus stress test
is indicative of complete MCL tear and dependent upon the degree of knee laxity also indicative of possible ACL/PCL involvement
50
Opening of the medial joint line at 30° during valgus stress test
Opening of the medial joint line at 30° is indicative of partial to complete MCL tear
51
unhappy triad
ACL, MCL, Medial meniscal tear
52
LCL injury
Force directed to the medial aspect of the knee (Rare)
| Injury to the lateral collateral ligament
53
LCL injury causes
| and clinical evaluation
Instability caused by abnormal opening of lateral joint space
use varus stress test
54
with LCL injury also check for
neurological function
55
varus stress test asses
lateral collateral ligament stability
56
varus stress test
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
Opening of the lateral joint line at 0° during varus stress test
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
Opening of the lateral joint line at 30° during varus stress test
Opening of the lateral joint line at 30° is indicative of partial to complete LCL tear
59
ACL Tear mechanism of injury
rotational (twisting) or hyperextension force
Sudden pain and giving way
about 1/3 of patients hear a pop
60
ACL tear joint effusion
Rapid development of joint effusion and associated stiffness
61
ACL tear
Majority involve a complete tear
| Associated meniscal tears are common
62
ACL Non contact MOI
planting and pivoting
| Valgus loading in combination with internal rotation of the femur and external tibial of the tibia rotation
63
ACL contact MOI
Hyperextension force applied to the anterior aspect of the knee while the foot is planted on the ground
64
ACL Signs and symptoms
Rapid effusion
Significant ROM limitation due to effusion
Pain and feeling of instability w/ weight bearing
65
Postive test for ACL tear
Positive Lachman test
| Positive anterior drawer test
66
Lachman's test asses
anterior cruciate ligament stability
67
Lachman's test
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
Lachman's test increased anterior translation of tibia when compressed when compared bilaterally or lack of.a firm end
indicative of an ACL injury
69
kne anterior drawer test
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
PCL Tear
Less common than ACL injuries
| Combined ligament injuries > isolated PCL injuries
71
PCL MOI
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
dashboard injury
posteriorly directed force to anterior knee with knee in flexion
73
PCL signs and symptoms
Effusion within first 24 hours
Active and passive ROM limited due to effusion
Pain and feeling of instability w/ weight bearing
74
PCL postive test
positive posterior drawer test
75
posterior drawer sign
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
types of meniscus tears
cross section, flap, radial, degenerative, bucket handle, longitudinal
look at pictures
77
meniscal tears clinical presentation
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
degenerative tears
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
mcmurray's test assess for
meniscal pathology
80
how to do the mcmurrary's test
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
Thessaly Test assess
meniscal pathology
82
Thessaly Test
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
positive Thessaly test
Joint line pain, clicking and/or locking is indicative of possible meniscal pathology and considered a positive test
84
during palpation take note of
```
muscle tone
edema
warmth
crepitus
and tendereness
```
85
palate known tender areas ___
last
86
palpating the calf for
tenderness
swelling
palpate for firm cord
end with palpation of the achilles tendon
87
whaat does a firm cord suggest in the calf
suggest thromboses vein (aka blood clot)
88
inspecting the ankle and foot for
deformities
nodules / masses
swelling
89
wha is a callus
skin thickening found on the bottom of the foot
| usually superficial and not cause pain
90
what are corns
they are usually found on the top of toes
| callus of dead skin but smaller than calluses and deeper and typically painful
91
ankle and foot caption landmarks
```
achilles tenon
medial malleolus lateral malleolus
heel, calcaneus, plantar fascia
heads of the 5 metatarsals
metatrosophalangeal joints
```
92
where is the posterior tibial pulse typically found
behind and slightly below the medial malleolus
93
where is the dorsalis pedis pulse typically found
on the dorsal of the foot
| over 1st and 2nd metatarsals
94
1+ pulse
diminished weaker than expected
95
2 + pulse
brisk, normal
96
3+ pulse
increasing pulse
97
4+ pulse
bounding pulse
98
an ankle x ray series is required only if there is any pain in malleolar zone and any of which findings
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
an foot x ray series is required only if there is any pain in misfit zone zone and any of which findings
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
ankle sprain inversion to eversion ratio
8 to 1
101
lateral ankle sprain mechanism
inversion
| combined inversion and plantarflexion
102
lateral ankle sprain ligament injury
stretch, partial tear or complete tear of
ATFL
CFL
PTFL (uncommon)
103
anterior drawer test ankle assess
the stability of the anterior talofibular ligament (ATFL)
104
anterior drawer test ankle
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
anterior drawer test ankle positive
Increased translation when compared bilaterally, pain and/or lack of end feel are indicative of injury to the ATFL
106
ATFL
anterior talofibular ligament
107
talar tilt test asses
for laxity of the calcanofibular ligament
108
talar tilt test
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
talar tilt postive test
Increased inversion talar tilt, pain and/or lack of end feel are indicative of injury to the CFL
110
cfl
calcanofibular ligament
111
eversion talar tilt assess
laxity of the deltoid ligament
112
eversion talar tilt test
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
eversion talar tilt positive test
Increased inversion talar tilt, pain and/or lack of end feel are indicative of injury to the deltoid ligament
114
common causes of achilles rupture
Explosive / rapid contraction
Change in direction
Rapid eccentric load
115
signs and symptoms of achilles tendon
```
“Kicked in the calf”
Audible “snap”
Observable / palpable gap
Severe swelling / ecchymosis
Pain / “weakness” on resisted plantar flexion
```
116
which test is positive in achilles tendon
Thompson test
117
how is Thompson test performed
knee is flexed and squeeze calf
| if pain is produced then the test is positive
118
what is neuropathic ulcer associated with
diabetes
119
pes planus commonly referred to as
flat foot
120
pes cavus
a rigid foot with a high arch
| often leads to claw toes
121
plantar soft tissues are shorted in which foot finding
Pes Cavus
122
it is difficult to absorb ____ with Pes Cavus
shock
123
claw toes hyperextension at
MP joints
124
claw toe flexion
at PIP and DIP joints
125
claw toes problems with
intrinsic musculature
126
hammer toes can be due to
congenital, poor fitting shoes, hallux valgus or muscular imbalance
127
hammer toe extension contracture
at MP joint
128
hammer toe flexion contracture
PIP
129
hammer toes DIP
may be in any position
130
hallux valgus is ____ ar _____ joint
lateral deviation at the MTP joint
131
hallux valgus may leas to
painful prominence of medial aspect of 1st meta teal head
| a bunion
132
hallux valgus female to male ratio
10 to 1
133
hallux valgus causes
pain and swelling aggrieved by show wear
| 2nd toe overrides the laterally deviated great toe
134
normal valgus at MTP
less than 20 degrees
