Lower extremity part 1 trigger Flashcards
if you do the FABER test and there is contralateral pain what is the likely etiology
sacroiliac dysfunction
ipsilateral indicated hip pathology!
if we measure from the anterior iliac crest to the medial malleolus and there is a 5cm difference between both legs is it considered significant?
yes. anything >3cm is significant!
what positive test indicates osteoarthritis or femoral head necrosis
leg roll test (internal and ext rotation of the related lower extremity in supine position)
positive is pain in anterior hip or groin.
Supine/unaffected side, then contralateral hip and knee flexed to 90deg. Stabilize pelvis, apply flexion adduction and internal rotation at knee
what test is this describing and what is a positive test? what does it indicate?
piriformis test.
+ is pain in the butt/leg
indicates piriformis impinging on sciatic nerve
flex hip and knee at 90d. apply posterolateral force through hip as femur rotates. passively adduct and internally rotate hip followed by abduction and external rotation.
what is this and what is a positive test? what does it indicate?
scouring test
pain/grating sound is positive
indicates labral pathology, loose body or internal derangement.
what test indicates impingement of sciatic nerve?
piriformis test
Supine/unaffected side, then contralateral hip and knee flexed to 90deg. Stabilize pelvis, apply flexion adduction and internal rotation at knee
what test indicates labral pathology, loose body or internal derangement.
scouring test
flex hip and knee at 90d. apply posterolateral force through hip as femur rotates. passively adduct and internally rotate hip followed by abduction and external rotation.
pt presents with severe pain in her LLE after a MVA where her knees hit the dashboard. she is unable to move her leg and reports numbness and tingling on the lateral portion of her leg. PE shows left leg is adducted and internally rotated. what diagnostics do you need and what is the tx and dx?
diagnostic: Xray of hip, femur and knee to r/o assocaited injuries.
dx: posterior hip dislocation
tx: allis maneuver w/i 6 hrs and CT hip w/o afterwards.
MOI for this is a hyperextended force against an abducted leg
anterior hip dislocation
could also be anterior force on the posterior femoral head.
shortened, adducted and internally rotated leg
posterior hip dislocation
leg that is abducted, externally rotated and flexed. dx and tx
anterior hip dislocation (this could also be a hip fx i suppose!)
tx: open reduction
what would cause us to want to assess for AVN for 2-3 years after treatment
a hip reduction
pt presents to the office 3 days after a fall during which she hurt her hip. She reports she is now having lateral hip pain what is worse when she rises from a seated position or lying on the affected side. Pt reports sometimes she thinks it gets better when she starts walking, but after about 30 minutes of walking it worsens again. PE shows point tenderness over greater trochanter.
what is dx and tx
dx: greater trochanteric bursitis
tx: NSAIDS, activity modification, ice, short term cane use, stretching.
bursal injections if needed
improves with walking but after 30 min of walking it worsens
greater trochanteric bursitis
Pt presents for her 6 month post hip reduction checkup and reports she began experiencing severe pain approximatly 2 weeks ago for about 3 days. she reports she thinks it is getting better becuase it is now just a dull aching and throbbing pain. She does however report that she is having decreased ROM and increased pain w ROM.
what diagnostics would you get on this patient and what would you see? what is the tx and dx?
Hip Xray - patchy areas of sclerosis and lucency. could also see crescent sign if late enough.
dx: AVN
tx: surgical intervention with core decompression or arthriplasty
severe pain at first then dull aching/throbbing
AVN
Xray shows patchy sclerosis and lutency and possible crescent sign
AVN
crescent sign = subchrondral fracture
what does focal tenderness over knee joint lines suggest
torn meniscus
what does generalized tenderness over knee joint lines suggest
arthritis
+ bulge sign suggests what
knee effusion
+ ballottement sign suggests what
knee effusion
push on patella and then rapidly releasing is what test? what is positive
ballottement test.
+ is rapid rebound indicating increased fluid pressure in knee
place patient in supine position w 30 d knee flexion. displace patella laterally via medial pressure.
what test is this and what is a positive test. what does it indicate
- patellar apprehansion sign
- pos is contraction of quads or apprehension d/t pain
- pos can indicat patellofemoral syndrome, patellar dislocation or subluxation
what test has pt supine with knee fully extended. one hand suprior to the patella and gently pushes patella inferiorly while patient contracts quads.
what is this and what is a positive test?
patellar grind/clarke sign
positive is pain, grinding or clicking.
indicates patellofemoral syndrome/chrondromalacia
what positive test indicates patellofemoral syndrome, patellar dislocation or subluxation
patellar apprehension test
what test suggests patellofemoral syndrome or chondromalacia
patellar grind test/clarke sign
lay patient supine and place one hand on heel and the other on the joint line. guide patient throuh ext rot + valgus + extension of the knee. then guide through int rot + varus + extension of knee.
what test and what is it for
McMurray test for meniscal tear
pos is popping, clicking or pain
supine w knee at 30 degree. on hand on distal femur + proximal tibia and pull tibia anteriorly.
what test and what for.
lachman test for ACL tear.
pos is anterior translation
supine w knee at 90 degree. on hand on distal femur + proximal tibia and pull tibia anteriorly while stabilizing the foot.
what test and what for
anterior drawer test. ACL tear.
also used in the ankle! for ankle sprain!
pos is significant laxity compared to contralateral side.
this test is done under anesthesia. full extension of knee followed by slow flexion with applied valgus stress and internal rotation.
what test and what for
pivot test for ACL tear (only pos in grade 2 or 3)
pos is sublexation occuring at 20-40 degree flexion
Pt is supine with knee flexxed to 90 degrees. apply pressure to lateral femoral condyle as you passively extend the knee.
what test and what for
nobles test
IT band syndrome
pos is tenderness over lateral femoral condyle at approx 30 d flexion
pt lies on unaffected side. flex unaffected knee and hip. flex affected knee and extend and abduct hip. lower affected side down to table
what is this and what for
obers test.
tensor fascia lata and IT band tightness
pos is inability to drop below horizontal plane to level of table
Where does the IT band originate from and where does it insert to?
Origin: ASIS
Insertion: Lateral tibia
i know ima forget this
pain in anterolateral aspect of knee, esp at heel strike
IT band syndrome
+ obers and nobles suggests what
IT band syndrome
displaced or intra articular distal femur fractures should see ortho in what amount of time
w/i 24 hours
if open, vascular compromise or compartment syndrome its EMERGENT and immediate ortho consult!
direct trauma, landing on a hyperextended knee or quad contraction during knee flexion are all possible MOIs for what injury
patellar dislocation
what diagnosis may have associated hemarthrosis ?
patellar dislocation
idk why i feel like this deserves a trigger but i keep forgetting it so here it is.
what is the reduction movement for patellar dislocation
flex hip
extend knee
apply medial force on patella
remember most patella diloscations are lateral!!!
what is runners knee AKA
patellofemoral syndrome
patellar squinting in the gait with associated pain posterior to knee cap is associated w what dx
patellofemoral syndrome
PT is hallmark of treatment for which diagnosis? what is used for stability in tx of this dx
patellofemoral syndrome
using a patellar stabilizer brace or taping techniques such as mcConnell taping is used.
pt presents with knee pain that was onset 2 weeks ago. she reports it initially was just when she was walking or kneeling during her daily prayers however now it is painful all the time. PE shows localized swelling over the knee and you are unable to differentiate the patella from the surrounding joint. what is the likely dx and tx.
inflammatory bursitis
tx: NSAIDS, ice, activity modification. corticosteroid injection if pt fails conservative and septic bursitis is R/O
when do we use oral keflex (MSSA) or bactrim/clinda (MRSA)? what are other treatments for this
mild infectious bursitis
IV Rocephin (MSSA) or vanc (MRSA) if severe disease!
