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MSK2 > lower leg > Flashcards

lower leg Flashcards

1
Q

Fx screening method

A

Tuning fork
-methodology: provocation of pain, sound conduction
128Hz
vibratory irritation at damaged periosteum

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2
Q

Fx screening clinical value

A

Tuning fork
-sensitivity is questionable
-may not identify fx with callus
-better for transverse fxs
-less accurate for stress fxs

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3
Q

Ottawa ankle rules

A

An ankle xray is only required if there’s pain in the malleolar zone AND these findings:
1. bone tenderness at lateral malleolus
2. bone tenderness at medial malleolus
3. inability to WB immediately for 4 steps
A foot xray is only required if there is pain in midfoot AND any of these findings:
1. Bone tenderness at base of 5th met
2. bone tenderness at navicular
3. inability to WB immediately for 4 steps

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4
Q

Traumatic fxs: distal tibia/fibula (MOI, types)

A

MOI: axial/rotational loading

Types:
-Unimalleolar fx: medial or lateral
-Bimalleolar fx: both
-Trimalleolar fx: both and posterior rim of tibia
-tibia and fibula shaft fx
-comminuted fx distal tibia
-intra-articular fxs

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5
Q

Traumatic fxs: Hindfoot

A

Calcaneus:
-MOI: fall from height
-intra vs extra-articular

Talus
-MOI: forced ankle DF
-Most intra-articular
-involving head neck or body

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6
Q

Traumatic fxs: Midfoot and forefoot

A

Navicular
-dorsal avulsion at deltoid attachment
-tuberosity fxs
-body fxs
-stress fxs: common insidious onset in WB athlete

Metatarsal
-MOI: direct trauma
-1st met
-2-4: spiral common
-5th: avulsion, stress fx

Phalangeal
-MOI: stubbing and direct trauma

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7
Q

Pediatric physeal ankle fxs surgery

A

-reduction of displaced fx (closed vs open)
-fixation vs no fixation (ORIF common for types 3 and 4)

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8
Q

Pediatric physeal ankle fxs prognosis

A

-worse if >1week prior to reduction
-larger gap
-gap >/= 3mm for types 1-2
-younger patients (more growth to come)
-higher risk of physis arrest in types 3-5 (f/u assess 2 yrs s/p fx)

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9
Q

Pediatric physeal ankle fxs types 1-5

A

1-2: typically casted 4-6 weeks following reduction

3-4: long leg NWB cast 1-4wks,
boot from 5-8wks (NWB first 2 wks, may remove for ROM)
If ORIF w/ type 3, common hardware removed once healed

5: recognized early-mx with removal of physis area f/b fat graft

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10
Q

Abnorms: Talipes Equinovarus (clubfoot)

A

-BILAT
-M>F
-PF heel, inversion STJ/varus rearfoot, met ADD/ varus forefoot

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11
Q

Rearfoot varus/valgus

A

varus: inversion of calc w/ subtalar in neutral (limit pron)
valgus: eversion calc w/ subtalar in neutral (excess pron, limit supin)

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12
Q

Forefoot varus/valgus

A

Varus: inversion forefoot on hindfoot w/ subtalar in neutral
Valgus: eversion of forefoot on hindfoot w/ subtalar in neutral

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13
Q

Pes planus(flat foot)/ cavus

A

Planus:
-Rigid/congenital: calc in varus, midtarsal region in pron, talus medial and downward, navicular dorsal and lateral on talus
-Aqcuired/flexible: like rigid, but foot mobile

Cavus: longitudinal arches accentuated

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14
Q

Hallux valgus (bunion)

A

-medial deviation of 1st met and lateral dev of great toe
-gait: collapse of medial arch, navicular drop, position of pronation during push-off= less rigid foot

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15
Q

Hallux rigidus

A

-arthropathy of great toe- pain, swelling, abnorm bone growth at dorsal 1st MTP

hx: arthropathy, trauma/injury, repetitive great toe ext

sxs: insidious onset, progressive, 1st MTP pain especially w/ walking uphill, stairs, terminal stance

exam: limited toe ext ROM, bony/hard PROM, gait devs, abrasion to skin, swelling, palpable osteophyte/tenderness

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16
Q

Ankle sprains (Inversion)

A

COMMON
ATFL involved a lot
Differential: avulsion fx 5th met styloid process, osteochondral lesion, malleolar fx

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17
Q

Ankle sprains inversion hx

A

30’s
running injury
athletes 5x likely to sustain lateral ankle sprain after initial sprain occurred
MOI: forced ankle inversion

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18
Q

Inversion sprain sxs

A

lateral ankle pain
lateral ankle swell/warmth/red
pain w/ activities that supinate foot

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19
Q

Inversion sprain exam

A

antalgic gait
increased figure 8 measure
local warm/tender (ATFL)
pain w/ inversion
+anterior drawer
+medial talar tilt
+reverse anterolateral drawer

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20
Q

Medial ankle sprain hx and sxs

A

-involves deltoid lig

hx: MOI forced ankle eversion

sx: medial ankle pain, medial swell/warm/red, pain with pronated positions

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21
Q

Medial ankle sprain exam

A

antalgic gait
increased figure 8
warm/tender area distal to medial malleolus
pain with pronation/eversion ROM
+lateral talar tilt stress test

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22
Q

Syndesmotic sprain MOI

A

“high ankle sprain”
concern chronic instability/degen arthropathy

MOI: forced DF, forced eversion of talus, forced ER of talus

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23
Q

Syndesmotic sprain sxs

A

pain distal lower leg
aggravated w/ stair descent/walking uphill/squat

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24
Q

Syndesmotic sprain exam

A

-early heel off in stance
-swell/tender A. tibiofib joint
-pain end range DF ROM
+fibular translation
+external rotation
+syndesmosis squeeze

25
Q

CAI hx

A

recurrent inversion sprains
fibular muscle weakness
impaired proprio

26
Q

CAI sxs

A

asymp. between sprains
feels of ankle giving way
ankle weakness
difficult/inability to run (worse on uneven)

27
Q

CAI exam

A

diminished proprioceptive func of ankle

28
Q

Dx/classify CAI

A

use Cumberland ankle instability tool or identification of functional ankle instability
also func performance tests

29
Q

Anterior ankle impingement hx

A

-soft tissue or bony spur formation at anterior TC joint

recurrent/high trauma ankle sprains

30
Q

AAI sxs

A

anterior ankle pain
anterior ankle swell/warm/red
pain with activities that put foot in DF

31
Q

AAI exam

A

antalgic gait/ early heel off
tender/palpable mass anterior tibiotalar joint
pain/limit with end range DF ROM
+forced DF test

32
Q

Impingement CPR (6)

A

5/6:
AL ankle joint tender
AL ankle joint swelling
Pain w/ forced DF
Pain w/ single leg squat
Pain with activities
Absence of ankle instability

*use with caution, not great

33
Q

FL/B tendinopathy hx

A

repeated inversion injuries
anatomic abnorms/anomalies

34
Q

FL/B sxs

A

pain posterior to lateral malleolus
sublux of fibularis tendons

35
Q

FL/B tendinopathy exam

A

swell/bruise lateral ankle
pain with AROM< RT ankle eversion
pain w/ end range inversion/supin
tender fibularis longus/brevis tendons

36
Q

Tib P tendinopathy hx

A

insidious, progressive, unilateral
concomitant deltoid lig injury
playing sports that require quick directional change

37
Q

Tib P tendinopathy sxs

A

pain near area of insertion at navicular
pain prox to medial malleolus

38
Q

Tib P tendinopathy exam

A

-foot posture: pronated foot/pes planus
-navicular drop in standing (1cm)
-tender/swell navicular or prox to medial malleolus
-pain with resisted inversion and PF
-painful eversion/ DF ROM

39
Q

Achilles tendinopathy hx

A

MOI: intense eccentric loading on triceps surae (gastroc/soleus complex)
running injuries!

40
Q

Achilles tendinopathy sxs

A

pain near insertion of achilles tendon
morning stiffness

41
Q

Achilles tendinopathy exam

A

-tenderness/swelling/hypertrophy/ palpable defect
-pain w/ DF ROM
-Pain w/ AROM< resisted PF

42
Q

Achilles tendon tear/rupture hx

A

MOI: sudden push off w/ extended knee, sudden forced DF

-Sudden/ acute onset known mechanism, “pop”, difficulty walking/WB
-hx of Achilles tendinopathy
-middle aged adult

43
Q

achilles tendon tear/rupture

A

sx: pain near insertion of achilles tendon

exam: tender/swell/hypertrophy/ palp defect of tendon/posterior calf
-pain DF ROM
-weak/absent active/resisted PF
+thompson test (rupture)

44
Q

Plantar faciitis hx, sx

A

high lifetime prevalence

hx: rfs- limited DF ROM, high BMI non-athletic populations

sxs: plantar medial heel pain (worse w/ first few steps following inactivity and with prolonged WB activity
-pain w/ terminal stance

45
Q

Fasciitis exam

A

-early heel off in stance
-guarding triceps surae
-swell/tender origin of plantar fascia (potentially heel spur)
-pain w/ passive DF of ankle and toes (windlass)

46
Q

Dx plantar fasciitis

A

-plantar medial heel pain, noticable after inactivity/prolonged WB
-heel pain from increase in WB activity
-pain w. palp of prox insertion of plantar fascia
-+windlass
-negative tarsal tunnel tests
-limit A/PROM TC joint DF ROM
-abnormal foot posture index score
-high BMI, nonathletic

47
Q

metatarsalgia hx

where is pain also

A

pain in distal forefoot, area of met heads

hx: health conditions that increase stress on met head

48
Q

metatarsalgia sxs

A

aggravated w/ prolonged WB activities, mid and terminal stance phases of gait

49
Q

metatarsalgia exam

A

-findings for concomitant health conditions
-antalgic gait/ diminished push off
-observable calluses on plantar foot
-tender plantar met heads

50
Q

Interdigital neuroma hx

A

thickening of soft tissue surrounding interdigital nerve

hx: insidious vs sudden onset (DF injury of toes)

51
Q

IN sxs

A

pain in area of met heads and web space

52
Q

IN exam

A

tenderness
+foot squeeze test

53
Q

TTS what is it

A

Peripheral nerve entrap of posterior tibial nerve
characterized as compression of soft tissue structures that pass deep to flexor retinaculum, posterior and distal to medial malleolus of tibia

54
Q

TTS sxs

A

loss plantar sensation
pain/paresthesia at plantar foot
increasing intensity of sxs w/ DF activities

55
Q

TTS rfs

A

obesity
venous insufficiency
space occupying lesions
trauma
peripheral vascular disease
DM
tight shoes/casts
foot deformities

56
Q

TTS Paucity of Lit

A

epidemiology of heel pain of neurologic etiology
*not a lot of research to show why, LACK OF LIT

57
Q

TTS exam

A

antalgic gait (alters to avoid DF)
limit/pain squat (avoid DF)
signs of invertor tendinopathy
diminished plantar sensation
weakness of intrinsics
limited ROM, pain DF eversion
+Tinel sign
LLTT w/ posterior tib bias

58
Q

TTS

rfs
what to do
aftercare

A

underlying cause not identified
>among females
~47 yos

Tarsal tunnel decompression (release) -flexor retinaculum incised, eliminates compressive force on deep neurovascular structures

post op careL
limits ankle ROM, splint 7-14days
mod locomotion w/ ADs
progress to WBAT after sutures removed
PT

MSK2 (7 decks)

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