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MSK > Lower leg MDT > Flashcards

Lower leg MDT Flashcards

1
Q

What is thought to be a secondary reaction of the periosteum in response to increased stress, as seen in runners

A

Shin splints

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2
Q

Pt presents with:

-Gradual onset of pain with prolonged walking or running
-Pain is localized to distal third of the medial tibia
-Recent increase training, intensity, pace or distance

A

shin splints

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3
Q

Signs of shin splints

A

Possible pes planus
Tenderness along posterior medial crest of tibia in middle to distal third of leg

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4
Q

Treatment of shin splints

A

NSAIDS, ice
Light duty
Gradual pain free return to running
Weight loss
Proper running shoes

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5
Q

What should be the differential for every patient with shin pain?

A

Tibial stress fracture

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6
Q

What condition has sx similar to tibial stress fracture?

A

Shin splints

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7
Q

What differentiates stress fracture from shin splints

A

Pain at rest
Pain suddenly increases in intensity around site of more mild sx

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8
Q

Rads for tibial stress fracture

A

Plain films
50% sensitivity
May not be seen
Periosteal reaction, cortical thickening, sclerosis may be seen
MRI, CT, bone scan are better at detecting

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9
Q

Treatment for tibial stress fracture

A

Rest/duty modification x 12 weeks
NSAID/Tylenol/Ice

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10
Q

What divides the muscles of the lower leg into 4 compartments

A

Fibrous septa

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11
Q

What is compartment syndrome

A

An elevation of intra-compartmental pressure to a degree that compromises blood flow to the involved muscles and nerves

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12
Q

What can cause acute compartment syndrome

A

Crushing injury, muscle strains or closed fractures

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13
Q

Pt presents with:
Severe leg pain out of proportion to apparent injury
Persistent deep ache or burning pain
Paresthesias
Sx progress over few hours

A

compartment syndrome

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14
Q

7 Ps for compartment syndrome PE

A

Pain
Pallor
Parasthesias
Paresis
Poikilothermia
Pressure
Pulselessness

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15
Q

What are the 2 most common clinical indicators of acute compartment syndrome?

A

Pain and paresthesia

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16
Q

Treatment for acute compartment syndrome

A

Fasciotomy by surgeon

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17
Q

What should be done for a patient prior to transport if they have compartment syndrome

A

Remove tight fitting items around extremity
Place limb in neutral position

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18
Q

Treatment of chronic exertional compartment syndrome

A

Rest from aggravating activities
NSAIDS
May require surgery

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19
Q

What is the largest tendon in the body?

A

Achilles tendon

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20
Q

Which 2 muscles converge to form the achilles tendon?

A

Gastrocnemius and soleus

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21
Q

Risk factors for achilles tendon rupture

A

Athletes
30-40 year olds
Male
Obesity
Bad running mechanics
Rheumatologic diseases

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22
Q

What antibiotic is associated with achilles tendon rupture

A

Fluoroquinolone

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23
Q

Pt presents with:
-Pop followed by acute onset of pain
-1/3 of patients report pain free at time of rupture

A

achilles tendon rupture

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24
Q

Special tests for achilles tendon rupture

A

Thompson test
Can still miss 10% of ruptures

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25
Q

Rads for achilles tendon rupture

A

US if available
MRI is gold standard

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26
Q

Treatment of achilles tendon rupture

A

Light duty, ice NSAID
Achilles tendon support
PT

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27
Q

Who should patients with achilles tendon ruptures be referred to

A

Ortho within 1-2 days

28
Q

What is the most common ankle sprain

A

Inversion
Lateral ankle sprain
Involves ATFL only

29
Q

Eversion ankle injury leads to which ankle sprain

A

Medial ankle sprain
Syndesmosis injury

30
Q

Eversion ankle injury with dorsiflexion results in which ankle sprain

A

High ankle sprain
Disruption of interosseous membrane

31
Q

How much more likely is someone to repeat an ankle injury

A

5x

32
Q

Ottawa ankle rules

A

Posterior edge/tip of lateral malleolus
Posterior edge/tip of medial malleolus
Base of fifth metatarsal
Navicular bone

33
Q

Special tests for ankle sprains

A

Anterior drawer- ATFL
talar tilt- CFL
Tib/fib squeeze – Syndesmosis

34
Q

Rads for ankle sprains

A

MRI for patients w/o relief after 6-8 weeks

35
Q

Treatment of ankle sprains

A

RICE, NSAIDS, Light duty
Pain free calf stretching and ankle strengthening
Bracing as need (prolonged will lead to poor proprioception)

36
Q

What injury can occur as a result from significant trauma or from indirect mechanism, may occur in athletics or as a result of tripping

A

Lisfranc fracture

37
Q

What joint is affected in a Lisfranc fracture

A

Tarsometatarsal joint

38
Q

Pt presents with:
-Report of a sprain
-Localized to dorsum of midfoot
-Swelling may be mild

A

lisfranc fracture

39
Q

Rads for Lisfranc fracture

A

AP radiograph shows second metatarsal has shifted laterally
CT and MRI if still unsure

40
Q

Treatment of Lisfranc fracture

A

Ortho consult
Non displaced: 6-8weeks of non weight bearing cast immobilization
Fractures or dislocations: require surgery
Analgesics
MEDEVAC

41
Q

Bunions are more common in who

A

Females

42
Q

Pt presents with:
- Pain and swelling aggravated by foot wear
- Great toe pronates

A

bunions

43
Q

How is severity of a bunion graded

A

Measuring forefoot angles on weight bearing AP radiographs

44
Q

What is normal hallux valgus angle and normal intermetatarsal angle

A

Hallux valgus: <15
IM: <10

45
Q

Treatment of bunions

A

Education and shoe wear modification
Light duty and ice
Surgical correction if persistent pain

46
Q

What is Morton Neuroma

A

Not a true neuroma but rather a perineural fibrosis of the common digital nerve as it passes between metatarsal heads

47
Q

Which digits is Morton Neuroma common

A

3rd and 4th toes

48
Q

Pt presents with:
-Plantar pain is most common
-Dysesthesias into affected2 toes or burning plantar pain that is aggravated by activity
-Occasionally, report numbness in adjacent toes of involved web space
-Patients state “walking on marble” or “wrinkle in my socks”
-Removing shoe and rubbing ball of foot provides relief

A

Morton Neuroma

49
Q

Special tests for Morton neuroma

A

Metatarsal squeeze

50
Q

Rads for Morton neuroma

A

Not needed
MRI and US if unclear

51
Q

Treatment of Morton neuroma

A

Low heeled, soft soled shoe with wide toe box
Metatarsal pads

52
Q

What is a long fibrous band like tissue that arises from the medial tuberosity of calcaneus and extends to the proximal phalanges

A

Plantar fascia

53
Q

What is the most common cause of heel pain in adults

A

Plantar fasciitis

54
Q

Who is more prone to plantar fasciitis

A

2x as likely in women
More common in overweight patients

55
Q

Pt presents with:
-Pain is most severe on awakening or when rising from resting position
-Prolonged standing and walking also increases pain
-Focal pain directly over medial calcaneal tuberosity and 1-2cm distally along the plantar fascia

A

plantar fasciitis

56
Q

Rads for plantar fasciitis

A

Not required
Plain films or MRI is not responding to conservative management

57
Q

Treatment of plantar fasciitis

A

NSAIDS, Ice, Light duty
OTC heel pads
Night splints may be helpful

58
Q

After 6-12 months of conservative management, what should be considered for plantar fasciitis

A

Surgical intervention

59
Q

Pt presents with:
“pump bump” irritated by shoe wear
Start up pain
Pain after activity
Antalgic gait

A

posterior heel pain

60
Q

Special tests for posterior heel pain

A

Thompson test

61
Q

Rads for posterior heel pain

A

Lateral radiographs of heel may show calcification of achilles tendon and spur formation

62
Q

Treatment of posterior heel pain

A

Light duty, Ice
Heel lift or open back shoes
Achilles stretch
Casting for 6 weeks in extreme cases

63
Q

What is turf toe

A

Hyperextension injury of first metatarsal

64
Q

Pt presents with:

Swelling, tendering and limited motion of first MP joint

A

turf toe

65
Q

What is a grade 1 turf toe

A

Injury of capsule, mild sx

66
Q

Rads for turf toe

A

Plain films
Bone scans or MRI can help exclude other possibilities

67
Q

Treatment of turf toe

A

RICE, NSAIDS
Stiff shoe inserts
Severe injury requires protective weight bearing or immobilization for 1-2 weeks and with 4-6week period of rest from sports

MSK (9 decks)

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