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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
Rads for achilles tendon rupture
US if available MRI is gold standard
26
Treatment of achilles tendon rupture
Light duty, ice NSAID Achilles tendon support PT
27
Who should patients with achilles tendon ruptures be referred to
Ortho within 1-2 days
28
What is the most common ankle sprain
Inversion Lateral ankle sprain Involves ATFL only
29
Eversion ankle injury leads to which ankle sprain
Medial ankle sprain Syndesmosis injury
30
Eversion ankle injury with dorsiflexion results in which ankle sprain
High ankle sprain Disruption of interosseous membrane
31
How much more likely is someone to repeat an ankle injury
5x
32
Ottawa ankle rules
Posterior edge/tip of lateral malleolus Posterior edge/tip of medial malleolus Base of fifth metatarsal Navicular bone
33
Special tests for ankle sprains
Anterior drawer- ATFL talar tilt- CFL Tib/fib squeeze – Syndesmosis
34
Rads for ankle sprains
MRI for patients w/o relief after 6-8 weeks
35
Treatment of ankle sprains
RICE, NSAIDS, Light duty Pain free calf stretching and ankle strengthening Bracing as need (prolonged will lead to poor proprioception)
36
What injury can occur as a result from significant trauma or from indirect mechanism, may occur in athletics or as a result of tripping
Lisfranc fracture
37
What joint is affected in a Lisfranc fracture
Tarsometatarsal joint
38
Pt presents with: -Report of a sprain -Localized to dorsum of midfoot -Swelling may be mild
lisfranc fracture
39
Rads for Lisfranc fracture
AP radiograph shows second metatarsal has shifted laterally CT and MRI if still unsure
40
Treatment of Lisfranc fracture
Ortho consult Non displaced: 6-8weeks of non weight bearing cast immobilization Fractures or dislocations: require surgery Analgesics MEDEVAC
41
Bunions are more common in who
Females
42
Pt presents with: - Pain and swelling aggravated by foot wear - Great toe pronates
bunions
43
How is severity of a bunion graded
Measuring forefoot angles on weight bearing AP radiographs
44
What is normal hallux valgus angle and normal intermetatarsal angle
Hallux valgus: <15 IM: <10
45
Treatment of bunions
Education and shoe wear modification Light duty and ice Surgical correction if persistent pain
46
What is Morton Neuroma
Not a true neuroma but rather a perineural fibrosis of the common digital nerve as it passes between metatarsal heads
47
Which digits is Morton Neuroma common
3rd and 4th toes
48
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
Morton Neuroma
49
Special tests for Morton neuroma
Metatarsal squeeze
50
Rads for Morton neuroma
Not needed MRI and US if unclear
51
Treatment of Morton neuroma
Low heeled, soft soled shoe with wide toe box Metatarsal pads
52
What is a long fibrous band like tissue that arises from the medial tuberosity of calcaneus and extends to the proximal phalanges
Plantar fascia
53
What is the most common cause of heel pain in adults
Plantar fasciitis
54
Who is more prone to plantar fasciitis
2x as likely in women More common in overweight patients
55
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
plantar fasciitis
56
Rads for plantar fasciitis
Not required Plain films or MRI is not responding to conservative management
57
Treatment of plantar fasciitis
NSAIDS, Ice, Light duty OTC heel pads Night splints may be helpful
58
After 6-12 months of conservative management, what should be considered for plantar fasciitis
Surgical intervention
59
Pt presents with: “pump bump” irritated by shoe wear Start up pain Pain after activity Antalgic gait
posterior heel pain
60
Special tests for posterior heel pain
Thompson test
61
Rads for posterior heel pain
Lateral radiographs of heel may show calcification of achilles tendon and spur formation
62
Treatment of posterior heel pain
Light duty, Ice Heel lift or open back shoes Achilles stretch Casting for 6 weeks in extreme cases
63
What is turf toe
Hyperextension injury of first metatarsal
64
Pt presents with: Swelling, tendering and limited motion of first MP joint
turf toe
65
What is a grade 1 turf toe
Injury of capsule, mild sx
66
Rads for turf toe
Plain films Bone scans or MRI can help exclude other possibilities
67
Treatment of turf toe
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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