Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK Redemption Arc > Lower Leg MDT > Flashcards

Lower Leg MDT Flashcards

1
Q

The following describes what injury:
- Formerly known as medial tibial stress syndrome
- Thought to be secondary to a reaction of the periosteum in response to increased stress, as seen in runners
- Must be differentiated from a tibial stress fracture

A

Shin Splints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pt presents with:
- Gradual onset of pain with prolonged walking or running activity
- Pain is localized to the distal third of the medial tibia
- Patient may have increased training intensity, pace or distance

A

Shin splints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pt PE:
- Tenderness along posterior medial crest of tibia in the middle to distal third of the leg
- Pain with resisted plantar flexion
- possible pes planus

A

Shin splints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you differentiate between shin splints and stress fracture

A

Plain film radiographs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment of Shin splints

A
  • NSAIDS
  • Ice
  • Light Duty-Activity modification
  • Gradual pain free return to running
  • Weight lose if needed
  • Proper running shoes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What sx differentiates shin splints from tibial stress fracture?

A

Pain at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of Tibial Stress Fracture

A
  • Rest/duty modification
  • Weight bearing modification and training
  • NSAID/Tylenol/ice for pain
  • Expect duty modification for roughly 12 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What divides muscles of the lower leg into 4 compartments?

A

Fibrous septa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The following describes what injury:
- elevation of intra-compartmental pressure to a degree that compromises blood flow to the involved muscles and nerves
- can be acute resulting from crushing injury, muscle strains or closed fracture
- Inflammation raises pressure in the compartment

A

Compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

Compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The 7 P’s of compartment syndrome

A

Pain
Pallor
Parasthesias
Paresis
Poikilothermia
Pressure
Pulselessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What of the 7 P’s is the most common indicator of compartment syndrome?

A

Pain and parasthesias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pt PE:
- Tense shiny skin that may be pale
- Tenderness, tense compartment and possible coolness to affected compartment
- Increased pain with passive stretching of muscle in the involved compartment
- Muscle weakness to muscles that are in or run through involved compartment
- Decreased sensation and pulses in and distal to involved compartment

A

Compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of Acute compartment syndrome

A
  • MEDEVAC
  • requires fasciotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How should patient with acute compartment syndrome be prepped for transport

A
  • Remove any tight fitting items around the extremity
    Including splints, dressings, etc
  • Place limb in neutral position
  • Not elevated or lowered
  • Analgesics and supplemental oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of chronic exertional compartment syndrome

A
  • rest from aggravating activities
  • Rest
  • NSAIDS
  • May require surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is contraindicated for CECS because of its constricting properties?

A

Ice is considered contraindicated because of it’s constricting properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The following are a risk for what injury:
- Athletes
- Age (30-40 year olds)
- Male gender
- Obesity
- Running mechanics issues
- Misalignment, footwear, leg length discrepancy
- Fluoroquinolone antibiotic use associated
- Rheumatologic diseases

A

Achilles tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pt presents with:
- Sensation of being struck violently in back of ankle
- Possible “pop” followed by acute onset of pain
- Pain is not always felt in rupture
- Reports of up to 1/3 of patients are pain free at time of rupture

A

Achilles Tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What position should a patient with Achilles tendon rupture be examined in?

A

prone position, feet hanging off end of table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pt PE:
- Ecchymosis, edema, foot malalignment
- Possible impaired plantarflexion
- Positive thompson test

A

Achilles tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What special test will be positive for achilles tendon rupture

A

Thompson test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the gold standard imaging for achilles tendon rupture

A

MRI
Can use US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pitfalls in missing Achilles tendon rupture

A
  • Patient able to plantar flex their foot
  • Patient is able to walk
  • Tendon is not painful
  • Examiner cannot palpate a defect in the Achilles tendon
25
Q

Treatment of Achilles Tendon Rupture

A
  • Light duty
  • Ice
  • NSAID
  • Consider Achilles tendon support
    Heel lift
    Elastic bandage
    Taping
    -Physical Therapy
    If available will give exercises and provide support as above
26
Q

The following describes what injury:
- Injury to these joints can occur as a result of significant trauma or from an indirect mechanism, as may occur in athletics or as a result of tripping
- The critical injury involves the second tarsometatarsal joint

A

Lisfranc Fracture

27
Q

Pt presents with:
- Patients often report a sprain
- Pain is localized to the dorsum of the midfoot
- The swelling may be relatively mild

A

Lisfranc fracture

28
Q

Pt PE:
- Ecchymosis in the plantar arch
- Edema in the tarsometatarsal joint
- Maximum tenderness and swelling over the tarsometatarsal joint rather than the ankle ligaments
- Pain to the tarsometatarsal region with all resisted ankle motions

A

Lisfranc fracture

29
Q

How do you confirm a Lisfranc fracture

A

Plain film radiographs
CT or MRI if unclear

30
Q

Treatment of Lisfranc fracture

A
  • MEDEVAC
  • Orthopedic consult
  • Nondisplaced injuries are treated with 6-8 weeks of non weight bearing cast immobilization
  • Fractures or dislocations that are displaced require surgery
  • Non-weight bearing (NWTB)
  • Analgesics
31
Q

What is the most common ankle sprain

A

Inversion injury

32
Q

Majority of ankle sprains involve which ligament only?

A

Anterior talofibular ligament (ATFL

33
Q

Stronger force ankle sprain can also damage which ligament?

A

Calcaneofibular ligament (CFL)

34
Q

What is a less common ankle sprain

A

Eversion

35
Q

Eversion with dorsiflexion injury leads to what kind of ankle sprain?

A

High ankle sprain

36
Q

Ottawa ankle rules

A
  • Posterior edge/tip of lateral malleolus
  • Posterior edge/tip of medial malleolus
  • Base of fifth metatarsal
  • Navicular bone
37
Q

Treatment of ankle sprain

A
  • RICE
  • NSAIDS
  • Light Duty-activity modification
  • Pain free calf stretching and ankle strengthening
  • Bracing as needed
    Prolonged bracing will lead to poor proprioception
38
Q

The following describes what injury:
- lateral deviation of the great toe at the MTP Joint
- Much more common in females (10:1)

A

Bunion (hallux valgus)

39
Q

Pt presents with:
- Pain and swelling, aggravated by shoe wear, are the principal complaints
- The Great toe pronates with resulting callus on the medial aspect

A

Bunion

40
Q

Pt PE:
- Valgus stress at the MTP with hypertrophic changes over joint
- A hypertrophic bursa is evident over the medial eminence of the first metatarsal
- The great toe is pronated (rotated inward) with subsequent callus on its medial aspect
- Tenderness over the joint
- MTP valgus greater than 15 degrees
- Numbness or tingling over the medial aspect of the great toe can result

A

Bunion

41
Q

Normal hallux valgus angle and normal intermetatarsal angle

A

hallux valgus: <15 degrees
intermetatarsal angle: <10 degrees

42
Q

Treatment of Bunion

A
  • The initial treatment is patient education and shoe wear modifications
  • Shoes should have adequate width at the forefront and should be constructed of soft uppers, with no thick stitching over the medial eminence
  • An orthotist or a shoe repair professional can stretch the shoe directly over the bunion
  • High heels place undue pressure on the forefoot and bunion prominence and should be avoided
  • Light Duty
  • Ice
43
Q

If bunion conservative treatment fails, what should be done

A

Surgical correction

44
Q

The following describes what injury:
- not a true neuroma but rather a perineural fibrosis of the common digital nerve as it passes between the metatarsal heads
- The condition is most common between the third and fourth toes (third web space)
- Less common between other digits

A

Morton Neuroma

45
Q

Pt presents with:
- Plantar pain in the forefoot is the most common presenting symptom
- Dysesthesias into the affected two toes or burning plantar pain that is aggravated by activity is common
- Occasionally, patients report numbness in the adjacent toes of the involved web space
- Night pain is rare
- Many patients state that they feel as though they are “walking on a marble” or that there is “a wrinkle in my socks”
- Removing the shoe and rubbing the ball of the foot often obtain relief
- Wearing high-heeled or tight, restrictive shoes aggravate symptoms

A

Morton Neuroma

46
Q

Pt PE:
- Isolated pain on the plantar aspect of the web space is consistent with an intermetatarsal neuroma
- Possible decreased sensation of the digital nerve

A

Morton Neuroma

47
Q

What special test will be positive for morton neuroma

A

Positive metatarsal squeeze test

48
Q

Treatment of Morton Neuroma

A
  • Patients should be advised to wear a low-heeled, soft-soled shoe with a wide toe box
  • Metatarsal pads
  • Takes pressure off of the metatarsal heads
49
Q

The following describes what injury:
- Most common cause of heal pain in adults
- Due to degeneration of the plantar fascia
- Occurs twice as much is woman as in men
- More common in over weight patients

A

Plantar Fasciitis

50
Q

Pt presents with:
- The pain is often most severe on awakening or when rising from a resting position because the first few steps stretch the plantar fascia
- Prolonged standing and walking also increases the pain; sitting typically relieves symptoms
- Focal Pain directly over the medial calcaneal tuberosity and 1-2 cm distally along the plantar fascia

A

Plantar Fasciitis

51
Q

Pt PE:
- TTP directly over the plantar medial calcaneal tuberosity and 1 to 2 cm distally along the plantar fascia
- Use heavy palpation while dorsiflexing toes with other hand

A

Plantar Fasciitis

52
Q

Treatment of Plantar Fasciitis

A

’- NSAIDS
- Ice massage
- Light duty to include activity modification
- OTC heel pads
- Night splints may be helpful

53
Q

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

A

Posterior heel pain

54
Q

Pt PE:
- Calcaneal prominence may be present with associated edema
- Superficial bursa may be present (pump bump)
- Tenderness may be noted over the heel or directly on the Achilles tendon
- Dorsiflexion may be limited by pain

A

Posterior heel pain

55
Q

Treatment of Posterior Heel Pain

A
  • Light duty- activity modification
  • Heel lift or open back shoes
  • Ice massage
  • Achilles stretch
  • Casting for 6 weeks in extreme cases
56
Q

The following describes what injury:
- Hyperextension injury of the first metatarsal
- Coined because of the increased incidence of hyperextension injury associated with playing on artificial turf

A

Turf Toe

57
Q

Pt presents with:
- Patients usually report swelling, tenderness, and limited motion of the first MP joint
- A grade 1 sprain is a stretch injury of the capsule
- Athlete usually able to participate in sports with mild symptoms
- Other more severe injuries may result in edema of the first MTP joint

A

Turf Toe

58
Q

Pt PE:
- Edema and ecchymosis with more severe injuries
- Antalgic gait
- Tenderness over the MTP
- Passive flexion and extension of the great toe is painful

A

Turf Toe

59
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 4-6 week period of rest from sports

MSK Redemption Arc (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions