MSK leg, knee, ankle, and foot Flashcards
(26 cards)
What are red flags for a Fx?
- joint effusion and hemiarthrosis
- bruising, swelling
- throbbing pain
- TTP
- unwilling to WB
definition: a focal area of damage that involves both the cartilage and a piece of underlying bone
thinning of the cartilage –> bone damage
osteochondral defect
chondral defect: stripping of the cartilage from the bone
What is peripheral arterial occlusive disease?
The manifestation of atherosclerosis below the bifurcation of the abdominal aorta
What are the physical exam red flags for peripheral arterial occlusive disease?
- unilaterally cooler extremity
- wounds on feet
- prolonged capillary refill time ( > 2 seconds)
- decreased pulse below the occlusion
- prolonged vascular filling rate
- ABI < 0.9
bilateral cooler extremities if aorta is the site of the occlusion
Patient interview:
- > 55 y/o
- PMH T2DM and/or ischemic heart disease
- smoker
- sedentary
- co-occurring intermittent claudication
How do you calculate ABI?
highest systolic BP at the ankle / BP in arm
What are red flags for DVT?
- calf pain
- edema
- warmth
- TTP
- pallor
- loss of dorsallis pedis pulse
Interview red flags:
- recent surgery
- prolonged immobilization
- malignancy
- trauma
- pregnancy
What aggravates calf pain caused by DVT?
standing and walking
relieved by rest and elevation
What is the cause of compartment syndrome?
Abnormal rise in pressure resulting from swelling
What can compartment syndrome cause?
Vascular occlusion and/or nerve entrapment
What are red flags for compartment syndrome?
- severe and persistent leg pain (intensified with involved muscle stretch)
- swelling
- TTP and palpable tension of the involved compartment
- 5 “P”s
5 “P”s: Pain, palpable tenderness, paresthesia, paresis, pulselessness
Patient interview:
- PMH of blunt trauma or crush injury (acute compartment syndrome)
- recent participation in a rigorous, unaccustomed exercise or training activity (Chronic exercise induced compartment syndrome)
What are the 5 “P”s associated with compartment syndrome?
- Pain
- palpable tenderness
- paresthesia
- paresis
- pulselessness
What are red flags for septic arthritis?
- constant aching and/or throbbing pain
- joint swelling
- tenderness
- warmth
- possible elevated body temperature
Patient interview:
- PMH of recent infection, surgery, or injection
- coexisting immunosuppressive disorder
What is cellulitis?
Infection of tissue (Skin)
What are red flags for cellulitis?
- pain
- swelling
- warmth
- advancing marginal erythema/red streaks
Patient interview:
- PMH of recent skin ulceration or abrasion
- venous insufficiency
- CHF
- cirrhosis
- PMH of DM
definition: Unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings
Restless leg syndrome
“Wittmaack-Ekbom’s Syndrome”
What are s/s of restless leg syndrome?
- burning, creeping, tugging sensation in the legs (feels like insects)
Varies in severity
What aggravates restless leg syndrome?
Caffeine
decreased by walking and stretching
What causes restless leg syndrome?
DM and neuropathy
Treatment consists of management of these comorbidities along with possible use of opioids and anticonvulsants
What are the ottowa KNEE rules?
1(+) of the risk factor for further imaging/evaluation:
- < 12 y/o OR > 50 y/o
- fibular head tenderness
- isolated patellar tenderness
- inability to flex the knee 90 degrees
- inability to WB after surgery or during first visit
What is a segond Fx?
avulsion fx of the lateral tibial plateau
What is a maisonneuve Fx?
fractures of the proximal fibula and the complete rupture of the anterior inferior tibiofibular ligament
Commonly a spiral Fx
force travels up the interosseous membrane and then branches superior and laterally
What are the ottawa ANKLE rules?
1+ of the following findings:
- Bone tenderness at the posterior edge OR tip of the 6 cm of the LATERAL malleolus
- inability to WB immediately
What are the Ottawa FOOT rules?
1+ of the following findings:
- bone tenderness at the base of the 5th metatarsal
- bone tenderness at the navicular
- inability to WB immediately
What is a lisfranc injury?
Broken bones or torn ligaments at the lisfranc joint complex in the foot
1st and 2nd metatarsal articulating with the first two cuneiform bones
