Practical 1 Disorders Flashcards
1
Q
lower ankle sprain grade 1
A
- ATFL
- slight and local edema and ecchymosis
- FWB or PWB
- stretched ligament
- no instability
2
Q
lower ankle sprain grade 2
A
- ATFL and CFL
- moderate and local edema and ecchymosis
- difficult to WB without crutches
- partial tear
- none or slight instability
3
Q
lower ankle sprain grade 3
A
- ATFL, CFL, and PTFL
- significant and diffuse edema and ecchymosis
- impossible to WB without significant pain
- complete tear
- definite instability
4
Q
high ankle sprain MOI
A
- extreme ER or DF of the talus
5
Q
medial ankle sprain MOI
A
- excessive eversion an DF
- injury to the deltoid ligament
6
Q
posterior tibial tendon dysfunction subjective findings
A
- Insidious onset of pain, with pain felt in one of 3 locations:
- Distal to the medial malleolus in the area of navicular
- Proximal to the medial malleolus
- At the musculotendinous origin (medial shin splints), or insertion
- Swelling on the medial aspect of the ankle
7
Q
posterior tibial tendon dysfunction objective findings
A
- Swelling and tenderness posterior and inferior to the med. Malleolus, along the course of the post. Tib tendon, and to its insertion into the navicular
- Medial arch is decreased or completely flattened
- Heel shows increased valgus
- Pain on resisted ankle PF and inversion
8
Q
plantar fasciitis subjective findings
A
- Hx of pain and tenderness on the plantar medial aspect of the heel, especially during initial wt. bearing in the morning or after a prolonged period of nonweight bearing
- Pain usually worsens with activity: jogging, climbing stairs)
9
Q
plantar fasciitis objective findings
A
- Localized pain on palpation along the medial edge of the fascia or at the origin on the anterior edge of the calcaneus
- Note: firm pressure is often necessary to localize point of maximum tenderness
10
Q
heel pain causes
A
- obesity
- excessive walking/ sporting activity
- tight plantar fascia
- flattening of the arch
11
Q
achilles tendinitis subjective findings
A
- Gradual onset of pain and swelling in the Achilles tendon 2 to 3 cm. proximal to the insertion of the tendon
- Exacerbated by activity
- Some patients will present with pain and stiffness along the Achilles tendon when rising in the morning or pain at the start of activity that improves as activity progresses
12
Q
achilles tendonitis objective findings
A
- Tenderness & warmth to palpation along tendon
- Decreased active and passive DF
- Gait may include: antalgia, premature heel off, leg may be held in ER
13
Q
achilles tendon rupture MOI
A
- loading on a dorsiflexed ankle with the knee extended or repeated microtrauma
14
Q
achilles tendon rupture subjective findings
A
- feels like being kicked in the leg or shot in the leg
15
Q
ACL tear subjective findings
A
- most are non contact
- Sensation of their knee “popping” or “giving out” as the tibia subluxes anteriorly
- Pain & Immediate dysfunction
- Instability in the involved knee and the inability to walk without assistance
- Immediate swelling (acute hemarthorsis)
16
Q
ACL tear MOI
A
twisting or hyperextension of the knee
17
Q
ACL tear objective findings
A
- Pain
- Positive special tests for anterior stability
- Involvement of other knee structures (med. Meniscus, MCL)
18
Q
ACL tear diagnostic tests
A
- anterior drawer
- lachman’s: most sensitive
- pivot shift
19
Q
MCL sprain subjective findings
A
- Immediate pain over medial knee
- Worse with flexion/extension of knee
- Pain may be constant or present with movement only
- Knee feels ‘unstable’
- Soft tissue swelling, bruising
20
Q
MCL sprain grade 1 objective findings
A
- local tendernesson the medial femoral condyle or medial tibial plateau, with minimal swelling
- pain but no laxity on valgus stress testing at 30 degrees knee flexion
21
Q
MCL sprain grade 2 objective findings
A
- marked tenderness over the MCL
- mild to moderate swelling and pain
- laxity on valgus stress testing (The knee should be stable at full extension, with laxity only present at 30 degrees flexion
22
Q
MCL sprain grade 3 objective findings
A
- Tenderness over the MCL
- Severe laxity on valgus stress testing without a distinct end-feel
- Usually laxity at full extension, indicating damage to the deeper, capsular fibers of the MCL
- May beminimal pain on testing, due to rupture of nociceptive fibers
- Rarely an associated medial mensicus injury, insteadlateral meniscus is more involved due to the mechanism of injury,compressing and shearing the lateral compartmentwhile opening the medial compartment
23
Q
meniscal tear MOI
A
- patient attempts to turn, twist or change direction when weightbearing
- can occur from contact to the lateral or medial aspect of the knee
24
Q
meniscal tear subjective findings
A
- Reports of significant twisting injury to the knee, although older patients with degenerative tears may have a Hx of minimal or no trauma
- Hx of popping, swelling, or clicking
- Pain along the joint line, particularly with twisting or squatting activities
25
Q
meniscal tear objective findings
A
- Tenderness over the medial or lateral joint line
Some degree of effusion - Forced flexion and circumduction (internal and external rotation of the foot) frequently elicit pain on the side of the knee with the meniscal tear
26
Q
meniscal tear diagnostic tests
A
- Mcmurray
- Apley’s
- Steinmann I Sign
27
Q
patellofemoral pain syndrome
A
- anterior or retropatellar knee pain associated with prolonged sitting or with wt-bearing activities that load the PF joint (squatting, kneeling, running, and ascending/descending stairs)
28
Q
patellofemoral pain syndrome subjective findings
A
- Reports of anterior knee pain with going up or down stairs or hills; instability of patella with activities
- Usually no Hx of trauma and swelling is uncommon
- More common in female than male patients
They will say it feels swollen
29
Q
patellofemoral pain syndrome diagnostic testing
A
- Clarke’s sign/patellar grind/patella tracking with compression
- apprehension test
30
Q
patellofemoral pain syndrome objective findings
A
- May see valgus alignment of knees, femoral anteversion (increased IR compared with ER), and abnormal tracking
- Quadriceps weakness
- Generalized laxity of the patellofemoral ligaments
- Hip weakness
- Poor eccentric quad control in weight-bearing
31
Q
hamstring strain subjective findings
A
- distinct mechanism of injury with immediate pain during full stride running or while decelerating quickly
- may hear a “pop”
- posterior thigh pain, worsened with knee flexion
32
Q
hamstring strain objective findings
A
- tenderness reported with passive stretching of the hamstrings
- tender to palpation
- pain with resisted knee flexion (IR/ER to isolate)
33
Q
CAM impingement provocative tests
A
FADIR
- hip flexion
- hip adduction
- hip IR
34
Q
CAM impingement
A
- Aspherical femoral head
- Bony prominence at anterolateral head-neck junction
- Impinges on the rim of labrum
- Leads to superior OA
- Young athletic males
35
Q
pincer impingement
A
- Over-coverage of femoral head by the acetabulum
- Acetabulum impinges on the neck of the femur
Lead to posterior-inferior or central OA - Middle aged females
36
Q
pincer impingement provocative test
A
- hip extension
- hip ER
37
Q
FAI symptoms
A
- When symptoms develop, it usually indicates that there is damage to the cartilage or labrum and the disease is likely to progress. Pain experienced in the anterior groin area
- The C sign
- Described as dull and aching
- Pain is worse with prolonged sitting
- Occasional sharp catching pain with activity
- Increase symptoms with hip flexion, adduction, and internal rotation.
- May limp
38
Q
adductor strain diagnosis
A
- pain with passive hip abduction
- pain with palpation
- weak adductor squeeze test
39
Q
hamstring strain grade 1 intervention
A
continue activities as much as possible
40
Q
hamstring strain grade 2 intervention
A
5-21 days of rehab
41
Q
hamstring strain grade 3 intervention
A
3-12 weeks of rehab
42
Q
biomechanical factors associated with hamstring strain
A
anterior pelvic tilt
43
Q
piriformis syndrome MOI
A
- insidious onset due to compression of sciatic nerve
- muscle tightness + long bouts of sitting
44
Q
piriformis syndrome symptoms
A
- pain in butt or hips that can extend down the thigh
- tingling + numbness
- difficulty sitting for long periods
- reduced ROM
