Skills Check 1 Flashcards
1
Q
Ottowa Ankle Rules
- Why do them?
- What are they?
A
-Clinical Prediction Rule to determine when to order ankle x-rays.
- If bone has tenderness at
1. Post edge or tip of lateral malleolus
2. Post edge or tip of medial malleolus
3. Base of 5th metatarsal
4. Navicular Bone
5. Cannot bear weight for 4 steps immediately after injury or during examination.
2
Q
Bernese Ankle Rules
-What are they?
A
- Indirect Fibular Stress: lateral malleolus is compressed ~10cm prox to fibular tip.
- Direct Medial Malleolar Stress: use them to apply pressure to medial malleolus avoiding tip.
- Compression of Midfoot on Hindfoot: longitudinal load applied through forefoot to compress! one hand fixes the calcaneus in neutral position, and the other hand applies a longitudinal load on the forefoot to compress midfoot and hindfoot.
3
Q
Figure 8 girth measurement
- What is it for?
- How is the patient positioned?
- How is the ankle positioned?
- Where is the tape measure placed? (5)
A
- determining effusion/edema
- Patient in supine or long-sitting.
- Ankle to be measured is placed in 20 degrees of plantarflexion with the rearfoot in neutral (neither everted nor inverted)
1. Start tape midway between ANT TIB tendon and LAT Malleolus
2. Tape taken medially and placed over navicular tuberosity
3. Tape placed across arch and behind the base of the 5th met
4. Tape placed around medial ankle below medial malleolus
5. Tape placed around lateral aspect of ankle just below lateral malleolus then back to starting point
4
Q
Anterior Drawer Test (Seated)
- What ligament is being assessed?
- How is the patient positioned?
- Why is the knee flexed?
- How is the test performed and how is the ankle positioned?
A
- Integrity of Anterior Talofibular Lig.
- Have patient sit over end of table with knee flexed to 90
- Knee flexion decreased influence of calf musculature
- Examiner places inside hand on lower leg proximal to malleoli. Outside hand maintains ankle in 10 platarflexion with forearm and moves the calcaneus in anterior direction.
5
Q
Anterior Drawer Test (Supine)
- What ligament is being assessed?
- How is the patient positioned?
- Why is the knee flexed?
- How is the test performed and how is the ankle positioned?
- What is a positive test?
A
- Integrity of Anterior Talofibular Lig.
- Have patient in supine with knee flexed to 90
- Knee flexion decreased influence of calf musculature
- Outside hand maintains ankle in 10 plantarflexion. Examiner places inside hand flipped over on lower leg proximal to malleoli and moves the tibia in posterior direction.
- Positive = talus glides out of mortise anteriorly and tibial glides away from talus posteriorly.
6
Q
Inversion Stress Test (Talar Tilt Test)
- What ligament is being assessed?
- How is the patient positioned?
- What is often done prior to the test?
- How is the test performed?
- What is a positive test?
A
- Calcaneofibular Lig.
- Supine
- Often done with patient under local anesthesia
- Inside hand inverts the calcaneus and outside hand palpates CF lig.
- If talar tilt is >15deg than non-involved side, strong indiciation that patient has a complete rupture of the ATF and CF
7
Q
Dorsiflesion-External Rotation Test (Keliger Test)
- What is being tested for?
- How is the patient positioned?
- How is the test performed?
- What is a positive test?
A
- Syndesmotic or High Ankle Sprain - Injury to Distal Tibiofibular Syndesmosis
- Supine
- Inside hand stabilizes the tibia. Outside hand grabs calcaneus and midfoot max dorsiflexes and externally rotates.
- Positive = pain provoked at anterolateral aspect of distal tibiofibular syndesmosis or movement observed when compared to uninjured side..
8
Q
Squeeze Test
- What is being tested for?
- How is the patient positioned?
- How is the test performed?
- What is a positive test?
A
- Syndesmotic or High Ankle Sprain - Injury to Distal Tibiofibular Syndesmosis
- Supine
- At midpoint of calf, use thenar eminences to squeeze or compress the fibula and tibia.
- Positive = pain provoked in distal tibiofibular syndesmosis.
9
Q
Crossed Leg Test
- What is being tested for?
- How is patient positioned?
- How is the test performed?
- What is a positive test?
A
- Syndesmotic or High Ankle Sprain - Injury to Distal Tibiofibular Syndesmosis
- Patient assumes a fig. 4 sitting position
- Involved mid-tibia rests just proximal to the knee. Patient applies downward stress on medial aspect of the involved side knee.
- Positive = reproduces the patient’s complaint in the area of the syndesmosis.
10
Q
Plantar Fasciitis
- How is the patient positioned?
- How is palpation performed?
- Where else can patients report pain?
A
- Supine
- Extend patients toes, palpate at the insertion of the medial band of the plantar fascia (anteromedial aspect of heel)
- Central band in midfoot region
- medial, lateral, and lower posterior aspect of calcaneus indicating fascial plane irritation
11
Q
Dorsiflexion-Eversion Test
- What is being tested for?
- How is patient positioned?
- How is the test performed?
- What is a positive test?
- What should be done if the no symptoms?
A
- Tarsal Tunnel Syndrome: entrapment of the Tibial Nerve and/or components
- Seated
- Evert and dorsiflex foot for at least 30 seconds and assess symptoms
- Tingling/burning
- Add Tinel’s sign (triangular tapping)
12
Q
Metatarsalgia
- What is done?
- What is looked for?
A
- Palpation of the metatarsal heads
- for pain as well as possible callus
13
Q
Dorsal and Plantar gliding of all five rays.
- How is the patient positioned?
- Which rays are glided?
A
- Supine
- 1st, 3rd, 4th, 5th.
14
Q
Thompson Test
- What is being assessed?
- How is the patient positioned?
- How is the test performed?
A
- To assess rupture of the Achilles tendon
- Prone
- Squeeze calf musculature together and observe foot for plantarflexion.
15
Q
Achillies tendon palpation
- Where do you want to palpate the tendon?
- What do you want to assess for?
- What else is assessed?
A
- Entire length of tendon
- Swelling and tenderness
- Retrocalcaneal and superficial calcaneal bursa
