Spine/LE Flashcards
Arteries in the leg
Femoral artery
popliteal artery
dorsalis pedis
posterior tibial
Venous system in the leg
Superficial: Great and small saphenous veins
Deep: femoral vein
Communicating or perforating veins
PVD Arterial ulcers
intermittent claudication pain, NO EDEMA, NO PULSE/WEEK PULSE, NO DRAINAGE round/smooth sores, black eschar;
Location: toes and foot
PVD Venous ulcers
dull achy pain lower leg EDEMA pulse present, drainage sores w/ irregular borders Yellow slough or Ruddy skin
Location: ankles
Signs of PVD
dangling foot makes pain better, elevating feet makes it works
Tx for PVD
antiplatelets, surgical (Fempop bypass)
Peripheral Artery Insufficiency sigsn
pallor, rubor, distal hair loss, atrophic skin/nail changes, Ulcers, Necrosis; check pulses, skin = cool, cap refill delayed; auscultate for bruits (aorta, femora, popliteal)
Venous insufficiency
dilated, tortous superficial veins due to defective structure and function of valves
Clinical presentation of venous insufficiency
dull achy/pressure after prolong standing; relieved with elevation
dependent ankle edema and ulcerations
superficial thrombosis/thromophlebitis
Stasis Dermatitis
Due to chronic venous insufficiency with incompetent valves and higher pressure in capillary bed; tissue is damaged and inflamed;
BRAWNY EDEMA: non-pitting
Brawny-edema
non-pitting edema found with Stasis Dermatitis
Lymphadema
lymph obstruction causing severe usually one sided swelling
Gangrene
necrosis/black
Principles of leg exam
inspection palpation ROM Neuro (motor) Vascular Specialized
Type of joint is the hip joint
Ball & Socket
Landmarks to palpate on the hip
ASIS
Greater Trochanter
Quads, Hamstrings Femur
Trendelenburg Test
Stand on one leg; hip drop means weak hip abductors on the contralateral side
FADIR
Adduction with internal rotation of the hit; tests for hip joint
FABER
abduction, external rotation (figure 4, patricks test); test for ipsilateral hip problem or contralateral SI joint issue
Knee palpation
Quad tendon Patella Patellar tendon Medial & Later joint lines Tibial Tuberosity Popliteal fossa/pulse
Palpation of Lower leg
tibia/fibula musculature calf tenderness swelling achilles tendon
Palpable cord
Thrombosed vein
Genus Varum
Bow-legged, knees more lateral, may have waddling gait
Genu Valgum
Knock-kneed/pigeon toed; knees more medial
Baker’s cyst
synovial fluid cyst located in the popliteal space; palpable as fluctuant fullness; may be painful or result in calf swelling if they leak fluid or rupture; extend knee to palpate a baker’s cyst
Popliteal aneurysm
due to atheroclerotic vascular disease; M>F, >65 YO; more common aneurysm of peripheral vascular; bilateral 50% of time
Dx of popliteal aneurysm
Pulsatile swelling behind the knee
Bulge Sign
With leg straight, place pressure over suprapatellar pouch while “milking” knee joint fluid down one side and up the other to observe a pulge; looks for presence of minor effusion
Ballottement
Compress suprapatellar pouch and sharply push patella against femur; feel for fluid under the patella and observe for fluid returning to the suprapatellar pouch; Test for LARGE EFFUSION
Valgus stress test
MCL
stabilize lateral joint line and place one hand on distal tibia; ABduct tibia vs. femur, restricting axial rotation; complete at 0 and 30 degrees of flexion; estimate medial joint space and evaluate sitffness of endpoint to determine amount of laxity
Varus stress test
LCL
stabilize medial joint like; ADduct tiba vs. femur; estimate for laxity
Anterior Drawer
ACL; stabilize foot (sit on it), thumbs on medial and lateral joint line with fingers on hamstring insertion; pull tibia foreward checking for excessive movement (+) anterior translation without firm endpoint
Posterior Drawer Sign
PCL
push tibia pack; excessive laxity suggests PCL tear
Lachman
ACL
patient supine, knee flexed 20-30 degrees; stabilized distal femur in one hand while attempting to displace tibia anteriorly with the other; most useful test for ACL; aymmetry compared to other leg and soft endpoint = ACL tear
Posterior Sag sign
PCL;
back of legs sagging compared to other; anterior tibial surace normally lies 1 cm anterior to the femoral surface; check in both extension and 90 degree flexion with both internal and external rotation
ACL tests
Anterior drawer, Lachman
McMurray test
Meniscus
Medial meniscus: flex knee, externally rotate at heel, flex maximally, then slowly extend the knee while providing valgus stress to knee
Lateral: internally rotate at heel, flex maximally, then slowly extend the knee while providing (varus) stress to knee
Ankle joint
weight bearing joint absorbs impact of gait Hinge joint (tibiotalar, subtalar (talocalcaneal)
Foot joints
Tarsal/metatarsal joint
PIP/DIP joint
Pes planus
flat foot; loss of foot arch
Pes Cavus
High arch
Neuropathic Ulcers
Diabetic Neuropathy
Palpation of foot and ankle
Achilles tendon medial and lateral malleoli calcaneus metatarsal MTP and IP joints
Where to check for pitting/non-pitting edema
Dorsum of foot, behind medial malleolus or on shins
Grading of pitting edema
0-4+
Foot pulses
Doralis pedis: lateral to tendon on first digit
Posterior tibial pulse: behind the MEDIAL malleolus
Pulse grading
0- absent, unable to palpate 1+- diminished, weaker than expected 2+- brisk, normal 3+- increased 4+- bounding
Anterior drawer test for ankle
Grasp calcaneus and pull forward; looking for sprain
Thompson Test
have patient knee and squeeze calf; foot should plantar flex if normal; will be (-) in injury to achilles tendon
Spine vertebrae #’s
7 Servical 12 Thoracic 5 Lumbar 5 Sacrum (fused) 4 Coccyx (fused)
Inspection of spine
posture, head erect, shoulders and pelvis level;
spinal curvature
Palpation of spine
spinous processes
paravertebral mm. (tenderness/spasm)
ROM for spine
flexion/extension
lateral bending (suitcase)
rotation (look over shoulder)
Scoliosis
lateral curvature of the spine
Kypohsis
Increased outer curvature of spine leading to hunchback
Lordosis
excessive inward curve of spine
Testing for LLD
Galeazzi
Compare medial malleolus
Straight leg raising test (SLR)
tests lumbosacral radiculopathy and/or sciatic neuropathy (L5-S1);
Passive ROM while supine with knees extended; dorsiflex ankle may further reproduce pain
(+): radiating pain in affected limb (note degree of elevation) (aka Laseque’s test)
Another name for SLR
Lasegue’s Test (Sign)
Seated SLR Test/Flip sign
patient seated, passively extend knee
(+) Patient will “flip back” due to pain
L4 radiculopathy
Pain: later thigh, anterior leg
Numbness: medial joint line
Weakness: extension of quads
Reflexes: knee diminished
L5 Radiculopathy
Pain: buttocks, lateral thigh/leg
Numbness: lateral calf
Weakness: dorsiflexion of great too and foot
**heel walking test
S1 radiculopathy
Pain: posterior butt/leg
Numbness: posterior calf, plantar surface of the foot
Weakness: plantar flexion of great toe/foot
***walk on toes test
Reflex: ankle jerk diminished
