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S6- MSK 2 > Week 6- Lower Leg Common Clinical Presentations > Flashcards

Week 6- Lower Leg Common Clinical Presentations Flashcards

1
Q

PART 1: COMMON CLINICAL PRESENTATIONS AND FRACTURE SCREENING

A

PART 1: COMMON CLINICAL PRESENTATIONS AND FRACTURE SCREENING

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2
Q

Lower Leg Common Clinical Presentations

A
  • Lower Leg Fractures
  • Structural Abnormalities
  • Hallux Rigidus
  • Ankle Sprains
  • Chronic Ankle Instability (CAI)
  • (Anterior) Ankle Impingement Syndrome
  • Achilles Tendon Tear/ Rupture
  • Plantar Fasciitis
  • Metatarsalgia
  • Interdigital Neuroma
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3
Q

What are the Ottawa Ankle Rules? (3)

A
  • Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
  • Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus
  • Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
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4
Q

What are the Ottawa Foot Rules? (3)

A
  • Bony tenderness at the base of 5th metatarsal
  • Bony tenderness at the navicular
  • Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
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5
Q

What are 2 other ways to screen for fracture, but are less accurate and useful?

A
  • Tuning Fork

- Ultrasound

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6
Q

-Tuning fork is better for identification of ________ fractures and less accurate for _______ fractures.

A
  • transverse

- stress

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7
Q

Ways to describe fractures.

A
  • Open vs. Closed
  • Anatomic site & extent
  • Type: complete vs. incomplete
  • Alignment of fragments
  • Direction of fracture lines
  • Special features
  • Associated abnormalities (dislocation, subluxation, soft tissue injury)
  • Special types (stress fracture, pathological fractures, bone graft fractures)
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8
Q

PART 2: FRACTURES

A

PART 2: FRACTURES

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9
Q

What are the (3) traumatic fracture areas in the lower leg?

A
  • Distal Tibia/Fibula
  • Hindfoot
  • Midfoot/Forefoot
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10
Q

Distal Tib-Fib Fractures:

  • What is a common MOI?
  • What are the (6) types of distal tib-fib fractures?
A

-Axial or rotational loading

  • Unimalleolar (medial OR lateral malleolus)
  • Bimalleolar (medial AND lateral malleolus)
  • Trimalleolar (Both malleoli AND posterior rim of tibia)
  • Tibia/Fibula shaft fracture
  • Comminuted fracture at distal tibia
  • Intra-articular fractures
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11
Q

Hindfoot Fractures:

-What are the (2) fractures of the hindfoot and their MOI?

A

Calcaneous Fx
-Common MOI: fall from height

Talus Fx (worse prognosis)
-Common MOI: forced ankle DF
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12
Q

Midfoot/Forefoot Fractures:

-What are the (3) common midfoot/forefoot fractures?

A
  • Navicular
  • Metatarsal
  • Phalangeal
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13
Q

Navicular Fractures:

  • Dorsal avulsion at _______ attachment.
  • Tuberosity/body fractures.
  • ______ fractures are common with insidious onset in WB athletes.
A
  • deltoid attachment

- Stress fractures

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14
Q

Metatarsal Fractures:

  • Common MOI?
  • What type of fracture is common at 2nd-4th mets?
  • What type of fracture is common at 5th met?
A
  • Common MOI: direct trauma
  • Spiral common at 2nd-4th
  • Avulsion at 5th (some stress)
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15
Q

Phalangeal Fractures:

-Common MOI?

A

-stubbing and direct trauma

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16
Q

List these fracture sites in order from most recommended time of immobilization to least:

  • Fibula
  • Toes
  • Metatarsal
A
  • Fibula (7-8 weeks)
  • Metatarsal (4-6 weeks)
  • Toes (3-4 weeks)
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17
Q

Pediatric Physeal Fractures:

List the first 5 types of pediatric physeal fractures and a way to remember them.

A
  • Type 1 (physis) = S (straight)
  • Type 2 (metaphysis/physis) = A (above)
  • Type 3 (epiphysis/physis) = L (lower)
  • Type 4 (epiphysis/metaphysis/physis) = T (through)
  • Type 5 (crush injury of physis) = R (rammed)

SALTR

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18
Q 
Pediatric Physeal Fractures:
Type VI (Rang’s):  involves \_\_\_\_\_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_\_\_ of physis
Types VII-IX (Ogden’s):  do not directly involve physis, though may disrupt \_\_\_\_\_\_\_\_\_\_\_\_\_\_
A
  • perichondral ring/periosteum

- blood supply

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19
Q

ORIF is common for types ___ and ___ physeal ankle fractures.

A

-Types 3 and 4

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20
Q

What are the prognostic factors for pediatric physeal fractures? (5)

A
  • Worse prognosis if >1 week prior to reduction.
  • Larger gap
  • Gap >/=3mm for type 1 and 2
  • Younger patients
  • Higher risk of physis arrest in types 3-5.
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21
Q
  • Types __ and __ physeal fractures are typically casted 4-6 weeks following reduction
  • Type __ and __ are in a long leg NWB cast weeks 1-4, and a boot from week 5-8.They are NWB first 2 weeks.
  • Type __ if recognized early, may be managed with removal of affected physis f/b fat graft.
A
  • Types 1 and 2
  • Types 3 and 4
  • Type 5
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22
Q

PART 3: STRUCTURAL ABNORMALITIES

A

PART 3: STRUCTURAL ABNORMALITIES

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23
Q

What are the lower leg structural abnormalities?

A
  • Talipes Equinovarus
  • Rearfoot varus
  • Rearfoot valgus
  • Forefoot varus
  • Forefoot valgus
  • Pes planus
  • Pes cavus
  • Hallux Valgus
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24
Q

Talipes Equinovarus:

  • “_________”
  • Does it affect males or females more?
  • What is it characterized by?
A
  • “clubfoot”
  • males > females
  • Characterized by plantarflexed heel, inversion STJ/varus rearfoot, metatarsal adduction/varus forefoot
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25
Q

Rearfoot Varus/Valgus:

  • Rearfoot varus: ________ of the calcaneus with the subtalar in neutral (limited ________)
  • Rearfoot valgus: ________ of the calcaneus with the subtalar in neutral (excessive _______ and limited ________)
A
  • Varus: Inversion of the calcaneus with neutral subtalar (limited pronation)
  • Valgus: Eversion of the calcaneus with neutral subtalar (excessive pronation and limited supination)
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26
Q

Forefoot Varus/Valgus:
-Forefoot varus: ________ of the forefoot on the hindfoot with the subtalar joint in a neutral position
Forefoot valgus: ________ of the forefoot on the hindfoot with the subtalar joint in a neutral position

A
  • -Varus: Inversion of the forefoot on the hindfoot with neutral subtalar
  • Valgus: Eversion of the forefoot on the hindfoot with neutral subtalar
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27
Q

Pes Planus/Cavus:

  • Pes planus: ______
  • Pes cavus: longitudinal arches accentuated
A

-flat foot

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28
Q

Hallux Valgus:

  • ______ deviation of 1st metatarsal and lateral deviation of great toe.
  • What are the gait implications of hallux valgus?
A
  • medial

- Collapse of the medial arch, navicular drop, position of pronation during push-off = less rigid foot

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29
Q

PART 4: HALLUX RIGIDUS

A

PART 4: HALLUX RIGIDUS

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30
Q

What is Hallux Rigidus?

A

-Arthropathy of the great toe characterized by pain, swelling, and abnormal bone growth at the dorsal aspect of the 1st MTP.

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31
Q

What is seen during Hx of someone with Hallux Rigidus?

A
  • Arthropathy
  • Trauma/injury to articular surface of distal metatarsal
  • Repetitive great toe extension
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32
Q

Hallux Rigidus Symptomology:

  • _________ onset, __________
  • 1st MTP pain, especially with what activities?
A
  • Insidious onset, progressive

- Great toe extension (walking up hill, stair ambulation, terminal stance

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33
Q

Hallux Rigidus Physical Examination:

  • Limited great toe ______ ROM at the MTP.
  • _______/_______/_______ to the dorsal 1st MTP.
A
  • extension

- Abrasion/swelling/tenderness

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34
Q

PART 5: ANKLE SPRAINS

A

PART 5: ANKLE SPRAINS

35
Q

Ankle Sprains:

  • Make up __% of ligament sprains.
  • ______ involved in 60-70% of ankle sprains.
A
  • 85%

- ATFL

36
Q

Ankle Inversion Sprain Hx:

  • Most common ___ decade.
  • Common ______ injury.
  • __x more likely to sustain a lateral ankle sprain after initial.
  • What is the MOI?
A
  • 3rd decade
  • running injury
  • 5x
  • MOI: forced ankle inversion
37
Q

Ankle Inversion Sprain Symptomology:

  • ______ ankle pain/swelling/warmth/redness.
  • Painful with activities that place the foot in ________.
A
  • lateral

- supination

38
Q 
Ankle Inversion Sprain Physical Exam:
-Antalgic gait
-Increased figure-8 measurement
-Local warmth/tenderness
-Pain with \_\_\_\_\_\_\_ ROM
What tests are positive with inversion ankle sprains?
A
  • inversion

- + Anterior Drawer (ATFL), Reverse Anteriolateral Drawer, Medial Talar Tilt Stress Test

39
Q

Medial Ankle Sprain:

  • Involves _______ ligament.
  • What is the MOI?
A
  • deltoid

- MOI: Forced ankle eversion

40
Q

Medial Ankle Sprain Symptomology:

  • _______ ankle pain/swelling/warmth/redness.
  • Painful with activities that place the foot in ________.
A
  • medial

- pronation

41
Q 
Medial Ankle Sprain Physical Exam:
--Antalgic gait
-Increased figure-8 measurement
-Local warmth/tenderness
-Pain with \_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_ ROM
What tests are positive with inversion ankle sprains?
A
  • pronation/eversion

- + Lateral Talar Tilt Stress Test

42
Q

Syndesmotic Ankle Sprain:

  • “___________”
  • Concern for _______ _______ and ________ ________.
A
  • “high ankle sprain”

- chronic instability and degenerative arthropathy

43
Q

Syndesmotic Ankle Sprain Hx:

-What are the common MOIs?

A
  • Forced DF
  • Forced eversion of talus
  • Forced ER of talus
44
Q

Syndesmotic Ankle Sprain Symptomology:

  • Pain in ______ lower leg
  • Aggravated with stair descent, walking up hill, and squatting.
A

-distal lower leg

45
Q

Syndesmotic Ankle Sprain Physical Exam:

  • Early ______ in stance phase.
  • Swelling/tenderness at ________ ______ joint.
  • Pain at end-range ___ ROM.
  • What tests are positive with syndesmotic ankle sprain?
A
  • heel-off
  • anterior tibiofibular joint
  • DF ROM
    • Fibular Translation, External Rotation, Syndesmotic Squeeze
46
Q

PART 6: CHRONIC (lateral) ANKLE INSTABILITY (CAI)

A

PART 6: CHRONIC (lateral) ANKLE INSTABILITY (CAI)

47
Q

CAI Hx:

  • Recurrent _______ sprains.
  • _______ muscle weakness.
  • Impaired _________.
A
  • Recurrent inversion sprains
  • Fibular muscle weakness
  • Impaired propioception
48
Q

CAI Symptomology:

  • Often ________ between sprains.
  • Feelings of ankle _________.
  • Ankle weakness
  • Difficulty/inability to run
A
  • asymptomatic

- “giving way”

49
Q

CAI Physical Examination:

-Diminished ________ function of ankle.

A

-proprioceptive function

50
Q

PART 7: (ANTERIOR) ANKLE IMPINGEMENT

A

PART 7: (ANTERIOR) ANKLE IMPINGEMENT

51
Q

What is anterior ankle impingement?

A

-Soft tissue or bony spur formation at the anterior talocrural joint.

52
Q

Anterior Ankle Impingement Hx:

-________/__________ ankle sprains

A

-recurrent/high trauma ankle sprains

53
Q

Anterior Ankle Impingement Symptomology:

  • _________ ankle pain/swelling/warmth/redness.
  • Painful with ____ ROM.
A
  • anterior

- DF ROM

54
Q

Anterior Ankle Impingement Physical Exam:

  • Antalgic gait/early heel-off
  • Tenderness/palpable mass anterior tibiotalar joint
  • Pain/limitation with end-range _____ ROM
  • What test is positive with anterior ankle impingement?
A
  • DF ROM

- + Forced DF Test

55
Q

PART 8: TENDINOPATHY

A

PART 8: TENDINOPATHY

56
Q

What are the 3 common muscles we see tendinopathy in at the ankle?

A
  • Fibular Longus/Brevis
  • Tibialis Posterior
  • Achilles
57
Q

Fib Longus/Brevis Tendinopathy Hx:

  • Repeated _________ injuries.
  • Anatomic abnormalities/anomalies.
A

-inversion injuries

58
Q

Fib Longus/Brevis Tendinopathy Symptomology:

  • Pain posterior to _____________.
  • __________ of fibularis tendons.
A
  • lateral malleolus

- Subluxation

59
Q

Fib Longus/Brevis Tendinopathy Physical Exam:

  • Swelling/bruising/tenerness _______ ankle.
  • Pain with resistive > AROM testing ankle _______.
  • Pain with end-range ______/_________.
A
  • lateral
  • eversion
  • inversion/supination
60
Q

Post Tib Tendinopathy Hx:

  • Insidious onset, progressive, typically _________.
  • Concomitant ________ ligament injury.
  • Participation in sports that require ____________.
A
  • unilateral
  • deltoid
  • quick directional change
61
Q

Post Tib Tendinopathy Symptomology:

  • Pain near area of insertion at ________.
  • Pain proximal to ___________.
A
  • navicular

- medal malleolus

62
Q

Post Tib Tendinopathy Physical Exam:

  • Pes ________ with ________ dropping.
  • Tenderness/swelling navicular and proximal to medial malleolus.
  • Painful with resisted _________/________.
  • Painful ________/_______ ROM.
A
  • Pes planus with navicular dropping
  • inversion/PF
  • eversion/DF
63
Q

Achilles Tendinopathy Hx:

  • Common MOI?
  • 5-18% of _______ injuries.
A
  • Common MOI: intense eccentric loading on triceps surae

- running injuries

64
Q

Achilles Tendinopathy Symptomology:

  • Pain near insertion of achilles tendon.
  • _______ stiffness.
A

-morning stiffness

65
Q

Achilles Tendinopathy Physical Exam:

  • Tenderness/ swelling/ hypertrophy/ palpable defect at achilles tendon.
  • Pain with _______ ROM
  • Pain with resisted > AROM ________
A

DF ROM

-resisted > AROM PF

66
Q

Achilles Tendon Rupture Hx:

  • Common MOI?
  • Sudden/acute onset with known mechanism, commonly audible “____” with subsequent difficulty walking and WB.
  • 2 things that put people at risk for rupture?
A
  • Sudden push off with extended knee, Sudden/forced DF
  • “pop”
  • achilles tendinopathy, middle-aged adult
67
Q

Achilles Tendon Rupture Symptomology:

-Pain near _________ of achilles tendon.

A

-insertion

68
Q

Achilles Tendon Rupture Physical Exam:

  • Tenderness/ swelling/ hypertrophy/ palpable defect Achilles tendon/ posterior calf.
  • Pain with ________ ROM.
  • Weak/ absent active/ resisted _____.
  • What test is positive with achilles rupture?
A
  • DF ROM
  • weak/absent PF
    • Thompson Test
69
Q

PART 9: PLANTAR FASCIITIS

A

PART 9: PLANTAR FASCIITIS

70
Q

Plantar Fasciitis lifetime prevalence = ___%.

71
Q

Plantar Fasciitis Hx:

-Risk factors include _______ and high _____ in non-athletic populations.

A

-limited DF ROM and high BMI

72
Q

Plantar Fasciitis Symptomology:

  • _____ ______ heel pain (worse with what?)
  • Pain with ___________.
A
  • Plantar medial heel pain (worse with first few steps after inactivity/prolonged WB.
  • Pain with terminal stance
73
Q

Plantar Fasciitis Physical Examination:

  • Early ____-___ in stance phase.
  • Guarding of ___________.
  • Sweling/tenderness origin of plantar fascia with potential ____ _____.
  • Pain with passive _____ of ankle and toes (windlass test).
A
  • heel-off
  • triceps-surae
  • potential heel spur
  • passive DF
74
Q

PART 10: METATARSALGIA

A

PART 10: METATARSALGIA

75
Q

What is metatarsalgia?

A

Pain in the distal forefoot, area of the met heads.

76
Q

Metatarsalgia Hx:

-Health conditions that increase stress on the ____ ______.

77
Q

Metatarsalgia Symptomology:

-Aggravated during prolonged ______ activities, _____ and _______ stance phases of gait.

A

-prolonged WB activities, mid and terminal stance phases of gait

78
Q

Metatarsalgia Physical Examination:

  • Findings for concomitant health conditions.
  • Antalgic gait/diminished push-off.
  • Observable ______ on plantar foot superficial to involved met heads.
  • Tender plantar met heads.
79
Q

PART 11: INTERDIGITAL NEUROMA

A

PART 11: INTERDIGITAL NEUROMA

80
Q

What is interdigital neuroma?

A

Thickening of soft tissue surrounding interdigital nerve.

81
Q

Interdigital Neuroma Hx:

-________ vs ______ onset

A

-insidious vs sudden

82
Q

Interdigital Neuroma Symptomology:

-Pain in area of met heads and corresponding ___ space.

A

-corresponding web space

83
Q

Interdigital Neuroma Physical Exam:

  • _______
  • What test is positive with interdigital neuroma?
A
  • Tenderness

- + Foot Squeeze

S6- MSK 2 (21 decks)

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