H & P > Lower extremity > Flashcards

Lower extremity Flashcards

(118 cards)

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1
Q

ROM of spine

A
  1. Flexion
  2. Extension
  3. Lateral bending
  4. Rotation (seated position)
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2
Q

Dextroscoliosis

A

Curve is convex (toward) the right

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3
Q

Levoscoliosis

A

Curve is convex (toward) the left

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4
Q

Straight leg raise (SLR)

A
  • Tests for impingement of spinal nn/ sciatic n
  • Elevate leg, dorsiflex foot
  • Pain into ipsilateral leg = + = lumbosacral radiculopathy
  • Pain in contralateral leg = + crossed SLR
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5
Q

Seated SLR

A
  • Pt has hands on table
  • Extend leg
  • Watch for pt to “flip back”
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6
Q

FAbEr test

A
  • F = flexion, A = abduction, E = external rotation
  • Supine figure 4
  • Checks SI joint dysfunction
  • Checks adductors
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7
Q

Slump test

A
  • Seated
  • Slump
  • Tuck chin
  • Knee extension
  • Dorsiflexion
  • Checks sciatica or a herniated disc
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8
Q

Antalgic gait

A
  • Limp adopted to avoid pain on weight-bearing structures
  • Short stance phase
  • Trendelenburg lurch
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9
Q

Trendelenburg sign

A
  • Identifies weak hip abductor on side that is bearing weight
  • If contralateral hip drops = +
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10
Q

Hip scour test

A
  • Acetabular labrum

- Apply axial load to femur as you rotate hip internally & externally

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11
Q

Ober’s test

A
  • IT band
  • Tibial IR & hip ABD & extension
  • Then lower leg to table
  • If leg will not lower = +
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12
Q

Noble’s test

A
  • IT band
  • Pt supine, palpate IT band & passively flex & extend knee
  • subjective test for pain
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13
Q

Thomas test

A
  • Iliopsoas (B)
  • If femur raises off table = +
    OR
  • Rectus femoris (A)
  • Unable to have 90˚ flexion of knee = +
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14
Q

Ottawa knee rules

A
  • 55 or older
  • Isolated tenderness at patella
  • Tenderness at fibular head
  • Unable to flex knee to 90
  • Unable to bear weight immediately after & ER for 4 steps
  • If any above are + = X-ray needed
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15
Q

Baker’s cyst

A
  • Synovial fluid cyst in popliteal region
  • Palpable as fluctuant fullness
  • May be painful (can leak –> calf swelling)
  • Best to palpate w/ knee extended
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16
Q

Popliteal artery aneurysm

A
  • Due to atherosclerotic vascular disease
  • Male > female
  • Usually > 65yo
  • Bilateral >50%
  • Best to palpate w/ knee extended
  • Most common aneurysm of peripheral vascular system
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17
Q

Popliteal artery aneurysm dx

A

Pulsatile swelling behind knee

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18
Q

Meniscal tears s/s & tx

A
  • Pain/swelling at joint line
  • Max swelling is seen day after injury
  • May report popping, clicking, locking
  • “Feel like knee is going to give out”
  • Surgery (repair or menisectomy)
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19
Q

Meniscal tear MOI

A

Weight bearing w/ rotation

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20
Q

Patellar dislocations MOI

A
  • Knee flexed btwn 20-45˚ w/ valgus load
  • Then max contraction of quads
  • Will almost always go laterally
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21
Q

Patellar fractures MOI

A
  • Direct blow/force

- Extremely painful (unable to SLR)

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22
Q

Chondromalacia patellae

A
  • Degenerative process –> softening of articular surface of patella
  • More frequent in women
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23
Q

Chondromalacia patellae MOI

A
  • Overuse w/ poor tracking

- Large Q-angle

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24
Q

Q-angle

A
  • Women have greater Q-angles

- Normal = <15˚

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25
Patellar tendonitis MOI
- "Jumper's knee" | - Overuse w/ heavy quad loads & poor quad flex
26
Patellar tendonitis s/s
- Increased pain w/ activity - Increased pain w/ resisted knee extension - Aches after exercise - Swelling - Tenderness at inferior pole * Risk of tendon rupture
27
MCL sprains MOI
- Most frequently injured ligament in knee | - Blow to lateral side of knee forcing valgus
28
MCL s/s
- Pain - Mild to moderate swelling exterior to joint - Discoloration - Point tenderness along length - Valgus instability - May feel "pop"
29
LCL sprains MOI
Foot planted, medial side impact/varus force
30
LCL s/s
- Pain - Lateral knee swelling - Ecchymosis - Point tenderness over length of LCL - Varus instability - May feel "pop" w/ complete rupture
31
ACL sprain MOI
Twisting maneuver during weight bearing - Hyperextension - Rotation w/ change of direction - Jump stop w/ weight posterior
32
ACL fxn
Stops anterior translation of tibia on femur
33
ACL sprain s/s
- Immediate pain & feeling of instability - Audible "pop" - Joint effusion & loss of motion within 24hrs - Unwilling to bear weight - Sense of instability w/ weight bearing
34
PCL sprains MOI
Direct force against anterior tibia, driving it posteriorly
35
PCL s/s
- Pain - Joint effusion - Limited range of motion into full flexion & extension - May have audible "pop"
36
Unhappy triad
Sprain of: - MCL - ACL - Medial meniscus * Receives lateral blow to knee w/ foot fixed * Combo of valgus force * Rotation of leg --> stress on medial collateral ligament 1st
37
Iliotibial band MOI
Overuse w/ tight TFL & gluteus maximus
38
Iliotibial s/s
- Pain over lateral epicondyle - Pain going downstairs * - Pain when leg is swinging forward during gait
39
Iliotibial tx
- Stretch gluteus maximus & TFL | - Arch supports
40
Popliteus tendonitis MOI
Overuse injury if hamstrings get tired & popliteus has to carry more than its regular load
41
Popliteus tendonitis s/s
- Pain w/ resisted knee flexion | - Pain w/ palpation
42
Knee bulge sign/ Sweep test
- Testing for knee effusion | - With leg straight, “milk” knee joint fluid down 1 side & up other - observe for bulge
43
Ballottement of patella
- Testing for knee effusion - Apply downward pressure from above the knee to milk fluid down - Push patella into the joint space, feel for fluid / boggy sensation
44
Osgood-Schlatter's disease MOI
- Repetitive traction on tibial tuberosity apophysis via patella tendon & quads - Young athletes
45
Osgood-Sclatter's disease s/s, what actions aggravate it?
- Aggravated by running, jumping, or kneeling | - Pain & swelling around tuberosity
46
Sinding-Larsen-Johansson disease
- Resembles Osgood-Schlatter's disease except involves proximal rather than distal end of the patellar tendon - Caused by repetitive traction forces on the inferior pole of the patella
47
Peroneal nerve contusion
- Nerve passes below proximal head of the fibula, where it lies subcutaneously - Localized pain from the contusion & radiating pain to anterior lateral leg musculature & dorsum of foot
48
Prepatellar bursa
- Most commonly injured - Direct trauma - Fluid btwn skin & patella - Looks like golf ball hanging
49
Infrapatellar bursa
Result of repetitive kneeling or repeated trauma over the distal patellar tendon
50
Suprapatellar bursa
- Fills whole knee joint capsule | - Common after ACL tear
51
Pes anserinus bursa
- Related to cycling or running | - Constant friction or external blow
52
Plica or "Medial Shelf" MOI
* Plica: unusual fold of synovium - Plica gets pinched under patella if the quads fatigue & can’t pull it out of the way soon enough before patella compresses
53
Plica s/s
- Pain - Popping - Snapping - Aching at rest under medial edge of patella
54
Fat pad impingement MOI
Bottom of the patella pinches, or impinges on, the fat pad on top of the tibia
55
Fat pad impingement s/s
- Sensation of pinching | - Bruise feeling in full extension
56
Genu valgus vs genu varus
``` Valgus = knock knees Varus = bow legs ```
57
Valgus stress test
- Testing for medial collateral ligament (MCL) laxity &/or pain - W/ leg slightly flexed, stabilize knee laterally & abduct distal leg - Note any ligament laxity or pain
58
Varus stress test
- Testing for lateral collateral ligament laxity &/or pain - W/ leg slightly flexed, stabilize knee medially, & adduct distal leg - Note any ligament laxity or pain
59
Lachman's test
- Testing for ACL tear - Knee is flexed 15-20º - Stabilize thigh w/ 1 hand, pull upper tibia forward w/ other hand - Compare sides
60
Anterior drawer test
- Testing for ACL tear - Knee is flexed 90º; foot & hips stable - Pull upper tibia forward assessing for excessive forward movement - Compare sides
61
Posterior drawer test
- Testing for PCL tear - Similar to anterior drawer sign, except tibia is pushed back (rather than pulled forward) - Excessive laxity suggest PCL tear
62
McMurray's test
Testing for meniscal tear
63
McMurray's test - medial meniscal tear
To test for medical meniscal tear: - Flex knee, place thumb & index finger on joint space - Rotate foot laterally & extend leg - Palpable click or pain at joint line = medial meniscal tear
64
McMurray's test - lateral meniscal tear
To test for lateral meniscal tear: - Same procedure done except – rotate foot medially, & extend leg - Palpable click or pain at joint line = lateral meniscal tear
65
Calf pain w/ dorsiflexion suggests what?
DVT
66
Which test is used to assess for achilles rupture?
Thompson's test
67
Which test is used to assess for DVT?
Homan's sign
68
What does a compression test assess?
Fx
69
Lymphedema
Blockage of the lymph vessels that drain fluid from tissues throughout the body
70
LE stasis dermatitis
- Chronic venous insufficiency w/ incompetent valves & higher pressure in capillary bed - Tissue damaged & inflamed - “Brawny,” non-pitting edema
71
Sx of venous insufficiency (varicose vv)
- Dull ache or pressure sensation after prolonged standing; relieved w/ elevation - Dependent ankle edema - Ankle ulcerations - SF thrombosis / thrombophlebitis
72
Signs of peripheral artery insufficiency
- Dependent rubor - Pallor w/ raised extremity ) - Hair loss on leg/foot - Atrophic skin; nail changes - Ulcers - Necrosis/gangrene
73
Consequences of peripheral artery insufficiency
- Gangrene | - Amputation
74
Pes cavus
- Rigid foot, High Arch/instep - Plantar soft tissues shortened - Leads to claw toes - Difficult to absorb shock
75
Pes planus
Flat, mobile foot
76
Pes planus MOI
- Congenital - Trauma - Muscle weakness
77
2 types of pes planus
1. Rigid or congenital - Rare - Calcaneous in valgus & midtarsal in pronation - Visible in NWB position 2. Flexible or acquired - Due to tibial torsion or subtalar jt. dysfunction - Apparent in WB position, but arch re-appears on tiptoes
78
Claw toes
Hyperextension of MP jt. & flexion of PIP & DIPs
79
What are claw toes associated w/ ?
- Pes cavus - Fallen metatarsal arch - Problems w/ intrinsic musculature
80
Hammer toes
- Extension contracture at MP jt. - Flexion contracture at PIP - DIP (any position)
81
Causes of hammer toes
- Congenital - Poor fitting shoes - Hallux valgus - Muscular imbalance
82
Bunion
Inflammation & thickening of the bursa of the MTP joint of the big toe – w/ valgus deformity
83
Metatarsalgia
- Pain & tenderness under metatarsal heads | - Unable to progress through terminal stance during walking bc cannot load forefoot
84
Morton's neuroma
- Compression of a nerve bundle btwn metatarsal heads in ball of foot - Commonly btwn 3-4 or 2-3
85
Morton's neuroma MOI
Shoes w/ narrow toe box
86
Morton's neuroma s/s
- Tingling - Burning - Pain in the ball of foot AND DISTALLY into assoc toes
87
Morton's neuroma tx
- Ditch tight shoes permanently | - Place felt pad directly under neuroma
88
Lisfranc injury
- Injury to any side of the 2nd metat head | - Dislocations or fx
89
Lisfranc s/s
- Painful wt bearing, inability to go into terminal stance of gait - Tender in dorsal apex of mid-foot around head of 2nd metat
90
Lisfranc MOI
Significant impact
91
Lisfranc tx
Refer immediately for x-rays
92
Fx to base of 5th MT MOI
Inversion combined w/ landing from a jump
93
Fx to base of 5th MT s/s
- Tender at head of 5th - Bone may even feel mobile - Cannot bear wt on foot - Pain w/resisted eversion
94
Tx for fx at base of 5th MT
Refer on crutches for x-ray
95
Turf toe MOI
Sprain of 1st MP jt from hyperextension
96
Turf toe s/s
- Moderate pain in ball of foot under big toe w/ gait - Swelling & tenderness on inferior jt - Incr pain w/toe extension
97
Tx of turf toe
- Tape | - Steel inserts
98
DDx of turf toe
Seasmoiditis or fx
99
Plantar fascitis MOI
Overuse, acute or chronic
100
Plantar fascitis s/s
- Pain most severe when 1st getting out of bed - Pain diminishes during activity & increases when activity stops - Tender at origin on the ant./medial calcaneous & distally to mid-fascia
101
Predisposing factors for plantar fascitis
- Excessive pronation - Obesity - Abnormally high arch
102
DDx for plantar fascitis
- Tarsal tunnel syndrome (Tinel's sign) - Sever disease (pain when squeezing heel, 13yo or younger) - Heel spur
103
Inversion sprains MOI
Plantarflexion w/ hindfoot inversion
104
Types of inversion sprains
- 1st degree = ATF lig torn, little laxity, pain - 2nd degree = ATF lig torn & some CF lig damage, clear laxity w/ end pt, pain - 3rd degree = all 3 lateral ligs torn, laxity w/ no end pt, pain, unable to bear weight
105
Eversion sprains MOI
Land in plantar-flexion & rotation into eversion
106
Excessive eversion can cause fx of what?
Fibula
107
Syndesmosis sprain MOI
- Plantarflexion w/ hindfoot inversion & rotation of talus in mortise - Damage to ATF lig, CF lig, distal tib-fib lig (ant &/or post) *HIGH ANKLE SPRAIN
108
Why do syndesmosis sprains take longer to heal?
Bc every time he/she steps, the tib-fib lig is stressed
109
What kind of ulcer is commonly associated w/ diabetes?
Neuropathic
110
Achilles Rupture MOI
- Big bang! - Age related - “weekend warrior”
111
Tx of achilles rupture
Surgery - Suture ends together = LOTS of scar tissue! - Long, slow rehab
112
Anterior tibialis tendonitis
- More acute | - Isolate to confirm w/ MMT
113
Achilles tendonitis
- More chronic - Obvious swelling - Long rehab w/ many set-backs
114
Difference btwn sprain & strain
``` Sprain = ligament Strain = tendon ```
115
Pulse grading (amplitude)
``` 0 Absent, unable to palpate 1+ Diminished, weaker than expected 2+ Brisk, normal 3+ Increased 4+ Bounding ```
116
Callus
- Skin thickening found on bottom of foot | - Generally SF & doesn't cause pain
117
Corns
- Found on top of toes - Specially shaped callus of dead skin - Smaller than calluses but deeper & painful
118
Anterior drawer sign
- Testing for anterior talofibular ligament tear - Stabilize distal tibia - Grasp & pull calcaneus forward assessing for excessive forward movement
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