20. Clinical Correlations of Lower Extremity Flashcards Preview

MSS > 20. Clinical Correlations of Lower Extremity > Flashcards

Flashcards in 20. Clinical Correlations of Lower Extremity Deck (39)
1

Young little chubbster comes in with history of groin and knee pain in the area of the anteromedial thigh. Pain is bilateral, but doesn't necessarily hurt at the same time. Hurts worse with activity. Dx?

Slipped capital femoral epiphysis (SCFE)

2

Causes of SCFE

repetitive overload

3

Expected exam findings of SCFE

Limitation of internal rotation

4

Test ordered for expected SCFE

Tests – plain x-rays.

5

Tx for SCFE

surgical fixation

6

Synovitis of hip exam findings

holding hip slightly flexed & ER Resistance to abduction and internal rotation

7

5 yo child comes in with mom, she was at her PC last wek for her vaccine updates. Any motion caused pain; child refuses to bear weight; otherwise looks okay

Synovitis of hip

8

Test findings in Synovitis of the hip

Sed rate 35-60mm/hr & CBC
- mild leukocytosis

9

Tx for synovitis of the hip

NSAIDs for 1-3 weeks

10

Swollen, extremely painful knee that is red and hot.
Passive & active ROM very painful
Expected Dx?

Septic joint

11

Septic Joint in these two types of patients may present different

Usually has systemic signs, but may be absent in diabetic
patient or immunosuppressed patient

12

Causes of septic knee joint?

typically Gonorrhea or skin flora

13

Treatment of septic joints:

often requires surgical incision and drainage followed by IV antibiotics;

14

articular surface destruction is a complication of what?

septic knee joint

15

Patellar dislocation is usually a _____ dislocation

lateral

16

Patient comes in with acute pain and swelling around her knee and feels a cutting sensation with active quadriceps contraction
Expected Dx?

Patellar dislocation

17

Exam findings you would expect in patient with patellar dislocation

ecchymosis, effusion with a Positive apprehension test – feeling of instability with stressing of the joint

18

Treatment for patient with patellar dislocation?

physical therapy-- If recurrent may eventually need
surgery

19

High school football player comes to your office the day after a football game. The night before he stated he quick changed directions when running a route and heard a 'pop' in his knee. He knee started swelling right away. What exam should we perform on this patient and why?

Perform a Lachmann exam; flex knee at 20-30 degrees, and flex; keep femur stabalized and check for anterior translation and endpoint of tibia.
--Expected ACL sprain

20

Causes for ACL sprains:
Acute
Chronic

twisting non-contact, deceleration or hyperextension
injury
Acute - pop and rapid effusion
Chronic - instability

21

Young lady was skiing and twisted her knee. She now experiences swelling in the joint as well as locking. Expected Dx?

Meniscal tear
usually occur with twisting on a loaded (weight-bearing)
knee in athletes; Degenerative tears are common in older patients

22

What exam findings are we expecting with a suspected meniscal tear?
Treatment
a) Locked - needs reduction; referral to orthopaedic surgeon
b) No locking - physical therapy and relative rest

pain over joint line; pain with circumduction tests
(McMurray is best known).

23

Pathology of Compartment syndromes

elevation of pressures in a muscular compartment high
enough to interfere with perfusion

24

Two causes of compartment syndrome

a) Acute – severe bleed – usually caused by fracture
b) Chronic exertional – from hypertrophied muscle in tight
compartment with exercise (which increases muscle bulk up to 20%)
c) Common locations – leg>>forearm

25

Patient presents with diffuse pain over leg and weird tingly sensation. Leg is cool to the touch. Excpected Dx?

Compartment syndrome--early findings

26

What are the late findings of compartment syndrome

Paralysis (late)
Pallor (late)
Pulselessness (late & rare)

27

Acute compartment syndrome injury pressures
0 - 10 mm Hg =

normal

28

Acute compartment syndrome of 10-30 mm Hg =

elevated, not dangerous

29

Acute compartment syndrome of 30-40 mm Hg =

in acute compartment syndrome potentially
dangerous

30

Compartment syndrome of ______ is usually dangerous, usually requires compartment release

40-60 mm Hg

31

Compartment syndrome of ______ is consistently dangerous, requires urgent release

> 60 mm Hg

32

Most ankle sprains are due to:

forced ankle inversion

33

How do you perform an anterior drawer test and what is it for?

2. Exam
a) Anterior drawer test – abnormal is 3-5 mm more than
uninjured side; may also fell softer end point on injured side

34

Positive squeeze test with pain at the ankle; suspicious for

high ankle sprain

35

Positive squeeze test with pain at knee suspicious for:

Maisonneuve fracture – fracture of the proximal fibula associated with ankle injury

36

What two tests would be positive for a high ankle sprain

External rotation test (+) suspicious for high ankle sprains

37

45 yr old pt was playing basketball and heard a pop and felt like some asshole kicked him in the back of the right ankle. He now has difficulty walking. Dx?

Achilles tendon rupture

38

What do we expect to see in exam findings in patient with achilles tendon rupture?

Defect in Achilles: Pain & weakness with plantar flexion

39

Recommendation for tx of achilles tendon rupture

either acute immobilization or surgery