Flashcards in 20. Clinical Correlations of Lower Extremity Deck (39)
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)
Causes of SCFE
Expected exam findings of SCFE
Limitation of internal rotation
Test ordered for expected SCFE
Tests – plain x-rays.
Tx for SCFE
Synovitis of hip exam findings
holding hip slightly flexed & ER Resistance to abduction and internal rotation
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
Test findings in Synovitis of the hip
Sed rate 35-60mm/hr & CBC
- mild leukocytosis
Tx for synovitis of the hip
NSAIDs for 1-3 weeks
Swollen, extremely painful knee that is red and hot.
Passive & active ROM very painful
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
Causes of septic knee joint?
typically Gonorrhea or skin flora
Treatment of septic joints:
often requires surgical incision and drainage followed by IV antibiotics;
articular surface destruction is a complication of what?
septic knee joint
Patellar dislocation is usually a _____ dislocation
Patient comes in with acute pain and swelling around her knee and feels a cutting sensation with active quadriceps contraction
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
Treatment for patient with patellar dislocation?
physical therapy-- If recurrent may eventually need
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
Causes for ACL sprains:
twisting non-contact, deceleration or hyperextension
Acute - pop and rapid effusion
Chronic - instability
Young lady was skiing and twisted her knee. She now experiences swelling in the joint as well as locking. Expected Dx?
usually occur with twisting on a loaded (weight-bearing)
knee in athletes; Degenerative tears are common in older patients
What exam findings are we expecting with a suspected meniscal tear?
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).
Pathology of Compartment syndromes
elevation of pressures in a muscular compartment high
enough to interfere with perfusion
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
Patient presents with diffuse pain over leg and weird tingly sensation. Leg is cool to the touch. Excpected Dx?
Compartment syndrome--early findings
What are the late findings of compartment syndrome
Pulselessness (late & rare)
Acute compartment syndrome injury pressures
0 - 10 mm Hg =
Acute compartment syndrome of 10-30 mm Hg =
elevated, not dangerous
Acute compartment syndrome of 30-40 mm Hg =
in acute compartment syndrome potentially
Compartment syndrome of ______ is usually dangerous, usually requires compartment release
40-60 mm Hg
Compartment syndrome of ______ is consistently dangerous, requires urgent release
> 60 mm Hg
Most ankle sprains are due to:
forced ankle inversion
How do you perform an anterior drawer test and what is it for?
a) Anterior drawer test – abnormal is 3-5 mm more than
uninjured side; may also fell softer end point on injured side
Positive squeeze test with pain at the ankle; suspicious for
high ankle sprain
Positive squeeze test with pain at knee suspicious for:
Maisonneuve fracture – fracture of the proximal fibula associated with ankle injury
What two tests would be positive for a high ankle sprain
External rotation test (+) suspicious for high ankle sprains
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
What do we expect to see in exam findings in patient with achilles tendon rupture?
Defect in Achilles: Pain & weakness with plantar flexion