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Family Medicine > Ankle + knee pain > Flashcards

Ankle + knee pain Flashcards

(74 cards)

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1
Q

ligament stretched or torn

-don’t hear or feel a “pop” but swollen

A

sprain

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2
Q

tendon or muscle stretched or torn

- tender, tight muscle

A

strain

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3
Q

lateral (fibula) ligaments of ankle joint (ant to post)

A 
#1 anterior talofibular ligament (most susceptible to acute injury)
#2 calcaneal fibular ligament
posterior talofibular ligament
peroneus longus
brevis tendons
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4
Q

medial (tibia) ligaments of ankle joint

A

deltoid ligament

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5
Q

primary plantar flexor

A

achilles tendon: attaches at posterior portion of calcaneus

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6
Q

primary everters of ankle

A 
inferior to lateral malleolus:
peroneus brevis (attaches to distal 5th metatarsal, can cause avulsion fracture)
peroneus longus
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7
Q

primary inverter of ankle

A

posterior tibialis tendon: inferior to medial malleolus

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8
Q

high ankle sprain ligaments

A

anterior tibiofibular ligament
posterior tibiofibular ligament
syndesmosis: sheet of interosseous membrane

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9
Q

ankle injury grades

A

grade I: minimal swelling + pain, ATFL stretch, no instability, able to bear weight with some pain
grade II: partial tear of ATFL, stretched CFL, > pain + swelling, mild-mod joint instability, lots pain with weight bearing, loss of ROM
grade III: complete tear of ATFL and CFL, partial tear of PTFL, > joint instability, can’t bear weight, loss of function

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10
Q

most common ankle injury

A

forced inversion with ankle in plantar flexion (tear anterior talofibular ligament)

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11
Q

causes of tendinosis (usually chronic ankle pain, d/t overuse causing inflammation, partial tendon rupture)

A

achilles tendon
peroneal tendon
posterior tibialis tendon

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12
Q

cause of achilles tendon rupture

A

jumping sports
steroid injection complication
FQ antibiotics

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13
Q

hemarthrosis think

A

hemophilia

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14
Q

knee pain + limp, think

A

hip disorder:
legg-perthes
slipped capital femoral epiphysis

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15
Q

ankle/knee pain + poor response to treatment

A

malignancy

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16
Q

bony swelling + ankle/knee pain

A

tumor

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17
Q

fever + ankle/knee pain

A

osteomyelitis

septic arthritis

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18
Q

if “snap” or “pop” felt

A

ligament rupture

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19
Q

inability to bear weight after injury think

A

fracture (not sprain)

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20
Q

PE for joint

A 
ROM
strength
palpation
stability
gait
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21
Q

ottowa ankle rules to determine need for xray with ACUTE ankle injury: sensitive for ankle and midfoot fractures
must be > 6yo

A

pain in malleolar or midfoot zone and one of following:
bony tenderness at posterior edge or tip of either malleoli
bony tenderness over navicular(medial)
bony tenderness at base of 5th metatarsal (lateral)
inability to bear weight both immediately and in ED (4 steps)
if negative: probably not a fracture

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22
Q

talar tilt test

A

lateral ankle pain
anterior talofibular + calcaneofibular ligament
grasp each side of foot at talus and apply varus stress (bow out)
+ if asymmetric ROM between ankles

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23
Q

anterior drawer test

A

lateral ankle pain
anterior talofibular ligament
grasp calcaneus and try to slide heel forward
+ if at least 3 mm difference between ankles

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24
Q

squeeze test

A

anterior/lateral ankle pain
compress tibia and fibula above midpoint of calf
+ pain: syndesmosis sprain (high ankle)

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25
cotton test/rocker test
anterior/lateral ankle pain | like talar tilt test - mediolateral force applied and any ROM > 3 mm is abnormal
26
eversion + dorsiflexion trauma (rare) causes
medial ankle pain: deltoid ligament sprain (very strong) often associated with fracture or posterior tibialis tendon injury
27
medial ankle pain think
deltoid liagment
28
posterior ankle pain think
achilles tendon: | crepitus, tenderness, swelling, gap
29
thompson (mildcalf compression) test
``` assess if achilles tendon is intact lie prone with feet over edge of table squeeze gastrocnemius and soleus normal: plantar flexion positive: no foot movement (complete or near complete rupture of tendon) ```
30
if ankle bone pain at night, bone pain without injury, or don't respond to tx get
xray
31
imaging for achilles tendinosis or achilles tendon rupture
no gold standard: U/S or MRI (good if young athlete - help with prognosis)
32
early mobilization of ankle sprain
``` more likely to return to sport vs brace improve functioning reduce pain + swelling return sooner less instability ```
33
lace up brace for ankle sprain
less likely to cause disabling swelling vs semirigid brace
34
semirigid brace for ankle sprain
return sooner vs elastic bandage | prevent ankle sprain during high risk sport if previous grade II or III tear
35
PT for ankle sprain
prevents subsequent sprains
36
acute grade I ankle sprain tx
RICE symptomatically early mobilization: bear weight as tolerated NSAID or acetaminophen for pain
37
acute grade II ankle sprain tx
RICE for 2-3 days NSAIDS immobilization in lace up splint 2-7 days, crutches
38
acute grade III ankle sprain tx
same as grade II - but longer recovery immobilization in air-stirrup splint or below knee cast for up to 3 mo PT afterward if still functionally impaired or separation of tibia and fibular: need surgery
39
syndesmosis sprain tx
body weight can increase stress, pain, instability removable splint or casting to allow for progressive weight bearing as tolerated passive ROM - esp dorsiflexion within week of injury
40
if avulsion fragment > 2mm
immobilize in cast or splint and refer to surgeon
41
avulsion of peroneus brevis on 5th metatarsal head
heals without treatment | immobilize until weight bearing tolerated
42
refer to surgeon if
fracture of base of 5th metatarsal (jones fracture) proximal 2nd, 3rd, 4th (Lis Franc) growth plate (salter-harris fracture)
43
treatment of achilles tendinosis
rest, ice, heel lifts rehab of gastroc and soleus: stretching, ROM, then strength NSAIDS
44
treatment of achilles tendon rupture or if very active with achilles tendinosis
surgery (prevent re-rupture)
45
all patients with ankle injuries should undergo
rehab
46
knee joint
patella tibia femur
47
primary stabilizers of knee
ACL (insertion), PCL, MCL, LCL menisci joint capsule medial and lateral retinacula attach to patella
48
knee actions
during flexion: forward translation, internal rotation of tibia extension: rearward translation, external rotation
49
ACL role
prevent anterior movement of tibia on femur | helps MCL stabilize knee during lateral stress when knee is flexed
50
menisci role
stabilize knee during pivoting
51
popliteus m. role
attached to lateral meniscus prevents lateral meniscus from sliding forward and getting crushed during flexion locks knee in full extension and unlocks
52
flexed knee hits dashboard in MVA
PCL injury
53
causes of anterior knee pain: pain climbing up/down stairs, squatting, pronged sitting, snap/pop/click/catching of knee
patellar tendonitis patellofemoral dysfunction chondromalacia patellae
54
sudden swelling of knee
hemarthrosis (most commonly associated with ACL tear, osteochondral fracture in 10%)
55
hear or feel pop think
ACL tear
56
knee gets "stuck" during ROM
meniscus injury or loose joint body (cartilage)
57
stiffness with inactivity - improves after few minutes (vs RA), pain with weight bearing activity
DJD
58
lachman test
ACL Tear knee flexed at 20-30 deg stabilize femur, other hand on proximal tibia - try to slide tibia forward + if: >3 mm difference or no endpoint
59
posterior drawer test
PCL tear flex knee to 90 degrees and push tibia posterior -do this before lachman test to ensure integrity
60
posterolateral or posteromedial pain at extreme of flexion or extension is a
meniscal injury
61
anterior joint line tenderness and pain with squatting suggests
chondromalacia
62
McMurray test
meniscal damage medial meniscus: extension + valgus + internal rotation lateral: extension + varus + external rotation + if: palpable click, pain
63
MCL or LCL test
varus or vagus stress | determine laxity
64
pathophys of anterior knee pain
quadricep atrophy | crepitus with manipulation of patella
65
patellar apprehension test | patellar compression test
anterior knee pain press inferiorly on superior patella: pain hold patella and contract quad: pain
66
ottawa knee rules if 18 yo or older to determine if acute knee injury has fracture
``` get xray if any of following: >55yo tenderness at head of fibula isolated patella tenderness inability to flex to 90 deg inability to bear weight immediately and in ED ```
67
confirmatory test for meniscal tear
MRI
68
refer for additional evaluation or surgery if:
``` hemarthrosis ACL or meniscal tear third degree collateral ligament injuries severe functional impairment poor response to conservative tx ```
69
treatment of knee pain
exercise
70
treatment of ACL
immobilization and then, surgery
71
treatment of meniscus tear
protected weight bearing + PT | if continues, surgery
72
treatment of DJD
glucosamine CS injections NOT NSAIDS - not inflammatory (unless acute flare)
73
treatment of collateral ligament tear
knee immobilizer, crutches until can tolerate walking
74
-focal area of bony tenderness
fracture

Family Medicine (21 decks)

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