Back and Lower Extremity Exam Flashcards

Question

Why is a disc herniation most common L5-S1?

Answer 1

The posterior longitudinal ligament narrows as it descends- makes herniation easier. Usually one sided- rarely bilateral

Answer 2

Lateral curvature of the spine Evaluate the extent and level of curvature Measure leg lengths in conjunction with scoliosis (distance from ASIS to medial malleolus)

Answer 3

Source of chronic low back pain in young people | Associates with uveitis (eye infection), psoriasis, and IBS

Answer 4

chronic inflammatory disease of spine with progressive stiffening, often involves hips and peripheral inflammatory signs. +HLA-B27

Answer 5

“Degenerative Disc Disease” Common in lumbar spine, especially at L5-S1 Worse due to being a postural transition point Deterioration and loss of cartilage and normal bone Low grade inflammatory issue

Answer 6

Thinning of bone Affects lumbar spine and hips commonly (Dexa Scan) 1:2 women and 1:4 men over age 50 will have an osteoporosis related fracture. Steroids increase risk Loss of height, Dowager’s hump Compression fractures cause the pain

Answer 7

Lumbar radiculopathy or peripheral nerve compression

Answer 8

L4, L5, S1, S2, S3

Answer 9

Pain unilateral from L5, through buttock, down lateral leg to the lateral foot. Often shooting; worse with sitting or Valsalva

Answer 10

Raise leg- if this reproduces the pain, lower leg just to the point of no pain and then dorsiflex the foot. If pain is reproduced = sciatic nerve pain. Most commonly positive if found between angles 40-60 degrees

Answer 11

internal and external rotation

Answer 12

Check trochanteric bursa

Answer 13

Gluteus Medius- keeps the hips stable during the gait cycle

Answer 14

Observe PSIS dimples standing on both legs Next have patient stand on one leg Gluteus medius on the standing leg should contract keeping the pelvis level (negative test = normal) If the pelvis cannot remain level, the gluteus medius is weak on the standing leg side.

Answer 15

Psoas muscle dysfuntion. (For flexion contractures of the hip due to tight Psoas (Iliopsoas)) "Thomas has a tight illiopsoas:

Answer 16

Pt. Supine: Flex hip(s) with so thigh touches abdomen Upon extending one leg, it should should extend to lie flat on table Positive test if hip does not fully extend

Answer 17

Pt lateral with side evaluating up | Hold leg, flex the knee to 90, abduct it and let go. It should fall back- if it does not = IT band contracture

Answer 18

The hip joint | --> Not the labrum

Answer 19

The figure 4 one, press on ASIS of leg extended and knee of leg bent.

Answer 20

Flexion ABduction ER: External Rotation

Answer 21

ASIS to medial malleolu

Answer 22

Think: shortended femur or tibia. Scoliosis, or hip deformity

Answer 23

Seated, raise knee, resist pressure down

Answer 24

Primarily by palpation | Supine, knees to chest and hold heels, rotate knees left and right comparing ROM

Answer 25

sartorius, gracilis, semitendinosus

Answer 26

sign of minor effusion in the knee. Milk downward, apply medial pressure then tap and look for a fluid wave.

Answer 27

sing of a large effusion in the knee

Answer 28

technique to examine a large effusuion in the knee. Compress suprapatellar pouch, use other hand to sharply press patella to feel for fluid returning to suprapateallar pouch. Also for large effusions

Answer 29

prepatellar bursitis- swelling over patella from excessive kneeling

Answer 30

Medial aspect of knee – tibial plateau Excessive running common cause Also from valgus knee deformity (Q angle) and arthritis

Answer 31

Cyst in the popliteal fossa, most often medial | Leg extended check posterior/medial aspect of knee for swelling or fullness, sometimes tenderness as well

Answer 32

occurs more with active ROM

Answer 33

Is equal with passive or active ROM

Answer 34

The pt lays supine with knees extended. You compress the patella against the femur and instruct the pt to tighten their quads- asses for roughness of motion, crepitus, or pain

Answer 35

The pt c/o of knee pain when going up stairs or rising from a chair. Consider chondromalacia or patellofemoral syndrome

Answer 36

Tests for dislocation or subluxation of the patella

Answer 37

Attempt to manually dislocate the patella laterally and observe the patients facial expression

Answer 38

The pt is supine and knees and hips flexed to 90 degrees, grasp the femur with one hand and the tibia with the other and attempt to move the forward.

Answer 39

Pt supine, knees flexed to 15 degrees. Grasp tibia with one hand and femur with the other and move them in opposite directions- asymmetric forward movement of the tibia suggests a positive test- ACL tear

Answer 40

Pt supine with hips and knees flexed to 90. Push the tibia posterior- compare to opposite side. Movement suggests PCL tear

Answer 41

Pt supine- grasp heel and fully flex the knee. Hold the knee joint with the other palpating along the joint line. Rotate the lower leg internally to engage the lateral meniscus and extend the leg. Pop's or clicks during motion are a poise test. Not very specific- Can rotate externally to test medial meniscus. Heel point to the meniscus being tested

Answer 42

Pt is prone with knees flexed to 90. Stabilize the thigh with one hand while pushing down to compress the medial and lateral menisci. Rotate the heel during compression notate any pain.

Answer 43

1. Locking or giving out: sensation of or actual occurrence 2. Not feeling they can trust the knee when walking or stepping off a curb 3. A catching sensation or true catching of the knee: sudden pain stops ROM, ie, suddenly cannot extend the leg fully.

Answer 44

The dance! Standing, rotatory motion on one leg at 5-10 deg, and again at 20 degrees. More sensitive and specific for mensical injury or tear than McMurray, bent knee position best.

Answer 45

Medial collateral ligament

Answer 46

Lateral colleteral ligament

Answer 47

Abduction Stress Test Patient supine and flex knee slightly One hand against lateral knee the other around medial ankle Push medially against knee while laterally against ankle

Answer 48

Adduction Stress Test Patient supine and flex knee slightly One hand against lateral knee the other around medial ankle Push laterally against knee while medial against ankle

Answer 49

Dorsiflex patient’s ankle with leg extended at knee. Pain in calf is a positive sign

Answer 50

Achilles rupture

Answer 51

Patient prone, leg bent 90 deg, squeeze calf and observe for normal passive plantar flexion. Best to determine achilles rupture if done in 48 hrs.

Answer 52

loss of longitudinal arch of foot- flat feet

Answer 53

bunion- abnormal abduction of big toe

Answer 54

calcium pyrophosphate crystal deposition (normal gout is uric acid crystals)

Answer 55

heel and arch pain especially with initial weight bearing in morning

Answer 56

compressive tenderness

Answer 57

hyperextension of MTP joint and flexion of IP joint (second toe most common)

Answer 58

painful thickening of skin from abnormal pressure over bony prominence (fifth toe)

Answer 59

viral, plantar aspect of foot, thickening of skin with dark stippling spots

Answer 60

Fungus infected nails

Answer 61

posterior talofibular, calcanoefibular, anterior talofibular

Answer 62

tibiotalar and talocalcaneal joint (subtalar)

Answer 63

Pt is sitting with legs dangling off table Doc inverts the calcaneus If the talus gaps or rocks in the ankle mortise, the ATF & calcaneofibular ligs are torn and the test is positive

Answer 64

yes-If there is pain in the mid-foot or around the the malleolus

Answer 65

only of if there is pain around the malleolus as well of the pt cannot bear weight

Answer 66

Only if there is tenderness at the base of the 5th metatarsal or the pt cannot bear weight

Back and Lower Extremity Exam Flashcards

(99 cards)