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Patient Management II > Exam IV Study Guide > Flashcards

Exam IV Study Guide Flashcards

1
Q

Achilles Tendonopathy risk factors

A

-Age between 30-50 y
-Recent increase in exercise dose or training
-Initiation of running program
-Obesity
-Decreased calf flexibility

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2
Q

ACHILLES TENDONOPATHY CLINICAL MANIFESTATIONS

A

-Achilles area pain 2-6 cm proximal to insertion
-Feeling of calf stiffness following immobility

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3
Q

Achilles rupture risk factors

A

-Male age 20-39 y
-Female age 40-59 y
-Tear during recreational sport most common (80%) with basketball most common

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4
Q

Achilles rupture clinical manifestations

A

-Severe pain in calf
-Localized swelling into foot
-Inability to PF ankle/ push off during gait

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5
Q

lateral ankle sprain risk factors

A

-Males age 14-24 y
-Females age >30 y
-Recent ankle sprain
-Recurring episodes of ankle sprains
-Increased rearfoot inversion at heel strike

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6
Q

lateral ankle sprain clinical manifestations

A

-Swelling
-Feeling of instability in weightbearing

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7
Q

Plantar fasciitis risk factors

A

-Change in exercise or training
-Excessive pronation
-High BMI

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8
Q

Plantar fasciitis clinical manifestations

A

-Pain with first few steps in morning along arch or after inactivity
-Pain with prolonged weight bearing

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9
Q

Syndesmosis pain risk factors

A

-Participation in sport with running (Basketball, soccer, lacrosse, Rugby)

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10
Q

Syndesmosis pain clinical manifestations

A
  • pain in full DF
    -recurrent joint swelling
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11
Q

Anterolateral impingement risk factors

A

-History of twisting injury/ sprain

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12
Q

Anterolateral impingement clinical manifestations

A

-Ankle joint swelling
-Anterolateral pain with weightbearing activities in full DF

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13
Q

Tarsal tunnel risk factors

A

-History of trauma
-Pronated foot
-Autoimmune disorders affecting joints
-History of diabetes
-History of hypothyroidism
-History of hyperlipidemia

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14
Q

Tarsal tunnel clinical manifestations

A

-Sharp shooting pain over tarsal tunnel that radiates into plantar arch
-Numbness plantar surface of foot
-Symptoms increase with walking or standing
-Dysesthesias may be worse at night

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15
Q

Meniscus tear risk factors

A

-Knee laxity following ACL injury
-Twisting injury
-Participation in competitive sports

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16
Q

Meniscus tear clinical manifestations

A

-Delayed effusion (6-24 hours post injury)
-History of catching or locking in knee

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17
Q

ACL tear risk factors

A

-Female gender
-Associated with injury
-Suddenly slowing down and
changing direction (cutting)
-Pivoting with your foot firmly
planted
-Landing awkwardly from a
jump
-Stopping suddenly
-Presence of valgus collapse with squats and plyometrics

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18
Q

ACL tear clinical manifestations

A

-Pop may have been heard or felt at time of injury
-Limited WB initially
-Produces rapid joint effusion when injured
-Unstable feeling/ “giving way” with WB

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19
Q

MCL tear risk factors

A

-Sport participation with abrupt turning, cutting, or twisting

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20
Q

MCL tear clinical manifestations

A

-Patients may feel pop, more commonly they feel tearing or pulling on the medial aspect of the knee
-Swelling
-Ecchymosis (bruising)
-Antalgic gait pattern

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21
Q

PCL tear risk factors

A

-Trauma to the knee with posterior translation(anterior force) tibia on femur

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22
Q

PCL tear clinical manifestations

A

-Mild to moderate knee effusion
-Antalgic gait pattern
-Pain in back of the knee

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23
Q

Patellofemoral pain syndrome risk factors

A

-idiopathic
-Greatest incidence 12-19 y/o and 50-59 y/o

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24
Q

Patellofemoral pain syndrome clinical manifestations

A

-Insideous onset anterior knee pain
-Increased pain with loading (squatting, descending stairs, jumping, running on inclines and prolonged sitting)

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25
Knee Osteoarthritis risk factors
-Age greater than 50 years -BMI greater than 30
26
Knee Osteoarthritis clinical manifestations
-Gradual onset -Varus or valgus misalignment
27
Lachman test
For ACL, Patient supine with knee flexed between 10-20 degrees and femur stabilized with one hand. Examiner uses other hand to anteriorly translate tibia
28
Anterior Drawer
For ACL, Patient supine. Knee is flexed between 60-90 degrees and foot on table. Examiner draws tibia anterior.
29
Pivot shift test
For ACL, Patient supine. Examiner lifts heel of foot to flex hip to 45 degrees. Knee placed in 10-20 degrees flexion. Examiner performs forceful IR of tibia and fibula while creating valgus force at knee. Positive if tibial plateau subluxes anteriorly.
30
Lever sign
For ACL, placing towel under knee and pressing straight down on thigh, if foot does not rise off of table then it is positive.
31
Loss of Extension Test
For ACL, Examiner stabilizes thigh of affected knee with one hand with the patella facing forward, while the other hand extends the knee into maximal passive extension Measure the distance from heal to plinth Positive= decreased extension ROM compared to unaffected knee
32
Varus and valgus stress tests
For collateral ligaments, Patient supine with knee flexed 20 degrees. Varus and valgus force applied at joint line. Positive is pain or laxity.
33
McMurray test
For meniscus, Patient supine. Examiner brings knee from extension to 90 degrees flexion while maintaining internal rotation of tibia and then repeats while maintaining external rotation of tibia. -Positive is click or pain
34
Apley Grind test
For meniscus, Patient prone with knee flexed to 90 degrees. Examiner places downward pressure through foot while IR and ER tibia. Positive= pain
35
Thessaly Test
For meniscus, Patient stands on affected leg while holding examiners hands. They then rotate their BODY and leg internally with knee bent 5 degrees and then 20 degrees. Positive with pain and or click in the knee.
36
TIC 1 PFP syndrome
Age <40y and Isolated anterior knee pain or Medial patellar facet tenderness
37
TIC 2 PFP syndrome
Age 40-58 y Isolated anterior or diffuse knee pain Mild to moderate difficulty descending stairs Medial patellar facet tenderness Full passive knee extension
38
Reversed dynamic patellar apprehension test
For patellar instability, Patient is supine with knee flexed 120 degrees. The knee is extended while patella is translated laterally with examiners thumb as far as possible. STOP test as first sign of apprehension Positive if apprehension occurs before full knee extension
39
Ballottement Test
For knee effusion, With patient supine and knee comfortable Therapist quickly pushes patella posterior with two to three fingers. Positive=patella bounces off trochlea
40
Quadriceps angle - Q angle
Patient supine. Knee in extension but not hyperextended. Proximal arm of goniometer is aligned with ASIS and distal arm with tibial tubercle. Fulcrum is at patella. Some therapists will perform in standing to mimic function in normal weight bearing Normative value: 13.5 +/- 4.5 degrees
41
Thomas test
For muscle length, The patient should be in the supine position. Have the patient flex both knees and hips by pulling the knees to the chest and holding it there. This will cause the lumbar lordosis to straighten out. Place your hand under the patient's spine to identify lumbar lordosis. Straighten out and lower one leg.
42
Ely test
For muscle length, Patient is prone with passive knee flexion
43
Ober test
For muscle length, Patient is sidelying. Examiner flexes knee to 90 degrees and ABD and Extends hip until it is in line with trunk. Slowly allows hip to ADD while maintaining pelvis in neutral.
44
Tenderness along anterior shin
medial tibial stress syndrome
45
Pain along calf muscle that increases with stretch and push off of gait
achilles tendonopathy
46
Pain at heel with first few steps in morning
Plantar fasciitis
47
Paresthesias and pain plantar surface of foot
tarsal tunnel syndrome
48
Pain between 3rd and 4th metatarsals
Morton’s neuroma
49
Figure of 8 Measurement
Measurement of swelling, Patient is seated or supine with ankle in resting position. Examiner places endpoint of tape midway between tibialis anterior and lateral malleoli. Tape is then pulled medially to planter surface of foot to base of 5th MTP. Then tape is pulled distal to medial malleoli, across achilles tendon to start point.
50
Dorsiflexion Compression Maneuver
For syndesmosis pain, Patient in sitting Examiner passively DF ankle with overpressure Positive is pain along tib fib syndesmosis
51
Dorsiflexion Compression Test
Patient in weight bearing lunge position Patient lunges to place ankle in full available DF Examiner notes location of pain and amount of DF with inclinometer Examiner applies medial-lateral compression and the test is repeated. Positive less pain at syndesmosis or increased ROM with second manuever
52
Squeeze test
Examiner squeezes syndesmosis with one hand Positive=recreates pain
53
Calcaneus tilt (talar tilt test)
For LCL, Patient in supine Lower leg is stabilized as examiner adducts calcaneus Positive = pain along lateral ankle
54
Anterior Drawer test (Ankle)
For ATFL, Patient in supine with hip and knee flexed to place foot on table and ankle in 10- 20 degrees plantar flexion Tibia is stabilized as heel is translated forward Movement compared to other side looking for asymmetry.
55
Achilles Tendonopathy test cluster
Tendon palpation (Painful) arc sign Royal London Hospital test
56
Arc Sign
The patient is asked to actively dorsiflex and plantarflex the ankle from a prone position. In tendinopathy, the area of swelling is localized, evident by palpation. If the swelling moves superior and inferior with active dorsiflexion and plantarflexion of the ankle, then the Arc Sign is positive
57
Royal London Hospital Test
Patient in prone with foot off edge of plinth. Foot in neutral -Palpate achilles tendon for tenderness 2-6 cm proximal to insertion -Ask patient to actively DF ankle -Palpate tendon for tenderness -Ask patient to actively PF ankle -Palpate tendon for tenderness Positive test NO PAIN IN MAXIMAL DORSIFLEXION
58
Matles Test
For achilles rupture, Patient prone. Patient flexes knee to 90 degrees Positive test- foot assumes neutral or slight dorsiflexion
59
Thompson test
for achilles rupture, squeeze calf, if foot moves into plantar flexion then it is negative
60
Windlass Test
For plantar fascitis, Patient seated with knee flexed to 90 degrees. Examiner stabilizes ankle and passively extends MTP joint while allowing IP to flex. Positive =pain and limited ROM
61
Impingement sign
for anterolateral impingement, Patient seated Examiner grasps calcaneus with one hand and places forefoot into plantar flexion Use opposite thumb to place pressure over the anterolateral ankle Foot is brought from plantar flexion to dorsiflexion maintaining pressure Positive more pain in Dorsiflexion than Plantar flexion
62
Triple Compression Stress Test
For tarsal tunnel, Full PF with inversion while placing pressure on posterior tibial nerve x 30 secs
63
Meniscus tear special tests
-Pain in knee extension and flexion with overpressure -Joint line tenderness -McMurray -Apley Grind test -Thessaly
64
ACL tear special tests
-Lachman -Anterior Drawer -Pivot shift -Lever Sign
65
MCL tear special tests
-Palpation pain -Valgus stress test
66
PCL tear special tests
-Lack of full knee extension -Posterior Drawer -Posterior sag test
67
Patellofemoral pain syndrome special tests
-Mediolateral orientation -Patellar tracking or pain and/or valgus collapse with squat and/or step up -Pain with palpation -Hip ABD, Hip extensor and HIP ER strength deficit
68
Osteoarthritis special tests
-Limited knee extension ROM -Crepitus
69
Achilles tendonopathy special tests
-limited ankle DF ROM -Palpable tenderness -Static arch height (arc sign) -Royal London Hospital Test
70
Achilles rupture special tests
-Matles test -Thompson test
71
Lateral ankle sprain special tests
-Talat tilt test -Anterior drawer test -Proprioceptive deficits -Limited weightbearing DF
72
Plantar fasciitis special tests
-Palpation pain -Limited DF AROM/PROM -Windlass test -Abnormal foot index score
73
Syndesmosis pain special tests
-Dorsiflexion Compression maneuver -Dorsiflexion Compression Test -Squeeze test -Pain in single leg squat
74
Anterolateral impingement special tests
-Impingement sign -Pain with DR and eversion with overpressure (Pronation)
75
Tarsal tunnel special tests
-Pain on palpation -Triple compression test -Decreased sensation medial plantar nerve distribution -Tinel sign

Patient Management II (8 decks)

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