Knee, ankle and foot pain Flashcards
(29 cards)
Q angle of knee
Normal= 15 degrees. Straight line from ASIS to center of patella, and another line is extrapolated up from tibial tuberosity and center of patella.
Patellar reflex
L4
Achilles tendon
S1
Valgus test of knee
(+) test = increased laxity, soft endpoint. Indicates MCL (tibial) pathology.
Varus test of knee
(+) test = increased laxity, soft endpoint. Indicates LCL (fibular) pathology.
Lachman’s Test
Patient is supine… places cephalad hand on distal thigh, caudal hand grasps the proximal tibia. Knee is flexed to 30 degrees.
(+) test = increased laxity, soft endpoint. Indicates ACL pathology.
McMurray’s Test
Patient is supine, with hip and knee flexed.
Medial meniscus = rotates the tibia into ER (AKA lateral rotation) and apply a valgus stress, then continues the leg into extension.
Lateral meniscus= rotates the tibia into IR (AKA medial rotation) and apply a varus stress, then continues the leg into extension.
Apley’s Grind Test
Compression: Flex the knee to 90 degrees, place force down while rotating the foot internally and externally. (+) test = pain, possible meniscal injury or collateral ligament.
Distraction= Same as before, but pull upwards. This reduces meniscal pressure, but increases the strain on ligaments. (+) test = pain, indicates collateral ligament damage.
Patellar Laxity and Apprehension test
Laxity: one hand on either side of the joint. Push the patella laterally and assess ROM.
Apprehension: When testing laxity, ask the patient if this promotes any discomfort.
Patellar compression
Patient is supine and knee is extended. provide downward force on patella with one hand, while moving the patella medial and lateral. (+) test = pain with compression.
Patella-femoral grinding test
Hold superior patella and apply superior/inferior force while the patient attempts to tighten quadriceps against resistance.
(+) test = pain/crepitus. This can indicate OA or chondromalacia (runner’s knee).
Patellar glide test
Patient will slowly extend and flex the knee while physician notes quality of the articular motion. (+) test = crepitis.
Anterior Drawer Test for ankle
Grasp posterior calcaneus and distal tib/fib with other hand. Provide anterior force on calcaneus while stabilizing distal tib/fib. Too much laxity= torn ATF ligament
Talar tilt test
AKA inversion test. Grasp distal tib/fib with one hand and inferior calcaneus with the other, blocking motion of the calcaneus on the talus. Then force the talus to invert. (+) test = increased laxity. Indicates calcaneofibular ligament pathology, possibly ATF too.
Eversion test
Graps distal tib/fib with one hand and plantar surface of foot with the other hand and induce eversion. (+) test = excess eversion. Indicates deltoid ligament pathology, although this is unlikely to tear.
Squeeze test
Squeeze tib/fib, this should elicit pain at the syndesmosis. This indicates a high ankle sprain.
Cross leg test
Patient crosses affected ankle over the opposite knee, then apply downward force over knee and ankle. (+) test = pain. Indicates syndesmosis (high ankle sprain).
Thompson test
Patient is prone with foot off the table, then squeeze patients calf. What does the foot do? it should elicit plantarflexion.
(+) test = absence of plantarflexion. This indicates a ruptured achilles tendon.
Homan’s sign
Force dorsiflexion of foot. (+) test = pain with dorsiflexion. This can indicate a DVT, although this is kinda risky…
Moses Sign
Patient is seated or supine with knee slightly flexed or extended. Hold foot up, and apply squeezing force on gastrocnemius. (+) test = pain with anterior compression. This can indicate DVT of the posterior tibial vein.
Genu Valgum
Increased Q angle. Lateral deviation of tibia and fibula.
Grace Hesse.
Genu Varum
Genu varus (bow legs) is normal in babies, but they grow out of it.
Osgood Schlatter
AKA osteochondrosis of tibial tubercle.
Seen in young teenage boys. Caused by secondary ossification of the tibial tubercle.
Starts to form a callous
Ottawa knee rules
55+ Tenderness at fibula Tenderness at patella Inability to flex knee to 90 degrees inability to walk up steps
