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PCM1 Final Exam > Knee, Foot, and Ankle Pain/Exam > Flashcards

Knee, Foot, and Ankle Pain/Exam Flashcards

1
Q

ACL injury/tear

A

Presentation: injury w/ popping sounds and pain/swelling at knee
Treatment: RICE, physical therapy, surgery

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2
Q

PCL injury/tear

A

Presentation: setting of MVA w/ multiple structures involved, complete dislocation of knee
Treatment: RICE, hinge bracing, PT, ortho referral

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3
Q

Medial Collateral L. injury

A

usually in sports w/ sudden movement changes
Presentation: pain and swelling of knee, laxity w/ valgus stress test
Treatment: RICE, physical therapy

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4
Q

Lateral Collateral L. injury

A

Presentation: blow to medial or anteromedial aspect of leg; lateral knee pain, swelling, locking, and knee giving out under stress
Treatment: physical therapy and crutches; immobilization if high grade

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5
Q

Meniscal injury

A

twisting injuries
Presentation: joint line tenderness, joint effusion/swelling, catching, pain w/ certain movements, inability to squat/kneel
Treatment: RICE, crutches, physical therapy, ortho referral

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6
Q

Patellofemoral pain

A

aka runner’s knee
Presentation: anterior knee pain around or behind patella
Treatment: modified activity, NSAIDs, physical therapy, steroids

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7
Q

Osteoarthritis

A

Presentation: joint pain, stiffness, restriction of motion, crepitus on flexion and extension of knee
Treatment: weight bearing exercise, braces, NSAIDs, steroids, hyaluronic acid injection

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8
Q

Osgood schlatter

A

callous appears and swelling of tibial tubercle where patellar tendon inserts
Presentation: teenager c/o pain and swelling of anterior knee
Treatment: usually self limiting, NSAIDs, PT

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9
Q

Ottawa knee rules

A

determines who gets radiograph of knee after trauma - sensitive rule
age 55 or older
tenderness at head of fibula
isolated tenderness of patella
inability to flex knee to 90
inability to walk 4 weight-bearing steps immediately after injury

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10
Q

Pittsburgh decision rules

A

determines who gets radiograph after knee trauma - more specific when dealing with isolated knee injury
blunt trauma or fall as mechanism of injury plus younger than 12 or older than 50; inability to walk 4 weight-bearing steps in ED

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11
Q

Q angle (knee)

A

normal = 15 degrees
difference measured by created straight line from ASIS to center of patella and another line through tibial tuberosity and center of patella

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12
Q

Knee flexion

A

145-150 - biceps femoris, semimembranosis, semitendinosis, gracilis, grastrocnemius, plantaris, sartorius, popliteus

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13
Q

Knee extension

A

0 - rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

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14
Q

Knee internal and external rotation

A

10

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15
Q

Patella reflex

A

L4

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16
Q

Achilles reflex

A

S1

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17
Q

Anteromedial thigh dermatome

A

L1-L3

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18
Q

patella dermatome

A

L4

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19
Q

anterior leg and ankle and great toe dermatome

A

L5

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20
Q

lateral leg and lateral phalanges dermatome

A

S1

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21
Q

posterior thigh dermatome

A

S1-S4

22
Q

Valgus Test (knee)

A

knee flexed to 30; physician supports lower leg and places hand on lateral aspect of knee; apply medial force to proximal tibia while abducting lower leg

(+) = increased laxity or pain
Indicates: medial collateral L. injury

23
Q

Varus Test (knee)

A

knee flexed to 30; physician supports lower leg and places hand on medial aspect of knee; apply lateral force to proximal tibia while adducting lower leg

(+) = increased laxity or pain
Indicates: lateral collateral L. injury

24
Q

Anterior Drawer Test

A

knee flexed to 90; physician sits on pt’s foot and grasps proximal tibia w/ both hands; pull anteriorly

(+) = excessive translation
Indicates: ACL injury

25
Q

Lachman’s Test

A

physician places hand on distal thigh above patella and other hand grasps proximal tibia; knee flexed 10-30 and tibia pulled anteriorly while other hand stabilizes thigh

(+) = increased laxity
Indicates: ACL injury (more sensitive)

26
Q

Posterior Drawer Test

A

knee flexed to 90; physician sits on pt’s foot and grasps proximal tibia w/ both hands; pull posteriorly

(+) = excessive translation
Indicates: PCL injury

27
Q

Reverse Lachman’s Test

A

physician places hand on distal thigh above patella and other hand grasps proximal tibia; knee flexed 10-30 and tibia pushed posteriorly while other hand stabilizes thigh

(+) = increased laxity
Indicates: PCL injury (more sensitive)

28
Q

McMurray’s Test

A

hip and knee flexed with hands placed to control ankle and distal femur
Medial meniscus = rotate tibia into external rotation and apply valgus stress
Lateral meniscus = rotate tibia into internal rotation and apply varus stress

(+) = pain or clicking during extension
Indicates: possible medial or lateral meniscus tear

29
Q

Apley’s Grind Test - compression

A

pt prone w/ knee flexed to 90; downward force placed on foot while rotating it internally and externally

(+) = pain w/ rotation and/or compression
Indicates: possible meniscal injury, collateral L. injury or both

30
Q

Apley’s Grind Test - distraction

A

pt prone w/ knee flexed to 90; apply upward traction to leg while rotating it (traction reduces meniscal pressure but increases ligamentous strain)

(+) = pain w/ distraction and rotation
Indicates: possible collateral L. damage

31
Q

Patellar Laxity and Apprehension Tests

A

Laxity: one hand above and below joint; thumbs placed against medial side of patella and push laterally

Apprehension Test: when testing laxity, ask pt if maneuver provokes discomfort or instability

(+) = sense of apprehension or instability
Indicates: possible previous patellar dislocation or instability

32
Q

Patellar Compression (Grind) Test

A

knee extended and provide compressive load to patella w/ one hand while moving patella medial and lateral

(+) = pain w/ compression
Indicates: possible inflammation, chondromalacia, or injury to patellofemoral articular surfaces

33
Q

Patella-Femoral Grinding Test

A

compress patella downward into trochlear groove and instruct pt to tighten quadriceps against resistance

(+) = crepitus or pain
Indication: roughness or articulating surfaces

34
Q

Patellar Glide Test

A

pt sitting or supine will slowly extend and flex knee while physician notes quality of motion

(+) = palpable or audible crepitus, pain, or catching of patella
Indicates: possible damage to articular surface

35
Q

Syndesmotic ankle injury

A

high ankle sprain - injury to one or more ligaments including distal tibiofibular syndesmosis

Presentation: tenderness, swelling, and ecchymosis of ankle w/ high impact mechanism of injury

Management: RICE, consider immobilization, rehab, surgery

36
Q

Morton Neuroma

A

pain between metatarsal heads from plantar digital N.

Presentation: burning pain third metatarsal space most common that radiates to toes w/ activity

Treatment: shoe inserts, wearing better fitting shoes, steroid injections

37
Q

Plantarflexion

A

55-65 - coupled motion of supination

38
Q

Dorsiflexion

A

15-20 - coupled motion of pronation

39
Q

Ankle inversion

A

20 - coupled motion of supination

40
Q

Ankle eversion

A

10-20 - coupled motion of pronation

41
Q

Anterior Drawer Test (ankle)

A

grasp posterior calcareous w/ one hand and distal tibia/fibula w/ other; provide anterior force on calcaneus while stabilizing distal tibia/fibula

(+) = pain, no springing, excessive motion/laxity
Indicates: ATF ligament injury (lateral ankle sprain)

42
Q

Talar Tilt Test

A

graps distal tibia/fibula and inferior calcaneous blocking motion of calcaneous on talus; invert talus

(+) = laxity, increased ROM or pain
Indicates: calcaneofibular L. injury (lateral ankle sprain)

43
Q

Eversion Test

A

grasp distal tibia/fibula and plantar surface of mid-foot; evert foot

(+) = laxity, increased ROM or pain
Indicates: deltoid L. injury (medial ankle sprain)

44
Q

Squeeze Test

A

wrap hands around leg proximal to ankle; squeeze 2-3 seconds and rapidly release

(+) = pain at syndesmosis
Indicates: syndesmosis pathology (high ankle sprain)

45
Q

Cross Leg Test

A

pt crosses ankle over opposite knee; apply pressure to affected leg

(+) = pain at distal ankle
Indicates: syndesmosis pathology (high ankle sprain)

46
Q

Thompson Test

A

pt prone w/ foot off table; squeeze pt’s calf and observe plantar flexion

(+) = absence of plantar flexion
Indicates: Achilles tendon rupture

47
Q

Homan’s Sign

A

dorsiflex pt’s foot

(+) = pain w/ dorsiflexion
Indicates: DVT

48
Q

Moses Sign

A

pt’s knee slightly flexed or extended, induce anterior compression on gastrocnemius into posterior aspect of tibia

(+) = pain w/ anterior compression
Indicates: DVT

49
Q

Ottawa Ankle Rules

A

ankle series indicated for pts w/ pain in malleolar zone and have bone tenderness at posterior edge or tip of lateral or medial malleolus or unable to bear weight immediately after injury (4 steps)

50
Q

Ottawa Foot Rules

A

foot series for pt’s w/ pain in mid-foot zone and bone tenderness at base of 5th metatarsal or navicular or unable to bear weight immediately after injury (4 steps)

PCM1 Final Exam (10 decks)

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