LE Lecture Midterm Flashcards
(180 cards)
1
Q
4 knee injury clues
A
Swelling
Pop @ injury
Gives way
Locking
2
Q
Immediate swelling of knee may indicate
A
*Blood
ACL tear
Fracture (Femur, Tib, Patella)
ICE
3
Q
Delayed swelling of knee may indicate
A
*Synovial fluid
Meniscus tear
Other joint irritation
Ice won’t help
4
Q
Knee: pop @ injury w/ immediate swelling?
A
ACL tear
5
Q
Knee: pop @ injury? (2)
A
+/- Meniscus tear
Patellar dislocation
6
Q
Knee gives way with pain may indicate
A
Reflex inhibition of quads
7
Q
Knee gives way, NO pain may indicate
A
Instability “Chronic ACL”
8
Q
Sequence of “On-field” Evaluation of KNEE (6)
A
- External injury/deformity?
Status of
- *Neurovascular
- *Collateral ligs
- *Cruciate ligs
- Can they stand/walk
- Challenge w/ progressively harder mvmt
9
Q
Ottawa Rules for the KNEE. Take x-rays if: (4)
A
55+ yo
Isolated tenderness @ patellar/fib head
Can’t flex knee 90*
Can’t bear weight right after injury
10
Q
“Return to Play” criteria for KNEE (5)
A
Full ROM
Good patellar mobility
Norm stability on manual testing (ACL/PCL/MCL/LCL)
Quad + hamstring strength = 80% of opposite side
Can complete RTP functional requirements for specific sport (E.g. swing a bat)
11
Q
Grades for PAIN SENSITIVE structure of the KNEE
A
Moderate-Severe Pain (Localized)
Minimal Pain (Poorly Local)
Moderate-Severe Pain (Poorly Local)
No pain
12
Q
Moderate-Severe, LOCALIZED pain may suggest (2)
A
Supra patellar pouch
Med/Lat Retinaculum
13
Q
Minimal, POORLY LOCALIZED pain may suggest (4)
A
Articular cartilage of femoral condyles
Trochlea
Tib plateaus
Odd facet of patella
14
Q
Moderate-Severe, POORLY LOCALIZED pain may suggest (1)
A
Tib/femoral origin for ACL/PCL
15
Q
Medial column bones of foot
A
Talus
Navicular
Cuneiforms
MT 1-3
16
Q
Lateral column bones of foot
A
Calcaneus
Cuboid
MT 4-5
17
Q
Rearfoot bones
A
Calcaneus
Talus
Navicular
18
Q
Forefoot bones
A
MT
Phalanges
19
Q
Ankle joints (3)
A
Talocrural
Subtalar
Transverse tarsal (“Midtarsal”)
20
Q
Bones of TALOCRURAL JOINT
A
Talus
Tib
FIb
21
Q
Bones of SUBTALAR JOINT
A
Talus
Calcaneus
22
Q
Bones of TRANSVERSE TARSAL JOINT (Midtarsal)
A
Medial = Talus/Navicular
Lateral = Calcanus/cuboid
23
Q
Movement of Talocrural joint
A
Dorsiflexion
Plantarflexion
24
Q
Movement of Subtalar joint
A
Inversion
Eversion
25
Movement of Transverse Tarsal joint (Midtarsal)
Forefoot
\*Supination/ADDuction
\*Pronatoin/ABduction
26
Muscles for dorsiflexion
Anterior leg muscles
27
Muscles for plantarflexion
Posterior leg muscles
28
Muscles for inversion
Tib Anterior/Posterior
29
Muscles for eversion
Peroneal muscles
30
Muscles for forefoot supination/ADDuction
TIb Anterior/Posterior
31
Muscles for forefoot pronation/ABduction
Peroneal muscles
32
Plane for Dorsiflexion
Sagittal
33
Plane for Plantarflexion
Sagittal
34
Plane for Eversion
Frontal
35
Plane for Inversion
Frontal
36
Plane for ABduction
Transverse
37
Plane for ADDuction
Transverse
38
How is the foot situated for forefoot VARUS?
Looks like inversion
Lateral column towards floor
Big toe up
39
How is the foot situated for forefoot VALGUS?
Foot looks everted
Medial column towards the floor
Little toe up
40
Equinas (Static)
Plantarflexion -\> dorsiflexion limited
41
Calcaneus (Static)
Dorsiflexion -\> plantarfelxion limited \*Patient walks on heel
42
Medial ankle ligaments
Deltoid/MCL
Spring Ligament (Plantar CalcaneoNavicular)
43
O/I of Spring Ligament
Sustentaculum Tali to Navicular Tuberosity
44
Lateral ankle ligaments
LCL
Bifurcate
45
Lateral Collateral Ligaments of the ankle
A/P TaloFibular
CalcaneoFibular
46
Bifurcate Ligaments of the ankle
CalcaneoNavicular
CalcaneoCuboid
47
Medial ankle ligaments
Deltoid lig or MCL
Spring Ligament
48
Deltoid Ligaments /MCL
A/P TibioTalar
TibioNavicular
TibioCalcaneal
49
Triplanar movement for PRONATION
Dorsiflexion
Abduction
Eversion
50
Triplanar movement for SUPINATION
Plantarflexion
Adduction
Inversion
51
List the general foot conditions (11)
Hyper PRO/SUPination
Morton's Neuroma
Tarsal Tunnel Syndrome
Stress Fractures
1st Toe Disorders
Heel Disorders
Ankle sprains
Lower Leg Disorders
Proximal Tib-Fib Subluxation
ITB Syndrome
Popliteus Tendinitis
52
List 1st Toe Disorders
Turf toe
Hallux valgus
Hallux rigidus
Gout
53
List Heel Disorders
Achilles Tendinitis/Rupture
Fat Pad Syndrome
Plantar Fascitis
54
List Lower Leg Disorders
Deep V. Thrombosis
Tennis Leg
Compartment Syndrome
55
Define "Metatarsalgia"
Generic term for metatarsal pain
56
Causes of metatarsalgia
Chronic stretching of transverse ligaments
Overuse/repetitive actions (jumping)
Over weight
Hammer toes
Pes planus/cavus
Dropped metatarsals
57
Metatarsalgia treatment
Proper support (Rocker bottom shoes)
Manipulation
58
Hammer Toe
59
Freiber's Infarction
Avascular necrosis
Most common @ **head** of MT2
60
Freiberg's Infarction is MC in
Teen girls 14-18 yo
Physically active
(Female to male = 4:1)
61
Cause of Freiberg's Infarction
(Freiberg = A pimp for hookers)
High heels
Gymnastics
Dancing
Direct trauma
62
Freiberg's Infarction ssx
May precede xray changes by 6 mos.
T2P
Decreased ROM
Crepitus
63
Freiberg's Infarction tx
Orthotic protection
Surgery (for fragmentation)
64
Hammer Toe
Mallet Toe = Plantar contracture of DIP
65
Claw Toe - DIP + PIP = flexed
66
Morton's Neuroma
Benign tumor
Entrapment or irritation of Digital Nerve
(Follows Tibial N. distribution)
67
Morton's Neuroma ssx
+/- palpable mass between 2-4 INTERmetatarsal space
Pain
Numbness
Tingling
68
What makes Morton's Neuroma pain/numb/tingle worse?
Dorsiflexion
Transverse Compression
69
What makes Morton's Neuroma pain/numbness/tingling better?
Plantarflexion of MTP joint
"Wave your toes closed"
70
Morton's Neuroma tx
Metatarsal pads
Orthotics
Surgery maybe
71
Tarsal Tunnel Syndrome
Posterior Tibial Nerve entrapped/compressed in Tarsal Tunnel
72
Tarsal Tunnel Syn ssx
Insidious onset of NUMBNESS/TINGLING across bottom of foot
No associated LBP
73
Cause of Tarsal Tunnel Syn (4)
Hyperpronation
Swelling
Ganglion
Subluxation
74
How do you test for Tarsal Tunnel Syndrome?
Tinnel's Test (Percuss behind Med Malleolus - reproduce sx)
Neuro tests - rarely (+)
Sensory findings = MC than motor
75
Tarsal Tunnel Syndrome Tx
Trial orthotics
Adjust foot
\*If due to GANGLION or other pathology = REFER out
76
What are the components of the TARSAL TUNNEL?
Flexor Retinaculum
Sustentaculum Tali
Medial Malleolus
77
Tarsal Coalition
When tarsals fuse together.
Osseous/cartilage fuse into a bridge.
78
What are 2 kinda common anomalies that may be the source of foot pain?
Tarsal Coalition
Accessory Ossicles
79
2 developmental problems that might cause foot pain?
Osteochondrosis
Osteophytic reactions
80
Os Tarsal
Os Navicular
Os Vers-something
Os Peroneum
81
What do accessory ossicles look like on x-ray?
Oblique
Smooth
82
What do Avulsion Fractures look like on X-ray?
Transverse
Jagged
(Jones Fracture)
83
Metatarsal Stress Fractures
Constant FOREFOOT PAIN
d/t prolonged walking or running
esp. when unaccustomed or menstrual irregularities
84
Metatarsal Stress Fractures occur when
Resorptive process is faster than OSTEOBLASTIC activity
85
MC spot for Metatarsal Stress Fractures
2nd MT
| (d/t length + biomechanical axis)
86
What makes Metatarsal Stress Fracture pain worse?
Weightbearing
Transverse presure
+/- tuning fork
87
How to detect Metatarsal Stress Fractures
#1 BONE SCAN = definitive
X-Ray maybe
88
Metatarsal Stress Fracture tx
#1 Rest
Stiff-soled shoes
Increase Ca++
Avoid activity for several weeks
89
Stress Fracture = ___ pain at rest.
Weight bearing = \_\_\_
NO
pain at rest
90
MC site of stress fracture in LE?
Tibia
91
5th Metatarsal Fractures
Pull of the Peroneous Brevis muscle
+/- cause avulsion fracture
92
5th Metatarsal Fractures must be differentiated from
accessory ossicles
93
5th MT Fractures may be SECONDARY to ____ or a PRIMARY fracture
ankle sprain
94
A TRANSVERSE FRACTURE is called a ______ found mainly in DANCERS
Jone's Fracture
| (Stop Jonesin' for that dancer)
95
Hallux Valgus
Lateral deviation of PROXIMAL PHALANX
96
Cause of Hallux Valgus
Hereditary
Morton's Deformity
Tight shoes
High heels
Arthritis
Forefoot varus
97
Hallux valgus ssx
Callous formation
Inflammation
Corns
Pain @ medial 1st MTP joint
98
Hallux Valgus tx
Taping
Pad the bunion
Shoes w/ larger toe box
Don't wear heels, man
99
Hallux Rigidus
Pain on DORSAL surface of 1st toe
Dorsal ring of osteophytes
100
Who gets Hallux Rigidus?
Old ppl
Athletes w/ recurrent capsular sprains
(Usually d/t turf toe)
101
Hallux Rigidus ssx
Pain w/ dorsiflexion
+/- bunion
102
Hallux Rigidus tx
Mobilization
Stiff-soled shoe
Rocker bottom shoe
+/- Surgery
Bucket, warm water, salt
103
Turf Toe
Hyperextension of 1st toe
Capsular sprain
104
Turf Toe tx
Tape to prevent extension
Stiff-soled shoe
Rocker bottom shoe
Rest, Ice, Support
105
Turf Toe's evil cousin
"Sand Toe"
Kicking into the ground - playing soccer in the sand
106
Sesamoiditis
Sudden onset
Pain at PLANTAR surface of first toe
(Medial sesamoid MC)
107
Cause of Sesamoiditis
Direct trauma
Overpull of FLEXOR HALLICUS BREVIS
Hallux Valgus
Super flexible footwear
Repetitive running/walking on hard surfaces
108
Sesamoiditis tx
Tape toe into neutral
w/ pad
(Do xray to R/O fracture)
109
Gout
Disorder of PURINE METABOLISM.
Allows accumulation of SODIUM-URATE crystals in joints
110
Gout ssx
Pain/swelling - abruptly
111
Gout MC occurs where (4)
1st toe
knee
elbow
behind ear
112
How do you DIAGNOSE Gout?
X-RAY:
Tophi (radiolucent)
Joint destruction
LAB:
Elevated serum URIC ACID levels
113
Gout tx
Don't eat meat, alcohol
Meds = Alopurinal, Colchicine
114
Avascular Necrosis examples w/ location (5)
Freiberg's - 2nd MT
Kohler's - Tarsal, Navicular
Iselin's - 5th MT head
Sever's Phenomenon - Calcaneus (heel pain)
Osteochondritis Dessicans - Talus
115
Point to the location of each AVASCULAR NECROSIS condition (5)
116
Achilles Tendinitis/Rupture
Pain, swelling usually 2 cm proximal to CALCANEAL TUBEROSITY
117
Cause of Achillies Tendinitis and who is it most commonly found in?
Overuse
Runners + Jumpers
118
Achillies Tendinitis ssx
Chronic degeneration +/- = **knotty swelling**
Palpable defects +/- with **impending rupture**
TENDERNESS OVER THE TENDON
+/- swelling
119
Evaluate for Achilles Tendinitis
Check tightness of Triceps Surae
w/ the **knee** FLEXED + EXTENDED
Thompson Test
MRI, Ultrasound
120
Achilles Tendinitis tx
Rest, Ice
Modify activity
Heel lift (propulses you forwarded)
Elastic Taping
Rupture = Surgical reattachment
121
What can irritate the Achilles Tendon?
Uphill running - in rigid shoes, strains it @ toe off
Downhill running - forceful impact transmitted
Pes Cavus = predisposes problems
Hyperpronation - causes torsion
122
Retrocalcaneal Bursitis
Irritation of the BURSA directly behind Achilles Tendon by insertion
leads to BURSITIS
123
Pinch in front of Achilles for tenderness
Haglund's Deformity
d/t Retrocalcaneal Bursitis
124
Fat Pad Syndrome
Fat pad degenerates or someone doesn't have a lot of fat under their heel
\*MC in old people
125
DDx Fat Pad Syndrome + Plantar Fascitis
Fat Pad Syn = Pain in the middle of the heel
Plantar fascitis wouldn't cause this
126
Fat Pad Syndrome: pain decreased when
Squeezing heel together or increasing padding
127
Fat Pad Syndrome tx
Better heel support - "Tuli Cups"
Firm heel counter in shoe
128
What does a LOOSE HEEL COUNTER do to the fat pad when running?
Lets calcaneal fat pad spread out during HEEL STRIKE.
This means INCREASED impact to the heel.
\*Firm, well-fitted heel counter = maintains fat pad = buffers impact of running
129
Plantar Fascitis
Burning/sharp pain at medial, plantar surface of the foot
130
Cause of Plantar Fascitis
Hyperpronation
Hypersupination
131
Plantar Fascitis ssx
Pain worse with 1st toe dorsiflexion
Or coupled w/ ANKLE dorsiflexion
Tenderness @ Medial tubercle of Calcaneus
132
Plantar Fascitis tx
Low-Dye Taping
Gradual stretching
Orthotics
133
Protocol for an ankle sprain injury?
Anterior Drawer Test
Talar Tilt (Inversion/Eversion)
Talar Rock
Tib-Fib Squeeze
Ottawa Rules for X-Rays
134
Ottawa Rules for X-Ray: Ankle
Can't bear weight after injury or at time of eval
Tender at a specific spot (bony: malleoli, navicular, 5th MT head)
Do this so you don't miss significant fractures
\*Significant = 3+ mm in breadth
135
Most common ankle sprain?
Inversion, plantarflexion
136
What view would you want to include for an ankle x-ray?
Mortise View
137
High ankle injury: external rotation ONLY
What ligments are involved?
Anterior TibioFibular
Anterior TibioTalar
TibioNavicular
138
Ankle Sprain tx
Air-Stirrup brace @ first
Open-Gibney Taping
Crutches (2nd/3rd degree tears)
Prophylactic taping (chronic sprains)
Train: Peroneals, Tib anterior, Hip abductor
139
ACSM Return-to-Play Criteria for Ankle Sprains (4)
Full ROM
No pain
Hop - 80% well side (full weight bearing, as far as pos)
Final RTP = Successful running, cutting, jumping, twisting (appropriate for sport)
140
Deep Vein Thrombosis Facts
D/t minor trauma, prolonged sitting, immobilization, birth control pills
Pain in ISOLATED portion of CALF muscles
Sudden onset w/o prior warning
141
How do you test for DVT?
Homan's Test coupled with
RESISTED MUSCLE TESTING
**Doppler-Ultrasound to DX** (old school = venography)
142
Why is a DVT dangerous?
Can emobolize to lungs = INFARCT or DEATH
143
DVT tx?
Warfarrin
Coumadin
(Anti-coagulant drugs)
3-6 months
144
Homan's Test (+)
[Knee extended, ankle passively dorsiflexed]
Pain in calf
T2P calf
+/- pallor, swelling in leg
+/- loss of dorsal pedis pulse
145
Tennis Leg
Tearing of MEDIAL GASTROC head
Occurs w/ **sudden extension of knee** + f**oot dorsiflexed**
146
Tennis Leg ssx
Sudden, SHARP pain @ **upper, medial calf**
Pain worse w/ plantarflexion
147
Tennis Leg tx
Crutch-walking (1\* or 2\*)
Heel-lift (temporary)
Serious injury? Long leg cast for many weeks
Surgery (3\*)
148
2 Types of Shin Spints and related muscles
Anterior = Tib anterior, extensors
Posterior = Tib posterior, flexors
149
Cause of Anterior Shin Splints?
Poor shock absorption (shoes)
Run/walk on hard surface
150
Cause of Posterior Shin Spints
Hyperpronation
151
What other foot condition would you expect to co-occur with shin splints?
Forefoot valgus
152
Shin Splints tx
Acute: Ice, support, elastic tape (spiral upward toward area of tenderness)
Orthotics (esp. for posterior for **posterior** ss)
New, more shock absorbant shoes (**anterior** ss)
Increase calcium
153
Cause of Stress Fractures of Tibia
Weak muscles
allows more bone loading/forceful repetitive contraction of muscles
...pulls on origins
154
AKA for early stage Tibial Stress Fracture
Medial Tibial Stress Syndrome
155
Tibial Stress Fractures account for ___ of all stress fractures in all athletes.
HALF
156
Tibial Stress Fractures: Who + Where
_Runners_ - **Distal & middle 1/3**
Dancers - **Middle 1/3** (Might progress to full fracture = "Dreaded Black Line" on xray)
Military Recruits - proximal
157
Tibial Stress Fracture tx for athletes + non-athletes
Athletes - Immobilization, increase calcium
Non-athletes - Restric impact
158
Compartment Syndrome
Increased pressure in compartment
d/t **blood or fluid build up** (acute)
**exercise** (chronic)
159
Contents of Anterior Compartment
Tibialis Anterior
Extensors
Tibial Artery/Vein
Deep Peroneal Nerve
160
Contents of Lateral Compartment
Peroneal muscles
Superficial Peroneal Nerve
161
Contents of Deep Posterior Compartment
Posterior Tibialis
Toe Flexors
Posterior Tibial Artery/Vein
Tibial Nerve
162
Contents of Superficial Posterior Compartment
Triceps Surae
| (Gastroc heads, Soleus)
163
Compartment Syndrome ssx
Athletes - Sx 10-30 minutes after exercise, pain goes away mins-hours after stopping activity
Pain/swelling in compartment
Normal pulse
Sensory deficit
Slit-catheter compartment pressure ABNORMALLY HIGH
164
Compartment Syndrome tx
ICE DOES NOT HELP
Stretching
Proper warm-up
Soft tissue work
Fasciotomy (Partial cut of fascia to relieve pressure)
165
Compartment Syndrome Pressures in mmHg
Normal: Rest (8), Activity (80), 5 mins after ceasing activity (\<30)
Compartment Syndrome: Rest (\>30), Activity (\>100)
166
Lateral (Valgus) force damages
MCL
167
Rotation with foot fixed on the ground damages
Meniscus
(With lateral/valgus force = ACL & MCL)
168
Hyperextension or sudden deceleration damages
ACL
169
A blow to Anterior Tibia (knee flexed) damages
PCL
170
ACL Injury video
http://www.youtube.com/watch?v=lpIOMuqXWrE
171
ITB Syndrome history
Lateral knee pain
Repetitive activity (running)
Gradually worsens
Occasionally squeaks
172
ITB Exam Findings (5)
Pain @ lateral epicondyle - 30\* knee flexion
(+) Modified Ober's - Leg kept in extension, doesn't drop below table
(+) Noble Compression Test
(+) Rinne's - pain with unilateral weightbearing @ 30\* knee flexion
+/- foot pronation
173
Popliteus Tendinitis History
Pain after downhill running/walking
Lateral knee pain
174
Popliteus Tendinitis Exam Findings
Pain w/ resisted internal rotation
Tenderness in front/behind LCL insertion
Pain w/ weight bearing @ 30\* + internally rotated femur
175
Proximal Tib-Fib Subluxation History
Ankle Injury w/ forced dorsiflexion/plantarflexion
Pain @ fib head (+/- radiate down leg)
\*Common Peroneal nerve wraps around fib neck
176
Proximal Tib-Fib Subluxation
Decreased ROM at Fib head on dorsi/plantarflexion
Decreased A-P glide of Fib head
Instability on full weight bearing at 30\*
(Do "Rinne's", then do "Modified Moossavi" to see if pain is eliminated)
177
Freiberg's Infarction description + tx: Category I
No DJD, Articular intact, Self-limits
Low heel shoe, orthotics, no sports, NSAIDS
178
Freiberg's Infarction description + tx: Category 2
Periarticular spurs, Articular intact
Cheilectomy, low-heel shoe, orthotics, no sports, NSAIDS
179
Freiberg's Infarction description + tx: Category 3
Severe degeneration, Joint disesase, Loss of articulation
Surgery: arthoplasty, MT head resection
180
Freiberg's Infarction description + tx: Category 4
Epiphyseal dysplasia, multiple heads
Same treatment as Category 1-3
