Lecture 11: Knee, Ankle, and Foot Complaint

Question 1

What does a “locking” sensation of the knee suggest?

Answer 1

Meniscal Tear

Question 2

What does a “popping” sensation of the knee suggest?

Answer 2

Ligamentous tear or rupture

Question 3

What does a “giving out” sensation of the knee suggest?

Answer 3

Ligamentous rupture or patellar subluxation

Question 4

What does a rapid onset of large, tense knee effusion suggest?

Answer 4

ACL rupture or tibial plateau fracture

Question 5

What does a slower onset of moderate knee effusion suggest?

Answer 5

Meniscal tear or ligamentous sprain

Question 6

What does a recurrent knee effusion suggest?

Answer 6

Meniscal tear

Question 7

What are different techniques to palpate for effusions?

Answer 7

Milking Techniques: Stroke down knee

Medial Pressure: Apply pressure to medial aspect of knee to look for lateral bulging

Fluid Wave Technique: Tap lateral knee and feel for fluid wave

Question 8

What does a Valgus knee stress test for?

What does a Varus knee stress test for?

Answer 8

Valgus: MCL injury

Varus: LCL injury

Question 9

What does an Anterior Drawer test indiacte?

What does an Posterior Drawer test indiacte?

Answer 9

ACL and PCL Injury

Question 10

What does a McMurray’s test indicate?

Answer 10

Medial or lateral meniscal tear

Question 11

What does the Ottawa Knee Rule encompass?

Answer 11

• Age is 55 years or over
• Inability to bear weight for four steps immediately after injury or in emergency setting
• Inability to flex knee to 90^o
• Tenderness over head of fibular or isolated to patella

Question 12

When should you obtain a knee x-ray after an acute knee injury?

Answer 12

If the patient fits one of the Ottawa Knee Rule criteria

Question 13

What is a meniscal injury?

Answer 13

Medial or lateral joint line tenderness

-can treat with RICE

Question 14

What is Patellofemoral Pain Syndrome?

Answer 14

Anterior Knee Pain

• ​Pain under patella
• Worsens when climbing up or down the stairs and prolonged sitting
• Pain with squatting
• Treat hip and quadriceps

Question 15

What is Osgood-Schlatter Disease?

Answer 15

Tibial Apophysitis

• Anterior knee pain seen often in children ages 9-14 with a rapid growth spurt
  
  • Tenderness of bony prominence over tibial tuberosity
• Chronic avulsion of tibial tuberosity

Question 16

What is Pes Anserinus Pain Syndrome?

Answer 16

Medial Knee Pain

• Worsened with repetive flexion and extension
• Risk Factors: Diabetes, Female, Obesity
• Pain worse at night

Question 17

What is Iliotibial Band Syndrome?

Answer 17

Knee Pain

• Common knee pain, especially in runners or cyclists
  
  • Intermittent sharp pain that can progress to constant, deep pain
• Noble Test can detect

Question 18

What is Popliteal Cyst (Baker’s Cyst)?

Answer 18

Bursa

• Mostly asymptomatic and an incidental finding
  
  • Can present with posterior knee pain, knee stiffness, or mass behind knee
• Foucher’s Sign: cyst softens or disappears with knees flexed to 45^o

Question 19

What does a Talar Tilt test indicate?

Answer 19

Lateral Ankle Sprain

Calcaneofibular Ligament Sprian

Anterior Tabofibular Ligament Injury

Question 20

What does an ankle Anterior Drawer Test for?

Answer 20

Lateral Ankle sprain

Question 21

What does an eversion ankle test for?

Answer 21

Medial Ankle Sprain

Deltoid Ligament Injury

Question 22

What does a squeeze test indicate?

Answer 22

High Ankle Sprain

Distal Tibiofibular Syndesmosis Injury

Question 23

What does Homan’s Sign test for?

Answer 23

DVT

Question 24

What is Plantar Fasciitis?

Answer 24

Foot Pain

• Very common foot pain in adults
  
  • Overuse can cause microtears in plantar fascia, resuliting in degeneration of fibrous tissue or acute inflammation
  • Presents as sharp, stabbing, medial, plantar heel pain
• Risk Factors: Running, obesity, flat feet, high-arched feet
• Tenderness to palpation over medial plantar calcaneal region
• Pain worse with passive dorsiflexion

Question 25

What is the most common ankle sprain?

Answer 25

Lateral Ankle Sprain

Question 26

What other injuries do you see with lateral ankle sprain? Is the foot everted or inverted? Is it plantar flexed or dorsi flexed?

Answer 26

Lateral ankle ligaments (e.g. anterior talofibular and calcaneofibular ligaments) injury secondary to _foot inversion_ and _plantar flexion_

Question 27

What other injuries do you see with medial ankle sprain? Is the foot everted or inverted?

Answer 27

Medial ankle ligaments (e.g. deltoid ligament complex) injury secondary to _eversion_

Question 28

What other injuries do you see with syndesmotic (high ankle) sprain? Is the foot everted or inverted? Is it plantar flexed or dorsi flexed?

Answer 28

Distal Tibiofibular Syndesmosis Injury _Foot eversion_ and _Dorsiflexion_

Question 29

How does the Ottawa Rules apply to the ankle?

Answer 29

**X-rays Performed if:** * Tenderness over medial or lateral malleolus * Inability to bear weight immediately after injury * Tenderness over base of 5^th metatarsal or navicular

Question 30

What joint is most likely to experience a gout flare?

Answer 30

1^st metatarsophalangeal joint