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Spring 2022 classes > Lower extremities exam 2 > Flashcards

Lower extremities exam 2 Flashcards

1
Q

genu varum aka

A

bowed legs

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2
Q

what is genu varum caused by

A

increased stretching force on lateral joint structures

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3
Q

genu valgum aka

A

knock knees

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4
Q

genu valgum caused by

A

increased stretching force on medial joint structures which can cause degeneration of lateral meniscus

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5
Q

genu recurvatum aka

A

hyperextended knees

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6
Q

genu recurvatum is often seen in which athletes

A

swimmers

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7
Q

genu recurvatum is at risk for what

A

ACL and PCL injury b/c contact b/w patella and femur can cause hyperextension

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8
Q

what does normal patellar alignment look like

A

the patella is aligned within the trochlea with the center of the femur

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9
Q

patella alta def

A

high riding patella, aka long patella tendon

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10
Q

patella baja

A

low riding patella, short patella tendon

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11
Q

squinting patella

A

medially positioned patella, creates problems with tracking

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12
Q

squinting patella caused by what

A

femoral anteversion and tibial internal rotation

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13
Q

what can be used to treat squinting patella

A

j-brace or patella tape

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14
Q

frog eyed patella def

A

lateral and high riding, creates tracking problem

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15
Q

frog eyed patella may be caused by

A

femoral retroeversion and tibial external rotation

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16
Q

what is the largest seasmoid bone

A

patella

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17
Q

what 3 purposes of patella

A

increased mechanical efficiency for quads, protect anterior portion of knee, absorb and transmit joint’s reaction forces

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18
Q

what are the 4 main anterior muscles acting on the knee

A

vastus lateralis, vastus intermedius, vastus medialis, rectus femoris

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19
Q

where does sartorius cross

A

at the hip to the knee

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20
Q

where does the IT band cross

A

at the lateral part of the knee

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21
Q

which hamstring muscle inserts at the fibula

A

biceps femoris

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22
Q

3 hamstring (posterior) muscle groups

A

semiteninosis: medial, semimembranosus, bicep femoris: lateral

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23
Q

what are the 3 medial adductors acting on the knee

A

adductor longus, adductor brevis, adductor magnus

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24
Q

what makes up the pes anserine muscle group

A

gracilis, sartorius, semitendinosus

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25
Q

what are 6 functions of the meniscus

A

deepen articulation and fill gaps when increase in load, improve lubrication for surfaces, provide shock absorption, increase passive joint stability, limit extremes of flexion and extension, serve as proprioceptive organ

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26
Q

what shape is the medial meniscus

A

c shape

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27
Q

what shape is lateral meniscus

A

o shape more round

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28
Q

if there is a tear in the red zone is the tissue more or less likely to heal on its own

A

more likely to heal on its own b/c more vascularization

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29
Q

MCL anatomy

A

medial epicondyle of femur connects to medial condyle of the tibia

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30
Q

LCL anatomy

A

lateral epicondyle of femur connects to head of fibula

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31
Q

posterolateral corner palpation

A

yes, you can find it; important for providing stability against forces throughout the knee

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32
Q

what is included in the posterolateral corner

A

popliofibular ligament, popliteus complex, arcuate ligament, fabella

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33
Q

where is suprapatella bursa located

A

b/w quad tendon and femur

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34
Q

where is prepatella bursa located

A

b/w patella and skin

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35
Q

what is the most commonly injured bursa of knee

A

prepatella bursa

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36
Q

deep infrapatella bursa

A

b/w patella tendon and tibia

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37
Q

superficial/subcutaneus intrapatella bursa

A

b/w patella tendon and skin

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38
Q

pes anserine bursa

A

b/w pes anserine group tendons and tibia

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39
Q

medial plica def

A

fold in synovial membrane, feels like a ridge, found medially kn knee

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40
Q

what is
ideal ROM of knee extension

A

0 deg

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41
Q

what is ideal ROM of hip flexion

A

135 deg

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42
Q

what is ideal ROM hip extension

A

30 deg

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43
Q

what is ideal ROM knee flexion

A

135 deg

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44
Q

what muscles are involved in knee flexion

A

quads, sartorius, gracilis, plantaris, popliteus, grastroc

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45
Q

what muscles are involved in knee extension

A

rectus femoris, vastus medialis, vastus intermedialis, vastus lateralis

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46
Q

4 pulses of lower leg

A

popliteal, posterior tibial, dorsal pedal

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47
Q

DTR of knee

A

L4= patella

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48
Q

where does LCL insert

A

fibular head

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49
Q

when doing girth measurements where does the 0 deg mark go

A

right on the joint line

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50
Q

what measurements should be done above joint line

A

5, 10, 15 cm

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51
Q

what is Q angle

A

b/w ASIS, midpoint of patella, tibial tuberosity

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52
Q

what is Q angle used for

A

quantify line of pull of quads and patellar tendon

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53
Q

normal Q angle for men and women

A

13 men, 18 women

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54
Q

what does a high Q angle create a risk factor for

A

ACL injury, especially in women

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55
Q

2 tests used for swelling of knee

A

sweep and ballotable patella test

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56
Q

sweep test+ test

A

reformation of edema on MEDIAL side

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57
Q

sweep test perform

A

apply pressure to knee on one side to get the fluid to move and bulge

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58
Q

what does sweep test indicate

A

swelling of knee

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59
Q

ballottable patella perform

A

one hand pushes fluid inferiorly towards the patella and the other hand pushes fluid superiorly towards the patella

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60
Q

+ test ballottable patella

A

bouncing, bobbing, floating of patella

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61
Q

what does ballottable patella test indicate

A

joint effusion

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62
Q

4 tests for patellofemoral dysfunction

A

clark’s sign, patella apprehesion, patellar tilt, medial and lateral patella glide

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63
Q

clark sign aka

A

c-sign

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64
Q

clark’s sign perform

A

one hand cups patella and other hand applies gentle downward pressure while patient is contracting quads

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65
Q

+ clark’s sign

A

pain and inability to hold quad contraction

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66
Q

what does clark’s sign indicate

A

patella femoral dysfunction or chondromalacia patella

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67
Q

is clark’s test usually reliable

A

sort of, can produce false positive

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68
Q

patellar apprehension test which direction does patella slide

A

laterally

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69
Q

+ patellar apprehension test

A

guarding of quads during contraction

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70
Q

patellar apprehension test indicates

A

laxity of medial retinaculum

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71
Q

+ patellar apprehension test may indicate

A

predisposition to subluxation/dislocation of patella

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72
Q

patellar tilt test description

A

grasp patella w/ index finger and thumb elevating lateral border

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73
Q

+ patellar tilt test

A

more than 15 deg = hypermobile and less than 0 deg hypomobile

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74
Q

what does 0 deg patellar tilt indicate

A

tightness of lateral restraints, more than 15 deg may predispose to anterior knee pain

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75
Q

medial and lateral patellar guide test description

A

supine with bolster under the knee and flexed 30 deg

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76
Q

how to perform medial and lateral patellar glide

A

move patella medial and laterally

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77
Q

+ medial and lateral glide test

A

medial: movement of 1-2 quadrants
lateral: movement of 0.5-2 quadrants

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78
Q

medial hypo and hypermobile of knee means

A

tightness of lateral retinaculum, laxity of lateral restriants

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79
Q

lateral hypo and hypermobile of knee means

A

tightness of medial restraints and patellofemoral ligaments, laxity of medial restraints

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80
Q

plica tests

A

medial plica test and stutter test

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81
Q

medial plica test description

A

flex knee 90 deg, internal rotate tibia, move patella medially and palpate capsule

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82
Q

+ medial plica test

A

reproduction of symptoms

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83
Q

when may clinican feel plica during medial plica test

A

around 45-60 deg flexion

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84
Q

stutter test description

A

cup hand over patella and patient extend knee

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85
Q

+ stutter test

A

irregular motion b/w 40-60 deg as plica passes medial condyle

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86
Q

what does stutter test look for symptoms of

A

irregular motion/stutter NOT pain increase

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87
Q

collateral ligament tests

A

valgus and varus stress tests

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88
Q

valgus stress test description

A

one hand supports medial tibia and then other grasps the knee laterally

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89
Q

+ valgus stress test

A

laxity, increase quality at end point, pain compared w/ uninvolved limb

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90
Q

what is the best position for testing valgus test

A

flex knee 25 deg to isolate MCL

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91
Q

varus stress test description

A

one hand on lateral portion of tibia and other hand grasps knee and applies varus force

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92
Q

varus stress test +

A

laxity, decrease quality of endpoint, pain increases

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93
Q

what ligament does varus stress test

A

LCL

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94
Q

what is best position for varus stress test

A

25 deg flexion

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95
Q

3 ACL tests

A

Lachman’s, modified lachman’s, anterior drawer

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96
Q

2 rotary ACL tests

A

slocum, pivot shift

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97
Q

what is best test for ACL

A

Lachman’s

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98
Q

what is position for knee to be in for Lachman’s

A

20-25 deg flexion

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99
Q

how is lachman’s test performed

A

draw tibia anteriorly while posterior pressure is applied to stabilize femur

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100
Q

+ Lachman’s test

A

increase amount of anterior tibial translation compared w/ opposite limb or lack of firm endpoint

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101
Q

lachman’s test indicative of

A

ACL sprain/tear

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102
Q

modified lachman’s test description

A

place bolster like towel under knee to assist in stabilizing femur

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103
Q

anterior drawer test description

A

hip flex 45 deg, knee extend 90 deg, tests ACL

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104
Q

anterior drawer test perform

A

draw tibia anteriorly, index finger used to palpate hamstring tendons and ensure they’re relaxed

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105
Q

+ anterior drawer test

A

increased amt anterior tibial translation compared w/ opposite limb or lack of firm endpoint

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106
Q

compare lachman’s and anterior drawer test

A

both for ACL. Lachman’s better clinical values. Anterior drawer= easier to perfrom

107
Q

slocum test set up

A

knee flexed 90 deg, tibia internally rotated 25 deg to test lateral capsule and tibia externally rotated to test medial capsule

108
Q

slocum test +

A

increased anterior translation or lack of firm endpoint

109
Q

anteriolateral instability= damage to

A

ACL, LCL, IT band, politeus, lateral meniscus

110
Q

anteriomedial instability=damage to

A

MCL

111
Q

pivot shift test description

A

patient supine w/ hip passively flexed to 30 deg, maintain 20 deg internal tibial rotation, increases force of internal rotation when knee is flexed

112
Q

pivot shift test +

A

tibia reduces or subluxes as the leg is flexed in 30-40 deg

113
Q

what does pivot shift test indicate

A

anterolateral rotary instability or ACL tear

114
Q

what are 2 PCL tests

A

posterior drawer and godfrey’s/posterior sag test

115
Q

+ posterior drawer test mean

A

increased posterior tibial translation and lack of firm endpoint

116
Q

posterior drawer test indicates

A

PCL sprain

117
Q

how to perform posterior drawer test

A

grasp tibia and put thumbs on both sides of patellar tendon, palpate hamstring tendons to make sure they are relaxed, push tibia posteriorly

118
Q

what will posterior drawer test feel like if PCL is sprained

A

it will feel empty

119
Q

posterior sag test/ godfrey’s test + test

A

unilateral displacement of tibial tuberosity

120
Q

posterior sag test perform

A

lift lower legs and hold them parallel to the table so the knees are flexed at 90 deg, observe tibial tuberosities

121
Q

what does posterior sag test indicate

A

PCL sprain

122
Q

external rotation/dial test positioning of pateint

A

patient should be prone

123
Q

dial test set up

A

knee flexed 30 deg then 90 deg and externally rotate the lower leg

124
Q

+ dial test

A

increase in external rotation greater than 10 deg compared w/ opposite side

125
Q

what does a difference of knee flexionat 30 deg but not at 90 deg for dial test indicate

A

injury of posterolateral corner of knee

126
Q

what does a difference of knee flexion at 30 and 90 deg for dial test indicate

A

trauma to PCL and related structures

127
Q

what does a difference in knee flexion at 90 deg but not 30 deg indicate for dial test

A

PCL sprain

128
Q

3 miniscal tests

A

McMurray’s, Apley’s compression/distraction, Thessaly test

129
Q

which meniscal test has the best clinical values

A

thessaly

130
Q

positioning of patient for McMurray’s test

A

patient supine

131
Q

set up for McMurray’s test

A

one hand supports lower leg, thumb and index finger are posteromedial and posterolateral on joint line, valgus stress applied when knee is flexed its available ROM

132
Q

+ McMuray’s test

A

pop, click, lock knee

133
Q

McMurray’s test indicates

A

meniscal tear

134
Q

apley’s compression/distraction test positioning

A

patient prone w/ knee flexed at 90 deg

135
Q

how is apley’s compression/distraction test performed

A

apply axial load to tibia w/ IR and ER of tibia, distract tibia away from femur while rotation is happening

136
Q

+ apley’s compression/distraction test

A

pain during compression that is eliminated during distraction

137
Q

what does apley’s test for

A

meniscal tear

138
Q

thessaly test set up

A

patient stand on one leg at a time, flex knee to 5 deg and rotate body to internally and externally rotate femur on the tibia, repeat at 20 deg

139
Q

+ thessaly test

A

joint line pain, clicking or locking

140
Q

2 IT band tests

A

noble’s compression and ober;s

141
Q

noble’s compression test set up

A

patient laying on side, 90 deg flexion, 45 deg hip flexion, knee supported and pressure applied while flexing and extending knee

142
Q

+ noble’s compression test

A

pain under thumb, common at 30 deg

143
Q

what does + noble’s compression test indicate

A

IT band friction syndrome

144
Q

ober’s test set up

A

patient side lying w/ knee flexed to 90 deg, one hand stabilizes pelvis and other supports lower leg, abduct and extend hip

145
Q

+ ober’s test

A

thighs remain abducted

146
Q

ober’s test indicates

A

IT band tightness: predisposing patient to IT band friction syndrome and/or lateral patellar malalignment

147
Q

wilson test set up

A

patient seated w/ knee flexed 90, actively extends knee w/ tibial IR for a few seconds, do ER of tibia after pain is felt

148
Q

wilson test + test

A

pain during extension w/ IR that is relived by ER

149
Q

what does wilson test indicate

A

osteochondral defect or osteochondritis dissecans on medial femoral condyle

150
Q

myositis ossificans def

A

calcification of bone deposits in muscle

151
Q

what causes myositis ossificans

A

inflammatory response to quad contusion

152
Q

tx myositis ossificans

A

ROM exercises, NSAIDs, refer for imaging

153
Q

s/s myositis ossificans

A

decreased ROM, pain, swelling, tender

154
Q

quad strain most common muscle

A

rectus femoris

155
Q

MOI quad strain

A

muscle overload, sprinting, kicking, improper warm up

156
Q

s/s quad strain

A

immediate pain, discoloration, pain w/ extension, pain w/ flexion, swelling

157
Q

tx quad strain

A

avoid stretching in early stages especially for 48 hours post-injury

158
Q

hamstring strain MOI

A

usually rounding curve or muscle overload

159
Q

s/s hamstring strain

A

immediate pain, grabbing back of leg, swelling, pain w/ extension

160
Q

tx hamstring strain

A

avoid stretching in early stages, RICE, NSAID

161
Q

popliteal strain MOI

A

hyperextension

162
Q

popliteal strain s/s

A

pain w/ hyperextension, pain w/ initiation of knee flexion, IR, behind knee

163
Q

popliteal strain tx

A

modify activity, RICE, NSAID

164
Q

hamstring tendonitis location on leg

A

can be proximal or distal

165
Q

MOI hamstring tendonitis

A

insidious, overuse, repetitive activity

166
Q

s/s hamstring tendonitis proximal

A

pain in gluteal fold, tender, pain w/ long strides

167
Q

s/s hamstring tendonitis distal

A

clicking behind knee, pain w/ knee flexion

168
Q

popliteus teninitis MOI

A

insidious onset, overuse

169
Q

risk factors politeus tendinitis

A

excessive pronation, posterior knee instability

170
Q

s/s popliteus tendinitis

A

pain in fossa radiating to LCL, pain when running downhill, swelling, crepitus, pain w/ knee flexion

171
Q

tx popliteus tendinitis

A

strengthening hip musculature, RICE, NSAID

172
Q

pes anserine tendinitis MOI

A

run, cycling, insidious, overuse, knee flexion

173
Q

s/s pes anserine tendinitis

A

pain at medial tibial plateau, anterior inferior medial knee pain, crepitus, swelling, pain w/ knee flexion

174
Q

pes anserine tendinitis tx

A

ratio of stretching and strengthening, RICE, NSAIDS

175
Q

def fat pad contusion/impingement

A

pad is impinged b/w femur and tibia

176
Q

MOI fat pad contusion

A

hyperextension, direct blow

177
Q

s/s fat pad contusion

A

pain on side of patella tendon, swelling

178
Q

most commonly injured bursa

A

prepatella bursa= housmaid’s knee

179
Q

MOI bursitis

A

direct contact, falling on knee, kneeling for increased duration

180
Q

s/s bursitis

A

pain, swelling, redness

181
Q

medial plica syndrome def

A

inflammation of medial plica, friction caused by rubbing medial femoral condyle

182
Q

MOI medial plica

A

trauma to knee, overuse, insidious

183
Q

s/s medial plica

A

anteromedial knee pain, click, pop, lock

184
Q

+ test medial plica

A

medial synovial plica, stutter

185
Q

what does medial plica sometimes look like

A

meniscal tear

186
Q

tx medial plica syndrome

A

ultrasound, laser, injection

187
Q

popliteal/baker’s cyst description

A

fluid filled cyst behind knee

188
Q

MOI popliteal/baker’s cyst

A

meniscal tear, arthritis, accumulation of fluid

189
Q

s/s popliteal cyst

A

bulge behind knee, tightness, inability to fully flex

190
Q

IT band friction syndrome def

A

friction b/w IT band and lateral femoral condyle

191
Q

MOI IT band

A

insidious, overuse, downhill running

192
Q

risk factors IT band syndrome

A

IT band tightness, genu varum, excessive pronation

193
Q

s/s IT band syndrome

A

pain lateral femoral condyle, pain w/ stairs, radiate to IT band

194
Q

+ tests for IT band

A

noble compression, ober

195
Q

who is IT band friction syndrome most common in

A

runners, cyclists

196
Q

patella tendonitis MOI

A

insidious, overuse, excessive jump/run

197
Q

risk factors patella tendonitis

A

patellar maltracking

198
Q

s/s patella tendonitis

A

pain inferior of patella w/ knee extension, tight quad, tight IT band

199
Q

tx patella tendonitis

A

improvement of jump/landing, good ratio of stretching and strengthening

200
Q

patella tendon rupture

A

overload of extensor mechanism, rapid quad contractions

201
Q

risk factors for patella tendon rupture

A

previous tendonitis, tendon degeneration, steroid injections

202
Q

s/s patella tendon rupture

A

immediate pain, displacement of patella, swelling, pop

203
Q

treatment patella tendon rupture

A

immobilize, reffer

204
Q

which knee condition should you use diagnosis of exclusion

A

patellofemoral pain syndrome

205
Q

MOI patellafemoral pain syndrome

A

change in surface, activity level or intensity

206
Q

risk factors patellafemoral pain syndrome

A

increased Q angle, patella alta or baja, female

207
Q

s/s patellafemoral pain syndrome

A

anterior pain, clicking, giving out, pain w/ glide

208
Q

+ patellafemoral pain syndrome tests

A

clarke’s sign, ober’s, patellar tilt

209
Q

tx patellfemoral pain syndrome

A

strengthening hip and knee muscles

210
Q

chondramalacia patella condition def

A

softening, roughening, degeneration of articular surface of patella

211
Q

MOI chondramalacia patella

A

patellar misalignment, direct or repetitive trauma

212
Q

s/s chondramalacia patella

A

anterior knee pain, crepitus

213
Q

+ chondramalacia patella test

A

clarke’s

214
Q

tx chondramalacia patella test

A

modify activity, strengthen hip and knee muscles

215
Q

patellofemoral instability/subluxation MOI

A

direct trauma, knee extension

216
Q

risk factors patellofemoral instability

A

shallow groove, excessive Q angle, hypermobile patella, female

217
Q

s/s patellofemoral instability

A

sharp pain, knee gives out, deformity, swelling

218
Q

+ test patellofemoral instability

A

patella tilt test, patellar apprehension

219
Q

tx patellofemoral insability

A

reduce, immobilize, refer, brace

220
Q

patellar dislocation MOI

A

lateral blow, rapid change of direction w/ foot

221
Q

risk factors patellar dislocation

A

patella alta, history of previous problems

222
Q

s/s patellar dislocation

A

immediate and sharp pain, deformity, swelling, pain

223
Q

tx patellar dislocation

A

immobilize, reduce, refer

224
Q

patellar fracture MOI

A

direct blow, hyperflexion

225
Q

s/s patellar fracture

A

immediate pain, unable to bear weight, deformity, swelling

226
Q

+ test patellar fracture

A

tap test

227
Q

tx patellar fracture

A

immediate referral, x-ray

228
Q

osgood-schlatter disease description

A

apophysitis at tibial tuberosity, usually adolescents

229
Q

MOI osgood-schlatter

A

stress on growth plate

230
Q

MCL sprain MOI

A

valgus force, ER of tibia

231
Q

MCL s/s

A

pain, decreased flexion/extension

232
Q

tx MCL sprain

A

brace, RICE, NSAID

233
Q

LCL sprain MOI

A

varus force

234
Q

LCL sprain s/s

A

pain, swelling, decreased flexion/extension

235
Q

tx LCL sprain

A

refer, RICE

236
Q

ACL sprain MOI

A

rotation of knee, valgus force, hyperextension

237
Q

risk factors ACL sprain

A

female, menstral cycle, increased Q angle

238
Q

s/s ACL sprain

A

feeling pop, buckling, pain w/ joint, ACL clutch

239
Q

allograft vs autograft ACL repair

A

donor ACL (less common), use piece of body for repair

240
Q

PCL sprain MOI

A

direct blow to anterior tibia that drives tibia posteriorly, hyperflexion, hyperextension

241
Q

PCL sprain usually happens

A

car accident or falling on knee

242
Q

s/s PCL sprain

A

pain w/i knee joint, may not pop

243
Q

is PCL usually surgical

A

no, usually not surgical

244
Q

rotary insability

A

multiple major structures involved

245
Q

straight insability

A

one major structure involved

246
Q

what test is used to differentiate b/w rotary and straight instability

A

slocum test

247
Q

knee dislocation def

A

rupture of at least 3 of major ligaments: ACL, PCL and at least one more

248
Q

MOI knee dislocation

A

hyperextension, rotation, varus force

249
Q

s/s knee dislocation

A

pain, deformity, popping, non-weight bearing, swelling

250
Q

tx knee dislocation

A

immobilize and immediate transportation to hospital

251
Q

risk of knee dislocation

A

neurovascular injury

252
Q

meniscus tears MOI

A

tibial rotation, hyperflexion, degeneration

253
Q

s/s meniscus tear

A

pain along medial or lateral joint, click, lock, pop, pain w/ flexion/extension

254
Q

OCD description

A

fracture of articular cartilage and underlying bone

255
Q

MOI OCD

A

repetitive trauma, compressive force, rotational force

256
Q

s/s OCD

A

increased pain w/ weight bearing, pain decreased w/ rest, joint line tenderness

257
Q

tx OCD

A

modify activity, unload brace, surgery

258
Q

osteoarthritis MOI

A

repetitive stress, poor mechanics, injury history, gradual onset

259
Q

osteoarthritis risk factors

A

female, obesity, FH

260
Q

s/s osteoarthritis

A

pain in morning, baker’s cyst, compensatory gait

261
Q

tx osteoarthritis

A

injection for lubrication, knee replacement surgery

262
Q

femur fracture MOI

A

direct blow

263
Q

femur fracture s/s

A

immediate and severe pain, muscle spasm, deformity

264
Q

tx femur fracture

A

immobilize and transport to hospital

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