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MSK 2 > Lower Leg > Flashcards

Lower Leg Flashcards

(75 cards)

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1
Q

unimalleolar fracture

A

medial OR lateral malleolus

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2
Q

Bimalleolar fracture

A

medial AND lateral malleolus

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3
Q

Trimalleolar fracture

A

both malleoli and posterior rim of tibia

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4
Q

Common MOI for distal tibia/fibula fractures

A

axial or rotational loading

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5
Q

Common MOI for calcaneus fractures

- What else can be injured during MOI

A

fall from height

- lumbar vertebra can also be injured/fractured after fall from height

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6
Q

Common MOI for talus fractures

A

forced ankle dorsiflexion

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7
Q

Forced _______ can cause avulsion fracture at navicular

A

eversion

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8
Q

Common MOI for metatarsal fractures

A

direct trauma - direct impact like dropping something heavy on the foot

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9
Q

Common MOI for phalangeal fractures

A

stubbing and direct trauma

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10
Q

pediatric physeal ankle fracture has worse prognosis if:

A
  • > 1 week prior to reduction
  • larger gap
  • gap >/= 3 mm for Types 1 and 2
  • younger patients
  • higher risk of physics arrest in types 3-5
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11
Q

Why are fat grafts used during physeal fractures? Which type?

A

to stop physeal arrest

- used during type 5 if recognized early

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12
Q

cast time after physeal fracture type 1 and 2 reduction

A

4-6 weeks

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13
Q

cast time after physeal fracture type 3 and 4 reduction

A
  • long leg NWB cast 1-4 weeks

- boot from week 5-8 (NWB for first 2 weeks)

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14
Q

How long is a patient NWB after type 3 or 4 physeal fracture reduction?

A

~6 weeks

- long leg NWB cast wk 1-4 the boot for weeks 5-8 w/ NWB for 2 weeks

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15
Q

With which physeal fracture is hardware typically removed after reduction?

A

If ORIF w/ Type 3 (> 2mm displacement)

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16
Q

What is Talipes Equinovarus?

A

clubfoot

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17
Q

characteristics of clubfoot. Who is more likely to get it?

A
  • plantarflexed heel
  • inversion STJ/varus rearfoot
  • metatarsal adduction/varus forefoot

males > females and common bilaterally

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18
Q

What is rearfoot varus? What motion is limited? Where is subtalar in relation to midline?

A
  • inversion of calcaneus
  • limited pronation (DF, abduction, eversion)
  • subtalar is farter from midline
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19
Q

What is rearfoot valgus? What motion is limited? Where is subtalar in relation to midline?

A
  • eversion of calcaneus
  • excessive pronation and limited supination (PF, adduction, inversion)
  • subtalar joint is closer to midline
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20
Q

What is forefoot varus? What muscles are typically weak and what motion does this cause at the knee?

A

Inversion of the forefoot
- big toe is higher off ground in subtalar neutral

PF are weak and causes knee valgus

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21
Q

What is forefoot valgus? What is it commonly found w/?

A

Eversion of the forefoot

  • pinky toe is higher than ground in subtalar neutral
  • commonly found w/ rearfoot varus
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22
Q

pes planus

A

flat foot

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23
Q

What is rigid/congenital pes planus?

A

arch stays flat in weight bearing and non-weight bearing

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24
Q

what is acquired/flexible pes planus? What is the cause?

A

arch returns in non weight bearing

- laxity of medial arch stabilizers (tib posterior)

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25
pes cavus
longitudinal arches accentuated
26
hallux valgus
- medial deviation of 1st metatarsal and lateral deviation of great toe
27
What gait deviations occur w/ hallux valgus?
- collapse of medial arch - navicular drop - pronation during push-off = less rigid foot
28
hallux rigidus and its characteristics
arthropathy of great toe - pain - swelling - abnormal bone growth at dorsal aspect of 1st MTP
29
History and symptoms of hallux rigidus
History - arthropathy (RA, gout, etc.) - trauma to distal metatarsal - repetitive great toe extension Symptoms - insidious onset, progressive - 1st MTP pain
30
What specific activities would be difficult w/ hallux rigidus?
- walking up hill - stair ambulation - terminal stance - will have lift off instead of push off during gait
31
Physical exam of hallux rigidus
- limited great toe extension ROM at MTP (hard end feel) - secondary gait alterations (limited terminal stance/push off) - abrasion of skin superficial to dorsal 1st MTP - swelling - palpable osteophyte complex/tenderness
32
What is the most common ligament sprained during an inversion ankle sprain?
ATFL - anterior tibiofibular ligament
33
What other injuries must be included in differential diagnosis during lateral ankle sprains?
- avulsion fracture of 5th met styloid process (fibularis brevis) - osteochondral lesion - malleolar fracture
34
History and Symptoms of lateral ankle sprain
History - 3rd decade of life (20s) - common running/athletes injury - MOI: forced ankle inversion Symptoms - lateral ankle pain/swelling - painful w/ activities that place foot in supinated position
35
Physical exam findings of lateral ankle sprain
- antalgic gait (decreased stance time and decreased end ROM) - increased figure 8 measurement - local warmth/tenderness - pain w/ inversion ROM
36
What special tests would be positive w/ lateral ankle sprains?
- anterior drawer test - medial talar tilt stress test - reverse anteriolateral drawer test
37
History and symptoms of medial ankle sprain
History - MOI: forced ankle eversion Symptoms - medial ankle pain/swelling - painful w/ activities that place foot in pronated position
38
Physical exam findings of medial ankle sprain
- antalgic gait - increased figure 8 - warmth/tenderness distal to medial malleolus - pain w/ pronation/eversion ROM
39
What special test would be positive for medial ankle sprain?
lateral talar tilt stress test
40
What injury would you suspect if patient reports pain w/ activities that place foot in supinated position? Pronated position?
supinated foot - lateral ankle sprain pronated foot - medial ankle sprain
41
What ligament is typically involved in medial ankle sprains? Lateral ankle sprains?
medial - deltoid ligament lateral - ATFL
42
What is the concern w/ syndesmotic sprains?
chronic instability/degenerative arthropathy
43
Common MOI for syndesmotic sprain
- forced DF - forced eversion of talus - forced ER of talus wedge of talus pushes apart the mallelous - someone trying to turn quickly on a planted foot
44
Symptoms of Syndesmotic sprain
- pain in distal leg - aggravated w/ stair decent/walking up hill/ squatting - aggravated w/ DF/any motion where tibial advancement occurs
45
Physical exam of syndesmotic sprain
- early heel-off in stance phase (trying to avoid tibial advancement) - swelling/tenderness anterior tibiofibular joint - pain at end-range DF ROM
46
What special tests would be positive for a syndesmotic sprain?
- fibular translation test - excessive laxity - external rotation test - syndesmosis squeeze test
47
History and symptoms of chronic ankle instability (CAI)
History - recurrent inversion sprains - fibular muscle weakness - impaired proprioception Symptoms - often asymptomatic between ankle sprains - feelings of ankle giving away - ankle weakness - difficulty/inability to run (worse on un-even surfaces)
48
Physical exam of chronic ankle instability (CAI)
diminished proprioceptive function of ankle
49
What is the cause of anterior ankle impingement?
soft tissue or bony spur formation at the anterior talocrural joint
50
History and symptoms of anterior ankle impingement
History - recurrent/high trauma ankle sprains Symptoms - anterior ankle pain - anterior ankle swelling - painful w/ activities that place foot in DF position
51
Physical Exam findings of anterior ankle impingment
- antalgic gait/early heel off - tenderness/palpable mass anterior tibiotalar joint - pain/limited end range DF (A/PROM)
52
What special tests would be positive w/ anterior ankle impingement?
forced DF test
53
fibulari longus/brevis tendinopathy history and symptoms
History - repeated inversion injuries - anatomic abnormalities Symptoms - pain posterior to lateral malleolus - subluxation of fibularis tendons
54
fibulari longus/brevis tendinopathy physical exam
- swelling/bruising lateral ankle - pain w/ AROM < resistive testing ankle eversion and pronation - pain w/ end-range inversion/supination (A/PROM) - tenderness fibularis longus/brevis tendons
55
tibialis posterior tendinopathy history and symptoms
History - insidious onset, progressive - concomitant (at the same time) deltoid ligament injury - sports that require quick directional change Symptoms - pain near area of insertion at navicular - pain proximal to medial malleolus
56
tibialis posterior tendinopathy physical exam
- pronated foot/pes planus - navicular drop - tenderness/ swelling at navicular and proximal to medial malleolus - painful resisted inversion and PF - painful eversion and DF ROM
57
Feiss angle of a patient w/ pes planus? pes cavus?
pes planus - < 130 deg pes cavus - > 150 deg
58
Achilles tendinopathy history and symptoms
History - common MOI: intesne eccentric loading on triceps surae - running injury Symptoms - pain near achilles insertion - morning stiffness
59
Achilles tendinopathy physical exam
- tenderness/swelling/hypertrophy/palpable defect at achilles tendon - pain w/ DF ROM - Pain w/ AROM < resisted PF
60
Physical exam of achilles tendon rupture
- posterior calf tenderness/swelling/palpable defect - pain w/ DF ROM - weak/absent active/resisted PF
61
What special test would be positive for achilles tendon rupture?
thompson test
62
Risk factors for plantar faciitis
- limited DF ROM | - high BMI in non-athletic populations
63
Symptoms of plantar faciitis
- plantar medial heel pain that is worse in morning and after prolonged w/b activity - pain w/ terminal stance
64
plantar fasciitis physical exam
- early heel off in stance - guarding of tricpes surae - swelling/tenderness origin of plantar fascia (heel spur) - pain w/ PROM DF of ankle and toes (windlass test)
65
Metatarsalgia history and symptoms
History - health condition that increase stress on the met head Symptoms - aggravated during prolonged weight bearing activities, mid terminal stance phases
66
Physical exam findings of metatarsalgia
- concomitant health conditions - antalgic gait/diminished push-off - observable calluses on plantar foot - tender plantar met heads - pain during mid and terminal stance
67
History and symptoms of interdigital neuroma
History - insidious onset - DF injury of toes Symptoms - pain in area of met heads and corresponding web space
68
Physical exam of interdigital neuroma
- tenderness | - + foot squeeze test
69
What nerve is entraped with tarsal tunnel syndrome?
posterior tibial nerve | - intrinsic muscles of plantar foot
70
symptoms of tarsal tunnel syndrome
- loss of plantar sensation - pain and paresthesia at the plantar foot - increasing intensity of symptoms w/ ankle DF activities
71
physical exam findings of tarsal tunnel syndrome
- antalgic gait - limited/painful squat - signs of invertor tendinopathy - diminished plantar foot sensation - weakness of intrinsic - limited ROM, painful DF and eversion
72
Who is more likely to develop tarsal tunnel? What is the average age?
females have a greater incidence average age of 47 yyears
73
Anterior ankle impingement CPR requirements
5/6 of the following: - anteriolateral ankle joint tenderness - anteriolateral ankle joint swelling - pain w/ forced DF - pain w/ single-leg activities - pain w/ activites - absence of ankle instability
74
What exercises can help with tib posterior tendinitis?
towel scrunches and marble pick ups w/ foot
75
Interventions for plantar faciitis
manual joint mobs - anterior and posterior talocruel to increase DF ROM triceps surae stretching

MSK 2 (8 decks)

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