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Musculoskeletal Lower Extremity Flashcards

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1
Q

Important factors that can point you toward a differential diagnosis

A

. Chief complaint
. Age
. Biological sex
. Vital signs

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2
Q

Septic joint

A

. Acute onset of mono articular joint pain, erythema, heat, and immobility
. Fever, chills rigor
. Failure to start antibiotics in first 24-48 hrs causes subchondral bone loss and permanent joint dysfunction

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3
Q

Most common route of entry in a joint for infection

A

. Contiguous, direct inoculation, and hematogenous

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4
Q

Risk factors for contiguous spread of infection in joint

A 
. Cellulitis 
. Cutaneous ulcers
. Osteomyelitis
. Septic bursitis 
. Abscess
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5
Q

Risk factor for direct inoculation of joint infection

A 
. Previous intraarticular injection 
. Prosthetic joint 
. Recent surgery 
. Arthrocentesis
. Trauma
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6
Q

Risk factors for hematogenous spread in joint infection

A 
. DM
. HIV
. Bacteremia
. Immunosuppressive meds 
. IV drug abuse 
. OA
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7
Q

Synovial fluid analysis

A

. Helpful to distinguish crystal arthropathy from infectious arthritis
. Synovial fluid sent for WBC count (usually over 50,000 per mm3)
. Isolation of causative agent of sepsis is essential for selecting antibiotic therapy

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8
Q

Arthalgia

A

. Joint pain

. Discomfort form w/in or surrounding joint

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9
Q

What to inspect for in musculoskeletal examination

A

. Joint symmetry, alignment, or bony deformities
. Surrounding tissues for skin changes, nodules, muscle atrophy, or crepitus
. Assess any degenerative or inflammatory changes, especially swelling, warmth, tenderness, or redness

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10
Q

Psoas syndrome

A

. Muscular strain, spasm, or flexion contracture
. Caused from being in position that allows prolonged shortening of psoas following sudden lengthening (desk work, road trip, trauma)
. Stooped posture, back/butt pain
. Tests: pos. Thomas test, non-neutral upper lumbar somatic dysfunction

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11
Q

Trendelenberg sign

A

. Weak abductor

. Could be caused by bone length, position (internal/externally rotated), gross deformity

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12
Q

Iliac crest anatomical landmark

A

L4

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13
Q

Pubic tubercle anatomical landmark

A

. Find greater trochanter then move thumbs medially at same level as trochanter

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14
Q

Antalgic

A

. Shortened stance phrase on affected side

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15
Q

Important bony structure to palpate on lower extremity exam

A

. Joint line
. Paella
. Tibial tubercle

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16
Q

Soft tissue structures to palpate in lower extremity exam

A 
. Pes anserine bursa
. Patellar tendon
. Quad tendon
. Iliotibial band
. Collateral ligaments
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17
Q

Patellar tendon tear results from ___

A

. Direct impact from a fall/blow and jumping
. Patellar tendinitis
. Chronic disease
. Steroid use

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18
Q

Patellar tendon tear symptoms

A 
. Tearing/popping sound
. Pain, swelling
. Unable to straighten knee
. Indentation where tendon tore 
. Displacement of patella 
. Difficulty walking due to knee buckling
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19
Q

Ankle sprain

A

. Inversion sprains 75% of the time
. Occur in plantar flexion most of the time (dec. ankle stability because ant. Aspect of talus is no longer wedged btw malleoli increasing mobility)

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20
Q

Spine

A

. Central supporting structure of trunk and back
. Can cave curves of cervical spine and lumbar spine
. Convex curves of thoracic and sarcococcygeal spine
. Help to distribute body weight to pelvis and lower extremities

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21
Q

Cervical lordosis

A

Abnormal straightening of the concavity

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22
Q

Thoracic hyperkyphosis

A

Hyper-convexity of thoracic curvature

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23
Q

Lumbar hyperlordosis

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A

Hyper-concavity of lumbar curvature

24
Q

Spine ROM and muscles that caus it

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A

. Muscles: psoas, quad lumborum, internal and external obliques, abs
. As flexion proceeds, lumbar concavity flattens
. Fl/extension, side Bending, rotation

25
Muscles in charge of spine extension
. Erector spinae and transversospinalis mm. | . Dec/ mobility common in OA and other inflammatory processes
26
Muscles in charge of sidebending and rotation
. Combo of flexion and extension muscle groups
27
Stance
. When foot is on ground and bears weight 960% walking cycle) . Hip problems appear during this phase
28
Swing
. When foot moves forward and doesn’t bear weight (40% walk cycle)
29
Width of the base when walking
. 2-4 inches heel to toe
30
Hip
. Ball and socket . High strength and stability . Essential for weight bearing . Rounded femur head articulates w/ cup-like cavity of acetabulum . Muscles crossing joint and inserting below femoral head provide leverage for femur movement
31
FABER test
. Evaluates hip and SI joint . Pos: post. Pain in SI joint, lumbar spine, or hip . Groin pain w/ this is sensitive for intra-articular pathology
32
Hamstrings motions
. Flexors of knee joint | . Extensors of hip joint
33
Seven structure of knee important to examine
. Med. and lat. menisci . Med., lat., ant., and post. Collateral ligaments . Patellar tendon
34
Bursas of the knee
. Suprapatellar . Prepatellar (beneath patella) . Infrapatellar . Pes anserine (on med. side at distal attachment of med. collateral ligament)
35
Baker’s cyst
. Large accumulation of fluid in popliteal fold (behind knee joint)
36
Bulge sign
. Test for knee joint effusions . Milk patella and fluid downward . Apply med. pressure. . Tap and watch for fluid wave
37
Allotment of patella
. Compress suprapatellar pouch and push patella sharply against femur . Palpable fluid wave returning into pouch is pos. For major effusion
38
Patellar grind test
. Pt supine w/ knees extended and relaxed . Apply downward force onto patella and move in all directions . Pos if pain and/or crepitus
39
Valgus
. Distal part deviated more lateral from midline
40
Varus
Distal part deviated for med. from midline
41
Valgus stress test
. Tests MCL . Pt supine, grip ankle w/ one hand and put other hand on lat. aspect on knee . Apply valgus force . Pos: joint laxity in medial aspect
42
Varus stress test
. tests LCL . Pt supine, grip ankle w/ other hand on med. aspect of knee . Apply varus force . Pos: joint laxity in lat. aspect
43
Mcmurray’s for lat. meniscus
. Start with knee flexed . Internally rotate for and apply varus stress at knee . Slowly extend knee . Pos: click at joint or tenderness along joint line in lat. aspect
44
McMurray for med. meniscus
. Pt. Supine w/ knee flexed . Externally rotate foot and apply valgus stress at knee . Slowly extend knee . pos: clicking or tenderness at med. joint line
45
Ant. And post. Drawer test
. Knee bent . Fingers behind knee, thumbs on tibial plateau . Either pull tibia ant. Or push post. . Pos: laxity in a direction compared w/ opposite knee
46
Lachman test
. Knee bent . Grab calf w/ dominant hand, thumb over ant. Joint line . Other hand stabilizes distal femur . Pull tibia ant. In sudden firm motion . Pos: laxity (>6-8mm shift) compared w/ opposite knee
47
Sag sign
. Injury to PCL causes inc. post. Knee laxity | . Drop back in pos. Direction upon femur
48
Accessory motions of foot
. Side-to-side glide . Rotation . Ab/duction . Only occur when joint is in plantar flexion
49
Lateral longitudinal arch of ankle
. Firm osteoid structure . Formed by calcaneous, cuboid, and 4th-5th metatarsals . Limited mobility and built to transmit weight
50
Medial longitudinal arch of ankle
. Higher and more mobile (calcaneous, talus, navicular, cuneiform, and 1st 3 metatarsals) . No firm osseous support . Can be inc. or reduced to meet needs of motion and terrain
51
Medial ligaments of ankle
. Deltoid ligament: fans out from med. malleolus to talus and prox. Tarsal bones . Protects against stress from eversion
52
Lateral ankle ligaments
. ATF . Calcaneofibular ligament . Post. Talofibular ligament . Protects against stress from inversion
53
Thompson test
. For Achilles rupture . Have patient get up on knees w/ feet hanging off table . Squeeze gastroc and soleus . Plantarflexion should occur, if not Achilles is ruptured
54
Diagnostic tests for lower extremity injuries
. Labs: CBC, erythrocyte sedimentation ate . Radiography: suspect fracture/dislocation . MRI for soft tissue issues . Ultrasound: bursitis, joint effusion, image guided injections . Arthrocentesis: joint fluid looks at for cell count, glucose and protein, bacterial culture, and crystals
55
Salter-Harris fractures
/ pediatric fractures involving growth plate . S: straight across (type I): complete break . A: above (type II): break above physis and prox. Through metaphysis . L: (III): break through physis and distally through epiphysis . TE: (IV): break through everything . R: cRush injury

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