Term
| What is the most sensitive test for ACL insufficiency? |
|
Definition
|
|
Term
| Performed with the knee flexed 90 deg, is negative in 50% of acute ACL tears |
|
Definition
|
|
Term
| Flexion and valgus force on the extended knee with the foot in internal rotation results in reduction of the knee with a “clunk” at 20-30 deg flexion |
|
Definition
|
|
Term
| Avulsion fracture of the lateral capsular margin of the tibia |
|
Definition
| lateral capsular sign or Segond fx (ACL tear) |
|
|
Term
| MC adverse outcome of ACL tear |
|
Definition
| recurring instability leading to degenerative disease and possible meniscal tears |
|
|
Term
| Required physical therapy after ACL injury |
|
Definition
| Full extension and flexion as soon as pain and swelling permit (extension more important), if pt is unable to perform rehab then ACL recon is not recommended. |
|
|
Term
| ACL functional bracing may be helpful with who? |
|
Definition
|
|
Term
| Most sensitive test for PCL injury |
|
Definition
|
|
Term
| What test may reveal anterior tibial displacement with quadriceps contraction? |
|
Definition
| Quadriceps active drawer test (PCL injury) |
|
|
Term
| TXT of isolated PCL injury |
|
Definition
| structured program that initially concentrates on resolving swelling and restoring ROM (emphasis on quads) |
|
|
Term
| MC mech of injury in a MCL tear |
|
Definition
| valgus force without rotation (football clipping injury) |
|
|
Term
| MC mech of injury in a LCL tear |
|
Definition
|
|
Term
| T or F? most pts can ambulate and return to play remainder of game after LCL/MCL injury? |
|
Definition
|
|
Term
| Most pts have swelling in and around the injured ligament, but the presence of a significant knee effusion indicate an associated what? |
|
Definition
|
|
Term
| Laxity in full extension indicates what when assessing a MCL/LCL tear? |
|
Definition
| more extensive injury (prob ACL/PCL + joint capsular injury) |
|
|
Term
| Avulsion fx from the femoral origin of the MCL or fibular insertion of the LCL |
|
Definition
|
|
Term
|
Definition
| Non-operative-RICE, NSAIDs, crutches, bracing as needed for each grade sprain |
|
|
Term
| Txt of grade III LCL tear? and why? |
|
Definition
| Surgery,as it often involves a tear of the posterolateral capsular complex, to avoid late instability |
|
|
Term
| What tear disrupts the mechanics of the knee, leading to varying degrees of symptoms, predisposing the knee to degenerative arthritis? |
|
Definition
|
|
Term
| Difference between younger athlete and elderly presentation for meniscal tear |
|
Definition
| Young athlete: significant twisting injury/trauma. Older pts: little or no trauma, maybe just simply standing from a squatting position |
|
|
Term
| The two PE tests for Meniscal tear? |
|
Definition
|
|
Term
| What is the biggest worry of Osteochondritis Dissecans? |
|
Definition
| the osteonecrotic fragment completely fragment and become a loose body in the joint. |
|
|
Term
| Best imaging study to assess osteochondritis Dissecans? |
|
Definition
|
|
Term
| Txt of OCD when fragment is loose? |
|
Definition
| remove free fragment and debride the articular surface defect |
|
|
Term
| Which compartment of the knee is the most frequently involved in OA? |
|
Definition
| Medial compartment, leading to a genu varum deformity |
|
|
Term
| imaging study to assess OA of knee? |
|
Definition
|
|
Term
| Presenting symptoms of bipartite patella? |
|
Definition
| usually asymptomatic, incidental finding on x-ray, but may progress to anterior knee pain |
|
|
Term
|
Definition
| modify activity, period of protected weight bearing, most respond to non-operative treatment |
|
|
Term
| 5 bursal sacs involved in the knee |
|
Definition
| Pre-patellar; Supra-patellar; Infra-patellar; Pes Anserine; Iliotibial tract |
|
|
Term
|
Definition
| Pre-patellar bursitis (chronic inflammation MC due to chronic kneeling) |
|
|
Term
| anatomical location of the supra-patellar bursa? |
|
Definition
| between the anterior surface of the lower part of the femur and the deep surface of the quadriceps femoris |
|
|
Term
| anatomical location of the infra-patellar bursa? |
|
Definition
| between the upper part of the tibia and the patellar ligament |
|
|
Term
| anatomical location of the pes anserinus bursa |
|
Definition
| under the insertion site of the sartorius, gracillis, and semitendinosus muscles on the medial flare of the tibia just below the tibial plateau |
|
|
Term
| location of iliotibial tract bursitis |
|
Definition
| lateral knee just superior to the joint line |
|
|
Term
| acceptable terms for anterior knee pain |
|
Definition
| Patellofemoral pain syndrome, retropatellar pain syndrome (not chondromalacia) |
|
|
Term
| MC clinical symptoms of anterior knee pain |
|
Definition
| diffuse, aching, anterior knee pain that is worse with sitting (theater sign), climbing stairs, jumping or squatting |
|
|
Term
| Describe the sign of increased femoral anteversion |
|
Definition
| when a patient walks the patellae point towards each other |
|
|
Term
|
Definition
|
|
Term
| test preformed to evaluate the possibility of patellar instability |
|
Definition
| patellar apprehension sign (with the knee extended, translate the patella laterally and flex the knee to 30 deg) |
|
|
Term
| Physical exam finding in Patellar/quadriceps tendinitis |
|
Definition
| normal knee motion but pain with extension |
|
|
Term
| initial txt for patellar/quadriceps tendinitis |
|
Definition
| period of relative rest from aggravating activities, NSAIDs but NO STEROIDS |
|
|
Term
| 2nd phase of txt for patellar/quadriceps tendinits |
|
Definition
| regaining pain-free ROM, flexibility of quads and hamstrings, and strength |
|
|
Term
| 3rd phase of txt for patellar/quadriceps tendinitis |
|
Definition
| gradual resumption of activities that caused the symptoms |
|
|
Term
| Loss of extension of the knee? |
|
Definition
| quadriceps and/or patella tendon rupture |
|
|
Term
| What two tests MUST a pt perform with all acute knee injuries? |
|
Definition
| fully extend their knee; perform a straight leg raise |
|
|
Term
| Patella higher than usual location? |
|
Definition
| Patella alta (rupture of patella tendon) |
|
|
Term
| Patella lower than its usual location? |
|
Definition
| patella baja (rupture of quad tendon) |
|
|
Term
| Txt of patella/quad tendon rupture or displaced patella fx? |
|
Definition
| Surgery (delay in txt significantly increases the difficulty of surg and may compromise outcome) |
|
|
Term
| Which plica most often becomes pathologic? |
|
Definition
|
|
Term
| How can you palpate a pathologic plica? what would you feel? |
|
Definition
| with the knee flexed; it would feel like a thickened band |
|
|
Term
|
Definition
| NSAIDS, modify activity, injections of local anesthetic and corticosteroids may be diagnostic and therapeutic |
|
|
Term
| 4 compartments of the leg (which is most commonly affected by compartment syndrome) |
|
Definition
| anterior (MC), Lateral, Posterior, Deep posterior |
|
|
Term
| Muscles of the anterior compartment |
|
Definition
| Tibialis anterior, Extensor hallucis longus, Extensor digitorum longus, Peroneus tertius. all innervated by deep peroneal nerve |
|
|
Term
| Muscles of the lateral compartment |
|
Definition
| Peroneus longus, Peroneus brevis. innervated by the superficial peroneal nerve |
|
|
Term
| Muscles of the posterior compartment |
|
Definition
| Gastrocnemius, Soleus, Plantaris. innervated by the tibial nerve |
|
|
Term
| Muscles of the deep posterior compartment |
|
Definition
| Polpiteus, Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior. all innervated by Tibial nerve |
|
|
Term
| Any condition that has the potential to cause significant swelling can lead to… |
|
Definition
|
|
Term
| What is the hallmark symptom of compartment syndrome? |
|
Definition
| Pain out of proportion of the injury |
|
|
Term
| What can you do to assess pain in anterior compartment syndrome |
|
Definition
| passively stretch the extensor hallucis longus |
|
|
Term
| early and late findings of compartment syndrome |
|
Definition
| Early: decreased sensation; LATE: loss of pulse and paralysis |
|
|
Term
| patient presentation in medial gastrocnemius tear |
|
Definition
| holding the ankle in plantar flexion to avoid placing tension on the injured muscle |
|
|
Term
|
Definition
| popliteal cyst at the posteromedial aspect of the knee joint |
|
|
Term
| MC synovial cyst of the knee? |
|
Definition
|
|
Term
| What are popliteal cysts commonly associated with? |
|
Definition
| degenerative meniscal tears and systemic inflammatory conditions (like RA) |
|
|
Term
| Why should you approach popliteal cyst aspiration with caution? |
|
Definition
| close proximity of neurovascular structures in the popliteal fossa |
|
|
Term
| What other condition can a cyst rupture mimic? |
|
Definition
| DVT (pain in the posterior calf with swelling) |
|
|
Term
| When immediate confirmation of stress fracture is needed, what imaging study would you order? |
|
Definition
|
|
Term
| Big difference between compartment syndrome and exertional compartment syndrome |
|
Definition
| Exertional compartment syndrome pts do not experience pain at rest |
|
|
Term
| What must you rule out inorder to make a diagnosis of shin-splints? |
|
Definition
| stress fractures and exertional compartment syndrome |
|
|
Term
| Type of pain that tends to progress from proximal to distal in the lower extremity |
|
Definition
|
|
Term
| type of pain that tends to start distally and radiate proximally |
|
Definition
|
|
Term
| pain and parasthesias that do not resolve immediately on cessation of walking indicates what? |
|
Definition
|
|
Term
| Test for achilles tendon rupture |
|
Definition
| Thompson test (passively flex the calf and assess for plantar flexion) |
|
|
Term
| initial txt for achilles tendon rupture |
|
Definition
| bulky jones posterior ankle splint |
|
|
Term
| MC MOI for an ankle sprain |
|
Definition
|
|
Term
|
Definition
| micro tear, mild pain, delayed edema, recover 1-2 weeks |
|
|
Term
|
Definition
| Partial tear, immediate disabling pain and swelling, later ecchymosis, recover in 4-8 weeks |
|
|
Term
|
Definition
| Complete tear, immediate instability and swelling, large area of ecchymosis, recovery 6-12 weeks |
|
|
Term
| MC ankle ligament injured |
|
Definition
| ATFL (anterior talofibular ligament |
|
|
Term
| 2 tests to evaluate tibiofibular syndesmosis injury |
|
Definition
| Squeeze test, external rotation test |
|
|
Term
| 2 tests to determine which ligament has been injured |
|
Definition
| Anterior drawer test (ATFL); Talar tilt test (CFL, but remember the ligaments are injured anterior to posterior ATFL,CFL,PTFL so the ATFL is also injured) |
|
|
Term
|
Definition
| Fx of the proximal fibula arising from rotational injury where force is transmitted prox through the syndesmotic ligaments. |
|
|
Term
|
Definition
| reasons for xray in ankle sprains: TTP over posterior tip of medial or lateral malleolus; inability to bear weight at time of injury or PE |
|
|
Term
|
Definition
| Arthritis of the first MP joint |
|
|
Term
| Location of arthritis that commonly occurs in older patients and also after a Lisfranc’s dislocation |
|
Definition
|
|
Term
| pain below the medial malleolus and distal fibula and frequently is a result of calcaneal fracture |
|
Definition
|
|
Term
| PE finding hallux rigidus |
|
Definition
| loss of motion in the first MP joint and difficulty pushing off with great toe |
|
|
Term
| PE finding midfoot arthritis |
|
Definition
| Tenderness and dorsal bump on palpation |
|
|
Term
| PE findings of talonavicular or talocalcaneal arthritis |
|
Definition
| loss of inversion and eversion of the hindfoot |
|
|
Term
| Where is joint narrowing especially evident in midfoot arthritis |
|
Definition
|
|
Term
| What xray view best visualizes talonavicular arthritis |
|
Definition
|
|
Term
| What Xray view best visualizes talocalcaneal arthritis |
|
Definition
|
|
Term
|
Definition
| stiff-soled shoe with rocker bottom, NSAIDs |
|
|
Term
| Hyperkeratotic lesion of the skin that forms in response to excessive pressure over a boney prominence |
|
Definition
|
|
Term
|
Definition
|
|
Term
| A persistant callus on the sole of the forefoot |
|
Definition
| intractable plantar keratosis |
|
|
Term
| Best exam test to differentiate between charcot arthropathy and cellulitis |
|
Definition
| elevate foot above heart for 1 minute. IF the foot loses it’s redness it is charcot. If it doesn’t it is cellulitis, soft tissues abscess, and/or osteomylitis |
|
|
Term
| Are neuropathies due to diabetic foot reversible |
|
Definition
|
|
Term
| fibular fx below the syndesmosis |
|
Definition
|
|
Term
| fibular fx at level of syndesmosis |
|
Definition
|
|
Term
| fibular fx above syndesmosis |
|
Definition
|
|
Term
| Surgery or not for: stable, unstable but not displaced, unstable and displaced |
|
Definition
|
|
Term
| In the midfoot, which fractures require surgical reduction |
|
Definition
| any fracture or fracture/dislocation with even minimal displacement requires surgical fixation |
|
|
Term
| Adverse outcome of talar neck fracture |
|
Definition
| osteonecrosis due to lack of blood supply |
|
|
Term
|
Definition
|
|
Term
| initial txt for hallux valgus |
|
Definition
| pt education and shoe wear modifications |
|
|
Term
| How to properly trim toenails |
|
Definition
| cut straight across to keep the lateral margin of the toenail beyond the nail fold |
|
|
Term
|
Definition
| Inflammation (induration, swelling and tenderness along the nail fold) |
|
|
Term
|
Definition
| Abcsess (purulent or serous drainage, increased tenderness, increased erythema |
|
|
Term
|
Definition
| Granulation (granulation tissue grows into nail plate, inhibiting drainage, less painful) |
|
|
Term
| forefoot pain localized under one or more of the lesser metatarsals |
|
Definition
|
|
Term
| Clinical presentation Morton neuroma |
|
Definition
| patients state that they feel as though they are “walking on a marble” or there is “a wrinkle in my socks” |
|
|
Term
| MC cause of heel pain in adults |
|
Definition
|
|
Term
| Is plantar fasciitis associated with a particular foot type |
|
Definition
|
|
Term
| When is plantar fasciitis pain most severe |
|
Definition
| on awakening or when rising from a resting position because the first few steps stretch the plantar fascia |
|
|
Term
| Surgery or not: plantar fasciitis? |
|
Definition
| 95% of patients can be managed satisfactorily with non-operative treatment |
|
|
Term
| If you scrape a wart what will you find? |
|
Definition
| punctate hemmorrhage and a fibrillated texture |
|
|
Term
| Posterior heel pain can be attributed to 1 of 4 things |
|
Definition
| Insertional achilles tendonitis, retrocalcaneal bursitis, Haglund’s syndrome, pump bump |
|
|
Term
| What increases the pain of retrocalcaneal bursitis |
|
Definition
| squeezing the bursa from side to side and just anterior to the achilles tendon |
|
|
Term
| What is the primary cause of medial foot/ankle pain in the middle-aged patient |
|
Definition
| Posterior tibial tendon dysfunction |
|
|
Term
| Adverse outcome of posterior tibial dysfunction |
|
Definition
| development of a flatfoot |
|
|
Term
| How can you assess flatfoot during PE |
|
Definition
| when viewed from behind, the affected foot will show “too many toes” becuase of the forefoot abduction and hindfoot valgus |
|
|
Term
| Txt options for flexible flatfoot |
|
Definition
| medial heel wedge, medial longitudinal arch support or a molded ankle-foot orthosis can help. No corticosteroids, maybe surgery |
|
|
Term
|
Definition
| stabilization of the hindfoot by arthrodesis |
|
|
Term
| What joints do you fuse in severe arthritis of the hindfoot |
|
Definition
| triple arthrodesis (talocalcaneal, talonavicular, and calcaneocuboid joints) |
|
|
Term
|
Definition
| inflammation of the sesmoids due to repeated stress |
|
|
Term
| MC soft-tissue tumors in the foot and ankle |
|
Definition
| Ganglia and plantar fibromas |
|
|
Term
| plantar fibromatosis is similar to what disease of the hand |
|
Definition
|
|
Term
| What kind of protective footwear are appropriate for metatarsal stress fractures |
|
Definition
| stiff-soled shoe, wooden soled postoperative sandals, or removable short leg fracture brace |
|
|
Term
| at what location would you consider internal fixation of a stress fracture |
|
Definition
|
|
Term
| Clinical symptoms of tarsal tunnel |
|
Definition
| paresthesias or dysthesias along the medial ankle and into the arch |
|
|
Term
| Fixed extension of the MP joint and flexion of the PIP |
|
Definition
|
|
Term
| usually affect all of the lesser toes and often are 2ndary to a neurologic disorder such as charcot-marie-tooth disease or rheumatoid arthritis |
|
Definition
|
|
Term
| flexion deformity of the PIP with no significant deformity of the DIP or MP joints |
|
Definition
|
|
Term
| Flexion deformity at the DIP with relatively normal alignment of the PIP and MP joints |
|
Definition
|
|
Term
| MC toe affected in hammertoe and mallet toe |
|
Definition
|
|
Term
| Sprain of the 1st MP joint that most commonly occurs with hyperextension but can occur with any forced range of motion |
|
Definition
|
|
