Shared Flashcard Set

Details

Ortho III
Knee/Leg/Ankle/Foot
170
Medical
Graduate
03/02/2015

Additional Medical Flashcards

 


 

Cards

Term
Primary stabilizer of the knee
Definition
ACL
Term
Results from a rotational (twisting) or hyperextension force, often full tears, tears the meniscus
Definition
ACL tear
Term
ACL/MCL/meniscal tear
Definition
Terrible triad
Term
Multiple ligament disruption resulting in limb threatening emergency
Definition
Popliteal artery injury
Term
Pt with: knee giving way from twisting/hyperextension injury, audible pop heard, activity partcitipation inability, hemarthrosis in 24 h,
Definition
ACL tear Symptoms
Term
(+) lachman test at 25-50 degrees
Definition
ACL tear
Term
(+) anterior drawer test at 90 degrees
Definition
ACL tear
Term
(+) Pivot shift test
Definition
ACL tear
flexion, valgus force with knee in extension while foot is internally rotated results in a clunk
Term
Segond Fx on Xray
Definition
ACL tear
Term
Untreated ACL injury adverse outcomes
Definition
recurring instability results in subsequent meniscal tears and OA, agility sport participation ineligibility
Term
ACL tear Tx
Definition
1. Rest, ice, NSAIDS, Narcotics, Crutches (NWB - TT- PWB- FWB)
2. Knee Brace- helpful for older/less active patients
3. PT- Full Flexion and Extension(more important)
4. SX- B-PT-B; HS Graft
Term
Which movement in rehab is more important for ACL tear
Definition
Extension
Term
If unable to perform rehab
Definition
ACL reconstruction is not recommended
Term
When can arthrofibrosis occur with an ACL tear
Definition
after ACL tear or post operatively after ACL reconstruction
Term
Adverse outcome of ACL reconstrucion when a portion of the patellar tendon is used for the ACL graft
Definition
Fracture of the femur/ patellar graft site
Term
Pt with: an ACL tear or with post traumatic knee effusions
Definition
Referral for ACL tear
Term
Strongest ligament in the knee
Definition
PCL
Term
Primary restraint to posterior translation of the tibia relative to the femur
Definition
PCL
Term
Originate on the medial intercondyler wall of the femur and inserts on the posterior aspect of the tibia running in an oblique direction
Definition
PCL
Term
4 injury patterns suggestive of PCL injury
Definition
1. Dashboard injury
2. Fall onto a flexed knee
3. hyperflexion injury
4. Hyperextension injury- ACL then PCL tear
Term
(+) posterior drawer test
Definition
PCL tear
Term
(+) quadriceps drawer test
Definition
PCL tear
Term
(+) posterior sag sign
Definition
PCL tear
Term
Adverse outcomes of PCL tears
Definition
unrecognized dislocated knee may cause limb threatening vascular injury, recurrent instability leading to subsequent meniscal tears and OA
Term
Tx of PCL tears
Definition
1. resolve swelling ans restoring ROM
2. Strenghtening exercises- emphasis on quadriceps exercise
3. Functional bracing
Term
Tx of failed non operative PCL Tx
Definition
PCL reconstruction to restore function, instability is improved but tibial translation remains increased
Term
PCL tear with neurovascular compromise or deficit or PCL tear with possible surrounding ligamentous structure damage
Definition
Referral to Ortho
Term
outside the joint and Stabilize in knee against valgus/varus stress
Definition
MCL/LCL
Term
inside the joint and stabilize the knee posteriorly and anteriorly
Definition
PCL/ACL
Term
Valgus force without rotation such as in football clipping injury
Definition
MCL tear
Term
Pure Varus force to the knee
Definition
LCL tear
Term
Able to ambulate post injury and return to play, small effusion and ecchymosis develop
Definition
collateral ligament tear
Term
Swelling in and around injured ligament, TTP along entire course of ligament
Definition
Collateral ligament tear
Term
Best palpated with valgus stress in slight flexion
Definition
MCL
Term
examined in the figure 4 position
Definition
LCL
Term
Laxity in full extension indicates
Definition
a more extensive injry to the ACL/PCL
Term
Laxity in full extension
Definition
ACL/PCL tear rather than MCL/LCL tear
Term
LCL/MCL tear grade:
Grade I
Grade II
Grade III
Definition
I = opening of 5 mm
II = b/t these two
III = 10mm
Term
Pellegrini- Stieda avulsion Fx
Definition
MCL tear
Term
Adverse outcomes in any knee ligament tear
Definition
Chronic instability, pain, further meniscal tear may lead to OA
Term
MCL Tx
Definition
Non-operative
I = resolve in couple weeks, RICE with crutches, NSAID
II = Brace, weight bearing as tolerated
III = brace (3-4mo), gradual return to weight bearing over 4-6 wks
PT - early ROM, quadriceps, hamstring progressive resistance
Term
LCL Tx
Definition
I and II = non operative
III = associated with posterior capsule tear, SX to avoid later instability
Term
LCL/MCL tear with hemarthrosis
Significant effusion
Instability
Definition
Referral
Term
failure to respond to non-operative Tx for anything
Definition
Referral
Term
Occur in association with ACL / MCL tears
Definition
meniscal tears
Term
significant twisting action to knee, older patient complains after rising from squatting position, ambulate post injury and continue participation, locking, catching, popping, twisting/squatting pain
Definition
Meniscal Tear
Term
incarcerated meniscal tissue leading to locked knee
Definition
Bucket handle tear
Term
Bucket handle tear Tx
Definition
Urgent orthopedic evaluation for special MCL tear
Term
MC finding is tenderness over the medial/lateral joint line
Definition
LCL/MCL/meniscal tear
Term
Timing of effusion:
LCL/MCL
Meniscus
PCL/ACL
Definition
24-48hr
over 2-3 days
24hr
Term
crystal arthropathy or infection Dx
Definition
Knee aspiration
Term
most tears are central and cannot heal Waiting too long can result in lost opportunity SX repair
Definition
Meniscal tear
Term
MCL tear Tx - absence of mechanical Sx
Definition
RICE
weight bearing as tolerated
NSAIS/Tylenol/ASA (Anti-inflammatories)
PT
Term
MCL tear Tx - traumatic tear, young patient, older pt refractory to non-SX Tx
Definition
Aggresive Tx
Activity restriction
SX debridement/repair
Term
MCL tear with traumatic effusion, mechanical Sx, ligamentous instability, refractory to non-SX Tx, persistent joint line tenderness
Definition
Referral for MCL
Term
Osteonecrosis, subchondral bone, MC in knee (medial)/talus/distal humerus, repetitive stress, disrupt blood supply, separated from viable bone by fibrous tissue, Shear forces Fx bone, fragment becomes loose body
Definition
Osteochondritis Dessicans (OCD) MOA
Term
insidious knee pain, catching/locking post over-lying cartilage disruption, Pinpoint TTP- MC site on b/t medial condyle and medial to inferior pole of patella
Definition
OCD Sx/PE findings
Term
(+) Appley's Test
Definition
Meniscus tear
Term
(+) McMurray's Test
Definition
Meniscus tear
Term
Best seen on tunnel and lateral X-ray view, MRI visualize overlying carilage, MRI for staging of lesion
Definition
OCD
Term
Adverse outcome of unTx/unsuccessfully Tx OCD, Adverse outcome Tx and complications
Definition
form loose bodies, leaving defects in articular surface, leads to OA - cartilage replacement - infection, further damage, failure
Term
OCD Tx-MC in kids/bones not matured
Definition
non-operatively= activity modification (avoid: running, jumping), crutches, immobilization for refractory/non-compliant pt
Term
OCD Tx- Adults/bones matured/total separation of articular cartilage
Definition
SX=
Stable lesion, cartilage intact- microfracture, leave cartilage alone
Unstable lesion- internal fixation
Loose Fragment- remove fragment, debride articular surface defect
Term
OCD < 1cm in child
OCD > 2 cm in child
OCD 1-2cm in child
OCD after physis has closed
Definition
non-operative Tx
progressive problems - redflag
Tx based Sx/xrays
further evaluation
Term
MC form of knee arthritis, MC is medial compartment, results in bowleg/genu varum
Definition
OA
Term
Strong Hx or trauma, ligament tears, intra/extra articular Fx
Definition
Secondary OA
Term
pain on wt bearing, buckling/giving way, difficulty going up and down stairs, limited ROM at flexion/extension extremes, mimick meniscal tear, pain with rest/sleeping if severe
Definition
OA Sx
Term
Varus/valgus/windswept knee deformity, ROM loss parallels progression, crepitus, Fairbank signs on radiograph
Definition
OA PE findings
Term
OA Tx non operative
Definition
Anti-inflammatory
glucosamine/chondroitin pills
Rest/ice/heat
PT- ROM/strengthening
Braces
Ambulation aids
Injections- viscosupplement/ corticosteroids
Term
OA Tx SX
Definition
Arthroscopy
Mosiacplasty
Cartilage transplantation
High Tibial Osteotomy (HTO)-realignment
Arthroplasty
Term
Pt with: OA paint at rest/ severe decreased ROM/significant functional limitations
Definition
Referral for OA
Term
1+ patellar secondary ossification centers fail to fuse, MC at superolateral pole, fibrous tissue joins unfused fragments, incidental finding, progress to anterior knee pain
Definition
Bipartite Patella
Term
follow direct/ indirect trauma/ insidious anterior knee pain development, increased stress of quadricps on patella/squatting/standing up increases pain, prominence over superolateral pole of patella, TTP over prominence
Definition
Bipartite Patella Sx
Term
Xray: AP/axial best views, rounded fragments, oblique lucency line
Definition
Bipartite Patella Radiograph findings
Term
Bipartite Patella Tx
Definition
Activity modification - crutches/knee immobilizer
NO SX
Term
Pt with: Bipartite patella Dx / failure of non-SX Tx
Definition
Referral for Bipartite Patella
Term
5 bursal sacs
Definition
Pre-patellar, Supra-patellar, Infra-patellar, Pes Anserine, Iliotibial tract
Term
line by synovial tissue, produce small amount of fluid, decrease friction b/t structures
Definition
Bursa sac
Term
Chronic pressure/friction, thickening of synovial lining, excessive fluid forms, local pain and swelling
Definition
Bursitis
Term
dome shaped swelling, anterior aspect of knee, b/t skin and bony patella, Chronic kneeling, carpenters/carpeters/mason workers
Definition
Prepatellar bursitis(Housemaids Knee)
Term
anterior surface, lower part of femur, deep to quadriceps femoris
Definition
Suprapatellar bursitis
Term
b/t upper tibia and patellar ligament
Definition
Infrapatellar bursitis
Term
under insertion of sartosius/ gracilis semitenidinosus, just below medial tibial plataeu
Definition
Pes Anserine bursitis
Term
Pt With: Early OA in medial compartment of knee
Definition
Pes Anserine bursitis
Term
Pt with: Pain in lateral knee-superior joint line, repetitive knee flexion/extension, found in long distance runners/cyclists
Definition
iliotibial tract bursitis
Term
pain with activity/direct pressure, more severe with activity after sedentary periods, limp when arising from a chair, pinpoint pain, swelling, xray: AP/Lat to r/o bony conditions
Definition
Bursitis Sx
Term
Bursitis Tx
Definition
Activity modification
Anti-inflammatories
U/S, phonophoresis
Stretch/strengthen- quadriceps/hamstring/IT band
Injection
SX only for severely refractory cases
Term
Pt with: non-operative refractory bursitis, ligament/tendon insufficiency
Definition
Bursitis referral
Term
aching anterior knee pain, increases with running/going up, down stairs/kneeling/squatting, knee joint overuse/overload, patellar malalignment may be present, chondromalacia is an inaccurate term, patellar undersurface degenerative changes
Definition
Patellofemoral pain syndrome/ retropatellar pain syndrome/ anterior knee pain
Term
MC Sx - diffuse aching anterior knee pain, Worse with: long periods of sitting (theater sign), climbing stairs, jumping, squatting, retropatellar catching no swelling, no Hx of trauma, sudden increase in activity level/wt training
Definition
Patellofemoral pain syndrome Sx
Term
Examine wt bearing stance and ambulation - increased femoral anteversion, Genu valgum- inadequate vastus medialis obliquus muscle development, increased Q angle, (+) patellar apprehension sign, xray: axial/sunrise views are most helpful
Definition
Patellofemoral Pain Syndrome PE
Term
Patellofemoral Pain Syndrome Tx
Definition
Activity modification
Closed chain PT- squats (individually modified to avoid knee pain)
Avoid full arc quadriceps exercises
Anti-inflammatories
Knee sleeve with patellar cutout/strap
Wt loss
Injections- judiciously
Term
Pt with: persistent retropatellar pain syndrome pain/effusions/patellar instability
Definition
Referral for retropatellar pain syndrome
Term
Normal flexion/extension Q angle for:
Men
Women
Definition
Men
Ext: <14
Flex: <8
Women
Ext: <17
Flex: <9
Term
Pt with:
abnormal motion, recurrent subluxation, recurrent dislocations, usually lateral direction with minimal trauma of patella, knee usually maintained in a flexed position, patella reduces spontaneously, pain from MPFL tear, retropatellar pain
Definition
Patelofemoral instability and malalignment
Pain with stairs/squatting/sitting
Non SX:
Initial: compressive dressing/ protective splint with knee in extension (immobilizer/ROM brace locked in extension), Ice, analgesics, activity modification
When pain is gone, begin PT (ROM/strengthening)
Chronic maltracking/instability includes quadriceps strenthening/flexibility
SX: non-SX fail, extensor mechanism realignment w/ MPFL repair(Fulkerson Procedure)/arthroscopy with lateral retinaculum release / Arthroplasty
Term
Pt with:
Causes are from patella alta/shallow
trochlear groove/ flat patella under surface/lateral tipped patella/ "loose ligaments"
Definition
Patelofemoral instability and malalignment
Initial: compressive dressing/ protective splint with knee in extension (immobilizer/ROM brace locked in extension), Ice, analgesics, activity modification
When pain is gone, begin PT (ROM/strengthening)
SX: non-SX fail, extensor mechanism realignment w/ MPFL (Fulkerson Procedure)/arthroscopy with lateral retinaculum release / Arthroplasty
Term
PE findins of:
(+) J sign, lateral translation over half the width of the patella, TTP over MFPL, Tightness of the lateral retinaculum
Definition
Patelofemoral instability and malalignment
Initial: compressive dressing/ protective splint with knee in extension (immobilizer/ROM brace locked in extension), Ice, analgesics, activity modification
When pain is gone, begin PT (ROM/strengthening)
SX: non-SX fail, extensor mechanism realignment w/ MPFL repair(Fulkerson Procedure)/arthroscopy with lateral retinaculum release / Arthroplasty
Term
Patelofemoral instability and malalignment Adverse outcomes
Definition
Anterior knee pain, quad weakness, recurrent patellar instability, reduced activity, patellofemoral arthrosis, residual parellofemoral pain, recurrent instability
Term
Fulkerson procedure
Definition
Patelofemoral instabiilty and malalignment Tx
Patellar relignment
Term
Pt with:
overuse/overload syndrome at quadriceps tendon insertion (Superior/inferior patellar pole), <40y/o = Jumper's Knee, anterior, tenderness at bony attachment of the quadriceps tendon/infrapatellar tendon, infrapatellar bursa, ROM motion normal with pain on extension, quadriceps atrophy, Heterotrophic ossification/ osteophytes at the upper/lower pole of the patella, MRI when all imaging failed
Definition
Patellar/ Quadriceps tendinitis;
3 aspects:
1. relative rest, vary 3days - 3wks, knee immobilizer, NSAID, NO INJECTIONS-rupture
2. regain pain free ROM, flexibility, strength, U/S, phonophoresis, knee sleeve with patellar cutout/compression strap
3. gradual activity resumption with continued PT exercises, heat before/ice after activity
Term
Common findings of all knee injuries:
Definition
Hurts right after activities
Hurts with squatting/kneeling/sitting/climbing stairs
Term
Pt with:
rupture of extensor mechanism
Patellar/quadriceps tendinitis recalcitrant to non-SX managment
Definition
Referral to ortho
Term
Pt with:
Same MOA as PCL tear, caused by quadriceps forcibly contracting to break the impact of a fall, can walk but unstable, INABILITY to EXTEND KNEE against gravity/ ABNORMAL STRAIGHT-LE RAISE TEST; Xray: Lat view = patella alta/patella baja
Definition
Quadriceps and patella tendon ruputure-->patella based off the Bluman-Satts Line
complete rupture=SX
Partial Tear = immobilization
Term
Usually a direct blow from a MVA/indirect mechanism of a fall, can walk but unstable, deformity present, Xray shows abnormality
Definition
Patellar Fx
Complete = SX
Incomplete = immobilization
Term
Quadriceps and patella tendon rupture adverse outcomes without SX/Delay in Tx
Definition
No SX= deficient extensor mechanism
Delay=muscle contraction increases difficulty of SX
Term
Pt with Sx/PE consistent with extensor mechanism rupture
Definition
Referral and evaluation for SX
Term
Pt with:
Inflammation of folds in synovium due to overuse/trauma, "bowstring" over the femoral condyle, painful snapping/popping over anterior/anteromedial knee, buckling (no giving way), palpated as a thickened band
Definition
Plica Syndrome
Initial: decrease inflammation and thickening plica, anti-inflammatories, activity modification, Injections= Dx and Tx, PT flexibility/strengthening
SX- persistant, recalcitrant cases require arthroscopic resection
Term
Plica =
Distinct v. Minor
Medial
Definition
5-normal fold in synovium
Distinct = suprapatellar, medial, infrapatellar
From medial joint capsule to medial anterior fat pad, MC one inflammed
Term
Adverse outcomes of Plica Syndrome
Definition
Repeated injections - accelerated destruction of articular cartilage and sepsis
SX complicated by infection/stiffness
Term
Pt with:
Continued discomfort and instability with plica syndrome PE and Sx findings
Definition
Referral
Term
Pt with:
Pain out of proportion to injury,pain with passive stretching of involved muscles, decreased sensation, loss of posterior tibial and dorsalis pedal pulses
Definition
Compartment Syndrome - Acute Leg Pain
Filet Mignon- SX
Term
DDx of Acute Leg Pain
MC compartment affected by compartment syndrome acute leg pain
Definition
Compartment Syndrome
Constusions
Medial gastroc tear
Rupture popliteal cyst
Anterior
Term
Muscles/nerve of:
Anterior compartment
Lateral compartment
Deep Posterior compartment
Superficial Posterior compartment
Definition
Deep peroneal/ TA,EHL,EDL,Peroneus tertius
Superficial peroneal nerve/ PL, PB
Tibial Nerve/ popliteus, FHL, FDL, TP(sometimes seperate compartment)
Tibial nerve/ Gastrocnemius, Soleus, Plantaris
Term
diastolic pressure - intracompartmental pressure <= 30 mmHg/ >=40mmHg within area
Definition
Compartment Syndrome - Filet Mignon - SX
Term
Failure to recognize/immediately Tx a compartment syndrome- Adverse outcomes
Definition
tissue necrosis and permanent contracture, pain, weakness, neurologic injury
Pulses and sensation may be intact with this condition
Term
Can result in compartment syndrome- subset of Acute leg pain, active/passive muscle contraction
Definition
Contusion
analgesics, Rest, Ice,elevation, ROM modification, calf stretching, stengthening
Term
Pt with:
pain is located proximally and medially over leg, medial proximal calf pain, pt presents in plantar flexion to avoid tension on injured muscle, (-) single-leg toe raise, (+) ecchymosis in 24 h
Definition
Medial gastrocnemius tears
analgesics, RICE, calf stretching, strengthening
Term
Pt with:
bulge on posteromedial aspect of knee, fluctuate in size, associated with RA/SLE, meniscal tears, swelling/fullness in popliteal fossa with pain/tenderness, rupture causes severe medial calf pain, decreased ankle ROM- mistaken for a DVT
Definition
Rupture of popliteal cyst (Baker's Cyst); Aspiration provides transient relief
Arthritic Cysts - Knee replacement
Cyst excision
Term
MC synovial Cyst
Definition
Baker's Cyst-Aspiration provides transient relief
Arthritic Cysts - Knee replacement
Cyst excision
Term
MC found b/t semimembranosus muscle and medial head of gastrocnemius muscle, mechanical signs of intra-articular irritant, if aspiration chosen- approach with caution due to close proximity of neurvascular structures in the area in addition to difficult aspiration due to viscosity of substance
Definition
Baker's Cyst-Aspiration provides transient relief
Arthritic Cysts - Knee replacement
Cyst excision
Term
Adverse outcomes of Popliteal Cyst
Definition
Rupture=pain in posterior calf -->DVT
Mass effect can compress surrounding neurovascular structures-->sensory/motor deficits
Term
Adverse outcome of Popliteal Cyst Tx
Definition
injury to neighboring nerves/blood vessals, reoccurance
Term
Pt with:
Constitutional Sx of cancer
Definition
Referral: F/C/NS/wt loss
Term
Pt with:
pain >2-3wk, Stress Fx/Exertional Compartment Syndrome/Shin splints/Caludication
Definition
Chronic Leg Pain- Tx based on Specific condition
Stress Fx- Rest, activity modification, cast immobilization/PWB
Exertional Compartment Syndrome;
Non SX- d/c or reduce activity
SX- fasciotomy
Neurgenic Claudication;OTC analgesics/NSAID, steroid injections, Lumbar flexion exercises, SX decompression
Vascular Claudication; Vascular SX
Term
Pt with:
pain initially with exercise, progress to pain with walking/at rest, localized to one area, >6wks post Sx-->Bony callus, Xrays appear normal for >=3wks after injury,
Definition
Stress Fx:
Most patients - rest
Mild Pain - activity modifications
Significant pain - cast immoblization/PWB
Low impact exercise- Bicycling/Swimming
Recovery usually ~ 2mo
BEWARE OF DREADED BLACK LINE
Term
Next Step w/ Stress Fx pt with normal radiographs and no activity/occupation with increased stress
Definition
Repeat Radiographs at 3-4wk after initial exam
Term
Dx imaging of choice for need to know pt with stress Fx (atheletes/occupation)
Definition
Bone Scan
Term
Pt with: Activitty induced increase in tissue pressure, leg pain, paresthesias radiating into foot, lots of running/walking, pain with activity, but once stopped goes away (~30min), NO PAIN at REST, dorsiflexor weakness, first web space paresthesias / plantar paresthesias
Definition
Exertional Compartment Syndrome; Non SX- d/c or reduce activity SX- fasciotomy (anterior nerve involvment/ Deep Tibial nerve)
Term
Best way to measure is indwelling catheter
Definition
Exertiaonal compartment syndrome
>40 mmHg ~30 min to RTN
Term
gradual onset of posteromedial pain in the distant 1/3 of the leg, inflammation of perriosteum, secondary to repetative muscle contraction, TTP- posterior medial crest, Dx of exclusion
Definition
Shin Splints- Don't be a pussy
Term
discomfort secondary to neurogenic/vascular etology, parethesias and dysesthesias
Definition
Claudication
Term
Spinal stenosis, caused by ischemia due to cauda equina syndrome- postures that mechanically compress the nerve roots with resultant paresthesias/dysethesias; Pain begins in buttocks and spreads to the legs while walking, Sx worsen with walking down inclines/loridotic posture/Sx resolve afer sitting down/lying down, progress proximal to distal, pain does not go away when stop walking, weakness/reflex changes develop after activities-provoke leg pain, Xray shows degenerative changes
Definition
Neurgenic claudication; OTC analgesics/NSAID, steroid injections, Lumbar flexion exercises, SX decompression
Term
PVD and compromised blood flow with walking, starts distally and radiates proximally, pain subsides when walking stops, diminished pulses below the waist, redness and pallor changes with limb elevation, Dopplerr Studies/Arteriography demonstrate abnormality
Definition
Vascular Claudication; Vascular SX
Term
MC location for disruption of the Achilles tendon
Definition
5 to 7 cm prox to the insertion on calcaneus
Term
Calf pain described as "gunshot wound" or "direct hit from racquet"
Definition
Achilles tendon rupture
Term
PE findings Achilles rupture
Definition

Swelling of lower calf

difficulty weight bearing

Palpable defect in tendon

+ thompson test 

Term
Thompsons Test
Definition
Squeeze the calf and look for plantar flexion.  A positive test is the absence of plantar flexion.
Term
X ray findings in Achilles tendon rupture
Definition

Soft tissue swelling

Disruption of Kager triangle

Term
Adverse outcomes of Achilles tendon rupture
Definition

Weakness during stance phase

Loss of power with push-off

Term
Tx of Achilles rupture
Definition

Initial: Bulky Jones posterior splint/crutches

Non-op tx: graduated program of casting or bracing with foot in plantar flexion

Surg Tx: young, healthy, active pts; must do soon

Rehab: 6-9 months

Term
MC mechanism of injury for ankle sprain
Definition

Ankle inversion (stresses the lateral ligamentous stabilizers)

 

Term
Less common locations for ankle sprain
Definition

Subtalar joint

Deltoid ligaments

Anterior inferior tibiofibular syndesmosis (high ankle)

Talar dome Osteochondral defect

Term

Grade sprain?

Micro tear

Mild pain

Delayed edema

Recover 1-2 weeks

Definition
Grade 1
Term

Grade sprain?

Partial tear

Immediate disabling pain and swelling

Later ecchymosis

Recover 4-8 weeks

Definition
Grade II
Term

Grade sprain?

Complete tear

Immediate instability and swelling

Large area of ecchymosis

Recovery 6-12 weeks

Definition
Grade III
Term
What is the most common ankle ligament injured?
Definition
Anterior talofibular ligament (ATFL)
Term
Order in which the lateral ligaments are injured
Definition
ATFL, CFL, PTFL (anterior to posterior)
Term
TTP over sinus tarsi and ecchymosis over the medial aspect of the heel indicates?
Definition
Subtalar joint injury (anterior to the lateral malleolus)
Term
TTP or crepitus over medial/lateral malleoli or base of the 5th MT suggests?
Definition
A fracture
Term
What two tests can evaluate a Tibiofibular syndesmosis injury
Definition

Squeeze test

External rotation test

Term
What two PE tests can be used to reveal which ankle ligament has been disrupted? and which correspond with which.
Definition

Anterior drawer test (ATFL)

Talar tilt test (CFL and ATFL)

Term
eponym for a proximal fibula fracture arising from a rotational injury where force is transmitted prox through the syndesmotic ligaments.
Definition
Maisonneuve's fracture
Term
Ottowa Rules
Definition

Indications for xray of an ankle injury to rule out fx

TTP at post tip of lateral malleolus

TTP at post tip of medial malleolus

inability to bear weight at time of injury/PE

Term
Optional xray views for acute ankle injury
Definition

Anterior drawer stress x-ray

talar tilt stress x-ray

Term
Adverse outcomes of ankle injury
Definition

Chronic pain/instability

post-traumatic arthritis

Subtalar stiffness

Term
Tx ankle sprain
Definition
RICE
Bracing
Cast/immob for severe pain/1st time injury
Physical therapy
Term
Tx chronic (reccurent/refractory) ankle sprains
Definition
operative management/surgical reconstruction
Term
Pt reports pain, loss of dorsiflexion, swelling of the great toe
Definition
Arthritis of the first MP joint aka hallux rigidus
Term
Midfoot osteoarthritis commonly occurs in older patients and also after what kind of injury?
Definition
Lisfranc's (tarsometatarsal) dislocation
Term
Diffuse aching of the midfoot that worsens with prolonged walking or standing and difficulty pushing off with the foot
Definition
S/S midfoot osteoarthritis
Term
Pain below the medial malleolus and distal fibula and frequently is a result of calcanea fractures
Definition
Subtalar arthritis
(talonavicular arthritis is focal pain directly over the talonavicular joint)
Term
PE finding in talonavicular or talocalcaneal arthritis
Definition
loss of inversion and eversion of the hindfoot
Term
X-ray findings in ALL arthritis
Definition
Joint space narrowing
Subchondral sclerosis
Osteophytes
Term
tx of ankle and foot arthritis
Definition
shoe modifications (stiff-soled w/rocker bottom)
orthotic inserts
NSAIDS
Corticosteroid injections
subtalar arthrodesis (fusion)
Term
Prominence of the lateral aspect of the 5th MT head and medial deviation of the small toe
Definition
Bunionette (Tailor's bunion)
Term
Tx of bunionette
Definition
shoes with roomy toe box (or stretch shoes)
metatarsal pad to shift pressure off 5th MT head
Arch supports (for flexible flat foot)
Surgical excision or realignment osteotomy (severe/chronic)
Term
Hyperkeratotic lesion of the skin that forms in response to excessive pressure over a bony prominence
Definition
Corn on the toe
Callus anywhere else
(persistant callus on the sole of the forefoot=intractable plantar keratosis)
Term
What is Metatarsalgia
Definition
pain over one or several metatarsal heads (associated with callus' beneath the MT heads)
Term
Occur over boney prominences?
Occur between toes in the web space?
(include latin names)
Definition
Hard corn (heloma durum)
Soft corn (heloma molle)
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