Omm; 4.2.07; Conditions Of The Ankle And Knee, Kek

Front 1

what is the normal dorsiflexion degree of the ankle?

Back 1

20

Front 2

what is the normal plantarflexion of the ankle?

Back 2

45

Front 3

name the term of when the ankle can't dorsiflex 10.

Back 3

ankle equinus

Front 4

How do you treat ankle equinus?

Back 4

stretching; surgical lengthening of the achilles tendon; and OMT

Front 5

What else is going on in ankle equinas besides not being able to dorsiflex beyond 10 degrees?

Back 5

posterior displacement of the tibia on the talus and posterior displacement of the proximal fibula

Front 6

What 2 OM techniques are used to treat ankle equinus?

Back 6

1) modified fibular head technique; 2)HVLA Tibiotalar joint gapping; S/E: 2days of soreness post tx

Front 7

Describe the amount of stretching determining the range of motion. Compare 30s, 2min, 5min a day.

Back 7

At 30S: 2.15 increase; 2min: 2.3 degree increase; 5min: 2.7 degree increase in dorsiflexion

Front 8

what are the majority of normal motions of the ankle?

Back 8

dorsiflexion and plantarflexion

Front 9

in what position are most ankle injuries?

Back 9

sudden inversion with downward and lateral forces on relatively weak lateral ligaments

Front 10

In 75% of ankle sprains this ligament is injuried?

Back 10

anterior talofibular ligament

Front 11

If the ankle is severely inverted what other ligament is generally involved beyond the ATFL?

Back 11

calcaneofibular ligament; the anterior capsule may also be torn

Front 12

what ligament attaches to the styloid process of the 5th metatarsal and is considered the major everter of the foot?

Back 12

Fibularis Brevis tendon

Front 13

explain what happens to the body if the foot in inverted enough to involve the calcaneofibular ligament.

Back 13

the ligament pulls the fibula inferiorly which may lock the proximal fibular head inferiorly and posteriorly -> this puts strain on the interosseous membrane and may cause a dysfxn of the entire lower extremity.

Front 14

since everything is connected explain the possible pain pattern from an ankle sprain.

Back 14

commonly ankle and leg, then lateral thigh, lower back, interscapular region, possibly head and neck.

Front 15

what major structures do you have to worry about with an inverted ankle sprain.

Back 15

since the distal fibular head may come down, it may compress the fibular nerve just posterior to the fibular head

Front 16

what lateral leg muscle inserts on the proximal head of the fibula (giving good reason for lateral thigh pain in an inverted ankle sprain).

Back 16

biceps femoris muscle

Front 17

these ligaments attach the vertebral column to the iliac crest of the pelvis.

Back 17

iliolumbar ligaments

Front 18

Anita Eisenhart, DO of PCOM did a study on 1st and 2nd degree ankle sprains seen in the ER of pts that were at least 18. Both treated and untreated groups exhibited a full loss of dorsal/plantar flexion of 30degrees and about a 2.75cm increase in joint circumference. Name the OMT techniques she used.

Back 18

Indirect Myofascial Release on the Posterior Proximal Fibula, Muscle Energy and Counterstrain and the Pain and Tenderness of Fibularis Muscles, Articulatory techniques on the plantar Rotation of the Cuboid, and Lymphatic Drainage on the edema.

Front 19

what were the general results of Dr. Eisenhart's ankle sprain study?

Back 19

OMT was best for immediate results, especially ROM. the categories tested were EDEMA, ROM, and Pain SCALE (1-10). at the one week follow up there wasn't that much difference.

Front 20

OMT for the knee is commonly used for ___ and ____.

Back 20

trauma (MVAs, Sports injuries, and household or work injuries) and Osteoarthritis

Front 21

What are the 2 steps in evaluating a knee?

Back 21

1) Configuration: observe the knee with patient weight bearing and look for abnormalities; 2) Assess for Joint Effusion

Front 22

In the first step (configuration) of evaluating a knee what are the 3 common knee deformities and define them.

Back 22

Genu varus - bowlegged; Genu valgus- knockneed; Genu recurvatum - back knee

Front 23

What can you do to determine the extent of a genu valgus?

Back 23

do a Q angle. draw a line from the ASIS to the mid-patella and draw another line from the tibial tuberosity to the mid-patella and take the superior angle. Normal: males 8-14; females: 15-17

Front 24

what are the consequences of an increased Q angle?

Back 24

lateral tracking of the patella, patellofemoral pain syndrome, patellofemoral dysfunction, chondromalacia patella, osteoarthritis of the patellofemoral joint, increased pressure on the lateral facets

Front 25

Name the autosomal dominant condition where there is absence or hypoplasia of the patella that is associated with onycho-osteodysplasia.

Back 25

nail-patella syndrome.

Front 26

What is abnormal in Nail-Patella Syndrome?

Back 26

Hypoplasia of the patella, Hypoplasia of the iliac horns, Dysplasia of the finger nails and toes, nephropathies with thickening of the glomerular lamina densa and get proteinuria, the distal femur looks like an erlenmyer flask.

Front 27

What are the tests in Step2 of evaluation of the knee?

Back 27

Assessing for joint effusion involves 3 tests. 1) Patellar Ballottement Test - looking for major effusion; 2) Bounce Home Test (flex knee) - Moderate effusion; 3) Fluid Shift Test - minor joint effusion

Front 28

If you get a positive effusion test, what do you do and how do you do it?

Back 28

joint aspiration with a needle into the medial side of the knee beneath the patellar tendon joint line

Front 29

What fluid is normally present in the knee?

Back 29

synovial fluid; it is very viscous and usually don't get any in the needle "dry tap"

Front 30

If a watery clear yellow fluid (may have celluar debris) is aspirated, what is that called?

Back 30

synovitis

Front 31

What is the most common form of synovitis?

Back 31

traumatic synovitis - caused by twisting or jarring of the knee and hours later the knee becomes swollen.

Front 32

What are the treatments for traumatic synovitis?

Back 32

aspirate, OMT (lymphatic approach); rest, slint, ice, NSAIDs

Front 33

If you aspirated frankly bloody, watery fluid where the blood doesn't clot, what would that be?

Back 33

ligamentous tear

Front 34

If you aspirated frankly bloody, watery fluid that had fat globules and looked like gross homemade gravy, what would it be?

Back 34

Intraarticular Fracture

Front 35

If you aspirated pus, what would it be and what is the most common cause?

Back 35

septic arthritis and it is most commonly from neisseria gonorrhoeae

Front 36

Give the epidemiology and etiology of the patellofemoral dysfxn.

Back 36

Epi: 12-35yrFemales, pain originates in teh subchondral bone and is usually a dull ache with occasional sharp pains, relieved by rest and ice and often feels like it will give way; ETIOLOGY: the Patella tracks too far laterally with excessive pressure on the lateral patellar facet: genu recurvatum, low lateral femoral condyle, tight hamstrings, increased Q angle, and occurs while in training and do rapid increases in runs or change shoes or surfaces;

Front 37

How do you DX patellofemoral dysfxn?

Back 37

1)shifting the patella laterally reproduces pain with pressure under the lateral facet; 2)Patellar GRIND TEST: press the patella down in the trochlear groove and get the pt. to contract the quadriceps; the motion should be smooth, any clicking or grinding is abnormal; 3)look at thigh circumference (atrophy is common on the worst side); 4)X-ray: see a sunrise view of the patella (patellar dislocation)

Front 38

How do you treat patellofemoral dysfxn?

Back 38

1)OMM: DMR, CS and Somatosomatic reflexes L3-S2; 2)Ice massage; 3)NSAIDs; 4)Hamstring stretches; 5)exercises: leg raise, Short Arc Leg Raise: hold knee extended for one min then flex to 45 degrees for 30s, extend knee and repeat 4-5xs (repeat 4-6Xs/day); straight leg raises to strengthen quads; 6) BRACING with infrapatellar strap - may need 6months of conservative therapy to get a response ----last resort: patellofemoral Dysfxn Surgery: reduces Q angle

Front 39

name the term that describes the degenerative condition of the cartilage surface of the back of the patella; diagnosis can only be made with an arthroscope.

Back 39

chondromalacia patellae (cartilage looks like shredded crabmeat)

Front 40

describe the differences in the a 1st, 2nd, and 3rd degree sprain of the knee.

Back 40

The main difference is the ligament: 1st: overstretch of the ligament; 2nd: partial tear; 3rd: complete tear - surgical repair

Front 41

how are the anterior and posterior cruciate ligaments named?

Back 41

they are named for where the insert (anterior: inserts on the anterior portion of the tibia; posterior: inserts on the posterior tibial plateau)

Front 42

what are the fxns of the cruciate ligaments?

Back 42

ACL: prevents the tibia from sliding forward; PCL: prevents the tibia from sliding posteriorly

Front 43

What tests do you do to test for cruciate tearing?

Back 43

1) Drawer Test; 2) Lachman's Test; 3) Apley's Distraction Test; Imaging (MRI is best)

Front 44

what position is the body in when you see ACL ruptures?

Back 44

leg is extended and internally rotated and the body continues forward; get a Positive anterior drawer and Lachman Test

Front 45

What position is the body commonly in when you see a PCL rupture?

Back 45

leg is hyperextended and loaded and tibia if forced backward or knee is flexed and backward force on the tibia. Positive Posterior Drawer and Sag Sign

Front 46

What position in the body commonly in when you see a rupture of the medial collateral ligament?

Back 46

a force from the posterolateral portion of the knee (valgus stress)

Front 47

What position in the body commonly in when you see a rupture of the lateral collateral ligament?

Back 47

caused by trauma pushing the knee into varus

Front 48

what is a the Terrible Triad of O'Donoghue?

Back 48

MAM: rupture of all 3: Medial Collateral, ACL, and tear in the Medial Meniscus

Front 49

How do you test for the Terrible Triad of O'Donoghue?

Back 49

Do a positive pivot shift test - extend the knee, place valgus stress on the knee and internally rotate the leg - will hear a "clunk" if positive

Front 50

what are the symptoms of menisceal tears?

Back 50

clicking, locking of the knee, and knee pain

Front 51

How do you diagnose menisceal tears?

Back 51

Apleys' Compression Test and McMurray Test; imaging with MRI

Front 52

There are typically __# of bursae about the knee.

Back 52

13

Front 53

How do you get prepatellar and infrapatellar bursitis?

Back 53

called the Housemaid's Knee, Nun's Knee, Clergyman's Knee - constant kneeling trauma (rarely TB)

Front 54

What is the name to describe the inflammation of the insertion of the conjoined tendons of 3 muscles (sartorius, gracilis, and semitendinous m)?

Back 54

ANSERINE BURSITIS: pes anserinus is the bursa beneath the conjoined tendon - lies superficial to the tibial insertion of the MCL) - get pain with forced extension of the knee

Front 55

what is a fabella?

Back 55

a sesamoid bone located in the gastrocnemius tendon; it will always remain in the same position on x-ray, posterior to the knee joint

Front 56

Name the term that describes osteochondrosis affecting the tibial tuberosity.

Back 56

Osgood-Schlatter DZ

Front 57

How do you dx and tx osgood-schlatter's dz?

Back 57

Tenderness and swelling of the tibial tuberosity; x-ray demonstrates seperation of the growth plate; TX: NSAIDs, avoid exercise when painful

Front 58

L4 radiculitis causes this syndrome where the pt can't extend the knee.

Back 58

Vastus medialis Syndrome of Pseudoblocking (get spasms in the vastus medialis)