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58 Cards in this Set

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  • Back
what is the normal dorsiflexion degree of the ankle?
what is the normal plantarflexion of the ankle?
name the term of when the ankle can't dorsiflex 10.
ankle equinus
How do you treat ankle equinus?
stretching; surgical lengthening of the achilles tendon; and OMT
What else is going on in ankle equinas besides not being able to dorsiflex beyond 10 degrees?
posterior displacement of the tibia on the talus and posterior displacement of the proximal fibula
What 2 OM techniques are used to treat ankle equinus?
1) modified fibular head technique; 2)HVLA Tibiotalar joint gapping; S/E: 2days of soreness post tx
Describe the amount of stretching determining the range of motion. Compare 30s, 2min, 5min a day.
At 30S: 2.15 increase; 2min: 2.3 degree increase; 5min: 2.7 degree increase in dorsiflexion
what are the majority of normal motions of the ankle?
dorsiflexion and plantarflexion
in what position are most ankle injuries?
sudden inversion with downward and lateral forces on relatively weak lateral ligaments
In 75% of ankle sprains this ligament is injuried?
anterior talofibular ligament
If the ankle is severely inverted what other ligament is generally involved beyond the ATFL?
calcaneofibular ligament; the anterior capsule may also be torn
what ligament attaches to the styloid process of the 5th metatarsal and is considered the major everter of the foot?
Fibularis Brevis tendon
explain what happens to the body if the foot in inverted enough to involve the calcaneofibular ligament.
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.
since everything is connected explain the possible pain pattern from an ankle sprain.
commonly ankle and leg, then lateral thigh, lower back, interscapular region, possibly head and neck.
what major structures do you have to worry about with an inverted ankle sprain.
since the distal fibular head may come down, it may compress the fibular nerve just posterior to the fibular head
what lateral leg muscle inserts on the proximal head of the fibula (giving good reason for lateral thigh pain in an inverted ankle sprain).
biceps femoris muscle
these ligaments attach the vertebral column to the iliac crest of the pelvis.
iliolumbar ligaments
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.
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.
what were the general results of Dr. Eisenhart's ankle sprain study?
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.
OMT for the knee is commonly used for ___ and ____.
trauma (MVAs, Sports injuries, and household or work injuries) and Osteoarthritis
What are the 2 steps in evaluating a knee?
1) Configuration: observe the knee with patient weight bearing and look for abnormalities; 2) Assess for Joint Effusion
In the first step (configuration) of evaluating a knee what are the 3 common knee deformities and define them.
Genu varus - bowlegged; Genu valgus- knockneed; Genu recurvatum - back knee
What can you do to determine the extent of a genu valgus?
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
what are the consequences of an increased Q angle?
lateral tracking of the patella, patellofemoral pain syndrome, patellofemoral dysfunction, chondromalacia patella, osteoarthritis of the patellofemoral joint, increased pressure on the lateral facets
Name the autosomal dominant condition where there is absence or hypoplasia of the patella that is associated with onycho-osteodysplasia.
nail-patella syndrome.
What is abnormal in Nail-Patella Syndrome?
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.
What are the tests in Step2 of evaluation of the knee?
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
If you get a positive effusion test, what do you do and how do you do it?
joint aspiration with a needle into the medial side of the knee beneath the patellar tendon joint line
What fluid is normally present in the knee?
synovial fluid; it is very viscous and usually don't get any in the needle "dry tap"
If a watery clear yellow fluid (may have celluar debris) is aspirated, what is that called?
What is the most common form of synovitis?
traumatic synovitis - caused by twisting or jarring of the knee and hours later the knee becomes swollen.
What are the treatments for traumatic synovitis?
aspirate, OMT (lymphatic approach); rest, slint, ice, NSAIDs
If you aspirated frankly bloody, watery fluid where the blood doesn't clot, what would that be?
ligamentous tear
If you aspirated frankly bloody, watery fluid that had fat globules and looked like gross homemade gravy, what would it be?
Intraarticular Fracture
If you aspirated pus, what would it be and what is the most common cause?
septic arthritis and it is most commonly from neisseria gonorrhoeae
Give the epidemiology and etiology of the patellofemoral dysfxn.
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;
How do you DX patellofemoral dysfxn?
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)
How do you treat patellofemoral dysfxn?
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
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.
chondromalacia patellae (cartilage looks like shredded crabmeat)
describe the differences in the a 1st, 2nd, and 3rd degree sprain of the knee.
The main difference is the ligament: 1st: overstretch of the ligament; 2nd: partial tear; 3rd: complete tear - surgical repair
how are the anterior and posterior cruciate ligaments named?
they are named for where the insert (anterior: inserts on the anterior portion of the tibia; posterior: inserts on the posterior tibial plateau)
what are the fxns of the cruciate ligaments?
ACL: prevents the tibia from sliding forward; PCL: prevents the tibia from sliding posteriorly
What tests do you do to test for cruciate tearing?
1) Drawer Test; 2) Lachman's Test; 3) Apley's Distraction Test; Imaging (MRI is best)
what position is the body in when you see ACL ruptures?
leg is extended and internally rotated and the body continues forward; get a Positive anterior drawer and Lachman Test
What position is the body commonly in when you see a PCL rupture?
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
What position in the body commonly in when you see a rupture of the medial collateral ligament?
a force from the posterolateral portion of the knee (valgus stress)
What position in the body commonly in when you see a rupture of the lateral collateral ligament?
caused by trauma pushing the knee into varus
what is a the Terrible Triad of O'Donoghue?
MAM: rupture of all 3: Medial Collateral, ACL, and tear in the Medial Meniscus
How do you test for the Terrible Triad of O'Donoghue?
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
what are the symptoms of menisceal tears?
clicking, locking of the knee, and knee pain
How do you diagnose menisceal tears?
Apleys' Compression Test and McMurray Test; imaging with MRI
There are typically __# of bursae about the knee.
How do you get prepatellar and infrapatellar bursitis?
called the Housemaid's Knee, Nun's Knee, Clergyman's Knee - constant kneeling trauma (rarely TB)
What is the name to describe the inflammation of the insertion of the conjoined tendons of 3 muscles (sartorius, gracilis, and semitendinous m)?
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
what is a fabella?
a sesamoid bone located in the gastrocnemius tendon; it will always remain in the same position on x-ray, posterior to the knee joint
Name the term that describes osteochondrosis affecting the tibial tuberosity.
Osgood-Schlatter DZ
How do you dx and tx osgood-schlatter's dz?
Tenderness and swelling of the tibial tuberosity; x-ray demonstrates seperation of the growth plate; TX: NSAIDs, avoid exercise when painful
L4 radiculitis causes this syndrome where the pt can't extend the knee.
Vastus medialis Syndrome of Pseudoblocking (get spasms in the vastus medialis)