Lower Extremity: Knee and Ankle
How do you perform the balloon sign?
- Place thumb and index finger on each side of the patella - Left hand compresses the suprapatellar pouch - Feel for fluid under your right thumb and index finger
A mild knee effusion will be what grade? Clinical significance?
1+ which may suggest: 1. old meniscal tear 2. osteoarthritis
What are the 4 ligaments of the knee?
1. ACL 2. PCL 3. MCL 4. LCL
Knee swelling within 0-12 hours can signify injury to what two structures?
1. ACL Tear 2. Patella dislocation
Hearing a pop with a twisting injury can signify which type of injuries?
1. ACL tear (80%) 2. Meniscal tear ( 15%) 3. Fracture
What are the steps in examination of the knee?
1. Inspection 2. Palpation 3. ROM 4. Special Maneuvers
A healed or repaired meniscal tear is at risk for?
1. Re-tear 2. Patella dislocation
A moderate knee effusion will be what grade? Clinical significance?
2+ which may suggest: 1. Acute meniscal tear 2. PCL tear
The knee should be placed in _______ degrees of flexion when performing the lachman's test.
20 degrees
A large knee effusion will be what grade? Clinical significance?
3+ which may suggest: 1. patellar dislocation 2. ACL tear
During palpation of the knee, the patient should be flexed to _________ degrees?
90
Significant forward excursion > ______mm indicates an ACL tear during the lachman test.
>5mm
Abrupt non-contact deceleration with a twisting motion
ACL injury
What is the classic triad aka the unhappy triad?
ACL, MCL, and medial mensicus tears
What does Thompson test assess for?
Achilles tendon rupture, test is + if there is no plantar flexion of the foot when squeezing the calf.
What is the most common MSK injury?
Ankle sprain
What two test check for lateral ligament rupture of the ankle?
Anterior drawer and talar tilt
Can cause distension of the gastocenium and semimembranous bursa
Baker's cyst
What is the most commonly affected joint in gout?
Base of the big toe
What is the most common tarsal fracture?
Calcaneous
Injury to the deltoid ligament is caused by?
Eversion
Knock knees is also called?
Genu valgum
Bow legs
Genu varum
During the anterior and posterior drawer tests what degree of flexion should the hips and knees be?
Hips: 60 degrees Knees: 90 degrees
Swelling over the tibial tuberosity can indicate?
Infrapatellar Bursitis
Fracture of the 5th metatarsal.
Jones fracture
The varus stress test assesses which ligament?
LCL
What is the best test to access the ACL?
Lachman test
What is the most common mechanism for an ankle sprain? What ligaments are most commonly affected?
Lateral inversion, anterior talofibular and posterior talofibular
IR and varus stress during the mcmurray's test checks for the ?
Lateral meniscus
The valgus stress test is used to access the?
MCL
Valgus strain can injure what structure?
MCL injury
The balloon sign and ballotting sign are used for __________ effusions
Major
ER and valgus stress during Mcmurray's assess the ?
Medial meniscus
Clicking or locking of the medial knee can indicate?
Medial meniscus tear
What does the apley's grind test check for?
Meniscal injury
Inability to fully extend the knee, suggests a ____________?
Meniscal tear
Bulge sign is used for _________ effusions
Minor
0 on the grade scale of knee effusion = ?
No effusion, normal knee joint
- Inflammation of the proximal tibial tuberosity - Common in boys between 11-18 years old - Common in repetitive jumping sports
Osgood-Schlatter disease
X-ray of the knee shows fragmentation of the tibial tuberosity
Osgood-Schlatter disease
Posterior translation of the tibia related to the femur, during a MVA dashboard injury
PCL rupture
- Patient lying supine, knee cap is pushed laterally - + Test is when the patient becomes apprehensive. - Suggests a recent patella dislocation
Patella Apprehension Test
What is Jumper's knee?
Patellar Tendonitis
- Common in adolescents and young adults - Women are more common 2:1 due to wider pelvis - Can be due to muscle imbalances and overuse.
Patellofemoral Syndrome
- Associated with flexion contracture of the knee - Bursa under hamstring tendon is inflammaed - Pain at distal medial knee
Pes Anserine Bursitis
Swelling between the patella and the tibial tubercle can indicate?
Pes Anserine Bursitis
Distial tibia fracture is called a ?
Pillon fracture
- Repetitive pressure on the knees - Can see swelling, warmth and erythema
Prepatellar bursitis (housemaid's knee)
Squeeze the proximal tibia and fibula together. + Test is pain felt at the distal ankle. What ligament are you assessing?
Squeeze test, tibiofibular ligament
Swelling over the patella can indicate?
Suprapatellar bursitis
Tenderness in ischiogluteal bursitis May mimic sciatica
Weaver's bottom
House maid knee from repetitive kneeling is an injury to what?
prepatellar bursitis
