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AA foot, ankle, knee

QuestionAnswer
The 4 patella tangential exams (patella floating) SHAM Settegast, Hughston, Axial, Merchant
Settegast exam, tangential patella Pt. prone w/ leg flexed 90, IR under knee, CR 15 - 20 from lower leg at PF joint.
M/L knee gets what CR angle and why 5 to 7 degree cephalad, medial condyle of femur sits more distally then the lateral condyle
6 patella exams PA, Lateral, Settegast, Hughston, Axial, Merchant
The intercondylar fossa exam looks at what area of the knee The Intercondylar fossa and intercondylar eminence and tibial plateau
What feature helps to identify lateral or medial femur condyle when doing a tangential patella The lateral condyle face is higher than the medial, The medial epicondyle has the Adductor Tuberosity on top side
4 intercondylar fossa exams (tunnel exams) BCHR Beclere, Rosenburg, Holmblad, Camp Coventry
Merchant Method (tangential axial bilat. patella) SID 48-72, Pt. sit at end of table w/ legs on 40° board, CR at 30° from upper legs Perpendicular to IR 12" below knees, CR b/w knees
Sunrise Method (axial tangential) Inferosuperior Pt supine/semi, IR sitting of lap, CR 10°-20° going up perpendicular to IR at PF joint
PA Patella Pt prone leg extended IR under knee CR perpendicular IR at Popliteal crease LEG 5° INTERNAL rotation
AP Knee pt. supine w/ leg extended 3°-5° internal rotation of leg, CR 1/2" below apex of patella, CR angle to ASIS measure to TT <19cm 5° caudal, 19 - 24 0° and > 24cm 5° cephalad.
Lateral Knee M/L Pt. recumbent on affected side, leg flexed 20°-30° true lateral with patella face perpendicular to IR; CR always 5°-7° cephalad at 1" distal the epicondyle
AP Oblique Knee external Pt. supine/semi w/ extended leg rotated 45° externally, CR perp. to IR at 1/2" below apex of patella. Tib/ Fib superimposed
AP Oblique Knee internal Pt. supine/ semi w/ extended leg rotated 45° internally, CR perp. to IR at 1/2" below apex of patella, Tib/Fib well demonstrated, lateral condyles in profile with patella in medial region
Position error for lateral knee, distal condyle and pos. condyles both the condyles should be superimposed distally and posteriorly, look at fib head and neck location to tib. posterior issue is rotation and distal is the tube angle issue
Lateral Patella M/L Leg flexed 5°-10°, patella face prep. to IR, CR prep. to IR at PF joint
Alternative to Lateral knee M/L X- Table when pt. can not flex leg. CR now goes 5°-7° caudal, IR b/w legs for L/M projection
AP Weight bearing Knee Pt. erect at WB, feet straight ahead, CR perp. to IR for Normal size pt. and CR Angled 5°-10° caudal for thin. CR b/w knees at 1/2" below patella apex.
Rosenburg Method (pa axial wt. bearing bilat) Knees against WB flexed at 45° ; CR angled 10° caudal b/w the knees; tunnel view PA Proj.
Camp Coventry Method (pa axial intercondylar fossa) pt. PRONE IR under knee with leg flexed 40°-50° ; CR Perp. to the lower leg at the popliteal crease PA Proj.
Beclere Method (ap axial intercondylar fossa) pt. SUPINE IR under knee with leg flexed 40°-45°; CR perp. to lower leg at 1/2" below apex patella AP Proj.
SID for adult Tib/Fib 48 " with IR on a diagonal , need 1" -2" of border on IR , get knee and ankle
AP tib/fib supine w/ leg extended. Dorsiflex foot, epicondyles Parallel to IR ; CR prep. to IR at mid tib; IR on diagonal with 48" sid
CR location for Foot, Calcaneus, Ankle Foot at base of 3rd metatarsal , Calcaneus at the 1" distal the medial malleolus and Ankle is at the medial malleolus
Tibial Plateau sits at what angle 10°-20° posteriorly
3 names for the depression the patella sits in Patella surface, Intercondylar sulcus and the Trochlear groove.
2 structures that must be included on a ankle, calcaneus and foot exams the Tuberosity of the 5th metatarsal and the Cuboid bone
CR location for the AP and Lateral ankle AP, Mortis and Oblique is at the mid region of the Malleoli and the Lateral is at the medial malleolus
CR for Toe exam CR at 10°-15° or 0° if using a 20° sponge, at the MTP joint
Degree of difference from tib to fib on intermalleolar plane Lateral malleolus sits 15° posterior to the medial malleolus or 1cm
Tangential Toe Sesamoid bones exam pt. prone w/ toes on flexed on IR and foot flexed 15°-20° from vertical; CR prep. to IR at the 1st MTP joint at plantar surface.
Oblique foot Leg flexed w/ foot rotated medially of 30° - 40° CR prep. to IR at the base of the 3rd Metatarsal; no super. except base of 1 &2, need 1" of tib/fib and 5th tuberosity, Proj. L/M and dorsum parallel to IR.
Plantodorsal Axial Calcaneus Pt. supine leg extended w/ foot dorsiflexed 90° CR angle down at 40° at the 3rd TMT region on plantar surface.
AP Foot dorsoplantar pt. supine w/leg flexed foot on IR ; CR angle of 5°-15° towards the calcaneus at the base of the 3rd metatarsal ; heads superimposed
AP Weight Bearing Foot Pt. erect w/ both feet on IR, CR at 15° posterior aimed at b/w the feet at the TMT joint region
Lateral Tib/Fib M/L exam Pt. supine, leg true lateral w/ patella face perp. IR, both knee and ankle in view, SID 48 ', CR perp. IR mid point of Tib. Tibial tuberosity in profile
Indications for over and under rotation of lateral knee M/L and x-table M/L over rotation tib and fib separation, under rotation tib and fib have more superimposition ; X - table is opposite
Holmblad exam Pt. on all 4's with knee on IR and legs flexed 60° - 70° and CR perp. to IR at the popliteal crease. can be done on a chair. PA Proj.
Lateral Foot Pt. leg flexed 45° foot dorsiflexed and plantar surface perp. to IR. CR at base of 3rd MT. M/L done most, L/M also
AP Mortise ankle Pt. Supine w/ leg extended. Foot dorsiflexed with 15*- 20* internal rotation, CR perp. IR at mid malleoli region
Why should oblique and lateral foot show mid metatarsal’s View of the tuberosity of the 5th MT
The lateral malleolus superimposes where when the ankle is in a True Lateral position Projects over the posterior distal region of tibia, fibula sits 15* posterior to tibia
Why are PA projections preferred over AP for tunnel exams of the knee OID and distortion ; control amount of dose to gonadal region
How much knee flexion for lateral patella 5* to 10*
How much leg flexion for Hughston 55*
Created by: scones and joe
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