Orthopedic exams
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| Deep Venous Thrombosis (DVT) | Risk factors: prolonged immobility-post-surgery/trauma, chronic venous insufficiency, OCPs, cancer, diabetes
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| Homan's Sign | passive, supine
-dorsiflex foot and squeeze calf +pain at posterior leg/calf= thrombophlebitis
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| Intermittent claudication | Sx of peripheral artery dz d/t insufficient blood flow causing pain during exercise relieved by rest
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| Claudication test | active standing
-walk a rate of 120 steps/minute for 60 secs (treadmill)
+leg cramp or pallor =PVD or chronic arterial occlusion
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| Neurological claudication | pain feels better with moving upper body
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| Buerger's test | passive, supine
-elevate leg to 45deg, dorsiflex, hold for 2 mins, then pt sits up and dangles legs
+immediate blanching when elevated or more than 2 mins for color to return=arterial compromise to lower extremity
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| Compartment syndrome | painful condition that results when pressure w/in muscle builds to dangerous levels and prevents nourishment from reaching nerve/muscle cells
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| Acute compartment syndrome causes | direct trauma (fracture/fall/crush injury/surgical complication/circulation blockage/change in activity level)
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| Acute compartment Syndrome classic signs | pain out of proportion w/ passive stretch, pressure, paresthesia, loss of pulses, pallor (SURGICAL emergency)
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| Chronic (exertional) compartment syndrome | muscle swelling from intensive exercise; aching/throbbing pain w/ activity that subsides after hours of rest (Tx: non-urgent surgery)
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| Calf circumference test | passive, supine
-measure circumference of bellies of gastronemius and soleus muslces b/l and compare
+dec size of affected leg=loss of muscular tone/atropy
+inc size of affected leg=muscular comprement pressure/hypertrophy
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| Complex Regional Pain Syndrome | intense pain w/ dramatic changes in color/temperature of skin of affected part (burning, sensitivity, sweating, swelling)
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| Tarsal Tunnel Syndrome | compression of posterior tibial nerve in tarsal tunnel (caused by scar tissue, post fracture callus, tendon sheath inflammation, excessive foot pronation)
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| Tinel's foot sign | passive, prone
-tap area of posteror tibial nerve +paresthesia of foot=tarsal tunnel syndrome
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| Ankle sprain | lateral ligaments commonly involved (anterior talofibular-strain when planterflexed + inverted, calcaneo-fibular, posterior talofibular)
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| Ankle sprain classifications | Grade 1=ligaments stretched, not torn. Grade 2=partial ligament tears. Grade 3=complete ligament tears
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| Lateral (inversion) ankle sprain | more common then medial, X-ray (mortise, AP, lateral)
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| Ankle sprain Tx | RI (20mins every 2 hrs) CE (above heart level)
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| Lateral stability test | passive, supine
-adduct (invert, supinate, varus) +inc gapping=tear of anterior talofibular or calcaneofibular ligament
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| Drawer's foot sign | passive, supine -anterior:stabilize tibia and pull calcaneus, posterior:stabilize foot dorsum and pull tibia +anterior: inc. gapping=tear of anterior talofibular ligament +posterior: inc. gapping=tear of posterior talofibular ligament
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| Peroneal tendon injury | persistent pain after sprain, elicited by resisted eversion of foot
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| Medial (eversion) sprain | less common (more severe injuries)
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| Medial stability test | passive, supine
-abduct (evert, pronate, valgus)
+inc gapping =deltoid ligament tear
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| Syndesmosis injury | separation of tibia from fibula (preceded by deltoid ligament tear) from forced external rotation
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| Ankle fracture | Refer if fibula fracture proximal to talar dome or w/ medial tenderness
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| Metatarsal fracture | acute plantar flexion or direct injury (common in runners), focal pain/swelling.
-Refer if fracture displaced, non-displaced (3-4 weeks in walking cast/boot)
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| Phalangeal fractures | common, w/ rotational deformity. Tx: buddy tape and hard-sole shoe for comfort 2-3 weeks
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| Morton's Test | passive, supine
-transverse pressure across heads of metatarsals
+pain in forefoot= neuroma between metatarsals/metatarsalgia
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| Morton's Interdigital Neuroma | abnormal function of foot that leads bones to squeeze nerve causing discomfort/extreme sharp/buring pain typically btw 3rd and 4th metatarsal heads.
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| Pes Planus | acquired flatfoot deformity, tender along course of tendon
-weak inversion treated w/ orthotics
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| Supple flat feet test (aka navicular drop test) | passive/active seated/standing -measure height of navicular seated
+ standing +>10mm=inc risk of pronated foot
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| Hallux valgus (bunion) | lateral deviation w/ pronated phalanges (strong family tendency w/ shoe wear implication)
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| Achilles Tendon rupture | acute event often occurs in chronic tendonitis
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| Achilles Tendinosis/Tendinopathy | Chronic injury in less vascular area of tendon d/t overuse injury in men >40
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| Thompson's test | passive, prone
-flex knee and squeeze calf muscles
+lack of plantar flexion=Achilles tendon rupture
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| Gout | Uric acid (monosodium urate crystal) deposition w/ sudden joint pain associated w/ heavy alcohol use, obesity, CAD, hypertriglyceremia
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| Pseudogout | calcium pyrophosphate deposition dz associated w/ metabolic d/o (hemochromatosis, hyper parathyroidism, DM)
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| Shin Spints | Periostitis of tibia-inflammation of muscle attachments d/t training improper footwear, low bone mass/density
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| Plantar Fasciitis | inflammation of the plantar fascia d/t tight achilles tendon w/ point tenderness at plantar fascia origin worse in morning or after rest and w/ dorsiflexion of toes
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| Hallux Rigidus | Stiffness osteoarthritis of the great toe MP joint -pain w/ dorsiflexion
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| Claw toes/hammer toes | Flexion deformity of PIP joints w/ hyperextension of MP joint causing painful calluses, metatarsalgia.
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| Retinacular test | seated, passive
-flexion of DIP and repeated w/ PIP flexed
+No flexion in neutral=tight collateral or joint capsules
+No flexion w/ flexed PIP=tight collaterals
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| Bounce Home test | supine w/ knee flexed
-pt relaxes/drops knee
+inability to fully extend or “rubbery” feeling on full extension =possible torn meniscus
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| Tibial Torsion test | (-)the line drawn btw the two malleoli is rotated externally 15deg from a perpendicular line drawn from tibial tubercle to ankle (+)the malleolar line faces directly anterior=internal tibial torsion
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