lower extremity disorders pfn: somool04slides.jsomtc.org/somool04/somool04.pdf · lower extremity...

1

Slide 1JSOMTC, SWMG(A)

Lower Extremity DisordersPFN: SOMOOL04


Terminal Learning Objective

Action: Communicate knowledge of “Lower Extremity Disorders”

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


References

Pathophysiology for the Health Professions, 4th edition

Manual of Orthopedics, 5th edition, Lippincott Williams & Wilkins, 2001

The Merck Manual, 18th edition

Special Operations Forces Medical Handbook, 2008 edition

2


Reason

The knee and the lower leg are very vulnerable to injury, especially in our physically active population.

Activities such as running, jumping, and pivot‐shifting all have potential for injury to the lower extremity structures.


Agenda

Communicate the anatomical function of the knee structures

Communicate the diagnostic tests that may be used to assess knee injuries

Communicate the signs and symptoms, physical exam findings, and management of patellar injury, to include fracture, subluxation, dislocation, and maltracking


Agenda

Communicate the signs and symptoms, physical exam findings, and management of a meniscal cartilage tear

Communicate the signs and symptoms, physical exam findings, and management of a ligamentous knee injury, to include the collateral and cruciate structures

3


Agenda

Communicate features of knee dislocation and its management guidelines

Communicate the signs and symptoms, physical exam findings, and management of an extensor mechanism injury

Communicate the signs and symptoms, physical exam findings, and management of knee disorders that are commonly seen in the child and adolescent age group


Agenda

Communicate the signs and symptoms, physical exam findings, and management of knee‐related inflammatory disorders to include tendonitis, iliotibial band syndrome, and bursitis

Communicate features of a popliteal cyst to include possible causes


Agenda

Identify complications associated with distal lower extremity fractures

Differentiate between the features of tibialstress fracture and shin splints

Communicate the signs and symptoms, physical exam findings, and management of distal lower extremity compartment syndrome

4


The Anatomical Function of the Knee Structures


Knee Anatomy and Function


Knee Disorder Types

Patellar

Fracture

Subluxation

Dislocation

Chondromalacia

Ligamentous

Collateral ligament injury

Cruciate ligament injury

Meniscal cartilage tear

Tendonitis / tendon rupture

Bursitis

Popliteal cyst

Dislocation

5


Knee Disorder Assessment

History

Onset

Location

Duration

Mechanical symptoms

Joint swelling

Mechanism of injury

Physical exam

Soft tissue lesion

Point tenderness

Assess for effusion

ROM evaluation

Ligament laxity

Meniscal exam

Diagnostics



The Diagnostic Tests That May be Used to Assess Knee Injuries

6


Knee Injury Diagnostics

X‐ray

Arthrocentesis

MRI



Potential pathologies

Fracture

Dislocation

Inflammatory changes

Pathologic cysts

Effusions

A



X‐ray

Indications: Ottawa criteria

• Inability to take four weight‐bearing steps

• Localized pain over patella or femoral neck

• Inability to flex knee to 90 degrees

• Age > 55 y/o or younger than 12 y/o

7



Arthrocentesis

Indications: Demonstrable joint effusion

Benefits

• Reduction of pain

• Improves ROM

• Fluid analysis provides clue to diagnosis


Knee InjuryJoint Effusion



Arthrocentesistechnique

Skin prep and draping

Lateral approach

Lidocaine analgesia

Equipment

• 30 mL syringe

• 3‐way stopcock

• 18 or 20 gauge needle

8


Infection Secondary to Aspiration


Knee Injury DiagnosticsArthrocentesis Interpretation


Knee Injury DiagnosticsArthroscopy

9


The Signs and Symptoms, Physical Exam Findings, and Management of Patellar Injuries to Include Fracture,

Subluxation, Dislocation, and Maltracking


Patellar Fracture

Mechanism of injury

Direct trauma

Distraction forces from quadriceps contraction

What function has this patient lost with this injury?


Patellar Fracture

Clinical presentation

Tenderness, swelling of the knee

Potential loss of knee extension

Palpable/visible defect

Patient describes “instability”

10


Patellar FractureClinical Presentation

A B


Patellar Fracture Clinical Presentation


Patellar Fracture

Patterns

Variable: depends on mechanism of injury

Inherently unstable

Majority require surgical stabilization

11


Patellar Fracture Confounders: Bipartite Patella


Patellar Fracture

Management

P.R.I.C.E.

Immobilization

Crutches (non‐weight bearing)

Orthopedic referral


Patellar Instability

Disorders

Patellar dislocation

Patellar subluxation

Chondromalacia patella

• a.k.a. Patellofemoral pain syndrome (PFPS)

12



Pre‐disposing factors

Younger age groups

Female gender

Exaggerated “Q angle”

Pes planus

Tibial torsion

Hypoplastic trochlear groove/patellar body


Patellar InstabilityPredisposing Factors



Predisposing factors (cont’d)

Hypoplasia

• Trochlear groove

• Patellar body

13


Patellar Dislocation

Displacement of the patella out of the trochlear groove

Contributing factors (MOI)

Malalignment

Maltracking

Blunt trauma

“Cutting” maneuver




Anterior knee pain

Anterior knee tearing sensation at injury

Patient describes hearing a “pop”

Knee flexes with dislocation

Patella often relocates with knee extension


Patellar DislocationClinical Presentation

A B

14


Patellar DislocationX‐ray “Sunrise view”





Management

P.R.I.C.E.

Dislocation reduction

Screening x‐ray

Knee sleeve 4‐6 weeks

Crutches (partial weight bearing)

Quadriceps strengthening exercise

Consultation if recurrent

15


Patellar Dislocation Reduction Technique



Management

Patellar knee sleeve


Patellar Subluxation

Definition: Condition in which the patella is hyper‐mobile with tendency towards medial or lateral displacement

Patella maintains partial relationship to the trochlear groove

Potential exists for advancement into complete dislocation of the patella

Pre‐disposition with patellar or trochlearhypoplasia

16


Patellar SubluxationClinical Presentation

A B



Clinical presentation (cont’d)

Recurrent anterior knee pain events

Perceived knee instability

“Mechanical” limitation of ROM



17


Patellar SubluxationClinical Presentation


Patellar Subluxation“Apprehension Test”


Patellar Subluxation“Apprehension Test”

18



Management

Patellar sleeve

Quadriceps strengthening exercises

Potential orthopedic referral

• Surgical lateral retinacular release


Chondromalacia Patella

A.K.A. Patellofemoral pain syndrome

Premature degeneration of the retropatellar cartilage due to:

Patellar malalignment

Direct trauma

Congenital abnormality

Recurrent patellar subluxation




Diffuse aching anterior knee pain

Pain increase with sitting (theater sign), climbing stairs, jumping, or squatting

Feeling of instability or a retro‐patellar catching sensation

Common in active‐duty military and female gender

19


Chondromalacia PatellaMechanism of Injury



Objective findings

Tender undersurface of medial or lateral patella

Crepitation with knee range of motion

+ Patellar compression test

No knee effusion


Patella Compression TestR/O Chondromalacia Patella

20



Diagnostic studies

X‐ray: AP, lateral, sunrise views

Arthroscopy



Management

Physical profiling

Analgesia

Activity modification

Isometric quadriceps strengthening

Knee sleeve / orthotics

Consultation if chronic


Chondromalacia PatellaPatellar Shaving

A B

21


The Signs and Symptoms, Physical Exam Findings, and Management of

Meniscal Cartilage Tears


Meniscal Cartilage

Anatomy and function

Semi‐lunar shape

Located within joint line

Dissipates impact shock

Assists joint stability

Augments lubrication


Meniscal Cartilage Tear

Mechanism of injury

Knee flexion

Weight fixed on foot, or “planted” foot

Rotational twist of knee

22




Pain over joint line

Feeling of instability

Catching, locking, popping feeling

Gradual onset of effusion following injury

Mechanical dysfunction

• Locking

• Sudden “giving way”


Meniscal Cartilage TearJoint Line Tenderness


Meniscal Cartilage TearPhysical exam: McMurray test

23


Meniscal Cartilage TearPhysical exam: Apley’s compression test



Diagnostic studies

Knee aspiration (if effusion present)

MRI: specific and sensitive

Arthroscopy


Meniscal Cartilage TearArthroscopy

24




Medial Meniscal Tear

Confounders: Knee plica syndrome

Redundant synovial membrane

Prone to irritation

Manifests similarly to meniscal tear

MRI diagnostic

Surgically reducible



Management

P.R.I.C.E.

NSAIDs as needed

Crutch‐walking (partial weight bearing)

Aspiration of effusion (diagnostic/therapeutic)

Consultation

•MRI

• Arthroscopy• Surgery

25



Ligamentous Knee Injuries , to Include the Collateral and Cruciate

Structures


Collateral Ligaments


Collateral Ligament Injury

Mechanism of injury

Medial collateral ligament (MCL) tear or sprain is commonly a valgus force to the knee (abduction of lower leg)

Lateral collateral ligament (LCL tear is the result of a pure varus force to the knee (adduction of lower leg)

Rotational twisting of knee

26


Collateral Ligament InjuryMechanism of Injury

A B




Pain to palpation over involved ligament

Localized pain to palpation

Localized edema

No effusion*

Joint line laxity


Collateral Ligament InjuryDiagnostic Maneuvers

“Varus / Valgus Stress Test”

27



Diagnostic studies

AP, lateral x‐rays: usually negative

An avulsion fracture from the femoral origin of the MCL or the fibular insertion of the LCL may be seen



Confounders: Combination injury

Collateral ligament

Anterior cruciate

Meniscal cartilage

Clue = Effusion



Management

P.R.I.C.E.

Physical profile


NSAIDs as needed

Hinged brace

Consultation• Grade III tears: Possible surgery

28


Cruciate Ligament Tears

Anterior cruciate ligament (ACL):

Primary stabilizer of the knee

Prevents anterior translation of the femur

Posterior cruciate ligament (PCL):

Prevents rearward translation of the tibia


Cruciate Ligament Tears

ACL tear is far more common than a tear of the PCL


ACL TearMechanism of injury

29


ACL TearClinical Presentation


ACL Tear


Painful “popping” sensation at time of injury

Swelling (hemarthrosis) within 1‐2 hours of injury

“Giving way” or buckling sensation of knee


ACL Tear


Effusion increases pain and limits ROM

Develops within initial few hours of injury

30


ACL Tear

Diagnostic tests

Positive Lachman test*

Positive anterior drawer sign

Hemarthrosis

MRI

Arthroscopy


ACL TearLachman Test


ACL Tear Anterior Drawer Test

31


ACL Tear

Arthrocentesis

Hemarthrosis with fat globules indicates associated fracture• Segond fracture

• Avulsed tibial spine


ACL Tear

Anatomical considerations

Broad attachments to tibial plateau

Increases potential for avulsion of bone structure


ACL Tear“Segond” Fracture

32


ACL Tear Avulsed Tibial Spine


ACL Tear Arthroscopy


ACL Tear

Management

P.R.I.C.E.

Joint aspiration*

Knee immobilizer

Crutches (NWB)

Analgesics

Orthopedic referral• Surgical consideration

33


Knee Immobilizer


Posterior Cruciate Ligament Tear


PCL Tear

Mechanism of injury

Direct trauma to tibia with knee flexed• “Dashboard” injury

• Forward fall onto object

Hyperextension

Rotational knee stress

34


PCL Tear

Acute clinical presentation

Minimal pain

Minimal hemarthrosis

Full ROM

Contusion over anterior tibia

Posterior tibial sag

Posterior drawer sign


PCL TearDiagnostic Tests

Sag Test Posterior Drawer Sign


PCL TearPosterior Drawer Sign

35


PCL Tear

Grading of posterior drawer test

Grade 1: Posterior displacement up to 5 mm

Grade 2:Posterior displacement 5‐10 mm or tibial plateau moves posterior ‐‐ even with femoral condyles

Grade 3: Posterior displacement greater than 10 mm or tibial plateau moves behind femoral condyles


PCL Tear

Chronic presentation

Overt symptoms may be absent with initial injury; delayed features include discomfort and instability sensation with the following:

• Semi‐flexed position

• Starting a run

• Lifting a load•Walking longer distances


PCL Tear

Diagnostic tests

X‐ray: AP, lateral, and tunnel views of the knee (evaluate for tibial avulsion fracture)

MRI: may confirm a PCL tear

Arthroscopy: diagnostic

36


PCL TearTibial Spine Avulsion Fracture


PCL Tear

Management

P.R.I.C.E.

Joint aspiration*

Knee immobilization (extension splint)


Analgesics

Orthopedic referral

• Surgical consideration


Features of Knee Dislocation and Its Management Guidelines

37


Knee Dislocation

True orthopedic emergency

Result of high‐energy force (e.g., falls/blunt trauma)

Types

Posterior*: Direct blow to proximal tibia

Anterior*: Hyperextension of knee

Medial: Valgus force to knee

Lateral: Varus force to knee

Rotary: Body rotation on planted foot


Knee Dislocation Types


Anterior Knee DislocationClinical Presentation

38


Posterior Knee Dislocation


Knee Dislocation


Severe pain

Unable to bear weight

Limited ROM

Visible ecchymosis

Visible deformity*

Unstable knee*

Potential for neurovascular deficit*


Knee Dislocation

Clinical presentation (cont’d)

Popliteal ecchymosis

• Popliteal artery injury

Knee hyperextension• Perform with heel lift

• > 30 degrees extension = unstable knee

39


Knee DislocationPotential Complications


Knee Dislocation

Potential complications

Ischemia* “Five Ps”

• Popliteal artery compromise

• Compartment syndrome

Peroneal nerve injury (presents as foot drop)

Deep venous thrombosis*

Aneurysm formation*

Associated fractures


Knee Dislocation

“Pointers”

Popliteal artery compromise is the greatest risk after knee dislocation

After eight hours of ischemia the majority of injuries require amputation

Presence of distal pulses does not rule out arterial injury

Popliteal artery lesions or thrombosis may not become evident for up to several weeks after injury

40


Knee Dislocation

Management

Systemic analgesia

Pre/post‐reduction x‐ray (if available)

Immediate reduction (linear traction for most)

Assess neurovascular status before and after

Posterior splint with knee flexed to 20 degrees

Evacuate for surgery/arteriogram

*Posterolateral dislocation requires surgical reduction


Posterolateral Knee Dislocation


Knee DislocationReduction Technique

41



an Extensor Mechanism Injury


Extensor Mechanism Components

Quadriceps tendon

Patella

Patellar tendon


Extensor Mechanism Rupture

The quadriceps complex may sustain injury through

Rupture of the quadriceps tendon

Fracture of the patella

Patellar tendon rupture

Avulsion of the tibial tuberosity

42


Extensor Mechanism Injury



Risk factors for rupture

Athletes in jumping sports

Repetitive trauma to knee extensor tendon

Tendonitis

Rheumatoid arthritis

Chronic renal failure

Diabetes mellitus

Local corticosteroid injections of tendons




Effusion/edema/pain

Palpable defect above or below patella

Difficult active knee extension

43



Diagnostic studies

X‐ray: AP, lateral knee views to R/O patellar fracture

MRI• Confirms tendon rupture



Management

P.R.I.C.E.

Knee immobilization long‐leg cast with knee in extension

Crutches (NWB)

Consultation

Surgical repair


The Signs and Symptoms, Physical Exam Findings, and Management of Knee Disorders Commonly Seen in the

Child and Adolescent Age Groups

44


Adolescent Knee Disorders

Physeal injuries

Posterior cruciate ligament avulsion

Osteochondritis dessicans


Physeal Injuries

“Growth Plate Injury”

Common in children and young adolescents

Potential risk for arrested linear bone growth


PCL Avulsion

Spontaneous avulsion of PCL with tibial spine disruption

Associated with jumping maneuver

Referral to orthopedics

45


Osteochondritis Dessicans

Defect involving medial femoral subcondyle surface

Localized necrosis followed by avulsion of osteochondralsegment




Gradual onset of pain

Intermittent “catching or “locking” of knee

Effusion

Modified gait

• External rotation of foot and leg (relieves pressure on lesion)


Osteochondritis DessicansClinical Presentation

46



Management

Orthopedic referral

•MRI

• Arthroscopy (fragment removal)

Note: Even after fragment removal, it may take several months for lesion to heal


Osgood Schlatter’s Disease

Traction injury involving tibialtubercle (patellar tendon insertion site)

Localized inflammation

Affects age group 10 to 15 years of age


Osgood Schlatter’s Disease“Tibial Tubercle Apophysitis”

47




Activity related pain

• Repetitive jumping or sprinting sports

• Typically pain is found in take‐off leg

Increased pain with kneeling

Prominent tibial tubercle

Patient may complain of mild swelling below the knee


Osgood Schlatter’s DiseaseClinical Presentation


Osgood Schlatter’s DiseaseClinical Presentation

A B

48



Management

Ice compresses

Protective pads

NSAIDs as needed

Referral*



Knee‐related Inflammatory Disorders to Include Tendonitis, Iliotibial Band Syndrome, and

Bursitis


Knee Tendonitis

A common overuse injury caused by microscopic tears of the tendon

May involve the patellar or quadriceps tendon

49


Knee Tendonitis


Localized pain (exacerbated with tendon stretch)

Edema

Erythema

Warmth

Palpable crepitus


Knee Tendonitis

Management

Physical profiling

Ice applications

NSAIDs

Note: No corticosteroid injection due to risk of weakening the tendon and increasing risk of rupture


Iliotibial Band Syndrome

Inflammatory condition involving the fascial band located over the lateral thigh and knee

Common cause of localized lateral knee pain

Associated with physical activities involving repeated flexion and extension of the leg and knee

50





Risk factors: Associated physical activities

Banked surface running

Cycling with feet toed‐in excessively

Inadequate warm‐up or cool‐down

Up‐ or down‐hill running

Repetitive stair climbing

Rowing

Anatomic anomalies




Regional to localized pain over lateral femoral epicondyle

Pain increases with weight bearing on the flexed knee (30 degrees flexion)

Overlying edema (occasionally)

Positive Ober’s test

51


Iliotibial Band SyndromeOber’s Test



Management

Physical profile

Activity modification

NSAIDs

Eversion orthotics

Consultation (physiotherapy)

Prevention: stretching, warm‐up, strengthening

Corticosteroid injection


Iliotibial Band SyndromePreventative Stretch Program

52


Iliotibial Band SyndromeMuscle Strengthening Program


Iliotibial Band SyndromeManagement


Knee Bursitis

Bursae: Fluid‐filled, synovial lined sacs

Located over bony prominences

Allows “sliding” of skin and tendon structures over bony prominences

53


Knee Bursitis

Chronic friction leads to inflammation and increased synovial fluid in bursae sac

Blunt trauma leads to bleed into bursal sac (hemobursa)


Knee BursitisClinical Presentation

A

B C


Prepatellar Bursitis

54


Bursitis

Management

NSAIDs

R.I.C.E

Aspiration

Corticosteroid injection

Compressive wrap

Activity modifications

Consultation (if recurrent)


Features of a Popliteal Cyst to Include Possible Causes


“Baker’s” (Popliteal) Cyst

Localized swelling of synovial membrane in the popliteal fossa

Extension of the knee synovium

Associated with intra‐articular pathology

55



Etiology

Secondary lesion

• Arthritis

• Collateral ligament injury

•Meniscal cartilage injury *

• Cruciate ligament injury

Note: Popliteal cysts in children are not associated with intra‐articular knee pathology




Localized pain

Fluctuant swelling

Cyst transilluminates

• Helps to differentiate from a tumor


“Baker’s” (Popliteal) CystClinical Presentation

56



“Confounders”

Popliteal artery aneurysm: Pulsatile?

Tumor: Non‐fluctuant

Thrombosis / thrombophlebitis: inflammation?


“Baker’s” (Popliteal) CystComplications

May mimic Deep Venous Thrombosis!



Management

Needle aspiration with caution

• Temporizing measure

Elastic wrap

Referral

• Intra‐articular assessment to rule out following

Meniscal tear

Collateral ligament tear

Partial cruciate tear

Arthritis

57



Management (cont’d)

Aspiration provides transient relief

MD, PA referral


Complications Associated with Distal Lower Extremity Fractures


Lower Extremity Fractures

Tibial fractures

The most common long bone fracture

Often involves fibula

The tibia is weight‐bearing; the fibula is non‐weight bearing

Mechanism of injury

• Low‐energy

• High‐energy

• Rotational

58


Lower Extremity FracturesTibia and Fibula Fracture



Mechanism of injury

Twisting force



Tibial fracture types

Tibial plateau: axial loading with varus or valgus force (fall from height, “bumper” injury)

Tibial tubercle: Jumping activities (basketball, football, gymnastics)

Tibial eminence: Trauma to distal femur while knee flexed (falling off bike, hyperextension)

Tibial shaft: Usually from major trauma, rotary force

Tibial plafond: High‐energy axial load

59


Lower Extremity FracturesTibial Plateau Fracture


Tibial and FibularDiaphyseal Fracture


Tibial Fracture


Pain

Swelling

Ecchymosis

Deformity

Knee effusion (tibial plateau fractures)

Inability to ambulate

Note: Patient able to ambulate with isolated fibula fracture

60


Tibial Fracture

Complications

Conversion to open fracture

Compartment syndrome

Neurovascular compromise

Fat emboli

Non‐union


Open Tibia Fracture


Tibial Nerve Damage

61


Fibula Fracture

Isolated fracture uncommon

Usually associated with tibia fracture

Fibula neck fracture may have associated peronealnerve injury

Isolated fibula shaft fracture

May be managed with crutches and short‐term casting


Fibula FracturePeroneal Nerve Damage


Fibula Fracture

Proximal fibular neck fracture complication: peroneal nerve injury

Foot drop or weak dorsiflexion

Hypoesthesia over dorsum of foot

62


Features of Tibial Stress Fracture and Shin Splints


Shin Splints

Medial tibial stress syndrome (MTSS)

Definition: Inflammatory condition involving muscular attachments along posterior‐medial surface of the tibia

Etiologies

Biomechanical factors

Running surfaces

Training progression/ intensity


Shin Splints


Linear pain pattern

• Medial‐posterior tibialsurface

• Distal 2/3 of tibia

Associated with running

Variable duration

No awakening from sleep

63


Shin Splints

Management

Ice

NSAIDS

Physical profile (light or limited duty)

Running surface modification

Running shoe assessment

Training modification

Pre‐run stretching


Tibial Stress Fracture

Definition: Impact activity related fracture (e.g., running or jumping)

Commonly occurs at junction of middle and distal 1/3 of tibialshaft




Localized tibial pain activity related, band‐like pattern

Variable duration (tends to persist through running event; extends into post‐run period)

Tends to awaken patients from sleep

Radiographic evidence (delayed)

64



A B




Shin PainDifferential Diagnosis

65



Distal Lower Extremity Compartment syndrome


Lower Extremity Injuries

Complications of trauma

Nerve compression syndrome

Fat embolism

Compartment syndrome

Non‐union



Complications: nerve compression

Peroneal nerve commonly involved• Foot drop

• Weak dorsiflexion

• Dorsal hypoesthesia of foot

66



Complications: Fat emboli

Tibial fracture

Pulmonary embolism (PE)• Tachypnea

• Dyspnea

• Tachycardia

• Pleuritic chest pain



Complications: compartment syndrome

Increased compartmental pressure leading to risk of ischemia and necrosis of tissue


Lower Extremity InjuriesCompartment Syndrome: Etiologies

Tibial fractures

High‐energy wounds

Penetrating injuries

Venous Injury

Crush injury

Exercise

Envenomation

MAST

Casting

Burns

67



Compartment syndrome: clinical presentation

“The six Ps”

• Pain* (exaggerated with muscle stretch)

• Parasthesia*• Paresis

• Pallor (not reliable)

• Pulselessness (not reliable)

• Poikilothermia (not reliable)



Compartment syndrome: Pearls

Disproportionate pain

Anterior compartment most common

Pain and parasthesia early clues

Sensory deficits first, then motor

Necrosis possible within six hours



Compartments

Anterior (most commonly involved)

Lateral

Deep posterior

Superficial posterior

68



Anterior compartment syndrome

Sensory ‐ 1st web space

Muscles ‐ Toe extensors / tibialis anterior

Pain with passive movement ‐ Toe flexion

Tenseness ‐ anterior between tibia and fibula



Lateral compartment syndrome

Sensory

• Dorsum of foot

Muscles

• Peronei

Pain with passive movement

• Inversion of foot

Tenseness

• Lateral fibula



Deep posterior compartment syndrome

Sensory

• Sole of foot

Muscles

• Toe flexors

Passive movement pain

• Toe extension

Tenseness

• Posteromedial leg

69



Superficial posterior compartment syndrome

Sensory

• None

Muscles

• Gastrocnemius / soleus

Passive movement pain

• Foot dorsiflexion

Tenseness

• Calf region



Compartment syndrome: diagnostics

Compartment pressure measurement

A compartment syndrome is present when the diastolic pressure minus the intra‐compartmental pressure is less than or equal to 30mm Hg (perfusion pressure)

Compartment pressure vs. perfusion pressure

Resting compartment pressure > 30 mmHg is abnormal (direct measurement)

Diagnosis can be made clinically


Lower Extremity Injuries Compartment Syndrome Measurement

Stryker Stick

70


Lower Extremity Injuries Compartment Syndrome Measure

Mercury Column Technique


Lower Extremity Injuries Mercury Column Technique



Compartment syndrome: management

No elevation of extremity

Keep extremity level with body

Supplemental O2

Surgical fasciotomy(referral)

71


Questions?


Terminal Learning Objective

Action: Communicate knowledge of “Lower Extremity Disorders”

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


Agenda

Communicate the anatomical function of the knee structures

Communicate the diagnostic tests that may be used to assess knee injuries

Communicate the signs and symptoms, physical exam findings, and management of patellar injury, to include fracture, subluxation, dislocation, and maltracking

72


Agenda

Communicate the signs and symptoms, physical exam findings, and management of a meniscal cartilage tear

Communicate the signs and symptoms, physical exam findings, and management of a ligamentous knee injury, to include the collateral and cruciate structures


Agenda

Communicate features of knee dislocation and its management guidelines

Communicate the signs and symptoms, physical exam findings, and management of an extensor mechanism injury

Communicate the signs and symptoms, physical exam findings, and management of knee disorders that are commonly seen in the child and adolescent age group


Agenda

Communicate the signs and symptoms, physical exam findings, and management of knee‐related inflammatory disorders to include tendonitis, iliotibial band syndrome, and bursitis

Communicate features of a popliteal cyst to include possible causes

73


Agenda

Identify complications associated with distal lower extremity fractures

Differentiate between the features of tibialstress fracture and shin splints

Communicate the signs and symptoms, physical exam findings, and management of distal lower extremity compartment syndrome


Reason

The knee and the lower leg are very vulnerable to injury, especially in our physically active population.

Activities such as running, jumping, and pivot‐shifting all have potential for injury to the lower extremity structures.


Break

lower extremity disorders pfn: somool04slides.jsomtc.org/somool04/somool04.pdf · lower extremity...

Documents