knee p2 and ankle

A 40-year-old runner reports feeling a sharp pain in his lower calf while sprinting, followed by swelling and difficulty pushing off with his foot. He heard a snapping sound during the injury. What test should be performed to confirm the diagnosis?

• Anterior Drawer Test
  

• Talar Tilt Test

• Thomas Test
  

• Squeeze Test

Answer explanation

The snapping sound and difficulty with push-off are classic signs of an Achilles tendon rupture, which can be confirmed by a positive Thomas test

A 30-year-old athlete who sustained an eversion injury to the ankle is more likely to have a medial ankle sprain than a lateral one. Lateral ankle sprains frequently involve the anterior talofibular ligament (ATFL), making it the most commonly injured ligament.

• Both statements are true

• First statement is false, second statement is true

• First statement is true, second statement is false

• Both statements are false

Answer explanation

Lateral ankle sprains are far more common than medial ankle sprains, and the ATFL is frequently injured in lateral sprains

Venelle, a 21 year old gardener, exhibits pain with all activities of functional mobility, including walking, running, going up the stairs, and squatting. She experiences pain with prolonged sitting, and shows swelling of her knees. On physical exam, she reports a grating sensation with flexion and extension. When you palpate the inferior aspect of her knee, she reports pain. When you ask to see Venelle’s arthroscopy results, you see a deformation of the cartilage of the patella, causing it to resemble crab meat. What is Venelle’s probable diagnosis?

• 1. Patellofemoral Pain Syndrome

• 1. Osteochondritis Dessicans

• 1. Osteochondritis Dessicans

• 1. Chondromalacia Patella

Answer explanation

Chondromalacia patella is the softening of the patella’s articular cartilage due to cartilage degeneration, possibly secondary to chronic patellofemoral overload and tracking dysfunctions or infection, trauma, or autoimmune processes.

The following are the symptoms of chondromalacia patella:

• Pain with walking, running, going up stairs and squatting

• Cinema sign (theater sign/moviegoer sign), which is pain after prolonged sitting

• Camel sign (patella alta when knee is bent to around 30 degrees of flexion)

• VMO weakness, inceased q angle, tight ITB

• Possible reccurent swelling, grating sensation w flexion and ext

• Pain at inferior border during palpation

• ST: Clarke’s Test or Waldron’s Test

• Imaging studies display roughened or fibrillated cartilage, with an appearance resembling crab meat

Adelaide, a retired Swedish-Russian track field athlete, comes into your Occupational Therapy clinic while in a wheelchair. She reports considerable swelling and pain on her right knee as well as a complete lack of knee extension. Upon reading her charts, you notice that Adelaide has had a history of patellar tendonitis which she explains is the reason for her forced retirement from being an athlete. A physical exam shows a palpable defect on her patella on the inferior border, where you notice a groove where the patellar tendon should be. Upon palpation, the client is also noted as experiencing severe pain. Based on the symptoms above, what could be the probable next course of action as a clinician?

• Recommend a knee orthosis which can immobilize the knee and allow it to heal

• 1. Make recommendations to limit Adelaide’s functional activities ONLY.

• 1. Make recommendations to limit Adelaide’s functional activities ALONG WITH recommending a knee orthosis to immobilize the knee,

• 1. Refer her to an orthopedic physician for consult and surgery of her knee.

Answer explanation

A complete lack of extension, swelling, pain as well as a palpable defect on the knee can often point to a complete patellar tendon rupture. As this injury cannot be healed on its own even with the aid of orthoses and activity limitation, surgical repair is needed.

Jefferson, a 21 year old gym instructor suffered an injury  on his leg. After suddenly adjusting the intensity of his exercise, the client noticed that through time, there is hyperpronation of the foot  and gradual onset of pain along the posteromedial border of the tibia. The patient tried to exercise but the pain got worse after doing the full exercise, the pain lasted until the morning after. What is the condition of the client? 

• Medial Tibial Stress Syndrome (MTSS)

• 1. Chronic Exertional Compartment Syndrome (CECS) 

• 1. Acute Compartment Syndrome (ACS) 

• 1. Patellar Tendonitis 

Answer explanation

This condition is also known as Shin splints, a common cause of exercise-induced leg pain. This is a type of injury that results from chronic traction on the periosteum at the periosteal-fascia junction. There can be tenderness on the medial tibial border or the entire length as little as 2-4 cm. There may be a history of repetitive running on hard surfaces and

inappropriate warm-up, inappropriate footwear, or recent change in footwear and excessive use of foot flexors. 

Jefferson, a 21 year old gym instructor suffered an injury  on his leg. After suddenly adjusting the intensity of his exercise, the client noticed that through time, there is hyperpronation of the foot  and gradual onset of pain along the posteromedial border of the tibia. The patient tried to exercise but the pain got worse after doing the full exercise, the pain lasted until the morning after. What treatment is not recommended for the client? 

• Orthotics to correct over-pronation or forefoot varus.

• Rest

• Training that starts at 80 % of pre-injury level for intensity and distance

• 1. Icing and stretching 

Answer explanation

Training only starts at 50 % percent of pre-injury level so that the affected area will not be stressed extensively. 

Phineas recently got into an accident wherein he experiences sudden audible snap with immediate swelling, ecchymosis, and weakness in plantarflexion , which are the symptoms of an achilles tendon rupture. What test will you perform to Phineas to confirm if he has an Achilles tendon rupture?

• 1. Thomas test

• 1. Tom Holland Test

• 1. Tom Hanks Test

• 1. Thomas and friends test

Answer explanation

(+) Thomas test aka Calf Squeeze test is indicative of a ruptured Achilles’ tendon if the heel will not move upon squeezing the back of lower leg (gastrocs)

Ferb was diagnosed with Dancer's Tendonitis. He was referred to occupational therapy for 3 days PTIE. What muscle will you target on the intervention?

• 1. FHL (Flexor Hallucis Longus) 

• 1. FDP (Flexor Digitorum Profundus) 

• 1. AOTA 

• NOTA

Answer explanation

Dancer ‘s Tendonitis is also known as FLEXOR HALLUCIS LONGUS (FHL) INJURY

A 45-year-old female presents with sharp, shooting pain in the forefoot radiating to the third and fourth toes. On examination, squeezing the metatarsal heads together reproduces the pain. Which of the following conservative treatment strategies would be most appropriate for her condition, and why? 

• Prescription of tight, pointed shoes to restrict foot movement 

  
  

• Neuroma pads and shoe modifications, such as wide toe boxes and cushioned insoles 

  
  

• Immediate surgical excision without further treatment 

  
  

• Immobilization of the foot using a cast for six weeks 

  
  

Answer explanation

The patient's symptoms are consistent with Morton’s Neuroma, a condition involving irritation and enlargement of the interdigital nerve, most commonly affecting the third intermetatarsal space. 

Conservative treatment typically includes using neuroma pads to relieve pressure on the metatarsal heads and modifying shoes to provide a wide toe box and cushioned insoles for better foot support. This reduces pressure on the nerves and provides pain relief.

A 25-year-old male is brought to the emergency department after a motorbike accident. He has a fracture of the tibia and complains of severe pain in his lower leg that is out of proportion to the injury. He also reports numbness and tingling in his foot. On examination, there is extreme pain with passive movement of the toes, but the pulses in the foot are normal. Which of the following is the most likely diagnosis, and what should be the immediate management? 

• The patient has a vascular injury; perform an urgent Doppler ultrasound to check for arterial blockage.

• The patient has acute compartment syndrome; perform an emergency fasciotomy to prevent muscle necrosis.

• The patient is experiencing a normal post-fracture reaction; continue with immobilization and pain management. 

• The patient has a nerve injury from the fracture; administer corticosteroids to reduce inflammation.

Answer explanation

The patient's severe pain out of proportion to the injury, along with numbness and tingling (paresthesia)*, and pain on passive movement* of the toes are classic signs of acute compartment syndrome (ACS) following trauma such as a tibial fracture. Although the pulses remain normal, ACS is a surgical emergency requiring immediate fasciotomy to release pressure and prevent irreversible muscle and nerve damage.