is the presentation of anterior impingement of the ankle?
on the anterior aspect of the ankle with full dorsiflexion
in closed chain position; active and passive non-weightbearing
motion is painful.
tenderness along the anterior ankle joint line
dorsiflexion range of motion with hard end-feel or
restricted Achilles tendon/gastrocnemius extensibility
resulting in anteromedial impingement of the talus on the
Physical Therapy Secrets
is the most sensitive office laboratory test for diagnosing
dermatophyte infections of the skin?
examination of a potassium hydroxide (KOH) preparation of
scrapings taken from the affected area is the most sensitive
office laboratory test, if performed properly. A study of
220 specimens examined by both KOH and culture demonstrated
positive KOH preparations and cultures in 45% of the samples,
a positive KOH preparation and a negative culture in 52% of
the samples, and a negative KOH preparation and a positive
culture in only 3% of the samples. Cultures can be useful
since other studies have shown a 5-15% increase in positive
specimens by culturing all KOH-negative materials. However,
it cannot be emphasized enough that the diagnostic accuracy
of the KOH preparation depends on the experience and skill
of the individual performing the test. A proper KOH preparation
and interpretation is an important skill for any health care
provider dealing with skin disease"
does stenosing tenosynovitis of the flexor hallucis longus (FHL)
tenosynovitis occurs in dancers who perform en pointe
or in any plantarflexed position of the foot. It may also
be seen in runners or soccer players. Patients complain of
tightness of the first MTP joint, with pain somewhere along
the course of the FHL tendon between the posterior aspect
of the ankle and under the arch towards the big toe. With
dorsiflexion of the hallux, there is a locking or clicking
of the FHL"
Medicine and Rehabilitation Secrets
is end feel? How are end-feels classified?
"The type of
resistance felt by an examiner at the end range of a passive-of-motion
test. Its assessment is used to guide diagnosis and treatment.
End-feels can be normal or pathologic, depending on the movement
they accompany at a particular joint and where in the range
of movement they are felt. When a hard end-feel is felt at
a particular joint where one would expect a soft one, or vice
versa, it is considered a pathologic end-feel. Strictly pathologic
end-feels are presence of muscle spasm, sensation of mushy
end-feel, springy rebound, and severe pain without any feeling
of motion restriction (empty end feel)."
- bone to bone - abrupt stop to the movement
that is felt when too hard surfaces meet
- capsular - feeling of immediate stop
of movement with some give
- tissue approximation - limb segment cannot
be moved further because the soft tissues surrounding the
joint cannot be further compressed
- empty - patient complains of severe pain
at the movement without the examiner perceiving increase
in resistance to the movement
- springy back - a rebound is felt at the
end of the range
- spasm - feeling of a muscle coming actively
into play during the passive movement"
Physical Therapy Secrets
is the natural history of intoeing?
limb shows a triphasic sequence of rotational development:
Initially, the limb bud is formed with the great toe in a
preaxial position, ie with the great toe pointing laterally.
Over the next few weeks of embryonic development, the limb
rotates medially to bring the great toe to the midline.
The second phase includes the remainder of intrauterine life
and early infancy. During this intrauterine period, the lower
limbs are positioned in lateral rotation in the uterus. This
results in a lateral rotation contracture of the hips. This
lateral rotation contracture resolves during early infancy.
The third phase occurs during infancy and childhood. Both
the tibia and femur gradually rotate laterally with growth"
Following the Socratic
principle that the best way to teach is to ask the right questions,
the highly popular Secrets Series® has become an important
part of medical education.
The "Secrets" approach has given birth to a whole series of
books in question-and-answer format. Lists, mnemonics, tables,
short answers, and an informal tone are employed to make these
books enjoyable as well as useful to practitioners, residents,
and students. The result is a combination of the best features
of a practical reference and a good verbal teaching lesson.