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What is the presentation of anterior impingement of the ankle?

Answer:

"1. Pain on the anterior aspect of the ankle with full dorsiflexion in closed chain position; active and passive non-weightbearing motion is painful.

2. Point tenderness along the anterior ankle joint line

3. Limited dorsiflexion range of motion with hard end-feel or restricted Achilles tendon/gastrocnemius extensibility

4. Pronation resulting in anteromedial impingement of the talus on the tibia"

Orthpaedic Physical Therapy Secrets

Orthpaedic Physical Therapy Secrets
 
 
What is the most sensitive office laboratory test for diagnosing dermatophyte infections of the skin?

Answer:

"Microscopic 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"

Dermatology Secrets

Dermatology Secrets
 
 
How does stenosing tenosynovitis of the flexor hallucis longus (FHL) present?

Answer:

"FHL stenosing 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"

Physical Medicine and Rehabilitation Secrets

Physical Medicine and Rehabilitation Secrets
 
 
What is end feel? How are end-feels classified?

Answer:

"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)."

"Cyriax's end-feel classification:

  • 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"

Orthpaedic Physical Therapy Secrets

Orthpaedic Physical Therapy Secrets
 
 

What is the natural history of intoeing?

Answer:

"The lower limb shows a triphasic sequence of rotational development:

Embryonic phase. 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.

Fetal phase. 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.

Childhood phase. The third phase occurs during infancy and childhood. Both the tibia and femur gradually rotate laterally with growth"

Paediatric Orthopaedic Secrets

Pediatric Orthopaedic Secrets
 

The Secret Series:

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.

 
Further Information:
Foot and Ankle Secrets Sports Medicine Secrets Rheumatology Secrets Dermatology Secrets
Physical Medicine and Rehabilitation Secrets Neurology Secrets Orthpaedic Physical Therapy Secrets    
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