Exam2 - Lower Body Clinical Applications

The LCL resists ______ stress

varus (medial)

The MCL resists ______ stress

valgus (lateral)

A 19-year-old basketball player reports medial knee pain after landing awkwardly from a rebound. You perform a valgus stress test, noting increased medial joint space opening at 30° of flexion but not in full extension.

Question:
What does a positive valgus stress test at 30° of flexion, but not at full extension, indicate about the likely location and severity of the injury?

injury to the medial collateral ligament (MCL)

A 32-year-old runner presents with lateral knee pain after tripping and twisting the leg inward. You perform a varus stress test and note excessive lateral gapping at 30° of flexion.

Question:
What structure is likely injured based on a positive varus stress test at 30° of flexion, and why is this angle used for testing?

lateral collateral ligament (LCL), (helps isolate the LCL by minimizing joint capsule involvement)

A 21-year-old tennis player rolls her ankle while lunging for a ball. She reports that her foot was pointed downward and twisted inward at the time of injury. You note localized swelling over the lateral ankle.

Question:
Which ligament is most likely injured in this case, and what common mechanism leads to this injury?

anterior talofibular ligament, when the foot is plantarflexed and inverted

A football player presents with pain above the ankle joint after his foot was forcefully externally rotated while planted. He reports difficulty with weight-bearing and pain when the ankle is squeezed.

Question:
What ligaments are likely injured, and what type of ankle sprain is this?

high ankle sprain, anterior and posterior tibiofibular ligaments

What two tests would you uses to test an Anterior Cruciate Ligament (ACL) tear in the knee as the therapist?

Lachman or anterior drawer test (confirmed with MRI)

What test would you use to test an Posterior Cruciate Ligament tear?

Posterior drawer test

A 35-year-old recreational skier reports medial knee pain after falling during a turn. He recalls that his foot was planted while his upper body twisted. He now experiences locking and catching sensations in the knee, especially during squatting or pivoting.

Question:
Based on the mechanism of injury and symptoms, which structure is most likely injured, and why is it more susceptible than its lateral counterpart?

Medial Meniscus, it is more firmly attached to the tibia and MCL (decreased mobility)

A 24-year-old soccer player reports hearing a "pop" in the knee after a sudden change in direction. She experiences rapid swelling, instability, and pain along the lateral joint line. MRI confirms an ACL tear and a lateral meniscus injury.

Question:
Why is the lateral meniscus often injured alongside an ACL tear rather than in isolation?

The shared mechanism—pivoting or cutting motions under load—often stresses both structures simultaneously.

_______ tears are among the most common intra-articular knee injuries

Meniscal

A 38-year-old warehouse worker reports intermittent locking and catching in the right knee following an incident where he twisted while lifting a heavy box. On exam, there is joint line tenderness and mild swelling.

Question:
Which two special tests would you perform to assess for a possible meniscal tear, and what do they evaluate?

The McMurray test and Apley compression test

Question:
What common mechanisms of injury are associated with meniscal tears, particularly of the medial meniscus?

twisting or pivoting on a planted foot, deep squatting, or sudden directional changes.

What makes up the "Unhappy or Terrible Triad" in the knee? You often hear an audible “pop” when injuring these ligaments.

Medial collateral, anterior cruciate, medial meniscus ligaments

A 13-year-old male cross-country runner presents with anterior knee pain that worsens with running and kneeling. On examination, there is localized swelling and tenderness over the tibial tuberosity. His parent notes he recently had a rapid growth spurt.

Question:
What is the most likely diagnosis, what anatomical structure is involved, and what is the underlying mechanism?

Osgood-Schlatter disease, a traction apophysitis of the tibial tuberosity, repetitive stress by the quadriceps muscle via the patellar ligament

During a functional movement assessment, a patient reports medial knee pain during sit-to-stand and resisted hip flexion. Palpation reveals tenderness over the pes anserine region.

What muscle involvement would you suspect?

Sartorius muscle

An adolescent track athlete reports sudden anterior hip pain after sprinting. What muscle is likely involved, and why is it prone to avulsion injuries in this population?

rectus femoris (It crosses both the hip and knee, it experiences strong eccentric loading during activities like sprinting. In adolescents, the growth plate at the anterior inferior iliac spine (AIIS) is weaker than the tendon, making it susceptible to avulsion injuries.)

A patient presents with anterior knee pain worsened by squatting and prolonged sitting. Observation reveals lateral patellar tracking during knee extension. What muscle could be involved?

Vastus Lateralis

A long-distance runner presents with sharp lateral knee pain that worsens with downhill running. What muscular or fascial tightness is most likely contributing to this condition and why?

tensor fasciae latae and iliotibial band

During a postural screening, a recreational cyclist demonstrates increased lumbar lordosis and limited hip extension. What muscle imbalance might be contributing to these findings, and what is the likely clinical consequence?

iliopsoas, limits hip extension

What are the primary biomechanical and anatomical factors that predispose female athletes to patellofemoral pain syndrome?

Females have a wider pelvis resulting in increased Q-angle, along with common overpronation and muscular imbalances.

During a biomechanical assessment, a patient with patellofemoral pain demonstrates increased hip adduction and internal rotation during single-leg squats. Which hip muscle groups are likely weak, and how does this contribute to PFPS?

Weakness of the hip abductors and external rotators allows excessive hip adduction and internal rotation, leading to medial knee collapse (valgus). This increases lateral patellofemoral joint stress and contributes to PFPS.

A soccer player reports groin pain following repetitive kicking and sudden lateral movements. Which muscle is most commonly injured in this scenario, and what mechanism typically causes this injury?

Adductor Longus

A female patient presents with a tender, palpable mass below the inguinal ligament. What anatomical landmark helps distinguish a femoral hernia from an inguinal hernia?

inguinal ligament

Common donor tendon in ACL reconstruction due to length and
strength?

Semitendinosus

An athlete reports sudden posterior thigh pain after an overstretch during sprinting. Which muscle is commonly involved in high-grade hamstring strains in this region, and what are its primary actions?

The semimembranosus is commonly involved in high-grade hamstring strains from overstretch injuries. It extends the hip, flexes the knee, and medially rotates the leg when the knee is flexed.

A 45-year-old patient presents with difficulty walking after falling and striking the lateral aspect of the right knee against a curb. On exam, he exhibits foot drop and sensory loss over the dorsum of the foot. Motor testing reveals weakness in dorsiflexion and eversion.

Question:
Which nerve is most likely injured, what anatomical structure does it course around, and why is this region clinically significant?

Common Fibular N, Fibular neck (Injury here can cause foot drop due to paralysis of the anterior and lateral compartment muscles)

The interosseous hiatus allows passage of _____________ into the _______compartment

anterior tibial vessels, anterior

A 22-year-old volleyball player twists her ankle after landing from a jump with her foot pointed downward. She reports pain and swelling along the lateral aspect of her ankle. You note tenderness over the anterior talofibular ligament.

Question:
Why is the ankle more prone to sprains in plantarflexion, and which anatomical feature contributes to greater stability in dorsiflexion?

because the talus is narrower posteriorly and wider anteriorly. In dorsiflexion, the wider anterior portion of the talus fits more snugly between the tibia and fibula, increasing joint congruency and stability. In plantarflexion, this congruency is reduced, making the joint more vulnerable to inversion injuries, especially to the anterior talofibular ligament.

Medial ligament sprains are ______ common than lateral ones due to the strength of the deltoid complex

less

A 30-year-old football player is tackled from the side, causing his foot to twist outward suddenly. He presents with severe ankle pain, visible deformity, and inability to bear weight. Imaging reveals fractures of the fibula and medial malleolus, with dislocation of the ankle joint.

Question:
Based on the mechanism of forceful eversion and rotation, what type of injury does this patient likely have?

Pott’s Fracture/Dislocation

A 20-year-old collegiate dancer presents with aching pain along the anterior shin, worsened by rehearsals and relieved with rest. On palpation, there is tenderness over the lateral tibia, and she reports the pain increases with dorsiflexion exercises.

Question:
What is the most likely diagnosis, which muscle is primarily involved, and what is the typical cause of this condition?

anterior shin splints, tibialis anterior, overuse of the anterior compartment muscles (particularly during repetitive dorsiflexion and high-impact activities like running or dancing)

A 28-year-old male is brought to the ER after a motorcycle accident resulting in a tibial fracture. Hours later, he reports escalating pain in the calf that is unrelieved by medication and worsens with passive toe extension. On exam, his foot is cool to the touch, with diminished posterior tibial pulse and paresthesia in the sole of the foot.

Question:
What condition should be suspected, which compartment is involved, and why is this area particularly vulnerable?

Compartment syndrome of the deep posterior compartment, This area is especially vulnerable because of its tight fascial boundaries, which do not easily expand

A 19-year-old track athlete complains of gradually worsening pain along the front of her shin. She reports recently increasing her hill training and practicing walking on her heels as part of a strength program. The pain worsens with activity, especially uphill running, and is tender along the lateral border of the tibia.

Question:
What condition is she likely experiencing, what muscle is primarily involved, and what movement pattern contributes to this presentation?

anterior shin splints (a less common variant of medial tibial stress syndrome (MTSS)), tibialis anterior, due to repetitive and forceful dorsiflexion, such as during uphill running or heel walking

A 35-year-old hiker presents to the emergency department after sustaining blunt trauma to the anterior leg from a falling rock. Several hours later, he reports increasing pain and tightness in the shin. On exam, he has diminished sensation in the web space between the first and second toes, and cannot extend his big toe against resistance.

Question:
Which muscle is likely affected, impaired big toe extension is considered an early sign in what compartment syndrome?

extensor hallucis longus, is a subtle but early clinical sign of anterior compartment syndrome.

A 25-year-old long-distance runner presents with diffuse pain along the anterior-lateral aspect of the lower leg that worsens after downhill runs (Inolving eccentric loading). On physical exam, there is tenderness lateral to the tibialis anterior, and pain increases with resisted dorsiflexion and toe extension.

Question:
Which muscle is most likely contributing to this pain?

extensor digitorum longus (EDL)

A 26-year-old recreational runner presents with persistent lateral ankle discomfort and a feeling of instability, especially when running on uneven ground. She has a history of lateral ankle sprains. On palpation, there is tenderness along the lateral leg and behind the lateral malleolus. Pain increases with resisted eversion.

Question:
Which muscle is likely contributing to her symptoms, and what clinical conditions may result from its dysfunction?

fibularis longus, lateral ankle instability and potentially cuboid syndrome, a condition involving subluxation or irritation of the cuboid bone due to tendon traction.

A 45-year-old recreational tennis player experiences a fierce strain in his posterior leg during a forceful push-off. He now has pain and weakness with plantarflexion. What muscle is most likely involved, and why is it prone to this type of injury?

The gastrocnemius is likely involved due to its biarticular nature, making it susceptible to acute strain during forceful push-off when the knee is extended and the ankle is dorsiflexed—commonly referred to as “tennis leg.”

The soleus muscle is referred to as the “peripheral heart” due to its role in venous return of blood to the heart from the lower extremities. It is a slow-twitch muscle.

Soleus

In a hospitalized patient on prolonged bed rest, what role does the soleus muscle play in preventing venous stasis, and what complication may arise from reduced activation of this muscle?

The soleus acts as a “venous pump” during standing and walking by facilitating venous return from the lower leg. Inactivity reduces this function, increasing the risk of venous pooling, edema, and deep vein thrombosis (DVT).

An adult patient presents with progressive flattening of the medial longitudinal arch and complains of medial ankle pain. Which muscle dysfunction is most likely responsible for this acquired flatfoot deformity?

tibialis posterior

A professional ballet dancer presents with localized tenderness along the posterior ankle and pain during passive dorsiflexion of the great toe. What is the most likely diagnosis

flexor hallucis longus tendinopathy or tenosynovitis

A 39-year-old recreational basketball player reports a sudden "pop" in his posterior leg during a push-off for a jump. He now has sharp calf pain, difficulty walking, and reports feeling like he was "kicked" in the leg. On exam, there is swelling, a palpable gap above the heel, and a positive Thompson test.
What is the most likely diagnosis, what mechanism typically causes it, and what patient population is most at risk?

Achilles Tendon rupture, eccentric loading, deconditioned middle-aged males