LE Red Flags

Cervical red flags with LE signs

Gait disturbances (wide BOS and ataxia)

Impaired balance and proprioception

UMN signs

Cervical myelopathy

Compression of SC via stenosis of central canal (mass, fluid, growth, degeneration, fracture/instability)

Neck or arm pain, UMN signs, wide-based and ataxic gait

+Hoffman, inverted supinator sign, babinski, gait deviation and >45

Cervical fx

MOI: trauma

Instability leads to myelopathy, injury to brainstem/SC, vascular injury

Canadian C-Spine RUles

>45 years, paresthesia in extremeities

Neck pain or tenderness down midline

Rotation <45 degrees

CAD and VBI

Ischemia to the vessels supplying the brainstem/brain

Dizziness, drop attacks, diplopia, dysarthria, dysphagia

Nausea, numbness, nystagmus

Ataxia, anxiety

Cauda Equina Syndrome

Compression of the SC via stenosis at the levels of the cauda equina

Lower back/leg pain

LMN signs (global progressive muscle weakness in LE with atrophy, hyporeflexia, sensory deficits at L4-S1)

Saddle anesthesia, urine retention/incontinence

Key Features of Traumatic fx

Acute macrotrauma (falls, MVA) → immediate loss of movement

Inability to WB

Pain unchanged by movement

General examination findings of traumatic fx

Swelling ,ecchymosis, deformity, cannot WB

Diffuse pain upon palpitation

Global AROM loss

Features of stress fractures

Pain with activity that subsides with rest (can be constant if progressed)

Local swelling and tenderness; pain with vibration

Ottawa Knee Rules

> 55 years

Isolated tenderness of patella, tenderness at head of fibula, inability to flex to 90

Cannot WB (4 steps)

Ottawa Foot and Ankle Rules

Bone tenderness at posterior edge of lateral and medial malleolus, base of 5th metatarsal, navicular

Inability to WB

DVT

Develops from venous stasis or slow-moving blood flow

Virchow’s Triad (endothelial injury, hypercoagulability, venous stasis) - increases the risk for DVT

Calf pain/tenderness, swelling with pitting edema (below knee or above knee; distal to proximal), increased temperature, dilation of veins, cyanosis

Cellulitis

Strep or staph bacterial infection after foot/ankle surgery (two types)

Superficial: skin is warm, tender, red, but joint motion is painless

Deep: abscess formation, skin is warm/tender/swollen

Infection RFs

Smoking, age, BMI, immunosuppressants, lifestyle

Wound size

Clinical presentation of wound infection

Palpable warmth, spreading erythema, drainage, failure of closure of incision

Systemic fever, nausea, chills

Insidious Leg Pain in children

Groin or anterior knee pain with a limp: SCFE or Legg Calve Perthes Disease

Osteosarcoma

Typically occurs after 50y

Metaphyseal regions of long bones (ribs, distal femur, proximal tibia, proximal humerus)

Compartment Syndrome

Increased tissue pressure in muscular compartment due to fluid accumulation in interstitial space of skeletal muscle (LE are at risk due to limited expansion)

Capillary occlusion, cell death, hypoxia

Pain, paresthesia, diminished pulse, paralysis, pallor