32 - Lower Extremity Flashcards
What is transient synovitis of the hip caused by and who gets it?
Viral, post-vaccine or drug-induced synovitis of the hip.
Occurs in ages 3-10.
What is seen on exam of someone with transient synovitis? How is it treated?
Any motion causes pain (+), refuses to bear weight. High sed rate and mild leukocytosis.
Treat with NSAIDs for 1-3 weeks.
What is the history of someone with slipped capital femoral epiphysis (SCFE)? What causes it?
Clasically ocerweight early adolescent with history of groin or knee pain, which may be referred to anteromedial thigh.
Often occurs bilaterally, but not simultaneously.
Caused by repetitive overload - presents with vague symptoms that are worwse with acitivty.
How would you treat a slipped capital femoral epiphysis? What is seen on exam? What test do you use for diagnosis?
Exam: limitation of hip internal rotation
Tests: plain exrays
Treatments: surgical fixation
What is seen on exam of someone with a septic jont? What is the etiology?
Exam: swollen, etremely painful joint, passive and active ROM very painful. Red, hot joint. Usually symptomatic signs but may be absent in DB or immunocomp pts.
Etiology: gonorrhea or skin flora
What is the treatment of a septic joint? What is a complication?
Treatment: surgical emergency, requires irrigation and drainage followed by IV abx.
Complcation: articular surface destruction
What artery is often injured in a knee dislocation? What type arteries should be checked with a knee dislocation?
Popliteal artery: dorsalis pedis (lateral to tendon of extensor hallucis lungus), poterior tibial artery (by medial malleolus)
What are the three articular surfaces of the knee?
- Femoral condyles
- Tibial plateau
- Patella
Note: the patella does NOT articulate with the tibia
What are the ligaments of the knee?
Medial meniscus: C-shaped
Lateral meniscus: O-shaped
Cruciates: anterior (ACL) and posterior (PCL)
Medial (tibial) collateral and Lateral (fibular) collateral
What are the components of the unhappy triad?
Torn:
- ACL
- Medial collateral ligament
- Lateral meniscus
What type of injury results in a postitive anterior drawer sign?
ACL tear - causes tibia to move forward in relation to the femur
Varus and valgus stress testing tests which ligaments of the leg?
The lateral collateral ligament (LCL) and medical collateral ligament (MCL)
What is the primary stabilizer of the knee in extension?
The ACL - strongest ligament of the knee itself; provides the most stability when leg is fulling extended at the knee.
How would you radiographically assess ligament tears of the knee?
MRI - to see associated ligament injuries, menisci, articular cartilage, and “bone bruises”
What are the structures denoted by each color?
What knee injury can cause locking, pain with twisting, and mild swelling?
Meniscul tear - free flaps in the joint space cause the joint to freeze up and lock, this results in a loss of ROM.
What is the McMurray and circumduction test?
Put load into knee joint and rotating it
-shift and load type test
Compress joint and then rotate to stress the structure in the middle of the joint
A 35 yo runner with a foot drop that occurs when running sub-5min mile pace and great toe numbness. No problem at slower speeds or with ADLs. There’s been no recept chance in exercise regiment. What diagnosis do you suspect?
Exertional compartment syndrome - local swelling from exertion can compress the nerve resulting in foot drop and numbness.
What are signs and sympoms of acute compartment syndrome?
P’s:
- poikilothermia - cool extremities often earliest sign
- pain - to passive motion, out of proportion to exam, and tense compartment on palpation
- parasthesias - tingling/pricking sensation
- pulselessness and pallor - rare
What nerve innervates each location?
Someone got a laceration to the bone on the posterior aspect of their medial malleolus. What nerve deficit would they likely have?
Medial plantar nerve injury - this is a branch of the tibial nerve.
The tibial nerve supplies the entire back of the leg and bottom of the foot. Any intrinsic foot problem will be associated with the tibial nerve.
What compartment of the lower leg is least likely to get compartment syndrome? Why?
Superficial posterior: it’s completely encapsulated by skin which allows for greater elasticity. More space for swelling to occur in = less pressure.
What is the function of the anterior, lateral, superficial posterior, and deep posterior compartment of the leg? How likely is exertional compartment syndrome in each?
Anterior: extensors - 40-50%
Lateral: eversion and external rotation - 20%
Superficial posterior: superficial flexors (gastroc, soleus, plantaris)-rare
Deep posterior: deep flexors - 30%
How would you measure the pressure in each cmpartment of hte leg?
Slit catheter system - 18 gauage blunt needle
Exertional compartment syndrome will show _____ pressure at rest.
Normal pressure at rest, high pressure after exercise.
What does the femoral nerve innervate? what is the action?
IPSquad-iliacus, pectineus, sartorius, and quads.
Anterior compartment of the leg - helps extend the lower knee
What does the obturator nerve innervate? what is the action?
Medial compartment of the thigh for leg adduction
POAAAS: pectineus, obturator externues, A add’s, gracillis
What nerve inervates the gluteus medius, minimus, and tensor fascia lata? What happens when this nerve doesnt work?
Superior gluteal nerve.
Trandelenburg gait - when you stand on right left with R nerve damage, the L hip will drop. Pts tend to lean over their affected side causing this characteristic gait.
What are the branches of the sciatic nerve?
Tibial nerve - posterior leg and foot; splits into medial and lateral plantar nerves
Common fibular (wraps around the head of the fibula and can get damaged here) - splits into superficial fibular nerve (lateral compartment), and deep fibular nerve (anterior compartment)
Meniscal and labral patholgoy causes symptoms with _____ stress.
rotational
What is apophysitis?
Pain at an open growth plate.
What are the lab findins in someone with a compression fracture due to osteoporosis?
Normal calcium and phosphate
Alkaline phosphatase is normal
PTH is normal
What illness shows pink, scaly, annular lesinos on sun-exposed areas?
Subacute cutaneous lupus erythematous
WhatWhat disease is associated with the following signs: heliotrope rash, gottrons papules, capillary injury, and interstitial lung disease?
Dermatomyositis
A child came in with her partents with short stature, bowed legs, and short arms. Genetic testing showed a mutation in the fibroblast growth factor receptor 3 (FGFR3) gene. Which drug would be the best to help this child with her developmental disorder?
Somatotropin (recombinant human growth hormone)
What genetic condition is associated with ewing’s sarcoma?
(11;22) translocation (looks onion-like on radiology)
What syndrome is assocaited with severe scleroderma?
CREST syndrome.
Someone with pagets disease would have a higher chance of developing what type of tumor?
Osteosarcoma.
