Acute Lower Leg Muscle Conditions

Question 1

Strain vs sprain

Answer 1

Strain = muscle injury’s

Sprain = ligament injury

Question 2

1st 2nd and 3rd degree sprains

Answer 2

1st: stretching or very slight tear of ligament
- no instability of joint and normal ROM

2nd: tear but incomplete
- some ROM dysfunction, swelling and joint reaction

3rd: complete tear of ligament
- abnormal ROM, significant swelling and complete instability of joint

Question 3

Collateral lateral vs collateral medial ligament damage

Answer 3

Medial ligaments: prevent valgus deformities and medial displacement

Lateral ligaments: prevents varus deformities and lateral displacement

Question 4

ACL injury common facts

Answer 4

More common in women
- more common in basketball and soccer sports

Cardinal clinical signs:

• Effusion in the knee joint that is palpable
• Hemarthrosis in the joint within 2 hours
• patient states they heard a “pop”

Question 5

Treatment of ACL injuries

Answer 5

1st and 2nd degrees: crutches and physical therapy

3rd degree: surgical repairing/ replacement

Question 6

Common sites of harvesting new CL’s if not using a cadaver

Answer 6

Patella ligament

Semitendinous or gracious tendon

Question 7

Ottawa knee rules

Answer 7

Describe when to obtain a knee xrays

• age greater than 55
• tenderness of fibular head
• unable to flex to 90 degrees or bear weight
• isolated tenderness of patella

Question 8

MRI vs ultrasound in the knee

Answer 8

MRI: ligaments, meniscus and tendons

Ultrasound: tendons only

Question 9

Meniscal injury facts

Answer 9

Meniscus moves posterior with flexion and anterior with extension

Medial meniscus is most likely to be torn

Most often result from stretching or crushing force between the tibia and femur

Include triad of symptoms: joint line pain, swelling and locking of the knee

Tested using Apleys and McMurray tests

Question 10

Patella dislocation facts

Answer 10

Most dislocations occur laterally and associated with underlying abnormalities

• Often caused by trauma with knee in flexion.
• or powerful contraction of quadriceps in combo with sudden flexion and external rotation of the tibia
• apprehension test can be used to confirm

Question 11

Dislocations of the leg

Answer 11

Dislocations are described according to displacement of the tibia to the fibia

• anterior dislocations are most common

Question 12

Nerves and vasculature that can be injured during dislocations

Answer 12

Popliteal artery and vein and the common fibular nerve in popliteal fossa and lateral fibular head respectively

Question 13

Most important thing to do when assessing knee dislocations

Answer 13

Must assess circulation, if its missed and there is a tear in popliteal artery: will result in amputation of the leg

Question 14

Achilles’ tendon rupture

Answer 14

Most common in middle aged athletes and runners

Collagen depredations from aging and repeated micro trauma

Most common site is 2-6 cm above tendon insertion onto the calcaneus

Question 15

Extensor injury four locations

Answer 15

Quadriceps tendon

Patella fracture

Patella ligament rupture

Avulsion of the tibial tubercle

Question 16

Tendon rupture facts

Answer 16

Most common cause is sudden contraction of quadriceps muscle when knee is flexed (stepping down from cub or stairs)

Fluoroquinolones are usually prescribed Incase of UTIs and pneumonia that commonly occur with tendon ruptures.

Question 17

Hip dislocation facts

Answer 17

Often produced by high-energy trauma (most common w/ motor vehicle accidents)

Acetabulum fractures are very common with dislocations and fractures

Posterior dislocation more common than anterior nerve

Can result in sciatic nerve damage and avascular necrosis.

Question 18

What antibiotics can cause increased chances of tendon ruptures?

Answer 18

Fluroquinolones

Question 19

Hip dislocation signs

Answer 19

More often than not it is a posterior dislocation

Affected leg is shortened, adducted and internally rotated
* can be externally rotated if accompanied with a hip fracture*

Can injury sciatic nerve, medial circumflex artery and cause OA

Treated with reduction with sedation and muscle relaxers