Anterior and Lateral Leg and Dorsum of Foot Flashcards
Subtalar joint
between the inferior surface of the talus and the superior surface of the calcaneus – a plane synovial joint
MOVEMENTS OF EVERSION AND INVERSION
Pes anserinus bursitis
is a common finding in patients and/or athletes who present with complaints of anterior knee pain. The anserine bursa, along with its associated medial hamstring tendons, is located along the proximomedial aspect of the tibia. This condition is usually found in patients who have tight hamstrings, although it also can be caused by trauma (eg, a direct blow). In most patients,pes anserine bursitis is a self-limiting condition that responds to a program of hamstring stretching and quadriceps strengthening.
Shin splints/Compartment Syndromes
‘Shin splints’ is an old term used to describe overuse syndromes; leg pain associated with exercise; types of overuse syndromes include:
a. Muscle cramps (muscle spasm)
b. Anterior compartment and posterior tibial syndromes
1. Injury causes muscle expansion and swelling in a closed compartment; increased pressure causes loss of muscle and nerve function; this is an orthopedic emergency. a fasciotomy can be done to relieve the pressure in the compartment which would eventually cut off the blood supply and kill the muscles.
http: //emedicine.medscape.com/article/828456-overview
Shin splints are a mild compartment syndrome in the anterior compartment (tibialis anterior strain).
common fibular nerve
Knee dislocations and fractures, fibular neck fractures, plaster casts that are too tight, skate blades that cut across this area => damage to common fibular nerve.
Runs between EHL and Tibialis Anterior.
Becomes superficial at the first webspace, branching into 2nd and 3rd dorsal digital nerves
Injury to the common fibular nerve (Moore, page 605)
- Most commonly injured nerve in the body because of its superficial location against the head of the fibula
- Foot-drop
a. Paralysis of all dorsiflexor and evertor muscles of the foot
b. Foot falls into plantarflexion when raised off the ground
Ski Boot Syndrome
Deep Fibular Nerve Entrapment, often caused by a tight ski boot or other type of shoe (also in sports with running). Produces pain in the dorsum of the foot and usually radiates to the web space between the 1st and 2nd toes. This is caused by compression of the deep fibular nerve deep to the inferior band of the extensor retinaculum and the extensor hallucis brevis. Associated with edema in anterior compartment of leg.
Dorsal artery pulse
evaluated during a physical exam; a diminished or absent pulse suggests vascular insufficiency resulting from peripheral arterial disease. The P signs of peripheral arterial disease/arterial occlusion are: pain, pallor, paresthesia, paralysis, and pulselessness.
review dermatomes
Do it. Do it meow.
most important muscle for stability of joint
quadriceps
The fibrous capsule of the knee joint is strengthened by 3 major strong extrinsic ligaments:
a. Ligamentum patellae (patellar ligament)
1. Continuation of quadriceps tendon
2. From apex of patella to the tibial tuberosity
b. Fibular collateral ligament (round, cordlike)
1. Extends from the lateral femoral condyle to the head of the fibula.
a. separated from joint cavity by the tendon of popliteus
b. Biceps femoris tendon split in two by this ligament
c. Tibial collateral ligament (flat, broad)
1. Extends from the femoral condyle to the medial tibia above and below the condyle.
2. It is attached to the medial meniscus.
3. Sprains of these two ligaments (b,c) usually show pain near their attachments.
Menisci
a. Crescentic plates of fibrocartilage that lie on the articular surface of the tibia-tibial plateau
b. They deepen the articular surface of the tibia for the femoral condyles
c. They are firmly attached to the articular cartilage around the periphery; they act as shock absorbers
d. Tears of the menisci present as tenderness at the joint line; a tear is usually surgically excised
1. Medial meniscus
a. C-shaped and firmly adherent to the deep surface of the tibial collateral ligament
2. Lateral meniscus
a. Circular, and separated from the fibular collateral ligament by the tendon of the popliteus muscle
Meniscal tears that are peripheral can often be repaired or heal on their own because of the generous blood supply. Those that cannot be repaired or heal need to be removed. Pain on lateral rotation of the tibia on the femur indicates injury to the lateral meniscus – vice versa is true for medial meniscus.
Cruciate ligaments
a. Anterior cruciate (weaker)
1. Prevents posterior displacement of the femur on the tibia (hyperextension)
2. Attaches to tibia anteriorly
3. Common injury in ski accidents
4. Poorer blood supply than PCL
b. Posterior cruciate
1. Stronger of the two
2. Attaches to the tibia posteriorly
3. Tightens during flexion of the knee joint, preventing anterior displacement of femur or posterior displacement of tibia
c. Surgery on isolated cruciate tears is usually not done; the strength of quads is then very important
The cruciate ligaments are inside the capsule but outside of the synovial membrane
unhappy triad
The fibular collateral ligament is not commonly torn, being very strong. However, rupture of the tibial collateral ligament, often associated with tearing of the medial meniscus and anterior cruciate ligament, is a common football injury called the unhappy triad (Moore, pages 662-663). This is usually caused by a blow to the lateral side of the knee.
Bursae
. Four bursae communicate with the synovial cavity of the knee joint; they are extensions of the synovium of the joint. Inflammation in these bursae can result in bursitis.
a. Suprapatellar bursa
1 .permits free movement of quadriceps over distal femur
b. Popliteus bursa
1. Lies between tendon of popliteus and lateral condyle of tibia
c. Gastrocnemius bursa
1. Deep to the origin of medial head of the gastrocnemius
d. Semimembranosus bursa
1. between medial head of the gastrocnemius and the insertion of the semimembranosus
e. Popliteal Cysts or Baker’s cysts are abnormal filled sacs of synovial membrane in the region of the Popliteal fossa. It is always a complication of chronic joint effusion. The cyst may be a herniation of c or d above through the fibrous layer of the capsule into the Popliteal fossa (read Moore, p. 665).
2. Several bursae do not communicate with the synovial cavity of the knee joint:
a. Subcutaneous prepatellar bursa
1. between skin and anterior patella
2. Prepatellar bursitis or “housemaid’s knee” (Moore, pages 664-665)
b. Subcutaneous infrapatellar bursa
1. between skin and tibial tuberosity
2. infrapatellar bursitis or “clergyman’s knee” (Moore, pages 664-665)
3. most commonly seen in roofers, carpet layers, floor tilers
c. Deep infrapatellar bursa
1. between patellar ligament and anterior tibia (above the tuberosity)
Pott’s fracture
dislocation occurs when the foot is forcibly everted: pulls on strong medial ligament often tearing off the medial malleolus. Talus moves laterally shearing off the lateral malleolus or more commonly, breaking the fibula.
Sprains
a. The ankle joint is the most frequently injured major joint in the body and the lateral ligament is the most frequently sprained.
1. A sprained ankle (a tear without fracture or dislocation) is usually the result of the foot being forcibly inverted; the lateral ligaments are stretched (sometimes torn). However, an eversion sprain can also occur where the medial (deltoid) ligament is stretched/torn.
2. Children’s ligaments are very tough and their ankles are more prone to fractures than sprains.
