Blue Boxes Flashcards
Hip and Thigh contusions
hip pointer - contusion of the iliac crest (usually ASIS)
or
charley horse - cramping of individual thigh muscles because of ischemia or to contusion
Compartment syndromes and Fasciotomy
increased pressure on compartments can affect the nerves and vessels in particular compartments
secondary to trama, compression, burns, sustained use
too much pressure can compromise blood flow to distal tissues and lead to ischemia
fasciotomy
surgical release of fascia to decrease the pressure in the compartment
saphenous cutdown
saphenous vein accessible by making an incision anteriorly to the medial malleolus, used to directly administer fluids to blood stream
saphenous nerve is closely associated with the great saphenous vein, responsible for cutaneous sensation to the medial border of foot
hip and thigh contusions
hip pointer - contusion of the iliac crest at ASIS
charley horse - usualy due to tearing of the fibers of the rectus femoris
paralysis of the quadriceps
If patient has paralyzed quad, they will press on the distal aspect of their thigh while walking to prevent flexion of the thigh
some extension with glut max and tensor fascia lata
patellar fractures
direct blow can fracture patella
transverse fracture of patella
can occur with rapid quadriceps flexion (when you catch yourself while falling)
proximal portion of patella is pulled back with quad tension, distal fragment remains attached to the patellar ligament
Palpation, compression and cannulation of the femoral artery
little finger on ASIS, thumb on pubic tubercle - femoral artery will be superior at point
compression of femoral artery can be achieved by applying posterior force against the pubic ramus/femoral neck, or psoas major
cannulation of the femoral artery can be achieved by inserting a slender catheter inferiorly into the inguinal ligament up to external iliac, common iliac, aorta to visualize left ventricle
Location of femoral vein
NAVL towards your navel
can find vein by going just medial to the femoral pulse
3cm inferior to femoral vein is tributary from great saphenous vein - important when tying off great saphenous vein during varicose vein operations to correctly identify the great saphenous as it has no tributaries
patellar tendon reflex
L2-L4
percussion activates quadriceps muscle to extend leg (afferent signals travel through femoral nerve to L2-L4 segments and enter dorsal horn, causing efferent signals to exit the anterior horn of the spinal cord and excite the femoral nerve, extending the leg.
Groin pull
tearing of the proximal attachments of the ateromedial thigh muscles (flexors/adductors)
Laceration of the femoral artery
cruciate anastomosis consisting of:
Transverse branch of the lateral circumflex femoral
transverse branch of the medial circumflex femoral
inferior gluteal artery
1st perforating artery of the deep femoral
can supply the leg through collateral circulation if the femoral artery needs to be occluded
Femoral hernia
protrusion of abdominal contents through the femoral ring into the femoral canal
if protrusion is pinched by fascia will lead to necrosis
more common in women (wider pelvis)
Trochanteric bursitis
friction bursitis caused by rubbing of the bursa over the greater trochanter
tenderness and paint of GT radiates along IT band
elicited by resisted abduction and lateral rotation
ischial bursitis
friction bursitis of the gbursae that lies between the ischial tuberosity
pain increased with movement of gluteus maximus, long periods of sitting
injury to superior gluteal n
innervates gluteus medius, gluteus minimus, tensor fascia lata
injury results in weak abduction and medial rotation
+ trendelenburg sign (hip drop on ipsilateral side when standing on one leg)
gluteal injection
superolateral to avoid sciatic nerve
imaginary line extending from PSIS to greater trochanter
popliteal abcess and tumor
pain is severe in popliteal abcess because fascia is very tough - can spread inferiorly and superiorly within popliteal fascia
popliteal pulse
since the popliteal a is deep, it is difficult to palpate unless the knee is flexed (relaxing the hamstrings)
a weak pulse would indicate an occlusion/pathology of the femoral a
injury to tibial n
uncommon due to depth in popliteal fossa
a deep laceration or posterior dislocation of the knee joint would result in loss of plantar flexion and flexion of the toes
containment and spread of compartmental infections in the leg
strong septal fascia separates the compartments of the leg, infections in the anterior and posterior compartment will typically spread distally
the lateral compartment, however, can spread proximally along the course of the fibular nerve to the popliteal fossa
if purulent, suppuration can lead to compartment syndrome (–> resolve with fasciotomy)
Shin splints
caused by microtrauma to the anterior aspect of the tibia, usually tibialis anterior - causing tears in the periosteum
can lead to anterior compartment syndrome if swelling/edema occur
common overuse injury
fibularis muscles and the evolution of the human foot
pronated form of human feet evolved due to the fibularis longus distal attachment across the sole of the foot and the development of the fibularis tertius
Injury to the common fibular n
common fibular n wraps the fibular head - prone to injury/dislocation
damage leads to flaccid paralysis of anterior compartment (TA, EHL, EDL, fibularis tertius === dorsiflexion) and lateral compartment (fibularis L and B == eversion) muscles
deep fibular n entrapment
deep fibular n is associated with anterior tibial a in the anterior compartment
overuse of anterior compartment m can cause edema and swelling - compressing the deep fibular n and lead to numbness/pain in the space between the 1st and second digit
ski boot syndrome
superficial fibular n entrapment
chronic ankle sprains can irritate the superficial fibular n in the lateral compartment causing pain and paresthesias over the lateral aspect of the leg and foot
Fabella in gastrocnemius
small sesamoid bone posterior to the knee joint in the proximal aspect of the lateral gastro
Calcaneal tendinitis
prone to inflammation after walking/running - usually proximal to insertion
Ruptured calcaneal tendon
tearing off insertion into calcaneus causes immediate dorsiflexion of ankle - pain
cant plantar flex against resistance so cant walk
calcaneal tendon reflex
S1-S2 segments of the sacral plexus being tested - normally results in plantar flexion
S1 injury/compression diminishes this reflex
absence of plantar flexion
patients rotate foot laterally to use midfoot
occurs from achilles rupture or failure to plantar flex
calcaneal bursitis
bursa between superoposterior aspect of the calcaneus near the insertion of the calcaneal tendon - can be inflamed due to friction from overuse
venous return from leg
dependent on musculovenous pump (contraction of the gastrocnemius, soleus pushing the venous blood proximally)
aided by strong fascia surrounding muscles
Plantar fasciitis
overuse injury common in athletes and overweight patients
inflammation in plantar aponeurosis - commonly near medial tubercle of calcaneus
inflammation can lead to a calcaneal osteophyte causing further pain in arch of the foot (it inflames a bursitis)
worst after long periods of rest before standing
infections of the foot
common and can lead to deep infections in muscular compartments
if severe enough, surgical intervention for debridement is used - medial incision passing superior to abductor hallucis
contusion of extensor digitorum brevis
dorsal foot muscle that joints the tendons of the EDL at the MP joints
belly of the muscle is anteromedial of the lateral malleolus - contusion of this muscle causes a distinct hematoma on the lateral dorsum of foot
sural nerve grafts
sural nerve commonly used in nerve grafts - located by finding small saphenous v
varies bilaterial
anesthesia of the superficial fibular n
cutaneous branches of this n can be found in the ankle region anterior to the fibular
can be anesthetized to provide more effective anesthesia than local
deep fibular n provides sensation to 1st and 2nd digital interspace
plantar reflex
L4-S2
run blunt object over lateral sole of foot and cross to the base of great toe
normal response = slight flexion
abnormal response = dorsiflection of great toe and fanning of lateral toes (babinskis sign, normal in infants up to age 4)
medial plantar n entrapment
compression of the medial plantar n can lead to pain and parasthesias in the medial aspect of the sole of foot near navicular tuberosity joggers foot (can be caused by repetitive eversion of foot)
Palpation of dorsalis pedis pulse
just lateral of the EHL
used to detect for peripheral vascular insufficiency from arterial disease
5 P of peripheral arterial occlusion
pain pallor parastheisa paralysis pulselessness
hemmorhaging wounds of soles of foot
hard to treat and control bleeding due to multiple anastomoses of the foot
ligation of deep arch is hard to complete due to depth and number of structures
lymphadenopathy
infections in the foot can spread proximally and cause inflamed lymph nodes in the popliteal region and inguinal region
popliteal more common, spreading to inguinal
inguinal lymph nodes can become inflamed as a result of an infection in the medial side of the foot
joints of lower limb
femoral neck fracture - causes lateral rotation of the lower limb
more common in osteoporotic patients
can disrupt capsular ligaments as well as the medial circumflex femoral a, main supplier of blood to the head and neck of femur
Hip dislocation
sitting in the car with thigh: adducted, flexed, medially rotated when collision occurs = posterior dislocation, disrupting inferior and posterior capsular ligaments
causes limb shortening and medial rotation of hip
sciatic nerve can be damaged as a result - paralysis of hamstring muscles
anterior hip dislocation
hip extended, abducted, laterally rotated
struck from behind
disrupts anterior capsule, can cause fracture of acetabular rim
Genu valgum and genu varu .
Q angle (angle of ASIS and patella and line of gravity) angled medially - genu varum angled laterally - genu valgum
varum wears on medial knee and LCL becomes overstressed
valgum wears on lateral knee joint and MCL becomes overstressed
patellar dislocation
tendency for patella to dislocate laterally
counterbalanced by the strong pull of vastus medialis
tensor fascia lata and IT band pull patella laterally - cause chondromalacia patella, counteracted by vastus medialis
stretch the IT band to treat chondromalacia patella
patellofemoral syndrome
pain deep to patella, can result from microtrauma and overuse
can arise from arthritis in patellofemoral compartment
weak vastus medialis can lead to patellofemoral syndrome and strengthening this muscle helps track the patella properly and prevent patellofemoral syndrome or dislocation
TCL injuries
TCL and medial meniscus are firmly fixed to each other and the medial meniscus is the most commonly torn meniscus - typically happens when there is an excessive force to the lateral aspect of the extended knee, when the knee is flexed/lateral twisting that stresses and tears the TCL and medial meniscus
ACL injuries
typically occur when the knee is semiflexed and an anterior force is directed at the femur
ACL stabilizes the knee by preventing the femur from sliding posteriorly on the tibia, preventing the tibia from moving anteriorly on the femur
anterior drawer test
