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MSK Midterm > Blue Boxes > Flashcards

Blue Boxes Flashcards

1
Q

Hip and Thigh contusions

A

hip pointer - contusion of the iliac crest (usually ASIS)
or
charley horse - cramping of individual thigh muscles because of ischemia or to contusion

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2
Q

Compartment syndromes and Fasciotomy

A

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

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3
Q

fasciotomy

A

surgical release of fascia to decrease the pressure in the compartment

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4
Q

saphenous cutdown

A

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

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5
Q

hip and thigh contusions

A

hip pointer - contusion of the iliac crest at ASIS

charley horse - usualy due to tearing of the fibers of the rectus femoris

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6
Q

paralysis of the quadriceps

A

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

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7
Q

patellar fractures

A

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

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8
Q

Palpation, compression and cannulation of the femoral artery

A

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

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9
Q

Location of femoral vein

A

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

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10
Q

patellar tendon reflex

A

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.

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11
Q

Groin pull

A

tearing of the proximal attachments of the ateromedial thigh muscles (flexors/adductors)

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12
Q

Laceration of the femoral artery

A

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

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13
Q

Femoral hernia

A

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)

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14
Q

Trochanteric bursitis

A

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

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15
Q

ischial bursitis

A

friction bursitis of the gbursae that lies between the ischial tuberosity
pain increased with movement of gluteus maximus, long periods of sitting

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16
Q

injury to superior gluteal n

A

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)

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17
Q

gluteal injection

A

superolateral to avoid sciatic nerve

imaginary line extending from PSIS to greater trochanter

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18
Q

popliteal abcess and tumor

A

pain is severe in popliteal abcess because fascia is very tough - can spread inferiorly and superiorly within popliteal fascia

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19
Q

popliteal pulse

A

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

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20
Q

injury to tibial n

A

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

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21
Q

containment and spread of compartmental infections in the leg

A

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)

22
Q

Shin splints

A

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

23
Q

fibularis muscles and the evolution of the human foot

A

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

24
Q

Injury to the common fibular n

A

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

25
Q

deep fibular n entrapment

A

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

26
Q

superficial fibular n entrapment

A

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

27
Q

Fabella in gastrocnemius

A

small sesamoid bone posterior to the knee joint in the proximal aspect of the lateral gastro

28
Q

Calcaneal tendinitis

A

prone to inflammation after walking/running - usually proximal to insertion

29
Q

Ruptured calcaneal tendon

A

tearing off insertion into calcaneus causes immediate dorsiflexion of ankle - pain
cant plantar flex against resistance so cant walk

30
Q

calcaneal tendon reflex

A

S1-S2 segments of the sacral plexus being tested - normally results in plantar flexion
S1 injury/compression diminishes this reflex

31
Q

absence of plantar flexion

A

patients rotate foot laterally to use midfoot

occurs from achilles rupture or failure to plantar flex

32
Q

calcaneal bursitis

A

bursa between superoposterior aspect of the calcaneus near the insertion of the calcaneal tendon - can be inflamed due to friction from overuse

33
Q

venous return from leg

A

dependent on musculovenous pump (contraction of the gastrocnemius, soleus pushing the venous blood proximally)
aided by strong fascia surrounding muscles

34
Q

Plantar fasciitis

A

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

35
Q

infections of the foot

A

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

36
Q

contusion of extensor digitorum brevis

A

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

37
Q

sural nerve grafts

A

sural nerve commonly used in nerve grafts - located by finding small saphenous v
varies bilaterial

38
Q

anesthesia of the superficial fibular n

A

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

39
Q

plantar reflex

A

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)

40
Q

medial plantar n entrapment

A 
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)
41
Q

Palpation of dorsalis pedis pulse

A

just lateral of the EHL

used to detect for peripheral vascular insufficiency from arterial disease

42
Q

5 P of peripheral arterial occlusion

A 
pain
pallor
parastheisa
paralysis 
pulselessness
43
Q

hemmorhaging wounds of soles of foot

A

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

44
Q

lymphadenopathy

A

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

45
Q

joints of lower limb

A

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

46
Q

Hip dislocation

A

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

47
Q

anterior hip dislocation

A

hip extended, abducted, laterally rotated
struck from behind
disrupts anterior capsule, can cause fracture of acetabular rim

48
Q

Genu valgum and genu varu .

A 
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

49
Q

patellar dislocation

A

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

50
Q

patellofemoral syndrome

A

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

51
Q

TCL injuries

A

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

52
Q

ACL injuries

A

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

MSK Midterm (10 decks)

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