Blue Boxes Flashcards
Increased pressure on compartments can affect the nerves and vessels in particular compartments
May be caused by trauma, compression, burns, or sustained muscle use
Excess pressure on vessels compromises blood flow to tissue distally and could lead to ischemia of severe enough
Compartment syndromes
________ = surgical release of fascia to decrease pressure in the compartment; tx for compartment syndromes
Fasciotomy
What procedure is often used to harvest venous tissue for coronary bypass surgery because the wall has high % of elastic fibers that make it a good candidate, and removal does not compromise the distal circulation
Saphenous vein grafts
Saphenous v. can be accessed by making an incision anterior to medial malleolus which is used to directly administer fluids to bloodstream
Saphenous cutdown
The ______ nerve is closely associated with the GSV, and if this nerve is cut the pt can experience numbness/pain on medial foot
Saphenous
Occurs in contact sports and can result from contusion of iliac crest, usually where sartorius attaches to ASIS, also known as hip pointer
Hip contusion
_____ fractures can occur as a result of the rectus femoris or sartorius being removed fom their proximal attachments
Avulsion
A contusion to the thigh leads to _______, most commonly in the quad region. This is known as a charley horse and is usually due to tearing of fibers of RF or even quad itself
Charley horse usually leads to pain and swelling
Hematoma
A pyogenic infection in the retroperitoneal region can be associated with Tb as well as Crohns disease; this can form an abcess that can traverse the fascia of the ____ muscle and form an abcess and edmea in the proximal thigh and inguinal area, causing pain down to the knee
This can be palpable and may be mistaken for an inguinal hernia
One way to confirm dx is to order x-ray of abdomen, and lateral border of this muscle will be obscured
Psoas
Someone with a paralyzed quad will typically press on ______ aspect of their thigh while walking to prevent _____ of the thigh
Some ______ can be obtained with glut max and tensor fascia lata
Weak VM or VL can lead to abnormal _____ movement or dislocation
Distal; flexion
Extension
Patella
How is the patella fractured
Direct blow or trauma causes transverse fracture
Can also occur with rapid quad flexion, such as catching yourself when falling
Proximall portion of patella is pulled back with quad tendon and distal fragment remains attached to patelar ligament
Patella begins as cartilage and develops ages 3-6 into bone, how might it be abnormally ossified?
As a bipartite or tripartite patella
Can be mistaken for fracture, must order bilateral studies to assess
How can you find femoral a.?
Place little finger on ASIS and thumb on pubic tubercle; femoral a. is superficial at this point
When might pulse of femoral a. be diminished?
Occlusion of common iliac a. or external iliac a.
How can compression of femoral a. be obtained?
Apply posterior force against pubic ramus, femoral neck, or psoas major
_______ of femoral a. is achieved by inserting slender catheter inferiorly to inguinal ligament which can feed up to external iliac, to common iliac, and the aorta to visualize left ventricle or coronary aa. of heart
Blood can be drawn for gas analysis
Cannulation
a saphenous _______ is a local dilation of great saph vein that can cause edema in FEMORAL TRIANGLE
This can lead to confusion with other femoral/inguinal abceses such as psoas abcess or hernia, but should be considered when pt presents with varicose veins in LE
Varix
Where is the femoral v.?
Found in femoral triangle just lateral to femoral a. So you can find vein by finding pulse of a. And moving laterally
3 cm infrior to femoral v. Is branching into GSV - important when tying off of GSV during varicose vein operations to make sure you correctly identify GSV; you know it is femoral v. because it does not have tributaries
Describe cannulation of femoral v.
Small slender catheters can be fed into femorall v. To reach right atrium of heart or pulm a.
Right cardiac angiography
Passed through external iliac vein, up to IVC and right atrium
What segments of the lumbar plexus are tested by patellar reflex?
L2-L4 segments (femoral n.)
Percussion activates quad muscels to extend leg (hitting patella causes afferent signals to travel through femoral n. To L2-L4 segements which enter dorsal horn, causing efferent signal to exit anterior horn of SC and travel to femoral n. Which tells quads to extend leg
Injury that results in tearing of proximal attachments of anteromedial thigh muscles (flexors/adductors)
Proximal attachments of these muscles are in inguinal region
Groin pull
After laceration of femoral a., what blood supply can save the leg?
Cruciate anastomosis:
Lateral circumflex femoral a. (Transverse branch)
Medial circumflex femoral a. (Transverse branch)
Inferior gluteal a.
1st perforating artery of DFA
Protrusion of abdominal contents through femoral ring into femoral canal; can lead to severe issue if pinched off d/t lack of blood flow –> necrosis
More common in women d/t wider pelvis
Femoral hernia
Friction bursitis caused by rubbing of bursa over greater trochnater of femur
Tenderness and pain over GT that radiates along IT tract
Elicited by resisted abduction and lateral rotation
Trochanteric bursitis
Friction bursitis of bursa that lies between ischial tuberosity
Pain increases with movemnt of glut max, sitting for prolonged periods of time
Ischial bursities
Superior gluteal n. innervates glut min, glut med, and tensor fascia lata; what is result of injury to this nerve?
Weakness with abduction and medial rotation
Pt will have + trendelenburg and lean toward affected side due to inability to stabilize pelvis
If glut med and glut min are paralyzed, pelvis will ascend on affected side and pt will lean toward affected side
Where are gluteal injections given
Superiolateral to avoid sciatic nerve, imaginary line from PSIS to site of greater trochanter
Also safe to go anterolateral and superior to sciatic n. by finding ASIS and tubercle of iliac crest
The _____ nerve exits inferiorly to piriformis, but in certain cases can branch early into tibial division and common fibular, with common fibular exiting through piriformi or superior to it which can make it more susceptible to injury
Sciatic
What occurs with popliteal abcess and tumor?
Pain in popliteal abscess is severe bc fascia is very tough, and this can spread through popliteal fascia inferior and superiorly
How might you feel popliteal pulse
Popliteal a. Is deep so hard to palpate pulse, but if you flex knee to relax hamstrings, you can feel inferiorly to popliteal fossa
What might weak popliteal pulse indicate
Occlusion or problem with femoral a.
How might damage to tibial n. occur?
These are uncommon bc n. is deep and protected in popliteal fossa, but can be damaged by deep lacerations of posterior dislocation of knee joint
Severed tibial n. Would result in loss of plantar flexion adn flexion of toes (posterior compartment = flexors) also loss of intrinsic foot muscles
In leg anterior compartments and posterior compartments, infections typically spread ______, whereas leg lateral compartment infections spread _________ (presumably along course of fibular n. to popliteal fossa
If purulent, suppuration (pus formation) spreads then compartment syndrome can occur
Fasciotomy may be needed
Distally; proximally
what injury is caused by microtrauma to anterior aspect of tibia, usually tibialis anterior m. and can cause tears in periosteum of tibia
Causes form of anterior compartment syndrome if swelling and edema
Commonly seen as overuse injury
Shin splints
The pronated form of human feet evolved d/t _______ ________attachement across sole of foot and dev’t of a _______ _______
Fibularis longus m.
Fibularis tertius m.
What does common fibular n. Control? What happens if injured
Anterior compartment mm. In leg (deep fibular) and lateral compartment (superficial fib)
Causes FLACCID paralysis of mm.
Loss of dorsiflexion (steppage gait, hear “clop” when foot hits ground) and eversion; waddling or swing out gait
Numbness over dorsum of foot
Ski boot syndrome
Deep fibular n. Entrapment, overuse of anterior compratment or tight fitting boots compress deep fibular nerve
Chronic ankle sprains can irritate what n. in lateral compartment of leg?
Superficial fibular n. - leads to entrapment, causes pain and paresthesias over lateral leg and foot
______ = small sesamoid bone that occurs posterior to knee joint in proximal aspect of gastrocnemius
Can be stress fractured after TKR
Fabella
Calcaneal tendonitis
This tendon prone to inflammation after walking or running, usually just proximal to insertion on calcaneus
Tearing of calcaneal tendon causes…….
Immediate dorsiflexion of ankle, pain, and inability to ambulate
Will not be able to flex against resistance, therefore nearly unable to walk
Only ambulate if foot is laterally rotated
What segments of sacral plexus are tested with calcaneal reflex
S1-S2
Normal reult is plantar flexion of foot
If S1 is injured or compressed, then there will be significantly decreased reflex
Absence of what joint motion leads to pts rotating their foot as far laterally as possible to use the midfoot
This may occur d/t achilles rupture
Plantar flexion
______ strain is caused by full overextension of leg and dorsiflexion of foot which strains medial head of this m. near its musculotendinous junction
Gastrocnemius
Calcaneal bursitis
Inflammation of bursa between superopoterior aspect of calcaneus near insertion of calcaneal tendon
How is venous return from leg done?
Dependent on musculovenous pump, contraction of calf muscles which push venous blood proximally
Also aided by fascia
What do you need to have pt do to talk their posterior tibial pulse?
Since it is deep to flexor retinaculum, need to have pt slightly invert foot to relax retinaculum
Diminished posterior tibial pulse may mean peripheral a. disease; can cause intermittent claudication – cramping when walking
Inflammation d/t this condition can lead to formation of calcaneal osteophyte which can cause further pain
Plantar fasciiitis
If foot infections are severe, what can be done?
Surgical intervention for debridement; incision made medially so abductor hallucis can be passed superiorly, allows for visualizing critical neurovascular structures and so that there is no pain from weight bearing area incision
Belly of what foot muscle is anteromedial to lateral malleolus and forms fleshy patch on lateral, dorsal, part of foot?
Extensor digitorum brevis; contusion –> distinct hematoma
Graft of this n. can be taken for procedures to repair nerve efects; located by finding small saphenous vein
Sural
Cutaneous branches of this nerve Can be found in ankle region, anterior to fibula, and can be anesthitized to provide more effective anesthesia than just local
Superficail fibular n.
Note that deep fibular controls 1+2 digits though
What nerve roots are tested by plantar reflex? Normal vs. abnoraml response?
L4-S2
Run blunt object over lateral sole of foot; cross to base of great toe
Normal response is slight flexion of toes
Abnormal response = dorsiflexion of great toe and fanning of lateral toes = BABINSKI sign - indicates brain injury or cerebral disease (although normal in infants bc corticospinal tract not fully developed)
5 p’s to diagnose peripheral a. occlusion
Pain Pallor Paresthesia Paralysis Pulselessness
Some people do not have dorsalis pedis pulse, rather have enlarged ______ ________ artery instead
Perforating fibular
How are hemorhage wounds of sole of foot treated?
Hard to treat d/t multiple anastomosis of foot
Ligation of deep arch is difficult d/t depth and number of structures
Where is lymphadenopathy located during infections of foot?
Typically popliteal nodes, but may spread to inguinal especially if medial foot affected
Fracture of what part of femur leads to lateral rotation of lower limb?
Femoral neck
Sitting in car with thigh adducted, flexd, and medially rotated (common position when riding in car) and striking dashboard in acident can lead to what type of hip dislocation?
Posterior dislocation
Causes limb shortening, medial rotation of hip
Sciatic n. Can be damaged, leading to paralysis of hamstrings as well as lower leg mm. On posterolateral side
Mech of injury for anterior hip dislocation
Hip extended, abducted, and laterally rotated (dashboard), being struck from behind which disrupts anterior capsule and causes fracture of acetabular rim
Patellar dislocation usually occurs in which direction
Laterally; counterbalance by vastus medialis and fact that anterior patellar facet is deeper
Tensor fascia lata can pull patella laterally which causes chondromalacia
stretch IT band to treat chondromalacia of patella
Pain deep to patella that can result from microtrauma and overuse; also can arise from arthritis or weak vastus medialis
Patellofemoral syndrome
How do ACL injuries of knee occur
Knee is semiflexed and anterior force is directed at femur
ACL usually stabilizes knee by preventing femur from sliding posteriorly on tibia and prevens tibia from moving atneriorly on femur
