Blue Boxes

Question 1

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

Answer 1

Compartment syndromes

Question 2

________ = surgical release of fascia to decrease pressure in the compartment; tx for compartment syndromes

Answer 2

Fasciotomy

Question 3

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

Answer 3

Saphenous vein grafts

Question 4

Saphenous v. can be accessed by making an incision anterior to medial malleolus which is used to directly administer fluids to bloodstream

Answer 4

Saphenous cutdown

Question 5

The ______ nerve is closely associated with the GSV, and if this nerve is cut the pt can experience numbness/pain on medial foot

Answer 5

Saphenous

Question 6

Occurs in contact sports and can result from contusion of iliac crest, usually where sartorius attaches to ASIS, also known as hip pointer

Answer 6

Hip contusion

Question 7

_____ fractures can occur as a result of the rectus femoris or sartorius being removed fom their proximal attachments

Answer 7

Avulsion

Question 8

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

Answer 8

Hematoma

Question 9

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

Answer 9

Psoas

Question 10

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

Answer 10

Distal; flexion

Extension

Patella

Question 11

How is the patella fractured

Answer 11

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

Question 12

Patella begins as cartilage and develops ages 3-6 into bone, how might it be abnormally ossified?

Answer 12

As a bipartite or tripartite patella

Can be mistaken for fracture, must order bilateral studies to assess

Question 13

How can you find femoral a.?

Answer 13

Place little finger on ASIS and thumb on pubic tubercle; femoral a. is superficial at this point

Question 14

When might pulse of femoral a. be diminished?

Answer 14

Occlusion of common iliac a. or external iliac a.

Question 15

How can compression of femoral a. be obtained?

Answer 15

Apply posterior force against pubic ramus, femoral neck, or psoas major

Question 16

_______ 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

Answer 16

Cannulation

Question 17

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

Answer 17

Varix

Question 18

Where is the femoral v.?

Answer 18

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

Question 19

Describe cannulation of femoral v.

Answer 19

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

Question 20

What segments of the lumbar plexus are tested by patellar reflex?

Answer 20

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

Question 21

Injury that results in tearing of proximal attachments of anteromedial thigh muscles (flexors/adductors)

Proximal attachments of these muscles are in inguinal region

Answer 21

Groin pull

Question 22

After laceration of femoral a., what blood supply can save the leg?

Answer 22

Cruciate anastomosis:

Lateral circumflex femoral a. (Transverse branch)
Medial circumflex femoral a. (Transverse branch)
Inferior gluteal a.
1st perforating artery of DFA

Question 23

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

Answer 23

Femoral hernia

Question 24

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

Answer 24

Trochanteric bursitis

Question 25

Friction bursitis of bursa that lies between ischial tuberosity Pain increases with movemnt of glut max, sitting for prolonged periods of time

Answer 25

Ischial bursities

Question 26

Superior gluteal n. innervates glut min, glut med, and tensor fascia lata; what is result of injury to this nerve?

Answer 26

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

Question 27

Where are gluteal injections given

Answer 27

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

Question 28

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

Answer 28

Sciatic

Question 29

What occurs with popliteal abcess and tumor?

Answer 29

Pain in popliteal abscess is severe bc fascia is very tough, and this can spread through popliteal fascia inferior and superiorly

Question 30

How might you feel popliteal pulse

Answer 30

Popliteal a. Is deep so hard to palpate pulse, but if you flex knee to relax hamstrings, you can feel inferiorly to popliteal fossa

Question 31

What might weak popliteal pulse indicate

Answer 31

Occlusion or problem with femoral a.

Question 32

How might damage to tibial n. occur?

Answer 32

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

Question 33

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

Answer 33

Distally; proximally

Question 34

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

Answer 34

Shin splints

Question 35

The pronated form of human feet evolved d/t _______ ________attachement across sole of foot and dev't of a _______ _______

Answer 35

Fibularis longus m. Fibularis tertius m.

Question 36

What does common fibular n. Control? What happens if injured

Answer 36

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

Question 37

Ski boot syndrome

Answer 37

Deep fibular n. Entrapment, overuse of anterior compratment or tight fitting boots compress deep fibular nerve

Question 38

Chronic ankle sprains can irritate what n. in lateral compartment of leg?

Answer 38

Superficial fibular n. - leads to entrapment, causes pain and paresthesias over lateral leg and foot

Question 39

______ = small sesamoid bone that occurs posterior to knee joint in proximal aspect of gastrocnemius Can be stress fractured after TKR

Answer 39

Fabella

Question 40

Calcaneal tendonitis

Answer 40

This tendon prone to inflammation after walking or running, usually just proximal to insertion on calcaneus

Question 41

Tearing of calcaneal tendon causes.......

Answer 41

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

Question 42

What segments of sacral plexus are tested with calcaneal reflex

Answer 42

S1-S2 Normal reult is plantar flexion of foot If S1 is injured or compressed, then there will be significantly decreased reflex

Question 43

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

Answer 43

Plantar flexion

Question 44

______ strain is caused by full overextension of leg and dorsiflexion of foot which strains medial head of this m. near its musculotendinous junction

Answer 44

Gastrocnemius

Question 45

Calcaneal bursitis

Answer 45

Inflammation of bursa between superopoterior aspect of calcaneus near insertion of calcaneal tendon

Question 46

How is venous return from leg done?

Answer 46

Dependent on musculovenous pump, contraction of calf muscles which push venous blood proximally Also aided by fascia

Question 47

What do you need to have pt do to talk their posterior tibial pulse?

Answer 47

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

Question 48

Inflammation d/t this condition can lead to formation of calcaneal osteophyte which can cause further pain

Answer 48

Plantar fasciiitis

Question 49

If foot infections are severe, what can be done?

Answer 49

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

Question 50

Belly of what foot muscle is anteromedial to lateral malleolus and forms fleshy patch on lateral, dorsal, part of foot?

Answer 50

Extensor digitorum brevis; contusion --> distinct hematoma

Question 51

Graft of this n. can be taken for procedures to repair nerve efects; located by finding small saphenous vein

Answer 51

Sural

Question 52

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

Answer 52

Superficail fibular n. Note that deep fibular controls 1+2 digits though

Question 53

What nerve roots are tested by plantar reflex? Normal vs. abnoraml response?

Answer 53

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)

Question 54

5 p's to diagnose peripheral a. occlusion

Answer 54

``` Pain Pallor Paresthesia Paralysis Pulselessness ```

Question 55

Some people do not have dorsalis pedis pulse, rather have enlarged ______ ________ artery instead

Answer 55

Perforating fibular

Question 56

How are hemorhage wounds of sole of foot treated?

Answer 56

Hard to treat d/t multiple anastomosis of foot Ligation of deep arch is difficult d/t depth and number of structures

Question 57

Where is lymphadenopathy located during infections of foot?

Answer 57

Typically popliteal nodes, but may spread to inguinal especially if medial foot affected

Question 58

Fracture of what part of femur leads to lateral rotation of lower limb?

Answer 58

Femoral neck

Question 59

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?

Answer 59

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

Question 60

Mech of injury for anterior hip dislocation

Answer 60

Hip extended, abducted, and laterally rotated (dashboard), being struck from behind which disrupts anterior capsule and causes fracture of acetabular rim

Question 61

Patellar dislocation usually occurs in which direction

Answer 61

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

Question 62

Pain deep to patella that can result from microtrauma and overuse; also can arise from arthritis or weak vastus medialis

Answer 62

Patellofemoral syndrome

Question 63

How do ACL injuries of knee occur

Answer 63

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