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MSK LE > Blue Boxes > Flashcards

Blue Boxes Flashcards

1
Q

Club foot

A

All types are congenital

Talipes equinovarus: involves subtalar joint, is the most common and affects boys more often

Presentation: Foot is inverted, ankle is plantarflexed and forefoot is adducted

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2
Q

Pes Planus (flat foot)

A

Flexible results from loose or degenerative intrinsic ligaments

Rigid results from bone deformity

Acquired is secondary to dysfunction of the tibialis posterior owing to trauma, degeneration with age, or denervation

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3
Q

Claw toes

A

Hyperextension of the metatarsophalangeal joints and flexion of the distal interphalangeal joints

Usually involves lateral 4 toes

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4
Q

Hammer toe

A

Proximal phalanx is permanently and markedly dorsiflexed at the metatarsophalangeal joint and middle phalanx strongly planterflexed at the proximal interphalangeal joint

Usually occurs in the 2nd digit from weakness of the lumbrical and interosseous muscles

Callosity or callus develops where dorsal surface rubs against shoes

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5
Q

Hallux valgus

A

Foot deformity caused by pressure from footwear and degenerative joint disease causing lateral deviation of the great toe

Surrounding tissues swell and create bursa known as a bunion and corns over proximal phalanges

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6
Q

Tibial nerve entrapment

A

Passes deep to the flexor retinaculum in interval between the medial malleolus and calcaneus

Impinged due to edema and tightness in the ankle involving the synovial sheath of the tendons resulting in heel pain

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7
Q

Pott fracture—

A

dislocation of the ankle occurs when foot is forcibly everted, often tearing off the medial malleolus followed by tearing off of the lateral malleolus by the talus

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8
Q

Ankle Injuries

A

Ankle sprains: (torn ligaments) most common and nearly always an inversion injury involving twisting of the weight bearing plantarflexed foot

-Anterior talofibular ligament is most vulnerable

Shearing injuries: fracture the lateral malleolus at sup ankle joint

Avulsion fractures: break the malleolus inf to the ankle joint

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9
Q

Popliteal cysts

A

Abnormal fluid filled sacs of synovial membrane in the region of the popliteal fossa which could be from herniation of the gastrocnemius or semimembranosus bursa

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10
Q

Housemaids knee

A

chronic inflammation of the prepatellar bursa resulting in swelling anterior to the knee

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11
Q

Clergymans knee

A

subcutaneous infrapatellar bursitis from excessive friction btw skin and the tibial tuberosity causing edema over proximal end of the tibia

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12
Q

Deep infrapatellar bursitis

A

caused by friction btw patellar tendon and structure post to it causing edema btw patellar ligament and tibia

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13
Q

Suprapatellar bursitis from

A

abrasions and bacteria

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14
Q

Contact sports can cause ligament sprains

A

from a force applied to a knee with foot planted in the ground

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15
Q

Tearing of TCL

A

results in tearing in the medial meniscus caused by lateral blow to the knee or excessive lateral twisting of the flexed knee

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16
Q

ACL tears occur in

A

hyperextension and severe force directed anteriorly against the femur with the knee semiflexed

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17
Q

ACL ruptures cause

A

the free tibia to slide anteriorly under the fixed femur=anterior drawer sign

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18
Q

PCL ruptures may occur when a player lands on the

A

tibial tuberosity with the knee flexed and in conjuction with tibial or fibular ligaments which causes the free tibia to slide posteriorly under the fixed femur=posterior drawer sign

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19
Q

Meniscal tears involve

A

medial meniscus in conjunction with TCL or ACL tears

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20
Q

Patellofemoral syndrome

A

Runner’s knee:deep pain to the patella from excessive running downhill

Microtrauma from abnormal tracking of the patella relative to the patellar surface of the femur

Also occurs from direct blow to patella and osteoarthritis of the patellofemoral compartment

Can be corrected by strengthening the vastus medialis

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21
Q

Patellar dislocation

A

Most commonly dislocated laterally and in women

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22
Q

Genu valgum and Genu varum

A

Q-angle🡪angle between the femur and the tibia and is assessed by drawing a line from the ASIS to the middle of the patella and extrapolating a 2nd ling passing thru the middle of the patella and tibial tuberosity

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23
Q

Genu varum—

A

small angle (bowlegged) which results in arthrosis

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24
Q

Genu valgum—

A

large angle which pulls patella even more lateral

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25
Q

Dislocation of hip joint

A

Inability to abduct thigh is sign of congenital dislocation

Occurs more often in girls, and is bilateral

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26
Q

Acquired dislocation can happen with trauma to

A

flexed, adducted, and medially rotated hip

Posterior most common

Sciatic nerve could be damaged resulting in paralysis of hamstrings and distal muscles of leg

Anterior dislocations occur to hips extended, abducted and laterally rotated

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27
Q

Trendelenburg sign

A

🡪hip appears to drop on one side while walking

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28
Q

Necrosis of femoral head in children

A

Traumatic dislocations of the hip joint disrupts artery to head of femur as well as fractures of sup femoral epiphysis

Hip pain radiates to the knee

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29
Q

Surgical hip replacement

A

Metal prosthesis anchored to the femur by bone cement replacing femoral head and neck, plastic socket replaced acetabulum

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30
Q

Hip fractures (femoral neck)

A

Often intracapsular and disrupts blood supply

In ppl <60 occurs due to extreme trauma to extended leg or flexed knee

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31
Q

Lymphadenopathy

A

Infections of the foot spreading proximally causing enlargement of the popliteal fossa and inguinal lymph nodes

Infections on medial side causes enlargement of just inguinal lymph nodes

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32
Q

Hemorrhaging wounds of the sole of the foot

A

Punctures of sole involving the deep plantar arch and branches results in severe bleeding

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33
Q

Medial plantar nerve entrapment

A

Compression as it passes deep to the flexor retinaculum or curves deep to the abductor hallucis may cause aching, burning, numbness, and tingling on the medial side of the sole and navicular tuberosity

Occurs during repetitive eversion of the foot=joggers foot

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34
Q

Contusion of the extensor digitorum brevis

A

Contusion and tearing of the fibers results in hematoma anteromedial to lateral malleolus

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35
Q

Foot infections

A

Common in places where footwear is scarce

Localize in compartments btw muscular layers

Incision to treat made on medial side of the foot sup to abductor hallucis

36
Q

Plantar fasciitis

A

Straining and inflammation of the plantar aponeurosis from running and high impact aerobics

Pain on plantar surface of the heel and medial aspect of the foot and most severe after sitting and first walking in the morning

Tender at proximal attachment of aponeurosis to the medial tubercle of the calcaneus and on the medial surface of this bone during extension of big toe and dorsiflexion of the ankle

37
Q

Calcaneal bursitis

A

Causes pain posterior to the heel and occurs during long distance running, basketball and tennis

38
Q

Gastrocnemius strain

A

Tennis leg: partial tearing of the medial belly of the gastrocnemius at or near its musculotendinous junction

Occurs with overstretching by concomitant full extension of the knee and dorsiflexion of the ankle

39
Q

Ruptured calcaneal tendon

A

Occurs in ppl who are poorly conditioned and with hx of tendonitis

Audible snap during a forceful push off followed by sudden calf pain and sudden dorsiflexion of the plantarflexed foot

Bruising appears in malleolar region and a lump appears in the calf due to shortening of triceps surae

40
Q

Calcaneal tendonitis

A

Micro tears of collagen fibers superior to attachment to the calcaneus causes pain while walking

41
Q

Avulsion of the tuberosity of the 5th metatarsal

A

Violent inversion of the foot causes avulsion of the distal attachment of fibularis brevis
Injury to superficial fibular nerve causes inversion of the foot

42
Q

Superficial fibular nerve entrapment

A

Due to chronic ankle sprains; causes pain along lateral side of the leg and dorsum of the ankle and foot

43
Q

Injury to the common fibular nerve and footdrop

A

Most commonly injured nerve in lower limb

Severance results in flaccid paralysis of all muscles anterior and lateral compartments of the leg=foot drop

Foot doesn’t clear the ground in swing phase so ppl:

Have a waddling gait by leaning to opposite side

Have a swing out gait of affected leg

Have a high stepping gate of affected leg

44
Q

Deep fibular nerve entrapment

A

Excessive use of muscles supplied by the nerve could cause edema and muscle injury in anterior compartment

Pain occurs in dorsum of the foot and radiates to web space btw 1st and 2nd toes

Ski boot syndrome🡪compression where nerve passes btw inferior extensor retinaculum and extensor hallucis brevis

45
Q

Tibialis anterior strain (shin splints)

A

Edema and pain in the area of the distal 2/3 of the tibia from repetitive microtrauma of the TA causing small tears in the periosteum or fleshy attachments to the overlying deep fascia

46
Q

Compartment infections and syndromes in the leg

A

Infections in ant and post compartments spread distally

Supparation (fancy word for pus) from purulent infections in the lateral aspect of the leg can spread proximally into popliteal fossa

May produce hemorrhage, edema, and inflammation of the muscles

Loss of distal pulses and lowering of temperature denotes arterial compression

Fasciotomy is used to relieve pressure

47
Q

Injury to tibial nerve

A

Uncommon, but can occur with deep lacerations along with posterior dislocations

Produces paralysis of the flexor muscles in the leg and intrinsic muscles in the sole of the foot

No plantarflexion or sensation to the sole of the foot

48
Q

Popliteal aneurysm and hemorrhage

A

Abnormal dilation of all or part of the artery causing edema and pain in the fossa

Pain from nerve compression referred to skin overlying the medial aspect of the calf, ankle or foot

Femoral artery ligation, blood can bypass thru genicular anastomosis and reach popliteal artery

49
Q

Popliteal pulse

A

Pt prone, knee flexed…pulse felt in the inferior part of the fossa where the artery is related to the tibia

Femoral artery obstruction can cause weakening of the pulse

50
Q

Popliteal abscesses and tumors

A

Spread superiorly and inferiorly because of toughness of fascia and results in severe pain

51
Q

Injury to sciatic nerve

A

Piriformis syndrome🡪pain in the ass from compression of the nerve by the piriform muscle

Complete section of the nerve results in total loss of use of the leg

52
Q

Anesthetic block of sciatic nerve

A

Paresthesia radiates to the foot

Sciatic-tibial-plantar nerves

53
Q

Injury to superior gluteal nerve

A

Results in disabling gluteus medius limp to compensate for weakened abduction of the thigh by the gluteus medius and minimus or gluteal gait

Medial rotation impaired

Positive trendelenburg test:when standing on one leg, pelvis on unsupported side descends

54
Q

Hamstring injuries

A

Common in running or kicking resulting in tearing of the proximal tendinous attachments of the hamstrings to the ischial tuberosity

55
Q

Hurdler’s injury:

A

forced flexion of the knee results in avulsion of the ischial tuberosity at the proximal attachment of biceps femoris and semitendinosus

56
Q

Trochanteric bursitis

A

From repetitive actions like climbing stairs with heavy objects

Deep diffuse pain in the lateral thigh and pt tenderness of greater trochanter

Elicited by resisting abduction and lateral rotation

57
Q

Ischial bursitis

A

Recurrent trauma results in inflammation of the bursa from excessive friction btw the ischial bursae and tuberosities

Calcification may occur and pressure sores

58
Q

Femoral hernia

A

Femoral ring is site of herniation, a protrusion of abdominal viscera through the femoral ring into the femoral canal

Inferolateral to the pubic tubercle

Bounded laterally by femoral vein and medially by lacunar ligament

59
Q

Cannulation of the femoral vein

A

In right cardiac angiography, a long catheter is inserted into the femoral vein as it passes through the triangle and then is passes sup thru the external and common iliac veins into the inferior vena cava

60
Q

Saphenous varix

A

Localized dilation of the terminal part of the great saphenous vein may cause edema in the femoral triangle

Should be considered with presence of varicose veins

61
Q

Replaced or accessory obturator artery

A

Enlarged pubic branch of the inf epigastric artery takes the place of the obturator aretery or joins it as an accessory artery

Could result in strangulated femoral hernia

62
Q

Laceration of the femoral artery

A

Occurs in anterior thigh wounds resulting in arteriovenous shunt

Cruciate anastomosis rarely occurs:
Medial and lateral circumflex femoral arteries
Inferior gluteal artery
Perforating artery

63
Q

Injury to adductor longus

A

In horseback riders with occurance of ossification in the tendons

64
Q

Groin pull

A

Injury to proximal attachments of the anteromedial thigh muscle, usually flexor and adductor thigh muscles

65
Q

Transplantation of the gracilis

A

Used to replace a damaged muscle (hand) because it can be removed without notice

66
Q

Abnormal ossification of the patella

A

Centers may remain separate on one or both sides to have a bipartite or tripartite patella

Occurs bilaterally

67
Q

Patellar Fractures

A

Transverse fractures from blow to knee or sudden contraction of the quads

68
Q

Chondromalacia patellae

A

Runner’s knee from quad imbalance from a blow to the patella or extreme flexion of the knee

69
Q

Paralysis of the quads

A

Can’t extend the leg against resistance and presses on distal end of thigh during walking to prevent flexion of the knee

Weakness of vastus medialis or vastus lateralis from arthritis or trauma

70
Q

Psoas abscess

A

in abdomen from intervertebral discs, sides of t12-l5 and their tps

medial arcuate ligament of diaphragm arches over proximal part of psoas major, their fascias are continuous with one another

TB associated with retroperitoneal pyogenic infection could result in psoas abscess

Pain referred to the hip, thigh or knee along with edema in proximal part of the thigh

71
Q

Hip and thigh contusions

A

Hip pointer: contusion of the iliac crest at the anterior part

Usually occurs with contact sports

Contusions cause bleeding from ruptured capillaries and infiltration of blood into muscles, tendons, and other soft tissues

Charley horse🡪cramping of individual thigh muscle due to ischemia or contusion and rupture of blood vessels that form a hematoma

Usually due to tearing of fibers of rectus femoris, and sometimes the quads

72
Q

Absence of plantarflexion in walking

A

Muscles of the calf are paralyzed or calcaneal tendon is ruptured, push off of the foot can still be accomplished with the gluteus max and hamstrings

Push off from forefoot isn’t possible, so ppl often rotate the foot as far laterally as possible

73
Q

Regional anesthetic nerve blocks of the lower limbs

A

Iliohypogastric and ilioinguinal nerves can be blocked by injecting an anesthetic agent 4-6 cm posterior to the ASIS

Femoral nerve can be blocked 2 cm inferior to inguinal ligament, lateral to femoral artery

Paresthesia radiates to the knee and over medial side of leg if the saphenous nerve is affected

74
Q

Enlarged inguinal lymph nodes

A

Lymphadenopathy: enlarged lymph nodes due to abrasion and minor sepsis with bacterial infection

Drains into trunk inferior to umbilicus and entire lower limb

In females, metastasis from uterine cancer should be considered

75
Q

Saphenous cutdown and nerve injury

A

Saphenous cutdown: located by making a skin incision anterior to the medial malleolus in order to insert a cannula for prolonged admin of blood, plasma expanders, or drugs

Nerve running with vein could be damaged resulting in numbness of medial border of the foot

76
Q

Saphenous vein grafts

A

Used for coronary arterial bypasses bc it is accessible, a good distance btw tributaries and perforating veins, and its wall contains a higher percentage of muscular and elastic fibers

Once removed, the vein is reversed so the valves don’t obstruct blood flow in the graft

77
Q

Varicose veins, thrombosis, and thrombophlebitis

A

Great sephanous vein becomes dilated so that the cusps of the valves do not close

Common in posteromedial parts of the lower limb

Lower limb veins subject to venous thrombosis after fracture which is caused by venous stasis

Venous inflammation with thrombus formation (thrombophlebitis) may develop around the vein

78
Q

Bone grafts

A

Fibula common source of bone for grafting

Periosteum and nutrient artery are generally removed

Middle third of fibula most often used

79
Q

Fibular fractures

A

Occur 2-6cm from lateral malleolus and associated with fracture dislocations of the ankle joint along with tibial fractures

Occurs when foot is forced into excessively inverted position, ankle ligaments tear, tilting the talus against the malleolus and shearing it off

80
Q

Fractures involving the epiphyseal plates

Osgood-schlatter disease

A

🡪May cause inflammation of the tibial tuberosity and chronic recurring pain during adolescence

81
Q

Tibial fractures

A

Narrowest at the junction of middle and inferior thirds with poorest blood supply

Most common site for compound fracture from direct trauma (bumper fracture)

Transverse stress fracture of inf third are common during long hikes

Diagonal fracture occurs during skiing at junction of middle and inferior thirds along with a fracture of the fibula

82
Q

Femoral fractures

A

Neck is most frequently fractured, can e transcervical and intertrochanteric that occur as a result of indirect trauma

Impaction can occur along with muscle spasm which results in shortening of the limb

Fractures of the greater trochanter and femoral shaft occur with direct trauma and could result in spiral fracture and foreshortening

Fractures of distal femur may have separation of the condyles resulting in misalignment of the articular surfaces of the knee joint

83
Q

Dislocated epiphysis of the femoral head

A

In older children or adolescents due to a weakened epiphysial plate

Due to trauma creating shearing stress on the epiphysis with abduction and lateral rotation resulting in progressive coax vara

Initial symptom is hip discomfort referred to the knee

84
Q

Coxa Vara and Coxa Valga

A

Vara🡪angle of inclination btw the long axis of the femoral neck and femoral shaft decreases resulting in limb shortening and limited abduction

Valga🡪when the angle increases

85
Q

Hip fractures

A

applied to fractures of femoral head, neck or trochanters

Avulsion fracture:occur during sports with sudden acceleration or deceleration forces which results in a small part of bone with a piece of tendon or ligament attached to be torn away

Occur at apophyses or bony projections that lack secondary ossification centers and where muscles attach

86
Q

Lower Limb Injuries

A

Knee, keg and foot are the most common from acute trauma during contact sports

Osteochondrosis: combined stress on epiphysial plates from physical activity and rapid growth may result in irritation and injury of the developing bone

MSK LE (7 decks)

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