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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
Dislocation of hip joint
Inability to abduct thigh is sign of congenital dislocation | Occurs more often in girls, and is bilateral
26
Acquired dislocation can happen with trauma to
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
27
Trendelenburg sign
🡪hip appears to drop on one side while walking
28
Necrosis of femoral head in children
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
29
Surgical hip replacement
Metal prosthesis anchored to the femur by bone cement replacing femoral head and neck, plastic socket replaced acetabulum
30
Hip fractures (femoral neck)
Often intracapsular and disrupts blood supply In ppl <60 occurs due to extreme trauma to extended leg or flexed knee
31
Lymphadenopathy
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
32
Hemorrhaging wounds of the sole of the foot
Punctures of sole involving the deep plantar arch and branches results in severe bleeding
33
Medial plantar nerve entrapment
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
34
Contusion of the extensor digitorum brevis
Contusion and tearing of the fibers results in hematoma anteromedial to lateral malleolus
35
Foot infections
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
Plantar fasciitis
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
Calcaneal bursitis
Causes pain posterior to the heel and occurs during long distance running, basketball and tennis
38
Gastrocnemius strain
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
Ruptured calcaneal tendon
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
Calcaneal tendonitis
Micro tears of collagen fibers superior to attachment to the calcaneus causes pain while walking
41
Avulsion of the tuberosity of the 5th metatarsal
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
Superficial fibular nerve entrapment
Due to chronic ankle sprains; causes pain along lateral side of the leg and dorsum of the ankle and foot
43
Injury to the common fibular nerve and footdrop
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
Deep fibular nerve entrapment
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
Tibialis anterior strain (shin splints)
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
Compartment infections and syndromes in the leg
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
Injury to tibial nerve
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
Popliteal aneurysm and hemorrhage
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
Popliteal pulse
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
Popliteal abscesses and tumors
Spread superiorly and inferiorly because of toughness of fascia and results in severe pain
51
Injury to sciatic nerve
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
Anesthetic block of sciatic nerve
Paresthesia radiates to the foot Sciatic-tibial-plantar nerves
53
Injury to superior gluteal nerve
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
Hamstring injuries
Common in running or kicking resulting in tearing of the proximal tendinous attachments of the hamstrings to the ischial tuberosity
55
Hurdler’s injury:
forced flexion of the knee results in avulsion of the ischial tuberosity at the proximal attachment of biceps femoris and semitendinosus
56
Trochanteric bursitis
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
Ischial bursitis
Recurrent trauma results in inflammation of the bursa from excessive friction btw the ischial bursae and tuberosities Calcification may occur and pressure sores
58
Femoral hernia
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
Cannulation of the femoral vein
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
Saphenous varix
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
Replaced or accessory obturator artery
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
Laceration of the femoral artery
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
Injury to adductor longus
In horseback riders with occurance of ossification in the tendons
64
Groin pull
Injury to proximal attachments of the anteromedial thigh muscle, usually flexor and adductor thigh muscles
65
Transplantation of the gracilis
Used to replace a damaged muscle (hand) because it can be removed without notice
66
Abnormal ossification of the patella
Centers may remain separate on one or both sides to have a bipartite or tripartite patella Occurs bilaterally
67
Patellar Fractures
Transverse fractures from blow to knee or sudden contraction of the quads
68
Chondromalacia patellae
Runner’s knee from quad imbalance from a blow to the patella or extreme flexion of the knee
69
Paralysis of the quads
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
Psoas abscess
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
Hip and thigh contusions
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
Absence of plantarflexion in walking
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
Regional anesthetic nerve blocks of the lower limbs
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
Enlarged inguinal lymph nodes
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
Saphenous cutdown and nerve injury
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
Saphenous vein grafts
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
Varicose veins, thrombosis, and thrombophlebitis
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
Bone grafts
Fibula common source of bone for grafting Periosteum and nutrient artery are generally removed Middle third of fibula most often used
79
Fibular fractures
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
Fractures involving the epiphyseal plates | Osgood-schlatter disease
🡪May cause inflammation of the tibial tuberosity and chronic recurring pain during adolescence
81
Tibial fractures
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
Femoral fractures
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
Dislocated epiphysis of the femoral head
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
Coxa Vara and Coxa Valga
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
Hip fractures
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
Lower Limb Injuries
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

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