BRS - LEA Highlights Flashcards
what is the pelvic girdle?
bony ring formed by the hip bones (ilium, ischium, pubis), and the sacrum that provides a strong connection b/w the trunk and lower limb
what is the strongest ligament of the hip joint?
iliofemoral ligament (forms an inverted Y shape);
limits hyperextension
what are the boundaries of the femoral triangle?
- bounds: inguinal ligament, sartorius, adductor longus
- floor: iliopsoas, pectineus, and adductor longus
- roof: fascia lata, cribriform fascia
what are the contents of the femoral triangle?
- from lateral to medial
- femoral nerve
- femoral sheath, containing (femoral artery, vein, and deep lymphatics)
what are the bounds of the popliteal fossa?
bounds:
- semimembranosus,
- semitendinosus,
- biceps femoris,
- medial and lateral heads of the gastrocnemius,
- plantaris
what are the contents of the popliteal fossa?
- popliteal vessles
- common peroneal and tibial nerves
- small saphenous vein
what is the pes anserinus?
- “goose foot”
- combined tendinous expansions of the sartorious, gracilis, and semitendinosus;
- attaches these muscles to the medial tibial condyle
what is the clinical use of the SEMITENDINOSUS tendon?
semitendinosus tendon may be used for surgical reconstruction of the ANTERIOR CRUCIATE LIGAMENT
anterior cruciate ligament:
function
- prevents excessive anterior translation (sliding) of the tibia in relation to the femur
- prevents hyperextension of the knee joint
- taut during EXTENSION of knee, relaxed during flexion
posterior cruciate ligament:
function
- prevents excessive POSTERIOR translation (sliding) of the tibia in relation to the femur
- prevents hyper-flexion of the knee joint
- taut during FLEXION of knee, relaxed during extension
what graft can be used for surgical repair of the anterior cruciate ligament?
patellar ligament
what may be used for autografts of the long flexors of the fingers?
plantaris tendon
medial (deltoid) ligament:
function
prevents OVEREVERSION of the foot
lateral ligament of the ankle:
composition and function
- (anterior and posterior talofibular and calcaneofibular ligaments)
- resists INVERSIONof the foot
the long and short plantar (plantar calcaneocuboid) ligaments support what?
supports the LATERAL side of the longitudinal arch of the foot
spring ligament
(other name and function)
- plantar calcaneonavicular (plantar CN ligament)
- supports the head of the talus and the medial longitudinal arch
- **the ligament is fairly elastic, hence its name
describe and explain the gluteal gait
- aka “gluteus medius limp”
- waddling gait with pelvis falling (or drooping) toward the unaffected side when the opposite leg is raised
- CAUSED by paralysis the gluteus medius muscle
common site for intramuscular injection of medications.
why?
superior lateral quadrant of the gluteal region;
to avoid injury to the underlying sciatic nerve and other neurovascular structures
piriformis syndrome:
define
- condition in which the piriformis muscle irritates and places pressure on the sciatic nerve;
- causes pain in the lower back, buttocks, and referred pain along the course of the sciatic nerve (sciatica)
sciatica:
define
pain in the lower back, buttocks, and referred pain along the course of the sciatic nerve caused by piriformis syndrome
positive trendelenberg sign
(cause and presentation)
- causes:
- fx of femoral neck
- hip dislocation (head of femur)
- weakness and paralysis of the gluteus medius (abductor)
- presentation: if R gluteus medius muscle is paralyzed, the left side (sound side) of the pelvis falls (sags) instead of rising (normally, pelvis rises on unsupported side)
hamstring injuries
- pulled or torn hamstrings;
- very painful and common in persons involved in running, jumping, and quick-start sports
what causes avulsion of the ischial tuberosity?
(the origin of the hamstrings)
forcible flexion of the hip with the KNEE EXTENDED can cause avulsion of hamstring origin
femoral hernia:
define and sequelae
- passes thru the femoral ring and canal
- lies lateral and inferior to the pubic tubercle and deep and inferior to the inguinal ligament
- its sac is formed by parietal peritoneum
- strangulation of femoral hernia –> interfere w/ blood supply to herniated intestine –> death of tissue
groin injury:
define and mechanism
- pulled groin; strain, stretching, or tearing of the origin of the flexor and adductor of the thigh
- often occurs in quick-start sports (sprinting/football),
which patients commonly strain their adductor longus?
may occur in horseback riders and produce pain bc the riders ADDUCT their thighs to keep from falling off the horse
what is the strongest extensor of the thigh at the hip?
- gluteus MAXIMUS is strongest extensor of thigh at the hip
- esp important when walking uphill, climbing stairs, rising from sitting position
iliopsoas muscle:
function, attachment
- fxn: powerful flexor of the thigh
- attaches at lesser trochanter
which muscle(s) can (1) flex the thigh at the hip joint, and
(2) extend the leg at the knee?
- tensor fascia lata
- rectus femoris
hamstring:
muscles and group fxn
- muscles:
- semitendinosus
- semimembranosus
- long head of biceps femoris
- fxn: extend the thigh at the hip, and flex leg at the knee
dorsal versus plantar interossei
actions
- dorsal interossei ABduct the toes, and flex MP joints
- plantar interossei ADduct the toes, and flex MP joints
Remember: PAD and DAB
(MP = metatarsophalangeal)
cc: anterior tibial compartment syndrome
define, cause
- ischemic necrosis of the muscles of the anterior compartment of the leg
- caused by compression of the anterior tibial artery and its branches by swollen muscles following excessive exertion
- accompanied by extreme tenderness and pain on anterolateral aspect of the leg
genu valgum
name, define, causes
- “KNOCK-KNEE”
- condition in which the tibia is BENT or TWISTED LATERALLY, and the knees are abnormally close together
- cause:
- normal in early childhood
- can occur w/ damage to medial collateral ligament in adults
genu varum:
name, define, cause
- “BOW-LEGGED”
- condition in which tibia is bent MEDIALLY
- cause: resulting from collapse of LATERAL collateral ligament
shin splint:
define, cause, types
- painful condition caused by swollen muscles in the ANTERIOR COMPARTMENT of the leg, along the shin bone (tibia), particularly the tibialis anterior muscle
- caused by athletic overexertion
- can be mild form of anterior compartment syndrome
MUSCLE CRAMP:
define, causes, location
- sudden, involuntary, painful contractoin of the muscles
- caused by:
- muscle fatigue from prolonged sitting,
- overexertion,
- dehydration, or
- depletion or imbalance of salt and minerals (electrolytes) as well as
- poor blood supply to leg muscles
- common in calf muscle, hamstrings, quadriceps
patellar (knee-jerk) reflex:
action, & which vertebra does it test
- patellar ligament is tapped –> sudden contraction of the quadriceps femoris
- tests L2-L4 (femoral nerve): its afferent and efferent impusles are transmitted in femoral nerve
ankle-jerk (achilles) reflex:
define, tests
- reflex twitch of the triceps surae (i.e. the medial and lateral heads of the gastrocnemius and the soleus muscles)
- induced by tapping the tendo-calcaneus –> plantarflexion of foot
- TIBIAL NERVE (afferent and efferent limbs are carried in tibial nerve)
effect of damage to obturator nerve
causes weakness of adduction & lateral swinging of the limb during walking bc of the unopposed abductors
effects of damage to femoral nerve
causes impaired flexion of the hip and impaired extension of the leg, resulting from paralysis of the quadriceps femoris
effects of damage to superior gluteal nerve
causes characteristic motor loss,
- resulting in weakened abduction of the thigh by the gluteus medius
- disabling gluteus medius limb
- gluteal gait
effects of damage to sciatic nerve
- causes impaired extension at the hip,
- impaired flexion at the knee,
- loss of dorsiflexion (foot drop) and plantarflexion at the ankle
- loss of inversion and eversion of the foot
- high-stepping gait (inc flexion at hip to lift the dropped foot off the ground)
phantom limb pain:
define
intermittent or continuous pain perceived as originating in an absent (amputated) limb
cause and effects of damage to
common peroneal (fibular) nerve
- can result from fx of the head or neck of fibula
- nerve damage –>
- foot drop (loss of dorsiflexion),
- loss of foot eversion, and
- loss of sensation on the dorsum of the foot and lateral aspect of the leg
effect of damage to superficial peroneal (fibular) nerve VERSUS deep peroneal
- superficial fibular –> results in loss of foot eversion
- deep fibular –> results in FOOT DROP (loss of foot dorsiflexion)
effects of damage to tibial nerve
- causes loss of plantarflexion of the foot
- impaired inversion resulting from paralysis of the tibialis posterior
- loss of sensation on the dorsum of the foot and lateral aspect of the leg
tarsal tunnel syndrome
define, causes
- pain, numbness, tingling sensations on the ankle, heel, adn sole of the foot
- results from compression of the tibial nerve or its medial and lateral plantar branches in the tarsal tunnel
- caused by repetitive stress, flat feet, or excess weight
greater saphenous vein:
purpose, location
- drains venous blood from the dorsal venous arch
- ascends along the MEDIAL side of the lower limb, passes through saphenous opening (fossa ovalis) in the fascia lata, and joins femoral vein
small saphenous vein:
purpose and location
- drains blood from the lateral dorsal venous arch
- ascends lateral leg, and enters into popliteal vein
thrombophlebitis:
define
venous inflammation w/ thrombus formation, esp in deep veins of the lower limb –>
can lead to pulmonary embolism
varicose veins:
define
develop in the superficial veins of the lower limb bc of REDUCED ELASTICITY and incompetent valves in the femoral head
describe major blood supply to femoral head
- from the medial and lateral femoral circumflex arteries
- acetabular branch of the posterior obturator artery (which runs in the round ligament of the femoral head)
femoral artery:
path, key feature
- reaches the popliteal fossa, passing thru adductor hiatus (aperture in the insertion tendon of the adductor magnus) to become the popliteal artery
- easily exposed and cannulated at base of femoral triangle
popliteal artery
branching
gives rise to ANTERIOR and POSTERIOR TIBIAL ARTERIES, and the posterior tibial artery provides a fibular branch
blood supply to the SOLE OF THE FOOT
- medial and lateral plantar arteries <– derived from the POSTERIOR TIBIAL ARTERY
medial femoral circumflex artery
clinical significance
- its branches supply most of the blood to the NECK AND HEAD OF THE FEMUR,
- (*except for the small proximal part of femur that receives blood from a branch of the obturator nerve)
cruciate anastomosis of the buttock:
define, function
- includes:
- a branch of the first perforating artery
- the inferior gluteal artery
- transverse branches of the medial and lateral femoral circumflex arteries
- fxn: allows blood to bypass an obstruction of the external iliac or femoral artery
popliteal aneurysm:
define, clinical correlate
- usually results in edema and pain in the popliteal fossa
- if the femoral artery must be ligated for surfical repair, blood can bypass an occlusion through the genicular anastomoses and reach the popliteal artery distal to the ligation
femoral artery pulse:
where?
felt at midpoint along the inguinal ligament
popliteal artery pulse:
where?
sometimes felt in the depths of the popliteal fossa
posterior tibial artery pulse
where?
can be felt behind the medial malleolus and b/w the flexor digitorum longus and flexor hallucis longus (FDL and FHL) tendons
dorsalis pedis artery pulse:
where?
can be felt b/w the extensor hallucis longus and extensor digitorum longus tendons midway b.w the medial and lateral malleoli of the ankle
superficial lymph vessels:
division
- medial group –> follows the greater saphenous vein to drain into the superficial inguinal nodes
- lateral group –> follows the small saphenous vein to the popliteal nodes
deep lymph vessels:
course
follow vasculature in the muscle compartments;
- leg drains via anterior tibial, posterior tibial, and peroneal vessels –> popliteal nodes
- thigh drains to deep inguinal nodes
what is the weight-bearing bone of the leg?
what is most common fracture of the long bones?
- TIBIA;
- whereas the fibula is largely a bone for muscle attachment
- MC Fx is FRACTURE OF THE TIBIAL SHAFT
most important tarsal bone(s)?
- calcaneus (heel bone)
- talus (articulates w/ the leg bones at the ankle joint)
which tarsal bone is MOST COMMONLY FRACTURED?
calcaneus
weight of body is transferred to foot through which bone?
TALUS
(ankle bone)
fracture of femoral head
cause, presentation, tx
- cause: posterior hip dislocation in advanced age (osteoporosis)
- presents: as shortened lower limb w/ medial rotation
- tx: hip replacement
fracture of femoral NECK:
causes what, presentation
- can result in ischemic necrosis of neck and head
- presents w/ affected lower limb being shortened w/ LATERAL ROTATION
pertrochanteric fracture
define
femoral fracture through the trochanters and is a form of extracapsular hip fracture –> producing shortening and lateral rotation of the leg
what can result from a dislocated knee or fractured distal femur?
can injure the popliteal artery because of its deep position adjacent to the femur and the knee joint capsule
pott fracture
(dupuytren fracture)
define, cause
- fx of the lower end of the fibula, often accompanied by the fx of the MEDIAL MALLEOLUS or rupture of the deltoid ligament
- caused by FORCED EVERSION of the foot
pillion fracture
define, cause
- T-shaped fracture of the DISTAL FEMUR w/ displacement of the of the condyles
- may be caused by a blow to the flexed knee of a person riding pillion on a motorcycle
fracture of fibular neck:
can damage what other structure
injury to the COMMON PERONEAL NERVE, as it winds laterally around the neck of the fibula
what is paralyzed with fracture to the fibular neck?
- common peroneal nerve –>
- paralysis of all muscles in anterior and lateral compartments of the leg
- (dorsiflexors and evertors of the foot)
- FOOT DROP
talar neck fracture:
sequelae
causes AVASCULAR NECROSIS of the body of the talus, because most of the blood supply to the talus passes through the talar neck
march fracture
define, cause, patient population
- (stress fracture) fatigue fracture of one of the metatarsals
- may result from prolonged walking
- common in female ballet dancers when the dancers lose balance and put full body weight on metatarsals
unhappy (o’donohue) triad
define
injury to:
- anterior cruciate ligament (ACL)
- tibial collateral ligament (MCL)
- medial mensicus
which is more commonly seen in athletes?
(medial or lateral meniscus tear)
lateral meniscus injuries are more common seen in athletes
anterior drawer sign
purpose
- forward sliding of the TIBIA on the FEMUR
- indicates rupture of the anterior cruciate ligament (ACL)
posterior drawer sign
purpose
- backward sliding of the tibia on the femur
- caused by rupture of posterior cruciate ligament (PCL)
(T/F) posterior cruciate ligament is injured more often than ACL
FALSE;
anterior cruciate ligament (ACL) is more commonly injured than PCL
prepatellar bursitis
(other name, define)
- “HOUSEMAID KNEE”
- inflammation and swelling of the prepatellar bursa
What occurs when the achilles tendon ruptures?
- avulsion or rupture of achilles tendon –>
- disables triceps surae (gastrocnemius and soleus) muscles
- patient is unable to plantarflex the foot
forced eversion foot injures what structures?
- avulses the medial malleolus, or
- ruptures the deltoid ligament
forced inversion foot injures what structures?
- avulses the lateral malleolus
- tears the lateral collateral ligament
- (anterior and posterior talofibular and calcaneofibular)
ankle sprain:
define, which side is more commonly injured?
- stretching (or tearing) of the ankle ligaments
- WEAKER LATERAL LIGAMENT is sprained more often
flat foot
(name, cause)
- PES PLANUS, or TALIPES PLANUS
- results from collapse of the medial longitudinal arch w/ eversion & abduction of the forefoot –>
- causing greater wear on the INNER BORDER of the soles and heels of the hsoes
pes cavus
define
- abnormally high medial longitudinal arch
club foot:
name, define
- TALIPES EQUINOVARUS
- condition in which the foot is plantar-flexed, inverted, and ADDucted
- heel is elevated and turned medially
bunion:
define, cause
- swelling at the medial side of the 1st metatarsal head
- caused by inflamed bursa or a bony projection and is unusually associated w/ hallux valgus
hallux valgus
define
deviation of the big toe TOWARDS the LATERAL side of the foot
hallux varus
define
deviation of the big toe TOWARD the MEDIAL side of the foot
claudication
define, location
- (intermittent) is limping caused by ischemia of the muscles
- chiefly in the calf muscles
gout
define, MC location
- joint inflammation from deposition of urate in a synovial cavity, resulting from abnormalities of purine metabolism
- MC location is metatarsophalangeal joint of the great toe
foot drop
define, cause
- weakened dorsiflexion
- due to lesion of the common or deep peroneal (Fibular) nerve
limb rotation in utero
movement and final orientation
- lower limb rotates in utero MEDIALLY BY 90 DEGREES
- upper limb rotates in utero LATERALLY by 90 degrees –>
Thus, the limbs are 180 degrees OUT OF PHASE with one another –> knee anterior and big toe is medial, versus elbow posterior and thumb lateral
