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BRS - LEA Highlights Flashcards

1
Q

what is the pelvic girdle?

A

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

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2
Q

what is the strongest ligament of the hip joint?

A

iliofemoral ligament (forms an inverted Y shape);

limits hyperextension

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3
Q

what are the boundaries of the femoral triangle?

A
  • bounds: inguinal ligament, sartorius, adductor longus
  • floor: iliopsoas, pectineus, and adductor longus
  • roof: fascia lata, cribriform fascia
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4
Q

what are the contents of the femoral triangle?

A
  • from lateral to medial
    • femoral nerve
    • femoral sheath, containing (femoral artery, vein, and deep lymphatics)
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5
Q

what are the bounds of the popliteal fossa?

A

bounds:

  • semimembranosus,
  • semitendinosus,
  • biceps femoris,
  • medial and lateral heads of the gastrocnemius,
  • plantaris
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6
Q

what are the contents of the popliteal fossa?

A
  • popliteal vessles
  • common peroneal and tibial nerves
  • small saphenous vein
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7
Q

what is the pes anserinus?

A
  • “goose foot”
  • combined tendinous expansions of the sartorious, gracilis, and semitendinosus;
    • attaches these muscles to the medial tibial condyle
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8
Q

what is the clinical use of the SEMITENDINOSUS tendon?

A

semitendinosus tendon may be used for surgical reconstruction of the ANTERIOR CRUCIATE LIGAMENT

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9
Q

anterior cruciate ligament:

function

A
  • 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
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10
Q

posterior cruciate ligament:

function

A
  • 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
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11
Q

what graft can be used for surgical repair of the anterior cruciate ligament?

A

patellar ligament

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12
Q

what may be used for autografts of the long flexors of the fingers?

A

plantaris tendon

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13
Q

medial (deltoid) ligament:

function

A

prevents OVEREVERSION of the foot

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14
Q

lateral ligament of the ankle:

composition and function

A
  • (anterior and posterior talofibular and calcaneofibular ligaments)
  • resists INVERSIONof the foot
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15
Q

the long and short plantar (plantar calcaneocuboid) ligaments support what?

A

supports the LATERAL side of the longitudinal arch of the foot

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16
Q

spring ligament

(other name and function)

A
  • plantar calcaneonavicular (plantar CN ligament)
  • supports the head of the talus and the medial longitudinal arch
  • **the ligament is fairly elastic, hence its name
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17
Q

describe and explain the gluteal gait

A
  • 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
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18
Q

common site for intramuscular injection of medications.

why?

A

superior lateral quadrant of the gluteal region;

to avoid injury to the underlying sciatic nerve and other neurovascular structures

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19
Q

piriformis syndrome:

define

A
  • 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)
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20
Q

sciatica:

define

A

pain in the lower back, buttocks, and referred pain along the course of the sciatic nerve caused by piriformis syndrome

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21
Q

positive trendelenberg sign

(cause and presentation)

A
  • 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)
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22
Q

hamstring injuries

A
  • pulled or torn hamstrings;
  • very painful and common in persons involved in running, jumping, and quick-start sports
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23
Q

what causes avulsion of the ischial tuberosity?

(the origin of the hamstrings)

A

forcible flexion of the hip with the KNEE EXTENDED can cause avulsion of hamstring origin

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24
Q

femoral hernia:

define and sequelae

A
  • 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
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25
Q

groin injury:

define and mechanism

A
  • 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),
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26
Q

which patients commonly strain their adductor longus?

A

may occur in horseback riders and produce pain bc the riders ADDUCT their thighs to keep from falling off the horse

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27
Q

what is the strongest extensor of the thigh at the hip?

A
  • gluteus MAXIMUS is strongest extensor of thigh at the hip
  • esp important when walking uphill, climbing stairs, rising from sitting position
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28
Q

iliopsoas muscle:

function, attachment

A
  • fxn: powerful flexor of the thigh
  • attaches at lesser trochanter
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29
Q

which muscle(s) can (1) flex the thigh at the hip joint, and

(2) extend the leg at the knee?

A
  • tensor fascia lata
  • rectus femoris
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30
Q

hamstring:

muscles and group fxn

A
  • muscles:
    • semitendinosus
    • semimembranosus
    • long head of biceps femoris
  • fxn: extend the thigh at the hip, and flex leg at the knee
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31
Q

dorsal versus plantar interossei

actions

A
  • dorsal interossei ABduct the toes, and flex MP joints
  • plantar interossei ADduct the toes, and flex MP joints

Remember: PAD and DAB

(MP = metatarsophalangeal)

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32
Q

cc: anterior tibial compartment syndrome

define, cause

A
  • 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
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33
Q

genu valgum

name, define, causes

A
  • “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
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34
Q

genu varum:

name, define, cause

A
  • “BOW-LEGGED”
  • condition in which tibia is bent MEDIALLY
  • cause: resulting from collapse of LATERAL collateral ligament
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35
Q

shin splint:

define, cause, types

A
  • 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
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36
Q

MUSCLE CRAMP:

define, causes, location

A
  • 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
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37
Q

patellar (knee-jerk) reflex:

action, & which vertebra does it test

A
  • 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
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38
Q

ankle-jerk (achilles) reflex:

define, tests

A
  • 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)
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39
Q

effect of damage to obturator nerve

A

causes weakness of adduction & lateral swinging of the limb during walking bc of the unopposed abductors

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40
Q

effects of damage to femoral nerve

A

causes impaired flexion of the hip and impaired extension of the leg, resulting from paralysis of the quadriceps femoris

41
Q

effects of damage to superior gluteal nerve

A

causes characteristic motor loss,

  • resulting in weakened abduction of the thigh by the gluteus medius
  • disabling gluteus medius limb
  • gluteal gait
42
Q

effects of damage to sciatic nerve

A
  • 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)
43
Q

phantom limb pain:

define

A

intermittent or continuous pain perceived as originating in an absent (amputated) limb

44
Q

cause and effects of damage to

common peroneal (fibular) nerve

A
  • 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
45
Q

effect of damage to superficial peroneal (fibular) nerve VERSUS deep peroneal

A
  • superficial fibular –> results in loss of foot eversion
  • deep fibular –> results in FOOT DROP (loss of foot dorsiflexion)
46
Q

effects of damage to tibial nerve

A
  • 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
47
Q

tarsal tunnel syndrome

define, causes

A
  • 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
48
Q

greater saphenous vein:

purpose, location

A
  • 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
49
Q

small saphenous vein:

purpose and location

A
  • drains blood from the lateral dorsal venous arch
  • ascends lateral leg, and enters into popliteal vein
50
Q

thrombophlebitis:

define

A

venous inflammation w/ thrombus formation, esp in deep veins of the lower limb –>

can lead to pulmonary embolism

51
Q

varicose veins:

define

A

develop in the superficial veins of the lower limb bc of REDUCED ELASTICITY and incompetent valves in the femoral head

52
Q

describe major blood supply to femoral head

A
  • 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)
53
Q

femoral artery:

path, key feature

A
  • 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
54
Q

popliteal artery

branching

A

gives rise to ANTERIOR and POSTERIOR TIBIAL ARTERIES, and the posterior tibial artery provides a fibular branch

55
Q

blood supply to the SOLE OF THE FOOT

A
  • medial and lateral plantar arteries
56
Q

medial femoral circumflex artery

clinical significance

A
  • 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)
57
Q

cruciate anastomosis of the buttock:

define, function

A
  • 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
58
Q

popliteal aneurysm:

define, clinical correlate

A
  • 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
59
Q

femoral artery pulse:

where?

A

felt at midpoint along the inguinal ligament

60
Q

popliteal artery pulse:

where?

A

sometimes felt in the depths of the popliteal fossa

61
Q

posterior tibial artery pulse

where?

A

can be felt behind the medial malleolus and b/w the flexor digitorum longus and flexor hallucis longus (FDL and FHL) tendons

62
Q

dorsalis pedis artery pulse:

where?

A

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

63
Q

superficial lymph vessels:

division

A
  • 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
64
Q

deep lymph vessels:

course

A

follow vasculature in the muscle compartments;

  • leg drains via anterior tibial, posterior tibial, and peroneal vessels –> popliteal nodes
  • thigh drains to deep inguinal nodes
65
Q

what is the weight-bearing bone of the leg?

what is most common fracture of the long bones?

A
  • TIBIA;
    • whereas the fibula is largely a bone for muscle attachment
  • MC Fx is FRACTURE OF THE TIBIAL SHAFT
66
Q

most important tarsal bone(s)?

A
  • calcaneus (heel bone)
  • talus (articulates w/ the leg bones at the ankle joint)
67
Q

which tarsal bone is MOST COMMONLY FRACTURED?

A

calcaneus

68
Q

weight of body is transferred to foot through which bone?

A

TALUS

(ankle bone)

69
Q

fracture of femoral head

cause, presentation, tx

A
  • cause: posterior hip dislocation in advanced age (osteoporosis)
  • presents: as shortened lower limb w/ medial rotation
  • tx: hip replacement
70
Q

fracture of femoral NECK:

causes what, presentation

A
  • can result in ischemic necrosis of neck and head
  • presents w/ affected lower limb being shortened w/ LATERAL ROTATION
71
Q

pertrochanteric fracture

define

A

femoral fracture through the trochanters and is a form of extracapsular hip fracture –> producing shortening and lateral rotation of the leg

72
Q

what can result from a dislocated knee or fractured distal femur?

A

can injure the popliteal artery because of its deep position adjacent to the femur and the knee joint capsule

73
Q

pott fracture

(dupuytren fracture)

define, cause

A
  • 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
74
Q

pillion fracture

define, cause

A
  • 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
75
Q

fracture of fibular neck:

can damage what other structure

A

injury to the COMMON PERONEAL NERVE, as it winds laterally around the neck of the fibula

76
Q

what is paralyzed with fracture to the fibular neck?

A
  • common peroneal nerve –>
    • paralysis of all muscles in anterior and lateral compartments of the leg
    • (dorsiflexors and evertors of the foot)
    • FOOT DROP
77
Q

talar neck fracture:

sequelae

A

causes AVASCULAR NECROSIS of the body of the talus, because most of the blood supply to the talus passes through the talar neck

78
Q

march fracture

define, cause, patient population

A
  • (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
79
Q

unhappy (o’donohue) triad

define

A

injury to:

  1. anterior cruciate ligament (ACL)
  2. tibial collateral ligament (MCL)
  3. medial mensicus
80
Q

which is more commonly seen in athletes?

(medial or lateral meniscus tear)

A

lateral meniscus injuries are more common seen in athletes

81
Q

anterior drawer sign

purpose

A
  • forward sliding of the TIBIA on the FEMUR
  • indicates rupture of the anterior cruciate ligament (ACL)
82
Q

posterior drawer sign

purpose

A
  • backward sliding of the tibia on the femur
  • caused by rupture of posterior cruciate ligament (PCL)
83
Q

(T/F) posterior cruciate ligament is injured more often than ACL

A

FALSE;

anterior cruciate ligament (ACL) is more commonly injured than PCL

84
Q

prepatellar bursitis

(other name, define)

A
  • “HOUSEMAID KNEE”
  • inflammation and swelling of the prepatellar bursa
85
Q

What occurs when the achilles tendon ruptures?

A
  • avulsion or rupture of achilles tendon –>
  • disables triceps surae (gastrocnemius and soleus) muscles
  • patient is unable to plantarflex the foot
86
Q

forced eversion foot injures what structures?

A
  • avulses the medial malleolus, or
  • ruptures the deltoid ligament
87
Q

forced inversion foot injures what structures?

A
  • avulses the lateral malleolus
  • tears the lateral collateral ligament
    • (anterior and posterior talofibular and calcaneofibular)
88
Q

ankle sprain:

define, which side is more commonly injured?

A
  • stretching (or tearing) of the ankle ligaments
  • WEAKER LATERAL LIGAMENT is sprained more often
89
Q

flat foot

(name, cause)

A
  • 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
90
Q

pes cavus

define

A
  • abnormally high medial longitudinal arch
91
Q

club foot:

name, define

A
  • TALIPES EQUINOVARUS
  • condition in which the foot is plantar-flexed, inverted, and ADDucted
    • heel is elevated and turned medially
92
Q

bunion:

define, cause

A
  • 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
93
Q

hallux valgus

define

A

deviation of the big toe TOWARDS the LATERAL side of the foot

94
Q

hallux varus

define

A

deviation of the big toe TOWARD the MEDIAL side of the foot

95
Q

claudication

define, location

A
  • (intermittent) is limping caused by ischemia of the muscles
  • chiefly in the calf muscles
96
Q

gout

define, MC location

A
  • 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
97
Q

foot drop

define, cause

A
  • weakened dorsiflexion
  • due to lesion of the common or deep peroneal (Fibular) nerve
98
Q

limb rotation in utero

movement and final orientation

A
  • 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

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