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Cuccurullo Book > Ch 4 - MSK: Lower Leg > Flashcards

Ch 4 - MSK: Lower Leg Flashcards

1
Q

What are the muscles and innervation for ankle dorsiflexion and foot inversion?

A

– Tibialis anterior

– Extensor hallucis longus (great toe extensor)

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2
Q

What are the muscles and innervation for ankle dorsiflexion and foot eversion?

A

– Extensor digitorum longus (toe extensor)

– Peroneus tertius

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3
Q

What are the muscles and innervation for foot eversion and weak plantar flexion?

A
  • Peroneus brevis

* Peroneus longus

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4
Q

What are the muscles and innervation for plantar flexion?

A
  • Gastrocnemius
  • Plantaris
  • Soleus
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5
Q

What are the muscles and innervation for plantar flexion and foot inversion?

A
  • Flexor digitorum longus

* Tibialis posterior

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6
Q

What are the muscles and innervation for toe flexion?

A
  • Flexor digitorum longus

* Flexor hallucis longus

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7
Q

What are the muscles and innervation for internal rotation of the tibia on the femur?

A

Popliteus

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8
Q

What compromises the anterior compartment of the leg?

A 
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius muscles
Anterior tibial a/v
Common peroneal n
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9
Q

What compromises the lateral compartment of the leg?

A

Peroneus longus and brevis
Superficial peroneal n
Common peroneal n dividing into superficial and deep branches

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10
Q

What compromises the deep posterior compartment of the leg?

A 
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior
Popliteus
Posterior tibial a/v
Tibial n
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11
Q

What compromises the superficial posterior compartment of the leg?

A

Gastrocnemius
Soleus
Plantaris

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12
Q

What is chronic exertional compartment syndrome (CECS)?

A

Chronically raised intracompartmental pressure during and after exercise

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13
Q

What can result from exertional compartment syndrome (CECS)?

A

Nerve impingement

Tissue ischemia

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14
Q

What is pain due to in exertional compartment syndrome (CECS)?

A

– Sensory receptor stimulation in fascia or periosteum
– Release of biochemical factors caused by reduced blood flow
– Tibial stress fractures or periostitis

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15
Q

What is the clinical presentation of exertional compartment syndrome (CECS)?

A

Pain inc with exercise and diminish after the activity is stopped

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16
Q

What can anterior exertional compartment syndrome (CECS) cause?

A

Dorsiflexor weakness and numbness over 1st web space of the dorsum of the foot (deep peroneal n)

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17
Q

What can lateral exertional compartment syndrome (CECS) cause?

A

Dorsiflexor weakness and 1st web space numbness (deep peroneal n) or foot evertor weakness

18
Q

What can deep posterior exertional compartment syndrome (CECS) cause?

A

Cramping of the foot intrinsics and numbness of the medial arch of the foot (tibial n)

19
Q

What indicates a (+) manometric technique for exertional compartment syndrome (CECS)?

A

Delay in return to preexercise pressure levels of 6 to 30 min with reproduction of pain syndrome

20
Q

What is the treatment for exertional compartment syndrome (CECS)?

A

Fasciotomy

21
Q

What is acute compartment syndrome?

A

Intracompartmental tissue pressure acutely inc and produces a secondary elevation in venous pressure that obstructs venous outflow

22
Q

Why is acute compartment syndrome a surgical emergency?

A

Necrosis of muscle and nerve tissue can develop in 4-8 hr

23
Q

What are the most common locations for acute compartment syndrome?

A

Volar aspect of the forearm and the anterior compartment of the leg

24
Q

What is Volkmann’s ischemic necrosis?

A

Untreated ACS l/t tissue necrosis with secondary muscle paralysis, muscle contractures, and sensory impairment

25
Q

What is the clinical presentation of acute compartment syndrome?

A

Pain, paresthesias, and paralysis (3 Ps)

26
Q

What is the most important exam finding in acute compartment syndrome?

A

Extreme pain on stretching the long muscles passing through a compartment

27
Q

What manometric pressure indicates acute compartment syndrome?

A

Diastolic pressure minus the intracompartmental pressure is <20 mmHg

28
Q

What is the treatment of acute compartment syndrome?

A

Surgical fasciotomy with delayed closure or skin grafting after the edema subsides

29
Q

What is medial tibial stress syndrome (MTSS)?

A

Overuse injury from chronic traction on the periosteum at the periosteal–fascial junction

30
Q

What is the most likely site of avulsion in medial tibial stress syndrome (MTSS)?

A

Attachment of the soleus muscle along the medial tibia

31
Q

What is the main predisposing factor to medial tibial stress syndrome (MTSS)?

A

Hyperpronation

32
Q

What is the clinical presentation of medial tibial stress syndrome (MTSS)?

A
  • Gradual onset of pain along the posteromedial border of the tibia
  • Pain may improve with exercise but worsens after the completion of the activity and can last until the next morning
33
Q

What are classic histories of medial tibial stress syndrome (MTSS)?

A
  • Repetitive running on hard surfaces
  • Inappropriate warm-up/footwear
  • Recent change in footwear
  • Excessive use of the foot flexors, as in jumping
34
Q

What is seen on imaging in medial tibial stress syndrome (MTSS)?

A
  • Plain films: normal
  • Bone scan: uptake along the medial tibial border in the 3rd phase
  • MRI: r/o stress fx
35
Q

What is the treatment of medial tibial stress syndrome (MTSS)?

A
  • Rest/relative rest or avoidance of the activity
  • Crutch walking if pain at rest or w/ normal walking
  • RTP gradual when pain free
  • Training start at 50% of preinjury level for intensity and distance
  • Soft, level surfaces should be used initially
  • Orthotics for over-pronation or forefoot varus
36
Q

What is the most common stress fracture in running sports?

A

Tibial

37
Q

What are causes of low bone mineral density (BMD)?

A

– Late onset of menses
– <75% ideal body weight
– Poor nutrition correlates with lower Ca intake
– Tobacco and alcohol use

38
Q

What is seen on x-rays in stress fracture?

A

~2-3 wks after sx develop
– Periosteal thickening 1st, then cortical lucency
– Linear stress fx: lucency within a thickened area of cortical hyperostosis during healing

39
Q

When should bone scans be used for stress fractures?

A

When x-ray normal and stress fx highly suspected

40
Q

What is the first choice of imaging for stress fracture?

A

MRI

41
Q

What is the treatment for stress fracture?

A
  • NWB 7-10 days if pain with walking
  • Avoid aggravating the injury
  • Cycling and swimming for cardiac fitness
  • ~1-2 wks pain-free normal walking before returning to impact activity
  • Impact activity started at low intensity for short periods (10–15 min) and inc as tolerated
42
Q

What nutritional supplementation is used for treatment of stress fracture?

A

Calcium intake 1,500 mg daily with 400 to 800 IU of vitamin D

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