Ch 4 - MSK: Lower Leg Flashcards
What are the muscles and innervation for ankle dorsiflexion and foot inversion?
– Tibialis anterior
– Extensor hallucis longus (great toe extensor)
What are the muscles and innervation for ankle dorsiflexion and foot eversion?
– Extensor digitorum longus (toe extensor)
– Peroneus tertius
What are the muscles and innervation for foot eversion and weak plantar flexion?
- Peroneus brevis
* Peroneus longus
What are the muscles and innervation for plantar flexion?
- Gastrocnemius
- Plantaris
- Soleus
What are the muscles and innervation for plantar flexion and foot inversion?
- Flexor digitorum longus
* Tibialis posterior
What are the muscles and innervation for toe flexion?
- Flexor digitorum longus
* Flexor hallucis longus
What are the muscles and innervation for internal rotation of the tibia on the femur?
Popliteus
What compromises the anterior compartment of the leg?
Tibialis anterior Extensor digitorum longus Extensor hallucis longus Peroneus tertius muscles Anterior tibial a/v Common peroneal n
What compromises the lateral compartment of the leg?
Peroneus longus and brevis
Superficial peroneal n
Common peroneal n dividing into superficial and deep branches
What compromises the deep posterior compartment of the leg?
Flexor digitorum longus Flexor hallucis longus Tibialis posterior Popliteus Posterior tibial a/v Tibial n
What compromises the superficial posterior compartment of the leg?
Gastrocnemius
Soleus
Plantaris
What is chronic exertional compartment syndrome (CECS)?
Chronically raised intracompartmental pressure during and after exercise
What can result from exertional compartment syndrome (CECS)?
Nerve impingement
Tissue ischemia
What is pain due to in exertional compartment syndrome (CECS)?
– Sensory receptor stimulation in fascia or periosteum
– Release of biochemical factors caused by reduced blood flow
– Tibial stress fractures or periostitis
What is the clinical presentation of exertional compartment syndrome (CECS)?
Pain inc with exercise and diminish after the activity is stopped
What can anterior exertional compartment syndrome (CECS) cause?
Dorsiflexor weakness and numbness over 1st web space of the dorsum of the foot (deep peroneal n)
What can lateral exertional compartment syndrome (CECS) cause?
Dorsiflexor weakness and 1st web space numbness (deep peroneal n) or foot evertor weakness
What can deep posterior exertional compartment syndrome (CECS) cause?
Cramping of the foot intrinsics and numbness of the medial arch of the foot (tibial n)
What indicates a (+) manometric technique for exertional compartment syndrome (CECS)?
Delay in return to preexercise pressure levels of 6 to 30 min with reproduction of pain syndrome
What is the treatment for exertional compartment syndrome (CECS)?
Fasciotomy
What is acute compartment syndrome?
Intracompartmental tissue pressure acutely inc and produces a secondary elevation in venous pressure that obstructs venous outflow
Why is acute compartment syndrome a surgical emergency?
Necrosis of muscle and nerve tissue can develop in 4-8 hr
What are the most common locations for acute compartment syndrome?
Volar aspect of the forearm and the anterior compartment of the leg
What is Volkmann’s ischemic necrosis?
Untreated ACS l/t tissue necrosis with secondary muscle paralysis, muscle contractures, and sensory impairment
What is the clinical presentation of acute compartment syndrome?
Pain, paresthesias, and paralysis (3 Ps)
What is the most important exam finding in acute compartment syndrome?
Extreme pain on stretching the long muscles passing through a compartment
What manometric pressure indicates acute compartment syndrome?
Diastolic pressure minus the intracompartmental pressure is <20 mmHg
What is the treatment of acute compartment syndrome?
Surgical fasciotomy with delayed closure or skin grafting after the edema subsides
What is medial tibial stress syndrome (MTSS)?
Overuse injury from chronic traction on the periosteum at the periosteal–fascial junction
What is the most likely site of avulsion in medial tibial stress syndrome (MTSS)?
Attachment of the soleus muscle along the medial tibia
What is the main predisposing factor to medial tibial stress syndrome (MTSS)?
Hyperpronation
What is the clinical presentation of medial tibial stress syndrome (MTSS)?
- 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
What are classic histories of medial tibial stress syndrome (MTSS)?
- Repetitive running on hard surfaces
- Inappropriate warm-up/footwear
- Recent change in footwear
- Excessive use of the foot flexors, as in jumping
What is seen on imaging in medial tibial stress syndrome (MTSS)?
- Plain films: normal
- Bone scan: uptake along the medial tibial border in the 3rd phase
- MRI: r/o stress fx
What is the treatment of medial tibial stress syndrome (MTSS)?
- 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
What is the most common stress fracture in running sports?
Tibial
What are causes of low bone mineral density (BMD)?
– Late onset of menses
– <75% ideal body weight
– Poor nutrition correlates with lower Ca intake
– Tobacco and alcohol use
What is seen on x-rays in stress fracture?
~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
When should bone scans be used for stress fractures?
When x-ray normal and stress fx highly suspected
What is the first choice of imaging for stress fracture?
MRI
What is the treatment for stress fracture?
- 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
What nutritional supplementation is used for treatment of stress fracture?
Calcium intake 1,500 mg daily with 400 to 800 IU of vitamin D
