Clinical Correlates: Exam 1 Flashcards
Saphenous cutdown
Use the saphenous vein to insert a catheter near the medial malleolus of the foot
Varicose veins
When valves of saphenous and perforating veins fail to function correctly, retrograde flow into superficial veins
Femoral hernia
When the intestines push through a weakness in the femoral canal, resulting in a direct inguinal hernia
Trendelenburg test
Injury to superior gluteal nerve - Gluteus medius/minimus work to pull hip down on supported side to lift leg off the ground. An abnormal case will not be able to pull hip up and leg will be dragging on unsupported side. Treat by giving a cane on the unaffected side.
Piriformis syndrome
compression of sciatic nerve by the piriformis, pain extends along the sciatic nerve and is worse when sitting (aka fat wallet syndrome)
Lumbar lordosis
hamstrings usually pull down on pelvis, tilting it superiorly to prevent it from falling forward, weak hamstrings allow hip flexors to pull pelvis anteriorly (tight hamstrings can cause flatback)
Hamstring pull
avulsion of hamstring tendon from ischial tuberosity
Iliotibial tract syndrome
inflammation of the IT tract causing pain on the lateral knee (from rubbing against lateral chondyle during flexion and extension)
also from excessive pronation that increases internal rotation of tibia, increasing friction
Gluteal injections
Inject in area between ASIS and ilial crest to avoid hitting sciatic nerve (upper lateral quadrant)
Sciatica
Lower back pain, with pain radiating down the leg and to the foot, from herniated disc, spinal stenosis, piriformis syndrome or hematoma
Popliteal artery aneurysm
pain behind the knee, edema in lower leg and foot, foot pain, can cause embolism and occlusion
Popliteal (Baker’s) cyst
herniation of synovial membrane of knee joint or distension of gastroc or semimembranosus bursae into popliteal fossa
Compartment syndrome
Increased pressure in a compartment - causes pain, paresthesia, pallor, paralysis and pulselessness, treated by releasing the pressure quickly (fasciotomy)
Achilles tendon rupture
Happens during dorsiflexion and extension of leg
Calcaneal tendon reflex
If absent, injury to S1 or S2, also have decreased sensation and weak plantarflexion of foor
Shin splints
microfractures in the tibia from extensor muscles of the anterior compartment
Stress fracture of the tibia
overuse causes injuries on bone, load exceeds ability to repair bone
Drop foot
damage to the deep peroneal nerve, results in inability to dorsiflex foot, loss of sensation in first web space, patients walk with high steppage gait
Pes planus
flat foot, from posterior tibial tendon dysfunction of spring ligament laxity - overpronation (eversion) and abduction of feet
High ankle sprain
sprain of the ligaments that join the tibia and fibula (anterior and posterior tibiofibular ligaments)
Low ankle sprain
tearing of deltoid ligaments on medial side of ankle (occurs when foot is inverted and plantar flexed) - more here
trimalleolar fracture
foot is everted and strong medial (deltoid) ligament breaks the medial malleolus - talus breaks free and breaks lateral malleolus - tibia breaks free and breaks at posterior distal end
plantar fasciitis
results from shorted Achilles or hypermobile forefoot, pain at the insertion of the plantar fascia into the calcaneous with or without bony formation
bunion (hallux valgus)
swollen bursal sac or bony anomaly of the metatarsophalangeal joint, cause by flat feet, excessive flexibility of ligaments, abnormal bone structure
Hip dislocation
femoral tears into the gluteal region, between iliofemoral and ischiofemoral ligaments, causing damage to sciatic nerve
Developmental dysplasia of the hip
malformed socket, common in first born females (decrease amnionic fluid), requires hip replacement
Coxa Vara/Valga
Vara = low angle of femoral neck to the acetabulum - shortening of limb and limp Valga = higher angle
avascular necrosis of femoral head
blood supply gets disrupted, causes death to osteocytes
femoral neck fractures
need to be repaired within 8 hours to prevent avascular necrosis, type 1 - crack, type 2 - fracture, type 3 - displacement, type 4 - full displacement
concern is medial circumflex artery
leg appears shortened and laterally rotated
types of hip repair
dynamic compression screw and plate and bipolar hip prosthesis
hip pain
referred pain - great trochanter is trochanteric bursitis - buttocks = sciatic
causes = arthritis, bursitis, tendinitis, muscle strain, cancer, avascular necrosis
Nursemaids knee
aseptic or septic prepatellar bursitis, swelling is more focal than effusion
knee effusion
synovial fluid accumulation around knee joint
Q-angle
angle that the femur makes relative to tibia
Genu valgum/varum
Varum - low Q angle, stress on medial menisci and LCL
Valgum - high Q angle, stress on lateral menisci, MCL
testing collateral ligaments
varus stress test angles leg medially to test LCL and valgus stress test angles leg laterally to test MCL
ACL tear
forces directed from posterior side of the leg
- rapid cutting maneuver with foot on ground and knee flexed
- knee hyperextension with internal tibial rotation
PCL tear
forces directed from anterior side of the leg, or forced flexion of knee with external rotation
test of ACL tear
Anterior drawer sign, flex knee to 90 and pull leg forward, more then 1cm anterior displacement = ACL tear
test of PCL tear
sag of the tibia posterior
meniscus injuries
medial side injured most (when medial meniscus is more secured and foot is planted with excessive rotation)
unhappy triad
medial meniscus is attache to MCL and both are torn during ACL tear (not LCL because of popliteus)
Shoulder separation
tearing of acromioclavicular and coracoclavicular ligaments, piano key deformity
winged scapula
damage to long thoracic nerve, medial scapula freely moves posteriorly, especially when pressing against wall, person has difficultly raising hands above head
breast cancer
lower medial quadrant is the most dangerous because it crosses the midline and because parasternal lymph nodes cant be palpated
rotator cuff injuries
supraspinatus and infraspinatus
frozen shoulder (adhesive capulisitis)
loss of range of motion from tendinitis, bursitis, rotator cuff injury, inflammation, treat with steriod and PT
biceps tendon reflex
tests musculocutaneous nerve
wrist drop
damage to radial nerve and deep brachial artery in the spiral groove, paralyze the extensor muscles
Erb palsy
C5 and C6 brachial plexus injury, limb will be adducted, extended and medially rotated
Klumpke’s palsy
lower brachial plexus injury
Nursemaids elbow
subluxation of the radial head
Colles fracture
extension fracture of the radius (dinner fork)
Smith fracture
flexion fracture of the radius
nightstick fracture
ulna fracture
scaphoid fracture
significant because of the limited blood supply
carpal tunnel syndrome
compression of the median nerve, from inflammation of flexor tendons of digits
