Clinical Correlations Flashcards
1
Q
What spinal root levels contribute to cutaneous of lower limb
A
L1-S2
2
Q
Meralgia paresthetica
A
physical deformation of lateral femoral cutaneous n within abdomen or as it passes deep to inguinal lig
3
Q
what is friction bursitis
A
fluid filled space- friction rub, inflammation, fibrosis, calcium deposits and rupture
4
Q
describe ischial friction bursitis
A
inflammation of bursa between ischial tuberosity and glut maximus, movement of glut max across inflamed bursa causes pain, could become calcific
5
Q
what causes trochanteric friction bursitis
A
repetitive motion of glut maximus across bursa during climbing and inclined walking
6
Q
how do you test for trochanteric friction bursitis
A
manually resisting abduction and lateral rotation of the thigh
7
Q
what are the more distal sites of bursitis in lower limb
A
deep to psoas, calcaneal bursitis, infra supra and pre-patellar bursitis
8
Q
Where do you see medial plantar n compression
A
deep to flexor retinaculum
9
Q
what can cause medial plantar n compression
A
excessive running or eversion resulting in irritation.
10
Q
symptoms of medial plantar n compression
A
paresthesias on medial side of sole of foot with weakness of intrinsic mm of great toe
11
Q
what is the condition when you have inflammation of plantar aponeurosis
A
plantar fasciitis
12
Q
how do you elicit pain in someone with plantar faciitis
A
direct pressure to calcaneus or by dorsiflexing the foot or extending the great toe
13
Q
what are other symptoms of plantar fasciitis
A
calcaneal bone spurs and tight triceps surae
14
Q
what gender are femoral hernias more common in
A
female
15
Q
what could a femoral hernia impede vascularly
A
the saphenous vein
16
Q
what are the 3 common muscular strains.ruptures
A
groin strains
hamstring strains
ruptured achilles tendon
17
Q
what causes groin strain
A
adductor group pulls during fast hip flexion
18
Q
what causes hamstring strains
A
strains of semitendinosus and semimembranosus and biceps femurs usually near ischial tuberosity
because fast extension during push off phase of running
19
Q
what usually is the cause of a ruptured achilles tendon
A
increased age and irregular bouts of exercise where rapid push off with feet are required
20
Q
What can a retroperitoneal abdominal or pelvic infection cause if it descends fascial sheath
A
psoas abscess
21
Q
what can a psoas abscess be mistaken for
A
femoral hernia, indirect inguinal hernia, inflammation of inguinal lymph nodes, saphenous varix
22
Q
What are shin splints
A
tibialis anterior sprain, micro tears in the periosteal attachment of distal 2/3 tibialis anterior to the tibia resulting in pain
23
Q
what causes shin splints
A
overuse or infrequent bouts of exercise not preceded by stretching or warming up
24
Q
what is calcaneal tendinitis
A
micro tears in attachment of calcaneal tendon to the calcaneal tuberosity as a result of overuse, poor footwear, poor training surfaces, or infrequency of activity
25
What causes avulsion fractures
fragments pulled off bones by rapidly loaded tendons and ligaments
26
where do avulsion fractures take place
pelvis- ischial tuberosity, ASIS, AIIS, ischiopubic rami
tibial tuberosity
ankle- lateral and medial malleoli
foot- 5th metatarsal
27
what are the 3 main fracture locations of femur
neck, greater trochanter or shaft and the distal femur
28
what can cause a femoral neck fracture
increased compressive forces on a limb already weakened by metabolic processes
29
what causes a fracture to the greater trochanter of femur
direct trauma due to falls of vehicular accidents
30
describe distal femoral fractures
fracture of femoral condyles or between them Salter Harris
31
What can cause transverse patellar fractures
avulsion type due to sudden forceful contraction of quads or direct blow
32
what is the risk of bipartite or tripartite patella
non union of ossification centers resulting in a patella with many components
33
Where do most tibial fractures occur
near junction of middle and distal third (least vascularized)
34
what causes a fracture of the medial malleolus
contact with talus during excessive exercise
35
What are the three types of fractures of the tibia
transverse
diagonal
disruption of epiphyseal plate
36
What is Osgood Schlatter disease
disruption of tibial tuberosity at its growth plate during youth due excessive action of quads-- inflammation and pain
37
What is the type I salter harris calssification of femoral fracture
through epiphyseal plate transversely
38
what is type II salter harris
though epiphysis then upwards through metaphysis
39
what is type III salter harris
splits femoral condyles then runs with half epiphysis
40
what is type IV salter harris
splits condyles and continues vertically through metaphysis
41
what is type V salter harris
compression of epiphyseal plate, decrease gap
42
what is the most common tibial fracture due to skiing
diagonal- severe torsion
43
where are most fractures of the fibula
just proximal to lateral malleolus
44
what can cause fracture to lateral malleolus
contact with talus during excessive inversion
45
What bone is used in bone graft procedures and why
fibula because it is NOT weight bearing
46
in what scenario does the calcaneus break
hard falls directly to heal
47
what joint does a calcaneal fracture disrupt
subtalar
48
when do talus fractures happen
forced dorsiflexion
49
what does a talar fracture look like
fracture of neck of talus with posterior dislocation of the talar body
50
What is the CCD angle
Caput Collum and Diaphyseal
| developmental variation of angle between head of neck and shaft of femur
51
What is the normal CCD angle
120 degrees
52
What is coxa vara
decrease in CCD angle, less than 120
53
what is the result of coxa vara
slight decrease in length of affected limb, concomitant increase in Q angle resulting in genu valgum
54
what is coxa valga
increase CCD angle, greater than 120
55
what is the result of coxa valga
slight increase in length of the affected limb; concomitant decrease in Q- angle opens lateral knee resulting in genu varum
56
What is the q angle
angle between line drawn from center of patella to the ASIS and a line drawn from middle of patella to middle of hip joint
57
what is the normal Q angle in males and females
male- 14 female- 17
58
What causes slipped capital femoral epiphysis
trauma in region of proximal femoral epiphysis
59
what age group does slipped capital femoral epiphysis usually occur
adolescents prior to plate closure
60
what is the seqelae condition of when the distal fragment of slipped capital femoral epiphysis dislocates posteriorly
coxa vara
61
what aa are usually implicated in avascular necrosis of femoral head
medial femoral circumflex a branches
62
when is the hip capsule loosest
in flexion
63
what is the most common way for hip dislocation
impact on knee driving femur posteriorly
64
What causes hip drop
paralysis of gluteus medius and minimus
65
loss of what nn causes hip drop
loss of superior gluteal n, L4 L5 S1
66
what is the action of glut medius and minimus
keeps hip on UNSUPPORTED side from dropping
67
What can cause tearing of both menisci
leg in full flexion under force
68
which meniscus is torn more often
medial because it is less mobile as it is attached to MCL
69
impact to the lateral side of knee disrupts what lig
MCL
70
what is the bucket handle tear of menisci
longitudinal tear through substance of meniscus
71
what happens after meniscus removal
mobility is the same with decreased stability and increased articular cartilaginous erosion
72
What else usually gets injured along with MCL
ACL and medial meniscus
73
What causes ACL injury
hyperextension injury or force to lower limb when foot is fixed and the femur is in medial rotation
74
What is the unholy triad
tearing of ACL, MCL and medial meniscus simultaneously.
75
How does the ACL get torn with MCL and medial meniscus
ACL through anterior horn of medial meniscus to reach tibial plateau
76
Which direction does the patella dislocate
laterally
77
why is patellar dislocation more common in females
increased Q angle, lateral pull on patella via rectus femoris and vastus lateralis
78
what is patellofemoral syndrome
pain caused by improper tracking of patella relative to patellar groove on femur
79
what can patellofemoral syndrome lead to
chondromalacia of patella- softening of cartilage
80
How do you treat patellofemoral syndrome
leg extension with emphasis on last 30 degrees to increase tension on most inferior vastus medialis fibers
81
What are Baker's cysts
popliteal cysts, fluid accumulation causing continuity in joint with bursa
82
What do Bakers cysts impede
flexion and puts pressure on structures in popliteal fossa
83
What is the Os trigonum
bone accessory to talus, secondary ossification center which fails to unite with talus
84
What causes injury to lateral collateral ligament
over inversion
85
what could get torn in a inversion sprain of ankle
anterior talofibular ligament
86
why does injury to medial collateral lig of ankle not occur as often
because musch stronger. happens in extreme overeversion
87
What is Pott's fracture
forced eversion of ankle
avulsion fracture of medial malleolus
talus shifts an fractures lateral malleolus
total disruption of mortise of ankle
88
What is a sign of common or external iliac arterial obstruction
decreased femoral pulse between ASIS and pubic tubercle
89
where does cannulation of femoral a take place for cardiac angiography
left femoral a inferior to inguinal lig
90
What is a diminished popliteal pulse indicative of
femoral arterial obstruction
91
what position must a patien be to read pulse of posterior tibial a
invert foot to relieve flexor retinaculum pressure
| posteriorly between calcaneal tendon and medial malleolus
92
intermittend cramping leg pain during exercise that disappears with rest is indicative of what
muscular ischemia due to narrowing of tibial aa
93
In genetic conditions where the dorsalis pedis a is not there, what supplies dorsum of foot
perforating branches of fibular a
94
What are superficial varicosities
weakened superficial vv which dilate under pressure of supported colum of blood. vv valves no longer competent
degenerated deep fascia reduces the musculovenous pump
95
What are saphenouse v grafts used for
coronary aa bypass surgery- VALVES inserted in reverse direction! so don't impede flow
96
what do you have to be careful about when cutting out parts of saphenous v near medial malleolus
not to cut saphenous n
97
what is saphenous varix
infrequen dilation of terminal portion of greater saphenous v
swelling of femoral triangle
98
What can saphenous varix be mistaken for
femoral hernia and psoas abscess
99
How is the femoral v located for femoral vein cannulation
find femoral arterial pulse and go one finger medially
100
What can cause DVThrombosis
prior trauma or vascular stagnation due to decreased exercise or weakened muscular fascia resulting in diminished musculovenous pump
101
What is thrombophlebitis
clot within a v leading to inflammation at the site of the clot
102
what is thromboembolism
a clot which breaks free and traverses to heart to become lodged in lung- pulmonary
103
what is lymphangitis
inflammation of lymph vessels- red streaks
104
what is lymphadenopathy
enlarged lymph nodes due to inflammation which reside in popliteal fossa and femoral triangle
105
Where are the superficial inguinal nodes
subcutaneous CT in femoral triangle
106
where do the superficial inguinal nodes receive drainage from
superficial thigh, abdomen inferior to naval, round lig of uterus and from perineum
107
where are deep inguinal nodes found
in femoral triangle
108
where do deep inguinal nodes receive drainage from
superficial inguinal nodes and deep structures of foot, leg and thigh
109
What cord level is responsible for tendon reflex
L4
110
what cord level is responsible for achilles reflex
S1
111
When is a babinskis sign normal
in children under 2 years of age
112
What cord levels are in femoral n
L2 L3 L4
113
what would severing the femoral n cause
total loss leg extension
impaired hip flexion
anethesia to anterior thigh, medial leg and foot with L4 dermatome
114
What cord levels are in obturator n
L2 L3 L4
115
what could cause compression of obturator n
entrapped as exits obturator canal
116
what would be signs of compressed obturator n
weakness in ADduction, flexion and rotation of thigh and paresthesis of medial thigh
117
What cord levels are in Sciatic N
L4 L5 S1 S2 S3
118
What is piriformis syndrome
tibial and common fibular portions of sciatic are split by piriformis
common fibular can run through piriformis
119
Where are gluteal injections given SAFELY
index finger on ASIS and middle finger on tubercle on crest of ilium, between these fingers
120
What cord levels are in superior gluteal n
L4 L5 S1
121
what results in injury to superior gluteal n, or to L4 intervertebral disk
takes out glut medius and minims
122
What is Trendelenberg test
the dropped hip sign
123
What cord levels are in inferior gluteal n
L5 S1 S2
124
Injury to inferior gluteal n presents how
weakness of gluteus maximus with concomitant decrease in hip extension especially visible when affected individual tries to negotiate going up stairs
125
what cord levels are in tibial n
L4 L5 S1 S2 S3
126
injury to tibial n occurs where
popliteal fossa
127
what would be the result of injured tibial n
complete loss of plantar flexion, flexion, Adduction and ABduction of toes and anesthesia to sole of foot
128
what cord levels are in common fibular n
L4 L5 S1 S2
129
direct trauma to common fibular n occurs where
where it courses around neck of fibula
130
result of common fibular n injury
complete loss of eversion and dorsiflexion and numbness to lateral anterior portion of leg and dorsum of foot
131
What cord levels are in superficial fibular n
L5 S1 S2
132
where can the superficial fibular n be injured
lateral crural region
133
what is result of superficial fibular n damage
major loss eversion, moderate loss plantar flexion and weakness for support of arches
anesthesia on lateral anterior portion of leg and dorsum of foot
134
what cord levels are in the deep fibular n
L4 L5
135
what is the sign of deep fibular n damage
foot drop
136
where does damage to deep fibular n occur
piercing trauma and compartment syndrome of anterior crural compartment
137
what else would be seen in deep fibular n damage
complete loss dorsiflexion and extension of toes and anesthesia between 1st and 2nd toes
138
describe foot drop
loss of extensor hallucis longus so tibialis anterior lifting foot and dragging of great toe
