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MSK III > Clinical Correlations > Flashcards

Clinical Correlations Flashcards

1
Q

What spinal root levels contribute to cutaneous of lower limb

A

L1-S2

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2
Q

Meralgia paresthetica

A

physical deformation of lateral femoral cutaneous n within abdomen or as it passes deep to inguinal lig

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3
Q

what is friction bursitis

A

fluid filled space- friction rub, inflammation, fibrosis, calcium deposits and rupture

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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

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5
Q

what causes trochanteric friction bursitis

A

repetitive motion of glut maximus across bursa during climbing and inclined walking

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6
Q

how do you test for trochanteric friction bursitis

A

manually resisting abduction and lateral rotation of the thigh

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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

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8
Q

Where do you see medial plantar n compression

A

deep to flexor retinaculum

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9
Q

what can cause medial plantar n compression

A

excessive running or eversion resulting in irritation.

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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

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11
Q

what is the condition when you have inflammation of plantar aponeurosis

A

plantar fasciitis

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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

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13
Q

what are other symptoms of plantar fasciitis

A

calcaneal bone spurs and tight triceps surae

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14
Q

what gender are femoral hernias more common in

A

female

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15
Q

what could a femoral hernia impede vascularly

A

the saphenous vein

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16
Q

what are the 3 common muscular strains.ruptures

A

groin strains
hamstring strains
ruptured achilles tendon

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17
Q

what causes groin strain

A

adductor group pulls during fast hip flexion

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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

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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

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20
Q

What can a retroperitoneal abdominal or pelvic infection cause if it descends fascial sheath

A

psoas abscess

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21
Q

what can a psoas abscess be mistaken for

A

femoral hernia, indirect inguinal hernia, inflammation of inguinal lymph nodes, saphenous varix

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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

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23
Q

what causes shin splints

A

overuse or infrequent bouts of exercise not preceded by stretching or warming up

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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

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25
Q

What causes avulsion fractures

A

fragments pulled off bones by rapidly loaded tendons and ligaments

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26
Q

where do avulsion fractures take place

A

pelvis- ischial tuberosity, ASIS, AIIS, ischiopubic rami
tibial tuberosity
ankle- lateral and medial malleoli
foot- 5th metatarsal

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27
Q

what are the 3 main fracture locations of femur

A

neck, greater trochanter or shaft and the distal femur

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28
Q

what can cause a femoral neck fracture

A

increased compressive forces on a limb already weakened by metabolic processes

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29
Q

what causes a fracture to the greater trochanter of femur

A

direct trauma due to falls of vehicular accidents

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30
Q

describe distal femoral fractures

A

fracture of femoral condyles or between them Salter Harris

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31
Q

What can cause transverse patellar fractures

A

avulsion type due to sudden forceful contraction of quads or direct blow

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32
Q

what is the risk of bipartite or tripartite patella

A

non union of ossification centers resulting in a patella with many components

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33
Q

Where do most tibial fractures occur

A

near junction of middle and distal third (least vascularized)

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34
Q

what causes a fracture of the medial malleolus

A

contact with talus during excessive exercise

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35
Q

What are the three types of fractures of the tibia

A

transverse
diagonal
disruption of epiphyseal plate

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36
Q

What is Osgood Schlatter disease

A

disruption of tibial tuberosity at its growth plate during youth due excessive action of quads– inflammation and pain

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37
Q

What is the type I salter harris calssification of femoral fracture

A

through epiphyseal plate transversely

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38
Q

what is type II salter harris

A

though epiphysis then upwards through metaphysis

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39
Q

what is type III salter harris

A

splits femoral condyles then runs with half epiphysis

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40
Q

what is type IV salter harris

A

splits condyles and continues vertically through metaphysis

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41
Q

what is type V salter harris

A

compression of epiphyseal plate, decrease gap

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42
Q

what is the most common tibial fracture due to skiing

A

diagonal- severe torsion

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43
Q

where are most fractures of the fibula

A

just proximal to lateral malleolus

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44
Q

what can cause fracture to lateral malleolus

A

contact with talus during excessive inversion

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45
Q

What bone is used in bone graft procedures and why

A

fibula because it is NOT weight bearing

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46
Q

in what scenario does the calcaneus break

A

hard falls directly to heal

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47
Q

what joint does a calcaneal fracture disrupt

A

subtalar

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48
Q

when do talus fractures happen

A

forced dorsiflexion

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49
Q

what does a talar fracture look like

A

fracture of neck of talus with posterior dislocation of the talar body

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50
Q

What is the CCD angle

A

Caput Collum and Diaphyseal

developmental variation of angle between head of neck and shaft of femur

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51
Q

What is the normal CCD angle

A

120 degrees

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52
Q

What is coxa vara

A

decrease in CCD angle, less than 120

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53
Q

what is the result of coxa vara

A

slight decrease in length of affected limb, concomitant increase in Q angle resulting in genu valgum

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54
Q

what is coxa valga

A

increase CCD angle, greater than 120

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55
Q

what is the result of coxa valga

A

slight increase in length of the affected limb; concomitant decrease in Q- angle opens lateral knee resulting in genu varum

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56
Q

What is the q angle

A

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
Q

what is the normal Q angle in males and females

A

male- 14 female- 17

58
Q

What causes slipped capital femoral epiphysis

A

trauma in region of proximal femoral epiphysis

59
Q

what age group does slipped capital femoral epiphysis usually occur

A

adolescents prior to plate closure

60
Q

what is the seqelae condition of when the distal fragment of slipped capital femoral epiphysis dislocates posteriorly

A

coxa vara

61
Q

what aa are usually implicated in avascular necrosis of femoral head

A

medial femoral circumflex a branches

62
Q

when is the hip capsule loosest

A

in flexion

63
Q

what is the most common way for hip dislocation

A

impact on knee driving femur posteriorly

64
Q

What causes hip drop

A

paralysis of gluteus medius and minimus

65
Q

loss of what nn causes hip drop

A

loss of superior gluteal n, L4 L5 S1

66
Q

what is the action of glut medius and minimus

A

keeps hip on UNSUPPORTED side from dropping

67
Q

What can cause tearing of both menisci

A

leg in full flexion under force

68
Q

which meniscus is torn more often

A

medial because it is less mobile as it is attached to MCL

69
Q

impact to the lateral side of knee disrupts what lig

A

MCL

70
Q

what is the bucket handle tear of menisci

A

longitudinal tear through substance of meniscus

71
Q

what happens after meniscus removal

A

mobility is the same with decreased stability and increased articular cartilaginous erosion

72
Q

What else usually gets injured along with MCL

A

ACL and medial meniscus

73
Q

What causes ACL injury

A

hyperextension injury or force to lower limb when foot is fixed and the femur is in medial rotation

74
Q

What is the unholy triad

A

tearing of ACL, MCL and medial meniscus simultaneously.

75
Q

How does the ACL get torn with MCL and medial meniscus

A

ACL through anterior horn of medial meniscus to reach tibial plateau

76
Q

Which direction does the patella dislocate

A

laterally

77
Q

why is patellar dislocation more common in females

A

increased Q angle, lateral pull on patella via rectus femoris and vastus lateralis

78
Q

what is patellofemoral syndrome

A

pain caused by improper tracking of patella relative to patellar groove on femur

79
Q

what can patellofemoral syndrome lead to

A

chondromalacia of patella- softening of cartilage

80
Q

How do you treat patellofemoral syndrome

A

leg extension with emphasis on last 30 degrees to increase tension on most inferior vastus medialis fibers

81
Q

What are Baker’s cysts

A

popliteal cysts, fluid accumulation causing continuity in joint with bursa

82
Q

What do Bakers cysts impede

A

flexion and puts pressure on structures in popliteal fossa

83
Q

What is the Os trigonum

A

bone accessory to talus, secondary ossification center which fails to unite with talus

84
Q

What causes injury to lateral collateral ligament

A

over inversion

85
Q

what could get torn in a inversion sprain of ankle

A

anterior talofibular ligament

86
Q

why does injury to medial collateral lig of ankle not occur as often

A

because musch stronger. happens in extreme overeversion

87
Q

What is Pott’s fracture

A

forced eversion of ankle
avulsion fracture of medial malleolus
talus shifts an fractures lateral malleolus
total disruption of mortise of ankle

88
Q

What is a sign of common or external iliac arterial obstruction

A

decreased femoral pulse between ASIS and pubic tubercle

89
Q

where does cannulation of femoral a take place for cardiac angiography

A

left femoral a inferior to inguinal lig

90
Q

What is a diminished popliteal pulse indicative of

A

femoral arterial obstruction

91
Q

what position must a patien be to read pulse of posterior tibial a

A

invert foot to relieve flexor retinaculum pressure

posteriorly between calcaneal tendon and medial malleolus

92
Q

intermittend cramping leg pain during exercise that disappears with rest is indicative of what

A

muscular ischemia due to narrowing of tibial aa

93
Q

In genetic conditions where the dorsalis pedis a is not there, what supplies dorsum of foot

A

perforating branches of fibular a

94
Q

What are superficial varicosities

A

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
Q

What are saphenouse v grafts used for

A

coronary aa bypass surgery- VALVES inserted in reverse direction! so don’t impede flow

96
Q

what do you have to be careful about when cutting out parts of saphenous v near medial malleolus

A

not to cut saphenous n

97
Q

what is saphenous varix

A

infrequen dilation of terminal portion of greater saphenous v
swelling of femoral triangle

98
Q

What can saphenous varix be mistaken for

A

femoral hernia and psoas abscess

99
Q

How is the femoral v located for femoral vein cannulation

A

find femoral arterial pulse and go one finger medially

100
Q

What can cause DVThrombosis

A

prior trauma or vascular stagnation due to decreased exercise or weakened muscular fascia resulting in diminished musculovenous pump

101
Q

What is thrombophlebitis

A

clot within a v leading to inflammation at the site of the clot

102
Q

what is thromboembolism

A

a clot which breaks free and traverses to heart to become lodged in lung- pulmonary

103
Q

what is lymphangitis

A

inflammation of lymph vessels- red streaks

104
Q

what is lymphadenopathy

A

enlarged lymph nodes due to inflammation which reside in popliteal fossa and femoral triangle

105
Q

Where are the superficial inguinal nodes

A

subcutaneous CT in femoral triangle

106
Q

where do the superficial inguinal nodes receive drainage from

A

superficial thigh, abdomen inferior to naval, round lig of uterus and from perineum

107
Q

where are deep inguinal nodes found

A

in femoral triangle

108
Q

where do deep inguinal nodes receive drainage from

A

superficial inguinal nodes and deep structures of foot, leg and thigh

109
Q

What cord level is responsible for tendon reflex

A

L4

110
Q

what cord level is responsible for achilles reflex

A

S1

111
Q

When is a babinskis sign normal

A

in children under 2 years of age

112
Q

What cord levels are in femoral n

A

L2 L3 L4

113
Q

what would severing the femoral n cause

A

total loss leg extension
impaired hip flexion
anethesia to anterior thigh, medial leg and foot with L4 dermatome

114
Q

What cord levels are in obturator n

A

L2 L3 L4

115
Q

what could cause compression of obturator n

A

entrapped as exits obturator canal

116
Q

what would be signs of compressed obturator n

A

weakness in ADduction, flexion and rotation of thigh and paresthesis of medial thigh

117
Q

What cord levels are in Sciatic N

A

L4 L5 S1 S2 S3

118
Q

What is piriformis syndrome

A

tibial and common fibular portions of sciatic are split by piriformis
common fibular can run through piriformis

119
Q

Where are gluteal injections given SAFELY

A

index finger on ASIS and middle finger on tubercle on crest of ilium, between these fingers

120
Q

What cord levels are in superior gluteal n

A

L4 L5 S1

121
Q

what results in injury to superior gluteal n, or to L4 intervertebral disk

A

takes out glut medius and minims

122
Q

What is Trendelenberg test

A

the dropped hip sign

123
Q

What cord levels are in inferior gluteal n

A

L5 S1 S2

124
Q

Injury to inferior gluteal n presents how

A

weakness of gluteus maximus with concomitant decrease in hip extension especially visible when affected individual tries to negotiate going up stairs

125
Q

what cord levels are in tibial n

A

L4 L5 S1 S2 S3

126
Q

injury to tibial n occurs where

A

popliteal fossa

127
Q

what would be the result of injured tibial n

A

complete loss of plantar flexion, flexion, Adduction and ABduction of toes and anesthesia to sole of foot

128
Q

what cord levels are in common fibular n

A

L4 L5 S1 S2

129
Q

direct trauma to common fibular n occurs where

A

where it courses around neck of fibula

130
Q

result of common fibular n injury

A

complete loss of eversion and dorsiflexion and numbness to lateral anterior portion of leg and dorsum of foot

131
Q

What cord levels are in superficial fibular n

A

L5 S1 S2

132
Q

where can the superficial fibular n be injured

A

lateral crural region

133
Q

what is result of superficial fibular n damage

A

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
Q

what cord levels are in the deep fibular n

A

L4 L5

135
Q

what is the sign of deep fibular n damage

A

foot drop

136
Q

where does damage to deep fibular n occur

A

piercing trauma and compartment syndrome of anterior crural compartment

137
Q

what else would be seen in deep fibular n damage

A

complete loss dorsiflexion and extension of toes and anesthesia between 1st and 2nd toes

138
Q

describe foot drop

A

loss of extensor hallucis longus so tibialis anterior lifting foot and dragging of great toe

MSK III (9 decks)

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