Clinical Correlations Flashcards
What spinal root levels contribute to cutaneous of lower limb
L1-S2
Meralgia paresthetica
physical deformation of lateral femoral cutaneous n within abdomen or as it passes deep to inguinal lig
what is friction bursitis
fluid filled space- friction rub, inflammation, fibrosis, calcium deposits and rupture
describe ischial friction bursitis
inflammation of bursa between ischial tuberosity and glut maximus, movement of glut max across inflamed bursa causes pain, could become calcific
what causes trochanteric friction bursitis
repetitive motion of glut maximus across bursa during climbing and inclined walking
how do you test for trochanteric friction bursitis
manually resisting abduction and lateral rotation of the thigh
what are the more distal sites of bursitis in lower limb
deep to psoas, calcaneal bursitis, infra supra and pre-patellar bursitis
Where do you see medial plantar n compression
deep to flexor retinaculum
what can cause medial plantar n compression
excessive running or eversion resulting in irritation.
symptoms of medial plantar n compression
paresthesias on medial side of sole of foot with weakness of intrinsic mm of great toe
what is the condition when you have inflammation of plantar aponeurosis
plantar fasciitis
how do you elicit pain in someone with plantar faciitis
direct pressure to calcaneus or by dorsiflexing the foot or extending the great toe
what are other symptoms of plantar fasciitis
calcaneal bone spurs and tight triceps surae
what gender are femoral hernias more common in
female
what could a femoral hernia impede vascularly
the saphenous vein
what are the 3 common muscular strains.ruptures
groin strains
hamstring strains
ruptured achilles tendon
what causes groin strain
adductor group pulls during fast hip flexion
what causes hamstring strains
strains of semitendinosus and semimembranosus and biceps femurs usually near ischial tuberosity
because fast extension during push off phase of running
what usually is the cause of a ruptured achilles tendon
increased age and irregular bouts of exercise where rapid push off with feet are required
What can a retroperitoneal abdominal or pelvic infection cause if it descends fascial sheath
psoas abscess
what can a psoas abscess be mistaken for
femoral hernia, indirect inguinal hernia, inflammation of inguinal lymph nodes, saphenous varix
What are shin splints
tibialis anterior sprain, micro tears in the periosteal attachment of distal 2/3 tibialis anterior to the tibia resulting in pain
what causes shin splints
overuse or infrequent bouts of exercise not preceded by stretching or warming up
what is calcaneal tendinitis
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
What causes avulsion fractures
fragments pulled off bones by rapidly loaded tendons and ligaments
where do avulsion fractures take place
pelvis- ischial tuberosity, ASIS, AIIS, ischiopubic rami
tibial tuberosity
ankle- lateral and medial malleoli
foot- 5th metatarsal
what are the 3 main fracture locations of femur
neck, greater trochanter or shaft and the distal femur
what can cause a femoral neck fracture
increased compressive forces on a limb already weakened by metabolic processes
what causes a fracture to the greater trochanter of femur
direct trauma due to falls of vehicular accidents
describe distal femoral fractures
fracture of femoral condyles or between them Salter Harris
What can cause transverse patellar fractures
avulsion type due to sudden forceful contraction of quads or direct blow
what is the risk of bipartite or tripartite patella
non union of ossification centers resulting in a patella with many components
Where do most tibial fractures occur
near junction of middle and distal third (least vascularized)
what causes a fracture of the medial malleolus
contact with talus during excessive exercise
What are the three types of fractures of the tibia
transverse
diagonal
disruption of epiphyseal plate
What is Osgood Schlatter disease
disruption of tibial tuberosity at its growth plate during youth due excessive action of quads– inflammation and pain
What is the type I salter harris calssification of femoral fracture
through epiphyseal plate transversely
what is type II salter harris
though epiphysis then upwards through metaphysis
what is type III salter harris
splits femoral condyles then runs with half epiphysis
what is type IV salter harris
splits condyles and continues vertically through metaphysis
what is type V salter harris
compression of epiphyseal plate, decrease gap
what is the most common tibial fracture due to skiing
diagonal- severe torsion
where are most fractures of the fibula
just proximal to lateral malleolus
what can cause fracture to lateral malleolus
contact with talus during excessive inversion
What bone is used in bone graft procedures and why
fibula because it is NOT weight bearing
in what scenario does the calcaneus break
hard falls directly to heal
what joint does a calcaneal fracture disrupt
subtalar
when do talus fractures happen
forced dorsiflexion
what does a talar fracture look like
fracture of neck of talus with posterior dislocation of the talar body
What is the CCD angle
Caput Collum and Diaphyseal
developmental variation of angle between head of neck and shaft of femur
What is the normal CCD angle
120 degrees
What is coxa vara
decrease in CCD angle, less than 120
what is the result of coxa vara
slight decrease in length of affected limb, concomitant increase in Q angle resulting in genu valgum
what is coxa valga
increase CCD angle, greater than 120
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
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
what is the normal Q angle in males and females
male- 14 female- 17
What causes slipped capital femoral epiphysis
trauma in region of proximal femoral epiphysis
what age group does slipped capital femoral epiphysis usually occur
adolescents prior to plate closure
what is the seqelae condition of when the distal fragment of slipped capital femoral epiphysis dislocates posteriorly
coxa vara
what aa are usually implicated in avascular necrosis of femoral head
medial femoral circumflex a branches
when is the hip capsule loosest
in flexion
what is the most common way for hip dislocation
impact on knee driving femur posteriorly
What causes hip drop
paralysis of gluteus medius and minimus
loss of what nn causes hip drop
loss of superior gluteal n, L4 L5 S1
what is the action of glut medius and minimus
keeps hip on UNSUPPORTED side from dropping
What can cause tearing of both menisci
leg in full flexion under force
which meniscus is torn more often
medial because it is less mobile as it is attached to MCL
impact to the lateral side of knee disrupts what lig
MCL
what is the bucket handle tear of menisci
longitudinal tear through substance of meniscus
what happens after meniscus removal
mobility is the same with decreased stability and increased articular cartilaginous erosion
What else usually gets injured along with MCL
ACL and medial meniscus
What causes ACL injury
hyperextension injury or force to lower limb when foot is fixed and the femur is in medial rotation
What is the unholy triad
tearing of ACL, MCL and medial meniscus simultaneously.
How does the ACL get torn with MCL and medial meniscus
ACL through anterior horn of medial meniscus to reach tibial plateau
Which direction does the patella dislocate
laterally
why is patellar dislocation more common in females
increased Q angle, lateral pull on patella via rectus femoris and vastus lateralis
what is patellofemoral syndrome
pain caused by improper tracking of patella relative to patellar groove on femur
what can patellofemoral syndrome lead to
chondromalacia of patella- softening of cartilage
How do you treat patellofemoral syndrome
leg extension with emphasis on last 30 degrees to increase tension on most inferior vastus medialis fibers
What are Baker’s cysts
popliteal cysts, fluid accumulation causing continuity in joint with bursa
What do Bakers cysts impede
flexion and puts pressure on structures in popliteal fossa
What is the Os trigonum
bone accessory to talus, secondary ossification center which fails to unite with talus
What causes injury to lateral collateral ligament
over inversion
what could get torn in a inversion sprain of ankle
anterior talofibular ligament
why does injury to medial collateral lig of ankle not occur as often
because musch stronger. happens in extreme overeversion
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
What is a sign of common or external iliac arterial obstruction
decreased femoral pulse between ASIS and pubic tubercle
where does cannulation of femoral a take place for cardiac angiography
left femoral a inferior to inguinal lig
What is a diminished popliteal pulse indicative of
femoral arterial obstruction
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
intermittend cramping leg pain during exercise that disappears with rest is indicative of what
muscular ischemia due to narrowing of tibial aa
In genetic conditions where the dorsalis pedis a is not there, what supplies dorsum of foot
perforating branches of fibular a
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
What are saphenouse v grafts used for
coronary aa bypass surgery- VALVES inserted in reverse direction! so don’t impede flow
what do you have to be careful about when cutting out parts of saphenous v near medial malleolus
not to cut saphenous n
what is saphenous varix
infrequen dilation of terminal portion of greater saphenous v
swelling of femoral triangle
What can saphenous varix be mistaken for
femoral hernia and psoas abscess
How is the femoral v located for femoral vein cannulation
find femoral arterial pulse and go one finger medially
What can cause DVThrombosis
prior trauma or vascular stagnation due to decreased exercise or weakened muscular fascia resulting in diminished musculovenous pump
What is thrombophlebitis
clot within a v leading to inflammation at the site of the clot
what is thromboembolism
a clot which breaks free and traverses to heart to become lodged in lung- pulmonary
what is lymphangitis
inflammation of lymph vessels- red streaks
what is lymphadenopathy
enlarged lymph nodes due to inflammation which reside in popliteal fossa and femoral triangle
Where are the superficial inguinal nodes
subcutaneous CT in femoral triangle
where do the superficial inguinal nodes receive drainage from
superficial thigh, abdomen inferior to naval, round lig of uterus and from perineum
where are deep inguinal nodes found
in femoral triangle
where do deep inguinal nodes receive drainage from
superficial inguinal nodes and deep structures of foot, leg and thigh
What cord level is responsible for tendon reflex
L4
what cord level is responsible for achilles reflex
S1
When is a babinskis sign normal
in children under 2 years of age
What cord levels are in femoral n
L2 L3 L4
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
What cord levels are in obturator n
L2 L3 L4
what could cause compression of obturator n
entrapped as exits obturator canal
what would be signs of compressed obturator n
weakness in ADduction, flexion and rotation of thigh and paresthesis of medial thigh
What cord levels are in Sciatic N
L4 L5 S1 S2 S3
What is piriformis syndrome
tibial and common fibular portions of sciatic are split by piriformis
common fibular can run through piriformis
Where are gluteal injections given SAFELY
index finger on ASIS and middle finger on tubercle on crest of ilium, between these fingers
What cord levels are in superior gluteal n
L4 L5 S1
what results in injury to superior gluteal n, or to L4 intervertebral disk
takes out glut medius and minims
What is Trendelenberg test
the dropped hip sign
What cord levels are in inferior gluteal n
L5 S1 S2
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
what cord levels are in tibial n
L4 L5 S1 S2 S3
injury to tibial n occurs where
popliteal fossa
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
what cord levels are in common fibular n
L4 L5 S1 S2
direct trauma to common fibular n occurs where
where it courses around neck of fibula
result of common fibular n injury
complete loss of eversion and dorsiflexion and numbness to lateral anterior portion of leg and dorsum of foot
What cord levels are in superficial fibular n
L5 S1 S2
where can the superficial fibular n be injured
lateral crural region
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
what cord levels are in the deep fibular n
L4 L5
what is the sign of deep fibular n damage
foot drop
where does damage to deep fibular n occur
piercing trauma and compartment syndrome of anterior crural compartment
what else would be seen in deep fibular n damage
complete loss dorsiflexion and extension of toes and anesthesia between 1st and 2nd toes
describe foot drop
loss of extensor hallucis longus so tibialis anterior lifting foot and dragging of great toe
