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MSK exam 3 AP lower limb > Clinical correlations of lower limb > Flashcards

Clinical correlations of lower limb Flashcards

1
Q

meralgia paresthetica

A

deformation of the lateral femoral cutaneous nerv within the abdomen (tumor pregnancy)

or as it passes deep to the inguinal ligament near its attachment to the ASIS (fluid overload, overly tightened belt)

feels like hot and cold, pins and needles, or numb

type of cutaneous irritation

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2
Q

friction bursitis ischial

A

on the ishcial tuberosity the bursa sitting here between ishial tuberosity and gluteus maximus

movement of the gluteus maximus across inflamed bursa causes pain

bursa may become calcific

with prolonged bed rest can lead to pressure sores and ulceration

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3
Q

friction bursitis trochanteric

A

inflammation of bursa between greater trochanter and gluteus maximus

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

every time you go long periods of time in extension (standing) or lots of flexion and extension can irritate this

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4
Q

medial plantar nerve compression

A

this is deep to the flexor retinaculum
compare to carpal tunnel syndrome

due to excessive running and eversion of foot
alot of pressure on the deltoid limit (which prevents excessive eversion)

results in paresthesias on the medial side of the sole of the foot with weakness of the intrinsic muscles of the great toe
(abductor hallucis, flexor hallucis brevis, flexor dig brevis, 1st lumbrical)

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5
Q

problem with friction bursitis

A

can cause the bursa to rupture and the ligament that is crossing it to rupture

from repetitive motion or bed rest

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6
Q

plantar fasciitis

A

inflammation of the plantar aponeurosis caused by overuse

(running, high impact activities, improper footwear)

pain elicited by direct pressure at the point of attachment to the calcaneus or by DORSIFLEXING the foot or extending the great toe

if this goes on long enough there can develop a calcaneal bone spur in the direction of the plantar aponeurosis

get tight in the foot

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7
Q

Femoral hernia

A

protrusion of a viscus (portion of the gut) through the femoral ring into the femoral canal

occurs more often in females b/c of wider hips

forms a protrusion in the femoral triangle inferolateral to the pubic tubercle

may protrude through the saphenous opening and impede venous return of the greater saphenous v.

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8
Q

compartmental syndromes of the leg

A

infection
inflammation
arterial hemorrhage within a fascial compartment of the leg can produce pressure increases within the compartment high enough to cause:

-reduced blood supply to muscles within or distal to the compartment

pressure can accumulate from blood and may impinge nerves to the point that paresthesias occur or paralysis occurs to the muscles located within the compartment

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9
Q

what do severe compartment syndromes require?

A

fasciotomy to relieve these compressive forces prior to the occurence of tissue necrosis

cut the intermuscular septum ?

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10
Q

why do muscular strains and ruptures occur

A

occur as a result of large muscles which must exert force very quickly to overcome large amounts of inertia

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11
Q

groin strains

A

usually occur in fast repetitive flexion

adductor group pulls

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12
Q

hamstring strains

A

get hurt in the “push off” phase

runners grab their butts

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13
Q

ruptured achilles tendon

A

week-end warrior injury due to increase age and irregular bouts of exercise

tennis or basketball
where rapid push-offs with the feet are required

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14
Q

psoas abscess

A

due to retroperitoneal abdominal or pelvic infection that descends within the psoas fascial sheat from the kidney?

FEMORAL NERVE
parasthesias all the way down to the foot and anterior part of leg

descends deep to inguinal ligament, resutling in pain and swelling within the femoral triangle

can be mistaken for femoral hernia, indirect inguinal hernia, inflammation of inguinal lymph nodes, saphenous varix

can be from inflammation of the kidney which inflames the psoas

so alot of pain near femoral triangle may need to check kidney function

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15
Q

shin splints!

A

tibialis anterior strain

micro tears in the periosteal attachment of the distal 2/3 of the tibialis anterior to the tibia resulting in pain

swelling and inflammation within the muscle decreased vascular exchange and leads to pain

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

running on hard surfaces after having trained on softer surfaces

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16
Q

calcaneal tendinitis

A

micro tears in the attachment of the calcaneal tendon to the calcaneal tuberosity as a result of over use, poor footwear, poor training surfaces, or infrequency of activity

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17
Q

avulsion fractures?

A

occur as a result of fragments being pulled away from bones by rapidly loaded tendons and ligaments

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18
Q

where are common sites of avulsion fractures?

A 
pelvis
ischial tuberosity (hamstrings)
ASIS, AIIS
ishiopubic rami
tibilal tuberosity (osgood schlatter) 
ankle (lateral and medial malleoli)
medial malleoli--> b/c of eversion of the foot the deltoid ligament gets stretched causing avulsion of the medial malleolar 
foot 5th metatarsal- fibularis brevis attaches there
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19
Q

osgood schlatter disease

A

tibial tuberosity is avulsed

continued traction on the tibial tuberosity

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20
Q

femur fracture (neck)

A

occur most often as a result of increased compressive forces (stepping from the curb or step) on a limb already weakened by osteoporosis

result in shortened limb and require internal fixation

fracture just distal to the junction of the femoral head with the feomral neck or fracture along the intertrochanteric line

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21
Q

greater trochanter and shaft fracture of femur

A

usually as a result of trauma due to falls or MVA

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22
Q

distal femoral fracture

A

fracture of femoral condyles or between condyles

Salter-Harris classification

both result in aberration of the articular surfaces of the knee joint

may disrupt blood supply to knee or leg

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23
Q

patella fracture

A

transverse patellar fracture

  • avulsion type due to sudden forceful contraction of the quadriceps
  • direct blow (car bumper or dashboard)

bipartite and tripartite patella (THIS IS NOT TRAUMA)
-but rather non union of ossification centers resulting in a patella that has two or three components
often misinterpreted as fractures

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24
Q

tibia fracture

A

most often fracture near junction of middle and distal third (narrowest and least vascularization)

if fractures occur through nutrient foramen can lead to non-union

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25
Q

tibia fracture types

A

transverse

diagonal

disruption of epiphyseal plate
***

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26
Q

fibula fracture

A

pg 340 buck book

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27
Q

calcaneus fracture

A

most often fractures as a result of hard falls directly on the heel

disrupts subtalar joint (active during eversion and inversion)

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28
Q

talus fracture

A

occurs during forced dorsiflexion

pg 341

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29
Q

Coxa vara (inward)

A

decrease in the CCD angle (less than 120 degrees)

moves the femur medially and makes it shorter

Q angle has increased

knock kneed (genu valgum-pushing ankle out)
lateral knee is going to wear out first
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30
Q

coxa valga (outward)

A

increase in the CCD angle

moves the femur outward and makes the femur longer

Q angle has decreased

genu varum (pushing ankle in) (bow leg) 
medial knee is going to wear out first
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31
Q

what is the Q angle

A

angle between a line drawn from the center of the patella to the ASIS and a line drawn from the middle of the patella to the middle of the hip joint

normal male Q angle is 14 degree

normal female Q angle is 17 degrees

the female has a larger Q angle

32
Q

slipped capital femoral epiphysis

A

trauma in the region of the proximal femoral epiphysis

usually occurs in adolescents prior to epiphyseal plate closure

distal fragment dislocates posteriorly leading to coxa vara

33
Q

Avascular necrosis of the femoral head

A

disruption of the arteries that surround the femoral neck to provides branches to the femoral head can lead to femoral head necrosis

branches of the medial femoral circumflex artery are most often implicated

34
Q

hip dislocation?

A

hip is most stable in standing

hip joint is loosest when the thigh is in flexion

so this can happen during a car accident easily
-hitting the knee and driving the femur posteriorly can dislocate the head of the femur from the acetabulum posteriorly (hitting the dashboard with the knee during a deceleration accident)

35
Q

hip drop

A

paralysis of the gluteal medius and minimus (superior gluteal nerve)

action of these muscles usually maintain the sacral base (keeps the unsupported side from dropping

when paralyzed the unsupported hip drops during the swing phase of locomotion

L4,5- S1

36
Q

menisci injuries?

A

(lateral and medial)
medial is more injured b/c of its attachment to the medial collateral ligament

most detrimental, putting full weight on these when you go into flexion

small tears can be trimmed and large tears in the peripherally where a good blood supply exists can be repaired

37
Q

typical bucket handle tera in menisci

A

longitudinal tear through substance of meniscus

when the handle tears free it must be removed

38
Q

test for meniscal injury?

A

if you put in lateral rotation and get pain (then have cartilage damage of lateral side)

if you put some medial rotation and get pain then you probably have medial meniscus injury

39
Q

collateral ligament injury

A

Hit hard medial then the opposie side will open up and stretch the lateral collateral ligaments
and opposite is true

40
Q

unhappy triad

A

anterior cruciate ligament
tibial collateral ligament
medial meniscus

tearing of these at the same time

41
Q

cruciate ligament s injury

A

ACL and PCL

these normally control anterior and posterior movement of the femur on the tibial plateau when the foot is fixed

ACL more often injured

42
Q

if you push the femur forward what gets tight? femur backward?

A

posterior cruciate ligament

backward–> anterior cruciate ligament

43
Q

drawer tests do what?

A

asses cruciate ligament compromise

if the anterior c l is not intact then you can pull the tibia forward (in leg flexion)

if the posteiror c l is not intact you can actually push the tibia back and the patella/femur comes forward

44
Q

patellar dislocation

A

the patella is more likely to dislocate laterally

more often dislocated in females due to greater Q angle

increased Q angle results in increased lateral pull on the patella via the rectus femoris and vatus lateralis muscles

45
Q

patellofemoral syndrome?

A

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

can result in chrondromalacia of the patella:

results in quadriceps imbalance and improper patellar tracking
patella rides more on the lateral femoral condyle

the vastus medialis muscles should be worked ON!!! so that the patella is kept in track

46
Q

what is chondromalacia of the patella

A

softening of the articular cartilage of the patella due to chronic over use (extensive running)
a direct blow to the patella
or repeated extreme flexion (deep squats)

47
Q

baker’s cysts

A

result of chronic knee effusion

p. 343

48
Q

os trigonum

A

bone accessory to talus

represents secondary ossification center which fails to unite with talus

occurs in 14-25 percent of adults

associated with sports where athletes utilizes excessive plantar flexion (soccer players, ballet dancers)

49
Q

Inversion sprain

A

over elevation of the medial border of the foot usually due to stepping on uneven surfaces while weight bearing

results in injury to the lateral collateral ligament of the ankle

anterior talofibular ligament is most often a torn component

50
Q

eversion sprain

A

over elevated of the lateral border of the foot

pg 344

51
Q

Pott’s fracture

A

bimaleolar ankle fracture

forced eversion of the ankle

avulsion fracture of the medial malleolus (tibia) via the deltoid ligament

talus shifts resulting in fracture of the lateral malleolus (fibula)

results in total disruption of the mortise of the ankle joint

52
Q

femoral artery compression?

A

decreased pulse in the femoral triangle

p. 344

53
Q

popliteal artery

A

p. 345

54
Q

posterior tibial artery

A

p. 345

55
Q

dorsalis pedis artery

A

p. 345

should have equal pulses

palpated inferior to the extensor retinaculum lateral to the tendon of the extensor hallucis longus

NOTE– some people have a condition where the dorsalis pedis artery is congenitally absent

56
Q

msculovenous pump

A

contraction of the muscles within a fascial limited space places pressure upon deep veins contained within the same muscular compartment and assists in venous return against gravity

venous valves prevent backflow during periods of alternating skeletal muscle contraction and relaxation

57
Q

varicosities

A

weakened superficial veins which dilate under the pressure of the supported column of blood

venous valves are no longer competent because they no longer appose

degenerated deep fascia reduces or eliminates the musculovenous pump

58
Q

saphenous vein grafts (greater saphenous v.)

A

p 346

59
Q

saphenous cut downs (greater saphenous v. )

A

pg 346

60
Q

saphenous varix

A

p. 346

infrequent dilatation of the terminal portion of the greater saphenous vein

causes a swelling in the femoral triangle

can be misdiagnosed as other femoral hernia, psoas abscess

61
Q

what do you use for right cardiac angiography

A

femoral vein

62
Q

DVT

A

clot formation as a result of prior trauma

vascular stagnation due to reduced physical activity for prolonged periods

weakened muscular fascia resuliting in musculovenous pump

63
Q

lymphangitis and lymphandenopathy

A

pg 346

64
Q

thromboembolism and thrombophlebitis

A

p. 346

65
Q

what does a femoral nerve injury look like

A

Loss of Patellar Reflex: L4

loss of anterior femoral compartment musculature

loss of leg extension (of the knee) with reduced flexion of the thigh

no sensation along medial leg anteriorly and anterior thigh

66
Q

lose the obturator nerve?

A

Compression results in decreased/weakness
in flexion,

adduction and rotation of the thigh
and paresthesias of the medial thigh

skin patch on the interior thigh

67
Q

sciatic nerve piriformis syndrome

A

the tibial and common fibular components of the sciatic nerve are split by a portion of the piriformis

if a person exercise their butt (extending and abducting) a lot it may cause compression on this nerve (the fibular component)

this results in complete loss of eversion and dorsiflexion
-numbness on the lateral anterior portion of the leg and dorsum of the foot

68
Q

what happens if you lose the sciatic nerve

A

lose the hamstrings and the gastrocnemius (knee flexors), everything going to the foot

Weakness of extension of the thigh,

major loss of flexion of the leg,

complete loss of inversion, eversion, plantar and dorsiflexion of the foot

Loss of Achille’s reflex (S1)

69
Q

gluteal injections ? where do you put it

A

go more towards the crest of the ilium

70
Q

what is the cause of hip drop

A

superior gluteal nerve damage

gluteus medius

71
Q

inferior gluteal n damage

A

going up steps, getting off toilet, is hard

weakness of the gluteus maximus

p 348

Loss of gluteus maximus (note loss of gluteal contour)

Difficulty going up stairs, especially on affected limb during push-off; difficulty getting up from a sitting position

72
Q

loss of tibial nerve

A

Loss of posterior superficial & deep compartments of the leg and ALL plantar foot muscles

Inability to plantarflex
reduced inversion of the foot;
decreased leg flexion;
loss of calf contour

Foot held in dorsiflexion and eversion***

Loss of the majority of cutaneous sensation to the sole of the foot

Loss of Achille’s reflex (S1)

73
Q

common fibular nerve damage

A

Loss of lateral & anterior compartments of the leg

Loss of dorsiflexion and eversion of the foot

Foot held in plantar flexion and inversion

lose

74
Q

superficial fibular nerve damage

A

Loss of musculature of the lateral compartment of the leg

Loss of eversion with reduced plantarflexion

Foot held dorsiflexed and inverted

75
Q

deep fibular nerve

A

Loss of musculature of the anterior compartment of the leg

Loss of dorsiflexion and reduced inversion of the foot

Foot held plantar flexed with slight eversion

76
Q

foot drop

A

loss of tibialis anterior L4

tibialis anterior has eccentric and concentric contraction so helps a person walk quietly

loss of extensor hallucis longus L5

MSK exam 3 AP lower limb (15 decks)

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