Clinical Correlations of the Lower Limb Flashcards
femoral hernia
protrusion of viscus through femoral ring into femoral canal
more common in females
protrusion in femoral triangle inferolateral to pubic tubercle
-may protrude through the saphenous opening and impede venous return of greater saphenous vein**
unique location to palpate a bump
compartment syndrome of leg
infection, inflammation, or arterial hemorrhage within a fascial compartment of leg can produce pressure increases within compartment high enough to:
reduce blood supply to muscles impinge nerves (paresthesias and paralysis)
severe cases require fasciotomy to relieve these compressive forces prior to occurence of tissue necrosis
groin strain
adductor group pulls up usually during fast hip flexion
hamstring strain
strains of semimembranosus, semitendinosus, biceps femoris usually near the ischial tuberosity as a result of fast extension (push off in running)
ruptured achilles tendon
weekend warrior
-increased age and irregular exercise (rapid push offs of feet are required)
psoas abscess
due to retroperitoneal abdominal or pelvic infection that descends within psoas fascial sheath
descends deep to ingunial ligament resulting in pain and swelling within femoral triangle
can be mistaken for:
-femoral hernia, indirect inguinal hernia, inflammation of inguinal lymph nodes, saphenous varix
**inflammation of kidney - close to psoas
tibialis anterior strain
aka shin splints
microtears in periosteal attachments of distal 2/3 of tibialis anterior to tibia (sharpeys fibers)
resulting in pain
also swelling and inflammation within muscle decreases vascular exchange and leads to pain
usually from overuse or infequent bouts of exercise not preceded by stretching or warming up
running on hard surfaces after having trained on softer surface
calcaneal tendonitis
microtears in attachment of calcaneal tendon to calcaneal tuberosity as result of overuse, poor footwear or train surfaces
avulsion fractures
fragment being pulled away from bones by rapidly loading tendons
pelvis, tibial tuberosity, ankle, foot
pelvic avulsion fractures?
ischial tuberosity
ASIS
AIIS
ischiopubic rami
tibial tuberosity avulsion fractures?
osgood shlatter**
ankle avulsion fracture
lateral and medial malleloli
foot avulsion fracture
5th foot metatarsal
osgood schlatter
tibial tubercle apophyseal traction injury
avulsion of patellar ligament from tibial tuberosity
malleolar avulsion fraction
occurs during eversion
avulsed by deltoid ligament
avulsion of 5th metatarsal
fibularis brevis attachments pulls bone off
fracture of femur neck
increased compressive forces on an osteoporotic leg
shortened limb and require internal fixation
greater trochanter and shaft femur fracture
direct trauma to falls or vehicular accidents
distal femoral fractures
fractures of femoral condyles or between condyles
**salter harris classification
both result in aberration of articular surfaces of knee joint
may disrupt blood supply to knee or leg
patella fracture
transverse
- avulsion type due to sudden forceful contraction of quadriceps
- direct blow
salter harris classification
3 and 4 - give you instability
-dividing lateral and medial compartments
all threat to growth of bone if with epiphysis
bipartite or tripartite patella?
growth centers that didn’t fuse correctly
often misinterpreted as fractures
most often fracture of tibia?
near junction of middle and distal third
-narrow and least vascularized
tibia fractures
subQ location - prone to compound fracture
fracture of tibia through nutrient foramen
can lead to non-union
fracture of medial malleolus?
excessive eversion
fibula fracture?
most common just proximal to lateral malleolus
often associated with fracture dislocations of ankle and distal tibial fractures
fracture of lateral malleolus due to contact with talus during excessive inversion
what is most likely for bone graft procedures
fibula (not weight bearing)
calcaneus fracture
most often fractures as a result of hard falls directly on heel
talus fractures
mot often fractures during forced dorsiflexion
normal male Q angle
14 degrees
normal female Q angle
17 degrees
CCD angle?
caput - collum - diaphyseal angle
normal 120 degrees
coxa vara
decreased CCD angle (less than 120)
slight decrease in length of affected limb
with increased Q angle, opens medial knee joint space resulting in genu valgum - increased likelihood of patellar dislocation
Q angle
angle between line drawn from center of patella to ASIS and line between middle patella and hip joint
coxa valga
increased CCD angle (greater 120)
slight increase in length of affected limb
with decreased Q angle opens lateral knee joint space resulting in genu varum
genu valgum
decreased CCD, increased Q angle
opens medial knee joint
increased occurence of patellar dislocation
genu varum
increased CCD, decreased Q angle
opens lateral knee joint
wide knees
coxa valga
wears out medial meniscus
knock kneed
coxa vara
wears out lateral meniscus
slipped capital femoral epiphysis
trauma in region of proximal femoral epiphysis
usually occurs in adolescent prior to epiphyseal plate closure
distal fragment dislocates posteriorly leading to coxa vara
avascular necrosis of femoral head
disruption of arteries that surround femoral neck to provide branches to femoral head can lead to femoral head necrosis
branches of medial femoral circumflex most often implicated
hip dislocation
capsule loosest when thigh in flexion
hitting dashboard with knee - posterior dislocation