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Lower Extremity Anatomy > Clinical Leg > Flashcards

Clinical Leg Flashcards

1
Q

Common fibular nerve (L4-S2) pathway

A
  • From sciatic nerve
  • Passes around fibular neck
  • Enters lateral compartment by passing through posterior intermuscular septum
  • Bifurcates into terminal branches
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2
Q

Bifurcation of someone fibular nerve (L4-S2) terminal branches

A
  • Deep fibular nerve

- Superficial fibular nerve

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3
Q

Deep fibular nerve pathway

A
  • Terminal branch of common fibular nerve
  • passes through anterior intermuscular septum
  • Enters anterior compartment
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4
Q

Common fibular nerve (L4-S2) injury

A
  • Susceptible to injury as it passes around fibula
  • Prolonged compression
  • Trauma
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5
Q

Prolonged compression of common fibular may result from

A
  • Tight casts

- Excessive sitting/sleeping position

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6
Q

Injury to common fibular nerve (L4-S2) associated with

A
  • Footdrop (increased tripping with gait)
  • Weak dorsifelxion, to extension, and eversion
  • Steppage gait
  • Loss of sensation of distal anterolateral leg, dorsum of foot, 1st web space
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7
Q

Transmalleolar angle

A
  • Line between center of medial/lateral malleoli
  • In relation to line passing through knee joint axis
  • Measures tibial torsion
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8
Q

Normal range of tibial torsion

A
  • Childhood: -10-0 degrees

- Adults: 10-15 degrees external rotation

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9
Q

Obtaining tibial torsion angle

A
  • Measure transmalleolar angle

- Can also use thigh foot angle

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10
Q

Measuring transmalleolar angle

A
  • Patient prone
  • Line through the longitudinal axis of the thigh
  • Line perpendicular to the most prominent point of the malleloli
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11
Q

Measuring thigh foot angle

A
  • Patient prone

- Line bisecting foot and line bisecting thigh

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12
Q

Kager angle

A
  • Radiolucent triangle seen one lateral radiographs

- Kager fat pad (pre-calcaneal fat pad/pre-Achilles fat pad)

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13
Q

Kager triangle may be obliterated by pathologies

A
  • Achilles pathology (tearing, inflammation)
  • Calcaneal fracture
  • FHL tendon pathology
  • Accessory soleus muscle
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14
Q

Tarsal tunnel syndrome

A
  • Compressive neuropathy of tibial nerve or it’s branches within the tarsal tunnel
  • Porta pedis is also entrapment site
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15
Q

Symptoms of tarsal tunnel syndrome

A
  • Altered sensation of medial/plantar foot and medial ankle (tibial nerve distribution)
  • Atrophy of intrinsic foot muscles (prolonged compression)
  • Tinel sign
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16
Q

Tinel sign

A
  • Pain with tapping

- Percussing the nerve in tunnel

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17
Q

Symptoms of tarsal tunnel syndrome may be reproduced by

A
  • Sustained dorsiflexion of ankle and MTPJs

- Sustained plantarflexion and inversion

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18
Q

Tarsal tunnel syndrome may be treated

A
  • Surgically

- Conservatively

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19
Q

Boundaries of tarsal tunnel

A
  • Medial: flexor retinaculum (laciniate ligament) and abductor hallucis
  • Lateral: calcaneus, posterior talotibial and calcaneotibial ligaments
  • Distal margin: porta pedis
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20
Q

Tarsal tunnel MEDIAL boundary

A
  • Flexor retinaculum (laciniate ligament)

- Abductor hallucis

21
Q

Tarsal tunnel LATERAL boundary

A
  • Calcaneus
  • Posterior tibial and calcaneotibial ligaments
  • Tibia, talus, calcaneus (body and sustentaculum tail)
22
Q

Tarsal tunnel DISTAL MARGIN

A
  • Porta pedis
23
Q

Ankle nerve blocks used for

A
  • Procedures fo the foot
  • Pain relief
  • When more local is not possible, etc.
24
Q

Ankle blocks avoid general anesthesia, avoiding

A
  • Motor block of the leg muscles

- Sensory of the leg

25
Q

Ankle blocks avoid releasing

A
  • Anesthesia into vessels and puncturing nerves

- Anesthesia is released around the nerve

26
Q

Most of the foot is innervated by nerves derived from

A
  • Sciatic nerve (except 1)
  • 5 nerves located at ankle (sensory innervation foot)
  • (3 superficial, 2 deep)
27
Q

3 superficial ankle nerves

A
  • Saphenous
  • Sural
  • Superficial fibular
28
Q

2 deep ankle nerves

A
  • Posterior tibial

- Deep fibular

29
Q

Posterior tibial nerve is blocked via

A
  • Medial calcaneal branches

- Medial/lateral plantar nerves

30
Q

Sural nerve blocks

A
  • Lateral ankle
  • Lateral heel
  • Lateral foot
  • Lateral 5th digit
31
Q

Deep fibular nerve blocks

A
  • 1st web space
  • Superficial fibular
  • Most of the dorsum of the foot and toes
32
Q

Saphenous nerve blocks

A
  • Medial foot
33
Q

Subcutaneous nerve blocks at level of malleoli

A
  • Saphenous
  • Superficial fibular
  • Sural
  • Where they are blocked depends on procedure
34
Q

Deep fibular nerve block landmarks

A
  • EHL and TA tendons

- Medial malleolus

35
Q

Perimalleolar (deep fibular nerve block)

A
  • Lateral to EHL

- Level of the superior aspect of medial malleolus

36
Q

Midtarsal (deep fibular nerve block)

A
  • Lateral to EHL

- Medial to dorsalis pedis artery pulse

37
Q

Superficial fibular nerve block

A
  • Subcutaneous between lateral malleolus and EHL tendon (landmarks)
  • Perimalleolar
  • Anesthesia is administered in the area between the 2 landmarks
38
Q

Perimalleolar (superficial fibular nerve block)

A
  • Between superior aspect of lateral malleolus and EHL
39
Q

Sural nerve block

A
  • Perimalleolar

- Anesthesia is administered between the 2 landmarks

40
Q

Perimalleolar (sural nerve block)

A
  • Subcutaneous

- Between Achilles tendon and superior aspect of lateral malleolus

41
Q

Posterior tibial nerve block

A
  • Perimalleolar
  • Posterior to posterior tibial pulse
  • (Midway between superior aspect of medial malleolus and Achilles tendon)
42
Q

Perimalleolar (posterior tibial nerve block)

A
  • Deep to the deep fascia

- Posterior to medial malleolus

43
Q

Saphenous nerve block

A
  • Perimalleolar

- Saphenous vein is nearby and can be punctured easily

44
Q

Perimalleolar (saphenous nerve block)

A
  • Subcutaneous between TA tendon and medial malleolus
45
Q

Posterior tibial nerve blocks

A
  • Plantar foot
  • Medial heel
  • Toe tips
46
Q

Deep fibular nerve block location

A
  • Deeply located at ankle

- Deep to deep fascia

47
Q

Types of deep fibular nerve blocks

A
  • Perimalleolar

- Midtarsal

48
Q

Deep nerve blocks at level of malleoli

A
  • Deep fibular
  • Posterior tibial
  • Located deep to retinacula
  • More superficial distally
  • Where they are blocked depends on procedure

Lower Extremity Anatomy (35 decks)

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