Clinical: Lower Extremity--Luehr

Question 1

Large central disk herniation at L4/L5. What will it take out?

Answer 1

L5, S1, S2, S3, S4.

This is called cauda equina syndrome.

You would see saddled (butt and leg) anesthesia + likely incontinence.

Emergency!

Question 2

Deep gluteal pain felt over the lateral buttox, usually due to repetitive action like climbing stairs or running on a steeply elevated treadmill or hills

Answer 2

Trochanteric bursitis

Question 3

True hip pain presents as what?

Answer 3

groin and sometimes butt (real medical term!?) pain

Question 4

The blood supply to the femoral head?

Answer 4

Primarily via the circumflex femoral artery. Starts at neck and goes to femoral head.

With a femoral neck fracture the blood supply to the femoral head is at risk for avascular necrosis.

Question 5

Why could the hip joint collapse with avascular necrosis?

Answer 5

Bones supply structural and nutritional support for the overlying cartilage.

Question 6

Lachman’s test

Answer 6

30 degrees knee flexion

Tests the ACL (and PCL)

Question 7

Drawer sign

Answer 7

sit on foot

pull anterior for ACL

push posterior for PCL

Question 8

Metatarsalgia and Morton’s Neuroma

Answer 8

Neurologic condition that is often due to compression to the digital nerve between the 3rd and 4th toe

Question 9

Plantar Fasciitis**

Answer 9

aka **heel spur **

Heel hurts tremendously (just medial-typicaly)

Treatment = rest, stretching (gastrocnemeous and “pull toes up”) and heel cups* that spreads out pressure on the heel.

Use *posterior splint* with complicated cases.

Question 10

How do you test for an Achille’s tendon rupture?

Answer 10

Patient often complains with weakness in plantarflexion. When squeezing the gastrocnemeous, the foot should plantarflex.

Question 11

What is the most common ligament torn in an inversion ankle sprain?*

Answer 11

anterior talofibular ligament

Question 12

What might suggest the need for a radiograph in an ankle sprain?

Answer 12

Tenderness in any of the following: posterior edge or tip of lateral malleolus, posterior edge or tip of medial malleolus, base of 5th metatarsal, navicular.

Question 13

What are the three components of the lateral collateral ligamenet of the ankle?

Answer 13

posterior talofibular ligament (test with anterior drawr sign)

cacaneofibular ligament

anterior talofibular ligament (most often ruptured in ankle sprain)

Question 14

What might happen in an eversion ankle sprain?

Answer 14

Deltoid ligament

More often associated with fracture and a need for surgery. Must check for alignment of:

tibia (medial malleolus) and talus

Question 15

What is a high ankle sprain?*

Answer 15

(aka *syndesmotic sprain*)

Caused by forced dorsiflexion

Tibiofibular ligament tear

Associated with fracture. Takes forever to heal.

Question 16

Pes Anserine bursitis**

Answer 16

(gooses foot). Pain just below the knee on the medial side. Caused by the semimembranosus bursa.

*3 muscles: Sartorius, Gracilis, Semitendinosus*

Treatment = steriod injection

Question 17

Osgood Schlatter’s disease**

Answer 17

“Jumper’s knee” (young teenager ~12years). Tibial tubercle apophseal traction injury.

Question 18

Knee sprain

Answer 18

first ask questions: how quickly did it start swelling?

immediatly = vascualar disruption = tear!

later = less serious injury

Question 19

The terrable three/O’ Donoghue Triad**

Answer 19

MCL,

ACL (anterior drawr sign*/anterior lockmans)

Medial Meniscus

Question 20

Housemaid’s knee

Answer 20

Prepattellar Bursitis–swelling across anterior portion of patella.

comes from kneeling a lot

Question 21

Patella femoral syndrome treatment

Answer 21

treatment = physical therapy + knee sleve