FINAL EXAM Flashcards
CAUDAL
tail end
Coronal / frontal plane
anterior / posterior halves
Sagittal plane
L + R halves
Axial Plane
upper and lower halves
Auricle / Pinna
collects sound for localization + directs high freq. sound to eardrum
Ext Auditory Canal
increases sound pressure at TM by 5-6 dB
Mastoid Process
supports external ear and posterior wall of middle ear
TM
vibrates in repsonse to sound
-changes acoustic energy to mechanical energy
Ossicular Chain
incus, malleus, stapes
-lever system
Eustachian tube
connects middle ear to nasopharynx
-equalizes air pressure
-not part of hearing process
Stapedius Muscle
connects stapes to middle ear wall
-contracts in response to loud sounds (Acoustic reflex)
Cochlea
converts mechanical energy into acoustic energy
Oval Window
sets cochlear fluid into motion by vibration of the footplate of stapes
Round Window
pressure relief port for cochlear fluid
Organ of Corti
end organ of hearing
-hair cells and stereocilia
Vestibular System
controls balance and shares fluid w/ cochlea
-no part in hearing
Hair cells
where fibers of auditory/CN 8 are present
Auditory Cortex
temporal lobe of the brain where sound is perceieved and analyzed
Parotid gland
-function: secretes saliva through Stenson’s duct, facilitates mastication/swallowing [alpha amylase breaks down amylopectin and amylose]
-sympathetic innervation: superior cervical ganglion –> internal carotid artery
-parasympathetic innervation: inferior salivatory nucleus –> auriculotemporal nerve
Tip of the tongue
sweet
Anterior/lateral tongue
salt
Middle/lateral tongue
sour
Posterior Tongue
bitter
Cranial nerve supplying Anterior 2/3 Tongue
CN 7/ Facial
Cranial nerve supplying Posterior 1/3 Tongue
CN 9/Glossopharyngeal
Elevatory nasal muscles
-proceris
-levator labii
-superioris alaque nasi
Depressor nasal muscles
-alar nasaris
-depressor septi nasi
Compressor nasal muscles
transverse consalis
Dilatory nasal muscles
posterior and anterior dilator nasaris
External nasal vascular supply
-artery = facial
-sellar and dorsal areas = internal maxillary, infraorbital and opthalmic
-veins = same as arteries
-lymphatics = retropharyngeal (posterior) and upper deep cervical/submandibular (anterior)
Internal nasal vascular supply
-Kiesselbach plexus = anterior 1/3 septum
-sphenopalatine = posterior inferior
-ethmoid = anterior and posterior superior
-superior labial artery = anterior
-greater palatine = posterior
-veins = same as arteries (direct communication with cavernosus sinus - no valves)
8 Cranial bones
-frontal bone
-parietal bone (2)
-temporal bone (2)
-sphenoid
-ethmoid
-occipital
Facial bones (14)
-lacrimal (2)
-mandible
-maxilla (2)
-nasal (2)
-palatine (2)
-vomer
-zygomatic (2)
-inferiro nasal conchae (2)
Cranial sutures
- coronal = parietal + frontal
- squamous = parietal + temporal
- lamboid = parietal + occipital
- occipitomastoid = occipital bone + mastoid process
- sagittal = atriculation between 2 parital bones
Motor Spinal Nerves
anterior / ventral roots
Sensory Spinal Nerves
posterior/dorsal roots
White Matter
myelinated axons connecting to grey matter for impulses
-bulk of the brain + superficial spinal cord
Grey Matter
unmyelinated neurons that routes sensory/motor input to interneurons of CNS
-major component of CNS
-nerve cell bodies
-glial cells (astroglia + oligodendrocytes)
-capillaries
-axons/dendrites
Motor Tracts
-corticospinal tract = voluntary
-extra pyramidal = basal ganglia
-rubro/reticulospinal tracts= smoothing of muscle activity
-upper motor neurons (UMN) = fibers from corticospinal tract that synapse with LMN in anterior horn of spinal cord
UMN vs LMN
-UMN
1. no atrphy
2. no fasiculations
3. spasicity
4. DTRS increased
5. contractures
6. EMG normal
-LMN
1. atrophy
2. fasiculations
3. flaccidity
4. DTRS decreased or absent
5. no contractures
6. EMG denervation
Wernicke’s Aphasia (AREA 22)
speech preserved with incorrect language content
-rate, intonation and stress are normal
-substitutions of one word for another
-comprehension/repitition are poor
“wacky wernicke”
Broca’s Aphasia (AREA 44 + 45)
unable to create gramatically correct + complex sentences
-expressive, motor, nonfluent aphasia
-pts aware of inability to speak
-normal comprehension but some trouble understanding complex sentences
“broken broca”
Limbic System
influences the formation of memory by integrating emotional states with stored memories of physical sensations
Telencephalon
-limbic
-cerebral cortex
-basal ganglia
-olfactory bulb
Diencephalon
between brainstem and cerebrum
-thalamus
-epithalamus
-subthalamus
-hypothalamus
Thalamus
Diencephalon
processing center of cerebral cortex
-regulates functional activity if cortex via integration of afferent input to cortex (except olfaction)
-contributes to affectual expression
Epithalamus
Diencephalon
conneciton between limbic system to other parts of the brain
Hypothalamus
DIencephalon
intergration center of ANS regulating body temperature and endocrine function
-anterior = parasympathetic (maintenance)
-posterior = sympathetic (fight/flight)
-behavioral patterns
-appestate = feeding cneter
-pleasure center
Subthalamus
Diencephalon
controls motor functions
-contains subthalamic nuclei + nerve tracts
Basal Ganglia
large collections of nuclei that modify movement (min to min basis)
-receives info via motor cortex
-sends to cortex via thalamus
-output = inhibitory (vs cerebellum - excitatory)
-works with cerebellum to balance / coordinate movement
Reticular System
-ascending / activating = provides input from all sensory organs to thalamus and cortex is repsonsible for arousal from sleep, wake, attention
-descending = projects to ANS; extrapyrimidal output to voluntary muscles via pontine tegmentum
Medulla
controls autonomic function and relays signals between brain and spinal cord
-CN 8 through 12
-Medulla oblongata = RR, BP, HR, reflex arcs, vomiting
Pons
relays sensory information between cerebellum and cerebrum
-CN 5, 6, 7
-regulates RR via pneumotaxic center
Archicerebellum
maintains equilibrium
Paleocerebellum
maintains muscle tone
Neocerebellum
controls coordination
Dura Mater
-superifical = skull’s inner periosteum
-deep = dura mater proper
-tentorium cerebelli = between/separates cerebellum and brainstem from occipital lobes of cerebrum
-falx cerbi = separates 2 hemispheres of the brain (in longitudinal fissure)
outer meningeal layer
Arachnoid Mater
middle meningeal layer
-separated from pia mater by subarachnoid space
Pia Mater
delicate, thin, fibrous tissue membrane attached to brain or spinal cord
-outer surface = impermeable to fluid
-pierced by blood vessels traveling to brain and spinal cord
-capillaries nourish brain
Epidural meningeal space
if bleeding occurs, it will separate the periosteum from dura
Subdural meningeal space
enlarges as the brain atrophies
below dura and above arachnoid
Subarachnoid meningeal space
major blood vessels and CSF
between pia and arachnoid
Sympathetic NS
ANS
fight or flight
-T1-L3 ateral grey of spinal cord
-noradrenaline
-increases HR, RR, dilate pupils
Parasympathetic NS
ANS
basal metabolism
-brainstem and spinal cord
-ACh
-slows HR, RR and constricts pupils
C2 + C3
Dorsal Sensory Roots
posterior head and neck
C4 + T2
Dorsal Sensory Roots
adjacent to each other in upper thorax
T4 + T5
Dorsal Sensory Roots
nipple
T10
Dorsal Sensory Roots
umbilicus
Upper extremity
Dorsal Sensory Roots
-C5 = anterior shoulder
-C6 = thumb
-C7 = index and middle finger
-C7/8 = ring finger
-C8 = pinky
-T1 = inner forearm
-T2 upper inner arm
-T2/3 = axilla
Lower extremity
Dorsal Sensory Roots
-L1 = anterior upper inner thigh
-L2 = anterior upper thigh
-L3 = kneww
-L4 = medial malleolus
-L5 - dorsum of foot + toes 1-3
-S1 = toes 4+5 + lateral malleolus
-S3/C1 = anus
Radial Nerve
Brachial Plexus
-posterior cord
-triceps
-extensors
-sensory = dorsum of hand
-saturday night palsy
Median nerve
Brachial Plexus
-median and lateral branches of brachial plexus
-anterior interosseus
-palmar cutaneous branch
-all flexors except FCU and FDP
-pronator teres and quadratus
Ulnar Nerve
Brachial Plexus
-median branches brachial plexus
-FCU and medial FDP interssei
-adductor policis
-opponens digiti minimi
-abductor digiti minimi
-flexor digiti minimi brevis
Lateral Femoral Cutaneous Nerve
Lumbar Plexus
-L2+L3
-pure sensory
Sciatic nerve
Lumbar Plexus
-largest of all peripheral nerves
-runs posterior
-divides into peroneal and posterior tibial
Peroneal Nerve
Lumbar Plexus
-2 articular branches = accompnay superior and inferior lateral geniculars to knee
-third articular branch = point of division of common peroneal; ascends with recurrent tibial artery through tibials anterior to front of knee
-lateral sural cutaneous nerve = supplies ksin on posterior and lateral surfaces of leg
Tibial Nerve
Lumbar Plexus
-motor innervation = muscles of posterior compartment of leg (superficial + deep)
-sensory innervation = posterior aspect of leg and sole of foot
-terminates by bifurcating into medial and lateral plantar nerves in sole of foot
CN 1 - Olfactory
-function = smell
-innervation = anterior olfactory nucleus in olfactory tract
-sensory
CN 2 - Optic
-function = vision
-innervation = lateral geniculate nucleus in thalamus
-sensory
CN 3 - Oculomotor
-function = elevation/adduction of eye
-innervation = oculomotor and edinger nuclei in midbrain
-motor
CN 4 - Trochlear
-function = depression of adducted eye (SO4)
-innervation = trochlear in midbrain
-motor
CN 5 - Trigeminal
-function = facial sensation / mastication
-innervation = principal in pons, spinal in medulla, mesencephalic in pons/midbrain
-both
CN 6 - ABducens
-function: abduction of eye (LR6)
-innervation: abducent in pons
-motor
CN 7 - Facial
-function: facial expression, taste, sensation (anterior 2/3 tongue)
-innervation: motor, solitary, superior salivatory in pons
-Both
CN 8 - Vestibulocochlear
-function: balance and hearing
-innervation: vestibular and cochlear in medulla
-sensory
CN 9 - Glossopharyngeal
-function: taste, salivation, pharynx (posterior 1/3 tongue)
-innervation: nucleus ambiguus, solitary, inferior salivatory in medulla
-Both
CN 10 - Vagus
-function: swallow, speech, GI, cardiac, RR
-innervation: nucleus ambiguus, solitary, dorsal motor vagal
-both
CN 11 - Accesory spinal
-function: pharynx, larynx, SCM, trapezius
-innervation: nucleus ambiguus in medulla + spinal accessory in cervical cord
-motor
CN 12 - Hypoglossal
-function: tongue movement
-innervation: hypoglossal in medulla
-motor
Anterior group muscles of hip
-iliopsoas
-tensor fasciae latae
Posterior group muscles of hip
-gluteus max
-gluteus min
-gluteus medius
-piriformis
Anterior group muscles of thigh
quadriceps femoris + sartorius
Medial group muscles of thigh
-pectineus
-adductor longus
-adductor brevis
-gracilis
-adductor magnus
Posterior group muscles of thigh
-biceps femoris
-semitendinosus
-semimembranosus
Quadriceps
extension and stability of patella from superiorly
-rectus femoris
-vastus medialis
-vastus intermedius
-vastus lateralis
Hamstrings
-biceps femoris
-semitendinosus
-semimembranosus
Iliotibial band
causes hip pain + most common L extremnity injury (esp athletes)
Anterior group muscles of the leg
-tibialis anterior
-extensor digitorum longus
-extensor hallucis longus
Posterior group muslces of the leg
-superficial
1. gastrocnemius
2. soleus
-deep
1. tibialis posterior
2. flexor digitorum longus
3. flexor hallucis longus
Lateral group muscles of leg
-peroneus longus and peroneus brevis
Extensor digitorum brevis
Dorsum Foot
dorsiflexion of digits
-innervation = deep peroneal nerve (S1-S2)
Extensor hallucis brevis
Dorsum Foot
dorsiflexion of 1st digit
-innervation: deep peroneal nerve (S1-S2)
Plantar Aponeurosis
Sole Foot
maintains longitudinal arch of foot and protects nerves/BV
Lumbriclas (4)
Sole Foot
plantar flexion of 2-5th digits
-innervation: medial plantar nerve (1st digit) + lateral plantar nerve (2-4th digits)
Ventricles
make and transport CSF
Lumbar Plexus
anterior + within psoas
-T12-L4
Lately Suzie’s In Heat Inappropriately Ill Gaining Lots of Fun Cuz of Fuckboys
(Lumbar = subcostal, iliohypogastric, ilioinguinal, genitofemoral, Lateral femoral cutaneous, Obturator, Femoral)
Obturator Nerve
Lumbar Plexus
L2, L3, L4
-sensory: skin medial thigh, hip, knee joints
-motor: adductor muscles
Femoral Nerve
Lumbar Plexus
L2, L3, L4
-sensory: thigh, leg, foot
-motor: anterior thigh muscles (quads)
Lateral Femoral Cutaneous Nerve
Lumbar Plexus
L2 + L3
-sensory = skin lateral thigh
Genitofemoral nerve
Lumbar Plexus
L1 + L2
-sensory: skin scrotum,, labia major, anterior thigh
-motor: cremaster muscle
Lumbosacral trunk
L4 and L5
Subcostal nerve
Lumbar Plexus
T12
Iliohypogastric nerve
Lumbar Plexus
T12 - L1
Ilioinguinal nerve
Lumbar PLexus
L1
Sacral plexus
L4-S4
-caudal to lumbar plexus + mostly posterior structures
Some Love Calm Surfing In Peak Flow Think Peace
(sacral = lumbosacral [trunk], common [fibular of sciatic], superior [gluteal], inferior [gluteal], posterior femoral cutaneous, tibial [part of sciaitc], pudendal)
Sciatic nerve
Sacral Plexus
thickest nerve in the body
-motor: hamstring
L4 - S3
Tibial Nerve Branch (sciatic)
Sacral Plexus
ventral rami L4-S2
-sensory: posterior leg and sole of foot
-motor: posterior leg and foot
Common fibular / peroneal branch (sciatic)
Sacral PLexus
dorsal rami L4 - S3
-sensory: anterior/lateral leg + dorsum foot
-motor: lateral tib. anterior and toe extension
Superior gluteal nerve
Sacral Plexus
L4, L5, S1
-motor: gluteus med/min + tensor fasciae latae
Inferior gluteal nerve
Sacral plexus
L5, S1, S2
-motor: gluteus maximus
Posterior femoral cutaneous nerve
Sacral Plexus
S1, S2, S3
-sensory: inferior buttocks, posterior thigh + popliteal fossa
Pudendal nerve
Sacral PLexus
S2, S3, S4
-sensory: external genitalia and anus
-motor: muscles of perineum
Deep veins emptying into IVC
-plantar
-tibial
-fibular
-popliteal
-femoral
-ext/common iliac
Superficial veins
-dorsal venous arch = foot
-great sapphenous = empties into femoral
-lesser sapphenous = empties into popliteal
Dorsalis pedis
forms when anterior tibial passes under superior extensor retinaculum
-where pulse is felt
-deep branch joins plantar arch
-gives rises to lateral tarsal artery
Lateral Plantar artery
most of plantar arch
-gives rise to plantar metatarsal and proper plantar digital arteries
Loss of dorsalis pedis pulse:
-PVD (Burger’s or DM)
-occluded BV (gangrene)
-autoamputation of 1st toe
DVT
thrombus forms in deep veins of leg/thigh
-600k cases annually
-1/3 form PE (15% death)
-160 / 100k incidence
Untreated proximal DVT
-30-50% risk for PE
-15% mortality
Treated DVT
<8% risk for PE
<2% mortality
Symptomatic non fatal PE
20/100k
Fatal PE
50/100k
Virchow’s Triad
factors contributing to thrombosis
-venous stasis
-hypercoagulability
-endothelium damage
Principal VTE factors
-immoblization
-trauma
-surgery
-infection
-post partum period
Other VTE risk factors
-incr. 2x when older than 50 y/o
-obesity
-malignancy (20-30%)
-previous VTE (25%)
-varicose veins
-dehydration
-hormonal therapy
DVT signs/symptoms
-asymptomatic
-pain/tenderness
-erythema
-acute swelling
-pallor (phlegmasia alba)
-cyanosis (phlegmasia cerulea)
PE signs/symptoms
-dyspnea/tachypnea
-diaphoresis
-hemoptysis
-low grade fever
-pleuritic CP
-cough
-hypotension
-coma
CXR and EKG
Venogrpahy for DVT
ex gold standard
-20% failure
-contraindication in allergy and decreased renal function
Duplex Ultrasound for DVT
primary method for diagnosis
-comfortable, inexpensive, no risk
-sensitive for distal DVT
-less sensitive for proximal DVT
Superficial veins affectd by DVT
greater + lesser sapphenous
Deep veins affectd by DVT
-iliac
-femoral
-popliteal
-tibial
PVD/PAD/PAOD
occlusive disease of lower extremity
-common cause = atherosclerosis
-other causes: arteritis, embolism, aneurysm
-arterial narrowing –> decr. blood flow = pain
-decr. supply, incr. demand (fails to satisfy metabolic requirements)
-predictor of coronary/CV risk
-prevalence: 10-25% >55y/o
-4x more likely to die w/in 10 years
-ABPI <0.9
Symptomatic PVD survivial rate
22%
Asymptomatic PVD survival rate
78%
(70-80% of pts w PVD)
Critical limb ischemia (rest pain)
PVD
1-2% of pts w/ PVD
-low ABPI values
-25% mortality
-alive w/ 2 limbs = 50%
-amputation = 25%
-cardiovasc. mortality = 25%
-gangrene/ischemic ulcers
Typical PVD Pt
-diabetic (3-4x)
-smoker (2.5-3x)
-HTN (>50 + male + fam hx)
-hypercholesterolemia, AF, IHD, CVA, homocysteinuria
PVD Risk Factors
-age > 70
-age 50-59 w/ hx of DM or smoking
-age 40-49 w/ DM or one other RF
-leg symptoms suggestive of claudication w/ exertion or sichemic pain at rest
-abnormal L ext pulse
-atherosclerosis at other sites ((coronary, carotid, RAD)
Intermittent Claudication
PVD
reproducible pain on exercise which is relieved by rest/leg elevation
-chronic PVD
-sore legs at night relieved by hanging legs over bed
-10-35% of pts
Other signs/symptoms of PVD
-burning/aching feet (esp at night)
-cold skin/feet
-increased infections
-non healing ulcers
-asymptomatic
Critical Stenosis
PVD
impending acute ischemic limb
60% + of pts
Abdominal aorta and iliac
PVD
30% butt/hip claudication
+/- impotence = Leriche’s syndrome
Common femoral
PVD
thigh claudication
Superficial femoral
PVD
60% upper 2/3 calf claudication
Popliteal
PVD
lower 1/3 calf claudication
Posterior Tibial
PVD
foot claudication
Diagnosis of PVD
-invasive (gold standard) = IV DSA ; intervention while imaging w/ iodine based dye
-non invasive = CT/MR angiogram
Treatment of PVD
-risk factor modification: smoking cessation, decr. BP/BSL/lipids
-exercise: claudication rehab program (45-60 min 3x a week for 12 weeks)
-med management: antiplatelets (aspirin, clopidogrel), phosphdiesterase inhibitor (cilostazol), foot care
Percutaneous Coronary Intervention (PCI)
PVD
angioplasty+ stent for significant comorbidities whose life expectancy is less than 1-2 years
-poor response to rehab/meds
-disabled by claudication (poor quality of life)
-low risk w/ high success
Bypass Surgery
PVD
reverse sapphenous vein for femoro-popliteal bypass
-aorto-iliac or femoro-popliteal
-cochrane review = not enough evidence than bypass>PCI
Amputation to treat PVD
last resort
6 P’s of Ischemic Limb
PVD
-pain
-pallor
-pulseless
-parasthesia
-perishing cold (poikilothermia)
-paralysis
DDx Leg Pain: Vascular
DVT or PVD
DDx Leg Pain: neurospinal
-disc disease
-spinal stenosis (pseudoclaudication)
DDx Leg Pain: Neuropathic
-DM
-chronic ETOH
DDx Leg Pain: musculoskeletal
-osteoarthritis
-chronic compartment syndrome
Physical exam (PVD)
-inspection = thick shiny skin, hair loss/brittle nails, pallor, ulcers
-palpation: cool temp, irregular pulse, slow capillary refill, poor sensation
-auscultation: femoral bruits
-ABPI = systolic ankle BP/sys. brachial BP
-Buerger’s test = elevate leg 45 degrees (observe for pallor), elevate 90 degree dependent position look for red flushed foot
-pallor at 20 degrees = severe PVD
Salter Harris Fx 1
fx of physis
-hypertrophic zone
-increased width of physis
-undistrubed grwoth
-dx by presentation = point tenderness at epiphyseal plate
(same)
Salter Harris Fx 2
fx of metaphysis + physis
-epiphysis not involved
-most common
-minimal shortening/rare functional limitations
(above)
Salter Harris Fx 3
fx of epiphysis + physis
-hypertrophic zone and split down
-damage to reproductive layer
-rarely physical deformity
-good prognosis
-Tillaux FX = SH3 prone to diability
(below)
Salter Harris Fx 4
fx of epiphysis, physis + metaphysis
-similar to SH3 (intraarticular)
-chronic diability
-premature focal fusion (joint deformity)
(through)
Salter Harris Fx 5
epiphyseal plate only
-growth disturbances
-poor prognosis
-difficult dx in teens (made after premature closure. ofplate)
-only 2% of SH fx
(crush)
Germinal layer of cartilage
epiphysis
Route of Cartilage growth
epiphysis –> metaphysis
Route of neovascularization
metaphysis –> epiphysis
Damage to vascular supply…
disrupts bone growth
Damage to cartilage…
vascular interruption is not permanent
SH Fx prone to chronic disability
SH 3 + 4
Normal femur neck angle
125 dgerees
Coxa Vara
NOF angle <120 degrees
women + short llmbs
Coxa Valga
NOF angle >135 degrees
Trochanteric Anastomosis
supplies NOF and head
-superior gluteal
-inferior gluteal
-medial circumflex
-lateral circumflex
“retinacular arteries”
Subcapital Fx
(NOF)
close to femoral head
common in elderly
Cervical Fx
(NOF)
midpoint neck
Basal Fx
(NOF)
close to shaft
-partly intra + extra capsular
-better union than subcapital FX
Complete Fx
(NOF)
vascular interruption to head of femur
-round ligament isnt strong enough to prevent avascular necrosis
Nonunion of NOF Fx due to
synovial fluid
-bathes fragments + inhibits osteogenesis
Patella stability maintained by:
-superiorly: quadriceps
-inferiorly: patellar ligament
-laterally: lateral condyle of femnur
-medially: vastus medialis
Patellar dislocation
comes out of joint by awkward twist motion
-pulled laterally to remain in line with muscle
-women >men (shallow/wide hips)
-genu valgum (knock kneed)
Patella Fx: Direct MOI
direct blow/fall/MVA (dashboard)
-small amount of tissue + femur contact drives force to patella
-considerable communition = little displacement
Patella Fx: Indirect MOI
jumping, rapid flexion against fully contracted quadricep muscles
-less communited
-displaced/transverse
Tib Fib Fx
-1 bone: little displacement (intact bone acts as splint)
-both bones: distal fragment pulled up by proximal fragment (by gastrocnemius and soleus)
-tibia fx: usually open
-ischemic necrosis w/ delayed union/nonunion = tibial nutreint artery torn in distal 1/3 fx
Distal leg Fx
common and usually indirect MOI
-Potts
-Dupuytrens
Pott’s Fx
Distal leg fx
medial + lateral malleolus fx
-ankle rolled in or out beyond ROM
-severe ankle sprain mayb pull bone off with ligament
-forcible ankle eversion
-symptoms = severe ankle pain, unable to bear weight, tenderness at malleoli
Dupuytren’s Fx
Distal Leg Fx
fx of distal fibula (lateral malleolus) + talus thrust upwards between tibia and fibula
-rupture of tib fib ligamanets
-diastasis of syndesmosis
-lateral dislocation. oftalus
-up and out foot diaplcement
Syndesmosis
fibrous tissue cord/ligament
-ankle ring= tibial plafond, medial malleolus, deltoid ligaments, syndesmosis, calcaneus, lateral collateral ligaments, lateral malleolus
-fx of single part = usually stable
-fx >1 part = unstable
-no true movement
-ex. distal tib fib joint
Syndesmosis Injury
tear/strain of anterior tib fib ligament
-high ankle sprain
-football, skiing, basketball
-slow to heal + tender to palpate
-painful external rotation on foot
-MOI: excessive dorsi/plantar flexion
-stress test: kleiger’s
-incorrectly treated at lateral ankle sprain (diff MOI/treatment)
-symptoms: + external rotation test, severe pain, “squeeze” test = pain @ syndesmosis
Wevber Classification
level of fib fx relative to syndesmosis
-describes lateral malleolus fx + integrity of syndesmosis
Weber A
below syndesmosis (intact)
-usually stable
-medial malleolus fx
-reduction, cast, ORIF usually needed
Weber B
level of syndesmosis (intact / partial tear)
-possible medial fx or deltoid damage
-variable stability
-may require oRIF
Weber C
above syndesmosis (damaged)
-unstable widening of joint
-medial fx or deltoid injury
-ORIF required
Foot Fx
MTB stress fx
-March fx: distal 1/3 MTB
-applied load >ability to heal
-commonly 2+3rd MTB
-minimal displacement (interosseous muscles act as splint)
SCFE
posterior + medial displacement of femoral capital epiphysis on NOF
-sudden or gradual defromation of subcapital growth plate
-incidence:
1. 3/100k white
2. 7/100k blacks
3. L>R
4. males: 12-16 y/o
5. females: 10-14 y/o
6. bilateral = 25%
Mechanical Etiology SCFE
-obesity
-decreased anteversion
-changes. inphyseal plate
Inflammatory Etiology SCFE
synovial inflammation
Hormonal Etiology SCFE
-obesity
-hypogonadism
-hypothyroidism
-renal osteodystrophy
-growth hormone therapy
SCFE symptoms
-limp
-pain (knee, gron, femur)
-decreased internal rotation
-lateral rotation aggravated when hip flexed
Hip Fx
-high incidence >65 y/o
-320k admissions/year
-15-20% die within 1 year of fx
-F>M
-risk factors:
1. >65 y/o
2. MS/parkinsons
3. osteoporosis
4. hyperthyroid/hypogonadism
5. caffeine, smoking, alcohol
6. low Ca2+ or vitamin D
7. eating disorders
8. steroids, anti convulsants, diuretics
Intracapsular Hip Fx
risk for nonunion / avascular necrosis (decreased blood supply to femoral head)
-subcapital = most common fx (Xray: increased density at femoral head)
-transcervical
-basicervical
I summon trashy boys
Extracapsular Hip FX
intertrochanteric + subtrochanteric
EatIng Subway
Pauwel’s Classification
the more vertical the line of angle increases risk for nonunion (avascular necrosis)
-incr. shear stress across fx
Garden 1
Hip FX Classification
incomplete fx of NOF
Garden 2
Hip FX Classification
complete fx w/o displacement
Garden 3
Hip FX Classification
complete fx w/ partial displacement
Garden 4
Hip FX Classification
complete fx w/ full dispalcement
Achilles Tendon Rupture
largest and most powerful tendon in the body formed by gastrocnemoius and soleus
-18/100k
-adults 4050 y/o, M>F, athletic
-snap in heels w/ pain
-25% have previous Achilles inflammation
-seen w/ **steroid/quinolone use, inflammatory arthritis
-diagnosis: weak plantarflexion, gap in tendon, + Thompson test
-Xray** if avulsion suspected
-US/MRI reveals tendon degeneration
