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First Quarter > Gross Anat Final-Injuries > Flashcards

Gross Anat Final-Injuries Flashcards

0
Q

For fractures of femoral neck: why is healing difficult?

A

Blood supply to femoral head often disrupted –> supplied by medial femoral circumflex a (part of cruciate anastomosis)

  • Artery to l. of femoral head may be only remaining source of blood supply to proximal fragment
  • ->Proximal fragment may undergo avascular necrosis
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1
Q

Fractures of femoral neck

A

Most common in women over 60

  • Result from indirect trauma
  • Intracapsular (no swelling)
  • Limb laterally rotated and shortened
  • Difficult healing-blood supply to femoral head often disrupted
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2
Q

Intertrochanteric Fractures

A

Most common in women over 60-direct trauma.

  • Swelling present in groin and thigh
  • Limb laterally rotated
  • Healing is good!
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3
Q

Posterior hip dislocation

A

Most common-usually car accident.

  • Limb flexed, ADD, and medially rotated–causes knees to strike dashboard
  • Femoral head forced out of acetabulum, joint capsule ruptures inferiorly and posteriorly
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4
Q

Which nerve is injured in a posterior hip dislocation?

A

May injure sciatic n.

  • Results in paralysis of hamstrings and everything distal to knee
  • Sensation affected over posterolateral aspect of leg and much of the foot
  • ->Often acetabular margin fractures
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5
Q

Anterior hip dislocation

A

Result of violent injury –forces limb into extension, ABD and lateral rotation
-Femoral head ends up inferior to acetabular margin

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6
Q

What nerve may be injured in an anterior hip dislocation?

A

May damage femoral n. –results in paralysis of sartorius m. and quadriceps m.

  • Loss of sensation to medial leg and foot
  • -> Often acetabular margin fractures
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7
Q

Injury to superior gluteal nerve

A

Caused by pelvic fracture, wound to gluteal region or compression by fetal head

  • Lesion impairs fxn of gluteus medius and minimus mm.
  • -> Weakens ABD of thigh, MR also greatly impaired
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8
Q

What does a positive Trendelenburg test (sign) show?

A

Gluteus med and min. on supported side are weakened, pelvis tilts toward undamaged side and pelvis on unsupported side descends when patient asked to stand on one leg.
–>Shows injury to superior gluteal nerve!

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9
Q

Gluteal gait

A

Places center of gravity over supporting lower limb

  • Descent of pelvis on unsupported side makes that limb “too long”
  • Foot won’t clear ground during swing phase, so leans away from injured side raising the pelvis to clear ground
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10
Q

Injury to sciatic nerve in gluteal region

A

Compression caused by piriformis m –May cause pain in buttock or radiating pain down leg
–> Complete section of sciatic n uncommon

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11
Q

Lateral/medial side of gluteal region

A

Lateral side “safe” side
-Best place for intragluteal injections is upper lateral quadrant

Medial side “danger” side
-Penetration or surgery here could damage sciatic nerve

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12
Q

Hamstring strain

A

Common in those who run and/or kick hard w/o proper warm up

-Usually accompanied by bruising and tearing of muscle tissue…extremely painful!

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13
Q

Most commonly torn muscle in a hamstring injury?

A

Semimembranosus muscle

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14
Q

How does an avulsion of the ischial tuberosity occur?

A

Forcible flexing of hip with knee extended

–> Proximal part of biceps femoris and semitendinosus mm

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15
Q

Intermittent Claudication

A

Due to obstruction of femoral, popliteal or posterior tibial aa.
–> Most commonly occurs at adductor hiatus

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16
Q

Intermittent Claudication causes _______ to muscles during exercise

Symptoms?

A

Causes ischemia (decreased blood flow)

Symptoms:

  • Pain in calf and foot when walking –> pain usually disappears with rest
  • May show decreased pulse below blockage
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17
Q

Saphenous vein grafts

A

Great saphenous vein is sometimes used for coronary artery bypass grafts (CABG)

  • Used to bypass blocked arteries
  • -> Vein is inverted so valves don’t block blood flow
  • Rarely produces problems yay!
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18
Q

Injury to femoral nerve

A

May be injured by pelvic fracture, psoas abscess, gunshot or other penetrating thigh wound

Results in: weakened flexion of thigh, loss of leg extension, sensation to anterior and parts of medial thigh
–> Anteromedial leg and foot via saphenous vein

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19
Q

Difficulties associated with injury to femoral nerve

A

Difficult to walk uphill or up stairs

–> Person will push against thigh to force knee into extension

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20
Q

Injury to femoral nerve

–> Patellar ligament and knee jerk reflex

A

Myotatic (deep tendon) reflex

  • Striking patellar l of flexed leg should result in extension of knee
  • Afferent and efferent limbs of reflex arc are via femoral nerve
  • -> If femoral n or L2-4 spinal cord segments are damaged, it will affect this reflex
  • -> May also be diminished by peripheral nerve disease
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21
Q

Femoral hernias

A

More common in females due to wider pelvis

  • Protrusion of ab-viscera through femoral ring
  • -> Passes through femoral canal
  • -> Appears as a mass in femoral triangle
  • -> Is located inferolateral to pubic tubercle
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22
Q

Femoral hernias bounded by…

A

Femoral v–laterally
Lacunar l–medially
Inguinal l–superiorly

Compressed contents of femoral canal

  • Hernia is at risk for strangulation
  • -> Interferes with blood supply, causes necrosis
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23
Q

Most common knee joint injuries

A

Ligament sprains!

-Occur when foot is fixed on the ground and force is applied to knee

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24
Q

“Unhappy triad”

Knee joint injuries

A

Blow to lateral side of extended knee or excessive lateral twisting of flexed knee causes:

  1. Rupture of TCL
  2. Concomitant tearing of medial meniscus (due to attachment of TCL)
  3. Tearing of ACL may also occur
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25
Q

ACL ruptures

A

Caused by hyperextension or force directed anteriorly when knee is semi-flexed, also common during skiing accidents

  • ACL may tear away from tibia or femur, but commonly occur at midpoint
  • Causes free tibia to slide anteriorly under fixed femur
  • -> Anterior drawer sign
  • -> Tested using Lachman test
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26
Q

PCL ruptures

A

Usually occur in conjunction with FCL or TCL tears

  • Occur when knees strike dashboard in car accident
  • Allow free tibia to slide posteriorly under fixed femur
  • -> Posterior drawer sign
27
Q

Meniscal tears

A

Most occurs in conjunction with TCL or ACL tears

  • Usually involve medial meniscus
  • -> Lateral meniscus less likely to be torn due to mobility

Menisci may be removed
-No loss of mobility, may be less stable, tibial plateau often undergoes inflammatory reactions

28
Q

Lateral/medial meniscal tears

A
  • Pain with lateral rotation of tibia on femur indicates lateral meniscus tear
  • Pain with medial rotation of tibia on femur indicates medial meniscus tear
29
Q

Exaggerated knee angles

“Q-angle”

A

Femur is placed diagonally on thigh, whereas tibia is almost vertical in leg

  • Creates angle between long axes of bones
  • -> Angle is typically greater in adult females due to wider pelvis
30
Q

How is the “Q-angle” assessed?

A
  1. Draw a line from ASIS to middle of patella
  2. Second vertical line passes through middle of patella to tibial tuberosity
    - Normal angle of femur in thigh places middle of knee directly inferior to head of femur when standing
    - -> Centers weight-bearing line over intercondylar region of knee
31
Q

Genu Varum (bowleg)

A

Medial angulation of leg in relation to thigh, femur abnormally vertical and Q-angle is small

  • Line of weight-bearing falls medial to center of knee
  • Results in arthrosis (destruction of knee cartilage)
32
Q

Genu Valgum (knock knee)

A

Lateral angulation of leg in relation to thigh, larger Q-angle

  • Line of weight bearing falls lateral to center of knee
  • Results in arthrosis, stresses TCL
  • Causes abnormal articulation with patella–pulls it further laterally
33
Q

Osteoarthritis

A

Degenerative joint changes

Eventually conditions of exaggerated knee angles lead to osteoarthritis

34
Q

Fasciotomy

Regarding compartment syndromes

A

Incision of overlying fascia or septum

–> Performed to relieve pressure I’m compartment concerned

35
Q

Compartment syndrome

A

Increased pressure in confined anatomical spaces affects circulation
-Threatens function and viability of tissues

(Fascial compartments of lower limb are closed spaces)

36
Q

Trauma to muscles and/or vessels in lower limb compartments may produce…

A

Hemorrhage, edema, and inflammation of muscles

  • Results in increased volume of compartment
  • -> Strong fascia doesn’t allow accommodation, increases intra-compartmental pressure
37
Q

Tibialis anterior strain (shin splints)

A

Mild form of anterior compartment syndrome

  • Results from repetitive microtrauma to tibialis anterior m
  • -> Causes small tears in periosteum of tibia and/or fleshy attachments to overlying deep fascia
  • Edema and pain usually in distal 2/3 of tibia, can decrease blood flow to area
38
Q

Injury to deep fibular nerve

A

“Ski boot syndrome”

Can be injured by lacerations, right fitting ski boots or anterior compartment syndrome

39
Q

High lesion (proximal) injury to deep fibular nerve

A

Causes pain in anterior compartment

-Affects dorsiflextion, inversion, extension of toes, and sensory loss to area between 1st and 2nd toes

40
Q

Low lesion (distal) injury to deep fibular nerve

A

Pain in dorsum of foot

-Sensory loss between 1st and 2nd toes

41
Q

Fracture of 5th metatarsal

A

Common in tennis or bball players

  • Caused by sudden inversion of ankle
  • -> Causes fibularis brevis m to fracture or avulse 5th metatarsal
  • Pain and edema around base of 5th metatarsal
  • -> Often misdiagnosed as ankle inversion sprain
42
Q

Injury to superficial fibular nerve

A

Chronic ankle sprains may stretch this nerve

  • Causes pain along lateral side of leg and dorsum of foot
  • High lesion would cause weakened eversion
  • -> Foot would invert with dorsiflexion
  • Sensory loss over anterolateral leg and dorsum of foot
43
Q

Calcaneal tendon reflex (AKA ankle jerk reflex or triceps surae reflex)

A

Calcaneal tendon struck with hammer–should result in plantar flexion of foot

  • Tests S1-S2 (tibial n)
  • -> If S1 damaged, reflex absent
  • Tests fxn of gastrocnemius and soleus mm
44
Q

Calcaneal tendon rupture

A

Most severe acute muscle injury in leg!

  • Occurs in those who are poorly conditioned and have a history of calcaneal tendinitis
  • Produces an audible “snap” during forceful push-off
  • Followed immediately by calf pain and dorsiflexion of plantarflexed foot
  • -> If tendon is completely ruptured, gap is palpable
45
Q

Calcaneal tendon rupture results in inability to…

A

Plantarflex against resistance

  • Passive dorsiflexion will be excessive
  • Ambulation is possible with laterally rotated limb
  • -> Usually requires surgical intervention
46
Q

Injury to tibial nerve in popliteal fossa

A

Results in:

  • Paralysis of flexor mm in leg
  • Paralysis of intrinsic mm of plantar foot
  • -> Unable to plantarflex foot or flex the toes
  • Sensation to sole of foot lost
47
Q

Injury to tibial nerve at ankle

A

Injured with trauma to or around medial malleolus
Results in:
-Loss of intrinsic mm of plantar foot
-Sensation over sole of foot

48
Q

Injury to common fibular nerve

A

Most commonly injured nerve in lower limb

  • May be severed during fracture of fibular neck or stretched with knee dislocation
  • Eccentric contraction lost (ability to control foot being lowered to ground–results in distinctive “clop”)
  • Sensation lost to anterolateral leg and dorsum of foot
49
Q

Severance of common fibular nerve results in…

A
  • Flaccid paralysis of all mm in anterior and lateral compartments of leg
  • Loss of dorsiflexion causes “foot drop”
  • Further exacerbated by unopposed inversion of foot
  • Makes limb too long (toes will not clear the ground)
50
Q

Different gaits to accommodate long limb when common fibular nerve is injured

A
  1. Steppage gait
  2. Waddling gait
  3. Swing-out gait
51
Q

Steppage gait

A

Extra flexion at hip and knee raise foot to keep toes from hitting ground

52
Q

Waddling gait

A

Leans to side opposite long limb, hiking the hip

53
Q

Swing-out gait

A

Long limb is swung out laterally (ABD) to allow toes to clear the ground

54
Q

Varicose veins

A

Affects women more than men

  • Can affect great saphenous v or any of its tributaries
  • Valves become damaged (incompetent) and no longer function properly
  • -> Blood flows inferiorly and vein becomes dilated (varicose)
  • -> Also become thick and rope-like
55
Q

Symptoms of varicose veins

A
  • Pain
  • Swelling
  • Restless leg
  • Burning, itching skin
  • Phlebitis
  • Skin ulcers
  • -> Treated using endovenous laser or stripped
56
Q

Deep vein thrombosis (DVT)

Thrombus=clot

A
  • Caused by venous stagnation due to muscular inactivity, external pressure on veins, or incompetent fascia that fails to restrict muscle expansion
  • Characterized by swelling, warmth, and inflammation/infection
57
Q

Pulmonary embolism

…in regards to deep vein thrombosis

A

Large thrombosis may break free and travel to lung

–> If large enough, may block off pulmonary a and cause death

58
Q

Ankle sprain

A

Most common ankle injury–tears fibers of ligaments

  • Most common type is inversion sprain
  • -> Foot forcefully inverted
  • Eversion sprains much less common –> involves medial collateral l complex
59
Q

Inversion ankle sprain

A

Involves twisting of weight-bearing plantarflexed foot

  • Injures lateral ligaments (Tear of anterior talofibular l most common)
  • -> Results in instability in ankle joint
  • Severe sprain may also injure calcaneofibular l
60
Q

Ankle fracture

A

Known as “Pott’s fracture” (Dislocation fracture)

  • Occurs when foot is forcefully everted
  • Often avulses medial malleolus
  • Talus then moves laterally
  • -> Shears off lateral malleolus or breaks fibula superior to syndesmosis
61
Q

“Trimalleolar fracture”

A

Ankle fracture involving the lateral malleolus, medial malleolus, and the distal posterior aspect of the tibia (“posterior malleolus”)

62
Q

Pes planus (flatfeet)

A

Disappearance of medial longitudinal arch

  • 3 types:
    1. Flexible flatfeet
    2. Rigid flatfeet
    3. Acquired flatfeet
63
Q

Flexible flatfeet

A

Most common type

  • Lack medial longitudinal arch when standing
  • -> Arch reappears when not weight bearing
  • Results from loose or degenerated intrinsic ll
  • Common in kids, may persist into adulthood
64
Q

Rigid flatfeet

A

Flat even when not bearing weight

  • Likely results from bone deformity
  • -> Fusion of adjacent tarsals
65
Q

Acquired flatfeet

A

“Fallen arches”

  • Secondary to dysfunction of tibialis posterior m (dynamic support)
  • -> Trauma, age, denervation
  • Plantar calcaneonavicular l fails to support talar head
66
Q

Plantar fasciitis

A

Most common hindfoot problem in runners

  • Inflammation of plantar fascia
  • Often caused by overuse
  • Causes pain on plantar surface of foot and heel, increases with extension of great toe
  • -> Most severe after long period of rest, usually gone within minutes

First Quarter (26 decks)

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