ICL 6.0: Lower Extremity Special Topics Flashcards
what is the anterior drawer test?
used to test integrity of the ACL
flex the knee 90 degrees then pull towards you
what is the posterior drawer test?
used to test the integrity of the PCL
flex the knee 90 degrees then pull away from you
what is the Trendelemburg sign?
the inability to maintain the pelvis in a horizontal position when a patient is asked to stand on one foot or asked to ambulate
this is what you’d see if the superior gluteal nerve is injured
if you suspect a right superior gluteal nerve injury, the left hip will drop when walking because the muscles on the right side won’t be able to pull the hip horizontal
what’s the difference between sensory skin supply by dermatome vs. peripheral nerve?
sensory skin supply by dermatome is related to the nerve roots (ex. would be effected by a herniated disc)
sensory skin supply by peripheral nerves is related to the branches of nerves (ex. would be effected by a stab wound to a branch of the femoral nerve)
where is the L4 dermatome located?
L4 dermatome goes across the knee and to the medial malleolus
below it is L5 and above it is L3!
what are the peripheral nerves of the lower limb?
Obturator nerve
Femoral nerve
Lateral cutaneous nerve of thigh
Saphenous nerve
Sural nerve
Superficial fibular nerve
Deep fibular nerve
what is the sensory skin supply of the lower limb by dermatome?
slide 7
what is the sensory skin supply by peripheral nerve?
slide 8 & 9
the patellar reflex tests which nerve root?
L4
the achilles reflex tests which nerve root?
S1
where is the dorsalis pedis pulse? how do you test for it?
feet slightly dorsiflexed then palpate immediately lateral to extensor hallucis longus tendon
diminished (1+) or absent (0) dorsalis pedis pulse usually suggests arterial disease or vascular insufficiency
what are the boundaries of the femoral triangle? what are its contents?
BOUNDARIES
1. inguinal ligament
- sartorius muscle
- superior border of adductor longus
CONTENTS
1. femoral nerve
- femoral artery
- femoral vein
- lymphatics
“NAVAL”
what are the boundaries of the adductor canal? what are its contents?
BOUNDARIES
it extends from the apex of the femoral triangle down to the adductor hiatus
it runs posterior to the sartorius but anterior to the adductor longus and adductor magnus
CONTENTS
1. femoral artery
- femoral vein
- saphenous nerve
- nerve to vastus medialis
the femoral artery and femoral vein go through the adductor hiatus but the saphenous nerve and nerve to vastus medialis exit before the hiatus
what are the boundaries of the popliteal fossa? what are its contents?
BOUNDARIES
1. semimembranosus
- biceps femoris muscle; both heads
- medial and lateral head of the gastrocnemius
CONTENTS
1. popliteal artery
- popliteal vein
- tibial nerve
- common fibular nerve
what is a Baker’s cyst?
it’s a cyst in the popliteal fossa
it would most likely impinge on the tibial nerve
what is a pulled groin? which muscles would most likely be effected in a pulled groin injury?
a straining of anteromedial thigh muscles from their proximal attachment
usually seen in sports that require quick starts, such as basketball, hockey and baseball
- pectineus
- adductor brevis
- adductor longus
what is the unhappy triad?
- tibial collateral ligament
- medial meniscus
- anterior cruciate ligament (ACL)
if someone were to get hit on their lateral knee, it could damage all 3 of these and it would be an unhappy triad
what are shin splints?
it’s an edema of muscles which reduces blood flow to the muscles
patients will complain of pain typically following sudden overexertion in untrained athletes
muscles will be tender to the touch and patients will experience mild compartment syndrome
which muscle is most likely to be effected with shin splints?
tibialis anterior
what are the 5 P’s of compartment syndrome?
- pain
- pallor
- pulselessness
- paralysis
- paresthesia
where in the body will a patient experience paresthesia if they have shin splits?
in-between their big toe and second toe
this is because with shin splits, the deep fibular nerve is most likely being compressed so this would could cause paresthesia in the area
what is plantar fasciitis? what causes it?
an inflammation of the plantar aponeurosis
it causes pain that is most severe after sitting for prolonged periods or after waking up and usually dissipates with activity
results from overuse, inappropriate footwear, and high-impact aerobics
how do you test for plantar fasciitis?
point tenderness at calcaneal tuberosity
which of the following joints is closest to the ball of the foot?
A. 1st metatarsophalangeal joint
B. 5th metatarsophalangeal joint
C. Calcaneocuboid joint
D. Talonavicular joint
E. Tarsometatarsal joint
A. 1st metatarsophalangeal joint
A 67-year-old man presents to the Emergency Department with left-sided “crushing” chest pain that began 20 minutes prior while eating dinner. He is sweating profusely and breathing rapidly. An EKG shows ST elevation and coronary angiography shows significant blockage of the left circumflex coronary artery. He is scheduled for immediate cardiac catheterization. As the cardiothoracic surgery resident on call, you will access the patient’s blocked coronary artery by introducing the catheter first through the _______ that is located deep to the ________ in the _________
- femoral artery
- fascia lata
- femoral triangle
which muscles make up the pet anserinus?
- semitendinosis
- gracilus
- sartorius
what is the sustentaculum tali?
the part of the calcaneus that supports the talus and the body weight
it’s the medial part of the calcaneus
the tendons of which muscle envelop the sesamoid bones?
flexor hallucis brevis
sidenote: the flexor hallucis longus passes between the sesamoid bones
what prevents the posterior displacement of the tibia on stationary femoral condyles?
posterior cruciate ligament (PCL)
sidenote: the ACL prevents anterior movement
which nerve roots contribute to the sciatic nerve?
L4-S3
what are the nerve roots of the obturator nerve?
L2-L4
what are the nerve roots of the femoral nerve?
L2-L4
what are the nerve roots of the superior and inferior gluteal nerve?
L5-S1
what is the proximal attachment of the gluteus medius?
the superior aspect of the posterior ilium
