Injuries Flashcards
Femoral Neck Fracture
“ broken hip”
- common in 60+ yrs and women because greater angle of femur and decrease in bone density
- high impact injury for a younger person
- intracapsular —> surgeon has to cut open
- Can disrupt blood supply to femoral head —> patient has risk for a vascular necrosis (AVN)
Iliotibial (IT) Band Syndrome
- overuse condition
- repetitive strain of IT band
- runners and cyclists
- friction b/w soft tissue and lateral epicondyle causes pain and inflammation
Abdominal Aortic Aneurysm (AAA)
- can extend into iliac arteries or can be isolated to the iliac artery
- enlargement of aorta
What is cut out during open heart surgery to bypass a clogged coronary artery?
Great saphenous vein
Compartment Syndrome
- thick fascia between compartments are compressed
- can be life-threatening
- the 5 P’s: pain, pallor, paresthesia, pulselessness, paralysis
- Fasciotomy to let everything inside breathe
What is most likely to be injured in the knee from pedestrian-auto accidents?
Tibial plateau (height at bumper for adults)
____ helps resists pulling the knee laterally when strengthened and is important for patellar tracking
Vastus Medialis Oblique (VMO)
The great saphenous vein is _____, so it doesn’t get clots that could lead to deep vein thrombosis
Superficial
What is a femoral hernia?
The femoral ring is a weak area in the anterior abdominal wall that is a size of the little finger.
● At the saphenous opening, the abdominal viscera (small intestine) can protrude through the femoral ring to create a femoral hernia.
● Often appears as a mass, often tender, in the femoral triangle, inferolateral to the pubic tubercle.
Aka knock knee
Genu valgum
larger Q angle (bigger in women because wider hips)
Remember gum is sticky so knees together
Aka bow leg
Genu varum
Lower Q angle
Remember drinking rum opens your legs
What prevents anterior displacement of the tibia on the femur and hyperextension of the knee joint?
ACL
What prevents anterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur and helps prevent hyperflexion of the knee joint.
PCL
“Unhappy triad”
MCL, ACL, medial meniscus
ACL Injury
The knee is the primary joint used for running, climbing stairs, and jumping. Therefore, the knee must be a very mobile joint, but this means the knee is more susceptible to injuries.
ACL tears can occur due to hyperextension along with severe force directed anteriorly against the femur with the knee semiflexed
ACL injuries can classified as contact or non-contact injury
Total Knee Arthroplasty (TKA)
An artificial knee joint in replacement of a degenerative knee from a disease such as OA
● The artificial knee joint consists of plastic and metal components cemented to the ends of the femur and tibia.
● This replacement mimics the smoothness of cartilage on cartilage.
“Low-demand” people have good results.
“High-demand” people active in sports and activity may breakdown their knee, but recent biomedical engineering improvements have improved this aspect.
What are the types of fifth metatarsal fractures?
“Broken pinky toe”
- Avulsion fracture a base of 5th Metatarsal: tendon is stronger than bone and comes off it and fractures bone
- Jones Fracture: b/w base and middle part
- Stress Fracture: distal to middle part
- Fibularis Brevis
- Ankle Sprain
What is a lateral ankle sprain?
“Rolled Ankle”
- anterior Talofibular, posterior Talofibular, and calaneofibular ligament
- inversion injury
What is a high ankle sprain?
- Involves tibiofibular syndesmosis, interosseous membrane, and anterior tibiofibular ligament
- “Syndesmotic” injury
- Cause by lower leg ER and DF of foot
- Rehab is longer (~3-4 wks)
What is the “Gimme 4 steps”?
Ottawa Ankle and Foot Fracture Rules
- Ankle x ray if (bone tenderness at posterior/tip of lateral malleolus OR medial malleolus) AND (inability to bear weight immediately and in ER for 4 steps)
- Foot X-ray if (bone tenderness at base of 5th metatarsal OR navicular) AND (inability to bear weight immediately and in ER for 4 steps)
What is a Bimalleolar Fracture vs. Trimalleolar?
- Bimalleolar and trimalleolar involve both medial and lateral malleolar fractures but trimalleolar also has fracture of plafond.
- some can be handled conservatively but majority need surgery
- “rolling the ankle” injury
What is a Lisfranc injury?
- Metacarpal fracture, lisfranc ligament rupture, dislocation
- lisfranc ligament articulates with medial cuneiform and 2nd base metatarsal
- MOI-foot twisting
What structures are in tarsal tunnel? And how is it different from carpal tunnel?
“Tom, Dick, and very nervous Harry” from superior to inferior
- Tibialis posterior, flexor Digitorum Longus, tibial artery, tibial vein, tibial nerve, Flexor Hallucis Longus
- not as much pressure in tunnel (except for flat feet)
What is a hallux valgus?
A Bunion
- 1st ray out of line with adducted great toe (can even move under 2nd digit)
- reduces medial longitudinal arch
- displacement of sesamoid bones
- more common in females because shoes
What are the symptoms of plantar fasciitis/heel spur/bone spur? Who is more susceptible?
- may be asymptomatic so don’t assume pain or severity based on radiograph
- can maybe set up for future problems
- lower arches, more weight, pregnancy
What is Piriformis Syndrome?
- Portion of sciatic n can pierce piriformis or piriformis can become chronically tight/spasm
- ice skaters, cyclists, rock climbers, and women
- Muscle contraction compresses nerve- symptom
- Piriformis does ER with hip extended and hip abduction so hip ROM affected (STRETCH positions!)
Other name for Lateral Femoral Cutaneous Nerve Entrapment? What causes and effects?
“Meralgia paresthetica”
- Inguinal ligament- 2 cm inf
- Causes: tight clothing, obesity/WG, pregnancy, local trauma, disease (diabetes)
- Paresthesia/decreased sensation
What are femoral nerve entrapment sites?
- beneath iliopsoas tendon
- inguinal ligament
- femoral ligament
- adductor canal
What can cause obturator nerve entrapment? What are the effects?
- Causes: Anterior hip dislocation, prostate surgery
- Effects: difficulty addicting thigh, decreased sensation over upper medial thigh (not at knee)
What causes Superior Gluteal Nerve Entrapment? How does it present?
- Cause: piriformis muscle compression
- Presentation:
- Achy-type claudication buttock pain
- waddling gait (trendelenburg)
- tender to palpation
What is nerve is most often injured in lower limb?
Common Fibular Nerve b/c…
- direct trauma
- severed during fracture of fibular neck
- severely stretched when the knee joint is injured or dislocated
What is a common fibular nerve injury?
- Flaccid paralysis of all muscles in the anterior and lateral compartments of the leg
- Loss of dorsiflexion of the ankle causes foot drop, which is further exacerbated by unopposed inversion of the foot (common or deep fibular nerve injury).
This makes the limb “too long”: The toes do not clear the ground during the swing phase of walking. Steppage gait is commonly employed in the case of flaccid paralysis. - No eccentric control produces a “clop” when the foot touches the ground.
- A variable loss of sensation on the anterolateral aspect of the leg and the dorsum of the foot.
What is deep fibular nerve entrapment?
- Excessive use of muscles supplied by the deep fibular nerve (skiing, running, and dancing) may result in muscle injury and edema in the anterior compartment.
- Tight ski boots may be where nerve passes deep to the inferior extensor retinaculum and the extensor hallucis brevis.
- Pain in foot dorsum and usually radiates to the web space between the 1st and 2nd toes.
What is superficial fibular nerve entrapment?
- Chronic ankle sprains may produce recurrent stretching of the superficial fibular nerve, which may cause pain along the lateral side of the leg and the dorsum of the ankle and foot.
- Numbness and paresthesia may be present and increase with activity.
What is pudendal nerve entrapment?
- Chronic, severely disabling neuropathic pain (“Pudendal neuralgia”)
- Perineal pain with sitting
- Exit between SS & ST ligaments (over SS ligament, through pudendal canal, inferior to pubic bone)
What is a Baker cyst?
“Popliteal Cyst”
- Fluid filled growth behind the knee
- Continuation of the bursa (gastroc or semi-memb)
- Complication of chronic knee joint effusion
- Common in children
- Can grow large in adults
What does a tibial injury at the knee?
- Posterior dislocation of the knee (popliteal joint)
- if severed, loss of PF and flexion of toes (AND lose sensation to sole of foot?)
What does Tibial Nerve damage at Tarsal Tunnel?
- Posterior to the medial malleolus
- Deep to the flexor retinaculum
- Edema, tightness (synovial sheaths), Heel pain
What are Sural N. Entrapment sites, symptoms, and exams/test findings?
- Entrapment sites: Fibrous arcade at lower lateral leg, Baker cyst, Gastroc strains, Fx of 5th metatarsal
- Symptoms: Achy posterolateral calf pain & Neuropathic pain in sural nerve distribution
- Exam & Test Findings: Tinels, hypoaesthesia, provocation by DF and inversion, diagnostic injection, imaging (EDT)
What is tarsal tunnel syndrome?
- Space occupying injury
- Varicosities Overpronation
- “Double crush”: irritate tunnel and back
- Burning, numbness, and tingling, toe weakness
- Pes planus (flat foot) deformity
What is Baxter’s Neuropathy?
- Medial Plantar nerve entrapment
- Compressive irritation deep to the flexor retinaculum, or curves deep to the abductor hallucis
- May cause aching, burning, numbness, and tingling (paresthesia) on the medial side of the sole of the foot and in navicular tuberosity region.
- May occur during repetitive eversion of the foot (e.g., during gymnastics and running).
- Because of its frequency in runners, these symptoms have been called “jogger’s foot.”
What is a chopart injury?
- Fracture-dislocation of midtarsal joints, often associated with calcaneus, cuboid and navicular fractures
- Transverse tarsal joint.
What is Charcot Marie Tooth?
- Neurological disorder- hereditary sensory and motor neuropathy
- Lack of muscle
- High arch (pes cavus) or low arch (pes planus) - Claw toes
What is Mallet Toe?
- Flexion of the distal phalanx of a long toe
- Cause: ill fitting shoes, arthritis, trauma, neuromuscular, and/or metabolic disease
What is Hammer Toe?
- Proximal phalanx hyperextended at the MTP
- Middle phalanx flexed at PIP
- DIP hyperextended
Which muscle(s) are weak which would allow this? Lumbricals and interrosei (?)
What is claw toe?
-Hyperextended of the MTP
-Flexion of the DIP
-Lateral four toes
What is Morton’s toe?
- 2nd toe
- Extends more distal than the other digits - Metatarsal origin
- 10-30% of individuals
- Can affect your gait and shoe style
What is Morton’s Neuroma?
- causes nerve pain
- caused by improper shoe types
- happens between digits 3 and 4
What are Perineal Tears?
• 1st – 4th Degree
• Very common cause of painful sex
• 3rd and 4th degree tears can also cause problems with bowel movements
What is Diastasis Recti?
- gap between 2 sides of Rectus abdominis
- created by stretching of linea alba
- commonly occurs in newborns and pregnant women
- Risk Factors: age >33, multiparity or multiple gestation, large baby, increased weight gain, c-section, pelvic floor weakness
- Treatment: retraining of abdominal muscles, bracing, taping, manual techniques
What is Endometriosis?
- often-painful condition in which tissue that is similar to the inner lining of the uterus grows outside the uterus
- Often cyclical pelvic pain and cramping, back pain, radiating pain
- Excessive bleeding
- Urinary or bowel dysfunction or pain with urination or bowel movements
- Infertility
