injuries Flashcards
what population is a femoral neck fracture most common in? and why?
greater than 60 years old especially in women
less bone density + greater angle at the greater trochanter
where does the femoral neck fracture occur?
intracapsular: within the hip joint capsule
what happens to blood supply during a femoral neck fracture?
the femoral neck receives blood primarily from the medial and lateral femoral circumflex arteries.
When a fracture occurs in this area, the blood supply can be disrupted, potentially leading to avascular necrosis (death of the bone tissue due to lack of blood)
what population does IT band syndrome affect more?
runners and cyclists
how does IT band syndrome occur?
-friction between the soft tissue and lateral epicondyle which causes pain and inflammation
-repetitive strain of IT band
what kind of condition is IT band syndrome?
overuse condition
What direction does patella injury happen?
laterally
what muscle is important for patellar tracking?
vastus medialis oblique: the distal portion of the teardrop-shaped VM muscle belly that has oblique fiber orientation
how do you fix the patellar tracking?
strengthen VMO, pull patella medially
what is a femoral ring?
the femoral ring is a weak area in the anterior abdominal wall that is a size sufficient to admit the tip of the little finger
what is a femoral hernia?
at the saphenous opening, the abdominal viscera (small intestine) can protrude through the femoral ring to create a femoral hernia
where does a femoral hernia usually occur?
often appears as a mass, often tender, in the femoral triangle, inferolateral to the pubic tubercle
what is genu valgum?
knees going inward (knock knee)
what is genu varum?
knees going outward (bowlegged)
what happens to the Q angle for genu varum?
decreases
what happens to the Q angle for genu valgum?
increases
what is the unhappy triad?
a ligament strain injury involving the….
ACL
MCL
medial meniscus
What is an ACL injury?
hyperextension along with severe force directed against the femur with the knee semi-flexed
what are the five P’s of compartment syndrome?
Pain
Pallor
Paresthesia
Pulselessness
Paralysis
What is compartment syndrome?
pressures builds up within a muscle compartment, restricting blood flow and damaging tissue
how do you treat compartment syndrome?
fasciotomy (cut the fascia and let the muscles breath)
what does both genu varum and valgum lead to?
osteoarthritis (degeneration)
what is a total knee arthroplasty?
an artificial knee joint in replacement of a degenerative knee from a disease such as osteoarthritis
what does the artificial knee joint consist of? and what does it mimic?
plastic and metal components cemented to the ends of the femur and tibia
this replacement mimics the smoothness of cartilage on cartilage
what type of population has good results with TKA?
low demand people
how are “high demand” people respond to TKAs?
high demand people active in sports and activity may breakdown their knee, but recent biomedical engineering improvements have improved this aspect
in a lateral ankle sprain, what ligaments are damaged?
anterior talofibular ligament (ATFL)
calcaneofibular ligament (CFL)
posterior talofibular ligament (PTFL)
what direction is a lateral ankle sprain?
inversion
what is layman’s terms for a lateral ankle sprain?
rolled ankle
what is the primary ligament injured in a lateral ankle sprain?
ATFL (anterior talofibular ligament)
what ligaments and vessels are injured in a high ankle sprain?
- tibiofibular syndesmosis
- anterior tibiofibular ligament
- inferior transverse ligament (part of posterior tibiofibular ligament)
- interosseous membrane
- perforating branch of fibular artery
what direction is a high ankle sprain?
lower leg external rotation with dorsiflexion
according to the Ottawa ankle and foot fracture rules, when is an ankle x ray required?
if there is pain in malleolar zone and any of these findings:
bone tenderness at posterior edge or tip of lateral malleolus
bone tenderness at medial edge or tip of medial malleolus
inability to bear weight both immediately and in emergency department (four steps)
according to the Ottawa ankle and foot fracture rules, when is an foot x ray required?
pain in mid-foot zone and any of these findings:
bone tenderness at base of 5th metatarsal
bone tenderness at navicular
inability to bear weight both immediately and in emergency apartment (four steps)
what are the three types of “rolling the ankle” injury?
isolated medial or lateral malleolar fracture
bimalleolar fracture (both)
trimalleolar fracture (medial + lateral + posterior malleolus)
what is a bunion?
a foot deformity called hallux valgus in which the big toe deviates outward toward the other toes, often resulting in a noticeable bump on the side of the foot at the base of the big toe
it can even move under the second digit
what happens to the medial longitudinal arch with a bunion?
it is reduced because the big toe putting pressure on the first metatarsal bone causes a collapse or flattening effect on the arch
what position is the great toe with a bunion deformity?
adduction (going towards the 2nd toe)
what is plantar fasciitis?
bone spur on the heel
what type of feet get plantar fasciitis?
flat feet (low arches)
high arches
over-pronated feet
is there any symptoms associated with plantar fasciitis?
may not always symptoms
what is piriformis syndrome? and what is affected?
portion of the sciatic nerve can pierce the piriformis, or the piriformis can become chronically tight/spasm
Hip ROM will be affected
what population are most affected by piriformis syndrome?
ice skaters, cyclists, rock climbers, and women
what compresses the nerve in piriformis syndrome?
muscle contraction
what muscle actions in piriformis syndrome are affected?
hip external rotation (extended hip)
hip abduction when flexed
stabilized hip joint
what is trendelenburg?
waddling gait: drop pelvis when lifting leg opposite to weak gluteus medius
what is the nerve most often injured in the lower limb?
common fibular nerve
what are some ways a common fibular nerve injury occur?
- direct trauma
- severed during fracture of the fibular neck
- severely stretched when the knee joint is injured or dislocated
what happens to the muscles during a common fibular nerve injury (motor and sensation)?
flaccid paralysis of all muscles in the anterior and lateral compartments of the leg
a variable loss of sensation on the anterolateral aspect of the leg and the dorsum of the foot
what muscle actions are affected with a common fibular nerve injury?
the 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)
what happens to the gait pattern during a common fibular nerve injury?
the limb is too long: the toes do not clear the ground during the swing phase of walking
no eccentric control produces a “clop” when the foot touches the ground
what type of gait is common in the case of flaccid paralysis as a result of a common fibular injury?
steppage gait: unable to lift foot while walking
what muscle actions are affected if the cut they common fibular nerve?
subtalar joint eversion (superficial common fib)
ankle dorsi flexion (deep common fib)
what muscle actions are affected if you just cut the deep common fibular nerve?
ankle dorsi flexion
what is another name for a Baker’s cyst?
popliteal cyst
what is a popliteal cyst?
fluid filled growth behind the knee
it is a continuation of the bursa (gastrocnemius or semi-membranosus)
complication of chronic knee joint effusion
what population is the popliteal cyst common in?
children
grow large in adults
where does a tibial nerve injury at the knee occur?
posterior dislocation of the knee
specifically the tibiofemoral joint
if the tibial nerve is severed, what muscle actions are affected?
will there be skin sensation loss? where?
loss of plantar flexion and flexion of toes
there would be a loss of sensation in the following areas:
the sole of the foot, which includes the lower lateral surface + plantar surface + the heel + toes
where is the tarsal tunnel?
posterior to the medial malleolus
deep to the flexor retinaculum
what happens to the tarsal tunnel when there is a tibial nerve injury?
edema and tightness (swelling)
synovial sheaths tightness
heel pain
what are the three branches of the tibial nerve?
calcaneal branch nerve
medial plantar nerve
lateral plantar nerve
what is varicosities? and how can it contribute to tarsal tunnel syndrome?
they are enlarged veins that can increase pressure in the confined space thus affecting the tibial nerve
what is a “double crush” in tarsal tunnel syndrome?
compression site #1: the lower back adds pressure to the sciatic nerve (L4, L5, S1)
compression site #2: pressure in the tarsal tunnel on the tibial nerve
*Basically, compression on both the tarsal tunnel and spine
what are symptoms of the tarsal tunnel syndrome?
burning, numbness, and tingling
toe weakness
pes planus deformity (FLAT FEET)
what injury is known as a syndesmotic injury? and what does that mean?
high ankle sprain
A syndesmotic injury, also known as a high ankle sprain, involves damage to the syndesmosis, which is a fibrous joint that connects the two bones of the lower leg: the tibia and the fibula.
This joint is located just above the ankle, where the two bones are held together by a ligament called the anterior inferior tibiofibular ligament (AITFL) and other supporting ligaments.
what is a lisfranc injury?
metatarsal fracture, lisfranc ligament rupture, dislocation
where is the lisfranc ligament?
between the tarsal and metatarsal bones
what is the motion of injury for Lisfranc injury?
foot twisting
what is AAA?
abdominal aortic aneurysm
where is the Lisfranc ligament?
medial cuneiform and base of 2nd metatarsal
