Lower Extremities Flashcards
Piriformis syndrome
pain in buttock
ipsilateral leg externally rotated
sciatica like sx down back of ispilateral leg
SD of sacrum and psoas associations
TP is 1/2 from ILA/PSIS midpoint to greater trochanter
Lateral femoral cutaneous n.
branch of femoral n.
causes meralgia paresthetica
L3-4 Disc Herniation
affects L4 nerve root
medial leg sensation
foot inversion
tested by patellar DTR
L4-L5 disc herniation
affects L5 nerve root
anterior leg and foot sensation
foot dorsiflexion
no DTR reflex
can’t walk on heels
L5-S1 disc herniation
affects S1 nerve root
lateral leg sensation
foot eversion
tested by achilles deep tendon reflex
can’t walk on tip toes
Congenital hip dysplasia
large baby, first born, female, breech
femoral head displaced posteriorly and inferiorly
Barlow’s test - displaces femur head
Ortolani’s test - femur head reduced
Legg-Calve-Perthes disease
osteonecrosis of femoral head or femoral capitus epiphysis
painless limp
males - 4-10 yo
XR: crushed or deformed femoral head
Slipped capital femoral epiphysis (SCFE)
displacement of femoral head on neck
progressive painful limp
loss of abduction, internal rot
overweight, teen male
XR: scoop of icecream sliding off the cone
Meralgia paresthetica
compression of lateral femoral cutaneous n. as it passes under inguinal lig
pain/paresthesia over lateral thigh
obese with large panis, pregnancy or heavy belt (police officer or construction worker)
Tx: wt loss, suspenders to redistribute wt of belt
Osgood-Schlatter Disease
painful swelling over tibial tuberosity
10-15 yo
XR: separation and new bone growth around tibial tuberosity
Tx: activity modification and conservative therapy
Wolf’s Law
Bone remodeling occurs along lines of stress
Femoroacetabular joint
hip joint
ball and socket
iliofemoral ligament
ischiofemoral ligament
pubofermoral ligament
capitus femoris - head of femur to acetabular fossa
Minor motions of the hip
anterior glide - head of femur glides anteriorly with external rotation of hip
Posterior glid - head of femur glides posteriorly with internal rotation of hip
External rotation SD of hip cause
piriformis or iliopsoas spasm
Internal rotation SD of hip cause
spasm of internal rotators:
gluteus minimus semimembranosus semitendinosus TFL adductor magnus adductor longus
Tibiofemoral joint
Stablized by:
2 C shaped menisci
ACL (O: posterior femur I: anterior tib)
PCL (O: ant femur I: post tib)
lateral knee stabilizers
MCL - femur to tibia, articulates w/ medial meniscus
LCL - femur to fibula
Tibiofibular joint
synovial joint
Fibular head glides anteriorly w/ pronation of foot; posteriorly with supination of foot
Foot pronation
dorsiflexion, eversion, abduction
talus push distal fibula posteriorly -> proximal fib anterior
Foot supination
plantarflexion, inversion, adduct
anterior talofibular ligament pull distal fibula anteriorly, proximal fib moves posterior
Femoral nerve
L2-L4
Motor: quadriceps, iliacus, sartorius, pectineus
Sensory: anterior thigh, medial leg
Sciatic nerve
L4-S3
Tibial division:
Motor: hamstrings (except biceps femoris), most plantar flexors, toe flexors
Sensory: lower leg, plantar aspect of foot
Peroneal division:
Motor: short head of biceps femoris, evertors, dorsiflexors of foot, most extensors of toes
Sensory: lower leg and dorsum of foot
Angulation of head of femor
normal 120-135
less than 120 coxa vara - R reduced angle
greater than 135 coxa valga - G greater angle
Q angle
ASIS through middle of patella, tibial tubercle through middle of patella
normal 10-12
increased angle - genu valgum - G greater angle (knock knee)
Decreased angle - genu varum - R reduced angle (bow legged)
Posterior fibular head
resists anterior spring
distal fib anterior, resists posterior
Tallus internally rotated - foot inverted, plantar flexed
Anterior fibular head
resists posterior spring
distal fib may be psoterior
talus externally rotated, foot everted and dorsiflexed
Patello-femoral sn
strong vastus lateralis and weak vastus medialis
patella tracks laterally
-> larger Q angle
Deep knee pain, esp when climbing stairs
patella crepitus
Women
Strengthen vastus medialis m.
Grades of sprains
First degree: no tear, no laxity
Second degree: partial tear, decreased tensile strength w/ mild to moderate laxity
Third degree: complete tear, no tensile strength and severe laxity
-may req surgery
Compartment syndrome
trauma or vigorous overuse -> increased intracompartmental pressure
compromise circulation w/in compartment
anterior compartment most common
severe unrelenting pain after and during exercise
Anterior tibilais m. hard and tender to palpation, pulses present, stretching m. causes extreme pain
Tx: ice and myofascial release to increase venous and lymph return
necrosis can develop w/in 4-8 hrs if intracompartmental pressure remains elevated -> surgical fasciotomy
O’Donahue’s triad (terrible triad, unhappy triad)
Lateral impact on planted foot
ACL
MCL
medial meniscus (although lateral 56 percent of the time)
Talocrural joint (tibiotalar joint)
plantar flexion and dorsi flexion
minor motions: anterior glid of talus w/ plantar flexion, posterior glide w/ dorsiflexion
Ankle more stable in dorsiflexion
Subtalar joint (talocalcaneal joint)
shock absorber
internal and external rotation of leg while foot fixed
Medial longitudinal arch
talus, navicular, cuneiforms, 1st - 3rd metatarsals
Lateral longitudinal arch
calcaneous, cuboid, 4th-5th metatarsals
Transverse arch
navicular, cuneiforms, cuboid
SD of arches
MC transverse arch - long distance runners
Cuboid - medial edge drops
Navicular - lateral edge drops
Cuneiforms - usually second cuneiform drops
Lateral stabilizers of ankle
prevent excessive supination
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament
Types of ankle sprains
Type I: only anterior talofibular ligament
Type II: anterior talofibular ligament and calcaneofibular ligament
Type III: anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament
Medial stabilizer of ankle
deltoid ligament
fracture of medial malleolus rather than pure ligamentous injury
Spring ligament (calcaneonavicular ligament)
strengthens and supports medial longitudinal arch
Plantar aponeurosis (plantar fascia)
calcaneus to phalanges
Chronic irritation -> calcium laid down along lines of stress -> heel spur
