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Musculoskeletal Pm&r Boards > Lower Extremity > Flashcards

Lower Extremity Flashcards

0
Q 
What disorder does not have Pez cavus as a feature?
A. Polio myelitis
B. Cerebral palsy
C. Friedrich ataxia
D. Peroneal spastic foot
A

D
The etiology of pes cavus includes malunion of the calcaneal or talar fractures, Burns, sequela resulting from compartment syndrome, residual clubfoot and neuromuscular disease. Neuromuscular diseases, such as muscular dystrophy, Charco Marie tooth disease, spinal Dysraphism, Polyneuritis, intraspinsltumors, polio myelitis, Suringomyelia, Friedrich ataxia, cerebral palsy and spinal cord tumors can have muscle imbalance that lead to elevated arches.

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1
Q

What exam findings is common for Morten’s neuroma?

A

Apply direct the inter digit web Space with one hand and apply lateral and medial pressure to the metatarsal heads together. Return isolated pain on plantar aspect of the web spaces is consistent with Morton’s neuroma.

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2
Q

When do hamstring injuries most commonly occur?

A

With eccentric contraction of the lateral hamstring.

The majority of hamstring injuries occur from indirect forces during running and sprinting activities. Most injuries occur at the myotendinous junction not at the osseous attachments, during eccentric contractions of the hamstring. The lateral hamstrings (biceps femoris) are affected more than the medial hamstring (semitendinosis and semimembranosus.

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3
Q

What muscles are in the anterior compartment of the leg?

A

4 Ankle Dorsiflexors, toe extensors and foot evertors and inverters

  • ankle Dorsiflexors and foot inverters-
  • tibialis anterior (the peroneal nerve L4 five )
  • extensor hallucis longus (deep peroneal nerve L4 -5)
  • ankle Dorsiflexors and foot evertors–
  • extensor digitorum longus (deeper peroneal Nerve: L4 L5) toe extensor
  • Peroneus tertius (the deep peroneal nerve: L4, L5)
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4
Q

What muscles make up the lateral compartment?

A

Foot evertors and weak plantar flexors

  • Peroneus Brevus (superficial peroneal nerve: L5,S1)
  • Peroneus longus (superficial peroneal nerve: L5, S1)
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5
Q

What is in the anterior compartment of the leg?

A
  • Tibialis anterior, extensor digitorum longus, extensor hallucis longus, and Peroneus tertius muscles,
  • the anterior tibial tibial artery and vein
  • peroneal nerve
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6
Q

What muscles make up the posterior compartment of the leg?

A

Gastrocnemius (tibial nerve L4, L5, S1, S2) plantar flexor

  • plantaris (tibial nerve, L5, S1, S2) weak plantarflexion
  • Soleus (tibial nerve L5, S1, S2) plantar flexor
  • flexor digitorum longus (tibial nerve, L5, S1, S2) flexion of the lateral four toes, inversion, plantarflexion
  • tibialis posterior inversion and plantar flexor (tibial nerve L5, S1, S2)
  • flexor hallucis longus (tibial nerve S2, s3)
  • popliteus internal rotation of the leg on the femur (tibial nerve L5, S1, S2)
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7
Q

What makes up the lateral compartment of the leg?

A

Peroneus longus and Bevis muscles, the superficial peroneal nerve, and the common peroneal nerve dividing into superficial and deep branches

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8
Q

What comprises the Deep posterior compartment of the leg?

A

Flexor digitorum longus, flexor hallucis longus, tibialis posterior, and popliteus muscles; the posterior tibial artery and vein and the tibial nerve.

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9
Q

What comprises the superficial posterior compartment of the leg?

A

Gastrocnemius, Soleus, and plantaris muscles.

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10
Q

What makes the media longitudinal arch of the foot?

A

The deltoid ligament maintains a close proximity in the medial malleolus and talus preserving the medial longitudinal arch of the foot

  • spring ligament
  • the medial and posterior talocalcaneal ligaments
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11
Q

How do you support the medial longitudinal arch?

A

Scaphoid pads
arch cookies
navicular pad

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12
Q

What internship modification could you do in the setting of a calcaneal spur?

A

He’ll Christian relief or excavation

-soft pad with excavation under painful part of the heel

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13
Q

What shoe modification could you do for innersole excavation or relief?

A

A soft pad with excavation under one or more painful bony prominence is usually metatarsal head. Excavation is usually filled the compressible material.

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14
Q

What does a metatarsal pad do in the shoe?

A

Dome shaped pads glued to the innersole with the apex and of the metatarsal shaft release pressure from metatarsal heads by transferring the load to the metatarsal shaft.

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15
Q

What service doesn’t internal heel wedge provide?

A

Can be applied medially and promote hind foot inversion (in flexible pes planus) or laterally and promote hindfoot Eversion and relieve pressure on the cuboid (inflexible pez Verus) it also increases total plantar-bearing area and can be used in fixed pez varus.

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16
Q

Whatever’s factors for avascular necrosis in the femoral head?

A

-in children aged 2 to 12 this is known as Legg-Calve-Perthes disease. - the most common causes and adults are steroid use and alcohol abuse

MRI is indicated to detect early change

Treatment is to keep the acetabulum in proximity to the femoral head while healing and remodeling occurs

Adults may require arthroplasty

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17
Q

What is the benefit to a bipolar implant for hip arthroplasty?

A

It theoretically reduces friction and impact at the prosthetic acetabular junction by allowing motion at two sites: prosthetic inner bearing surface and prosthetic bearing acetabular surface.
-Acetabular erosion and protrusion should theoretically be reduced by reducing motion at the acetabulum

18
Q

What is the most common type of hip fracture?

A

The most common type of hip fracture is intertrochanteric.

  • Highly fragmented fractures may result in significant blood loss and hypovolemia
  • postoperatively, a leg length discrepancy may result due to comminution status post fixation.
  • Moderately high forces are generated in this area and a strong fixation is required
  • fractures maybe I’m displaced, displaced 2 part fractures, or unstable three-part fractures
19
Q

What are the two types of femoral neck stress fractures?

A
  • Compression type or

- transverse /tension type.

20
Q

How do you treat a compression type stress fracture of the femoral neck?

A

Because they’re more stable, they may be treated with bedrest.
When there’s no pain at rest and weight-bearing to limitation of pain is allowed.
If compression type fracture progress they may require internal fixation.

21
Q

How do you treat a transverse or tension type stress fracture the femoral neck?

A

Internal fixation due to the high risk of displacement

22
Q

What is the main predisposing factor to shinsplints Otherwise known as medial tibial stress syndrome?

A

Hyper pronation of the foot or 4 foot varus. (Calcaneal eversion)
Chronic traction on the periosteum at the periosteal fascial junction

23
Q

What is the splatt procedure?

A

Split anterior tibialis tendon transfer is done for ankle varus or calcaneal supination caused by spasticity of the anterior tibialis and toe flexors. It is a transfer of the lateral portion of tibialis anterior to the third cuneiform or the cuboid bone transforming deforming forces to correcting forces.

24
Q

Tha sciatica affects which portion of sciatic nerve

A

Lateral 2/3 of sciatic nerve is peroneal division.

25
Q

What is the function of the articularis genus muscle?

A

And pulls the synovial membrane proximally when the knee is flexed

26
Q

Name the hip flexors.

A

Iliopsoas ip Nerve or femoral nerve prime hip flexor

  • sartorius femoral nerve
  • rectus femoris femoral nerve
  • pectineus femoral nerve
  • Tensor fascia Latae superior gluteal nerve l4 through S-1
  • adductor brevis obturator nerve
  • abductor longus obturator nerve
  • addictor Magnus obturator and sciatic nerves L2 through S1
  • Grascillis L2 through L4
27
Q

Hip adductor doors anteriorly placed

A 
Gracilis 
Pecineus  
 adductor longus 
  adductor brevis 
adductor Magnus
28
Q

Hip adductors placed posteriorly

A
  • Gluteus maximus inferior gluteal nerve
  • obturator externus l3-4
  • Grascillis obturator nerve l2-4
  • long head of the biceps femoral and sciatic nerve l5-s1
  • semitendinosus sciatic nerve- l4-s1
  • semimembranosus sciatic nerve l5-s2
29
Q

Hip Abductor

A

Gluteus medius superior Gluteal nerve l4- S1

gluteus minimus

30
Q

Abductor’s and internal rotators of the hip

A

Tensor fascia lata superior gluteal nerve L4 S1

  • piraformis L5 S2
  • gluteus maximus superior fibers inferior gluteal Nerve L5 S2
31
Q

Scrub internal snapping hip syndrome

A

Internal snapping hip syndrome is due to tightness over the iliopectineal prominence of the pelvis or less commonly acetabular labrum tear with a loose body in the hip joint.

-A tight iliotibial band or gluteus maximus now they over the greater trochanter causes external snapping hip

32
Q

Describe the Q angle and what increases it

A

The q angle is formed by drawing a line from the ASIS through the patella and the tibial tubercle through the patella.

  • Normal for males is 14° normal for females is 17°
  • increased q angle can be caused by genu valgum, increased femoral anteversion, external tibial torsion, laterally positioned tibial tuberosity, or a tight lateral Retinaculum
33
Q

What is the function of Polpliteus?

A

It unlocks the femur- tibia complex by externally rotating the femur on the tibia to allow flexion.

34
Q

What is Patrick’s test?

A

Flexion, Abduction, External Rotation, and Extension AKA FABER for SI and HIP.

35
Q

Is the most specific test for ACL injury?

A

The most specific test for ACL tear is the pivot shift test reaching 100% specificity under Anastasia. lachman is usually considered the most sensitive test for ACL.

36
Q

What is the most common site of compartment syndrome in the leg?

A

The anterior compartment is most frequently affected followed by the lateral compartment in the deep posterior compartment.

37
Q

What are anterior hip dislocation pro cautions?

A

No hip extension, bridging, prone lying, or hip external rotation beyond neutral when the patient is supine keep the hip flexed to approximately 30° by placing a pillow under the knees or by raising the head of the bed

38
Q

In lateral ankle sprain what is the predictable sequence of ligament injury with increased force?

A
  • Anterior talofibular ligament
  • calcaneofibular ligament
  • posterior talofibular ligament
39
Q

What position do you expect to see a dislocated hip?

A

The hip will be flexed
adducted and
internally rotated
it will be shorter than the contralateral side

40
Q

What are the anterior patella Bursa?

A

Prepatellar, suprapatellar, deep infrapatellar, and superficial

41
Q

Where is pez anseeine located?

A

Medially

42
Q

What is the APLC?

A

The arcuate popliteal ligament complex provides attachment for the posterior lateral meniscus, and this site can be mistaken for a posterior tear of the lateral meniscus

Musculoskeletal Pm&r Boards (7 decks)

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