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Clinical A and P > lower extremity > Flashcards

lower extremity Flashcards

1
Q

Muscles of the thigh originate on the pelvis and insert on the femur, acting only on the hip joint

A

Gluteals, small external rotators, adductors

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2
Q

Muscles that originate on the femur and cross the knee

A

Vastus medius, intermedius, and lateralis

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3
Q

Muscles that cross both hip and knee joints

A

Rectus femoris, biceps femoris, medial hamstrings

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4
Q

Causes of limps

A

length, deformity, muscle weakness

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5
Q

Abnormally decreased angle of inclination

A

Coxa vara

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6
Q

Abnormally increased angle of inclination

A

Coxa valga

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7
Q

Where patellar tendon attaches

A

TIbial tuberosity

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8
Q

Weight bearing bone in the leg

A

Tibia

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9
Q

True or false: You can ambulate with a broken fibula

A

True

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10
Q

Bone that bears body weight transmitted from the tibia

A

Talus

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11
Q

Largest, strongest bone in the foot, transmits most of the body weight from the talus to the ground

A

Calcaneus

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12
Q

Tarsal bone between talus head posteriorly and three cuneiforms anteriorly

A

Navicular “little ship”

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13
Q

Lateral tarsal that articulate between calcaneus and metatarsals

A

Cuboid

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14
Q

Where are sesamoid bones in the foot?

A

Two on distal, plantar side of first metatarsal

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15
Q

Flat foot , name and cause

A

Pes planus
Rarely symptomatic
Posterior tibial tendon dysfunction or Charcot disease in diabetes

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16
Q

High arch, name and cause

A

Pes cavus
More symptomatic than flat feet
Congenital

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17
Q

Most clinically significant arch of the foot

A

Longitudinal

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18
Q

Factors going into arch support

A

Shape of tarsals, plantar ligaments, plantar fascia, muscle pull

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19
Q

Weak point of hip in trauma

A

Pubic symphysis

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20
Q

Sacroiliac joint has ____ ligaments posteriorly and ____ ligaments anteriorly.

A

Strong posteriorly, weak anteriorly

Open book injury

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21
Q

Strongest, most important hip joint ligament

A

Iliofemoral (Y ligament)

Resists hyperextension and lateral rotation of the hip.

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22
Q

Iliofemoral ligament attachment

A

AIIS and intertrochanteric line of femur below

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23
Q

Spiral shaped ligament that limits medial rotation. Name and where it attaches

A

Ischiofemoral ligament.

Attaches to ischium and greater trochanter.

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24
Q

Triangular ligament that limits medial rotation. Name and where it attaches

A

Pubofemoral ligament

Attaches pubis to femur (intertrochanteric line)

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25
Q

True or false: Ligament of femoral head helps to stabilize the femur.

A

False

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26
Q

True or false: Artery to the head of the femur enters through the ligament of the femoral head.

A

True

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27
Q

What is the position of stability of the hip?

A

Extension

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28
Q

True or false: Fibula is part of the knee joint.

A

False

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29
Q

Stabilize varus and valgus in knee

A

Collateral ligaments

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30
Q

Stabilize anterior/posteriorly in knee

A

Cruciate ligaments (named for where they attach on the tibia)

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31
Q

Tendons above the patella and below the patella

A

Above: Quadriceps tendon
Below: Patellar tendon

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32
Q

Where does the iliotibial band insert?

A

Gerdy’s tubercle

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33
Q

Caused by running downhill or hyperpronation of foot. Causes pain in lateral knee.

A

Iliotibial band syndrome

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34
Q

Overpull of the patellar tendon on the tibial tubercle. Usually around puberty in running sports.

A

Osgood Schlatter disease

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35
Q

What is the normal Q angle in men and women?

A

13 in men

18 in women

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36
Q

Knee flexion ____ (contracts, relaxes) ACL and _______ (increases, decreases) knee stability.

A

Relaxes, decreases

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37
Q

Prevents posterior displacement of femur on the tibia and joint hyperextension

A

ACL

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38
Q

Prevents knee hyperflexion, femur’s main stabilizer with walking downhill or down stairs

A

PCL

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39
Q

When is the knee most stable?

A

In extension with taut cruciate ligaments

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40
Q

Function of menisci

A

Deepen articular surface of the tibia to allow better connection with femur, which improves weight transfer and stability

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41
Q

Where to medial meniscus attach?

A

Medial collateral ligament

More susceptible to injury

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42
Q

Bursa that communicates with synovial cavity of the knee joint and may infect knee joint of housemaid. Also may be injured with distal femur fracture.

A

Suprapatellar bursa

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43
Q

Synovial effusion that accumulates in popliteal fossa. May interefere with knee movement in adults, asymptomatic in children.

A

Baker’s cyst

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44
Q

What can a baker’s cyst mimic with rupture?

A

DVT

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45
Q

When in the ankle joint most stable?

A

Dorsiflexion

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46
Q

Medial ligament of foot attaches to where?

A

Deltoid ligament. attaches medial malleolus to talus, calcaneus, and navicular

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47
Q

Lateral collateral ligament of ankle attaches where?

A

Lateral malleolus to talus and calcaneous. Not as strong as deltoid ligament
Has 3 parts: A/P talofibular and calcaneofibular

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48
Q

Creates mortise for the ankle

A

Distal tibiofibular joint

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49
Q

Common tendon of gastrocnemius and soleus

A

Achilles tendon

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50
Q

Rupture feels like being kicked in the calf and weak plantar flexion

A

Achilles tendon rupture

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51
Q

Rupture causes posterior lateral malleolus pain/tenderness

A

Peroneal tendon

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52
Q

Rupture causes tenderness along anterior ankle

A

Extensor rupture

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53
Q

Metatarsals connect with proximal phalanges

A

MTP joint

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54
Q

Proximal and middle phalanges connect

A

PIP joint

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55
Q

MIddle and distal phalanges connect

A

DIP

56
Q

Disrupts subtalar joint and can be disabling with subsequent instability. jumping off a ladder can cause this

A

Calcaneal fracture

57
Q

What ligament can cause medial foot tenderness?

A

Posterior tibialis

58
Q

What ligament can be sprained with excessive eversion injury?

A

Deltoid ligament

59
Q

What two things can muscles do?

A

Shorten or elongate (concentric v. eccentric contraction)

Both create tension

60
Q

When a muscle crosses a joint, ____ (contraction/relaxation) moves or stabilizes a joint.

A

Contraction

61
Q

Dense fibrous tissue that ensheaths the lateral thigh

A

Fascia lata

62
Q

What does fascia lata connect?

A

Tendons of gluteus maximus and tensor fascia lata to form IT tract, inserts on Gerdy’s tubercle of tibia.

63
Q

What does the fascia lata pass over on its way from ASIS to Gerdy’s tubercle?

A

Greater trochanter

64
Q

What may result in snapping hip syndrome?

A

Friction as IT band moves AP during repetitive motion (stair climbing, running)

65
Q

Primary hip flexor. Main postural muscle.

A

Iliopsoas.

66
Q

Where does iliopsoas muscle attach?

A

Femur’s lesser trochanter

67
Q

Muscles that work in hip flexsion

A

Iliopsoas, rectus femoris, sartorius, TFL

I really shouldn’t though

68
Q

Muscles that work in hip extension

A

Gluteus maximus, medius, and minimus. More postural than ROM (short, fat muscles). Hamstrings.

69
Q

What causes a limp? (abductor lurch)

A

weak gluteus medius and minimus

70
Q

Span both hip and knee joints. Extend the thigh at hte hip and flex hte leg at the knee.

A

Hamstring muscles

71
Q

Muscles that abduct the hip

A

Gluteus medius and minimus.

72
Q

Additional movement of the hip produced by these muscles

A

sartorius, TFL, piriformis

73
Q

What is a positive Trendelenberg gait?

A

Pelvis descends on unsupported side when standing on one leg

74
Q

Treatment for trendelenberg gait

A

Cane on opposite side of disease. Lessens forces across hip joint by 2/3 by decreasing abductor force

75
Q

Muscles that adduct the hip

A

Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus

76
Q

What is the nerve supply of hip adductors?

A

Everything is supplied by obturator nerve EXCEPT picky pectineus (femoral nerve)

77
Q

Muscles that externally rotate the hip

A

Gluteus maximus, deep rotator muscle group (piriformis, obturator internus and externus, superior and inferior gamellus, quadratus femoris)

78
Q

Muscles that internally rotate the hip

A

Gluteus medius and minimus

79
Q

Muscles that flex the knee

A

Posterior thigh compartment

Hamstrings: Biceps femoris, semitendinosis, semimembranosis, popliteus

80
Q

Muscles that extend the knee

A

Anterior thigh compartment
Quadriceps (major knee stabilizers)
Vastus lateralis, medialis, intermedius.

81
Q

Prevents lateral patellar dislocation

A

Vastus medialis

82
Q

Kicking muscle that crosses both hip and knee

A

Rectus femoris

83
Q

Pes anserine bursitis

A

Bursitis of medial knee. Separates sartorius, gracilis, and semitendinosis muscles from tibia and medial collateral ligaments.

84
Q

“Foot of the goose”

A

Pes anserine bursitis

85
Q

Muscles that dorsiflex the ankle

A

Anterior leg compartment

Tibialis anterior, extensor digitorum longus, extensor hallucis longus

86
Q

Weak tibialis anterior may cause what?

A

foot drop

87
Q

Muscles that evert the ankle

A

Lateral leg compartment

FIbularis longus and fibularis brevis

88
Q

Muscles that invert the ankle

A

Deep posterior compartment.

Tibialis posterior, flexor hallucis longus, flexor digitorum longus

89
Q

Muscles that plantar flex the ankle

A

Posterior compartment
Gastrocnemius
Soleus
Plantaris

90
Q

What are the most superficial structures in the popliteal fossa and therefore at high risk of injury?

A

Popliteal artery and tibial nerve

91
Q

Continuation of femoral artery that divides into anterior and posterior tibial arteries at inferior end of fossa

A

Popliteal artery

92
Q

Popliteal artery –> anterior tibial artery –> ____?

A

Dorsalis pedis to dorsum of foot

93
Q

Popliteal artery –> posterior tibial artery –> -___?

A

Medial malleolus

94
Q

Foot dorsiflexors

A

Anterior tibialis and anterior compartment

95
Q

Muscles in anterior leg compartment

A

Tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius

96
Q

Muscles in lateral leg compartment

A

FIbularis longus, fibularis brevis, common peroneal nerve

97
Q

Muscles in superficial posterior leg compartment

A

Gastrocnemius, soleus, and plantaris muscles

98
Q

Muscles in deep posterior leg compartment

A

Flexor digitorum longus, flexor hallicus longus, popliteus, tibialis posterior. Tibial artery, nerve, and vein are here as well.

99
Q

Normal tissue pressure

A

0-8 mmHg

100
Q

When does tissue become ischemic due to bleeding?

A

Pressure rises over capillary perfusion pressure

101
Q

What do we use to measure compartment pressure?

A

Hand held manometer (Stryker)

102
Q

What pressure requires decompression by fasciotomy?

A

Delta pressure less than 30 mmHg

103
Q

What are some criteria to make diagnosis of compartment syndrome clinically?

A

Pain out of proportion, pain despite treatment, pain with passive stretch

104
Q

Muscles that plantar flex the toes

A

Extrinsic muscles from deep posterior leg compartment (flexor hallucis longus, flexor digitorum longus)
Intrinsic muscles from plantar foot compartment (flexor hallucis brevis, flexor digitorum brevis)

105
Q

Muscles that dorsiflex the toes

A

Extrinsic muscles from anterior compartment (extensor hallucis longus, extensor digitorum longus)
Intrinsic muslces from dorsal foot compartment (extensor hallucis brevis, extensor digitorum brevis)

106
Q

Covers structures posterior to medial malleolus (Forms tarsal tunnel)

A

Retinacula flexor

107
Q

Tarsal tunnel syndrome is compression of what nerve?

A

Tibial nerve

108
Q

Restrain extensor tendons at the ankle

A

Retinacula extensor

109
Q

Restrain peroneal tendons lateral to the ankle

A

Retinacula peroneal

110
Q

Structures passing posterior to the medial malleolus

A 
Tom, Dick, and Harry
TIbialis posterior
flexor Digitorum longus
posterior tibial Artery and tibial Nerve
flexor Hallucis longus
111
Q

“midline” that other toes move relative to

A

Second toe

112
Q

How many layers of plantar foot muscles are there?

A

4

113
Q

Spinal level of lumbosacral plexus

A

L4, L5, S1-S3

114
Q

Lumbosacral plexus to the lower limb

A

Gluteal, femoral, obturator, sciatic

115
Q

Sciatic nerve is made of what?

A

Tibial and common peroneal, which separate in distal part of thigh

116
Q

Supplies more skin than any other nerve

A

Posterior femoral cutaneous

117
Q

Gluteal nerve leaves the pelvis through what?

A

Greater sciatic foramen

118
Q

Femoral nerve passes deep to the middle of the __________ into the femoral triangle. Supplies ______ and ______ thigh muscles.

A

inguinal ligament

anterior, medial

119
Q

Supplies quadriceps L2-L4

A

Femoral nerve

120
Q

Enters thigh behind inguinal ligament

A

femoral nerve

121
Q

What are the boundaries of the femoral triangle?

A

Superior: inguinal ligament
Medial: Adductor longus
Lateral: sartorius

122
Q

What is contained in the femoral triangle?

A

Femoral nerve, artery, and vein. As well as lymph nodes and vessels

123
Q

Continuation of fascia from abdominal cavity around femoral vessels

A

Femoral sheath

124
Q

Damage to femoral nerve blocks what reflex?

A

Patellar

125
Q

L2,L3,L4. Emerges from medial psoas muscle

A

Obturator nerve

126
Q

Obturator nerve —> anterior division–> ___?

A

thigh adductors and hip joint

127
Q

Obturator nerve –> posterior division –> ____?

A

adductors and knee joint

128
Q

Nerve supply of gluteal compartment

A

Gluteal nerves

129
Q

Nerve supply: Thigh, anterior compartment

A

Femoral nerve

130
Q

Nerve supply: Thigh, medial compartment

A

Obturator

131
Q

Nerve supply: Thigh, posterior compartment

A

Tibial nerve

132
Q

Nerve supply: Leg, anterior compartment

A

Deep peroneal nerve

133
Q

Nerve supply: Leg, lateral compartment

A

Superficial peroneal nerve

134
Q

Nerve supply: Leg, posterior compartment

A

Tibial nerve

135
Q

Nerve supply: Foot, dorsal compartment

A

Deep peroneal nerve

136
Q

Nerve supply: Foot, plantar copartment

A

plantar nerve

Clinical A and P (5 decks)

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