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MSS Weeks 3-5 > Lower Extremity Injury: Clinical Correlations > Flashcards

Lower Extremity Injury: Clinical Correlations Flashcards

1
Q

LE Neuromuscular Anatomy:

  1. Psoas mjr,mnr br.:
  2. 6(5) External rotators br.:
  3. G max:
  4. **G med,G min,TFL: **
A
  1. Psoas mjr,mnr br.:
    • L1,2,3
  2. 6(5) External rotators br.:
    • L5,S1,2
  3. G max:
    • Inferior gluteal n.
  4. G med,G min,TFL:
    • Superior gluteal n.
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2
Q

Name the msucles the following nerves innervate:

  1. Femoral n.
  2. Obturator n.
A
  1. Femoral n. (IPSquad)
    • Iliacus
    • Pectineus
    • Sartorius
    • Quads
  2. Obturator n. (POAAAG)
    • Pectineus
    • Obt ext
    • 3 Add’s
    • Gracilis
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3
Q

Name the descending nerve braches of the leg, starting with the sciatic nerve:

A
  1. Sciatic n. ⇒ Tibial n. & Common fibular n.
  2. Common fibular n. ⇒ Superficial fibular n. & deep fibular n.
  3. Tibial n. ⇒ Med. plantar n. & Lat. plantar n.
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4
Q

What muscles does the sciatic nerve innervate?

A

BSASB

  1. Biceps long
  2. Semi T
  3. Add mag
  4. Semi M
  5. Biceps short
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5
Q

What muscles does the tibial n. innervate?

A

PGPS(TFF)

  1. Popliteus
  2. Gastrocnemius
  3. Plantaris
  4. Soleus
  5. Tib post
  6. FDL
  7. FHL
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6
Q

What muscles does the superficial fibular n. innnervate?

A

FF

  1. Fibularis long
  2. Fibularis brev
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7
Q

What muscles does the deep fibular n. innervate?

A

TEEP(F)EE

  1. Tib ant
  2. EDL
  3. EHL
  4. Fib tertius
  5. EDB
  6. EHB
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8
Q

How are the foot muscles innervated?

A

Tibial n. ⇒ Med. & Lat. Plantar nerves

  • Medial Plantar (3 1/4 mm.)
    1. Abductor hallucis
    2. Flexor digitorum brevis
    3. medial Lumbrical
      • 1 of 4 lumbricals
    4. Flexor hallucis brevis
  • Lateral Plantar
    • All other muscles
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9
Q

Slipped capital femoral epiphysis (SCFE):

  • History:
  • Etiology:
  • Presentation:
  • Exam:
  • Imaging:
  • Treatment:
A
  • History:
    • classically overweight early adolescent with history of groin or knee pain
      • may be referred to anteromedial thigh
      • may occur bilaterally (not simultaneous)
  • Etiology:
    • repetitive overload
  • Presentation:
    • Vague symptoms, worse with activity
  • Exam:
    • Limitation of hip internal rotation
  • Imaging:
    • plain X-rays
  • Treatment:
    • surgical fixation
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10
Q

**Transient synovitis of the hip **

  • **Epidemiology: **
  • **Etiology: **
  • **Examination: **
  • **Tests: **
  • **Treatment: **
A
  • **Epidemiology: **
    • Ages 3-10
  • Etiology:
    • viral, post-vaccine or drug-induced
  • Examination:
    • Holds hip slightly flexed & ER
    • Any motion causes pain (+) log roll
    • Refuses to bear weight; otherwise looks okay
  • **Tests: **
    • Sed rate 35-60mm/hr & CBC
      • mild leukocytosis
  • Treatment:
    • NSAIDs for 1-3 wks
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11
Q

**Septic joint **

  • Etiology:
  • **Examination: **
  • **Treatment: **
  • Complication
A
  • Etiology:
    • Gonorrhea or skin flora
  • **Examination: **
    • Swollen, extremely painful joint
    • Passive & active ROM very painful
    • Red, hot joint
    • Usually has systemic signs,
      • may be absent in diabetic patient or immunosuppressed patient
  • **Treatment: **
    • often requires surgical I&D followed by IV antibiotics
  • **Complication: **
    • ​articular surface destruction
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12
Q

Patellar dislocation

  1. Epidemiology
  2. History
  3. Examination
  4. Treatment
A
  1. Epidemiology - usually lateral dislocation
  2. History
    • cutting with active quadriceps contraction,
    • immediate pain & swelling
  3. Examination - ecchymosis, effusion
    • Positive apprehension test – feeling of instability with stressing of the joint
  4. Treatment – physical therapy
    • _​​_If recurrent may eventually need surgery
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13
Q

Definitions:

  1. effusions
  2. bursa ⇒ bursitis
  3. ganglions
A
  1. effusions
    • excessive fluid in joint
  2. bursa ⇒ bursitis
    • ​​synovial lined sac that contains fluid
    • acts to reduce friction between structures
    • Common locations: Achilles, olecranon, subacromial, prepatellar & other knee locations
      • inflammation can happen with repeated rubbing or pressure
  3. ganglions
    • fluid filled soft tissue mass filled with collection of synovial or peritendinous fluid that arises from a joint or tendon sheath
    • Common location: wrist
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14
Q

**Presentation: **Effusions vs Bursitis vs Ganglions

A
  1. Effusions
    • Uniform & diffuse around a joint
    • Does not move independently (non-mobile)
      • “attached” to joint
  2. Bursitis
    • Localized, mobile
    • Small or large
    • Located throughout body
    • Usually feel “squishable”
  3. Ganglion
    • Usually relatively small < 2 cm
    • Usually near joints
    • Usually fairly tense
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15
Q

Describe the different musculotendinous injuries:

  1. Enthesopathy
  2. Tendinitis
  3. Tendinosis
A
  1. Enthesopathy
    • disorder of muscular or tendinous bony attachment
  2. Tendinitis
    • technically acute inflammation of tendon
    • Traumatic – blow or pull
  3. **Tendinosis **
    • chronic degenerative condition of tendon
    • Chronic – submaximal repetitive irritation
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16
Q

What is a strain?

What are the associated symptoms?

A
  • Muscle fiber damage from overstretching
    • Eccentric loading (muscle lengthening during firing)
  • Symptoms
    1. Stiffness
    2. Bruising
    3. Swelling
    4. Soreness
17
Q

What is a sprain?

What are the associated symptoms?

A
  • Ligamentous damage from overloading
  • Symptoms
    1. Instability or laxity
    2. Swelling
18
Q

What are the articular surfaces of the knee joint?

A

See Netter Plate 496 & 499

  1. Femoral condyles
  2. Tibial plateau
  3. Patella
19
Q

What are the knee ligaments?

A
  1. Medial meniscus
    • C-shaped
  2. Lateral meniscus
    • o-shaped
  3. Cruciates
    • Anterior (ACL)
    • Posterior (PCL)
  4. Medial (tibial) collateral
  5. Lateral (fibular) collateral
20
Q

What is the “unhappy triad”?

A
  1. Anterior Cruciate Ligament (ACL) - (Tear)
  2. Medial Collateral Ligament (MCL) - (Tear)
  3. Lateral Meniscus - (Compression)
21
Q

Anterior cruciate ligament sprain or tear

  1. **Etiology **
  2. **History **
  3. Exam
A
  1. Etiology
    1. twisting non-contact, deceleration or hyperextension injury
  2. History
    1. Acute - pop and rapid effusion
    2. Chronic - instability
  3. Exam
    • (+) Lachmann
      1. knee at 20-30° flexion
      2. stabilize femur
      3. check anterior translation & endpoint of tibia
    • Postitive Anterior Drawer test (less commonly used)
22
Q

Describe the Lachmann test:

A

Lachmann Test:

  1. knee at 20-30° flexion
  2. stabilize femur
  3. check anterior translation & endpoint of tibia
23
Q

What are you looking for in an MRI of a knee (i.e. radiologic assessment)?

A
  • Associated ligament injuries
  • Menisci
  • Articular cartilage
  • “bone bruise”
24
Q

**Joint stability **

  1. Dislocation
  2. **Subluxation **
  3. Laxity
A
  • Dislocation – complete displacement
  • Subluxation – transient, partial displacement
  • Laxity – normal variant in “joint looseness”
25
Q

Meniscal tear

  1. **Etiology **
  2. **History **
  3. **Exam **
  4. Treatment
A
  1. Etiology
    • usually occur with twisting on a loaded (weight-bearing) knee in athletes;
    • degenerative tears are common in older patients
  2. History - locking & effusion
  3. Exam
    1. pain over joint line
    2. pain with circumduction tests (McMurray)
  4. Treatment
    1. Locked - needs reduction; referral to orthopaedic surgeon
    2. No locking - physical therapy and relative rest
26
Q

Compartments of the leg: Anterior

  1. Muscles
  2. Major neurovascular structures
  3. Exertional compartment syndrome (%)
A
  1. Muscles
    • Extensors
      • Tibialis anterior
      • Extensor hallucis longus
      • Extensor digitorum longus
      • Fibularis tertius
  2. Major neurovascular structures
    • Deep fibular n (1st dorsal web space)
    • Anterior tibial a & v
  3. Exertional compartment syndrome (%)
    • 40-50%
27
Q

Compartments of the leg: Lateral

  1. Muscles
  2. Major neurovascular structures
  3. Exertional compartment syndrome (%)
A
  1. Muscles
    • Fibularis longus & brevis
  2. Major neurovascular structures
    • Superficial fibular n (lateral leg & lateral dorsal foot)
    • Fibular a & v
  3. Exertional compartment syndrome (%)
    • 20%
28
Q

Compartments of the leg: **Superifical Posterior **

  1. **Muscles **
  2. **Major neurovascular structures **
  3. **Exertional compartment syndrome (%) **
A
  1. **Muscles **
    • Superficial flexors
      • gastrocnemius
      • soleus
      • plantaris
  2. **Major neurovascular structures **
    • Tibial n (motor)
    • Sural n (sensory, lateral foot & distal calf)
  3. **Exertional compartment syndrome (%) **
    • rare
29
Q

Compartments of the leg: **Deep Posterior **

  1. **Muscles **
  2. **Major neurovascular structures **
  3. **Exertional compartment syndrome (%) **
A
  1. **Muscles **
    • Deep flexors
      • FDL
      • tibialis posterior
      • FHL
      • popliteus
  2. **Major neurovascular structures **
    • Tibial n (plantar foot)
    • Posterior tibial a & v
  3. **Exertional compartment syndrome (%) **
    • 30%
30
Q

Compartment syndromes

  1. **Pathology **
  2. Etiology
    1. Acute
    2. Chronic exertional
    3. Common locations
A
  1. Pathology
    • elevation of pressures in a muscular compartment high enough to interfere with perfusion
  2. Etiology
    1. Acute – severe bleed
      • usually caused by fracture
    2. Chronic exertional – from hypertrophied muscle in tight compartment with exercise
      • increases muscle bulk up to 20%)
    3. Common locations – leg >> forearm
31
Q

Compartment Syndromes

  1. Presentation (6P’s)
  2. Acute compartment syndrome injury pressures
  • ​What do different pressures indicate clinically?
A
  • Presentation (6P’s)
    1. Pain out of proportion (early sign)
    2. Paresthesia (early sign)
    3. Poikilothermia (coolness)
    4. Paralysis (late)
    5. Pallor (late)
    6. Pulselessness (late & rare)
  • Acute compartment syndrome injury pressures
    1. 0 - 10 mm Hg = normal
    2. 10-30 mm Hg = elevated, not dangerous
    3. 30-40 mm Hg = in acute compartment syndrome potentially dangerous
  • Follow clinical picture and repeat measurements until resolves
  • 40-60 mm Hg = usually dangerous, usually requires compartment release
  • > 60 mm Hg = consistently dangerous, requires urgent release
32
Q

Ankle sprains

  1. **Etiology **
  2. **Exam **
A
  1. Etiology – forced ankle inversion
  2. Exam
    1. Anterior drawer test – abnormal is 3-5 mm more than uninjured side
      • may also feel softer end point on injured side
      • Squeeze test
        1. squeeze the tibia & fibular together mid-shaft
        2. pain at ankle suspicious for high ankle sprain
        3. pain at knee suspicious for Maisonneuve fracture – fracture of the proximal fibula associated with ankle injury
    2. External rotation test (+) suspicious for high ankle sprains
33
Q

Achilles tendon rupture

  1. **Typical patient **
  2. **History **
  3. Exam
  4. **Treatment **
A
  1. Typical patient
    • middle aged male ruptures while playing basketball
  2. History
    • heard pop & felt like someone hit them in back of ankle with golf club
    • difficulty walking
  3. Exam
    1. Defect in Achilles
    2. Pain & weakness with plantar flexion
  4. Treatment – either acute immobilization or surgery

MSS Weeks 3-5 (22 decks)

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