Lower leg and ankle MSK

Question 1

Anterior compartment of leg contains what

Answer 1

tib anterior (dorsi flex and inverter of foot)
EHL
EDL
fibularis tertius 
anterior tibial artery (becomes DP)
Deep fibular nerve

Question 2

Lateral compartment of leg

Answer 2

Fibularis longus and brevis (plantar flex and everters), superficial fibular nerve

Question 3

Superficial posterior compartment of leg

Answer 3

Gastroc, soleus, plantaris (plantar flexors)

Question 4

If you want to test for an achilles tendon tear and you squeeze the calf it shouldnt plantar flex foot (thomson test), if the foot plantar flexes but there is a torn achilles then you are squeezing the

Answer 4

plantaris

Question 5

Deep posterior compartment (tibial tunnel)

Answer 5

TP (inversion), FDL, FHL, Posterior tibial artery, tibial nerve

Question 6

attachemnt of fib longus and brevis

Answer 6

base of 1st meta (long) base of 5th metatarsal (brevis)

Question 7

MOA of ATFL injury

Answer 7

suddenly inverting foot, test with anterior drawer test

Question 8

ankle doriflexors

Answer 8

TA, fibularis tertius, EHL and EDL

Question 9

Ankle plantar flexors

Answer 9

Gastroc, soleus, plantaris, tib posterior, FHL and FDL, Fib longus and brevis

Question 10

Ankle everters

Answer 10

fib longus, brevis (L5/s1 superficial fibular nerve) and fib tertius L5/s1 deep fib nerve

Question 11

Pronation of foot

Answer 11

Eversion + DF + External rotation of tibia

Question 12

Supination of foot

Answer 12

inversion, plantar flexion, internal rotation

Question 13

Maisonneuve fx

Answer 13

complication of high ankle sprain, proximal fibular fx due to rupture of tibiofibular syndesmosis

Question 14

Medial tibial stress syndrome diagnosis

Answer 14

squeeze medial and lateral sides of tibia tober (tibial squeeze) that reproduces pain along length of tibia

common risk factor is hyper pronation

Counsel your patient to return to running at about a 50% pre-injury level for intensity and distance to prevent recurrence of symptoms.

Question 15

Untreated shin splints can lead to

Answer 15

tibial stress fracture, xray, MRI can show bone marrow edema, relative rest, if too much pain NWB and progressing to WB if there is pain with normal ambulation, tylenol, IC, PT, strengthing hip girdle and knee musculature, re-image before clearing for running again

Question 16

Talus fx at risk for

Answer 16

AVN with talar dome fx, surgery/ortho referral, tx: NWB if nondisplaced fx and low risk for AVN otherwise ortho referral

Question 17

talar dome

Answer 17

highest part of talus that articulates with tibia

Hawkin’s II and above talar neck fractures require an urgent surgical referral secondary to the increased risk of AVN. Hawkin’s I fractures require immediate closed reduction.

Question 18

Calcaneal fx

Answer 18

cast and NWB if stress fx or small, otherwise ortho referral for ORIF

Question 19

Sever’s disease

Answer 19

calcaneal apophysitis from achilles/gastroc pulling on calcaneus ; self limiting, calf stretches, RICE

Question 20

Syndesmosis injury

Answer 20

talus pushes into fibula and fibula goes laterally tearing syndesmosis, AITFL and PTFL are torn as well, can cause maisonneuve fx (prox fibular fx), CAM boot for 3 weeks, if maisonneuve fx then ORIF

Question 21

Lateral ankle sprain grading

Answer 21

Gr 1: partially torn ATFL, intact CFL
Gr 2: Fully torn ATFL, partially torn CFL
Gr 3: Fully torn ATFL and CFL (surgery vs rehab)

Question 22

Talar tilt tests what

Answer 22

CFL

Question 23

Anterior drawer test of ankle

Answer 23

more than 5 mm displacement, ATFL testing

A positive anterior drawer test performed with the ankle in plantarflexion is the best test of the answer choices listed to assess for an ATFL injury. A positive anterior drawer test in dorsiflexion best assesses the CFL.

Question 24

Contents of tibial tunnel

Answer 24

Tibialis posterior, FDL, FHL, Tibial artery vein and nerve

Question 25

Haglund’s deformity

Answer 25

bony enlargement on the back of the heel “pump bump!”, can irritate retrocalcaneal or retroachilles bursa

Question 26

Acute Compartment syndrome of leg usually in what compartment

Answer 26

anterior compartment, pain out of proportion “pain, paresthesias, paralysis” 3 Ps; manometry and fasciotomy

Question 27

Chronic exertional compartment syndrome

Answer 27

tight fascia that causes temporarily raised intra-compartmental pressure, pain, paresthesias, weakness, worse with exercise, resolved with rest ; diagnosis pre and post exercise manometry, tx fasciotomy , xray to r/o shin splints

Question 28

Tib anterior tendon injury

Answer 28

tenosynovitis if overuse, rupture if eccentric overload , may be due to excessive pressure from EXTENSOR retinaculum

Question 29

Tibialis posterior tendon injury

Answer 29

from excessive pronation or medial ankle sprains…medial retromalleolar pain and swelling worse with resisted inversion and plantar flexion “too many toes sign”

Question 30

Too many toes sign

Answer 30

tib posterior injury

Question 31

dancer’s tendonitis

Answer 31

FHL injury

Question 32

Poorly vascularized area of achilles

Answer 32

distal 2-6 cm

Question 33

Salter Harris type 1 fx

Answer 33

Transverse fx through hypertrophic zone of the physis, typically not visible on radiographs but there may be widening of growth plate
“S” straight across”

Question 34

Salter Harris type 2 fx

Answer 34

Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis (most common)
“A” Above

Question 35

Salter Harris type 3 fx

Answer 35

Type III – A fracture through growth plate and epiphysis, sparing the metaphysis
“L” lower, or below

Question 36

Salter Harris type 4 fx

Answer 36

A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis.
“T” two or through

Question 37

Salter Harris type 5 fx

Answer 37

Type V – A compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray)
“ER” erasure of growth plate

Question 38

HOCM increases/decr with valsalva

Answer 38

increases