Lower limb Flashcards
What is compartment syndrome
pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells
3 Bones of the hip
ilium
ischium
pubis
what is the innominate bone
hip bone
What is the ASIS
anterior superior iliac spine
Difference between condyle and epicondyle
Condyle forms an articulation with another bone
epicondyle provides site of attachment of muscles
Difference between and intracapuslar and extracapsular fractures in the hip joint.
Can damage the medial femoral circumflex artery + cause avascular necrosis of femoral head
whereas in the extra the blood supply is intact
In a femoral shaft fracture what can be injured?
Femoral nerve and artery
patella fractures - what ligaments pull what
Proximal fragment displaced superiorly by quadriceps tendon
Distal fragment displaced inferiorly by patellar ligament
In a tibia injury what do you need to look out for (2)
fibula fractures and monitor compartment syndrome
How can the medial malleolus be fractured
over-inversion (ankle being twisted inwards)
How can the lateral malleolus be fractured
eversion (ankle being twisted outwards)
If the talus is forced against the medial malleolus what type of fracture can occur
spiral fracture
If the talus is forced against the lateral malleolus what type of fracture can occur?
transverse fracture
Two main places for interosseous access
Anteromedial surface, 2-3 cm below tibial tuberosity
Proximal to the medial malleolus
Complications of interosseous access?
osteomyelitis- infection of the bone marrow
iatrogenic fracture- doctor caused fracture
compartment syndrome- within the fascia
Why do we need to have interosseous access?
Allows administration of fluid, blood products and medications directly into bone marrow
Two most frequent tarsal bone fractures?
Talus and calcareous
Why is a neck of the talus fracture caused by high energy injuries by excessive dorsiflexion so important?
avascular necrosis
What part of the talus can be injured when jumping
Talar body
What is the most common cause of a calcaneus fracture?What type of fracture? and what other associated injures do you need to look for?
Fractured as result of axial loading (typically fall from height)
comminuted fracture
Assess these patients for associated injuries - lower limb/lumbar spine fractures
What are the 3 mechanisms to fractures to the metatarsal bones
Stress fractures
direct blow
over inversion
Often seen in runners what it is Iliotibial band syndrome?
(ITBS) is a common knee injury that usually presents with pain and/or tenderness on palpation of the lateral aspect of the knee, superior to the joint line and inferior to the lateral femoral epicondyle
where do the all the hamstring muscles attach to
ischial tuberosity and epicondyle
What is piriformis syndrome
is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).
What does the tensor fascia lata do
The tensor fascia lata is a gluteal muscle that acts as a flexor, abductor, and internal rotator of the hip.
dorsal interossei in the foot
two movements
spreading the toes apart
flexing the metatarsophalangeal joints of the second to the fifth toe.
plantar interossei muscles
adduct the third to fifth toe
what is deep vein thrombosis
blood clot in the vein
symptoms of deep vein thrombosis
Throbbing/cramping Swelling Warm skin Dark red skin Swollen veins
risk factors of deep vein thrombosis
Over 60 Overweight Smokers Contraceptive pill Cancer/heart failure Varicose Veins- pools of venous blood, valves normally legs don't work Confined in bed (after hospital op) Long journey (>3 hours) Pregnant or up to 6 weeks post pregnancy Dehydratio
Treatments for deep vein thrombosis
Anticoagulants injection before ultrasound to diagnose = heparin
Anticoagulants tablets = warfarin, rivaroxaban
IVC filter
complication of deep vein thrombosis
Pulmonary embolism (PE)
compartment syndrome 5 ps
Pain (disproportionate) Pain refractory to analgesia Pain on passive stretch Paraesthesia - “pins & needles” Pulses NORMAL
critical ischemia 6 ps
no repeats
Pain Paraesthesia Paralysis Pale Pulseless Perishingly cold
baker cyst
inflammation of semimembranous bursa atone - can’t flex
similar to deep vein thrombosis
popliteal aneurysm compressing what nerve
dilation of the artery - tibial nerve compression
popliteal artery entrapment syndrome
muscles compress artery restricting blood flow
Femoral nerve
roots
sensory
motor
L2,3,4
anterior thigh muscles that flex hip and extend knee
sensory to cutaneous branches to antermedial thigh, medial leg and foot (saphenous nerve ) ((adductor canal))
obturator nerve
roots
sensory
motor
L2,3,4
innervates the medial thigh
sensory to skin over the medial thigh
Damage to the obturator nerve can affect gaits how?
because medial aspects paralysed so loss of adduction
Lateral cutaneous nerve
roots
motor
sensory
L2,3
no motor
sensory to anterior and lateral thigh
enters at the lateral inguinal ligament
iliohypogasTric nerve
nerve roots
motor and sensory
L1, and T12
innervates the internal oblique and transverses abdominus
sensory to skin posterolaterla gluteal skin
ilioinguinal nerve
root
motor and sensory
L1
same as illiohypogastric
sensory to anteromedial thigh , root of the penis and the scrotum
gentiofemoral nerve
roots
and supply
L1,L2
scrotum and upper anterior thigh
what is Lumbosaral plexopathy
can symptoms be localised ?
caused by damage to nerve bundles and suspected when symptoms cannot be localised
parsonage turner syndorme
brachial plexus, neuritis(inflammation)
Sciatic nerve
roots
motor
sensory
L4-S3
posterior thigh and adductor Magnus , indirectly all muscles of the leg and foot
sensory no direct but indirect to lateral leg and dorsal and plantar surfaces of the foot
piriformis syndrome
how is pain made worse
compression of the sciatic nerve by piriformis muscle , pain made worse by internal rotation
common fibular nerve
roots
motor and sensory
L4-S2
lateral and anterior compartment of leg and bit of bicep femoris
sensory to skin of lateral leg and dorsum of the foot
Tibial nerve
roots
motor
sensory
L4-S3
posterior compartment of the leg and intrinsic foot muscles
sensory to posteroolateral surface , lateral foot and sole
Tarsal tunnel syndrome what compressed
tibial nerve compressed
3 joints in the hip
Pubic symphysis
sacroiliac joint
hip joint
Intracapsular - what does the transverse acetabular ligament do
bridges the acetabular notch
(intracapsular) what does the ligamentum teres do
carries blood supply to head of femur and prevents inferior sublimation during flexion and abduction
iliofemoral ligament
prevents hyperextension of the hip joint
pubofemoral ligament
prevents abduction and extension
ischi-femorale ligament
holds femoral head and prevents hyperextension
blood supply to femoral head in adults
reticular branches
Legg-Calve perthes disease
symptoms are limping, limited range of movement
childhood condition where blood supply to the femoral head is interrupted and dies
idiopathic osteonecrosis of capital femoral epiphysis
shortening of one leg
if you fracture the proximal neck of the femur does it move?
NO
if you fracture the distal neck of the femur does it move?
yes the distal femur is pulled proximally by the Quad and Ham , also pulled laterally by gluteus Maximus
If you fracture the mid shaft of the femur if distally does it move?
Yes pulled anterioly by quads and posteriorly by gastro
medial collateral ligament function
primary stabiliser and if injured puts pressure on acl
Lateral collateral ligament function
stabilises lateral side , resistant to varus rotation
posterior cruciate ligament symptoms of injury
stiffness and swelling
anterior cruciate ligament function
restraining force of anterior translation and rotation , stabilises rotational movements
How to test the ACL
hip 45degree, knee at 90degree and pull should be about 6cm
What are the meniscuses
2 pieces of cartilage between the bones in knee and act as shock absorbers
Which vein goes down the medial malleolus?
Great saphenous vein
What is varicose veins
are the valves faulty
dilated and tortus veins due to increased intraluminal pressure , lots of blood and faulty valves
What is bunion
vagus strain on 1st metatarsal
How is a bunion caused and treated
tight fitting shoes or arthritis
and treated by reduced standing and foot pads and spacious shoes
What is hammer toe
how is it treated
dorsiflex MTPJ and plantar flexed IPJ caused by
loss of adduction of lumbricals
treated with foot pads and exercise
Clubfoot (talipes equinovarus)
strong (plantarflexion) and inversion, seen at brith , tightness of deep posterior leg
Treatment for clubfoot
realign the bones using plaster of panis
pes planus
longitudinal arch collapse , flat feet , plantar aponeurosis
shin splints
excessive force cause muscle to swell and put pressure on bones - Tibilais anterior on periosteum
jumpers knee
patellar tendonitis
What pneumonic describes fractures through the epiphyseal plate?
SALTER harris fractures
straight across through the growth plate
above through metaphysics too
lower through epiphysis and growth plate
Through Everything
crush injury growth plate
what common injury occurs with an olecranon fracture
avulsion injury of the triceps tendons , ulna nerve and radial nerve
hill-sachs lesion
cortical depression in posterolateral head of the humerus resulting from forceful impact
What clinical implication result of humeral shaft fracture
radial nerve damage causing wrist drop in the radial groove
What two classifications can be used for ankle injuries
webers
ottawa
Ottawa ankle rules to assess for what?
So shouldn’t need to do an X-ray or any type of imaging technique
- bony tenderness along distal 6cm of posterior edge of the fibular or tip of lateral malleolus
- bony tendernsss along distal 6cm of posterior edge of tibia of medial malleolus
- bony tenderness at base of 5th metatarsal
- bony tenderness at the navicular
- inability to bear weight both immediately after injury and for 4 steps during initial evaluation
Which fracture results in leg shortened and externally rotated>
neck of the femur fracture
how do you locate the inguinal ligament and what two structures does it run between
anterior superior iliac crest of the ilium
to the pubic tubercle of the pubic bone
what is sciatica
symptoms
Sciatica is a type of pain caused by an irritated nerve. It’s felt from your bottom down to your feet and toes- slipped disc -
tingling numb and weakness
shooting pain in your bottom and the backs of your legs.
treatment for sciatica
Treatment for sciatica includes exercise, stretches and painkillers.
A 48 year old man complains of pain radiating from his back down the outside of his right leg. He is a nurse and the pain typically manifests when he bends over to lift patients.
What is the most likely diagnosis?
S1 nerve root compression- sciatica
what is Guillian-barre syndrome
symptoms
bodies immune system attack your nerves
weakness and tingling in your extremities
rapid onset
what is acute motor axonal neuropathy
AMAN is a variant of the guillian-Barre syndrome. It is characterised by acute paralysis and loss of reflexes without any sensory loss.
what is prolapsed disk
A slipped disc is when a soft cushion of tissue between the bones in your spine pushes out(herniates).
It is painful as it presses on the nerves and gets better with rest and gentle exercise with the use of painkillers.
what is caudal equina syndrome
nerves at the very bottom of the spinal cord are pressed on
causing back pain
Problems with bowel and bladder function (usually inability to pass urine).
Numbness in the saddle area around the back passage (anus).
Weakness in one or both legs.
two congenital abnormalities of the spine
Separation of S1 from sacrum termed lumbarisation
Fusion of L5 to sacrum is termed sacralisation
what is the difference between the mid inguinal point and the midpoint of the inguinal ligament
mid inguinal point at artery bit
what are the pedal pulses
dorsalis pedis artery
posterior tibial artery
