Lower Limb Clinical Anatomy Flashcards
What is the usual demographic affected with Perthe’s disease?
Boy between the ages of 4-8 with delayed skeletal maturity
How will a patient with Perthe’s Disease complain?
Complain of hip joint and start to limp
Joint will be irritable
Movements are diminished and painful at extremes
What movements are most commonly affected in a patient with Perthe’s disease?
Abduction and internal rotation
What is the femoral head dependent on for blood supply between the ages of 4-7?
Lateral epiphyseal vessels
How may the lateral epiphyseal vessels be occluded?
Pressure from effusion around the hip
What is the pathology of Perthe’s disease?
Three-stage process
One or more episodes of ischaemia causing bone death
Revascularisations and repair then occur
Distortions and remodelling of femoral head and neck
What can Perthe’s disease lead to?
Incomplete covering of the femoral head by the acetabulum
What is the purpose of Ottawa Ankle Rules?
Determine the need for radiographs in acute ankle injuries
What are the 5 components of the Ottawa Ankle Test?
Bony tenderness along distal 6cm of posterior edge of fibula or tip of lateral malleolus
Bony tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus
Bony tenderness at base of 5th metatarsal
Bony tenderness at navicular
Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
When is an ankle X-ray required?
Pain in malleolar zone
Bony tenderness @ 6cm….
Inability to bear weight immediately and four steps
When is a foot x-ray indicated?
Pain in midfoot zone
Bony tenderness @ navicular or base of 5th metatarsal
or Inability to bear weight immediately and four steps
What demographic are the Ottawa Ankle rules used on?
Those over 18
How does one attain a positive Trendelenburg Test?
Hip drop on opposite side to supporting leg
Muscles of opposite side dropped leg are affected
Define Perthe’s Disease.
Idiopathic Avascular Necrosis of head of femur in children ages 4-8
How do we measure true limb length?
ASIS to just below medial malleolus
When is the anterior cruciate ligament usually injured?
Landing on one foot while the trunk is rotating
How do we check if the ACL and PCL are intact?
ACL - anterior drawer test
PCL - posterior drawer test
Knee bent, ACL prevents the tibia being pulled anteriorly
How can we distinguish if there is a problem in the PNS or CNS with the knee reflex?
Increased/brief reflex means CNS
Decreased/absent reflex means PNS
How is an intraosseous needle inserted?
Anteromedial surface of proximal tibia - easy to locate and presents a flat, wide surface for insertion with minimal subcutaneous layers overlying the bone
Insert needle 1 fingerbreadth medial to tibial tuberosity
What deformity is associated with damage to the common peroneal nerve?
Footdrop
Where is the common peroneal nerve liable to injury?
As it passes under the head of the fibula
What is the Thompson/Simmonds Test?
Squeeze gastrocnemius/tendocalcaneus and should cause plantarflexion
What is plantar fasciitis?
Inflammation of the ligament that connects the calcaneus to the Phalanges
What movement causes an ankle sprain?
Inversion
