Lower-Limb: Clinical App Flashcards
Name some general probelms of the Lower-Extremities associated with trauma
- Peripheral Nerve damage (injuries)
- Hip, Knee, & Ankle Injuries (Sprains, dislocations, etc)
- Bone Fractures
- Pulled muscles
- Torn Ligaments
- Lacerations
Describe how Varicose veins form.
Which vein in the lower-extremities often has this problem?
Varicose veins form when the valves of the superficial veins become incompetent. These veins become tortuous and dilated, due to an increase in i_ntralaminar pressure_ (gravity associated).
The Great Saphenous vein (+ tributaries) often become varicose.
In occlusive coronary disease (caused by atherosclerosis), the diseased artery can be bypassed using what blood vessel?
What must be done with the blood vessel prior to placing it?
The Great Saphenous vein (or portion of it) can serve as a graft to bypassed diseased arteries (coronary, brachial, or femoral arteries). The vessel must be reveresed so the valves do not obstruct arterial flow.
If an individual is in hemorrhagic shock, where can an IV be placed for rapid volume repletion?
The Distal Greater Saphenous vein provides an excellent location to replete fluid in the critically injured.
Describe what occurs with a Femoral Hernia.
A Femoral Hernia occurs when abdominal viscera passes through the (rigid) femoral ring and ultimately through the Saphenous opening into the subcutaneous tissue of the thigh. The rigid Femoral Ring can strangulate the herniating mass, resulting in compromised vascular supply and necrosis.
It will present just below the groin on the inner thigh, within the Femoral Triangle.
*This is more common in females whose pelves are wider than males.
If Inguinal Lymph nodes are swollen, what should be done?
Examine the entire field of drainage to determine the causes of their enlargement. Includes the lower-limb, perineum, and trunk of the body inferior to the umbilicus.
Describe what occurs in Compartment Syndrome.
In what compartment does this occur most often within the lower-extremity?
Compartment syndrome occurs when fluid accumulates (bleeding or other) in a compartment. The fascia surrounding the compartment does not stretch, thus this swelling causes an increase in pressure within the compartment. This pressure can disrupt capillaries, nerves, and muscles, reducing the blood flow to them. If the pressure is not relieved quickly, it can cause permenant disability and tissue death.
Compartment syndrome most often occurs in the anterior leg.
What is the most common stie of Femoral artery Stenosis?
Why?
The adductor Canal
Constriction by the Adductor Hiatus
When nerves supplying a joint are damaged or lost, what occurs?
Degenerative changes;
- Hypertrophy of bone
- Degeneration of cartilage
What are Shin Splints?
How do they occur?
Shin Splints (Medial Tibial Stress Syndrome) is essentially edema and pain in the area of the distal 2/3 of the Tibia.
Shin Splints are caused by changes in physical activity or with improper footwear, resulting in repetitive microtrauma of the muscles and small tears in the periosteum of the tibia.
What causes Foot Drop?
How is it presented?
Which muscles are typically associated with Foot Drop?
Weakening of the muscles involved in flexing the ankle and toes.
Without the ability to flex the ankle/toes, the patient drags the front of their foot while walking. They compensate by having a higher step gait.
Typically, the Anterior Tibilias, Extensor Hallucis Longus, and Extensor Digitorum Longus.
If a great enough force is applied to the anterior of the (semiflexed) knee, what type of injury may occur?
What sign is present if it occurs?
In what sport does this typically occur?
ACL Ruptures; The tear will allow the tibia to slide anteriorly on the femur, thus called the Anterior Drawer Sign.
Skiiers commonly have this injury
If an individual lands on their Tibial Tuberosity with their knee flexed, what injury may occur?
What sign would be present if the injury occurred?
Posterior Cruciate Ligament (PCL) Tear; This allows the Tibia to slide Posteriorly on the femur, called the Posterior Drawer Sign.
This injury commonly occurs in basketball players or in car accidents.
Force applied to the lateral side of the knee can result in what injury?
Medial Collateral Ligament (MCL) Tear
A Force applied to the medial side of the knee can result in what injury?
Lateral Collateral Ligament (LCL) Tear
If Force is applied to the Lateral side of the knee while twisting, what injury may occur?
The Unhappy Triad:
MCL tear
Medial Meniscus tear
ACL tear
What are the knee deformities discussed?
How do these effect the weight distribution?
Genu Varum: Medial deviation of the Tibia
- Medial side of the knee takes all of the pressure.
- Presented as “Bow-Legs”
Genu Valgum: Lateral deviation of the Tibia
- Lateral side of the knee takes all the pressure
- Presented as “knock-knees”
Why is the Gluteus Maximus ideal for Intramuscular Injections?
What must be done to avoid causing damage?
The Gluteus Maximus is large/thick with a dense fasciculi that can be easily separated without damage.
To avoid damage to the Sciatic nerve, the injection should be given in the upper-outer quadrant of the buttocks.
What is Piriformis Syndrome?
Who does it affect?
Why is it a tricky diagnosis?
Piriformis Syndrome occurs when the Piriformis Muscle becomes tight and compresses/irritates the Sciatic nerve, resulting in lower-back and buttocks pain. The tightening of the muscle can occur from excessive sitting, spasm, hematoma, or overuse.
Diagnosis can be tricky because Piriformis Syndrome can be confused with Sciatica.
If Poliomyelitis involves the lower lumbar segments of the spinal cord, what occurs?
What sign will be presented?
Paralysis of the Gluteus Medius & Minimus (supplied by the Superior Gluteal Nerve) interferes with the ability of the patient to tip the pelvis when walking.
A positive Trendelenburgs Sign would be present.
What factors stabilize the hip joint?
Which type of Hip Dislocations are most common?
The hip joint is stabilized by;
- Depth of the Acetabulum
- The Labrum
- Strong muscular Support
- Intrinsic Stability
Posterior dislocations of the hip are by far greater (90%+)
