Lower limb clinical correlations

Question 1

Describe how a patient would present with transient synovitis of the hip. How would you treat?

Answer 1

• 3-10 yo
• viral, post-vaccine, or drug induced
• any motion causes pain; refuses to bear weight but otherwise looks ok
• high sed rate and mild leukocytosis on CBC

**Treat; NSAIDs for 1-3 weeks

Question 2

Describe how a patient would present with slipped capital femoral epiphysis (SCFE). How would you treat?

Answer 2

• classically overweight early adolescent with history of groin/knee pain
• often occurs bilaterally (but not simultaneously)
• from repetitive overload
• presents with vague symptoms; worse with activity

**treat; surgical fixation

Question 3

Describe how a patient would present with a septic joint. How would you treat?

Answer 3

• usually from gonorrhea or skin flora
• swollen, extremely painful joint (passive and active ROM)
• usually has systemic signs but may be absent in diabetics or immunosuppressed patients

**treat; surgical irrigation/drainage followed by IV antibiotics

Question 4

What is the main artery running through the knee?

Answer 4

Popliteal

Question 5

What pulses would you check if you’re worried about arterial damage in the leg (e.g. popliteal artery rupture)

Answer 5

1. dorsalis pedis (find lateral to extensor hallus longus)
2. posterior tibial (find by medial malleolus)

Question 6

What is the most common complaint from a patient with an ACL injury?

Answer 6

Buckling of the knee

Question 7

Describe the anatomic difference between the medial and lateral maniscus

Answer 7

• medial= C shaped
• lateral= O shaped

Question 8

What is the “unhappy triad”?

Answer 8

From a lateral force to the knee… ruptured tendons;

• anterior cruciate ligament (ACL)
• medial collateral ligament (MCL)
• lateral meniscus (due to compression damage)

Question 9

What are the tests commonly positive in an ACL tear?

Answer 9

Lachman and anterior drawer tests

Question 10

What is the primary medial stabilizer of the knee in extension?

Answer 10

ACL

Question 11

What are the tests commonly positive for a meniscus tear?

Answer 11

McMurray and circumduction “shift and load” tests

Question 12

What are the signs of acute compartment syndrome?

Answer 12

• poikilotherma (cool extremity; earliest sign of impending compartment syndrome)
• pain (passive motion)
• parathesis
• pulselessness and pallor (rare)

**surgical emergency

Question 13

If a patient has problems with any intrinsic muscles of the foot, what nerve must be involved?

Answer 13

Tibial nerve

Question 14

What nerve runs along the posterior aspect of the medial malleolus?

Answer 14

Medial plantar nerve

Question 15

What compartment is least likely to get exertional compartment syndrome?

Answer 15

Superficial posterior compartment (surrounded by skin, allowing more stretch)

Question 16

What is the most common compartment to experience compartment syndrome? What are the muscles/nerves involved?

Answer 16

Anterior compartment 40-50%;

deep fibular nerve (dorsal web space)

**extensor muscles

(next= deep posterior compartment 30%, lateral 20%)

Question 17

How do you test for compartment syndrome?

Answer 17

Slit catheter system

Question 18

What nerve would be responsible for the trendellenburg gaits?

Answer 18

Superior gluteal nerve (gluteus medius/minimus paralysis)

Question 19

What nerve is damaged when a patient experiences “foot drop”?

Answer 19

Deep fibular nerve (in the anterior compartment, needed for dorsiflexion)

**when with damaged external rotation, think common fibular problem

Question 20

What nerve is likely damaged if a patient cannot externally rotate their leg?

Answer 20

The superficial fibular nerve (in the lateral compartment)

****when with foot drop, think common fibular problem

Question 21

What are the main signs of a muscle or tendon injury?

Answer 21

• weakness (also consider neurologic cause)
• pain to resisted motion

Question 22

What are the main signs of a joint injury?

Answer 22

passive and active motion pain

Question 23

What are the main signs of a ligament injury?

Answer 23

instability (also consider neurologic cause)

Question 24

What are the main signs of a meniscus/labrum injury?

Answer 24

locking

Question 25

What are the main signs of a capsulitis/arthritis?

Answer 25

loss of motion