Lower limb clinical correlations Flashcards
Describe how a patient would present with transient synovitis of the hip. How would you treat?
- 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
Describe how a patient would present with slipped capital femoral epiphysis (SCFE). How would you treat?
- 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
Describe how a patient would present with a septic joint. How would you treat?
- 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
What is the main artery running through the knee?
Popliteal
What pulses would you check if you’re worried about arterial damage in the leg (e.g. popliteal artery rupture)
- dorsalis pedis (find lateral to extensor hallus longus)
- posterior tibial (find by medial malleolus)
What is the most common complaint from a patient with an ACL injury?
Buckling of the knee
Describe the anatomic difference between the medial and lateral maniscus
- medial= C shaped
- lateral= O shaped
What is the “unhappy triad”?
From a lateral force to the knee… ruptured tendons;
- anterior cruciate ligament (ACL)
- medial collateral ligament (MCL)
- lateral meniscus (due to compression damage)
What are the tests commonly positive in an ACL tear?
Lachman and anterior drawer tests
What is the primary medial stabilizer of the knee in extension?
ACL
What are the tests commonly positive for a meniscus tear?
McMurray and circumduction “shift and load” tests
What are the signs of acute compartment syndrome?
- poikilotherma (cool extremity; earliest sign of impending compartment syndrome)
- pain (passive motion)
- parathesis
- pulselessness and pallor (rare)
**surgical emergency
If a patient has problems with any intrinsic muscles of the foot, what nerve must be involved?
Tibial nerve
What nerve runs along the posterior aspect of the medial malleolus?
Medial plantar nerve
What compartment is least likely to get exertional compartment syndrome?
Superficial posterior compartment (surrounded by skin, allowing more stretch)
What is the most common compartment to experience compartment syndrome? What are the muscles/nerves involved?
Anterior compartment 40-50%;
deep fibular nerve (dorsal web space)
**extensor muscles
(next= deep posterior compartment 30%, lateral 20%)
How do you test for compartment syndrome?
Slit catheter system
What nerve would be responsible for the trendellenburg gaits?
Superior gluteal nerve (gluteus medius/minimus paralysis)
What nerve is damaged when a patient experiences “foot drop”?
Deep fibular nerve (in the anterior compartment, needed for dorsiflexion)
**when with damaged external rotation, think common fibular problem
What nerve is likely damaged if a patient cannot externally rotate their leg?
The superficial fibular nerve (in the lateral compartment)
****when with foot drop, think common fibular problem
What are the main signs of a muscle or tendon injury?
- weakness (also consider neurologic cause)
- pain to resisted motion
What are the main signs of a joint injury?
passive and active motion pain
What are the main signs of a ligament injury?
instability (also consider neurologic cause)
What are the main signs of a meniscus/labrum injury?
locking
What are the main signs of a capsulitis/arthritis?
loss of motion
