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LECOM MS1 Gross Anatomy - Back/UE/LE 2022 > Lower Limb Clinical Supplement > Flashcards

Lower Limb Clinical Supplement Flashcards

1
Q

Neurovascular structures related to bone (things at risk for fracture)

A

Fibular neck -> common fibular nerve
Posterior tarsal tunnel & calcaneus -> tibial nerve, posterior tibial artery

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2
Q

What is coxa vara?

A

Angle between the femoral shaft and neck

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3
Q

What is the coxa valga?

A

The angle between the femoral shaft and neck

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4
Q

What is genu varum?

A

The knee angles outward

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5
Q

What is genu valgum?

A

The knee angles inward
Bilateral -> common and typically physiological
Unilateral -> usually attributable to pathology

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6
Q

What is happen if the superior gluteal nerve was injured?

A

paralysis of gluteus medius, minimus (weakness in abduction and medial rotation at hip) and tensor fascia lata

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7
Q

What is the Trendelenburg sign?

A

weakness in gluteus medius and minimus demonstrated by inability to maintain a level pelvis when standing on one foot = pelvis drops to good side

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8
Q

What nerve causes the Trendelenburg sign?

A

Superior gluteal nerve (L4-S1)

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9
Q

What happens if inferior gluteal nerve is injured?

A

paralysis of gluteus maximus; weakness in extension of the thigh – difficulty walking up stairs or rising from seated position

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10
Q

How can you injure your sciatic nerve?

A

Endometriosis, posterior dislocation of the hip, IM injection, piriformis syndrome

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11
Q

What happenes if sciatic nerve is injured?

A

Weakness/paralysis of hamstrings and all muscles below knee [foot drop; Achilles/calcaneal reflex is decreased] + loss of sensation along lateral and posterior leg and
entire foot; injury in popliteal fossa would spare hamstrings

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12
Q

What would happen if tibial branch of sciatic nerve is injured at the popliteal fossa?

A

immediately deep to the investing fascia here and at risk with penetrating trauma in this region; injury here will result in paralysis of all muscle in the posterior compartment of the leg and all intrinsic foot muscles + loss of sensation along the sole of the foot

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13
Q

What would happen if tibial branch of sciatic nerve was injured at the tendinous arch of the soleus?

A

foot pain with weakness in TP, FD and FH
but spares gastrocnemius, soleus, plantaris and popliteus

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14
Q

What would happen if the tibial branch of the sciatic nerve was injured at the tarsal tunnel?

A

entrapment between medial
malleolus and calcaneus by abductor hallucis; characterized by pain/tingling/numbness
along the plantar aspect of the foot and weakness in intrinsic foot muscles

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15
Q

What would happen if the tibial branch of the sciatic nerve was injured at the medial plantar?

A

Nerve entrapment; innervates 1LAFF; paresthesia on medial plantar aspect of foot

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16
Q

What would happen if the tibial branch of the sciatic nerve was injured via the lateral plantar nerve?

A

innervates all other intrinsic foot muscles (but see 1st and 2nd dorsal interossei); injury results in paresthesia affecting plantar aspect of digits 4 (lateral toe side) and 5

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17
Q

How can the common fibular branch of the sciatic nerve be injured?

A

IM injection in gluts, popliteal fossa injury via fibular neck fracture, chronic leg crossing, knee surgery, Baker’s cyst

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18
Q

What are the symptoms of the common fibular branch of the sciatic nerve injury?

A

injury results in paralysis of all muscles in
anterior (foot drop) and lateral compartment of leg + sensory loss along the anterior aspect of
the leg and dorsum of the foot [excluding tips of the toes

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19
Q

Superficial fibular nerve of common fibular branch of sciatic nerve injury signs

A

aralysis of muscles in the lateral compartment of the leg + sensory loss on the dorsum of the foot [sparing the web space between the first two digits]; most often injured by local trauma or more distally with inversion ankle sprains (only
sensory deficits)

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20
Q

What causes a femoral nerve injury?

A

Diabetes, lithotomy position, injury in inguinal region

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21
Q

What occurs when there is a femoral nerve injury?

A

paralysis of muscles in the anterior compartment of the thigh (patellar reflex is decreased) + sensory loss along anterior thigh and medial leg (including medial malleolus)

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22
Q

What occurs when there is a saphenous nerve injury?

A

ONLY SENSORY -> entrapped where it pierces the adductor canal (vasto-adductor membrane); affected by pes anserine bursitis, knee trauma and surgery
- results in pain/numbness along the medial knee, leg, malleolus and foot

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23
Q

Lateral femoral cutaneous nerve injury is the description of…

A

Merlagia paresthetica

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24
Q

Obturator nerve injury signs and symptoms

A

paralysis of muscles in the medial compartment of the thigh + sensory loss in a small
patch along the medial thigh, just above the knee; can be entrapped at the obturator canal, injured during hip surgery, pelvic metastases (ovarian cancer)

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25
Q

What occurs during a lumbosacral trunk injury?

A

Can be injured by trauma to the sacral ala, bony changes in the SI joint, local metastases or diabetic amyotrophy. The axons from L4 in the lumbosacral trunk are destined for the sciatic nerve, as are the axons from L5. L5 deficits will appear as an L5 radiculopathy, but will spare the deep back muscles. L4 deficits will be restricted to the distribution of the tibial, superficial and deep fibular nerves (sparing structures innervated by the femoral nerve)

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26
Q

Radiculopathy signs and symptoms

A

✓ sensory loss “radiates” in a dermatomal patterns
✓ muscle weakness involves multiple compartments
✓ intact sympathetic innervation to skin (normal sweating, vascular tone)
✓ injury to spinal nerves will also result in weakness/fasciculations/fibrillations in deep back muscles

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27
Q

What is the weakness associated with L4 radiculopathy?

A

Tibialis anterior, quadriceps, and sensory loss in L4 dermatome

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28
Q

L5 radiculopathy signs and symptoms

A

Weakness in EDL; gluteus medius, gluteus minimius, NORMAL reflexes, but sensory loss in L5 dermatome

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29
Q

S1 Radiculopathy

A

Weakness in fibularis longus, gluteus maximus, gastrocnemius (reduced Achilles reflex), sensory loss in S1 dermatome

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30
Q

What reflex is reduced in an L4 radiculopathy?

A

Patellar reflex

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31
Q

Sympathetic innervation of the lower limb is from…

A

Spinal cord levels T10-L2

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32
Q

What do disc herniations NOT impact?

A

Symphatetic innervation to the lower extremity

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33
Q

What DOES impact sympathetic innervation to the lower limbs?

A

Injury to peripheral nerves

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34
Q

Skin over inguinal ligament…

A

L1 Dermatome

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35
Q

Proximal, anterolateral thigh…

A

L2 dermatome

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36
Q

Distal, anteromedial thigh

A

L3 dermatome

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37
Q

Anteromedial leg, medial mallelous…

A

L4 dermatome

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38
Q

Proximal anterolateral leg, second digit

A

L5 dermatome

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39
Q

Lateral malleolus, fifth digit…

A

S1 dermatome

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40
Q

Posterior thigh…

A

S2 dermatome

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41
Q

Gluteal crease…

A

S3 dermatome

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42
Q

Patellar reflex deets

A

L2-4, femoral nerve

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43
Q

Achilles reflex deets

A

S1-2, tibial nerve

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44
Q

Myotomes of Hip Joint

A
  • Flexion = L1-3
  • Extension = Glut Max (L5-S1)
  • Adduction = L2-3
  • Abduction = L4-S1
  • Medial rotation =L4-5
  • Lateral rotation = L4-S1
45
Q

Myotomes of knee joint

A
  • Extension = L3-4
  • Flexion = L5-S1
46
Q

Myotomes of ankle joint

A
  • Dorsiflexion (stand on heel) = L4-5
  • Plantarflexion (stand on tip toes) = S1-2
  • Inversion = L4-5
  • Eversion = L5-S1
47
Q

Myotomes of toe joint

A
  • Flexion = S1-2
  • Extension = L5-S1
  • Abduction/Adduction = S2-3
48
Q

What is the Thompson Test?

A

used to assess the integrity of the Achilles tendon; with the pt laying face down and the foot hanging off the edge of the table, squeeze the belly of the gastrocnemius muscle – with an intact muscle and tendon, the foot will plantarflex; if the Achilles tendon is torn, the foot will not move

49
Q

What occurs in compartment syndrome?

A

the deep investing fascia of the limbs is fairly inflexible – edema and/or inflammation
within muscle compartments can result in compression of nerves and vessels (especially, the vasa vasorum/nervosum); pressure can be relieved by a fasciotomy

50
Q

What are the 7 P’s of compartment syndrome?

A

Pain
Parasthesia
Pressure
Pallor
Paresis/Paralysis
Pulselessness
Poikilothermia (abnormal temperature)

51
Q

What are varicose veins?

A

common in superficial veins of the lower extremity; results from incompetent valves and
subsequent venous dilation

52
Q

Deep vein thrombosis cause

A

Venous stagnation

53
Q

What are risk factors of DVT?

A

Obestiy, previous DVT, recent surgery and immobility

54
Q

What are signs of DVT?

A

Swelling, warmth, and inflammation

55
Q

If a thrombus breaks off, where can it cause death?

A

Pulmonary artery blockage

56
Q

What is saphenous cutdown

A

The great saphenous vein can be reliably identified immediately anterior to the medial
malleolus for accessing the venous system; caution must be taken to avoid iatrogenic injury to the saphenous nerve

57
Q

How is the great saphenous vein used for CABG surgery?

A

the superficial and deep veins of the extremities anastomose freely, so removal of this vein is
compensated by other venous channels

58
Q

Lymph from the entire lower extremity goes to…

A

Inguinal lymph nodes

59
Q

What do inguinal nodes receive lymph from

A

Lower extremity, skin of genitals and perineum

60
Q

Superficial lymph drainage from the foot utilizes lymph vessels that follow…

A

Superficial veins

61
Q

Drainage from medial foot drains to…

A

Superficial inguinal nodes

62
Q

Drainage from the lateral foot drains to…

A

Popliteal nodes

63
Q

Lymph from the knee joint drains…

A

First in popliteal nodes -> inguinal nodes

64
Q

Femoral ring is formed by…

A
  • Anterior: inguinal ligament
  • Medial: lacunar ligament&raquo_space; conjoint tendon
  • Posterior: pectineal ligament (Cooper’s lig), superior ramus of the pubis, pectineus muscle and fascia
  • Lateral: femoral sheath (femoral vein)
65
Q

Accessory obturator artery is known as…

A

Corona mortis

66
Q

What occurs in corona mortis

A

~20% of individuals have an accessory obturator artery which arises from the external iliac or inferior epigastric artery; such a vessel is in danger of iatrogenic injury during repair of inguinal/femoral hernias; nicking the corona mortis can lead to exsanguination

67
Q

Trochanetric bursitis is…

A

Inflammation near greater trochanter bursa

68
Q

What is the causes of trochanteric bursitis?

A

Trauma, repetitive use (running, walking)

69
Q

Signs and symptoms of trochanteric bursitis

A

Pain at greater trochanter, worse when laying on affected hip

70
Q

What is ischial bursitis?

A

inflammation of the bursa superficial to the ischial tuberosity; commonly results from repeated hip extension while seated (cycling, rowing)

71
Q

What happens during a gluteal intramsucular injection?

A

injections should be delivered in the superolateral quadrant of the gluteal
region; what structures are in danger of iatrogenic injury -> deep & superficial fibular nerves

72
Q

What is piriformis syndrome?

A

compression/irritation of the sciatic nerve caused by its proximity to the piriformis muscle;
in ~15% of people at least part of the sciatic nerve passes through the piriformis muscle

73
Q

What can impact stenosis of abdominal aorta or peripheral artery in the LE?

A

Ischemia in lower extremities and vascular claudication; intermittent pain and cramping in LE

74
Q

If we compress external iliac or proximal femoral artery…

A

Blood flow is maintained via inferior gluteal & femoral circumflex artery

75
Q

What puts the popliteal artery in danger?

A

Dislocation of knee, distal fracture of femur

76
Q

Baker’s cysts are…

A

Popliteal cysts

77
Q

What is a Baker’s cyst?

A

cyst-like expansion from the synovial capsule of the knee, found between the medial head of the gastrocnemius and tendon of the semimembranosus muscle; caused by knee effusion

78
Q

What can Baker’s cyst cause?

A

Compresion of popliteal artery -> popliteal vein (DVT)

79
Q

Where are the pulses of the lower extremity?

A

Femoral, popliteal, posterior tibial, doralis pedis

80
Q

Hip dislocation are majorly…

A

Posterior

81
Q

What can cause a hip dislocation?

A

Head-on motor vehicle accidents

82
Q

What is a posterior hip dislocation?

A

most common; affected limb is shortened, femur is internally rotated and adducted; commonly occur with other injuries (fractures of pelvis, acetabulum, femur, sciatic nerve injury) → ShIn PAd = shortened, internally rotated, posterior dislocation, adducted

83
Q

What is an anterior inferior hip dislocation?

A

AX: abducted, externally rotated

84
Q

What is an anterior superior hip dislocation?

A

hip is extended and externally rotated; may injury femoral vein, artery and/or nerve

85
Q

Fracture of femoral shaft at upper 1/3

A

▪ proximal fragment is flexed (iliopsoas), abducted (glut med + min) and laterally rotated
▪ distal fragment: adducted, shortened (hamstrings, quads), laterally rotated (adductors and weight of foot)

86
Q

Fracture of femoral shaft at middle 1/3

A

distal fragment is shortened (hamstrings, quads) and pulled posteriorly (gastroc)

87
Q

Fracture of the distal 1/3 of femoral shaft

A

Distal fragment is shorterned, popliteal artery is at risk

88
Q

ACL tear

A

can be assessed with the Lachman test, pivot-shift test or the anterior drawer test; a torn ACL will result in anterior displacement of the tibia with a stable femur

89
Q

PCL tear

A

can be assessed with the posterior drawer test; a torn PCL will result in posterior displacement of the tibia on a stable femur

90
Q

Unhappy triad

A

Injury to ACL, MCL, and medial meniscus

91
Q

What is more common to occur?

A

Acute ACL injuries involving the MCL and LATERAL meniscus

92
Q

Pain on lateral rotation of tibia indicates…

A

Injury to lateral meniscus

93
Q

Pain in medial rotation of tibia indicates…

A

Injury to medial meniscus

94
Q

Where does the fibular collateral ligament run?

A

Between the lateral epicondyle and head of the fibula. This ligament is distinct/separate from the joint capsule of the knee and does not attach to the lateral meniscus.

95
Q

What is patellofemoral syndrome

A

“runner’s knee”; pain is deep to the patella, results from abnormal tracking of the
patella on the femur, may be corrected by strengthening of the vastus medialis

96
Q

Prepatellar bursistis

A

Housemaids knee -> swelling between skin & patella

97
Q

Subcutaneous infrapatellar bursitis

A

Between skin and tibial tuberosity

98
Q

Deep infrapatellar bursitis

A

Between patellar ligament and knee

99
Q

Suprapatellar bursitis

A

between the quadriceps tendon and distal femur, communicates with the synovial capsule of the knee

100
Q

What is the most common ankle sprain?

A

Inversion affecting anterior talofibular ligaments

101
Q

Eversion damages deltoid ligaments and may cause…

A

Avulsion of medial malleolus

102
Q

What is a Pott fracture?

A

occurs during forceful eversion; this action pulls on the deltoid ligament (avulsing the medial malleolus), the talus slips laterally and fractures lateral malleolus and/or fibula and tears the posterior tibiofibular ligament

103
Q

What is a Cotton fracture?

A

fractures involving the medial malleolus, fibula (lateral malleolus) and posterior lip of the inferior articular surface of the tibia (considered a third malleolus)

104
Q

What is the fracture of the Talus?

A

displaced fractures of the neck of the talus may lead to avascular necrosis of the posterior aspect of the bone

105
Q

What is Morton’s neuroma?

A

characterized by pain between the 3rd and 4th toes on the plantar aspect (“ball”) of the foot
and fibrous changes in the common plantar nerve

106
Q

What is Hallus valgus?

A

Lateral deviation of the great toe

107
Q

What is fallen arches?

A

With weakness in the tibialis posterior muscle, the plantar calcaneonavicular (spring) ligament fails to support the talus. This results in collapse of the medial longitudinal arch of the foot

108
Q

What is plantar fascitis

A

pain and stiffness along the plantar aspect of the foot from inflammation (resulting from
overuse) of the plantar aponeurosis

109
Q

What occurs in plantar fascitis?

A

Intense heel pain in morning or after prolonged sitting, palpation at the calcaneal tubercle or passive dorsiflexion of toes causes pain

LECOM MS1 Gross Anatomy - Back/UE/LE 2022 (25 decks)

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