Musculo/Derm 1 Flashcards

1
Q

Where does the Anterior Cruciate Ligament run from?

A

Lateral femoral condyle to anterior tibia

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2
Q

Where does the Posterior Cruciate Ligament run from?

A

Medial femoral condyle to posterior tibia

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3
Q

What is a Valgus deformity?

A

Knock kneed, lower leg abducted

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4
Q

What is a Varus deformity?

A

Bow legged, lower leg adducted

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5
Q

What stress does the Medial Collateral Ligament resist?

A

Resist valgus stress

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6
Q

What stress does the Lateral Collateral Ligament resist?

A

Resists varus stress

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7
Q

What are the attachments of the Lateral Collateral Ligament?

A

Lateral epicondyle of femur and head of fibula

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8
Q

What are common presentations of knee injuries?

A

Swelling, instability, sensation that knee will ‘give out’

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9
Q

What is the most commonly injured knee ligament?

A

ACL

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10
Q

What often causes ACL injury?

A

Noncontact athletic injury, e.g., running/jumping, sudden change of direction

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11
Q

What are two tests for ACL injury?

A

Anterior drawer: bend knee 90 degrees
Lachman test: bend knee 30 degrees

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12
Q

What often causes PCL injury?

A

Trauma, dashboard injury

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13
Q

How does MCL injury present?

A

Abnormal passive abduction of lower leg, medial space widens

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14
Q

What is the Unhappy triad?

A

Triad of injury common in contact sports, includes: ACL tear, MCL tear/sprain, Medial meniscal tear

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15
Q

What force leads to an Unhappy triad?

A

Lateral to medial force applied to knee when foot planted

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16
Q

What often causes LCL injury?

A

Trauma to medial knee

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17
Q

How does LCL injury present?

A

Abnormal passive adduction of lower leg

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18
Q

When does a Meniscal Tear often occur?

A

When foot is planted and there is sudden change in direction, twisting the knee

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19
Q

How to perform McMurray test?

A

Patient supine with knee flexed, extend knee while rotating foot
-Internal rotation tibia → tests lateral meniscus
-External rotation → tests medial meniscus

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20
Q

What type of joint is the knee?

A

Synovial joint

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21
Q

What is a bursa?

A

Synovial lined sac that acts as a cushion between bones and tendons/muscles

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22
Q

What often causes Prepatellar Bursitis?

A

Repeated kneeling (‘Housemaid’s knee’), Gout, infection

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23
Q

How does Prepatellar Bursitis present?

A

Swelling and warmth anterior to patella

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24
Q

What is a Baker’s Cyst?

A

Fluid collection in the Gastrocnemius-semimembranosus bursa (Popliteal cyst)
Often related to Chronic joint disease because it communicates with synovial space

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25
Q

What is the clinical presentation of a Baker’s Cyst?

A

Often small, asymptomatic. May cause posterior knee pain/swelling that worsens with activity. Can rupture and cause acute pain that mimics DVT.

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26
Q

In what condition are Baker’s Cysts common?

A

Rheumatoid arthritis

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27
Q

What is Osgood Schlatter Disease?

A

Tibial tuberosity avulsion from overuse. Usually benign, self-limited condition. Pain/swelling at tibial tubercle (Secondary ossification center of tibia)

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28
Q

In what age group does Osgood Schlatter Disease usually occur?

A

Children

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29
Q

What is the clinical presentation of a Patellar Fracture?

A

Cannot extend knee against gravity

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30
Q

What can cause inability to extend knee against gravity?

A

Patellar fracture, Quadriceps tendon tear, Injury to patellar tendon

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31
Q

What is the Glenoid?

A

Fossa of scapular bone

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32
Q

What are the 4 rotator cuff muscles?

A

(SITS) Supraspinatus, infraspinatus, teres minor, subscapularis

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33
Q

What does Rotator Cuff Tendonitis cause?

A

Pain with abduction

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34
Q

What does a Rotator Cuff tear lead to?

A

Inability to abduct

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35
Q

What is the action of the Supraspinatus?

A

Initial abduction (0-15°)
Innervation: Suprascapular nerve

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36
Q

What is the most common rotator cuff injury?

A

Supraspinatus

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37
Q

Why is the Supraspinatus vulnerable to impingement?

A

Tendon travels between humeral head and acromion process of scapula. Inflammation or tear can occur.

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38
Q

What are two tests that can identify Supraspinatus injury?

A

Empty Can Test, Full Can Test

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39
Q

What is the action of the Infraspinatus?

A

Assists in external rotation/abduction of shoulder

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40
Q

What nerve innervates the Infraspinatus?

A

Suprascapular

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41
Q

Who commonly injures the Infraspinatus?

A

Overhead throwers (pitchers)

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42
Q

What is the action of Teres Minor?

A

External rotation/adduction of shoulder
Innervation: Axillary nerve

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43
Q

What is the action of Subscapularis?

A

Internal rotation
Innervation: Upper/lower subscapular nerves

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44
Q

What muscles are responsible for full range abduction of the arm?

A

Supraspinatus: First 15°, Deltoid: up to 90°, Trapezius/serratus anterior: abduction beyond 90°

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45
Q

What type of dislocation typically occurs in shoulder dislocation?

A

Anterior dislocation of the humeral head

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46
Q

What nerve is commonly injured in shoulder dislocation?

A

Axillary nerve, leading to sensory loss of deltoid and weak abduction (usually too painful to move)

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47
Q

Where does a Humerus Fracture often occur?

A

Proximal humerus, which may disrupt blood supply leading to avascular necrosis of head and injury to axillary nerve causing loss of arm abduction

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48
Q

What is Epicondylitis?

A

Pain at epicondyle from overuse, few inflammatory cells + disorganized tissue/vessels

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49
Q

What causes elbow pain in Lateral epicondylitis?

A

Wrist extension (tennis elbow)

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50
Q

What causes elbow pain in Medial epicondylitis?

A

Wrist flexion (golfer’s elbow)

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51
Q

What is nursemaid elbow?

A

Radial head subluxation caused by axial traction on pronated forearm, leading to annular ligament slipping over head of radius

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52
Q

What is the most common pediatric elbow fracture?

A

Supracondylar Fracture, often occurring from falling on an outstretched arm

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53
Q

What is at risk for injury in a Supracondylar Fracture?

A

Brachial artery and Median nerve (travels with brachial artery) → most common neurovascular artery, Radial or ulnar nerves

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54
Q

What are two muscles innervated by the axillary nerve?

A

Teres minor, deltoid

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55
Q

What are the presentations of Radial Nerve Lesions?

A

Triceps weakness, Wrist drop, Sensory loss of back of hand/forearm

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56
Q

What are common causes of Radial Nerve Lesions?

A

Midshaft humeral fracture, Crutches, ‘Saturday night palsy’

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57
Q

Where does the Radial Nerve run?

A

Spiral/radial groove

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58
Q

What is the presentation of a radial nerve lesion at the radial groove?

A

Triceps spared, Most sensory nerves (arm/forearm) unaffected, Weakness wrist/finger extensors, Sensory loss of dorsal hand

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59
Q

What are the nerve roots for Musculocutaneous Nerve?

A

C5-C7 (lateral cord of brachial plexus)

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60
Q

What does the Musculocutaneous Nerve innervate?

A

Biceps and sensation to lateral forearm

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61
Q

What is Erb’s palsy?

A

Upper plexus (C5-C6) injury caused by excessive angle at neck/shoulder. Classic cause: Birth Trauma

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62
Q

What nerves are injured in Erb’s palsy?

A

Axillary, Musculocutaneous, Suprascapular

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63
Q

What is the clinical presentation of Erb’s palsy?

A

Arm straight at side + internally rotated (‘Waiter’s tip’)

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64
Q

What is Klumpke Palsy?

A

Lower Plexus (C8-T1) Injury caused by excessive abduction of arm, e.g., catching a tree branch while falling

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65
Q

What nerves are injured in Klumpke Palsy?

A

Median and Ulnar

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66
Q

What is the clinical presentation of Klumpke Palsy?

A

Clawed hand: MCP hyperextended, IP joint flexed (other flexors at wrist are spared)

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67
Q

What is Thoracic Outlet Syndrome?

A

Compression of nerves/vessels leaving thorax, occurs above first rib and behind clavicle (Scalene triangle)

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68
Q

What does the scalene triangle consist of?

A

Anterior scalene, Middle scalene, Above first rib

69
Q

What predisposes an individual to Thoracic Outlet Syndrome?

A

Extra rib from 7th cervical vertebrae

70
Q

What are three clinical features of Thoracic Outlet Syndrome?

A

Injury to Brachial plexus → Klumpke palsy, Venous compression → Arm swelling, Arterial compression (rare) → hand ischemia (cool temp, pallor) + weak distal pulses

71
Q

What does the Long Thoracic nerve innervate?

A

Serratus anterior muscle

72
Q

What does injury to Long Thoracic nerve lead to?

A

Winging of scapula

73
Q

What is the most commonly fractured carpal bone?

A

Scaphoid, classically caused by FOOSH injury

74
Q

What are two complications of a Scaphoid fracture?

A

Avascular necrosis, nonunion

75
Q

What is the blood supply to the Scaphoid?

A

Palmer and dorsal branches of Radial artery, Retrograde flow

76
Q

What is the Lunate attached to?

A

Radius

77
Q

What can Lunate dislocation cause?

A

Carpal tunnel, median nerve dysfunction.

78
Q

What ligament forms the Carpal tunnel?

A

Transverse carpal ligament (flexor retinaculum)

79
Q

What does a Median nerve lesion at carpal tunnel lead to?

A

Loss of Thumb movement, flexion/extension of lateral fingers (lumbricals), sensory loss of lateral 3.5 fingers

Sensation at thenar eminence is spared because there is a branch that comes off the median nerve before the carpal tunnel

80
Q

What is the clinical presentation of Carpal Tunnel Syndrome?

A

Begins with sensory symptoms, hallmark is pain or paresthesia

81
Q

What are eight risk factors for Carpal Tunnel Syndrome?

A

Repetitive use of hands/wrists, Obesity, Pregnancy (edema), Other disorders: Diabetes, Rheumatoid arthritis, Hypothyroidism, Acromegaly, Dialysis related Amyloidosis (deposits of β2 microglobulin)

82
Q

What is a classic sign of Acromegaly?

A

Increasing glove/shoe size

83
Q

What is the Guyon’s canal?

A

Ulnar canal, located above transverse carpal ligament + roof formed by palmar fascia

84
Q

What do Ulnar Nerve Lesions lead to?

A

Loss of Finger abduction/adduction (interossei), Motor/Sensory loss to little and ring finger

85
Q

In which activity are many cases of Guyon’s Canal Syndrome reported?

A

Bicyclists (overuse of wrist)

86
Q

What type of fractures are pediatric fractures often?

A

Incomplete

87
Q

What is a Greenstick Fracture?

A

Pediatric fracture → Bent bone, fracture does not extend through width of bone
Often due to FOOSH injury

88
Q

What force causes a Greenstick Fracture?

A

Bending force applied to bone, often occurs in distal radius

89
Q

What is a Torus Fracture also called?

A

Buckle fracture

90
Q

What is a Torus Fracture due to?

A

Axial force trauma

91
Q

Where does a Torus Fracture occur?

A

Distal metaphysis (most porous bone)

92
Q

What are the Intrinsic Hand muscles?

A

Thenar, Hypothenar, Interosseous muscles (abduction/adduction), Lumbrical muscles

93
Q

What innervates the Interosseous muscles of the hand?

A

Ulnar nerve

94
Q

What are the three Thenar muscles?

A

Abductor pollicis brevis, Flexor pollicis brevis, Opponens pollicis

95
Q

What are the three Hypothenar muscles?

A

Abductor digiti minimi, Flexor digiti minimi brevis, Opponens digiti minimi

96
Q

Which Interosseous muscles cause finger abduction?

A

Dorsal

97
Q

Which Interosseous muscles cause finger adduction?

A

Palmer

98
Q

Where do Lumbricals originate from?

A

Tendons of flexor digitorum profundus

99
Q

What is the action of the Lumbricals?

A

Flex MCP joints, Extend IP joints (form L shape)

100
Q

What innervates the Lumbricals?

A

Medial two lumbricals: ulnar nerve, Lateral two lumbricals: median nerve

101
Q

What does loss of lumbricals lead to?

A

Claw fingers

102
Q

What is the innervation for Flexor digitorum profundus?

A

Lateral two digits: Median nerve, Medial two digits: Ulnar nerve

103
Q

What innervates the Extensor digitorum?

A

Radial nerve

104
Q

What are two major Wrist flexors?

A

Flexor carpi radialis, Flexor carpi ulnaris

105
Q

What are three major Wrist extensors?

A

Extensor carpi radialis longus, Extensor carpi radialis brevis

106
Q

What is the innervation for Flexor digitorum profundus?

A

Lateral two digits: Median nerve
Medial two digits: Ulnar nerve

107
Q

What are 2 major Wrist flexors?

A

Flexor carpi radialis
Flexor carpi ulnaris

108
Q

What are 3 major Wrist extensors?

A

Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris

109
Q

The wrist will deviate to which side with median nerve lesion?

A

Ulnar side

110
Q

What are 2 ways to test for Median Nerve Lesions? What is the presentation?

A

Ask patient to make a fist → unable to flex thumb and lateral digits → ‘Pope’s blessing’ ask

At rest → Thumb adducted, thenar atrophy → ‘Ape hand’

111
Q

Will median nerve wrist lesions lead to wrist deviation?

A

No, flexor muscles are intact

112
Q

What are 2 causes of Median nerve wrist lesions?

A

Laceration
Carpal tunnel

113
Q

What is a cause of Median nerve elbow lesion?

A

Supracondylar fracture of humerus

114
Q

Median Nerve Lesion at the elbow will have what clinical presentation?

A

-Loss of flexors/pronators in forearm → forearm supinated
-Ulnar deviation

115
Q

What does the Recurrent branch of the median nerve supply?

A

Motor innervation to thenar muscles, no sensory innervation

116
Q

Recurrent branch of the median nerve is injured with?

A

Superficial laceration

117
Q

Injury to the Recurrent branch of the median nerve lead to?

A

Thumb immobilization

118
Q

Ulnar Nerve Lesions lead to?

A

-Loss of abduction/adduction (interossei)
-Motor and sensory loss to little/ring fingers

119
Q

What is a clinical sign of Ulnar Nerve Lesions? Why?

A

Loss of medial lumbricals → extension of MCP joint + flexion at IP joint at rest → Ulnar claw

120
Q

What Elbow lesion can lead to Ulnar nerve damage?

A

Fracture at medial epicondyle

121
Q

Fracture at medial epicondyle leads to?

A

Ulnar nerve damage

122
Q

Ulnar nerve lesion at Proximal Elbow presents with?

A

Loss of flexor digitorum profundus → Ulnar digits paralyzed without clawing

123
Q

Lumbar Plexus includes what nerve roots?

A

T12 to L4

124
Q

Sacral plexus includes what nerve roots?

A

L4-S4

125
Q

What does the Iliohypogastric nerve innervate?

A

-Motor: internal oblique and transversus abdominis
-Sensory: Suprapubic (hypogastric) region

126
Q

Iliohypogastric nerve is commonly injured in?

A

Abdominal/pelvis surgery

127
Q

Iliohypogastric nerve injury after surgery leads to?

A

Burning pain or paresthesia that radiates from incision to suprapubic area

128
Q

What does the Genitofemoral nerve innervate?

A

Motor: Cremasteric muscle
Sensory:
-Genital branch: skin of anterior scrotum, mons pubis and labia majora
-Femoral branch: skin upper anterior thigh

129
Q

Genitofemoral nerve injury leads to?

A

Absent cremasteric reflex
↓ sensation anterior thigh
↓ sensation labia/scrotum

130
Q

Lateral Femoral Cutaneous compression occurs via?

A

Tight clothing, obesity, pregnancy

131
Q

Lateral Femoral Cutaneous compression leads to?

A

Meralgia paresthetica: burning pain/paresthesia over outer thigh

132
Q

What does the Obturator Nerve innervate?

A

Motor: Thigh adductors
Sensory: Medial thigh

133
Q

Thigh adductors include?

A

Adductor Longus
Adductor Brevis
Adductor Magnus
Gracilis
Obturator Externus

134
Q

Obturator nerve is often injured during?

A

Pelvic surgery

135
Q

Femoral nerve innervates?

A

Motor: Hip flexors and knee extensors

Sensory:
-Anterior femoral cutaneous branches: anteromedial thigh
-Saphenous nerve: Medial leg and foot

136
Q

What are the 3 hip flexors innervated by the femoral nerve?

A

Pectineus
Iliacus
Sartorius

137
Q

What is the knee extensor innervated by the Femoral nerve? What does it include?

A

Quadricep femoris
-Rectus femoris
-Vastus lateralis
-Vastus medialis
-Vastus intermedius (deep to rectus)

138
Q

Saphenous vein stripping is commonly used for?

A

CABG

139
Q

Saphenous vein stripping can lead to?

A

Damage to saphenous nerve → numbness in medial leg and foot

140
Q

How to perform a Femoral nerve block?

A

Find femoral artery then move laterally to find nerve (NAVL)

141
Q

Rarely Femoral nerve can be injured in?

A

Pelvic fracture or surgery

142
Q

Femoral nerve injury will lead to?

A

-Weakness in flexion of thigh and extension of knee
-Absent patellar reflex
-Numbness, tingling in thigh/knee

143
Q

What is the largest nerve in the body?

A

Sciatic nerve

144
Q

What are the 2 branches of the sciatic nerve?

A

Common peroneal and tibial

145
Q

What are the sensory and motor functions of the Common peroneal nerve?

A

-Motor: Short head of biceps femoris → flexes knee
-Sensory: lower leg and dorsum of foot

146
Q

What are the branches of the Common peroneal nerve?

A

Superficial and deep fibular nerve

147
Q

Superficial fibular nerve innervates which muscles? What is the action?

A

Muscles of lateral lower leg
-Fibularis longus and brevis → Evert the foot

148
Q

Deep fibular nerve innervates which muscles? What is the action?

A

Muscles of anterior lower leg
-Tibialis ant, extensor digitorum longus, extensor hallucis longus → Dorsiflexion of foot, extension of toes + some intrinsic muscles of foot

149
Q

Common Peroneal Nerve is injured by?

A

-Prolonged lying (bed rest, surgery)
-Leg casts
-Fibular neck fracture

150
Q

Injury to Common Peroneal Nerve leads to?

A

-Foot drop (loss of dorsiflexion)
-Sensory loss of dorsum foot, lateral shin

151
Q

Tibial nerve travels?

A

Down the leg posterior to tibia → travels under medial malleolus through tarsal tunnel

152
Q

Tibial nerve innervates?

A

Posterior leg muscles + sensory to heel/sole

153
Q

What are the Posterior Leg Muscles?

A

-Popliteus
-Flexor hallucis Longus
-Flexor digitorum Longus
-Tibialis posterior
-Plantaris
-Soleus
-Gastrocnemius

154
Q

What are the 3 actions of the Posterior Leg Muscles?

A

Plantar flexion
Toe flexion
Inversion

155
Q

Tibial Nerve Damage can occur due to?

A

-Tarsal tunnel narrowing
-Large Baker’s cyst (rare)
-Trauma

156
Q

Tarsal tunnel narrowing will damage what nerve? What are the symptoms?

A

-Tibial nerve
-Mostly sensory, pain and numbness on sole of foot

157
Q

A Large Baker’s cyst can damage the tibial nerve and cause loss of?

A

Plantar flexion
Toe flexion
Loss of inversion

158
Q

What are the motor and sensory innervations for the Pudendal nerve?

A

Motor:
-Muscles of perineum
-External urethral sphincter
-External anal sphincter
-Levator ani

Sensory: penis/clitoris and skin of perineum

159
Q

Pudendal Nerve is often injured from?

A

Vaginal childbirth

160
Q

Injury of the pudendal nerve leads to?

A

-Urinary/fecal incontinence
-Vulvar/scrotal pain

161
Q

Pudendal Nerve Block is used in?

A

Vaginal childbirth to reduce pain (largely replaced)

162
Q

Pudendal Nerve Block involves anesthesia to what area?

A

Ischial spine of pelvis

163
Q

What is Radiculopathy?

A

Compression of nerve root at the spine

164
Q

What are 3 possible causes of Radiculopathy?

A

Spinal stenosis
Herniated disc
Spondylolisthesis

165
Q

What are the 2 components of the Intervertebral Discs?

A

Outer fibrous ring: annulus fibrosus
Soft center: nucleus pulposus

166
Q

What is the most common cause of radiculopathy?

A

Herniated disc

167
Q

What causes a Herniated disc? What does it cause?

A

Degeneration of annulus fibrosis → extrusion of nucleus pulposus → unilateral nerve compression

168
Q

Herniated disc often occurs anteriorly or posteriorly? Why?

A

Posteriorly, posterior longitudinal ligament is weaker than anterior ligament

169
Q

Where is the Posterior longitudinal located? What does it cover?

A

Sits within spinal canal, covers posterior surface of vertebrae