Popliteal Fossa and Leg

Question 1

where do popliteal abscesses spread?

Answer 1

superiorly and inferiorly b/c of the toughness of popliteal fascia

Question 2

palpation of popliteal pulse

Answer 2

can be difficult - Pt in prone position w knee flexed - feel in inferior part of the fossa where popliteal artery is related to tibia

Question 3

what does weakening or loss of popliteal pulse indicate?

Answer 3

femoral artery obstruction

Question 4

popliteal aneurysm

Answer 4

abnormal dilation of all or part of the popliteal artery - causes edema and pain in popliteal fossa

Question 5

how to distinguish popliteal aneurysm from other masses

Answer 5

palpable pulsations (thrills) and abnormal arterial sounds (bruits) detected w/ stethoscope

Question 6

referred pain from popliteal aneurysm

Answer 6

compresses tibial nerve - referred pain to skin over medial aspect of calf, ankle, or foot

Question 7

arteriovenous fistula

Answer 7

communication b/w an artery and a vein

Question 8

how can blood bypass a ligated femoral artery to reach the popliteal fossa?

Answer 8

through the genicular anastamosis

Question 9

causes of injury to tibial nerve

Answer 9

• posterior dislocation of the knee joint

- deep lacerations in fossa

Question 10

severance of tibial nerve

Answer 10

• paralysis of flexor muscles in the leg and intrinsic muscles in the sole of the foot
• can’t plantarflex ankle or flex toes
• lose sensation on sole of foot

Question 11

containment and spread of compartmental infections in leg

Answer 11

• in ant and post: spreads distally

- in lat: can ascend proximally into the popliteal fossa

Question 12

shin splints

Answer 12

edema and pain in the area of the distal 2/3 of the tibia from repetitive microtrauma of the tibialis anterior (mild form of anterior compartment syndrome)

Question 13

unique features of human foot

Answer 13

stand more pronated b/c of:

• medial migration of distal attachment of fibularis longus across sole of foot
• development of a fibularis tertius attached to base of 5th metacarpal

Question 14

what is the most common nerve injured in the lower limb?

Answer 14

common fibular nerve - due to superficial position

Question 15

severance of common fibular nerve

Answer 15

flaccid paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexors of ankle and evertors of foot)

Question 16

footdrop

Answer 16

loss of dorsiflexion of ankle

Question 17

3 ways to compensate for a limb that is too long

Answer 17

1. waddling gait
2. swing-out gait
3. steppage gait

Question 18

sound associated with footdrop

Answer 18

clop - due to foot slapping on the ground - more shock to forefoot and up tibia to knee

Question 19

sensation loss w/ common fibular nerve lesion

Answer 19

• anterolateral aspect of leg

- dorsum of foot

Question 20

ski boot syndrome

Answer 20

deep fibular nerve entrapment -where nerve passes deep to the inferior extensor retinaculum and extensor hallucis brevis (also due to tight shoes)

Question 21

what can produce recurrent stretching of the superficial fibular nerve?

Answer 21

chronic ankle sprains

Question 22

calcaneal tendinitis

Answer 22

inflammation of Achilles tendon

Question 23

most severe acute muscular problem of leg

Answer 23

rupture of Achilles (calcaneal) tendon

• no plantarflexion against resistance
• excessive passive dorsiflexion
• bruising in malleolar region
• lump in calf (shortened triceps surae)

Question 24

calcaneal tendon reflex

Answer 24

= ankle jerk reflex = triceps surae reflex

• normal: plantarflexion of ankle joint
• tests S1 and S2 nerve roots

Question 25

stance during absence of plantarflexion

Answer 25

rotated foot as far laterally as possible - to allow a more effective push off through hip and knee extension exerted at midfoot

Question 26

tennis leg

Answer 26

gastrocnemius strain - painful acute injury from partial tearing of the medial belly of the gastrocnemius at/near it’s musculotendinous jxn

Question 27

calcaneal bursitis

Answer 27

retro-achilles bursitis - inflammation of the deep bursa of the calcaneal tendon

• pain posterior to heel
• caused by excessive friction on the bursa as tendon continuously slides over it

Question 28

musculovenous pump

Answer 28

• blood pumped superiorly in deep veins by contraction of calf muscles
• improved by deep fascia that invests muscles like an elastic stocking

Question 29

accessory soleus

Answer 29

appears as a distal belly medial to the calcaneal tendon - can cause pain and edema during prolonged exercise

Question 30

palpation of posterior tibial pulse

Answer 30

b/w the posterior surface of the medial malleolus and the medial border of the calcaneal tendon - have Pt invert foot to relax retinaculum

Question 31

why are both posterior tibial pulses taken simultaneously?

Answer 31

for equality of force - needed for diagnosis of occlusive peripheral arterial disease

Question 32

intermittent claudication

Answer 32

presents w/ leg pain and cramps during walking that disappears w/ rest - from ischemia of leg muscles caused by narrowing or occlusion of the leg arteries