radiology 1 (leg) Flashcards by Emily Fothergill

In anatomy, what does the term leg refer to?

knee to ankle

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in anatomy, what does the term lower limb refer to?

hip to ankle

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in radiology, how would you describe the location of an injury on the bone

joint surface=articular, just below=metaphysis, middle portion=diaphysis. use proximal and distal

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give the different fracture patterns and how they occur?

google picture
transverse, oblique, butterfly fragment, spiral, comminuted, segmental.
pattern determined by size of force: larger=bone more brittle=shatters e.g. comminuted fractures in motor sport.
oblique vs spiral: in tibia if close to fibular more likely to be oblique and spiral further away as is likely caused by twisting e.g. skiing

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describe the terminology of fracture displacement

undisplaced=best
angulation: describe degree of rotation
translation=displacement: describe as a % of the bone that has displaced

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what imaging tools are used to view fractures?

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when would you use a CT to view a fracture?

when the fracture location is articular or metaphyseal (shown by inital XR)

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which bone in the lower limb is most likely to have an open fracture?

tibia as close to skin

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what is internal fixation and when do you use it?

rod is inside the bone

if fracture is closed and clean

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what is external fixation and when do you use it?

rod outside of bone

if fracture is open and potentially contaminated

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what else must you do other than fixation for open fractures?

abx asap

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what are the 2 causes of stress fractures?

bone is too weak for normal activity (osteoporosis)

normal bon ebut hight demand (long distance running)

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how are stress fractues diagnosed?

can be hard
may need MRI (T2 weighted, water shows so get lots of bright white in affected area due to odema)
bone scan (use technetium 99 tracer which is taken up in areas of high bone turnover so affected area is dark)

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what is a pathological fracture?

not due to trauma, tumour, osteoporitic stress fracture

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what is the technical name for shin splints?

medial tibial stress syndrome

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what is chronic exertional compartment syndrome and where is most commonly affected?

usually anterior compartment of leg
when running the front part of the leg begins to burn as the muscles are swelling due to blood flow but thick fascia blocks the muscles from swelling as they want to

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draw and label the compartments of the lower leg

google https://www.google.com/imgres?imgurl=https%3A%2F%2Fupload.wikimedia.org%2Fwikipedia%2Fcommons%2F8%2F8f%2FGray440_-_Fascial_compartments_of_leg.svg&imgrefurl=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FFascial_compartments_of_leg&tbnid=hlBMxT2Ci9V9wM&vet=12ahUKEwiowKiq6LrzAhVUPhoKHS9kApQQMygAegUIARDNAQ..i&docid=8QeqWHOjpkGPvM&w=1200&h=875&q=compartments%20of%20leg&ved=2ahUKEwiowKiq6LrzAhVUPhoKHS9kApQQMygAegUIARDNAQ

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which compartments of the leg are mirror images?

anterior and deep posterior. anterior deals with extension, posterior with flexion, both have 3 muscles separated by interosseus membrane

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what is in the anterior compartment of the leg?

tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius, deep peroneal nerve, anterior tibial vessels

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what is in the lateral compartment of the leg?

peroneus longus, peroneus brevis, superficial peroneal nerve

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what is in the superficial posterior compartment of the leg?

gastrocnemius, plantaris, soleus, sural nerve

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what is in the deep posterior compartment of the leg?

tibialis posterior, flexor hallucis longus, flexor digitorum longus, popliteus, tibial nerve, posterior tibial vessels

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which nerve in the leg is most likely to be damaged?

superficial peroneal nerve

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what is the origin of tibialis anterior?

upper 1/2 or 2/3 of lateral surface of tibia and adjacent interosseous membrane

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where is the insertion of tibialis anterior?

medial cuneiform and the base of the 1st metatarsal bone of the foot

which nerve supplies tibialis anterior?

deep fibular (peroneal), L5

what are the actions of tibialis anterior?

dorsiflexion and inversion of foot

where is the origin of tibialis posterior?

tibia and fibula

where is the insertion of tibialis posterior?

navicular and medial cuneoform bone

which nerve supplies tibialis posterior?

tibial

what are the actions of tibialis posterior?

inversion of foot and plantar flexion of foot at the ankle

where is the origin of peroneus longues?

proximal part of shaft of fibula

where is the insertion of peroneus longus?

first metatarsal, medial cuneiform

which nerve supplies peroneus longus?

superficial fibular (peroneal)

what are the actions of peroneus longus?

plantarflexion, eversion, support arches

where is the origin of peroneus brevis?

lower 2/3 lateral fibula

where is the insertion peroneus brevis?

5th metatarsal

which nerve supplies peroneus brevis?

superficial fibular

what are the actions of peroneus brevis?

plantarflexion, eversion

where is the origin of extensor hallucis longus?

middle portion of fibula on the anterior surface ad interosseous membrance

where is the insertion of extensor hallucis longus?

dorsal side of base of distal phalanx of big toe

which nerve supplies extensor halllucis longus?

deep fibular (L5)

what is the action of extensor hallucis longus?

extends big toe and assists in dorsiflexion of foot and ankle

where is the origin of extensor digitorum longus?

anterior lateral condyle of tibia, anterior shaft of fibula and superior 3/4 of interosseous membrane

where is the insertion of externsor digitorum longus?

dorsal surface, middle and distal

which nerve supplies extensor digitorum longus?

deep fibular (L5)

what are the actions of extensor digitorum longus?

extension of toes and dorsiflexion of ankle

where is the origin of the achilles (calcaneal) tendon?

gastrocnemius and soleus

where does the calcaneal tendon insert?

calcaneal tuberosity

what is the action of the calcaneal tendon?

plantar flexion of foot

what causes achilles tendon rupture and what will it look like?

inability to disepate heat from stretching, unravelling of type 1 collagen. loss of tendon definiton, bruisng, swelling

what is the clinical test for achilles tendon rupture?

Thompson/simmonds | squeeze the calf while patient laying on front, should be plantar flexion, if not then complete rupture

give some rf for achilles tendone rupture

ageing, fluoroquinolone abx, steroid injectins, male, increased BMI, smoking, peripheral vascular disease, diabetes

what is achilles tendonitis?

chronic, thickens and degenerated tendon

what imaging is used for tendons?

MRI and US(good as can see while moving)

why are medial ankle sprains less common?

length of fibula acts as buffering

what causes a high ankle sprain?

forced external rotation of foot and dorsiflexion | posterior inferior tibiofibular ligament, anterior inferior tibiofibular ligament

what causes a low ankle sprain?

supination and adduction | posterior talofibular ligament, calcaneofibular ligament, anterior talofibular ligament

describe the grades of ankle sprains

grade1=minimal tissue damage, tx rice, usually resolves within a week 2= 1+ ligaments damaged, more swelling and brusing, healing can take 2-6 weeks 3=ligament torn, often popping sound, inability to weight bare, 6-12 weeks to recover

what are the Ottawa ankle XR rules?

if have 1 of these then need an XR: bone tenderness at posterior edge or tip of lateral malleolus bone tenderness at posterior edge or tip of medial malleolus inability to weight bare for 4 steps immediatelt and at the emergency department

why do ankle fractures often have to be operated on?

need to restore full anatomy to prevent arthtiris

what is the classification for ankle fracturs?

Weber A: rare but best Weber B: tibia and fibula still well connected Weber C: tibia and fibula not connected

name and draw the bones of the foot

calcaneus, talus, navicular, cuboid, cuneiforms https://www.google.com/imgres?imgurl=https%3A%2F%2Fi.pinimg.com%2Foriginals%2Fd1%2F3d%2F3d%2Fd13d3d674d99b39b41334102720b1475.jpg&imgrefurl=https%3A%2F%2Fwww.pinterest.com%2Fpin%2F202450945722792046%2F&tbnid=RQUHLWwUdYBavM&vet=12ahUKEwjWvd-R7rrzAhVF0RoKHUwiBlUQMygOegUIARDwAQ..i&docid=frvDmopuPgUISM&w=1118&h=1398&q=foot%20bones%20anatomy&ved=2ahUKEwjWvd-R7rrzAhVF0RoKHUwiBlUQMygOegUIARDwAQ

describe the surface abatomy of the cuboid.

lateral (proximal and superior to 5th MT)

describe the surface anatomy of the 5th metatarsal.

lateral, midfoor inferior prominance

describe the surface anatomy of the navicular

medial, 2cm anterior to sustentaculum tail

describe the surface anatomy of sustentaculum tail.

medial, 2cm inferior to MM

when is the calcaneus often broken?

when fall from a hight

what are the important ligaments in the foot?

spring/calcaneonavicular: holds the arch together | plantar, tibialis posterior

what are the brevis toe extendors?

extensor hallucis brevis, extensor digitorum brevis

what is the origin of the extensor hallucis brevis?

calcaneus

where is the insertion of the extensor hallucis brevis?

proximal phalanx of hallux

which nerve supplies extensot hallucis brevis?

deep fibular

what is the action of extensor hallucis brevis?

extend hallux

where is the origin of extensor digitorum brevis?

dorsal surface of calcaneus

where is the insertion of extensor digitorum brevis?

proximal dorsal region of middle phalanges 2,3 amd 4

what are the actions of extensor digitorum brevis?

extends digits 2,3,4

which nerve supplies the extensor digitorum brevis?

deep fibular

where is the origine of the tibialis posterior tendon?

tibia and fibula

where does the tibialis posterior tendon insert?

navicular and medial cuneiform

which nerve supplies the tibialis posterior tendon?

tibial

what are the actions of the tibialis posterior tendon?

inversion of foot and plantar flexion of ankle

what is the medial longitudinal arch formed and supported by?

formed by: calcaneus, talus, navicular, 3 cuneiforms, 1st 3 metatarsal bones supported by: muscles ( tibialis anterior and posterior, fibularis longus, flexor digitorum longus, flexor hallucis, intrinsic foot muscles), ligaments (plantar, medical ligament of ankle joint), shape of bones, plantar aponeurosis

what is the function of the medial longitudinal arch of the foot

distribute force

what is plantar fascitis and how is it treated?

lots of pain, plantar fascia becomes tight, bulls bone and creastes calcification at insertion , causes bone spur (shown on XR) need US/MRI to look at fascia tx: stretching, rest, ice, arch supports, steroid injections, surgery to release plantar fascia

is peroneus brevis associated with base of 5th metatarsal avulsion fracture due to inversion injury to ankle

yes

what can stress fractures to metatarsals be called?

march fractures

what is mortons neuroma?

soft tissue between 3rd and 4th toes, get stabbing/burning pain, need MRI