Stuff I Don't Know Flashcards
How do proximal femur fractures occur?
Indirect trauma (taking a bad step off a curb)
Where do all of the hamstring muscles insert?
Ischial Tuberosity
A psoas abscess may be secondary to what?
A pyogenic infection in the abdomen
Treatment for compartment syndrome
Fasciotomy
What is riders strain? What weird thing can happen secondary to riders strain?
Strain of the adductor longus. The tendon of adductor longus can become ossified bc horseback riders actively adduct their thighs to keep from falling
Where can a femoral nerve block be administered?
2 cm inferior to the inguinal ligament, approx 1 finger’s breadth lateral to the femoral artery
3 causes of venous stasis
- ) loose fascia that diminishes effectiveness of the musculovenous pump
- ) External pressure on veins from bedding during a prolonged hospital stay
- ) Muscular inactivity
What nerve does the patellar tendon reflex test?
The femoral nerve (L2-L4 spinal cord segments)
Where is the femoral artery cannulated?
Just inferior to the midpoint of the inguinal ligament. In cardiac angiography a catheter is placed in the artery and goes to the external iliac artery, common iliac artery, aorta, then left ventricle of the heart
A psoas abscess should always be considered under what clinical finding?
Edema in the proximal part of the thigh
Saphenous varix
A localized dilation of the terminal part of the great saphenous vein
The distal fragment of a transverse patellar fragment is pulled by what?
The patellar ligament
Where are varicose veins common?
Great saphenous vein in the posteromedial parts of the lower limb
Dislocation of the epiphysis of femoral head
- Happens in age 10-17
- The epiphysis of the femoral head may slip away from the femoral neck bc of a weakened epiphysial plate
- Sx = hip discomfort with radiation to the knee
Coxa valga
An increase in the angle of inclination between the long axis of the femoral neck and the femoral shaft
The proximal fragment of a transverse patellar fragment is pulled by what?
The quadriceps tendon
When is cannulation of the femoral vein used?
To secure blood sample, to take pressure recordings from the chambers of the right side of the heart and pulmonary artery, and for right sided cardiac angiography
Trochanteric bursitis is a result of what?
Repetitive actions such as climbing stairs with heavy items.
Where do avulsion fractures of hips occur?
At apophyses (bony projections that lack secondary ossification centers)
Two locations where the proximal femur might break?
Transcervical and intertrochanteric
Where would a saphenous varied cause edema?
The femoral triangle, since they meet there
What would happen if the saphenous nerve was affected during a femoral nerve block?
Paresthesia radiating to the knee and over the medial side of the leg bc it is the terminal branch of the femoral nerve
What bone is a common source for bone grafting?
The fibula because walking, running etc. can return to normal
What problem can a saphenous cutdown lead to?
Saphenous nerve damage. The saphenous nerve runs with the great saphenous nerve and can be nicked during cutdown
What is a hip pointer?
Contusion of the iliac crest, normally occurs at its anterior portion
Spiral fracture
Occurs in the femoral shaft. May be comminuted with fragments of bone displaced in multiple directions due to muscle pull
When inguinal lymph nodes are enlarged, what should be inspected?
Their entire field of drainage (the trunk inferior to the umbillicus, perineum, and entire lower extremity). In females the remote possibility of metastasis of cancer of the uterus should also be considered
Intracapsular fractures
Occur within the hip joint
A person with a paralyzed quadriceps muscles cannot do what?
Extend the leg against resistance
Muscle strains of the adductor longus often occur in what kind of sports?
Sports that require quick acceleration (hockey, football, rugby, cricket, breaststroke swimming)
Are proximal femur fractures stable or unstable? Why?
Unstable, due to angle of inclination. Shortening and impaction occurs. Shortening due to muscle spasm also occurs
Fractures of the greater trochanter and femoral shaft
Usually result from direct trauma
Most commonly fractured location on the femur?
The neck
Intraosseous infusion (IO)
Delivering stuff directly into the medullary cavity of a bone when peripheral venous access is difficult.
If the saphenous nerve were to be severed, where would the patient experience pain/numbness?
Medial border of the foot
Compartment syndrome
Fascia encloses anatomical compartments. Increases in pressure due to edema, hemorrhage, or inflammation will be trapped within the fascia. The increase in pressure will constrict vessel and limit blood supply to distal structures which can result in ischemia
Two common signs of compartment syndrome
Loss of distal pulses and decrease in temperature distal to compression
Transverse patellar fracture may be the result of what?
A direct blow to the knee or sudden contraction of the quadriceps (when one slips and attempts to prevent a backwards fall)
Common area for avulsion fractures of the hip bone
The ASIS and AIIS, ischial tuberosities, and ischiopubic rami
Saphenous Cutdown
Used to insert a cannula for prolonged administration of blood, drugs, etc
Cruciate anastomosis is made up of what 4 arteries?
- ) transverse branch of the medial circumflex femoral a.
- ) terminal part of the transverse brach of the lateral circumflex femoral a.
- ) 1st perforating a.
- ) inferior gluteal a.
Pyogenic infection in the abdomen is secondary to what 2 things?
TB and Crohn’s disease
Bipartite or tripartite patella
Result of abnormal ossification of the patella. The ossification centers don’t fuse correctly, resulting in two or three fragments of the patella. Abnormal ossification usually occurs bilaterally, so it is wise to check both patellae before diagnosing it as a fracture
Where is the femoral pulse palpated?
Midway between the ASIS and the pubic symphysis with the palm
Fractures of the inferior or distal femur may compromise what?
The blood supply to the leg due to hemorrhage off the large popliteal artery that run directly below this part of the femur
How/where can you always find the great saphenous vein?
By making a skin incision anterior to the medial mallelous
What are two possible fragments of a transverse patellar fracture?
Proximal and distal
Trochanteric bursitis
Inflammation of the trochanteric bursa
Comminuted fracture
Broken into multiple pieces
Where does the saphenous vein meet with the femoral vein?
The femoral triangle
Femoral nerve roots
L2-L4
Superior gluteal nerve branches
L4-S1
What is special about the gracilis muscle?
It can be transplanted into the hand and external anal sphincter due to its relatively weak adductor abilities in the thigh
Vericose vein
Dilation of vein so that the cusps of their valves do not close
Coxa vara
A decrease in the angle of inclination between the long axis of the femoral neck and the femoral shaft. Causes a mild shortening of the limb and limits passive abduction of the hip
What condition weakens the femur?
Osteoporosis
Thrombophlebitis
DVT is inflammation around the involved veins
Most common site for IO
Proximal tibia due to thinness of skin
Why is the saphenous vein used from coronary artery bypass? (3 reasons)
- ) Readily accessible
- ) A sufficient distance occurs between its tributaries and perforating branches, therefore usable lengths can be harvested
- ) Its walls contain high amounts of muscular and elastic fibers
Blood may be taken from the femoral artery for what reason?
Blood gas analysis
Important cause of a DVT
Venous stasis
Ischial bursitis cause?
Repeated micro trauma resulting from repeated stress (aka rowing, cycling, etc) on the ischial bursa
Where is the ischia bursa located?
On the sacrotuberous ligament
Hamstring strains are common in individuals who do what?
Run and/or kick hard
Thigh strains are usually accompanied by what?
Contusion and tearing of the muscle fibers
Superior gluteal nerve innervates what?
Gluteus medius, gluteus minimus and tensor fascia lata
Injury to the superior gluteal nerve results in what?
gluteus medius limp by weakened abductors of the thigh and/or gluteal gait, a compensatory list of the body to the weakened gluteal side
What is a positive trendelenburg test?
When a person who has suffered a lesion of the superior gluteal nerve is asked to stand on one leg, the pelvis on the unsupported side descends. This shows that the glut medius and minimum on the supported side are weak or non-functional
Other causes of a positive tendelenburg test?
fx of the greater trochanter and dislocation of the hip joint
In what percentage of people does the common fibular division of the sciatic nerve pass through piriformis? Why is this significant?
12%. It may compress the nerve
Significance of the popliteal fascia?
It is very tough. Pain from an abscess or tumor in the popliteal fossa is severe. Abscesses will move superiorly and inferiorly bc it is so dense
Politeal pulse
Taken with the patient prone with the knee flexed
Popliteal aneurysm
abnormal dilation of all or part of the popliteal a.
How may a popliteal aneurysm be detected?
palpable pulsations (thrills) and abnormal arterial sounds (bruits), which are detectable with a stethoscope
Injury to the tibial nerve results in what?
Paralysis to the flexor muscles in the leg and intrinsic muscles of the foot. Pt’s are unable to plantarflex and flex the toes
Why is a purulent infection of the lateral compartment severe?
It can ascend to the popliteal fossa along the course of the fibular nerve
What muscle is affected in shin splints?
The tibialis anterior
Where is fibularis tertius attached distally?
The base of the 5th metatarsal
Evolution of the human foot
The development of the fibularis tertius and medial migration of the attachment of the fibularis longus made humans feet more everted (pronated) than our ancestors
Most commonly injured nerve of the lower limb?
The common fibular nerve
Severance of the common fibular nerve results in what?
flaccid paralysis of all muscles in the anterior and lateral compartments of the leg (the dorsiflexors of ankle and evertors of the foot)
What do you see in the gait of a patient with foot drop?
The toes of the affected foot do not clear the ground during the swing phase of walking
Ski boot syndrome
Tight ski boots cause pain in the dorsum of the foot with radiation to the web space of the 1st and 2nd toes
Chronic ankle sprains may result in what?
Reccurent stretching of the superficial fibular nerve, which leads to pain along the lateral side of the leg and dorsum of the ankle and foot
Calcaneal tendonitis
9-18% of all running injuries. It causes pain with walking, especially with rigid soled shoes
Ruptured calcaneal tendon is likely to happen in what population of people?
Sustained by poorly conditioned people with a history of calcaneal tendonitis
Clinical findings of calcaneal tendon rupture
Since the calcaneal tendon is the insertion site of the gastrocs, soleus, and plantaris, patients cannot plantarflex against resistance
The calcaneal tendon reflex tests which nerve roots?
S1 and S2
Where is the posterior femoral cutaneous nerve found?
Medial to the sciatic nerve as it exits the gluteus maximus
When gluteus maximus and tensor fascia lata work together, what can they accomplish?
They can extend the leg to make up for paralysis of the quadriceps femoris
The medial sural cutaneous nerve comes off of what nerve?
The tibial nerve
The lateral sural cutaneous nerve comes off of what nerve?
The common fibular nerve
The sural communicating brach comes off of what nerve?
The lateral sural cutaneous nerve
Medial plantar nerve innervates what? (4)
Medial 1 Lumbrical, abductor hallucis, flexor digitorum brevis, flexor hallucis brevis
Marfans syndrome gene
fibrillin I gene
Findings of marfans syndrome?
Targets ocular, skeletal, and CV systems. Also cardio problems
Reticular fibers are found where?
Liver, lymph nodes, bone marrow, and spleen
Ehlers Danlos is due to a lack of what?
Collagen
Where is dense regular connective tissue found?
Tendons, ligaments, aponeurosis, dense fascia
Where is dense irregular connective tissue found?
Dermis of the skin, capsules around the organs, perichondrium, periosteum, fascia
Where are elastic fibers found?
BV’s, bronchioles, special ligaments
Where is loose connective tissue generally found?
Immediately beneath membranous epithelia and around BVs, muscle, and nerves
Function of loose connective tissue?
support and bind other tissues, defend against infection, hold body fluid
Loose pes planus
due to laxity of the intrinsic muscles of the foot
Dense pes planus
due to a deformity in the bones of the foot
Acquired pes planus
Tibialis posterior tendon has become lax due to age
Where do fibular fractures commonly occur?
2-6 cm proximal to the distal end of the lateral malleolus
How do fibular fractures commonly occur?
With excessive inversion. Can cause the talus to tilt against the lateral malleolus
When is the hip joint the most stable?
When is person is bearing weight
Surgical hip replacement description
Metal prosthesis is anchored to the persons femur by bone cement. It replaces the femoral head and neck. A plastic socket replaces the acetabulum
Fractures that result in the separation of the femoral epiphysis are also likely to result in what?
Inadequate blood supply to the femoral head and in avascular necrosis of the head of the femur
How many more times likely is it for a girl to have a congenital dislocation of the hip?
8 times
Main characteristic of congenital dislocation?
Inability to abduct the thigh
What percentage of cases of arthritis result from congenital dislocation of the hip?
25% of all cases
Position of hip during an automobile accident?
Flexed, adducted, and medially rotated
What nerve may be injured in posterior dislocation of the hip?
Sciatic nerve. This can result in paralysis of the hamstrings.
How do anterior dislocations occur?
Violent injuries that force the hip into extension, abduction, and lateral rotation
What is the angle between the femur and tibia called?
The Q angle
How is the Q angle assessed?
By drawing a line from the ASIS to the middle of the patella and adding a second vertical line through the middle of the patella and tibial tuberosity
Is the Q angle greater in males or females?
Females, due to larger hips
What is medial angulation of the leg called?
Genu varum aka bow leg
What happens in genu varum?
Excessive pressure on the medial aspect of the knee which results in arthrosis of the knee. Also, the fibular collateral ligament is stressed
What is genu valgum?
Lateral angulation of the knee aka knock knee
What ligament is affected in genu valgum?
The tibial or medial collateral ligament
When do children normally appear bowlegged?
1-2 years after starting to walk
When do children appear knock kneed?
Age 2-4
What is the anterior drawer test?
Pt lying supine. Knee flexed between 80 and 90 degrees. Pulling the back of the leg anteriorly. The test is positive if the tibia moves anteriorly
What is the posterior drawer test?
Push the tibia backwards. Positive test is if the tibia moves posteriorly and means PCL pathology
In knee arthroscopy, what is the second cannula used for?
The passage of specialized tools
What are the landmarks for knee aspiration?
Approach laterally using Gerdy Tubercle, lateral epicondyle of the femur, and the apex of the patella
How is prepatellar bursitis obtained?
Jobs where people are on their knees. This leads to excessive friction between the skin and the patella. Nursmaids knee.
How is subcutaneous infrapatellar bursitis obtained?
Excessive friction between the skin and the tibial tuberosity
Deep infrapatellar bursitis results in edema where?
Between the patellar ligament and the tibia, superior to the tibial tuberosity
Suprapatellar bursitis is a result of what?
An infection caused by bacteria entering the supra patellar bursa
Other name for a popliteal cyst?
Baker Cyst
What is a popliteal cyst almost always a result of?
Chronic knee joint effusion
The tendon of what muscle passes through the lesser sciatic foramen?
Obturator internus
In IPSP, what ions move where?
K+ can leave the cell. Cl- (or another negative ion) can enter the cell.
Spatial activation of a neuron
many pre-synaptic neurons acting on a post synaptic neuron. The signals occur at the same time
Temporal activation of a neuron
One pre-synaptic neuron acting on a post synaptic neuron. This occurs over time. “stair stepping”
Extrafusal mnemonic
If you have an extra fuse, you have a-motor protein
Infrafusal muscle afferent and efferent
efferent = g-motor afferent = 1-a
Where is the femoral nerve cannulated?
2-3 cm inferior to the midpoint of the inguinal ligament. Between ASIS and pubic tubercle
Does the great saphenous vein run anterior or posterior to the medial malleolus?
Anterior
Does slow twitch have more red or white muscle fibers?
Red
Does fast twitch have more red or white muscle fibers?
White
What is the flip flop spot innervated by?
The deep fibular nerve
What is most of the dorsum of the foot innervated by?
The superficial fibular nerve
Where does one palpate the posterior tibial pulse?
posterior to the medial malleolus. Have the pt invert their foot to relax the flexor retinaculum
When is it important to check the PT pulse?
In patients >60 years old because of PVD
Plantar reflex nerve roots?
L4-S2
Abnormal response of the plantar reflex?
Babinski sign, or fanning of the toes
How is medial plantar nerve entrapment obtained?
During repetitive eversion
Palpation of DP pulse
Just lateral to Extensor Hallucis Longus tendon
Where is a hemorrhaging wound of the foot usually obtained?
At the deep plantar arch
Inguinal lymphadenopathy without popliteal lympadenopathy can occur how?
From infection on the medial foot, leg, or thigh
