Blue Boxes

Question 1

Hip and Thigh contusions

Answer 1

hip pointer - contusion of the iliac crest (usually ASIS)
or
charley horse - cramping of individual thigh muscles because of ischemia or to contusion

Question 2

Compartment syndromes and Fasciotomy

Answer 2

increased pressure on compartments can affect the nerves and vessels in particular compartments
secondary to trama, compression, burns, sustained use
too much pressure can compromise blood flow to distal tissues and lead to ischemia

Question 3

fasciotomy

Answer 3

surgical release of fascia to decrease the pressure in the compartment

Question 4

saphenous cutdown

Answer 4

saphenous vein accessible by making an incision anteriorly to the medial malleolus, used to directly administer fluids to blood stream
saphenous nerve is closely associated with the great saphenous vein, responsible for cutaneous sensation to the medial border of foot

Question 5

hip and thigh contusions

Answer 5

hip pointer - contusion of the iliac crest at ASIS

charley horse - usualy due to tearing of the fibers of the rectus femoris

Question 6

paralysis of the quadriceps

Answer 6

If patient has paralyzed quad, they will press on the distal aspect of their thigh while walking to prevent flexion of the thigh

some extension with glut max and tensor fascia lata

Question 7

patellar fractures

Answer 7

direct blow can fracture patella
transverse fracture of patella
can occur with rapid quadriceps flexion (when you catch yourself while falling)

proximal portion of patella is pulled back with quad tension, distal fragment remains attached to the patellar ligament

Question 8

Palpation, compression and cannulation of the femoral artery

Answer 8

little finger on ASIS, thumb on pubic tubercle - femoral artery will be superior at point
compression of femoral artery can be achieved by applying posterior force against the pubic ramus/femoral neck, or psoas major
cannulation of the femoral artery can be achieved by inserting a slender catheter inferiorly into the inguinal ligament up to external iliac, common iliac, aorta to visualize left ventricle

Question 9

Location of femoral vein

Answer 9

NAVL towards your navel
can find vein by going just medial to the femoral pulse
3cm inferior to femoral vein is tributary from great saphenous vein - important when tying off great saphenous vein during varicose vein operations to correctly identify the great saphenous as it has no tributaries

Question 10

patellar tendon reflex

Answer 10

L2-L4
percussion activates quadriceps muscle to extend leg (afferent signals travel through femoral nerve to L2-L4 segments and enter dorsal horn, causing efferent signals to exit the anterior horn of the spinal cord and excite the femoral nerve, extending the leg.

Question 11

Groin pull

Answer 11

tearing of the proximal attachments of the ateromedial thigh muscles (flexors/adductors)

Question 12

Laceration of the femoral artery

Answer 12

cruciate anastomosis consisting of:
Transverse branch of the lateral circumflex femoral
transverse branch of the medial circumflex femoral
inferior gluteal artery
1st perforating artery of the deep femoral
can supply the leg through collateral circulation if the femoral artery needs to be occluded

Question 13

Femoral hernia

Answer 13

protrusion of abdominal contents through the femoral ring into the femoral canal
if protrusion is pinched by fascia will lead to necrosis
more common in women (wider pelvis)

Question 14

Trochanteric bursitis

Answer 14

friction bursitis caused by rubbing of the bursa over the greater trochanter
tenderness and paint of GT radiates along IT band
elicited by resisted abduction and lateral rotation

Question 15

ischial bursitis

Answer 15

friction bursitis of the gbursae that lies between the ischial tuberosity
pain increased with movement of gluteus maximus, long periods of sitting

Question 16

injury to superior gluteal n

Answer 16

innervates gluteus medius, gluteus minimus, tensor fascia lata
injury results in weak abduction and medial rotation
+ trendelenburg sign (hip drop on ipsilateral side when standing on one leg)

Question 17

gluteal injection

Answer 17

superolateral to avoid sciatic nerve

imaginary line extending from PSIS to greater trochanter

Question 18

popliteal abcess and tumor

Answer 18

pain is severe in popliteal abcess because fascia is very tough - can spread inferiorly and superiorly within popliteal fascia

Question 19

popliteal pulse

Answer 19

since the popliteal a is deep, it is difficult to palpate unless the knee is flexed (relaxing the hamstrings)
a weak pulse would indicate an occlusion/pathology of the femoral a

Question 20

injury to tibial n

Answer 20

uncommon due to depth in popliteal fossa
a deep laceration or posterior dislocation of the knee joint would result in loss of plantar flexion and flexion of the toes

Question 21

containment and spread of compartmental infections in the leg

Answer 21

strong septal fascia separates the compartments of the leg, infections in the anterior and posterior compartment will typically spread distally
the lateral compartment, however, can spread proximally along the course of the fibular nerve to the popliteal fossa
if purulent, suppuration can lead to compartment syndrome (–> resolve with fasciotomy)

Question 22

Shin splints

Answer 22

caused by microtrauma to the anterior aspect of the tibia, usually tibialis anterior - causing tears in the periosteum
can lead to anterior compartment syndrome if swelling/edema occur
common overuse injury

Question 23

fibularis muscles and the evolution of the human foot

Answer 23

pronated form of human feet evolved due to the fibularis longus distal attachment across the sole of the foot and the development of the fibularis tertius

Question 24

Injury to the common fibular n

Answer 24

common fibular n wraps the fibular head - prone to injury/dislocation
damage leads to flaccid paralysis of anterior compartment (TA, EHL, EDL, fibularis tertius === dorsiflexion) and lateral compartment (fibularis L and B == eversion) muscles

Question 25

deep fibular n entrapment

Answer 25

deep fibular n is associated with anterior tibial a in the anterior compartment overuse of anterior compartment m can cause edema and swelling - compressing the deep fibular n and lead to numbness/pain in the space between the 1st and second digit ski boot syndrome

Question 26

superficial fibular n entrapment

Answer 26

chronic ankle sprains can irritate the superficial fibular n in the lateral compartment causing pain and paresthesias over the lateral aspect of the leg and foot

Question 27

Fabella in gastrocnemius

Answer 27

small sesamoid bone posterior to the knee joint in the proximal aspect of the lateral gastro

Question 28

Calcaneal tendinitis

Answer 28

prone to inflammation after walking/running - usually proximal to insertion

Question 29

Ruptured calcaneal tendon

Answer 29

tearing off insertion into calcaneus causes immediate dorsiflexion of ankle - pain cant plantar flex against resistance so cant walk

Question 30

calcaneal tendon reflex

Answer 30

S1-S2 segments of the sacral plexus being tested - normally results in plantar flexion S1 injury/compression diminishes this reflex

Question 31

absence of plantar flexion

Answer 31

patients rotate foot laterally to use midfoot | occurs from achilles rupture or failure to plantar flex

Question 32

calcaneal bursitis

Answer 32

bursa between superoposterior aspect of the calcaneus near the insertion of the calcaneal tendon - can be inflamed due to friction from overuse

Question 33

venous return from leg

Answer 33

dependent on musculovenous pump (contraction of the gastrocnemius, soleus pushing the venous blood proximally) aided by strong fascia surrounding muscles

Question 34

Plantar fasciitis

Answer 34

overuse injury common in athletes and overweight patients inflammation in plantar aponeurosis - commonly near medial tubercle of calcaneus inflammation can lead to a calcaneal osteophyte causing further pain in arch of the foot (it inflames a bursitis) worst after long periods of rest before standing

Question 35

infections of the foot

Answer 35

common and can lead to deep infections in muscular compartments if severe enough, surgical intervention for debridement is used - medial incision passing superior to abductor hallucis

Question 36

contusion of extensor digitorum brevis

Answer 36

dorsal foot muscle that joints the tendons of the EDL at the MP joints belly of the muscle is anteromedial of the lateral malleolus - contusion of this muscle causes a distinct hematoma on the lateral dorsum of foot

Question 37

sural nerve grafts

Answer 37

sural nerve commonly used in nerve grafts - located by finding small saphenous v varies bilaterial

Question 38

anesthesia of the superficial fibular n

Answer 38

cutaneous branches of this n can be found in the ankle region anterior to the fibular can be anesthetized to provide more effective anesthesia than local deep fibular n provides sensation to 1st and 2nd digital interspace

Question 39

plantar reflex

Answer 39

L4-S2 run blunt object over lateral sole of foot and cross to the base of great toe normal response = slight flexion abnormal response = dorsiflection of great toe and fanning of lateral toes (babinskis sign, normal in infants up to age 4)

Question 40

medial plantar n entrapment

Answer 40

``` compression of the medial plantar n can lead to pain and parasthesias in the medial aspect of the sole of foot near navicular tuberosity joggers foot (can be caused by repetitive eversion of foot) ```

Question 41

Palpation of dorsalis pedis pulse

Answer 41

just lateral of the EHL | used to detect for peripheral vascular insufficiency from arterial disease

Question 42

5 P of peripheral arterial occlusion

Answer 42

``` pain pallor parastheisa paralysis pulselessness ```

Question 43

hemmorhaging wounds of soles of foot

Answer 43

hard to treat and control bleeding due to multiple anastomoses of the foot ligation of deep arch is hard to complete due to depth and number of structures

Question 44

lymphadenopathy

Answer 44

infections in the foot can spread proximally and cause inflamed lymph nodes in the popliteal region and inguinal region popliteal more common, spreading to inguinal inguinal lymph nodes can become inflamed as a result of an infection in the medial side of the foot

Question 45

joints of lower limb

Answer 45

femoral neck fracture - causes lateral rotation of the lower limb more common in osteoporotic patients can disrupt capsular ligaments as well as the medial circumflex femoral a, main supplier of blood to the head and neck of femur

Question 46

Hip dislocation

Answer 46

sitting in the car with thigh: adducted, flexed, medially rotated when collision occurs = posterior dislocation, disrupting inferior and posterior capsular ligaments causes limb shortening and medial rotation of hip sciatic nerve can be damaged as a result - paralysis of hamstring muscles

Question 47

anterior hip dislocation

Answer 47

hip extended, abducted, laterally rotated struck from behind disrupts anterior capsule, can cause fracture of acetabular rim

Question 48

Genu valgum and genu varu .

Answer 48

``` Q angle (angle of ASIS and patella and line of gravity) angled medially - genu varum angled laterally - genu valgum ``` varum wears on medial knee and LCL becomes overstressed valgum wears on lateral knee joint and MCL becomes overstressed

Question 49

patellar dislocation

Answer 49

tendency for patella to dislocate laterally counterbalanced by the strong pull of vastus medialis tensor fascia lata and IT band pull patella laterally - cause chondromalacia patella, counteracted by vastus medialis stretch the IT band to treat chondromalacia patella

Question 50

patellofemoral syndrome

Answer 50

pain deep to patella, can result from microtrauma and overuse can arise from arthritis in patellofemoral compartment weak vastus medialis can lead to patellofemoral syndrome and strengthening this muscle helps track the patella properly and prevent patellofemoral syndrome or dislocation

Question 51

TCL injuries

Answer 51

TCL and medial meniscus are firmly fixed to each other and the medial meniscus is the most commonly torn meniscus - typically happens when there is an excessive force to the lateral aspect of the extended knee, when the knee is flexed/lateral twisting that stresses and tears the TCL and medial meniscus

Question 52

ACL injuries

Answer 52

typically occur when the knee is semiflexed and an anterior force is directed at the femur ACL stabilizes the knee by preventing the femur from sliding posteriorly on the tibia, preventing the tibia from moving anteriorly on the femur anterior drawer test