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clinical correlations/blue boxes Flashcards

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1
Q

Meralgia paresthetica

A

compression of lateral femoral cutaneous nerve as it passes under inguinal ligament causes pain along lateral thigh

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2
Q

Palpation, Compression, Cannulation, of the Femoral Artery:

A

Palpation = Femoral pulse palpated midway between ASIS and pubic tubercle
Compression = pushing posteriorly to reduce blood flow through femoral artery and deep femoral artery
Putting pressure proximal to branching of deep femoral artery
Cannulation = catheter inserted for left cardiac angiography, coronary artery angiography, and to take blood for measurement of blood gasses

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3
Q

Great saphenous v

A
  • Used to administer blood, electrolytes, drugs, etc
  • For coronary bypass surgery
  • For access to venous sys in incision may be made anterior to medial malleolus (“saphenous cutdowm”)
  • Pt may complain of pain along medial border of foot as a result
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4
Q

femoral (inguinal) hernia

A

protrude out of the saphenous opening of femoral canal (direct and indirect)
*more common in females
Lacunar ligament may strangle SI portion causing necrosis

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5
Q

Laceration of the Femoral Artery:

A

When ligated, blood can be supplied to thigh and leg via cruciate anastomosis
Cruciate anastomosis:
Medial and lateral circumflex femoral arteries
Inferior gluteal artery
First perforating artery

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6
Q

Saphenous Varix:

A

Localized dilation of the terminal part of great saphenous vein
May cause edema in femoral triangle
Should be considered when varicose veins are present in other areas of the body

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7
Q

iliopectineal bursa

A

Located where iliopsoas crosses hip joint

Forms if run/cycle a lot

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8
Q

anserine bursa

A

bursa at pes anserinus

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9
Q

Osgood-Schlatter Dis

A
  • During activities that involve a lot of running, jumping, bending (sports!), a child’s thigh muscles (quads) pull on the tendon that connects the kneecap to the shinbone
  • This repeated stress can cause the tendon to pull away from the shinbone–>pain
  • In some cases, a child’s body may try to close that gap w new bone grth, which can result in a bony lump at that spot
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10
Q

Groin pull

A

Strain, stretching, and prob some tearing of the proximal attachments of the thigh adductor/flexor muscles

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11
Q

Hip and thigh contusions

A

Hip Pointer - contusion of anterior portion of iliac crest
Around ASIS
Contusions cause rupturing of capillaries and infiltration of blood into muscles, tendons, and other soft tissues
Charley horse - cramping of thigh muscle due to ischemia, contusion causing hematoma to form
Commonly caused by tearing of rectus femoris

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12
Q

Psoas abscess

A

Commonly seen in pts. With TB
Abscess passes between psoas and its fascia to inguinal and proximal thigh regions
Causes severe pain in hip, thigh, and knee joint
Can be palpated in inguinal region
May be mistaken for indirect inguinal hernia or femoral hernia

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13
Q

Paralysis of quadriceps

A

Can’t extend leg against resistance

Presses on distal thigh during walking to prevent flexion of knee joint

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14
Q

Chondromalacia patellae

A

“Runner’s Knee”

Soreness and aching around or deep to patella due to quadriceps imbalance

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15
Q

Patellar fractures

A

Transverse patellar fractures - may result from direct blow to knee or sudden contraction of quadriceps

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16
Q

Abnormal ossification of the patella

A

Cartilaginous at birth, ossifies between years 3-6
Ossification Abnormalities:
Ossification centers don’t coalesce
Usually bilateral

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17
Q

Patellar reflex

A

Test femoral nerve (L2-L4)

Westphal’s Sign = absence of decreased reflex

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18
Q

posterior hip dislocation:

A

Can cause damage to sciatic n
May result in paralysis of hamstrings and muscles diastal to knee
Sensory change may occur in skin over the posterolateral aspects of leg and most of foot

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19
Q

intragluteal injections

A

Should be made in the supero-lateral part of gluteal region in order to avoid the sciatic n and other glueal nerves and vessels
-Can also be given in antero-lateral part over TFL
In triangular region formed by fingers by placing index finger on ASIS and moving middle finger posteriorly to find iliac tubercle

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20
Q

Duchenne’s Limp/Gluteal Limp

A

Cause: superior gluteal n injury
Effect: Pt loses steadying action of gluteus medius and minimus
→ lean twd affected side during stance phase of gait → opp hip drops to keep mass over leg

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21
Q

Trochanteric Bursitis:

A

Causes - repetitive climbing of stairs with heavy objects, running on steep incline
Pain in lateral thigh
Characterized by point tenderness of greater trochanter

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22
Q

Ischial Bursitis:

A

Causes - cycling, rowing, repetitive hip extension while seated activities
Pain over bursa and increases with gluteus maximus movement
Creates pressure sores in debilitated people, particularly paraplegic persons

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23
Q

Dislocation VS Fracture:

A

Dislocation - LE is medially rotated

Fracture - LE is shortened and laterally rotated

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24
Q

fabella

A

sesamoid bone close to its proximal attachment of lat head gastroc
• 3-5% pop
• Function: possibly provide leverage for lateral head of gastroc
• Painful fabellar stress fracture may accompany total knee replacement

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25
use of plantaris
Long tendons commonly used in reconstructive surgery of hand tendons -Its removal does not affect knee or ankle mvmts (we think?)
26
plantaris rupture
during violent ankle mvmts (eg sudden dorsiflexion) - Common injury in bball players, sprinters, ballet dancers - Pain so severe that person unable to bare weight
27
Posteroir tibial artery pulse
Palpated btwn: • Posterior surface of medial malleolus • Medial border of calcaneal tendon • Deep to flexor retinaculum • Important to have patient relax retinaculum by inverting foot *Used to examine patients w occlusive peripheral arteral dis (intermittent caudication):
28
occlusive peripheral arteral dis (intermittent caudication
* Condition caused by ischema of leg muscles due to narrowing or occlusion of leg arteries * Chara by leg cramps and pain during walking (disappears after rest)
29
Containment and Spread of Compartmental Infections in the Leg:
Inflammation from infection typically limited to within septal compartments and moves distally Inflammation in lateral compartment can move proximally and enter popliteal fossa via path of fibular nerve
30
Injury to the Common Fibular Nerve:
May be severed during fracture of fibular neck Results in paralysis in anterior and lateral compartment muscles Loss of dorsiflexion causes "foot drop" Means of compensation: "waddling gait" - pt. leans to side opposite long limb (injured limb) "hiking" the hip "swing-out" gait - long limb swings out laterally to allow toes to clear the ground "steppage" gait - extra flexion at hip and knee to raise foot high off ground to clear toes
31
Tibialis Anterior Strain (Shin Splints):
Microtrauma to tibialis anterior causing small tears in periosteum of shaft of tibia Mild form of anterior compartment syndrome
32
Dynamic arches of foot
``` Tibialis posterior Tibialis anterior Flexor hallucis longus Fibularis longus Intrinsic plantar muscles ```
33
Passive arches of foot
``` Plantar aponeurosis Long plantar ligament Short plantar ligament *plantar calcaneonavicular ligament Aka spring ligament *most important one ```
34
Leg compartmental syndromes
o Septa very tough o Trauma may lead to hemmorage, edema, inflammation o Intracompartmental pressure may lead to ischemia and permanent injury o Incising fascia (fasciotomy) may be performed to relieve pressure
35
superficial fibular n
* Most commonly injured lower extremity n * = injury results in paralysis of all anterior and lateral crural muscles * -loss of dorsiflexion and eversion cuases “foot drop”:
36
foot drop
• injury to superficial fibular n - difficult to achieve heel strike - patient has high stepping gait, waddling gait, or a swing-out gait - if leg swings strongly fwd, the foot strikes with a “clap” - loss of sensation along anterolateral leg and dorsum of foot
37
Sciatic Nerve Injury:
Pain in buttocks may be piriformis compressing sciatic nerve Common in sports with excessive gluteus muscle use Complete section of nerve = loss of leg function Gluteus maximus: Side of safety = lateral side Side of danger = medial side
38
Acetabulum labrum tears
• Can be fixed arthroscopically • Can be induced by twisting on weight bearing hip o 80% actually don’t know the cause • (as w all hip probs) = diffuse pain => difficult to diag • Not see swelling, although the inflamed joint may become larger in volume bc of an “effusion “ due to trauma • If fron t of hip is affected = may be a pinching sensation when flex the hip • The pain may be reproduced in sport during activities that req weight bearing and twisting (kicking a football)
39
Anterior hip dislocation
* 10-15% of traumatic dislocation of hip * occur when knee strikes dashboard w thigh abducted, falls from height, or from a blow to back while in a squatted pos * Neck of femur or graeter trochanter impinges in rim of acetabulum and thereby levers head of femur out of acetabulum through tear in anterior hip capsule
40
hip replacement
• Hip joint susceptible to degenerative processes (osteoarthritis) o Metal prosthesis anchored to femur bone cement to replace femoral head and neck o Plastic socket cemented to hip bone to replace acetabulum
41
ACL tear tests
``` o Anterior-drawer sign • Pull tibia outward o Lachman’s Test • Hold quad and move tibia up and down • If move a lot = ACL tear ```
42
PCL tear tests
``` o Posterior-drawer sign • Push tibia twd back of thigh o Pivot-Shift test • Pull out so ACL disengaged, flex knee • It PCL torn, will drop back o Quads active test • Push tibia back ```
43
Meniscal tears
* Commonly involve medial meniscus * Lateral meniscus usu not tear bc of mobility * Peripheral meniscal tears can often be repaired or will heal bc of blood supply * Meniscal tears that do not heal or cannot be repaired are removed arthroscopically
44
The Unhappy Triad of O’Donahue = tear in:
o ACL o Tibial collateral ligament o Medial meniscus
45
The Unhappy Triad (NOT of O’Donahue) = tear in:
o ACL o Tibial collateral ligament o Lateral meniscus
46
Bipedalism and Congruity of Articular Surfaces of Hip Joint:
Angle of 30-40˚ between axes of acetabulum and femoral head/neck Extensive contact compared to other joints, causing increased stability
47
Fracture of the Femoral Neck:
Fractures cause lateral rotation of the limb Disrupt blood supply to head Retinacular arteries are torn
48
Necrosis of the Femoral head in Children:
Fractures separating epiphysis from shaft result in inadequate blood supply to femoral head Incongruity of joint surfaces, growth retarded Pain radiates to knee
49
Congenital dislocation of the hip --> seen in neonates
Affected limb appears shorter | See + trendelenburg sign
50
Acquired dislocation of the hip --> uncommon
Usually occur when hip is flexed, adducted, and medially rotated Posterior dislocation - joint capsule ruptures posteriorly and inferiorly Anterior dislocation - hip forced into extension, abduction, and lateral rotation
51
bursa in knee
Suprapatellar - between femur and quadriceps tendon Popliteus - between popliteal tendon and lateral condyle of tibia Anserine - separates pes anserinus from tibia Gastrocnemius - deep to proximal attachment of medial head of gastrocnemius Semimembranosus - between medial head of gastrocnemius and semimembranosus tendon Subcutaneous pre-patellar - between skin and patella Subcutaneous infrapatellar - between skin and tibial tuberosity Deep infrapatellar - between patellar ligament and tibia
52
Genu Valgum and Genu Varum:
Angle between long axes of femur and tibia = Q angle Line from ASIS to middle of patella Line from middle of patella to tibial tuberosity Q-angle greater in females Places middle of knee joint directly inferior to head of femur when standing Genu varum = bowleg Line of weight-bearing falls medial to center of knee LCL overstressed Genu valgum = knock-knee Angle >17˚ Line of weight-bearing falls lateral to center of knee MCL overstressed
53
Patellar Dislocation:
Almost always dislocates laterally
54
Patellofemoral Syndrome:
Pain caused by repetitive microtrauma due to abnormal tracking of patella relative to patellar surface of femur Corrected by strengthening vastus medialis muscle
55
Knee Joint Injuries:
Most common injury = ligament sprain Foot fixed in ground and force applied to knee when foot can't move Meniscial tears usually involve medial meniscus
56
Prepatellar bursitis
- friction between skin and patella May also be inflamed via direct blow to bursa "Housemaid's Knee"
57
Subcutaneous infrapatellar bursitis
- excessive friction between skin and tibial tuberosity | "Clergyman's Knee"
58
Deep infrapatellar bursitis
- edema between patellar ligament and tibia | Overuse and friction between patellar tendon and structures posterior to it
59
Suprapatellar bursitis
- infection caused by bacteria entering from torn skin during abrasions or penetrating wounds Infection may spread to knee joint
60
Ankle injuries
ATFL, calcaneoficular ligament, P TFL Can also fracture lateral malleolus o Broken superior to ankle joint in shearing injuries o Broken inferior to ankle joint in avulsion fractures
61
Pes Planus (Flatfeet)
``` o Flexible • Lack medial arch when wt bearing • Look normal when not wt bearing • Common in kids o Rigid • Flat even when not bearing wt • From a bone deformity • Acquired flatfeet • Dysfunction of tibialis posterior from trauma, degeneration w age, denervation ```
62
plantar fasciitis)
o Inflammation of plantar fascia o Most pain after sitting, and in am, and increases w passive extension of the great toe and dorsiflexion of ankel o Point tenderness at proximal attachment of aponeurosis to medial tubersle of calcaneous
63
Calcaneal (heel) spur:
* Abnormal bony process from medial tubercle * Plantar fasciitis will cause pain on the medial side of foot when walking * Bursa develop at end → inflamed and tender
64
Hallux Valgus
Foot deformity chara by lateral deviation of great toe o Surrounding tissues swell and resultant pressure and friction against shoe cause bursa to form = bunion o Corns – inflamed areas of thick skin over proximal interphalangeal joints
65
Tibial n entrapment
Tibial n leaves the posterior compartment of the leg by passing deep to flexor retinaculum • Entrapment when there is edema and tightness in the ankle involving the synovial sheaths of the tendons of muscles in the posterior compartment in the leg • Area involved:medial malleolus to calcaneous • Heel pain!
66
Infections of the Foot:
Deep infections localize in muscular layers | Require surgery to drain
67
Contusion of Extensor Digitorum Brevis:
Inflammation of EDB causes swelling and edema anteromedially to lateral malleolus
68
Sural Nerve Grafts:
Used for nerve areas that have been wounded | Located via following small saphenous vein
69
Anesthetic Block of Superficial Fibular Nerve:
Inject anesthetic anterior to palpable region of fibula creates broader nerve block than local anesthetic for superficial surgery
70
Plantar Reflex:
L4-S2 nerve roots Normal sign = flexion of the 4 digits Babinski sign = abnormal = fanning of 4 digits and dorsiflexion of big toe
71
Medial Plantar Nerve Entrapment:
Compression of medial plantar nerve in flexor retinaculum Common among runners and people whom evert their foot a lot "jogger's foot"
72
Palpation of Dorsalis Pedis Artery:
``` Feet slightly dorsiflexed 5 P's of acute arterial occlusion: Pain Pallor Paresthysia Paralysis Pulselessness Some adults have soft dorsalis pedis pulses bilaterally ```
73
Hemorrhaging of Wounds of Sole of Foot:
Involve severe bleeding when involve deep plantar arch and its branches

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