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Flashcards in clinical correlations/blue boxes Deck (73)
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1

Meralgia paresthetica

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

2

Palpation, Compression, Cannulation, of the Femoral Artery:

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

3

Great saphenous v

• 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

4

femoral (inguinal) hernia

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

5

Laceration of the Femoral Artery:

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

6

Saphenous Varix:

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

7

iliopectineal bursa

Located where iliopsoas crosses hip joint
Forms if run/cycle a lot

8

anserine bursa

bursa at pes anserinus

9

Osgood-Schlatter Dis

• 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

10

Groin pull

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

11

Hip and thigh contusions

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

12

Psoas abscess

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

13

Paralysis of quadriceps

Can't extend leg against resistance
Presses on distal thigh during walking to prevent flexion of knee joint

14

Chondromalacia patellae

"Runner's Knee"
Soreness and aching around or deep to patella due to quadriceps imbalance

15

Patellar fractures

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

16

Abnormal ossification of the patella

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

17

Patellar reflex

Test femoral nerve (L2-L4)
Westphal's Sign = absence of decreased reflex

18

posterior hip dislocation:

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

19

intragluteal injections

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

20

Duchenne’s Limp/Gluteal Limp

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

21

Trochanteric Bursitis:

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

22

Ischial Bursitis:

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

23

Dislocation VS Fracture:

Dislocation - LE is medially rotated
Fracture - LE is shortened and laterally rotated

24

fabella

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

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