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MSS - MSK Exam 3 > Clinical Correlations of the Lower Limb > Flashcards

Clinical Correlations of the Lower Limb Flashcards

(108 cards)

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1
Q

femoral hernia

A

protrusion of viscus through femoral ring into femoral canal

more common in females

protrusion in femoral triangle inferolateral to pubic tubercle
-may protrude through the saphenous opening and impede venous return of greater saphenous vein**

unique location to palpate a bump

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2
Q

compartment syndrome of leg

A

infection, inflammation, or arterial hemorrhage within a fascial compartment of leg can produce pressure increases within compartment high enough to:

reduce blood supply to muscles
impinge nerves (paresthesias and paralysis)

severe cases require fasciotomy to relieve these compressive forces prior to occurence of tissue necrosis

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3
Q

groin strain

A

adductor group pulls up usually during fast hip flexion

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4
Q

hamstring strain

A

strains of semimembranosus, semitendinosus, biceps femoris usually near the ischial tuberosity as a result of fast extension (push off in running)

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5
Q

ruptured achilles tendon

A

weekend warrior

-increased age and irregular exercise (rapid push offs of feet are required)

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6
Q

psoas abscess

A

due to retroperitoneal abdominal or pelvic infection that descends within psoas fascial sheath

descends deep to ingunial ligament resulting in pain and swelling within femoral triangle

can be mistaken for:
-femoral hernia, indirect inguinal hernia, inflammation of inguinal lymph nodes, saphenous varix

**inflammation of kidney - close to psoas

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7
Q

tibialis anterior strain

A

aka shin splints

microtears in periosteal attachments of distal 2/3 of tibialis anterior to tibia (sharpeys fibers)

resulting in pain

also swelling and inflammation within muscle decreases vascular exchange and leads to pain

usually from overuse or infequent bouts of exercise not preceded by stretching or warming up

running on hard surfaces after having trained on softer surface

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8
Q

calcaneal tendonitis

A

microtears in attachment of calcaneal tendon to calcaneal tuberosity as result of overuse, poor footwear or train surfaces

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9
Q

avulsion fractures

A

fragment being pulled away from bones by rapidly loading tendons

pelvis, tibial tuberosity, ankle, foot

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10
Q

pelvic avulsion fractures?

A

ischial tuberosity
ASIS
AIIS
ischiopubic rami

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11
Q

tibial tuberosity avulsion fractures?

A

osgood shlatter**

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12
Q

ankle avulsion fracture

A

lateral and medial malleloli

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13
Q

foot avulsion fracture

A

5th foot metatarsal

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14
Q

osgood schlatter

A

tibial tubercle apophyseal traction injury

avulsion of patellar ligament from tibial tuberosity

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15
Q

malleolar avulsion fraction

A

occurs during eversion

avulsed by deltoid ligament

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16
Q

avulsion of 5th metatarsal

A

fibularis brevis attachments pulls bone off

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17
Q

fracture of femur neck

A

increased compressive forces on an osteoporotic leg

shortened limb and require internal fixation

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18
Q

greater trochanter and shaft femur fracture

A

direct trauma to falls or vehicular accidents

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19
Q

distal femoral fractures

A

fractures of femoral condyles or between condyles

**salter harris classification

both result in aberration of articular surfaces of knee joint
may disrupt blood supply to knee or leg

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20
Q

patella fracture

A

transverse

  • avulsion type due to sudden forceful contraction of quadriceps
  • direct blow
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21
Q

salter harris classification

A

3 and 4 - give you instability
-dividing lateral and medial compartments

all threat to growth of bone if with epiphysis

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22
Q

bipartite or tripartite patella?

A

growth centers that didn’t fuse correctly

often misinterpreted as fractures

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23
Q

most often fracture of tibia?

A

near junction of middle and distal third

-narrow and least vascularized

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24
Q

tibia fractures

A

subQ location - prone to compound fracture

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25
fracture of tibia through nutrient foramen
can lead to non-union
26
fracture of medial malleolus?
excessive eversion
27
fibula fracture?
most common just proximal to lateral malleolus often associated with fracture dislocations of ankle and distal tibial fractures fracture of lateral malleolus due to contact with talus during excessive inversion
28
what is most likely for bone graft procedures
fibula (not weight bearing)
29
calcaneus fracture
most often fractures as a result of hard falls directly on heel
30
talus fractures
mot often fractures during forced dorsiflexion
31
normal male Q angle
14 degrees
32
normal female Q angle
17 degrees
33
CCD angle?
caput - collum - diaphyseal angle normal 120 degrees
34
coxa vara
decreased CCD angle (less than 120) slight decrease in length of affected limb with increased Q angle, opens medial knee joint space resulting in genu valgum - increased likelihood of patellar dislocation
35
Q angle
angle between line drawn from center of patella to ASIS and line between middle patella and hip joint
36
coxa valga
increased CCD angle (greater 120) slight increase in length of affected limb with decreased Q angle opens lateral knee joint space resulting in genu varum
37
genu valgum
decreased CCD, increased Q angle opens medial knee joint increased occurence of patellar dislocation
38
genu varum
increased CCD, decreased Q angle | opens lateral knee joint
39
wide knees
coxa valga wears out medial meniscus
40
knock kneed
coxa vara wears out lateral meniscus
41
slipped capital femoral epiphysis
trauma in region of proximal femoral epiphysis usually occurs in adolescent prior to epiphyseal plate closure distal fragment dislocates posteriorly leading to coxa vara
42
avascular necrosis of femoral head
disruption of arteries that surround femoral neck to provide branches to femoral head can lead to femoral head necrosis branches of medial femoral circumflex most often implicated
43
hip dislocation
capsule loosest when thigh in flexion hitting dashboard with knee - posterior dislocation
44
hip drop
paralysis of gluteus medius and minimus (superior gluteal nerve L4,5 - S1) these muscles keen hip on unsupported side from dropping paralysis causes hip drop during swing phase
45
menisci tear?
knee in full flexion can cause tears
46
what menisci more often torn?
medial meniscus less mobile due to attachment to medial collateral opening medial angle of joint stretches the ligament and tears cartilage
47
bucket handle tear
longitudinal tear through substance of meniscus when handle tears free it must be removed
48
opening medial angle of knee?
stretch medial collateral
49
opening lateral angle of know?
stretch lateral collateral
50
injury of medial collateral?
associated with tear or medial meniscus and tearing of ACL
51
cruciate ligaments
control anterior and posterior movement of femur on tibial plateau when foot fixed
52
unholy triad
tearing of ACL, MCL, and medial meniscus simultaneously
53
patellar dislocation?
more likely laterally more often in females (larger Q angle)
54
drawers test
assess cruciate ligament compromise
55
anterior drawer sign
ACL tear tibia moves anterior
56
posteiror drawer sign
PCL tear tibia moves posterior
57
reduction of torn ACL?
patellar tendon graft
58
patellofemoral syndrome
chondromalacia patella softening of cartilage due to imbalance of quads so the tracking is off patella rides more on lateral femoral condyle
59
bakers cyst
chronic knee joint effusion (fluid accumulation) continuity of fluid in joint space with bursae surrounding knee occurs most often posteriorly may impede flexion, put pressure on structures of popliteal fossa and result in pain
60
os trigonum
bone accessory of talus represents secondary ossification center that doesn't fuse occurs in 14-25 % of adults associated with sports where athletes use excessive plantarflexion
61
sprain
Ligaments
62
strain
Muscles
63
inversion sprain
over elevation of medial border of foot injures lateral collateral ligament torn - anterior talofibular ligament
64
eversion sprain
over elevation of lateral border of foot injury to medial collateral ligament occurs less often
65
pott's fracture
bimaleolar of ankle due to forced eversion talus shifts resulting in fracture of lateral malleolus (fibula) results in total disruption of mortise of ankle joint
66
femoral pulse
patient supine | palpate midway ASIS and pubic tubercle
67
femoral artery compression?
can be compressed against structures which compose floor of femoral triangle as well as pelvic brim (superior pubic ramus)
68
cannulation of femoral artery?
for purposes of left cardiac angiography takes place just inferior to inguinal ligament
69
popliteal pulse?
pulse can be palpated where??
70
diminished popliteal pulse??
Femoral artery obstruction
71
posterior tibial artery pulse??
Posteriorly between calcaneus tendon and medial malleolus. Deep to flexor retinaculum
72
diminished pulse of posterior tibial?
Popliteal artery obstruction
73
intermittent claudication
cramping leg pain during exercise sign of muscular ischemia due to narrow tibial arteries
74
dorsalis pedis pulse?
Inferior to extensor retinaculum lateral to tendon of extensor Hallucis longus
75
diminished dorsalis pedis pulse?
Anterior tibial artery obstruction
76
absent dorsalis pedis?
Dorsum of foot provided by perforating branch of fibular artery
77
when checking pulse?
check BOTH SIDES
78
musculovenous pump
contraction of muscles within fascial space - pressure on deep veins that assists in venous return against gravity
79
varicosities
superficial veins weak and dilate under presure valves no longer competent degenerated deep fascia reduces or eliminates the musculovenous pump
80
saphenous vein grafts
greater saphenous vein use in coronart artery bypass surgery good candidate due to increased muscular and elastic fibers of wall removeal forces drainage to deeper veins (not bad) vein installed as bypass with valves reversed so they don't impede flow
81
saphenous cut down
greater saphenous vein large vein, easy to locate at medial malleolus where it lies very superficial access port for cannulation for delivery of fluid drugs etc care should be taken not to cut, ligate
82
saphenous varix
infrequent dilation of terminal portion of greater saphenous vein causes swelling of femoral triangle can be misdiagnosed as other entity: femoral hernia, psoas abscess
83
DVT
deep vein thrombosis clot formation
84
thrombophlebitis
clot within a vein leading to inflammation at site of clot
85
thromboembolism
clot which has broken free from lower limb vein and traverses to heart - gets lodged in lung (pulmonary arterial branch)
86
lymphangitis
inflammation of lymph vessels - red streaks
87
lymphadenopathy
enlarged lymph nodes due to inflammation resnde in popliteal fossa and femoral triangle
88
drainage of lymph?
Superficial inguinal nodes- subQ connective tissue superficial to femoral triangle, receive drainage from superficial thigh, abdomen inferior to the navel, round ligament of the uterus and from perineum Deep inguinal nodes- located within the femoral triangle receive drainage from the superficial inguinal nodes and from deep structures of foot leg and thigh
89
femoral nerve damage
all knee extension reduced flexion of thigh lose patellar reflex L4 lose anterior femoral compartment muscles
90
patellar reflex?
L4
91
achilles reflex?
S1
92
plantar reflex?
babinski - fanning normal children less than 2 abnormal in adults
93
anesthesia of femoral nerve?
anterior thigh, medial leg and foot L4 dermatome
94
obturator nerve damage?
strong flexors, adductors, and rotators - loss causes weakness in flexion - all adduction gone skin patch on the medial side of thigh
95
obturator nerve?
L 2,3,4
96
femoral nerve?
L 2,3,4
97
sciatic neve
L 45 S 123 from greater sciatic foramen
98
piriformis syndrome
tibial and common fibular components of sciatic nerve split by portion of piriformis hypertrophy of piriformis may cause compression of common fibular component - lose eversion and dorsiflexion - paresthesia on lateral anterior portion of leg and dorsum of foot
99
loss of sciatic nerve?
loss of achilles reflex S1 weakness of extension fo thigh loss of flexion of leg complete loss of inversion, eversion, plantar and dorsiflexion of foot anesthesia posteiror thigh and lateral leg and posterior foot
100
gluteal injection
palpate ASIS with index finger spreading fingers and palpate tubercle of crest of ilium with middle finger injection made between index and middle finger
101
superior gluteal nerve loss?
L45 S1 hip drop!
102
inferior gluteal nerve loss?
L5 S12 weak gluteus maximus with decreased hip extension especially visible when affected individual tries to negotiate going up stairs
103
tibial nerve loss?
L45 S123 within poplitela fossa result in complete loss of plantarflexion, flexion, adduction, abduction of toes and anesthesia to large portion of sole of foot
104
common fibular nerve loss?
L45 S12 direct trauma when courses around neck of fibula and results in complete loss of eversion and dorsiflexion and numbness of lateral anterior portion of leg and dorsum of foot
105
superficial fibular nerve
L5 S12 direct trauma to lateral crural region can lead to damage of superficial fibular nerve resulting in major loss of eversion, moderate loss of plantar flexion, and weakness of support for arches of foot (fibularis longus) and anesthesia on lateral anteiror portion of leg and dorsum of foot
106
deep fibular nerve
L45 foot drop trauma to deep fibular nerve may occur as result of piercing trauma and compartment syndrome of anterior crural compartment would reult in complete loss of dorsiflexion and extension of toes and anesthesia between 1st and 2nd toes above losses would result in dropping of foot as a result of tibialis anterior and dragging of great toe due to loss of extensor hallucis longus slap the floor
107
tibialis anterior nerve level?
L4
108
extensor hallucis longus nerve level?
L5

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