Clinical Correlations of the Lower Limb Flashcards Preview

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Flashcards in Clinical Correlations of the Lower Limb Deck (108):
1

femoral hernia

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

2

compartment syndrome of leg

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

3

groin strain

adductor group pulls up usually during fast hip flexion

4

hamstring strain

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

5

ruptured achilles tendon

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

6

psoas abscess

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

7

tibialis anterior strain

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

8

calcaneal tendonitis

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

9

avulsion fractures

fragment being pulled away from bones by rapidly loading tendons

pelvis, tibial tuberosity, ankle, foot

10

pelvic avulsion fractures?

ischial tuberosity
ASIS
AIIS
ischiopubic rami

11

tibial tuberosity avulsion fractures?

osgood shlatter**

12

ankle avulsion fracture

lateral and medial malleloli

13

foot avulsion fracture

5th foot metatarsal

14

osgood schlatter

tibial tubercle apophyseal traction injury

avulsion of patellar ligament from tibial tuberosity

15

malleolar avulsion fraction

occurs during eversion

avulsed by deltoid ligament

16

avulsion of 5th metatarsal

fibularis brevis attachments pulls bone off

17

fracture of femur neck

increased compressive forces on an osteoporotic leg

shortened limb and require internal fixation

18

greater trochanter and shaft femur fracture

direct trauma to falls or vehicular accidents

19

distal femoral fractures

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

20

patella fracture

transverse
-avulsion type due to sudden forceful contraction of quadriceps
-direct blow

21

salter harris classification

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

all threat to growth of bone if with epiphysis

22

bipartite or tripartite patella?

growth centers that didn't fuse correctly

often misinterpreted as fractures

23

most often fracture of tibia?

near junction of middle and distal third
-narrow and least vascularized

24

tibia fractures

subQ location - prone to compound fracture

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