Lower Extremities

Question 1

Piriformis syndrome

Answer 1

pain in buttock

ipsilateral leg externally rotated
sciatica like sx down back of ispilateral leg

SD of sacrum and psoas associations

TP is 1/2 from ILA/PSIS midpoint to greater trochanter

Question 2

Lateral femoral cutaneous n.

Answer 2

branch of femoral n.

causes meralgia paresthetica

Question 3

L3-4 Disc Herniation

Answer 3

affects L4 nerve root
medial leg sensation
foot inversion

tested by patellar DTR

Question 4

L4-L5 disc herniation

Answer 4

affects L5 nerve root
anterior leg and foot sensation
foot dorsiflexion

no DTR reflex
can’t walk on heels

Question 5

L5-S1 disc herniation

Answer 5

affects S1 nerve root
lateral leg sensation
foot eversion

tested by achilles deep tendon reflex
can’t walk on tip toes

Question 6

Congenital hip dysplasia

Answer 6

large baby, first born, female, breech

femoral head displaced posteriorly and inferiorly

Barlow’s test - displaces femur head
Ortolani’s test - femur head reduced

Question 7

Legg-Calve-Perthes disease

Answer 7

osteonecrosis of femoral head or femoral capitus epiphysis

painless limp

males - 4-10 yo

XR: crushed or deformed femoral head

Question 8

Slipped capital femoral epiphysis (SCFE)

Answer 8

displacement of femoral head on neck

progressive painful limp

loss of abduction, internal rot

overweight, teen male

XR: scoop of icecream sliding off the cone

Question 9

Meralgia paresthetica

Answer 9

compression of lateral femoral cutaneous n. as it passes under inguinal lig

pain/paresthesia over lateral thigh

obese with large panis, pregnancy or heavy belt (police officer or construction worker)

Tx: wt loss, suspenders to redistribute wt of belt

Question 10

Osgood-Schlatter Disease

Answer 10

painful swelling over tibial tuberosity
10-15 yo

XR: separation and new bone growth around tibial tuberosity

Tx: activity modification and conservative therapy

Question 11

Wolf’s Law

Answer 11

Bone remodeling occurs along lines of stress

Question 12

Femoroacetabular joint

Answer 12

hip joint
ball and socket

iliofemoral ligament
ischiofemoral ligament
pubofermoral ligament
capitus femoris - head of femur to acetabular fossa

Question 13

Minor motions of the hip

Answer 13

anterior glide - head of femur glides anteriorly with external rotation of hip

Posterior glid - head of femur glides posteriorly with internal rotation of hip

Question 14

External rotation SD of hip cause

Answer 14

piriformis or iliopsoas spasm

Question 15

Internal rotation SD of hip cause

Answer 15

spasm of internal rotators:

gluteus minimus
semimembranosus
semitendinosus
TFL
adductor magnus
adductor longus

Question 16

Tibiofemoral joint

Answer 16

Stablized by:
2 C shaped menisci
ACL (O: posterior femur I: anterior tib)
PCL (O: ant femur I: post tib)

Question 17

lateral knee stabilizers

Answer 17

MCL - femur to tibia, articulates w/ medial meniscus

LCL - femur to fibula

Question 18

Tibiofibular joint

Answer 18

synovial joint

Fibular head glides anteriorly w/ pronation of foot; posteriorly with supination of foot

Question 19

Foot pronation

Answer 19

dorsiflexion, eversion, abduction

talus push distal fibula posteriorly -> proximal fib anterior

Question 20

Foot supination

Answer 20

plantarflexion, inversion, adduct

anterior talofibular ligament pull distal fibula anteriorly, proximal fib moves posterior

Question 21

Femoral nerve

Answer 21

L2-L4

Motor: quadriceps, iliacus, sartorius, pectineus

Sensory: anterior thigh, medial leg

Question 22

Sciatic nerve

Answer 22

L4-S3

Tibial division:
Motor: hamstrings (except biceps femoris), most plantar flexors, toe flexors

Sensory: lower leg, plantar aspect of foot

Peroneal division:
Motor: short head of biceps femoris, evertors, dorsiflexors of foot, most extensors of toes

Sensory: lower leg and dorsum of foot

Question 23

Angulation of head of femor

Answer 23

normal 120-135

less than 120 coxa vara - R reduced angle
greater than 135 coxa valga - G greater angle

Question 24

Q angle

Answer 24

ASIS through middle of patella, tibial tubercle through middle of patella

normal 10-12

increased angle - genu valgum - G greater angle (knock knee)
Decreased angle - genu varum - R reduced angle (bow legged)

Question 25

Posterior fibular head

Answer 25

resists anterior spring distal fib anterior, resists posterior Tallus internally rotated - foot inverted, plantar flexed

Question 26

Anterior fibular head

Answer 26

resists posterior spring distal fib may be psoterior talus externally rotated, foot everted and dorsiflexed

Question 27

Patello-femoral sn

Answer 27

strong vastus lateralis and weak vastus medialis patella tracks laterally -> larger Q angle Deep knee pain, esp when climbing stairs patella crepitus Women Strengthen vastus medialis m.

Question 28

Grades of sprains

Answer 28

First degree: no tear, no laxity Second degree: partial tear, decreased tensile strength w/ mild to moderate laxity Third degree: complete tear, no tensile strength and severe laxity -may req surgery

Question 29

Compartment syndrome

Answer 29

trauma or vigorous overuse -> increased intracompartmental pressure compromise circulation w/in compartment anterior compartment most common severe unrelenting pain after and during exercise Anterior tibilais m. hard and tender to palpation, pulses present, stretching m. causes extreme pain Tx: ice and myofascial release to increase venous and lymph return necrosis can develop w/in 4-8 hrs if intracompartmental pressure remains elevated -> surgical fasciotomy

Question 30

O'Donahue's triad (terrible triad, unhappy triad)

Answer 30

Lateral impact on planted foot ACL MCL medial meniscus (although lateral 56 percent of the time)

Question 31

Talocrural joint (tibiotalar joint)

Answer 31

plantar flexion and dorsi flexion minor motions: anterior glid of talus w/ plantar flexion, posterior glide w/ dorsiflexion Ankle more stable in dorsiflexion

Question 32

Subtalar joint (talocalcaneal joint)

Answer 32

shock absorber | internal and external rotation of leg while foot fixed

Question 33

Medial longitudinal arch

Answer 33

talus, navicular, cuneiforms, 1st - 3rd metatarsals

Question 34

Lateral longitudinal arch

Answer 34

calcaneous, cuboid, 4th-5th metatarsals

Question 35

Transverse arch

Answer 35

navicular, cuneiforms, cuboid

Question 36

SD of arches

Answer 36

MC transverse arch - long distance runners Cuboid - medial edge drops Navicular - lateral edge drops Cuneiforms - usually second cuneiform drops

Question 37

Lateral stabilizers of ankle

Answer 37

prevent excessive supination Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament

Question 38

Types of ankle sprains

Answer 38

Type I: only anterior talofibular ligament Type II: anterior talofibular ligament and calcaneofibular ligament Type III: anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament

Question 39

Medial stabilizer of ankle

Answer 39

deltoid ligament fracture of medial malleolus rather than pure ligamentous injury

Question 40

Spring ligament (calcaneonavicular ligament)

Answer 40

strengthens and supports medial longitudinal arch

Question 41

Plantar aponeurosis (plantar fascia)

Answer 41

calcaneus to phalanges Chronic irritation -> calcium laid down along lines of stress -> heel spur