Lower Extremity Quiz 2 Flashcards
(76 cards)
1
Q
What is the only Deep Gluteal Nerve that is superior to the piriformis?
A
Superior Gluteal Nerve
2
Q
What is the largest nerve in the body?
A
Sciatic Nerve
3
Q
What structures of the body does the Sciatic Nerve innervate?
A
- Skin of the foot and most of the leg
- Posterior Thigh (Hamstrings) and all of the leg and foot muscles.
4
Q
What does the distal part of the sciatic nerve break off into?
A
- Common Fibular Nerve
- Tibial Nerve
5
Q
What is Piriformis Syndrome?
A
When the Common Fibular Nerve is impinged due to the Piriformis compression.
6
Q
Which directions do each of the branches of the sciatic nerve run?
A
- Tibial nerve is inferior to the piriformis
- Common Fibular nerve pierces the piriformis and passes superior to it.
7
Q
What roots are part of the Posterior Cutaneous Nerve of the Thigh?
A
S1-S3
8
Q
What does the Posterior Cutaneous Nerve of the Thigh Supply?
A
- Skin Sensation for the following:
1. Inferior part of the buttock
2. Skin of the Perineum
3. Posterior Thigh
4. Proximal Part of the Leg
9
Q
What nerve runs laterally between the gluteus medius and minimus?
A
Superior Gluteal Nerve
10
Q
What roots are involved with the Inferior Gluteal Nerve?
A
L5-S2
Superficial to the Sciatic Nerve
11
Q
What does the Inferior Gluteal Nerve supply?
A
- Gluteus Maximus
12
Q
What does the Superior Gluteal Nerve supply?
A
- Gluteus Medius
- Gluteus Minimus
- Tensor of Fascia Lata
13
Q
What does the Nerve to Quadratus Femoris supply?
A
- Quadratus Femoris
- Inferior Gemellus
14
Q
What does the Nerve to Obturator Internus supply?
A
Obturator Internus Muscle
15
Q
What does the Trendelenburg Test indicate?
A
The side in which the person is shifting their weight towards has an insufficient or disabling Gluteus Medius.
Other signs would be lifting of the foot, waddling gait, or steppage gait
16
Q
What are some signs that indicate Piriformis Syndrome?
A
- Patient is involved in sports that require excessive use of the gluteal muscles
- Hypertrophy of the Piriformis
- Spasms of the Piriformis
17
Q
Name all of the posterior thigh muscles?
A
- Semitendinosus
- Semimembranosus
- Long Head of the Biceps Femoris
18
Q
What are the main actions of the posterior thigh muscles?
A
- Hip Extension
- Knee Flexion
19
Q
Patients with paralyzed hamstrings tend to what?
A
Fall forward as they cannot maintain posture. If they fall backwards then it is their psoas major/iliopsoas
20
Q
What nerve innervates the posterior thigh muscles?
A
Tibial nerve except the short head of the bicep femoris which is common fibular.
21
Q
Where does a hamstring strain usually occur?
A
Proximal-Medial attachments of the hamstrings with the ischial tuberosity
22
Q
What can you see from a hamstring strain?
A
Bruise that falls on the distal side of the posterior knee
23
Q
What is Hurdler’s Injury?
A
Inadequate stretching leads to forcible flexion of the hip causing avulsion of the ischial tuberosity from either the biceps femoris or semitendinosus
24
Q
Where is Nelaton’s Line?
A
From the Anterior Superior Iliac Spine to the Ischial Tuberosity
25
What are infrapatellar fatpads?
Mass of loose fatty tissue on the sides of the patellar ligament
26
What can cause a leg length discrepancy?
A femoral fracture and now the legs are unequal in length.
You measure from ASIS to the distal tip of the medial malleolus on both sides. Difference must be greater than 1.25 cm to be abnormal
27
What is the Popliteal Fossa?
A diamond-shaped depression on the posterior aspect of the knee, containing the nerves and vessels from the thigh into the leg.
28
What are the borders of the Popliteal Fossa?
- Superolaterally: Biceps Femoris
- Superomedially: Semimembranosus and Semitendinosus
- Inferolaterally: Lateral Head of gastrocnemius
- Inferomedially: Medial Head of gastrocnemius
- Posterior: Skin and fascia
- Anterior: Popliteal surface of femur, Oblique Popliteal Ligament, Popliteal Fascia over the popliteus
29
What is inside of the Popliteal Fossa?
- Small Saphenous Vein
- Popliteal Arteries and Veins
- Tibial and Common Fibular Nerve
- Posterior Cutaneous Nerve of Thigh
- Popliteal Lymph Nodes and Lymphatic Vessels
30
Where does the Popliteal artery fall in the descent of the artery line? (Proximal to Distal)
1. Femoral artery into Popliteal Artery
2. Popliteal artery ends at the interior border of the popliteus splitting into...
3. Anterior and Posterior Tibial Artery
31
What are the 5 Genicular branches of the Popliteal Artery?
1. Lateral Superior Genicular Artery
2. Medial Superior Genicular Artery
3. Middle Genicular Artery
4. Lateral Inferior Genicular Artery
5. Medial Inferior Genicular Artery
32
What does the Common Fibular Nerve divide into?
Superficial and Deep Fibular Nerve
33
What is a Popliteal Aneurysm?
Dilation of the Popliteal Artery causing edema and pain in the popliteal fossa.
Femoral Artery has to be ligated and this affects the tibial nerve.
34
When there is an enlarged lymph node... which direction should we look to in order to address the situation?
Look distally in the vessel.
35
What are the muscles in the Anterior Compartment of the Leg?
1. Tibialis Anterior
2. Extensor Hallucis Longus
3. Extensor Digitorum Longus
4. Fibularis Tertius
36
What type of pulse should you check after a hip replacement?
The pulse of the dorsal artery of the foot, located between the malleoli
37
What are the severities of Compartment Syndrome?
- Trauma = Hemorrhage, edema, and inflammation
- Emergency = Fasciotomy may be performed to relieve pressure
38
What are Shin Splints?
- Anterior Tibialis Strain; results from repetitive trauma and it is a mild form of compartment syndrome
39
What is Ski Boot Syndrome?
- Deep Fibular Entrapment; Compression of the nerve leads to pain in the dorsum webbing between the 1st and 2nd digit of the foot.
40
What boundaries make up the lateral compartment of the leg?
1. Lateral Surface of Tibula
2. Anterior Intermuscular Septa
3. Posterior Intermuscular Septa
4. Crural Fascia
41
What nerve innervates the lateral compartment of the leg?
Superficial Fibular Nerve
42
Severance of the Common Fibular Nerve results in?
1. Paralysis of all anterior compartment and lateral compartment muscles of the leg, resulting in weakened/loss of dorsiflexors and evertors of the foot.
2. Foot drop will appear due to no dorsiflexion and eversion
3. Toes drag while walking
43
What are the superficial Posterior muscles in the leg?
1. Gastrocnemius
2. Soleus
3. Plantaris
44
What is Calcaneal Tendinitis?
Inflammation of the calcaneal or achilles tendon.
Symptoms include: Calf pain and an audible snap.
Caused by a sudden dorsiflexion of a plantarflexed foot
45
What are the deep muscles in the posterior compartment of the leg?
1. Popliteus
2. Flexor Digitorum Longus
3. Flexor Hallucis Longus
4. Tibialis Posterior
46
What is the screw home mechanism of the popliteus in both the closed and open chains?
In a closed chain, the popliteus is responsible for the 15 degrees of external rotation of the femur during knee extension.
In an open chain, the popliteus is responsible for the 15 degrees of internal rotation of the tibia during knee extension.
47
Which muscle is the spring off of our step when walking?
Flexor Hallucis Longus
48
What is Jogger's Foot?
Medial Plantar Nerve Entrapment; Occurs from repetitive eversion of the foot
49
Plantar Reflex occurs amongst which nerve roots?
L4-S2
50
What is Babinski Sign?
When a pen runs across the center of the plantar surface of the foot and the toes span out instead of curling in.
It is not a sign in individuals younger than 4 years old
51
Are puncture wounds to the sole of the food severe? How do you compress or maintain the bleeding?
There is some serious bleeding involved and you can either compress the tibial artery or femoral artery.
52
When there is an infection of the foot, what side of the foot should be incised, why?
The medial side of the foot should be incised because when you walk your weight-bearing step begins on the lateral side of the foot.
53
What are the ligaments of the hip joint and what purpose do they serve?
- Iliofemoral ligament and Ischiofemoral: Prevents hyperextension
-Pubofumoral Ligament: Prevents overabduction
- Ligament of the head of the femur: Weak ligament
54
What are fatpads in the hip joint?
They allow the space that is unoccupied with the femoral head to be filled in the acetabular fossa.
55
Which muscles are involved in HIP FLEXION
1. Iliopsoas (Strongest)
2. Sartorius
3. Tensor of Fascia Lata (Only works if Iliopsoas is weak or cannot function)
4. Rectus Femoris (Crosses the Hip Joint)
5. Pectineus
6. Adductor Longus
7. Adductor Brevis
8. Adductor Magnus (Adductor Part)
9. Gracilis
56
Which muscles are involved in Hip Abduction?
1. Gluteus Medius
2. Gluteus Minimus
3. Tensor Fascia Lata
57
Which muscles are involved in Hip Extension?
1. Adductor Magnus (Hamstring Portion)
2. Long Head of Biceps Femoris
3. Semimembranosus
4. Semitendinosus
5. Glute Maximus (Only in forceful extension such as getting up from a seat)
58
Which muscles are involved in Hip Adduction?
1. Adductor Longus
2. Adductor Brevis
3. Adductor Magnus
4. Gracilis
5. Pectineus
6. Obturator Externus
59
Which muscles are involved in medial rotation of the hip?
1. Gluteus Medius
2. Gluteus Minimus
3. Tensor Fascia Lata
60
Which muscles are involved in External Rotation?
1. Obturator Internus
2. Obturator Externus
3. Superior and Inferior Gemelli
4. Piriformis
5. Quadratus Femoris (Strongest)
6. Gluteus Maximus
61
What artery supplies the hip joint?
Medial and Lateral circumflex femoral arteries
62
Does hip replacement occur in the younger population?
Usually no, unless it is an athlete who needs the best performing hip.
63
In a hip fracture, is there any blood supplying the femoral head?
Yes, the artery to the head of the femur supplies a small amount of blood to it, however, if that is severed then there is a possibility for necrosis.
64
Do we always cement the hip when performing a hip replacement?
No, unless they are old and do not need an additional hip replacement in the future, most younger patients will not have it cemented just in case they need a new one.
65
What is the difference between congenital and acquired dislocation of the hip?
- Congenital: Femoral head is not properly located in the acetabulum
- Acquired: Almost like a posterior dislocation, when the hip joint is flexed, adducted and slight medially rotated, the sciatic nerve can be compromised here
66
Which tibial collateral ligament is thicker?
The medial tibial collateral ligament
67
Which meniscus is more likely to sustain injury?
Medial meniscus as most impacts to the knee occur on the lateral side, which transmits the force to the medial causing a tear.
68
What is the unhappy triad?
Damage to:
1. Tibial collateral ligament
2. Medial Meniscus
3. Anterior Cruciate ligament (ACL)
69
Which is weaker, ACL or PCL?
- ACL is weaker
70
What are the ACL and PCL Functions?
- ACL prevents hyperextension of the knee
- PCL Prevents hyperflexion of the knee
71
When the knee is prone to locking up, there is a chance the patient has what going on?
There is a torn meniscus and there are fragments of the disc displaced in the knee that need to be removed/replaced.
72
What is the Q angle?
It is the angle between the line connecting the ASIS to the middle of the knee and the line from mid-knee to tibial tuberosity.
73
Which lateral ligament in the ankle joint are you most likely to injure?
Anterior Talofibular ligament; plantarflexion and eversion would be painful
74
What is commonly referred to as the Deltoid Ligament?
The medial ligaments of the ankle joint; they stabilize the ankle joint during eversion and prevents subluxation of the joint
75
What is the first ray of the foot?
The metatarsal of the first digit and how it rotates slightly during plantarflexion and dorsiflexion
76
What is hammer toe and what is claw toe?
- Hammer toe: Proximal phalanx is permanently flexed and the second digit is plantarflexed
- Claw Toes: Hyperextension of the Metatarsophalangeal joints and flexion of the DIP joints of the toes.
