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Block 4 > Week 4 > Flashcards

Week 4 Flashcards

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1
Q

Name structures

A

Tibia: Medial malleolus, Inferior articular surface (for trochlea of talus), Fibular notch

Fibula: Lateral malleolus, Ligaments Interosseous membrane, Anterior and posterior tibiofibular ligament

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2
Q

Muscle that pass in the front of malleolus?

Muscules that pass in the back of malleolus?

A

Dorsiflexion

Plantar flexors

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3
Q

Name compartments

A

Anterior

Lateral

Posterior deep

Posterior superficial

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4
Q

Posterior superficial compartment muscles?

A

Gastrocenmius

Soleus

Plantaris

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5
Q

Deep posterior compartment muscles?

Function?

A

Tibialis posterior

Flexor digitorum longus

Flexor Hallucis Longus

Popliteus

Invertors and plantarflexors / unlocking the knee

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6
Q

Anterior compartment?

Function?

A

Extensor digitorum longus, extensor hallucis longus, Tibialis anterior

dorsiflexion, Tibialis anterior - inversion

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7
Q

Lateral Compartment muscles?

A

Fibularis (peroneus) lonugs

Fibularis ()peroneus) brevis

Plantar flexors and everters

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8
Q

Nerve supply to the leg?

Posterior?

Anterior?

Lateral?

A

Tibial n

Fibular n

Fibular n

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9
Q

What is the continuation of anterior tibial?

What artery supplies lateral muscles in a leg?

A

Dorsalis pedis

Perforating branches of fibular

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10
Q

Tendon Sheaths and Retinacula

A
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11
Q

Name the vessels in flexor retinaclum

A

Tibialis posterior

Flexor digitorum longus

Posterior tibial atery and nerve

Flexor hallucis longus

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12
Q

Name structures in dorsal side of the foot

A
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13
Q

What innervates dorsal side of the foot (muscles)?

What supplies dorsal compartment of the foot?

What supplies plantar compartment of the foot?

A

Fibular nervew

Dorsalis pedis (anterior tibial)

LKateral plantar artery forms arch

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14
Q

Cutaneous nerve supply to leg

A

Lateral sural cutaneous nerve

Superficial fibular (peroneal) nerve

Sural never via lateral dorsal cutaneous branch

Deep fibular (peroneal) nerve

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15
Q

First layer of the plantar comparment

A

Plantar aponeurosis

Abductor digiti minimi

Flexor digitorum brevis

Abductor hallucis

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16
Q

Second layer of foot muscles on plantar side

A

Lumbricals

Flexor hallucis longus

Flexor digitorum longus

Quadratus plantae (flexor accessorius)

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17
Q

Third layer muscles

A

Flexors

Adductor hallucis transverse and/oblique head

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18
Q

Fourth layers of foot

A

Plantar and dorsal interossi

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19
Q

Innervation of the plantar foot

Lateral Plantar Nerve?

Medial Plantar Nerve?

A

Lateral Plantar Nerve-(like the ulnar) All intrinsic muscles except the thenar equivalents, the lumbrical to the functional midline on the medial side, and the flexor digitorum brevis (like the flexor digitorum superficialis)

Medial Plantar Nerve innervates the above named exceptions -(like the median)

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20
Q

Nerve innervation to foot

A
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21
Q

Bone is the foot

A
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22
Q

Ligaments

A
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23
Q

Posterior ligaments

A
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24
Q

Joints in the foot?

A

Subtalar joint

Transverse tarsal joint

Tarsometatarsal joint

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25
Ligaments attached to lateral malleolus Injury?
Posterior talofibular ligament Anterior talofibular ligament Calcaneofibular ligament Angkle spains (inversion injury, anterior talobiular ligament)
26
Medial Malleolus ligaments
Deltoid ligament Pott’s fracture-dislocation, eversion injury
27
Two arches of the foot? What holds them? Dynamic changes provided by tendonds of?
Longituinal arch, transverse arch Bones/ligaments Peroneus longus, tibialis anterior, flexor hallucis longus, flexor digitorum longus (also tibialis posterior)
28
Ligaments that mantain arches
Spring ligament (Plantar Calcaneonavicular) Long and short plantar (calcaneocuboid) ligaments Plantar aponeurosis
29
What tendons specifically support the transverse curvature?
Tendons of the Fibularis longus and Tibialis posterior
30
Pes Planus When normal? Why?
Flatfoot before 3yo, fat in foot
31
Distal Femur Sturctures
32
Tibia and Fibula Structures
33
Ligaments of knee joint
34
Name the ligaments on opposite medial/lateral side of knee joint? Comparison?
Medial meniscus, C-shaped, attached to tibial collateral ligament Lateral meniscus, O-shaped, not attached to fibular collateral ligament
35
Popliteal Cyst
Popliteal cysts are fluid-filled herniations of the synovial membrane of the knee joint
36
Name structures
Adductor magnus tendon (AM) Superior attachments of lateral & medial heads of gastrocnemius (with underlying bursae) Tibial collateral ligament (TC) Fibular collateral ligament (FC) Semimembranosus tendon (SM) Biceps femoris tendon (BF) Popliteus muscle (P)
37
Drawer Test
Test for anterior cruciate ligament
38
Acetabulum structures
Acetabulum Margin (limbus) Lunate surface Acetabular notch
39
Femur
Head Fovea for ligament of head Neck Greater & lesser trochanter Shaft Lateral & medial epicondyle
40
Ligaments in hip joint
Iliofemoral ligament (IF) Ischiofemoral liagment (IsF) Pubofemoral ligament (PF) Ligament of head of femur
41
Where does the blood supply to femur comes from?
Major blood supply to the femoral head and neck are from the **femoral circumflex arteries** especially **medial**
42
Varus / Genu Varum Valgus / Genu Valgum
Angulation towards the midline Angulation away from the midline
43
Comminuted Subluxation
Crushed Partial dislocation
44
Normal limb development
Varus -\> Valgus
45
Fracture description Pattern Location Other?
Transverse, Oblique, Sprial, comminuted Metaphysis, diaphytsis, epiphysis Displacement, angulation, intra vs. extra articular involvment
46
Bone fracture healing stages?
Hematoma - hematoma formation Cartilage - callus formation Woven bone - callus ossification Dense bone - bone remodeling Inflammatory -\> Reparative -\> Remodeling
47
Green stick fracture
A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces.
48
What nerve might be affected in compartment syndrome in the leg?
Peroneal
49
Intramedullary Rod
The nail sticked into the medulla of the bone
50
—Septic tenosynovitis
Inflammation of a tendon and its sheath
51
Orthopedic Emergencies
**—Fractures:** open, neurovascular injury —Compartment syndrome **—Dislocations:** hip, knee, shoulder, elbow, ankle **—Infection:** septic joints —Septic tenosynovitis
52
What things should be asked during fracture presentation?
History (mechanism of injury), PMH, meds/allergies; PE: ABCDE Touching Looking for brusing, lacerations, deformit, pain Neurovascular: nerve, pulses, capillary refil X-ray
53
ABCDE
Airway maintenance with cervical spine protection Breathing and ventilation Circulation with hemorrhage control Disability/Neurologic assessment Exposure and environmental control
54
Imagining techniques
X-rays in orthogonal planes CT scan (for complex intra-articular injuries) MRI (ligaments, meniscus, soft tissue injuries) Ultrasonography
55
Why bone in immobalized?
Prevent neurovascular compromise / tissue necrosis Decrease bleeding, stabilize hematoma Pain relief Ease of transport
56
Arthroplasty
The surgical reconstruction or replacement of a joint.
57
5P's of compartment syndrome
* *—Pain** – out of proportion * *—Paresthesia** - tingling * *—Palor** - whiteness * *—Paralysis** – muscle not working * *—Pulselessness** – pressure so high that disrupts blood flow
58
Exertional Compartment Syndrome
59
Septic Arthritis What is it? Pathophysiology? Common agents? Complications? RFs? Symptoms? Diagnosis?
—Infectious agent inside synovial cavity —Damage to the articular cartilage from chondrocyte proteases, hyaluronidase, cytokines from WBC’s Staph aureus, nisseria gonorrhea (sexual) salmonella, SCA Avascular necrosis due to excessive pressure Trauma, surgey, IVDA, DM, SCA, immunosup, sex activity Joint pain, swelling, stiffness, fever, chills Fluid analysis
60
Joint Fluid Analysis (4 C’s)
* *—Cell count**- elevated WBC * *—Culture**- aerobic and anerobic with gram stain * *—Crystals**- uric acid, calcium pyrophosphate * *—Chemistry**- glucose, protein
61
Virchow’s Triad
Thromboembolism Statis of blood flow Endothelial injury Hypercoagulability
62
What provides both rotational and anterior stability?
ACL
63
Where is Patellar tendon Quadriceps tendon Hamstrings tandom Popliteus Tendon
Inferior to patella Anterior Posterior Lateral of humerus
64
Synovium
Synovial membrane
65
Evaluation of limb
Pain (character/mechanism/location) Tenderness Swelling Inability to bear weight Loss of motion Range of motion Instability Deformiy Crepetus
66
Lachman exam
Drawer exam (ACL) 15 degree bend, then anterior/posterior
67
Pivot Shift Test
Rotation test (ACL)
68
What causes blood in the knee?
Intrasynovial ligament ACL or PCL
69
How these are treated? Fracture Meniscus Aricular surface Ligament tear/spain
Splint it Repair/cut Smooth it out Repair/let heal
70
Articular cartilage damage problems?
Difficult to diagnose - microfracture
71
Why excise meniscus?
Poor blood suplly
72
Tanner Stages
Prepubestent - T1,2 - B6-10,G5-9 Early pubescent - T3, sex characterstics Midpubescent - rapid growth Latepubescent - rate declines
73
Physes Apophyses
Growth of the bone Attachement of the bone
74
Osgood-Schlatter Disease (Adolesent) What is it?? Treatment
Secondry to repetitve microtrauma Traction apophysitis tibial tubercle Rest, ice, NSAIDs
75
Salter Harris Classification (Adolesent) I and II (non displaced) II displaced II and IV
Classification of bone breaks long leg cast for 4-6 wk Closed or open reduction, pin Open anatomic reduction, epiphyselal foxation
76
Tibial tubercle fracture (Adolesent) Most common in who? Cause? Adult? Position of tubercle? Growtg disturbance?
Boys 12-17 Rapid contraction in jumping Patellar tendon Slightly off to lateral (need X ray with interal rotation) Uncommon
77
Tibial Spine fracture (Adolesent)
A fracture of the bony attachment of the ACL on the tibia
78
Patellar Sleeve Fracture (Adolesent) Ages? Treatment
8-12 yo reduction and suture fixation
79
Are fractures around knees common in children?
Less comon Proximal tibial physeal injuries - hyperextension force across the knee
80
Meniscal injuries (Adolesent) Function? Associated with?
Stability Ligametnous instability
81
What can cause knee pain? (Adolesent)
Hip fracture
82
Slipped Capital Femoral Epiphysis SCFE (Adolesent)
83
Bimodal Incidence of Hip fracture Types of them? Treatment? Reoperation rate? Types? One Year morataility?
Elderly (chronic) Intracapsular (neck. subcapital transcervical) 45% / Extracapsular 55% - better outcome / Subtrochanteric Depends of age e.g. young-no metal, older patients-mobilize and lower discrease complications, young - spare fermmoral head and deformity prevent AVN 20-50% Stable/Unstable 14-50% (commorbidities), Venous Thromboembolism
84
Blood supply to hip
Lateral epiphyseal atetry (terminal MFC) predominant to head Inferior metaphyseal atery (acending LFC) Obturator (through ligamentum teres)
85
Shoulder Instability (pathological) Laxity (non-pathological)
Inability to mantain humeral head centerd in the glenoid fossa Humeral head can be transalted or rotated from a refrence position (full range of functional motion)
86
Shoulder Static stabilizers? Dynamic?
Articular anatomy, capsuligamenous structures Rotator cuff, Long head of biceps
87
Capsoligamentous
superior glenohumeral lig - primary - adducted, middle glenohumeral - poorly defined - abduction, inferior - important -ABDUCTION/EXTENSION Capsule Anteior - tight in external rotation Postierior - tight in internal rotation
88
Shoulder tests
Apprehension test
89
Anteior instability of shoulder Posterior instability Multidirectional instability
Force anterior on arm or shoulder Acute or overuse (baseball pitcher) Positive apprehension/relocation Rare Traumatic: Seizure or Electric shor Externally rotated prominal humeral head on the posterior Atraumatic: wieght liften Different than both Rotator cuff weakness

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