Term
| Why are lower limb injuries so common in kids and young adults? |
|
Definition
| The endochondral ossification of these bones isn't complete until early adulthood so they still have cartilaginous epiphyseal plates which injure easily. |
|
|
Term
| What stressor in kids and young adults makes is epiphyseal plate irritation and osteochondrosis (injury of developing bone) more likely? |
|
Definition
| The growing bone may grow faster than the muscle which places stress on the epiphysial plates and bone during high activity. |
|
|
Term
| What are the 4 most likely places for hip avulsions? |
|
Definition
| Where the muscles are attached. anterior superior and inferior iliac spines, ischial tuberosities, and ischiopubic rami. |
|
|
Term
Define coxa vara.
Define coxa valga. |
|
Definition
Coxa vara - angle of inclination between long axis of the femoral neck and femoral shaft is decreased.
Coxa valga - angle is increased |
|
|
Term
| What are the effects of coxa vara? |
|
Definition
| Shortening of the limb and limited abduction. |
|
|
Term
| In older children, a weakened epiphyseal plate may result in ___________. Name 2 symptoms. |
|
Definition
Dislocation of the epiphyseal plate of the femoral head.
Coxa vara and hip discomfort radiating to the knee. |
|
|
Term
| What is the most frequently fractured part of the femur? |
|
Definition
| The neck is the narrowest and weakest part of the femur |
|
|
Term
| Where is the most common site of tibial fractures? |
|
Definition
| Junction of the middle and inferior thirds because it is the narrowest here. |
|
|
Term
| Where is the most common site for a tibial compound fracture? Why? |
|
Definition
| The shaft because the anterior surface is subcutaneous. |
|
|
Term
| What is Osgood-Schlatter disease? |
|
Definition
| Disruption of the epiphysial plate at the tibial tuberosity causes pain |
|
|
Term
| Fibular fractures often occur where and are associated with what? |
|
Definition
| At the distal end of the lateral malleolus and are associated with fracture/dislocation of the ankle joint. |
|
|
Term
| where is a common source of bone grafting? |
|
Definition
|
|
Term
| Where is site for intramedullary infusion in dehydrated or shocked children? |
|
Definition
|
|
Term
| Why is a calcaneal fracture so disabling? |
|
Definition
| It disrupts the subtalar joint where the talus articulates with the calcaneus |
|
|
Term
| What is likely to fracture from severe dorsiflexion? |
|
Definition
|
|
Term
| What is "dancer's fracture"? |
|
Definition
| Fracture of the metatarsal from putting full body weight on it. |
|
|
Term
| How can avulsion of the 5th metacarpal occur? |
|
Definition
| Violent inversion of the foot forces fibularis brevis to tear the 5th metacarpal in abduction |
|
|
Term
|
Definition
| An accessory bone in the talus caused by lack of fusion of the secondary talus ossification center to the body of the talus. Typically caused by forceful plantarflexion during teens. |
|
|
Term
Where are sesamoid bones in the feet?
What is significant about them? |
|
Definition
| In the tendon of the extensor hallucis longus (big toe). Bears the weight of the body during walking and can be fractured due to a crush injury. |
|
|
Term
| What is compressed in compartment syndrome? |
|
Definition
| Small vessels of the muscle and nerves |
|
|
Term
| What is a fasciotomy and when is it performed? |
|
Definition
Incision of fascia or a septum.
Compartment syndrome |
|
|
Term
Define varicose
Where are they common? |
|
Definition
Varicose: dilated veins so that the valves do not close
posteromedial parts of lower limb |
|
|
Term
| Signs of Deep venous thrombosis (DVT) |
|
Definition
| swelling, warmth, erythema (inflammation and infection) |
|
|
Term
| Define venous stasis. What is it a cause of? |
|
Definition
Venous stasis: stagnation of venous blood
Thrombus formation |
|
|
Term
| What can cause venous stasis (3)? |
|
Definition
1) Loose fascia that fails to resist muscle expansion, diminishing the effectiveness fot he muscuclovenous pump
2) External pressure on the veins from prolonged bed rest
3) Muscular inactivity |
|
|
Term
| What is the danger with DVT? |
|
Definition
| The thrombus may break off and be carried towards the lungs producing a pulmonary embolism which can be fatal. |
|
|
Term
| 3 reasons the great saphenous vein is ideal for coronary arterial bypasses |
|
Definition
1) accessible
2) tributaries are far enough apart that a usable length can be harvested.
3) more muscular and elastic than other superficial veins. |
|
|
Term
What is a saphenous cutdown?
What nerve is at risk?
Signs of nerve paralysis? |
|
Definition
An incision anterior to the medial malleolus to find the great saphenous vein.
Saphenous nerve.
pain or numbness along medial foot border |
|
|
Term
| Where can a femoral nerve block be performed? |
|
Definition
| Just inferior to the inguinal ligament |
|
|
Term
| The most common site of thigh hematoma is where? |
|
Definition
|
|
Term
| The medial arcuate ligament of the diaphragm arches obliquely over the proximal part of the ________. |
|
Definition
|
|
Term
| Transversalis fascia is contiguous with ____ _______ _______ that accompanies the muscle down to the anterior region of the thigh. |
|
Definition
|
|
Term
Where may the pain from a psoas abscess be felt?
What will it cause? |
|
Definition
hip, thigh, knee joints
edema in the proximal thigh |
|
|
Term
Paralzyed quadriceps cannot do what?
How does this patient often present? |
|
Definition
Extend the leg
May hold distal thigh to prevent inadvertent flexion of the knee. |
|
|
Term
| Define chondromalacia patellae |
|
Definition
| Overstressing of the knee joint that causes soreness or aching around or deep to the patella |
|
|
Term
| When a transverse fracture of the patellar occurs, where do the pieces go? |
|
Definition
| Proximal fragment is pulled superior by quadriceps. The distal fragment remains with the patellar ligament. |
|
|
Term
When does the patella ossify?
What can occur if ossification centers don't properly fuse? |
|
Definition
Years 3-6
Bipartite or tripartite patella (almost always bilaterally) |
|
|
Term
What does the patellar reflex test the integrity of?
Why? |
|
Definition
L2-L4 spinal cord
The quadriceps are innervated by the femoral nerve which arises from L2-L4 |
|
|
Term
| What does diminished or absent patellar reflex indicate? |
|
Definition
| A lesion is interrupting the innervation of the quads. |
|
|
Term
| Why can the gracialis be transplanted? |
|
Definition
| It's a weak adductor and can be replaced without a noticeable loss of function |
|
|
Term
|
Definition
| Strain, stretching, tearing of proximal attachments of anteromedial thigh muscles. Usually flexor and adductor thigh muscles |
|
|
Term
| What is "rider's bones" and why does it occur? |
|
Definition
| Ossification of parts of the adductor thigh muscles because riders are constantly adducting their thigh muscles so they don't fall. |
|
|
Term
| What part of the femoral artery is in a superficial position? |
|
Definition
| the initial part proximal to the profunda femoris |
|
|
Term
| What artery is used in cardiac angiography? |
|
Definition
| Femoral artery just inferior tot he inguinal ligament |
|
|
Term
| Injury to both the femoral artery and vein may result in what? |
|
Definition
|
|
Term
| What is the cruciate anastomosis and who participates? |
|
Definition
| Medial and lateral circumflex femoral, inferior gluteal artery, and the 1st perforating artery from the profunda femoris |
|
|
Term
Define a saphenous varix
What may it cause? |
|
Definition
Localized filation of the great saphenous vein
Edema in the femoral triangle |
|
|
Term
| Name the tributaries of the femoral vein in the inguinal region |
|
Definition
None.
It only joins to the great saphenous inferior to this region |
|
|
Term
| Where do femoral hernia often occur? When is this dangerous? |
|
Definition
The femoral ring. Inferolateral to the pubic tubercle.
Strangulation of the femoral hernia may occur because the femoral ring has sharp rigid boundaries. This may result in necrosis of the herniated intestines |
|
|
Term
| In approximately 20% of people the _____ __________ ______ takes the place of the obturator artery or joints it as an accessory |
|
Definition
| inferior epigastric artery |
|
|
Term
Deep diffuse pain in the lateral thigh region following repetitive actions that involve the gluteus maximus and move the superior tendinous fibers repeatedly back and forth is termed what?
How is it characterized? |
|
Definition
Trochanteric bursitis
Point tenderness over greater trochanter. Pain radiating along iliotibial tract |
|
|
Term
|
Definition
| Inflammation of the ishial bursa from excessive friction between the ischial bursae and the ischial tuberosities |
|
|
Term
| What does injury to the superior gluteal nerve result in? When standing? |
|
Definition
Gluteal medius limp. -- Body leans to affected site to compensate for abducted limb.
When asked to stand on one leg, if the unsupported pelvis descends then the supported leg's nerve is paralyzed (couldn't stabilize the pelvis) |
|
|
Term
Foot drop indicates what?
What is the compensatory gait? |
|
Definition
common fibular nerve paralysis (specifically, deep)
steppage gait |
|
|
Term
| Where is a sciatic nerve block placed? |
|
Definition
| Posterior superior iliac spine and superior border of the greater trochanter. |
|
|
Term
What muscle may compress the sciatic?
What nerve may pass directly these muscle fibers? |
|
Definition
Piriformis
Common fibular division of the sciatic nerve. |
|
|
Term
| Complete transection of the sciatic results in what? |
|
Definition
| Lost - extension of the hip, flexion of the leg, all foot and ankle movements |
|
|
Term
| Where on the buttocks is a danger zone for sciatic nerve transection? |
|
Definition
|
|
Term
| Where are gluteal IM injections safely performed? |
|
Definition
|
|
Term
| Where can thigh IM injections be safely given? |
|
Definition
| anterolateral in the tensor fascia lata as it extends from the ASIS |
|
|
Term
Pain from popliteal abscesses is severe. Why?
Where does the abscess spread? |
|
Definition
| The popliteal fascia is thick and limits expansion. They spread superior and inferior |
|
|
Term
How may a popliteal aneurysm be distinguished from other abscesses?
What nerve may be affected? |
|
Definition
palpable pulsations and artery sounds upon auscultation
tibial n. |
|
|
Term
| Where is tibial nerve pain referred? |
|
Definition
|
|
Term
| What artery and nerve are in danger with distal femur fractures or dislocations of the knee? |
|
Definition
| popliteal artery, tibial nerve |
|
|
Term
| If the popliteal artery must be ligated, will blood still reach the distal limb? How? |
|
Definition
yes.
genticulate anastomoses |
|
|
Term
| Severence of the tibial nerve produces what? |
|
Definition
| Paralysis of flexor muscles in the leg and intrinsic plantar muscles in the foot. Pt is unable to plantarflex or flex toes. Sensation to sole of foot is lost. |
|
|
Term
| While infections in the _____ and ______ compartments descend the leg, infections in the ______ compartment may ascend the leg along the _______ nerve. |
|
Definition
anterior and posterior
lateral
fibular |
|
|
Term
|
Definition
| Repeated microtrauma to the tibialis anterior and fascia covering it. |
|
|
Term
| Higher primates have _______ feet while humans have slightly ______ feet due to the medial migration of the distal attachment of the fibularis longus across the sole of the foot and development of the fibularis tertius |
|
Definition
inverted
everted (pronated) |
|
|
Term
If the neck of the fibula is fractures, what nerve is in danger?
What results? |
|
Definition
Common peroneal (fibular) nerve.
Paralysis of all the muscles in the anterior and lateral compartment of the leg. Loss of sensation on anterolateral leg and dorsum of the foot |
|
|
Term
| Excessive use of muscles supplied by the fibular nerve may cause what? |
|
Definition
| Injury, edema, and compartment syndrome to the anterior compartment |
|
|
Term
What is ski boot syndrome?
Symptoms? |
|
Definition
Entrapment of the deep fibular nerve
Symptoms are pain to the dorsum of the foot and the 1st and 2nd toes |
|
|
Term
Chronic ankle sprains may stretch what nerve?
Symptoms? |
|
Definition
superficial fibular nerve
pain along lateral side of leg and dorsum of ankle and foot |
|
|
Term
| What is the fabella? Where is it? |
|
Definition
| A sesamoid bone located by the lateral condyle origin of the gastocnemius |
|
|
Term
| Calcaneal tendinitis can often progress to what? |
|
Definition
| Ruptured calcaneal tendon |
|
|
Term
What is the likely diagnosis? Audible snap in the lower limb followed by calf pain and sudden dorsiflexion of the plantarflexed foot. Cannot plantarflex against resistance. A bruise in the malleolar region and a lump in the calf
What are the affected muscles |
|
Definition
Ruptured calcaneal tendon
Plantaris, gastrocnemius, soleus |
|
|
Term
| The calcaneal tendon reflex tests what? |
|
Definition
|
|
Term
| In the absence of plantarflexion, how will a patient walk? |
|
Definition
| Gluteus maximus and hamstrings extend the thigh at the hip and the quadriceps extend the leg at the knee. Foot rotates laterally to disable passive dorsiflexion. |
|
|
Term
| Tennis leg is also known as what? |
|
Definition
|
|
Term
Define calcaneal bursitis
Causes pain where? |
|
Definition
Inflammation of the deep bursa of the calcaneal tendon between the calcaneal tendon and the posterior surface of the calcaneus
Posterior heel. |
|
|
Term
| When a person is standing the venous return of the leg depends largely on what? |
|
Definition
| The muscular activity of the triceps surae. |
|
|
Term
Where might an accessory soleus appear?
What is it associated with? |
|
Definition
As a distal belly medial to the calcaneal tendon
Pain and edema following prolonged exercise |
|
|
Term
| What are the symptoms of plantar fascitis |
|
Definition
Pain in the plantar surface of the foot and heel.
Most severe pain after siting and when beginning to walk in the morning and dissipates after 5-10 min of activity.
Point tenderness at the medial tubercle of the calcaneus
Pain increases with extension of great toe, dorsiflexion |
|
|
Term
| A calcaneal spur will cause what? |
|
Definition
| An abnormal bony process protruding from the medial tubercle will cause pain on the medial side of the foot when walking. |
|
|
Term
| Inflammation of the extensor digitorum brevis produces what? |
|
Definition
Swelling anteromedial to the lateral malleolus.
Can be easily confused with a sprained ankle. |
|
|
Term
| What nerve is frequently used for nerve grafts? |
|
Definition
|
|
Term
Where is a block of the superficial fibular nerve placed?
What is anesthetized? |
|
Definition
In the ankle region anterior to the fibula
Anesthetizes the skin on the dorsum of the foot |
|
|
Term
| What is a plantar reflex and what does it test the integrity of? What is a normal response? |
|
Definition
When the sole of the foot is stroked by a blunt object from the heel to the base of the toe. Flexion of the toes is a normal response.
Tests L4-S2 |
|
|
Term
What is babinski's sign?
What does it indicate?
When is this not the case? |
|
Definition
Fanning of the lateral 4 toes and dorsiflexion of the great toe in response to plantar reflex test.
brain injury or cerebral disease
In children under 4 |
|
|
Term
| Medial plantar nerve entrapment induces loss of sensation where? |
|
Definition
| Medial side of the sole and in the region of the navicular tuberosity |
|
|
Term
| What are the 5 P signs of acute arterial occlusion |
|
Definition
Pain
Pallor
Paresthesia
Paralysis
Pulselessness |
|
|
Term
| Infection of the foot will cause enlargement of what lymph nodes? |
|
Definition
| popliteal and inguinal lymph nodes |
|
|
Term
When is the hip joint most stable?
Which part of the femoral head is "exposed"?
What is the normal angle between the axis of the acetabulum and the femoral head? |
|
Definition
When a person is bearing weight
Anterior
30-40 degrees |
|
|
Term
| What artery supplies blood to the head of the femur and may be disrupted with a fracture of the femoral neck? |
|
Definition
| median circumflex femoral artery |
|
|
Term
| In children, fractures that result in separation of the superior femoral epiphysis can cause.. |
|
Definition
| post-traumatic avascular necrosis of the femoral head. Growth retardation of the epiphysis results and produces pain radiating from hip to knee. |
|
|
Term
Congenital dislocation of the hip joint occurs why?
What is a characteristic of this disease? |
|
Definition
The femoral head is not properly located in the acetabulum.
Inability to abduct the thigh.
Affected limb appears shorter (+Trendelenburg sign) |
|
|
Term
In what direction are hip locations most common?
What nerve may be injured? |
|
Definition
|
|
Term
What is the Q-angle?
This angle is greater in __________
This angle places the _______ directly inferior to the ____ when standing |
|
Definition
The angle between the femur and the tibia
females
middle of the platella; head of femur |
|
|
Term
Define Genu Varum
Where does the weight-bearing line fall? |
|
Definition
| The femur is abnormally vertical and the Q-angle is small - "bowleg" |
|
|
Term
Define Genu Valgum
Where does the weight-bearing line fall?
This overstretches what? |
|
Definition
A lateral angulation of the leg in relation to the thigh. The weight bearing line falls lateral to the knee.
Tibial collateral ligament |
|
|
Term
| When the platella dislocates it almost always dislocates ______. |
|
Definition
|
|
Term
Define patellofemoral syndrome.
What may correct this? |
|
Definition
Microtrauma from abnormal tracking of the patella relative to the femur.
Strengthening the vastus medialis |
|
|
Term
| Which collateral joints prevent disruptions to the sides of the knee joint? |
|
Definition
| tibial and fibular collateral ligaments (TCL and FCL) |
|
|
Term
Injury to the ACL (anterior collateral ligament) produces what sign?
What test is used? |
|
Definition
Anterior drawer sign - Tibia slides anterior to the femur
Lachman test |
|
|
Term
| Posterior drawer syndrome is what? What is it a sign of? |
|
Definition
Where the tibia slides posterior to the femur
PCL (posterior collateral ligament) injury |
|
|
Term
Pain on lateral rotation of the tibia indicates what?
Pain on medial rotation of the tibia indicates what? |
|
Definition
Lateral miniscus tear
Medial miniscus tear |
|
|
Term
| What are the consequences of removing a meniscus? |
|
Definition
| No loss of mobility. Some loss of stability and easier inflammation reactions in the tibial plateaus |
|
|
Term
|
Definition
| The escape of fluid from blood or lymphatic vessels resulting in increased amounts of fluid in the joint cavity. |
|
|
Term
| The _____ ______ communicates with the synovial fluid. Therefor fullness of the ________ may indicate joint effusion |
|
Definition
suprapatellar bursa
anterior thigh |
|
|
Term
| Define the borders of the triangle of aspiration of the knee |
|
Definition
| Anterolateral tibial tubercle, lateral epicondyle of the femur, apex of the patella |
|
|
Term
| Define prepatellar bursitis |
|
Definition
| Friction between the skin and the patella |
|
|
Term
Define subcutaneous infrapatellar bursitis
Edema occurs where? |
|
Definition
Friction between the skin and the tibial tuberosity
Proximal end of the tibia |
|
|
Term
| Define deep infrapatellar bursitis |
|
Definition
| Friction between patellar ligament and the tibia superior to the tibial tuberosity |
|
|
Term
Define popliteal cysts
What is it a complication of? |
|
Definition
Abnormal fluid-filled sacs of synovial membrane in the region of the popliteal fossa.
Chronic knee joint effusion |
|
|
Term
| A sprained ankle is almost always a ____ injury |
|
Definition
|
|
Term
Define a Pott fracture
When does it occur |
|
Definition
Dislocation of the ankle
Forced eversion of the foot |
|
|
Term
| What is a trimalleolar fracture |
|
Definition
| Posterior margin of the distal end of the tibia, medial malleolus, lateral malleolus |
|
|
Term
| What is tarsal tunnel syndrome |
|
Definition
| Tibial nerve compression between the medial malleolus and calcaneus |
|
|
Term
| Hallux Valgus is characterized by... |
|
Definition
lateral deviation of the big toe
decrease in the medial longitudinal arch |
|
|
Term
| Why can't individuals with Hallux valgus move their 1st digit away from their 2nd? |
|
Definition
| Sesamoid bones under the head of the 1st metatarsal are displaced and lie between the heads of the 1st and 2nd |
|
|
Term
|
Definition
| Subcutaneous bursa from friction (usually against a shoe) that is tender and inflamed |
|
|
Term
|
Definition
| Deformity in which the proximal phalanx is permanently dorsiflexed at the metatarsophalangeal joint and the middle phalanx is strongly plantarflexed |
|
|
Term
| What may cause hammer toe |
|
Definition
| Weakness of the lumbrical and interosseous muscles |
|
|
Term
|
Definition
| hyperextension of the metatarsophalangeal joints and flexion of DIP |
|
|
Term
|
Definition
| Degenerated instrinsic ligaments |
|
|
Term
| Rigid flatfeet from childhood is likely caused by? |
|
Definition
| bone deformity (eg. fusion of adjacent tarsal bones) |
|
|
Term
|
Definition
| A foot that is twisted out of position. Congenital. |
|
|
Term
| Talipes equinovarus is the common type of clubfoot. What does it involve? Symptoms? |
|
Definition
The subtalar joint
Foot is plantarflexed and inverted |
|
|
