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71 Cards in this Set
- Front
- Back
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Which veins form an alternate pathway in a femoral vein occlusion?
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Gluteal veins communicate with tributaries of femoral veins
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What is a hip pointer? What causes it?
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contusion (bruise) of the iliac crest by direct blow or fall
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What is an avulsion fracture? What are 3 examples?
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in an immature skeleton, bone fragments can be avulsed at the origin of muscle attachment during sports
ischial tuberosity > hamstrings ASIS > sartorius AIIS > rectus femoris |
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What happens in a pelvic fracture and when does this occur?
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The head of the femur is driven through the acetabulum
caused by a fall on the greater trochanter or from height on the feet |
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What allows safe ligation of the femoral artery?
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The arteries that make up the cruciate anastomosis around the head of the femur
** medial circumflex femoral artery (supplies most blood to head and neck of femur) lateral circumflex femoral artery artery to head of femur (from acetabulur branch of obturator artery, more imp in kids) superior & infeior gluteal arteries first perforating branch of deep artery of the thigh |
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What is the angle of inclination? What are 2 abnormalities related to this angle?
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(frontal plane) angle between the femoral neck and femoral shaft, usually 126
coxa vara = decreased angle > mild passive abduction of hip/limp coxa valga = increased angle > osteoarthritis risk, dislocation femur head |
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What is the angle of torsion? What are 2 abnormalities related to this angle?
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(transverse plane) angle between femoral neck and femoral condyles, usually 15
anteversion = increased angle retroversion = decreased angle |
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What is the most common hip fracture? What is it actually called? What are some complications associated with this?
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called femoral fractures
most common is neck fracture complications: retinacular branches of medial femoral circumflex artery may tear > avascular necrosis of femoral head risk deep vein thrombosis and pulmonary embolism |
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What can cause avascular necrosis of femoral head?
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sickle cell disease
alcoholics long term corticosteroids use Legg Calve Perthes |
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What is Legg Calve Perthes?
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epiphyseal ossification centers of the femoral head in children
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What causes avulsion fractures of the lesser and greater trochanters?
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lesser: iliopsoas pull, frequent in kids but in adults is a sign of cancer
greater: gluteus medius and minimus pull |
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posterior hip dislocation - what can get damaged?
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All 3 hip ligaments limit extension, but are relaxed during flexion and adduction of the thigh, making traumatic posterior hip luxation easier in that position; 90% of hip dislocations are posterior.
It can damage sciatic nerve & cause paralysis of muscles of posterior thigh and muscles below knee. |
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anterior hip dislocation
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5% of all hip dislocations
they are caused by forceful abduction and external rotation, (e.g., being hit by a truck) |
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congenital hip dislocation
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Congenital hip dislocation/ developmental dysplasia of the hip occurs in 1.5/1,000 live births, more commonly in girls; risk factors include family history, generalized ligamentous laxity, and a breech birth
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slipped capital femoral epiphysis
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Another type of hip injury that occurs prior to skeletal maturity is a slipped capital femoral epiphysis
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trochanteric bursitis
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trochanteric bursa between gluteus maximus and greater trochanter
common and produces pain, radiates distally along iliotibial tract |
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Positive Trendelenburg sign
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Results from paralysis or weakness of the gluteus medius and mimimus
Pelvis drops on opposite side when the affected side is supporting the body the patient leans trunk toward the affected side to maintain balance may lead to an altered gait pattern: patient does a “hip hicking” to keep the foot from hitting the floor on unaffected side (longer limb) |
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lymph of gluteal region
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Deep gluteal tissues > gluteal lymph nodes to internal, external, common iliac lymph nodes to lumbar lymph nodes
Superficial gluteal tissues > superficial inguinal nodes to external, common iliac lymph nodes to lumbar lymph nodes |
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Piriformis syndrome
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The sciatic nerve may become irritated or compressed by the piriformis muscle, often creating pain and/or paresthesia in the gluteal region and posterior thigh
An early division of the sciatic n. occurs in about 12% of the population and may predispose a person to this condition Hypertrophy of the piriformis plays a role as well Dancers, ice skaters, cyclists, etc. |
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intramuscular injection site
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Sciatic nerve & gluteal nerves may be damaged by an improperly placed gluteal injections!
place in upper lateral part of gluteus maximus Lesion paralyzes posterior thigh muscles & all muscles below knee |
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What is th Q angle? What are 3 pathologies associated with it?
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angle between femur (pull of quadriceps) and patellar tendon pull
185-190 genu varum = decreased, bow legs genu valgum = increased, knock knees overloading > damage to joint cartilage on side of compression |
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What can be injured during a fracture of the distal femur? What complicates it?
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popliteal artery can be injured
complicated by separation of condyles > misalignment of knee joint |
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What happens when a femoral fracture involves the epiphyseal plates?
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disturbs growth
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What happens when the femoral shaft is fractured?
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could cause fatal fat emboli, which can travel to lung or brain and block arteries
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What 2 things cause birth fractures of the femur?
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a difficult delivery
osteogenesus imperfecta: many fractures because of mutation of type I collagen genes so bones break easily |
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What is osteosarcoma? What 2 places does it commonly occur?
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is a common primary malignant tumor
occurs in distal femur or proximal tibia (often involves knee joint as well) |
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What is Osgood-Schlatter Disease?
What causes it? What are the sumptoms? |
Partial Avulsion of tibial tuberosity from epiphyseal plate > pull of quadriceps
Caused by repetitive stress or tension on part of the growth area of the upper tibia Characterized by inflammation of the patellar tendon and surrounding soft tissues at the point where the tendon attaches to the tibia Common in adolescents, particularly athletes |
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What are 2 injuries to the collateral ligaments of the knee?
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LCL may be injured by medial blow to knee (varus stress)
MCL may be injured by lateral blow to knee (valgus stress) |
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What stresses affect the collateral ligaments of the knee?
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LCL may be injured by medial blow to knee (varus stress)
MCL may be injured by lateral blow to knee (valgus stress) |
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Which menisci is more frequently injured?
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medial menisci (attached to MCL)
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What are 2 problems that can arise from the bursa associated with the quadriceps femoris tendon?
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suprapatellar bursa may mask joint effusion or spread infection to the knee joint
prepatellar bursa, superficial and deep infrapatellar bursae may be irritated by friction and fill with fluid (bursitis) |
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Osteoarthritis
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MC type - ~21 million Americans
Articular cartilage broken down Typically associated w/ aging Can be brought on earlier and more severely w/ an injury that affects joint structure Mainly affects weight bearing & high-use joints like hip & knee |
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Rheumatoid Arthritis
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An autoimmune disorder
Has some genetic components Synovial membrane is attacked Usually concentrated in the small joints Often bilateral & symmetrical A systemic problem, joint dysfunction is a symptom **different origin so can see this in young people |
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What is injured in "the unhappy triad"? How does this happen?
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Injury to TCL, ACL & miniscus
Blow to extended knees or twisting of flexed knees while running (football) |
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What happens when ACL ruptures?
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Sport like skiing
Free tibia slides forward when leg pulled: anterior drawer sign |
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What happens when PCL ruptures?
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Land on tibial tuberosity when knee flexed
Free tibia slides backward when leg is pushed: posterior drawer sign |
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What ruptures in an anterior knee joint dislocation?
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rupture of both cruciate ligaments in a patient struck from the rear by a car
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What ruptures in a complete dislocation of the knee joint?
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ruptures of the medial collateral ligament, medial meniscus, both cruciate ligaments, and the posterior capsule
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What are common ages for ruptures of quadriceps tendon? Patellar tendon?
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Rupture of quadriceps tendon
Over 40 yrs of age, associated with tendinitis Rupture of patellar tendon Below 40 yrs of age |
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What is typical of a patella fracture?
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Typically in middle, distal fragment pulled upward
Comminuted (many pieces) fracture, non displaced fragments due to direct trauma |
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What direction does dislocation of patella from patellar groove usually happen? What are predisposing factors?
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Usually lateral
predisposing factors include a shallow patellar groove, an abnormal patella, or a laterally displaced quadriceps femoris insertion |
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Hamstring strains
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Hamstring strains are relatively common and third degree strains (complete rupture of tendon) do occur (as shown here) when sprinting or kicking
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Where does the popliteal artery lie? What could injure it?
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Lies against the posterior surface of the femur superiorly, one site where vascular complications may arise from fractures or other means;
possible vascular complications include: Laceration or fracture of artery, damage can happens during surgery for varicosities Arterial spasm with resultant occlusion due to sudden traction Arterial compression; may be iatrogenic due to an excessively tight cast or bandage Arterial thrombosis |
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Popliteal (Baker's) Cyst
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Synovial lining of knee joint herniates through capsule into popliteal fossa
Rupture causes sudden calf pain & swelling similar to deep venous thrombosis |
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What can you test with the patellar tendon?
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All quadriceps femoris muscles insert on patellar tendon > knee jerk reflex that tests for L3-L4.
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Describe iliopsoas bursitis and its causes
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Iliopsoas bursa deep to the iliopsoas muscle as it crosses the hip joint;
the bursa may become inflamed in rheumatoid arthritis or as in overuse injury, causing anteromedial thigh pain (iliopsoas bursitis) |
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psoas abcess
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Infection caused by tuberculosis of the lumbar vertebrae or a fistula related to diverticulitis of sigmoid colon may track along the psoas fascia deep to the inguinal ligament, producing a bulge in the upper thigh and referred pain to the hip and/or knee joints
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referred pain in hip and knee
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Because articular branches of the femoral (L2-L4) and obturator (L2-L4)nerves innervate both the hip and knee joints, hip pain often is referred to the knee; on the other hand, pain may be referred to the hip from the vertebral column & sacroiliac joint
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Why and where is pain referred to from hip and knee?
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Because articular branches of the femoral (L2-L4) and obturator (L2-L4)nerves innervate both the hip and knee joints, hip pain often is referred to the knee;
on the other hand, pain may be referred to the hip from the vertebral column & sacroiliac joint |
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What is a groin pull?
When does it occur? What is painful afterward? |
Groin pull: lay term for strain to the tendons of the hip adductors
Commonly occurs when an accidental stress abducts the thigh during a powerful contraction of the adductors. These muscles also may be injured from overuse in an unconditioned patient. Local pain is noted at the inferior pubic ramus and the ischial tuberosity. Extension, abduction, and adduction of the hip are painful. |
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What is Lymphadenopathy of superficial inguinal nodes an indicator of?
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indication of scrotal cancer or uterine cancer (via round ligament)
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Femoral Hernia - why is it dangerous?
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Abdominal content pass through the femoral ring into the femoral canal and through saphenous opening
Much more common in females than in males Prone to strangulation Aberrant obturator artery (origins from inferior epigastric artery instead of internal iliac artery) is in danger from hernia or its repair However, indirect inguinal hernia is the most common type of hernia in both sexes |
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What bursitis is associated with Pes Anserinus?
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Pes anserinus bursitis
Associated bursa inflamed > knee pain on medial side |
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What are some clinical consideration of the femoral artery?
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Pulse is palpable just inferior to midpoint of the inguinal ligament, between the ASIS and the pubic tubercle
The first part of the artery may be compressed against the superior pubic ramus to control bleeding in the lower extremity May be cannulated for angiography to view the heart or the coronary vessels or for angioplasty (for widening the vessels) For blood gas analysis especially in children. |
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tibial shaft fracture
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Frequent
often open skin (compound fracture) > osteomyelitis (bone infection) Nonunion & delayed union common in adult > damage to nutrient artery |
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stress fractures of tibia
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Leg pain after sudden increase in strenuous activity
Microscopic cracks that can progress to full fracture if overuse continue |
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what happens during strong deltoid ligament ruptures?
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Medial malleolus is avulsed before strong deltoid ligament ruptures
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which lateral ligaments are most frequently torn?
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Anterior talofibular ligament,
the most frequently torn part Calcaneofibular ligament, which is sprained next Posterior talofibular ligament |
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What is the more common ankle injury? When is the ankle most stable?
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More commonly suffers inversion injuries because of the weak lateral ligament and lateral malleolus longer than the medial malleolus
Is most stable in dorsiflexion because the trochlea of the talus is wider anteriorly than posteriorly |
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ankle sprains
(ligament injury) |
This is an example of an ankle inversion sprain with rupture of the anterior talofibular and calcaneofibular ligaments; ankle sprains typically occur during plantarflexion.
Also possible avulsion fracture of 5th metatarsals by fibularis brevis tendon. |
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Pott's fracture
(ankle) |
Occurs when foot is forcibly everted
Avulsion of medial malleolus or tear of medial ligament Shear off lateral malleolus Can shear off posterior margin of distal tibia end |
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Fibular fracture
(ankle) |
Occurs with excessive inversion of foot
Avulsion of lateral malleolus or tear of lateral ligament Can fracture tibia at higher level |
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compartment syndrome
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Acute medical problem following injury or surgery in which increased pressure (usually caused by inflammation) within a muscle compartment of lower limb (or upper limb) that impairs blood supply
Can lead to nerve damage and muscle death Left untreated when acute, can lead to death Leg and forearm are most susceptible Signs & Symptoms: The 5 "P's" Pallor (lack of color), pulse deficit, paralysis, paresthesias (tingling/itching), and pain on passive motion |
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fasciotomy
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Sometimes the only option
Necessary to prevent permanent tissue damage |
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common fibular nerve injury and foot drop
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The most commonly injured nerve in the lower extremity is the common fibular nerve as it winds around the neck of the fibula
This can lead to loss of motor (flaccid paralysis) and/or sensory function in the anterior and/or lateral regions of the leg Foot drop resulting from lack of dorsiflexion may lead to compensation by: Waddling gait: leaning on opposite side Swing-out gait: abduction Steppage gait: extra flexion Treatments Orthoses &nerve stimulation |
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What happens when gastrocnemius and soleus (triceps surae) are injured?
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Paralysis > triceps surae gait where pelvis drops on affected side during stance phase of walking
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shin splints
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Leg pain common in athletes who run on hard surfaces
Stress reaction of periosteum or muscles attachment to repetitive use : “Sharpey’s fibers” that attach muscles to bones are irritated More commonly occurs with tibialis anterior muscle Flat foot predisposes to shin splints Mild form of compartment syndrome |
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varicose veins
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Occur in superficial veins when either the deep fascia or valves of perforating veins are incompetent
Blood flow slows, go from deep to superficial veins and collects in the superficial vein, causing a bulge Symptoms: pain, achiness, and heaviness of affected leg, worsened by standing Alleviated by sitting down and/or wearing elastic stockings Major treatments: Sclerotherapy: injecting a sclerosing agent to cause vein to shrink and close Surgery: vein stripping or removal, or ligation of great saphenous v. at entrance to femoral v. in femoral triangle/ small sephanous v. at popliteal fossa |
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Deep vein thrombosis
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Large clot develops in vein (usually in calf)
Clot breaks off and enters circulatory system> pulmonary embolus Classic triad etiology: Venous stasis – not moving Injury to vessel wall - surgery Hypercoagulable state – tend to form clot, will go to lunch > fatal Difficult to detect since there may be no clinical signs Common causes: Surgery Travel (economy class syndrome) |
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Tarsal Tunnel Syndrome
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Entrapment and compression of tibial nerve by flexor retinaculum that causes pain
Results from edema & thighness involving synovial sheaths of tendons of muscles from posterior compartment of leg |
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What do you test at the calcaneal tendon?
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gastrocnemius, soleus, and plantaris All insert on the calcaneus via the calcaneal (Achilles’) tendon
ankle-jerk reflex (S1-2) is tested by tapping the calcaneal tendon |
