Clinical Boxes - Lower Limb

Front 1

Describe Avulsion Fractures of the hip

Back 1

During sports that require sudden acceleration or deceleration.

Small part of bone and tendon/ligament is torn away.

Older adults - at least two fractures of the ring of bone formed by the pubis, pubic rami, and acetabulum

Front 2

Proximal Femur Fractures

Back 2

Transcervial and intertrochanteric

Violent/Direct blow.

MVA - Spiral Fracture

Front 3

Distal Femur Fractures

Back 3

May be complicated by separation of the condyles, resulting in misalignment of the knee joint

Front 4

Changes in angle of Inclination

Back 4

Can change due to weakening of the neck of the femur

Coxa Vara - When angle is decreased

-Causes mild passive abduction of the hip

Coxa Valga - when angle is increased

Front 5

Describe Tibial Fractures

Back 5

Most common at inferior and middle thirds

Most common type of Open Fracture due to anterior surface being subcutaneous

Front 6

Nutrient Canal Fractures

Back 6

Tibia

Predisposes to nonunion of the bone fragments resulting from damage to the nutrient artery.

Front 7

Describe Fibular Fractures

Back 7

Most common just proximal to the lateral malleolus and often associated with ankle dislocations.

Front 8

Describe Bone Grafts

Back 8

Fibula is the most common site for bone grafting.

Restore skeletal integ to limbs with congenital bone defects and replace bone after trauma.

Graft is bone + Nutrient artery

Front 9

Describe Epiphysial Plate fractures

Back 9

Can jeopardize growth in children (Salter Harris)

Disruption of Epi Plate near tibial tuberosity may cause inflammation of the tuberosity and chronic recurring pain during adolescence

Front 10

Decsribe Calcaneal Fractures

Back 10

Occur when people fall on their heels.

Typically broken into several fragments that disrupt the subtalar joint

Front 11

Describe Talar Neck Fractures

Back 11

Occur during severe dorsiflexion of the ankle - pressing on a break pedal during MVA

Front 12

Describe Metatarsal and Phalangeal fractures

Back 12

Common in endurance atheletes

Common when heavy objects fall on the foot

Common in Dancers using the Demi-Ppoint technique - typically when the dancer loses balance and places all their weight on their foot

Front 13

Describe Compartment Syndrome

Back 13

Increased pressure in a confined anatomical space adversely affects the circulation and threatens the function and viability of tissue within or distal to the space.

Loss of leg pulses and lower temp is sign of arterial compression

Front 14

What is a Fasciotomy

Back 14

incision of overlying fascia or septum to relieve the pressure in the compartment.

Front 15

What can you see in a Saphenous Vein injury

Back 15

Pain, Tingling, or numbness along the medial border of the foot

Front 16

Describe Varicose Veins

Back 16

Dilated and/or tortuous so that the cusps of their valves do not close.

Incompetent valves due to dilation or rotation, resulting in reverse flow and weight of long broken

Front 17

Describe Deep Venous Thrombosis

Back 17

Characterized by swelling, warmth, and erythema and infection.

Front 18

What causes Venous Stasis

Back 18

- Incompetent, loose fascia that fails to resist muscle expansion and diminishes the effectiveness of the musculovenous pump

- External pressure on the veins from bedding during prolonged casting, bandages, or bands of stockings

- Muscular inactivity

Front 19

What is Pulmonary Thromboembolism

Back 19

When a large thrombus that breaks free from a lower limb vein may travel to a lung.

May obstruct a main pulmonary artery and cause death

Front 20

What is Lymphadenopathy

Back 20

Enlarged Lymph nodes

Can be caused by pathogenic microorganisms or their toxins in the blood or other tissues.

Front 21

Where can the femoral nerve be blocked?

Back 21

2cm inferior to the inguinal ligament, approx fingers breadth lateral to the femoral artery,

Parasthesia radiates to the knee and over the medial side of the led if the saphenous nerve is affected

Front 22

Contusion of the iliac crest

Back 22

Hip Pointer injury

Most common injury to the hip region in sports

May also refer to avulsion of the bony site of muscle attachments.

Front 23

What is a contusion

Back 23

Bleeding from ruptured capillaries and infiltration of blood into the muscles tendons and other soft tissues

Front 24

Charley Horse

Back 24

Acute cramping of an individual thigh muscles due to ischemia. nocturnal leg cramps, or hematoma

Localized pain, muscle stiffness, muscle fatigue

Front 25

Describe the Patellar tendon reflex

Back 25

Tapping the patellar ligament with a reflex hammer normall produces a knee jerk.

Tests integrity of femoral nerve and L2-L4

Front 26

Paralysis of Quadriceps

Back 26

Cannot extend the leg against resistance and usually press on distal end of thigh during walking to prevent inadvertant flexion of the knee joint.

Front 27

Chondromalacia Patellae

Back 27

common knee injury for marathon runners. Aching around or deep to the patella results from Quad imbalance.

Front 28

Transplantation of Gracilis

Back 28

Can be removed without noticeable loss of its actions on the leg. Often move it to forearm or to create a replacement for a non functional anal sphincter

Front 29

Groin Pull

Back 29

Refer to a strain stretching and some tearing of the proximal attachments of the flexor and adductor thigh muscles.

Front 30

What is a Femoral Hernia

Back 30

Occurs in the femoral ring and is a protrusion of abdominal viscera out the ring and through the canal.

Strangulation may occur and interfere with the blood supply to the herniated intestine and vascular impairment may result in death of the tissues

Front 31

Femoral artery pulse

Back 31

May be diminished if common or external iliac arteries are partially occluded.

May be compressed at midpoint of inguinal lig to control bleeding after lower limb trauma

Front 32

Left Cardiac Angiography

Back 32

long slender catheter is inserted percutaneously into the femoral artery and passed superiorly in the aorta to the openings of the coronary artery

Front 33

Trochanteric and Ischial Bursitis

Back 33

Diffuse deep pain in the lateral thigh region during stair climbing or from a seated position.

Front 34

Popliteal Pulse

Back 34

Prone with knee flexed to relax the popliteal fascia and hamistrings

Vulnerable in knee dislocations.

Front 35

Popliteal Aneurysm

Back 35

dilation of the popliteal artery

Causes edema and pain in the popliteal fossa

Genicular anastomosis

Front 36

What is Plantar Fasciitis

Back 36

Straining and inflammation of the plantar aponeurosis.

Pain increases with passive extension of the great toe and by dorsiflexion of the ankle

Front 37

Sural Nerve Grafts

Back 37

Often used for nerve grafts in procedures such as repairing nerve defects resulting from wounds.

Front 38

Contusion of Extensor Digitorum Brevis

Back 38

Commonly confused for an ankle sprain

Front 39

Medial Plantar Nerve Entrapment

Back 39

Iriitation as it passed deep to the flexor retinaculum or curves deep to abductor hallucis

cause aching, numbness, and tingling on medial sole of foot.

May occur in repetitive eversion of the foot.

Front 40

Tibial Nerve Entrapement

Back 40

edema and tighness in the ankle involving the synovial sheeaths in the posterior compartment

Heel pain is common

Front 41

Ankle Sprains

Back 41

Most frequently injured joint in the body

Almost always an inversion injury - twisting and weight bearing

Anterior talofib lig is most commonly torn

Front 42

Describe Pott Fracture

Back 42

Dislocation of the ankle when the foot is forcibly everted. pulls on medial ligaments and pulls off medial malleolous

Front 43

Hallux Valgus

Back 43

Foot deformity caused by degenerative joint disease. Characterized by lateral deviation of the great toe.

Front 44

Pes Planus

Back 44

Fallen arches

Secondary to dysfunction of the tibialis posterior owing to trauma, age, or denervation.

Front 45

Describe Shin Spints

Back 45

Edema and pain in the area of the distal two thirds of the tibia - microtrauma of Tibialis Anterior. (Mild form of anterior compartment syndrome)

Front 46

Consequences of infection on the compartments of the lower limb

Back 46

Pus forming infections increase intracompartmental pressure.

Inflammation spreads chiefly in a distal direction.

Pus forming in lateral compartment can ascend proximally into the popliteal fossa along common fibular nerve.

Front 47

Severance of the fibular nerve

Back 47

Causes foot drop

Loss of dorsiflexion of the ankle.

Toe does not clear the ground when walking "limb too long"

Front 48

Compensating for foot drop

Back 48

Waddling gait

Swing out gait

High Stepping gait

Front 49

Deep Fibular Nerve entrapment

Back 49

Common with tight fitting shoes.

"Ski boot Syndrome"

Pain in dorsum of the foot and usually radiates to the web sapcebetween the first and second toes.

Front 50

Superficial nerve entrapment

Back 50

Common with chronic ankle sprains - stretching of the nerve.

Pain along the lateral side of the leg and dorsum of the ankle and foot

Front 51

Dorsal Pedis Pulse

Back 51

Evaluated during a physical examination of the peripheral vascular system. May be palpated in dorsiflexion.

Five P Signs: Pain, Pallor, Parethesia, Paralysis, and Pulselessness - acute arterial disease

Front 52

Gastrocnemius Strain

Back 52

painful calf injury resulting from partial tearing of the medial belly of the gastrocnemius at or near its musculotendious junction.

Front 53

Posterior Tibial Pulse

Back 53

Between posterior surface of the medial malleolus and the border of the calcaneal tendon.

Must have patient evert the foot to relax the extensor retinaculum to be able to palpate

Front 54

Injury to the tibial nerve

Back 54

May be injured by deep lacerations in the fossa or due to posterior dislocation of the knee joint.

Severance causes paralysis of the flexor muscles in the leg and intrinsic muscles of the sole of the foot

Front 55

Absence of Plantar Flexion

Back 55

People will often rotate the foor as far laterally as possible during the stance phase to disable passive dorsiflexoin and allow more efficient push off

Front 56

Calcaneal tendon reflex

Back 56

Striking the calcaneal tendon briskly with a reflex hammer while legs are hanging.

Tests S1 and S2

Front 57

Rupture of the Calcaneal Tendon

Back 57

Microscopic tears of collagen fibers in the tendon.

Often occurs with history of calcaneal tendonitis

Passive Dorsi - excessive

Cannot Plantar flex against resistance

Front 58

Calcaneal Bursitis

Back 58

Inflammation of the bursa of the calcaneal tendon.

Often seen in long distance runners

Front 59

What is Patellofemoral Syndrome

Back 59

Pain due to abnormal tracking of the patella - long distance running.

Can be corrected by strengthening the vastus medialis - prevents lateral dislocation of patella

Front 60

Patellar dislocation

Back 60

Almost always laterally - more common in women most likely due to larger Q-angle

Front 61

Popliteal Cysts

Back 61

abnormal fluid filled sacs of snyonvial membrane near the popliteal fossa.

May be a herniation of the gastrocnemius or semimembranosus bursa.

Front 62

MCL and meniscus tears

Back 62

common in athelets who twist their flexed knees while running

Front 63

ACL Rupture

Back 63

Serves as a pivot for rotatory movements of the knee and is taut during flexion.

Front 64

Arthroscopy of the knee

Back 64

Allows removal of torn menisci and loose bodies in the join such as bone chips and debridement