Lower Limb Clinical Correlates

Front 1

1. Fracture of the neck of the femur

Back 1

results in ischemic necrosis of neck and head b/c of an interruption of blood supply from the medial femoral circumflex artery, except for its small proximal part. It causes a pull of the distal fragment upward by the quadriceps femoris, adductors, and hamstring muscles so that the affected lower limb is shortened with lateral rotation

Front 2

2. Pertrochanteric fracture

Back 2

a femoral fracture through the trochanters and is a form of the extracapsular hip fracture. More common in elderly women than in men due to osteoporosis

Front 3

3. Dislocated knee or fractured distal femur

Back 3

May injure the popliteal artery b/c of its deep position adjacent to the femur and the knee joint capsule

Front 4

4. Transverse patellar fracture

Back 4

results from a blow to the knee or from sudden contraction of the quadriceps muscle. The proximal fragment fo the patella is pulled superiorly w/ the quadriceps tendon and the distal fragment remains with the patellar ligament

Front 5

5. Bumper fracture

Back 5

a fracture of the lateral tibial condyle that is caused by an automobile bumper, and it is usually associated with a common fibular nerve injury

Front 6

6. Pott's fracture (Dupuytren's fracture)

Back 6

a fracture of the lower end of the fibula; often accompanied by fracture of the medial malleolus or rupture of the deltoid (medial) ligament.

Caused by forced eversion of the foot.

Front 7

7. Fracture of the fibular neck

Back 7

may cause an injury to the common fibular nerve, which winds laterally around the neck of the fibula.

This injury results in paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexors and evertors of the foot) causing FOOT DROP

Front 8

8. March fracture (stress fracture)

Back 8

a fatigue fracture of the one of the metatarsals, which may result from prolonged walking.

Occurs frequently in female ballet dancers

Front 9

9.Cox valga and vara

Back 9

Cox valga - alteration of the angel made by the axis of the femoral neck to the axis of the femoral shaft so that the angle exceeds 135 degrees - makes the femoral neck straighter

Cox vara - angle is less than 135 degrees so the femoral neck becomes more horizontal

Front 10

10. Hemarthrosis

Back 10

blood in a joint

usually causes rapid swelling of the injured knee joint whereas inflammatory joint effusion causes a slow swelling of the knee joint.

Front 11

11. Anterior drawer sign

Back 11

forward sliding of the tibia on the femur due to a rupture of the ACL

Front 12

12. Posterior drawer sign

Back 12

backward sliding of the tibia on the femur caused by a rupture of the PCL

Front 13

13. Which is more frequently torn; the medial or lateral meniscus?

Back 13

Medial meniscus ; b/c of its strong attachment to the tibial collateral ligament

Front 14

14. What is the unhappy triad of the knee joint?

Back 14

Foot is planted firmly on ground and player's knee is struck from the lateral side.

Knee is markedly swollen, esp in suprapatellar region; results in tenderness on application of pressure along the extent of the tibial collateral ligament.

Involves tearing or rupture of:
1. Tibial collateral ligament
2. ACL
3. Medial meniscus

Front 15

15. Patellar tendon reflex

Back 15

elicits extension of the kene joint

tests femoral nerve (L2-L4)

Front 16

16. Prepatellar bursitis (housemaid's knee)

Back 16

inflammation and swelling of the prepatellar bursa

Front 17

17. Popliteal (Baker's) cyst

Back 17

swelling behind knee caused by knee arthritis, meniscus injury, or herniation or tear of the joint capsule. Impairs flexion and extension of the knee joint and the pain gets worse when the knee is fully extended.

Cyst is full of synovial fluid - can be drained to decompress the cyst

Front 18

18. Thromboplebitis

Back 18

a venous inflammation with thrombus formation that occurs in the superficial veins in the lower limbs, leading to pulmonary embolism

Front 19

19. Gluteal gait

Back 19

a waddling gait characterized by the pelvis falling (or dropping) toward the unaffected side when the opposite leg is raised at each step.

Results from paralysis of the gluteus medius muscle (Superior gluteal nerve), which normally functions to stabilize the pelvis when the opposite is off the ground.

Front 20

20. Location of intramuscular injections

Back 20

should be made in the superior lateral quadrant of the gluteal region to avoid injury to the underlying sciatic nerve and other neurovascular structures.

Front 21

21. Piriformis syndrome

Back 21

a condition in which the piriformis muscle irritates and places pressure on the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve.

Also called "sciatica"

Front 22

22. Positive Trendelenburg's sign

Back 22

seen in a fracture of the femoral neck, dislocated hip joint (head of femur), or weakness and paralysis of the gluteus medius and minimus muscle.

Results in inability to abduct the hip joint. If the right glutes med and min are paralyzed, the unsupported left side of the pelvis falls instead of rising, normally, the pelvis rises.

Front 23

23. Hamstring injury or strains

Back 23

common in persons who are involved in running, jumping, etc... Origin of the hamstrings from the ischial tuberosity may be avulsed, resulting in rupture of blood vessels.

Avulsion of ischial tuberosity may result from forcible flexion of the hip with the knee extended.

Front 24

24. Anterior dislocation subluxation of the hip joint

Back 24

characterized by tearing of the joint capsule anteriorly w/movement of the femoral head out from the acetabulum; the fermoral head lies anteroinferior to the pubic bone or the acetabulum.

Front 25

25. Post dislocation of the hip joint

Back 25

characterized by posterior tearing of the joint capsule, retaining the fractured femoral head on the post surface of the ischium.

Results in probable rupture of both the posterior acetabular labrum and the ligamentum capitis femoris, and usually, injury of the sciatic nerve.

Also results in the affected limb being shortened, adducted, and medially rotated

Front 26

26. Medial or intrapelvic dislocation of the hip joint

Back 26

characterized by tearing of the joint capsule medially, and the dislocated femoral head lies medial to the pubic bone. May be accompanied by acetabular fracture and rupture of the bladder

Front 27

27. Femoral hernia

Back 27

more common in women than in men, passes through the femoral ring and canal, and lies lateral and inferior to the pubic tubercle and deep and inferior to the inguinal ligament.

Its sac it formed by the parietal peritoneum. Strangulation of a femoral hernia may occur b/c of the sharp stiff boundaries of the femoral ring, and the strangulation interferes w/the blood supply to the herniated intesting, resulting in death of the tissues.

Front 28

28. Groin injury or pulled groin

Back 28

strain, stretching, or tearing of the origin of the flexor and adductor of the thigh

Front 29

29. Muscle strains of the adductor longus

Back 29

may occur in horseback riders and produce pain b/c the riders adduct their thighs to keep from falling

Front 30

30. Anterior tibial compartment syndrome

Back 30

characterized by ischemic necrosis of the muscles of the anterior compartment of the leg. Occurs as a result of compression of arteries (ant. tibial artery and branches) by swollen muscles following exercise. Extreme tenderness and pain on the anterolateral aspect of the leg.

Front 31

31. Shin splint

Back 31

Painful condition of ant. compartment of leg along the tibia causes by swollen muscles in the ant. compartment - specifically the tibialis anterior

Front 32

32. Intermittent claudication

Back 32

condition of limping caused by ischemia of the muscles in the lower limbs and is seen in occlusive peripheral arterial diseases particularly in the popliteal artery and its branches.

Front 33

33. Knee jerk (patellar) reflex

Back 33

tests the L2-L4 spinal (femoral) nerves by activating muscle spindle in the quadriceps. Afferent impulses travel in the femoral nerve to the spinal cord, and efferent impulses are transmitted to the quadriceps via motor fibers in the femoral nerve

Front 34

34. Ankle jerk (Achilles) reflex

Back 34

twitch of the triceps surae (medial and lateral heads of the gastrocs and the soleus) induced by tapping the tendo calcaneus.

Causes plantar flexion of the foot and tests its reflex center in the L5-S1 or S1-S2 segments of the spinal cord.

Front 35

35. Tarsal tunnel syndrome

Back 35

a complex symptom resulting from compression fo the tibial nerve or its medial and lateral plantar branches in the tarsal tunnel.

Pain, numbness, and tingling sensations on the ankle, heel, and sole of the foot.

Caused by repetitive stress with activities, flat feet, or excess weight.

Front 36

36. Avulsion or rupture of the Achilles tendon

Back 36

Disables the gastrocs and soleus muscles.

The patient is unable to plantar flex the foot.

Front 37

37. Forced eversion of the foot

Back 37

Avulses the medial malleolus or ruptures the deltoid (medial collateral) ligament

Front 38

38. Forced inversion of the foot

Back 38

Avulses the lateral malleolus or tears the lateral collateral (anterior and posterior talofibular and calcaneofibular) ligament

Front 39

39. Ankle sprain

Back 39

Forced Inversion injury

Results from rupture of calcaneofibular and talofibular ligaments and a fracture of the lateral malleolus

Front 40

40. Flat foot (pes planus)

Back 40

disappearance or collapse of the medial longitudinal arch with eversion and abduction of the forefoot

Strains the spring ligament and the long and short plantar ligaments.

Front 41

41. Pes cavus

Back 41

an exaggerated height of the medial longitudinal arch of the foot

Front 42

42. Clubfoot (talipes equinovarus)

Back 42

congenital deformity in which the foot is plantarflexed, inverted, and adducted.

Front 43

43. Damage to obturator nerve

Back 43

Loss of adduction

Causes a weakness of adduction and a lateral swinging of the limb during walking because of the unopposed abductors.

Front 44

44. Damage to the femoral nerve

Back 44

Causes impaired flexion of the hip and impaired extension of the leg resulting from paralysis to the rectus femoris muscle

Front 45

45. Injury to the superior gluteal nerve

Back 45

Causes a characteristic motor loss, resulting in weakened abduction of the thigh by the gluteus medius, a disabling gluteus medius limp, and gluteal gait.

Front 46

46. Damage to the sciatic nerve

Back 46

Causes impaired extension at the hip and impaired flexion at the knee.

Loss of dorsiflexion and plantar flexion at the ankle, inversion and eversion of the foot, and peculiar gait b/c of increased flexion at the hip to lift the dropped foot off the ground.

Front 47

47. Damage to common fibular nerve

Back 47

May occur as a result of fracture of the head or neck of the fibular b/c it passes behind the head of the fibula and then winds laterally around the neck of the fibula.

Results in foot drops (loss of dorsiflexion) and loss of sensation on the dorsum of the foot and lateral aspect of the leg and causes paralysis of all muscle sin the anterior and lateral compartments of the leg.

Front 48

48. Damage to the superficial fibular nerve

Back 48

Loss of eversion of foot

No foot drop

Front 49

49. Damage to the deep fibular nerve

Back 49

Results in foot drop (loss of dorsiflexion)

Causes a characteristic high stepping gait.

Front 50

50. Damage to the tibial nerve

Back 50

Loss of plantar flexion of the foot

Also impaired inversion resulting from paralysis of the tibialis posterior.

Results in clawing of the toes and secondary loss on the sole of the foot, affecting posture and locomotion

Front 51

51. Conora mortis (crown of death)

Back 51

Cascular anastomoses btw the obturator and external iliac systems. Vessels in this area are hard to distinguish and can be injured in group or pubic surgery leading to massive uncontrolled bleeding.

Front 52

52. Medial femoral circumflex artery

Back 52

branches run through the neck to reach the head and supplies most of the blood to the neck and head of the femur

Front 53

53. Femoral artery

Back 53

easily exposed at the base fo the femoral tiangle just inferior to the midpoint of the inguinal liagment. Vulnerable to injury by laceration and gunshot wounds.

Can be ligated if necessary as the cruciate anastomosis will supply blood to the thigh and leg.

Front 54

54. Popliteal aneurysm

Back 54

Edema and pain in the popliteal fossa. Must be ruled out before a popliteal cyst can be diagnosed

Front 55

55. Femoral vein

Back 55

Medial to the femoral artery; admits administration of fluids or catheters, which are passed superiorly through the external and common iliac veins into the inferior vena cava and then the right atrium of the heart.