Musculoskeletal: Clinically Oriented Anatomy Cases

Front 1

Tibial Fracture most common location, March fractures

Back 1

At middle. and inferior thirds, worst supply, can get bumper fracture

March fractures - fractures inferior third, common in nonconditioned people

Front 2

Most common bone used in grafting

Back 2

Fibula, can get normal running, etc. later on.

Front 3

Calcaneal fracture

Back 3

Hard fall onto heel (from a ladder), totally disabaling b/c disrupts subtalar joint

Front 4

Talar Neck fracture

Back 4

From severe dorsiflexion (hard press on pedal in head on collision, posterior displacement)

Front 5

Metatarsal fracture

Back 5

Something hard falls on foot or run over, female dancers

Front 6

Sesamoid fracture

Back 6

Crushing injury to great toe

Front 7

Varicose Veins most common location

Back 7

Great saphenous vein, valves preventing flow from deep to superficial are incompetent, gravity pulls blood into varicosities. Superficial vessels dilate and tortuous. Get clots

Front 8

Why is saphenous vein good for grafts

Back 8

Easily accesible, sufficient distance between tributaries and perforating veins so can be harvested, high percentage of muscular and elastic fibers compared to others.

Must be inserted so valves do not impede flow

Front 9

Saphenous cutdown and role

Back 9

In infants, obese, or people in shock with collapsed veins can easily locate great saphenous vein by cutting skin anterior to medial malleolus. Insert cannula for blood, plasmaexpanders, drugs, etc.

Can damage nerve leading to numbness along medial foot

Front 10

Saphenous nerve cut leads to

Back 10

numbness along medial border of foot

Front 11

Calf paralysis or achilles rupture does what to gait

Back 11

Less efficient push off that uses glut. max and hamstrings more, passive dorsiflexion and absence of plantarflexion

Front 12

Hip and Thigh Contusions

Back 12

Ruptures of capillaries and blood inflow into muscles and soft tissue.

Front 13

Loss of joint stability in knee in arthritis or trauma is often due to

Back 13

weakness in vastus medialis or vastus lateralis

Front 14

Chondromalacia patellae cause

Back 14

Runner's knee from overstressing, soreness and aching around or deep to patella from quadriceps imbalance

Front 15

Ischial Bursitis causes

Back 15

Recurrent microtrauma from stress activity, friction bursitis between tuberosities and bursae. Local pain increases with GLUT MAX movement. Can get pressure sores

Front 16

Trochanteric Bursitis Causes

Back 16

Inflammation of trochanteric bursae from repetivite climbing stairs or inclined treadmill. Glut max and move superior fibers over trochanter. Deep diffuse pain in lateral thigh, friction bursitis down IT band

Front 17

Superior gluteal nerve injury does

Back 17

motor loss in gluteus medius. Weakened abduction in hip, sag when stand on one leg (trendelenburg sign)

Front 18

Things causing Trendelenburg Sign

Back 18

Sup gluteal nerve injury, fracture of greater trochanter, dislocation of hip joint

Front 19

Common fibular nerve injury does

Back 19

Foot drop, steppage gait or swing out

Front 20

Sciatic nerve injury

Back 20

from piriformis syndrome (esp. sports using gluteals a lot), Rarely complete compression and leg flexion/hip extension lost. Incomplete

Front 21

Buttock Injection site

Back 21

lateral quadrant between tubercle of iliac crest and ASIS. Want to avoid sciatic nerve

Front 22

Tibial Nerve injury causes and effect

Back 22

Posterior dislocation of knee can cause

paralysis of flexor muscles in leg and intrinsic muscles soles of foot. NO plantarflexion and loss of sensation in the sole

Front 23

Shin Splints

Back 23

Tibialis anterior strain with edema and pain from microtrauma. Pain from sudden rush of blood and edema to damaged area

Front 24

Deep fibular nerve entrapment

Back 24

excessive use of anterior compartment muscles can cause edema and injury. Pain in dorsum of fut and WEB SPACE TOES 1-2. SKI BOOT SYNDROME

Front 25

Superficial Fibular Nerve entrapment

Back 25

from chronic anckle sprains stretching. Lateral leg pain, dorsum of ankle and foot

Numbness and paresthesia may be present

Front 26

Most common avulsion fracture in foot

Back 26

5th metatarsal where fibularis brevis attaches in severe ankle sprain and can cause foot inversion due to paralysis of fibular muscles in lateral compartment via superficial fibular nerve

Front 27

Calcaneal Tendonitis and Rupture

Back 27

Tendonitis from tears in collagen fibers, pain in walking

Rupture from history of calcaneal tendonitis, audible snap during push off. Sudden calf pain and dorsiflexion of pantarflexed foot.

Cannot plantarflex against resistance, can't raise heel or balance.

Front 28

Calcaneal bursitis

Back 28

inflammation of bursa between tendon and calcaneous. Posterior heel pain.

Front 29

Plantar fasciitis

Back 29

Straining and inflammation of the plantar aponeurosis from running and high impact

plantar heel and medial aspect pain, severe after sitting and dissapates after activity.

Front 30

medial plantar nerve entrapment

Back 30

From compression near abductor hallucis in joggers or everting activities

Medial aching, burning, tingling

Front 31

Why is hemorrhage of the sole so severe

Back 31

piercing of plantar arch and many anastamoses. Difficult to ligate

Front 32

Posterior vs Anterior hip dislocation force

Back 32

Posterior - Flexed, adducted, medially rotated

Anterior - Flexed, abducted, laterally rotate

Front 33

Genu Valgum and Genu Varum

Back 33

Genu Valgum - small Q angle in knee, bowlegged, medial pressure causes arthrosis and LCL is overstressed

Genu valgum is large Q angle, knock knee, lateral stress. MCL damaged.

Front 34

Patellofemoral Syndrome

Back 34

Painf rom running downhill to patella. Microtrauma. Can cause osteoarthritis of patellofemoral comparment

Vastus medialis strengthening can correct

Front 35

Anterior and Posterior Drawer Signs

Back 35

Anterior - lay down pull knee foward on own - ACL damage

Posterior - lay down push knee back - PCL damage

Front 36

Testing damage to collateral ligaments

Back 36

Twist knee towards that ligament. If there is severe pain it is injured

Front 37

Severe edema in knee anterior

Back 37

Probably pre patellar bursitis. Housemaids knee

Front 38

Baker's cysts

Back 38

Synovial fluid filled cysts on knee posterior

Front 39

Ankle Sprains most common type, ligament injured

Back 39

Almost always inversion injury. Lateral ligament sprains usually b/c it is weaker than medial ligament, anterior talofibular is most vulnerable part of lateral ligament

Calcaneofibular ligament can be damaged

Front 40

Clubfoot

Back 40

Congenital syndrome where foot twisted out of position. Inverted, plantarflexed and adducted foot. Often malformed bones