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56 Cards in this Set
- Front
- Back
Anterior compartment leg?
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TA
EHL EDL Peroneus tertius |
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Posterior compartment leg?
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superficial and deep, separated by transverse intermuscular septum
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Superficial posterior compartment?
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Gastrocnemius
Soleus Plantaris |
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Deep Posterior compartment
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FHL
FDL Tib Post Popliteus |
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Lateral Compartment leg - separated from other compartments by..., and composed of...?
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-separated by ant and posterior intermuscular septum
2 muscles: peroneus brevis (inserts on base of 5th MT) -peroneus longus (corsses plantar surface of foot to insert in medial cuneiform 1st MT base |
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phases of gait?
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Stance
Swing |
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Stance phase gait?
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begins w heel-strike and ends w toe-off
faster run = less time spent in stance phase |
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Swing phase gait?
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begins w toe-ff and ends w heel-strike, 28% cycle
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amount of axial load the proximal tib-fib joint takes?
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1/6
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PTFJ anatomy
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Anterior joint capsule composed of three ligamentous bands which pass obliquely upward and attach to the lateral tibial condyle
-Posterior tibiofibular ligament composed of two broad, thick ligamentous bands which pass obliquely from the fibular head to the posterior aspect of the tibial condyle reinforced by the popliteus tendon |
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Additional stabilizers to the PTFJ besides capsule?
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LCL
arcuate ligament fabellofibular ligament popliteofubular ligament popliteus biceps femoris tendon |
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PTFJ injury mechanism?
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-occurs w knee in flexion
ankle internally rotated and plantar-flexed -activities w aggressive twisting knee motions |
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PE for PTFJ injury?
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-pain, swelling
-may be unable to bear weight -transient peroneal nerve palsy, esp w posteromedial and superior dislocations |
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Anterolateral PTFJ dislocation?
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-fall on flexed knee w foot inverted/plantar flexed
-most common pattern (>85%) -ankle motion exacerbates knee pain |
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**Posteromedial PTFJ dislocation?
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-10% of all types, least common
-direct trauma from car bumper or horseback riding striking knee on post |
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**Superior PTFJ dislocation?
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-2% of all types
-ass d w high-energy ankle injury amd superior migration of ENTIRE FIBULA -**interosseous membrane disrupted |
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PTFJ imaging?
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-AP/lat xray 72% sensitive
-comparison xrays to opposite side sensitivity 82% -CT if dx is equivocal |
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Rx PTFJ subluxation?
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-nonsurgical
-casting x 2-3 weeks -strap 1cm below fibular head -avoid knee flexion activities |
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PTFJ dislocation treatment?
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-closed reduction w knee in 80-110 deg flexion
-ankle dorsiflexed and ER -reverse injury -reassess knee stability/LCL once relocated |
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indications for ORIF for PTFJ dislocation?
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-failed closed red attempt
-posteromedial and superior dislocations -stabiliz reduction w temp screw/ K wire -immobilize x 6 weeks |
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When do overuse injuries occur?
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-When athlete changes mode, intensity, or duration of training - "principle of transition"
-mismatch between overload and recovery can lead to breakdown on all levels. |
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Shin Splints?
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Medial Tibial Stress Syndrome
-length of attachments vary anatomically in muscles, considerable overlap |
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Primary etiology of MTSS?
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**Excessive pronation of feet**
runners, joggers |
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Mechanism of MTSS?
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Excessive pronation causes eccentric contraction of soleus and periostitis
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MTSS PE?
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-tenderness distal 1/3 posteromedial border of tibia
-pain w resisted foot plantarflexion or standing on tip-toe |
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When and where is radionuclide uptake visible for MTSS?
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1/3+ length of tibia w variable intensity
**tracer uptake only visible on delayed-phase images |
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Rx MTSS?
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**REST**
also, if excessive pronation prescribe orthotics |
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"CECS" def?
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Chronic Exertional Compartment Syndrome
typically in a runner w no Hx trauma |
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CECS most affected?
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-Anterior 50-60%
-deep posterior 20-30% -other 20% divided evenly among lateral and posterior, and compartment around tib post |
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%fascial hernia in CECS?
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25-46%
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**Diagnostic standards for CECS compartment pressures?
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1)resting pressure exceeding 15mm Hg before exercise
2) 1-minute post-exercise pressure exceeding 30mm Hg |
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Nonoperative Rx and CECS?
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only nonoperative Rx is cessation of athletic participation.
**must have surgery to continue athletics |
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% return to play after CECS fasciotomies?
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60% returned to their highest level of sport, alghough 33% reported continued pain
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% bilaterality in tibial stress fx's?
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11-23%
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Sullivan article on etiology of stress fx's?
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-all occurred within 12 weeks of a change in training program
-most common change was increased training mileage |
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Tibial stress fx's more common in male or female?
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10-12x more common in women
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assn menses w stress fx?
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high association of irregular menses w tibial stress fx
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When is bone scan positive in tibial stress fx's?
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3-5 days after onset of pain.
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progression of stress fx on MRI?
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periosteal edema-->progressive marrow involvement--> ultimate frank cortical stress fx
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Imaging test preference for stress fx's?
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***MRI***
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healing stress fx?
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most heal w rest
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recurrence rate stress fx?
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10%
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most common nerve entrapment for leg?
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common peroneal nerve,
second is sup peronel n. saphenous n |
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sup peroneal n entrapment occurs in...?'
Rx? |
dancers and body builders,
Rx is typically surgical |
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surgical treatment stress fx/'s?
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fasciotomy sufficient in most cases ( w external neurolyses) and resection osteophytes, ganglion cysts
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What clinical entity can mimic CECS?
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vascular causes, eg popliteal artery entrapment syndrome (PAES)
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sine qua non for poplieteal entrapment syndrome?
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paradoxical claudication w calf cramping during walking but with the subject remaining asympromatic during running!
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"Tennis Leg"?
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partial tear a the MT jct of medial gastrocnemius muscle
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Symptoms tennis leg?
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-occurs with extgended knee and ankle in max dorsiflexion
-feels like leg hit by stick or tennis ball -sometimes "pop" -20% with 1-2 day prodromal calf pain -ambulation produces intense pain |
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Tennis leg PE?
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-palpable defect in medial belly of gastroc just above MT jct
-swelling mayt obscure defect for days -xrays not indicated |
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management tennis leg?
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ice/elevation x 24-48 h
NOT anticoag (->hematoma!) complications include DVT dute to extrinsic compression -nonoperative, conservative - |
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When consider removal of myositis ossificans?
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-wait between 6-12 months
-only removed if it interferes with joint motion or if it is irritating a nerve |
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18yo runner w 1 year Hx lower let pain while running. Only runs 7 minutes prior to onset of Sx, then Sx resolve p 30 minutes after cessation of running.At rest her comp pressures in ant, lat, sup post, and deep post are 19,17,13, and 9 respectively. next step in management?
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decompressive fasciotomy.
has chronic exertional comp in ant and lat comp, which are most commonly affected. |
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Midshaft tib/fib fx in football player. Mech?
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struck from the front while making a tackle. based upon ant butterfly frag seen on xray p 495
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Complications tib tubercle avulsion fx in 10yo?
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athlete is at risk for recurvatum deformity of tibia in future
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48yo dance instructor w activity related lower leg and dorsal foot pain worse w exercise and dance.Failed conserv Tx, next step?
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selective fascial release (p 496) pt has superficial peroneal nerve compression
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