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92 Cards in this Set

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Symptoms of Osteoarthritis
characterized by pain, edema, limited movement
erosion of articular cartilage
Hip Replacement
metal prosthesis can replace femoral head and neck
plastic or teflon socket to replace acetabulum
Hip/Thigh contusion
bleeding from ruptured capillaries
infiltration of blood into muscles, tendons, and soft tissue
Hip Pointer
contusion of iliac crest
can also be an avulsion of bony muscle attachments (avulsion fracture)
Charley Horse
cramping of thigh muscles because of Ischemia (low blood amount)
Epiphysis of femoral head
head slips away from neck due to weakened epiphyseal plate
caused by acute trauma or repetitive microtraumas
Loss of blood supply to Femoral Head
avascular necrosis may occur
can be caused by compression of head or slippage of epiphyseal plate
Congenital Dislocation of Femoral Head
femoral head slips out of joint
much more common than acquired dislocation
car accident injury where hip is flexed, adducted, medially rotated and knew strikes dash board
Superior Gluteal Nerve Injury
more loss w/ weakened abduction of thigh
compensation by moving center of gravity over supporting limb, impairing medial rotation of thigh
Trendelenburg Test
patient w/ paralysis of sup. gluteal N asked to stand on one leg
pelvis on unsupported side descends, indication loss of function
may also be fracture of greater trochanter
Sciatic Nerve Block
result of injection of anesthetic agent inferior to midpoint of PSIS and greater trochanter
paresthesia can radiate inferior to foot
Sciatic Nerve Injury
"Piriformis Syndrome"
compression by Piriformis, resulting in pain in buttocks
common in those that use gluteus (climbers, cyclists)
often runs THROUGH piriformis, becoming entrapped
Complete loss of Sciatic Nerve
leg is useless, extension and flexion of hip is impaired
no movement of ankle possible
Injections of Gluteal Region
safe side=lateral side
danger side=medial side
sciatic nerve on medial side
always inject Sup. to line b/t PSIS and greater trochanter
Herniated Nucleus Puplposes
HNP
lower back pain and motor weakness of lower limbs
Myelography for HNP
contrast injected into theca sac b/t L2-3
outlines of lower SN can be seen
Herniation of Disc
through anterior annulus
may or may not pass through posterior longitudinal ligament
Symptoms of Herniated Disc
movement of area where herniation is causes pain
secondary increased pressure of spinal fluid through coughing, sneezing can cause pain
Sciatica
irritation of SN root from L4-S3
painful sensory disturbance from buttock to lateral thigh
can cause reflex loss, weakness
L5-S1 herniation:
regions of pain
sciatic (back of leg, buttock)
weak plantar flexion and achilles tendon reflex
L4-L5 herniation:
regions of pain
numbness over dorsum of foot
weak dorsiflexion of ankle and big toe
L5 root compression:
regions of pain
pain over dorsum of toes 1-3
no knee jerk reflex
S1 root compression:
regions of pain
pain on lateral surface of foot to dorsum of toes 4-5
weakness of foot flexion
Radicular Pain Onset
can be sudden, shooting pain down buttocks, leg
Radicular Pain Position
flexed and leaned toward side of pain
hip and knee flexed when standing
reduces stretch of sciatic nerve
Straight Leg Test
used to assess radicular pain and HNP
lies flat on back with leg/knee fully extended
leg is slowly raised
pain will present on back of leg if positive
Femur neck: angle of inclination
normally around 126 degrees
varies w/ age and gender
Femur neck angle of inclination:
Coxa Valga
increase in angle of inclination
allows greater mobility
increases strain on neck of femur
Femur neck angle of inclination:
Coxa Vara
decrease in angle of inclination
causes shortening of lower limb
limits abduction
angle of Anteversion (forward tilting)
occurs b/t neck and shaft
Femoral Neck Fractures
can result from traumatic force to foot or ankle
rare in contact sports due to young age of participants
Femoral Neck Fractures:
Subcapital
completely intracapsular (within capsule)
can endanger blood supply of femoral head
Femoral Neck Fractures:
Transcervical
transects neck of femur
intracapsular, along a line that crosses mid neck of femur
can cause capsular tear involving medial and lateral circumflex aa
Femoral Neck Fractures:
Pertrochanteric Fractures
through trochanter
Greater: direct blow or strong muscular pull
Lesser: result from strong pull of Iliopsoas during abduction
Femoral Neck Fractures:
Intertrochanteric
b/t greater and lesser trochanters
"extracapsular"
fast healing, due to well nourished spongy bone
Importance of Medial Circumflex Artery
supplies blood to head and neck of femur
often torn when femoral neck is fracture or hip dislocated
Femoral Shaft Fractures:
General Features
very long heal time, up to one year
displacement of bones depends on muscular pulls
Femoral Shaft Fractures:
Upper 1/3
proximal fragment pulled anterior, rotated lateral, and abducted
Femoral Shaft Fractures:
Middle 1/3
proximal fragment segment abducted, causing it to lateral to distal segment
Femoral Shaft Fractures:
Lower 1/3, Supracondylar
gastrocnemious pulls shaft, displacing distal segment posteriorly
Femoral Shaft Fractures:
Lower 1/3, Intracondylar
T-Type
two distal articular surfaces of femur are separated
Retroperitoneal Pyogenic infection of abdomen
if pus passes b/t psoas and fascia to inguinal/thigh region
pain can refer to hip, thigh, or knee joint
could be result of edema of proximal thigh
Paralyzed Quadraceps Femoris
cant extend leg against resistance
inadvertent flexion of knee can occur during walking
Innervation of Biceps Femoris
both heads have different innervating branches of the psiatic N
injury can paralyze one head but not the other
Hamstring Length Variation
Short: can prevent from touching toes when knees are straight
Long: easily touch toes, can do high kicks
Hamstring Injuries
common in sports with strong muscular exertion
can cause tearing of proximal tendinous insertions from ischial tuberosity
Tear of Proximal Tendinous Insertion of Hamstring
more common than quadriceps strains
usually accompanied by contusion/tearing of muscle fiber and rupture of blood vessel
can result from inadequate warmup
Hurdlers Injury
Avulsion of tuberosity at Proximal attachment of Biceps Femoris and Semitendinosus
results from forcible flexion of hip with knee extended (ball kicking)
Adductor Longus Strain
"Riders Strain"
Ossification of accessory bone may occur in tendons due to great Adduction of Thigh
Femoral Artery Palpation
can occur w/ supine patient
inferior to midpoint of inguinal ligament
can also compress here
Cannulation of Femoral Artery
occurs at base of Femoral Triangle
for left cardinal angiography, catheter is inserted into femoral artery, then run up to heart
Areas of Vulnerability of Femoral Artery
very superficial in femoral Triangle
Aberrant Obturator Artery
closely related to free margin of lacunar ligament and neck of a femoral hernia
must be careful during endoscopic repair of hernia for this common variant
Femoral Hernia
appears as mass in the femoral triangle
can pass inferiorly into saphenous opening
strangulation can occur through femoral ring
Ankle Sprain
torn ligaments
common at Talocrural joint (no side-side motion)
Eversion Ankle Sprain
medial malleolus usually broken before tearing deltoid ligament
Inversion Ankle Sprain
most often anterior talofibular ligament
most common type of sprain
High ankle sprain
tear of the anterior tibiofibular ligament
takes longer to heal
Plantar Fasciitis
pain in the plantar aponeurosis, may involve inflammation
thought to be an overuse injury
worse at beginning of day, better in middle, worse at end
Stress Fracture
calcaneal stress fracture may present as plantar fasciitis
Infection of Central Compartment of Foot
the thick plantar aponeurosis can cause internal pressure to form in infection rather than external swelling
Accessory Bones of the Feet
fairly common, often asymptomatic
most common are accessory naviculars, can cause chronic or acute pain
Auricular Tags and Ear Pits
absence of 1 or more hillocks (Treacher Collins Syndrome) causes malformation of auricle
failure to fuse completely may result in "ear pit" (prearicular cyst)
Insufficient Migration of Neural Crest Cells:
First Arch-Teacher-Collins Syndrome
underdeveloped zygomatic and mandible bone
hearing loss from underdeveloped malleus and incus
malformed external ear
Insufficient Migration of Neural Crest Cells:
First Arch-Robin Sequence
underdeveloped mandible
tongue posteriorly placed in mouth
unfused palate
ear malformation
Deletion of Chromosome 22 long arm:
DiGeorge Syndrome
cardiac defects, conotruncal malformation
abnormally wide face
cleft palate
hypocalcemia
Deviated Septum
usually result of injury
can obstruct breathing
can lead to sinusitis
What is the overlying factor in facial and palatal defects in Development?
failure of neural crest cells to migrate or proliferate
Cleft Lip General Features
more common in men, left side, and asian descent
Orbicularis oris muscle fibers curve upward in parallel to cleft, rather than ending at angle to it
Cleft Lip: Unilateral
maxillary prominence and medial nasal prominence fail to fuse
Cleft Lip: Bilateral
result of anterior displacement of intermaxillary segment
Cleft Palate: Anterior
anterior to incisive foramen
may split maxilla from premaxilla all the way up
Cleft Palate: Posterior
posterior to incisive foramen
-palatine shelves too small to fuse
-palatine shelves fail to elevate
-Tongue doesnt drop and palatine shelves cant fuse
Facial Clefts:
Median Cleft Lip
bifid nose and lip
result of Shh mutation
can also have CNS problems: no fusion of lateral ventricles of brain
Facial Clefts:
Lower Cleft Lip
can result from Van Der Woude Syndrome, failure of 1st arch to form
Facial Clefts:
Oblique Facial Cleft
maxillary process doesnt fuse w/ lateral nasal process
cleft occurs along course of nasolacrimal duct
Facial Clefts:
Lateral Facial Cleft
this is when mouth is too wide b/c maxillary prominences havent grown
Microstomia
tongue doesnt drop, palatal shelves cant fuse
Injury to Middle Meningeal artery
located directly under pterion of skull, very thin
blow to the head here may lacerate artery
nowhere to drain, increases cranial pressure
unconsciousness and death
Importance of Pterygoid plexus of veins
due to their connections w/ cavernous sinus via the deep facial, inferior ophtalmic and emissary veins in the sphenoid
facial infections can lead to meningitis
what is the most common area for nasopharyngeal carcinoma?
pharyngeal recess
what muscle is commonly involved in pharyngeal carcinoma, and where is it commonly detected?
levator veli palatine
enlarged cervicale lymph nodes
what are the reasons for a tonsillectomy, and what are complications?
obstruction of airway
unstoppable bleeding from lingual artery
Bell’s palsy
lesion of facial nerve leading to unilateral paralysis of face
distortion of facial features
Trigeminal neuralgia
Paroxysmal pain along course of Trigeminal
relieved by sectioning sensory root of V
Corneal blink reflex
Bilateral contraction of orbicularis oculi
Reflex arc efferent limb – facial nerve
Afferent limb – nasociliary nerve of V1
Horner’s syndrome
constriction of the pupil, drooping of upper eyelid, retraction of eyeball, absence of sweating
III Nerve Palsy
Ptosis: eye drop
Loss of upward, downward and medial movement of the affected eye
eye is in a 'down and out' position
IV Nerve Palsy
Eye movement inferior laterally
can no longer look down and out
VI Nerve Palsy
double vision due to lateral rectus loss
if left is affected, double vision occurs when looking right
clinical eye movement tests
Inward: Medial rectus
Outward: Lateral rectus
Upward and outward: Superior rectus
Downward and outward: Inferior rectus
Upward and Inward: Inferior oblique
Downward and inward: Superior oblique
what is the integrity test for IX?
gag reflex