Anatomy LL Clinical Only

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ribbit228
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223064
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Anatomy LL Clinical Only
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2013-06-09 16:46:45
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  1. Hip pointer:
    Bruised iliac crest (particularly near origin of sartorius muscle to ASIS/ attachment of rectus femoris to AIIS; common in athletes
  2. Avulsion fracture:
    Origin of hamstrings avulsed from ischial tuberosity; common in children
  3. Inflamed ischial bursa:
    Caused by repetitive movement where ischial tuberosity isn't covered by gluteus maximus muscle (such as in bicycle riding)
  4. Hip of femur fracture (may damage which structures):
    • -transcervical fracture
    • -secondary to osteoporosis in females (decrease of calcium in bones -> bones become brittle & susceptible to fracture)
    • -branches of medial circumflex femoral artery (supplies femoral head)
  5. Position of LL post femoral neck fracture and muscles that act on distal fragment:
    • -LL shortened & laterally rotated
    • -quadriceps femoris, adductor & hamstring muscles
  6. Fracture of shaft of femur:
    • -caused by a direct, violent injury (auto accident)
    • -causes substantial shortening of femur from contraction of powerful longitudinally oriented muscles
  7. Fracture of distal femur (may injure which structure):
    • -may cause complications if condyles are separated
    • -leads to misalignment of knee joint
    • -may injure popliteal artery
  8. Supracondylar fracture of femur (may damage which structure):
    • -gastrocnemius muscle can rotate distal fragment posteriorly
    • -popliteal artery
  9. Iliotibial tract (muscles and attachments):
    • -lateral thickening of fascia lata
    • -conjoint aponeurosis of tensor fascia lata & gluteus maximus muscles
    • -attaches to Gerdy tubercle (on lateral condyle of tibia)
  10. Venous drainage of LL:
    -superficial & deep veins (both = valves, but more in deep) -> connected by perforating veins
  11. Great saphenous vein accompanies which nerve and empties into which vein:
    • -saphenous nerve
    • -femoral vein
  12. Small saphenous vein accompanies which nerve and empties into which vein:
    • -sural nerve
    • -popliteal vein (in popliteal fossa)
  13. Deep veins accompany deep arteries as (and action):
    • -venae comitantes
    • -compressed by contraction of surrounding muscles -> push blood toward heart
  14. Deep vein pathways:
    -from anterior thigh & everywhere below knee
    -from medial thigh
    -from gluteal region
    • -femoral vein -> external iliac vein
    • -obturator vein -> internal iliac vein
    • -internal iliac vein
  15. Groin pull/ strain:
    • -strain/ stretching/ tearing of proximal attachments of anteromedial thigh muscles (involves flexor & adductor thigh muscles)
    • -occur in sports that require quick starts (hockey, baseball, basketball, and short-distance racing)
  16. Gracilis of transplantation:
    • -gracilis = relatively weak member of adductor group (can be removed)
    • -done to replace a damaged muscle in hand/ create a replacement for non-functional external anal sphincter
  17. Paralysis of quadriceps (cause, weakened muscles, results in):
    • -due to arthritis/ trauma to knee joint
    • -weakness of vastus medialis & lateralis
    • -results in abnormal patellar movement/ joint stability
    • -patient can't extend leg against resistance and presses on distal end of thigh during walking to prevent inadvertent flexion of knee
  18. Patellar tendon reflex (ligament tapped, nerves tested, absence due to):
    • -tap patellar ligament with hammer
    • -L2-L4 nerves (femoral nerve)
    • -absence/ lessened reflex due to loss of innervation to quadriceps (peripheral nerve disease)
  19. Runner's knee (chondromalacea patellae) due to, results in, occurs in:
    • -damage to articular cartilage on inner surface of patella (quadriceps imbalance)
    • -leads to knee pain/ soreness/ aching around or deep to patella
    • -marathon runners and power lifters (when they squat with weights & get hurt)
  20. Femoral triangle boundaries and contents:
    • -superior: inguinal ligament
    •  medial: medial border of adductor longus
    •  lateral: medial border of sartorius
    • -femoral nerve & femoral sheath (femoral artery, femoral vein, femoral canal: lymphatic vessels & deep inguinal lymph node of Cloquet)
  21. Hunter's canal (subsartorial/ adductor) boundaries and contents (artery, vein, 2 nerves, and...):
    • -superior: apex of femoral triangle
    •  inferior: adductor hiatus
    • -femoral artery & femoral vein, saphenous nerve, nerve to vastus medialis, lymphatics)
  22. Femoral hernia (occurs how, common in, present as, risk, treatment):
    • -part of abdominal viscus/ fat protrudes into femoral canal
    • -common in women b/c of wider femoral ring & pelvis & small size of femoral vessels (can occur after 1st/ 2nd pregnancy when muscles more relaxed)
    • -present as an often tender mass inferolateral to pubic tubercle
    • -may enlarge by passing through saphenous opening (high risk of strangulation)
    • -surgical reduction
  23. Abnormal obturator artery:
    • -pubic branch of inferior epigastric artery may run along medial side of femoral ring to reach symphysis pubis
    • -dangerous b/c it crosses lacunar ligament
    • -cutting lacunar ligament to free strangulated hernia = high risk of bleeding
  24. Femoral artery path:
    • -continuation of external iliac artery & main artery of anterior thigh
    • -goes inside femoral triangle lateral to femoral vein (within femoral sheath)
    • -exits at adductor hiatus to become popliteal artery
  25. Profunda femoris path:
    • -main artery of posterior thigh & largest branch of femoral artery
    • -comes from lateral aspect of femoral artery in femoral triangle
  26. Cannulation of femoral artery:
    • -catheter inserted percutaneously into femoral artery and passed superiorly in the aorta for cardioangiography
    • -pulse of femoral artery can be found just inferior to midinguinal point
  27. Cannulation of femoral vein:
    • -located just medial to femoral arterial pulse
    • -IVC/ RA/ RV can be reached w/ fluoroscopy
  28. Obturator artery:
    • -branch of internal iliac artery
    • -enters medial thigh through obturator canal
    • -anterior & posterior branches
    • -supplies adductor compartment of thigh
  29. Popliteal artery:
    • -continuation of femoral artery at adductor hiatus
    • -bifurcates into anterior and posterior tibial arteries at lower border of popliteus muscle
    • -palpable in popliteal fossa with flexed knee
    • -5 genicular branches (anastomose around knee joint and supply articular capsule & ligaments of knee joint)
    • -branches: medial & lateral superior genicular, middle genicular, medial and lateral inferior genicular arteries
  30. Varicose veins:
    • -due to incompetent venous valves
    • -stagnation and back flow of blood into superficial veins (dilated)
    • -common site: posteromedial parts of LL
    • -may lead to leg ulcers, secondary failure of saphenofemoral valve, thrombosis and thrombophlebitis (subsequent inflammation)
  31. Pulmonary embolism (DVT):
    • -IVC -> RA -> RV -> PT -> branch of pulmonary artery blocked -> death of lung tissue
    • -big thrombus = PT/ PA blocked = maybe instant death
  32. Paradoxical Embolism (DVT):
    -embolus in IVC -> RA -> presence of patent formen ovale -> LA -> LV -> aorta -> carotids -> cerebral arteries -> stroke/ paralysis
  33. Saphenous vein graft:
    • -used for bypassing occluded coronary artery/ branches
    • -part of vein reversed when used to make sure valves don't obstruct blood flow
    • -removal doesn't affect circulation b/c many other leg veins present (provided deep veins intact)
  34. Venesection (saphenous cutdown):
    • -infants/ obese people/ people in shock w/ collapsed veins
    • -incision made anterior to medial malleolus (cannula for prolonged administration of blood, drugs, electrolytes, etc.)
    • -may damage saphenous nerve -> loss of sensation/ pain along medial leg, medial border of foot up to base of great toe
  35. Superficial lymphatic vessel drainage: -accompanying great saphenous vein
    -accompanying small saphenous vein
    • -end in vertical group of superficial inguinal lymph nodes -> external iliac lymph nodes (along external iliac vein) -> deep inguinal lymph nodes (on medial aspect of femoral vein)
    • -enter popliteal lymph nodes
  36. Deep lymphatic vessels (accompany deep veins):
    -enter popliteal lymph nodes -> ascends through deep lymphatic vessels -> deep inguinal lymph nodes -> external iliac lymph nodes -> common iliac lymph nodes
  37. Enlarged inguinal lymph nodes:
    • Lymphadenopathy (enlargement) and lymphadenitis (inflammation) by:
    • -infection (sepsis: perineal abscess, infection/ boils from LL and lower abdomen below umbilicus
    • -malignancy (from external genitalia, uterus)
  38. Iliotibial band syndrome (friction syndrome of iliotibial tract):
    -knee flexion/ extension -> iliotibial tract glides back & forth over lateral epicondyle (femur) = friction = pain & tenderness along lateral side of thigh right above knee
  39. Trendelenburg's sign (waddling gait):
    • -caused by weakness/ paralysis of gluteus medius & minimus muscles, injury to superior gluteal nerve, fracture of femoral neck, and dislocated hip joint (head of femur)
    • -right gluteus medius & minimus muscles paralyzed -> unsupported (left) side of pelvis sags instead of rising as it normally does
  40. Chronic compression of inferior gluteal nerve:
    • -elderly, sedentary people
    • -initial partial paralysis of gluteus maximus muscle diminishes extension at hip (from flexed to standing position)
    • -rising from a chair/ climbing stairs = difficult -> patient sits more = more compression -> further paralysis
    • -atrophy of buttock
  41. Sciatic nerve may be damaged by:
    -posterior dislocation of hip -> foot drop/ intramuscular injection into buttock
  42. Intragluteal injection (why this region, complications):
    • -gluteal muscles (superolateral quadrant of buttock) = large & thick (large area for venous absorption)
    • -improper technique = sciatic nerve injury, hematoma, abscess
  43. Injury to sciatic nerve can occur with:
    • -piriformis syndrome (compression by piriformis muscle)
    • -stab wound (could also involve inferior gluteal & posterior cutaneous nerve of thigh)
    • -wound/ surgery to medial side of buttock may injure branches to hamstrings -> paralysis -> impaired thigh extension & leg flexion
    • -posterior dislocation of hip (clinically seen as foot drop = inability to dorsiflex foot)
  44. Herniated lumbar disc at L3-L4 (nerve root affected, pain area, numbness in, weakness in, atrophy of, reflexes affected):
    • -L4
    • -LBP, hip, posterolateral thigh & anterior leg
    • -anteromedial thigh & knee
    • -quadriceps
    • -quadriceps
    • -knee jerk
  45. Herniated disc at L4-L5 (nerve root affected, pain area, numbness in, weakness in, atrophy of, reflexes affected):
    • -L5
    • -above SI joint, hip, lateral thigh & leg
    • -lateral leg & first 3 toes
    • -dorsiflexion of great toe & foot, difficulty walking on heels & maybe foot drop
    • -minor/ non-specific
    • -posterior tibial reflex
  46. Herniated disc at L5-S1 (nerve root affected, pain area, numbness in, weakness in, atrophy of, reflexes affected):
    • -S1
    • -over SI joint, hip, posterolateral thigh & leg to heel
    • -back of calf, lateral heel, foot and toe
    • -maybe plantar flexion of foot & great toe, difficulty walking on toes
    • -gastrocnemius & soleus
    • -ankle jerk
  47. Femoral neck/ hip fractures:
    • -disrupts blood supply to neck & head of femur b/c retinacular arteries (from medial circumflex femoral artery) torn
    • -proximal fragment of femoral head undergoes aseptic/ avascular necrosis if retinacular artery inadequate
    • -common in 60+ individuals, especially women (femoral necks weak & brittle due to osteoporosis)
  48. Popliteal fossa contents:
    • -sciatic nerve & its divisions (tibial & common peroneal/fibular nerves)
    • -popliteal artery & branches
    • -popliteal vein

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