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Hip pointer:
Bruised iliac crest (particularly near origin of sartorius muscle to ASIS/ attachment of rectus femoris to AIIS; common in athletes
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Avulsion fracture:
Origin of hamstrings avulsed from ischial tuberosity; common in children
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Inflamed ischial bursa:
Caused by repetitive movement where ischial tuberosity isn't covered by gluteus maximus muscle (such as in bicycle riding)
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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)
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Position of LL post femoral neck fracture and muscles that act on distal fragment:
- -LL shortened & laterally rotated
- -quadriceps femoris, adductor & hamstring muscles
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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
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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
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Supracondylar fracture of femur (may damage which structure):
- -gastrocnemius muscle can rotate distal fragment posteriorly
- -popliteal artery
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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)
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Venous drainage of LL:
-superficial & deep veins (both = valves, but more in deep) -> connected by perforating veins
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Great saphenous vein accompanies which nerve and empties into which vein:
- -saphenous nerve
- -femoral vein
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Small saphenous vein accompanies which nerve and empties into which vein:
- -sural nerve
- -popliteal vein (in popliteal fossa)
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Deep veins accompany deep arteries as (and action):
- -venae comitantes
- -compressed by contraction of surrounding muscles -> push blood toward heart
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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
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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)
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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
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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
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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)
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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)
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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)
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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)
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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
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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
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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
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Profunda femoris path:
- -main artery of posterior thigh & largest branch of femoral artery
- -comes from lateral aspect of femoral artery in femoral triangle
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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
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Cannulation of femoral vein:
- -located just medial to femoral arterial pulse
- -IVC/ RA/ RV can be reached w/ fluoroscopy
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Obturator artery:
- -branch of internal iliac artery
- -enters medial thigh through obturator canal
- -anterior & posterior branches
- -supplies adductor compartment of thigh
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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
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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)
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Pulmonary embolism (DVT):
- -IVC -> RA -> RV -> PT -> branch of pulmonary artery blocked -> death of lung tissue
- -big thrombus = PT/ PA blocked = maybe instant death
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Paradoxical Embolism (DVT):
-embolus in IVC -> RA -> presence of patent formen ovale -> LA -> LV -> aorta -> carotids -> cerebral arteries -> stroke/ paralysis
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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)
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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
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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
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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
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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)
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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
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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
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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
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Sciatic nerve may be damaged by:
-posterior dislocation of hip -> foot drop/ intramuscular injection into buttock
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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
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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)
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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
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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
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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
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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)
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Popliteal fossa contents:
- -sciatic nerve & its divisions (tibial & common peroneal/fibular nerves)
- -popliteal artery & branches
- -popliteal vein
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