*Surface Anatomy Below the Knee

palpating the 1st MPJ- pain or deformity suggests...?
palpating the 1st MPJ- pain or deformity suggests…?
hallux valgus or hallux rigidus

palpating tarsometatarsal (Lisfranc) joint - tenderness suggests..?
palpating tarsometatarsal (Lisfranc) joint – tenderness suggests..?
acute sprain or dislocation

when palpating syndesmosis of the ankle leads to tenderness, what does this suggest?
when palpating syndesmosis of the ankle leads to tenderness, what does this suggest?
a high ankle sprain

ecchymosis/ swelling at medial malleolus suggest...
ecchymosis/ swelling at medial malleolus suggest…
fracture or sprain

T/F: deltoid ligaments are rarely injured in ankle sprains/fractures
T/F: deltoid ligaments are rarely injured in ankle sprains/fractures
False- they’re commonly involved

tibialis posterior tendon- tenderness on palpation suggests..
tibialis posterior tendon- tenderness on palpation suggests..
posterior tibial tendinitis or rupture (causing flat feet)

ecchymosis/swelling at lateral malleolus suggests?
fracture

tenderness of lateral ankle ligaments on palpation suggests
tenderness of lateral ankle ligaments on palpation suggests
lateral ankle sprain

tenderness of base of 5th met on palpation suggests
tenderness of base of 5th met on palpation suggests
– fracture (including stress fracture)
– peroneus brevis overuse

achilles tendon – tendon defect suggests
achilles tendon tear; nodule or tenderness suggests degeneration

pain on palpation to calcaneus with tenderness suggests
plantar fasciitis or stress fracture

pain on palpation to sesamoids with tenderness suggests
pain on palpation to sesamoids with tenderness suggests
sesamoiditis or sesamoid fx

which cuneiform is the easiest to palpate?
medial cuneiform

weakness of loss of popliteal pulse is usually indicative of
femoral artery obstruction

T/F: you should invert patient’s foot to relax flexor retinaculum when taking posterior tibial pulse
True

T/F: both right and left posterior tibial pulses can be examined at the same time
true

T/F: posterior tibial pulse is always found in young patients
false- can be absent in young patients

if posterior tibial pulse is absent in patients over 60 years this is indicative of
arterial occlusion

should you slightly dorsiflex or plantar flex patient’s foot when looking for dorsalis pedis pulse?
dorsiflex

where to put fingers when looking for dorsalis pedis pulse
where to put fingers when looking for dorsalis pedis pulse
place fingertips along a line from the inferior extensor retinaculum, just lateral to EHLT

T/F: both left and right dorsalis pedis pulses can be taken at the same time?
true

how come some adults don’t have a palpable dorsalis pedis pulse?
they could have a larger perforating fibular artery which has compensated for this

5 P signs of arterial occlusion
Pain
Palor
Paresthesia
Paralysis
pulselessness

what motor test can you do to check L4 spinal nerve?
what motor test can you do to check L4 spinal nerve?
See if tibialis anterior is working properly:
– ask seated patient to flex toes in order to eliminate other ankle dorsiflexors
– apply resistance as patient dorsiflexes ankle
– weakness indicates possible L4 nerve compression
– absence of function may indicate injury to deep fibular or common fibular nerve

what reflex can you check to see if patients L4 spinal nerve is working properly?
Patellar tendon reflex (L2-L4):
– with patient’s legs hanging freely, tap the tendon proximal to the tibial tuberosity
– this sensory info is conveyed to motor cells
– in turn, motor cells instruct the same muscle to contract to restore balance

normal grade of reflex?
2+

somewhat diminished reflex grade?
1+

no reflex response- grade?

brisker than average reflex response- grade?
3+

very brisk, hyperactive reflex response- grade?
4+

hyperactive reflexes may indicate disease such as…
hyperthyroidism

absence of reflexes may be caused by…
damage to the muscle, peripheral nerve, nerve roots, or spinal cord at that level

to test the L5 spinal nerve, what motor test can be done?
to test the L5 spinal nerve, what motor test can be done?
extensor hallucis longus

which reflex can be done to test L5 spinal nerve?
none

what specific nerves supply the L5 dermatome?
– lateral sural cutaneous
– sural
– superficial fibular & its terminal branches
– medial terminal branch of deep fibular
– terminal branches of the medial and lateral plantar nerve

to test S1 spinal nerve, which motor test can be done?
to test S1 spinal nerve, which motor test can be done?
peroneus longus and brevis to evert the foot

which reflex can be performed to test S1 dermatome?
calcaneal tendon reflex (S1,S2):
– pt sits with legs hanging freely
– examiner taps calcaneal tendon proximal to the calcaneus

what nerves supply the S1 dermatome?
– sural nerve and it’s branches
– tibial nerve & its branches

the plantar reflex tests spinal nerves (L4-S2)
the plantar reflex tests spinal nerves (L4-S2)
– trace tool across bottom of foot: normal response toes plantar flex
– babinski response: MPJ 1 dorsiflex & toes fanning

dorsiflexion uses which spinal nerves?
dorsiflexion uses which spinal nerves?
L4/L5

plantar flexion uses which spinal nerves?
plantar flexion uses which spinal nerves?
S1 & S2

inversion uses which spinal nerves?
inversion uses which spinal nerves?
L4/L5

eversion uses which spinal nerves?
eversion uses which spinal nerves?
L5/S1

which spinal nerve mainly innervates medial thigh muscles and quadriceps femoris?
L3 (hip adduction & knee extension)

which spinal nerve mainly innervates tibialis anterior (ankle dorsiflexion)?
L4

which spinal nerve mainly innervates extensor hallucis longus?
L5

which spinal nerve mainly innervates triceps surae, posterior thigh (hamstrings), and gluteus maximus?
S1 (ankle plantar flexion, hip extension & knee flexion, power hip extension & lateral rotation)

which spinal nerve mainly innervates some of triceps surae and the foot intrinsics
S2

Where is the adductor tubercle of the femur located, and what attaches there? -Located just superior to the medial epicondyle -Tendons of the adductor magnus attach to it What bone articulates with the prominent surfaces on the anterior parts of …

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