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Year 1 > Anatomy clinical scenarios (lower limb) > Flashcards

Anatomy clinical scenarios (lower limb) Flashcards

1
Q

What causes the patella to be pulled laterally and therefore not track normally?

A

line of femur slightly oblique coming medially compared to line of pull of quadriceps muscles
resolution of forces = lateral pull

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2
Q

What 2 factors help to ensure normal tracking of the patella?

A

raised lateral femoral condyle

vastus medialis produced medial pull to correct overall pull of quadriceps muscles

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3
Q

What anatomical feature cause women to be more prone to anterior knee pain than men?

A

line of angle of femur more oblique due to wider female pelvis

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4
Q

Borders of the femoral triangle

A 
medially = adductor longus
laterally = sartorius
superiorly = inguinal ligament
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5
Q

What is in the femoral triangle?

A

femoral vein
femoral artery
femoral nerve

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6
Q

What reflex is associated with the femoral nerve?

A

knee jerk

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7
Q

What group of muscles does the femoral nerve supply?

A

quadriceps

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8
Q

Which group of muscles does the obturator nerve supply?

A

adductor muscles

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9
Q

Which muscle (near the adductors) does the obturator nerve not supply?

A

obturator internus

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10
Q

What is the function of the extensor retinaculum?

A

hold long tendons of anterior leg muscles against underlying bones as they cross the ankle joint

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11
Q

How does the extensor retinaculum improve efficiency of the muscles?

A

without retinaculum, tendons could lift from bones resulting in bowstringing
helps to redirect direction the muscles pull in, maximising efficiency

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12
Q

How many compartments are there in the leg?

A

lower leg = 4

anterior, lateral, deep posterior, superficial posterior

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13
Q

What is the function of fascia?

A

surrounds tissues + provides shape for muscles, tendons + joints
reduced friction between structures

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14
Q

What is compartment syndrome?

A

bleeding/swelling within an enclosed bundle of muscles (muscle compartment)
increased pressure in muscle compartment

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15
Q

What occurs if emergency surgery is not performed in compartment syndrome to open the fascia?

A

muscle necrosis

cells lose blood supply (avascular necrosis)

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16
Q

Why are pulses still palpable (sometimes) in compartment syndrome?

A

pressure increase sufficient to obstruct capillaries, but blood can still pass through arteries

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17
Q

Which muscle is responsible for ankle extension (dorsiflexion)?

A

anterior compartment

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18
Q

Which nerve supplies the lower leg anterior compartment?

A

fibular nerve (deep peroneal)

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19
Q

Why is it harder to flex hip with knee straight as opposed to knee bent?

A

hamstrings limit hip flexion (needs to be slack in muscle around back of hip joint )
when knee extended, hamstrings are pulled tight behind the knee joint
reduces slack in muscle and limits range of hip flexion movement

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20
Q

When is gluteus maximus used in walking?

A

when hip flexed, helps to return it to anatomical position

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21
Q

If a patient has weakness affecting gluteus maximus, which activities will this be noticeable in?

A

any action that requires extension of a flexed hip

rising from seated position, stairs

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22
Q

What function does gluteus maximus have at the knee via the iliotibial tract?

A

some fibres attach to iliotibial tract (ITT), pulling it tight
ITT passes along lateral aspect of knee joint
ITT pulled tight = lateral support to knee

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23
Q

What 2 actions do gluteus medius and gluteus minimus produce at the hip joint?

A

hip abduction

medial rotation

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24
Q

What is the main action of gluteus medius and gluteus minimus at the hip joint of a non-weight-bearing (free) lower limb?

A

abduction of lower limb

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25
Q

What is the main action of gluteus medius and gluteus minimus at the hip joint of a weight-bearing (fixed) lower limb?

A

pull centre of gravity over weight-bearing limb by pulling pelvis (and therefore trunk) over stance leg

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26
Q

Damage to which nerve will cause loss of function to gluteus medius and gluteus minimus?

A

superior gluteal nerve

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27
Q

What procedure can affect the superior gluteal nerve?

A

intramuscular injections

28
Q

If the superior gluteal nerve is damaged on the left side, the patient will lose function to gluteus medius and minimus on their left. What will happen when a patient tries to bear weight on their left lower limb?

A

fall to right side

nothing pulling centre of gravity over stance leg

29
Q

What 3 gaits may a patient adopt to compensate for gluteus minimus and gluteus medius weakness? (trendelenburg gait presentations)

A

waddling gait
stepping gait
swing gait

30
Q

The thick fascia at the posterior aspect of the knee can make it difficult to access the popliteal pulse. How can you get around this issue?

A

ask patient to flex knee
fascia around space should relax
popliteal artery can be palpated

31
Q

How can you confirm that a popliteal pulse is present (other than palpation)?

A

popliteal artery terminates by dividing into anterior + posterior tibial arteries
strong pulses in both arteries = assume popliteal artery has good pulse (dorsalis pedis + anterior tibial)

32
Q

What does simmonds-thompson test test for and how does it indicate this?

A

achilles tendon rupture

squeezing muscles causes them to contract which should result in plantar flexion of ankle joint

33
Q

Why is achilles tendon rupture treatment to put them in a heeled boot?

A

prevents use of soleus and gastrocnemius
ankle fixed in plantar flexion
affected muscles placed in position of non-function
avoids stretching muscle, allowing rupture to heal

34
Q

Why is the arterial supply to head of femur initially from the obturator artery instead of the retinacular vessels?

A

there is a growth plate just below the femoral head
blood vessels can’t cross a growth plate
retinacular vessels supply head of femur once growth plates fused

35
Q

Why do the retinacular vessels need to take over supplying the head of femur?

A

once the growth plate fuses, the retinacular vessels are able to travel up the neck and supply the femoral head
this is vital as eventually the obturator artery becomes worn down and no longer supplies blood to the head

36
Q

Compare depth of socket of hip and shoulder

A 
hip = deep, made deeper by labrum of acetabulum
shoulder = shallow depression (smaller + less rounded)
37
Q

Compare relative size of head to socket of hip + shoulder

A 
hip = very similar, head fits snugly in socket
shoulder = big head, small socket
38
Q

Compare capsule of hip + shoulder

A 
hip = tight
shoulder = loose
39
Q

Compare extra-capsular ligaments of hip + shoulder

A 
hip = strong + tightly wound (pubofemoral, iliofemoral + ischiofemoral) + surround joint 
shoulder = loose + weak (glenohumeral), deficient inferiorly
40
Q

Compare mobility/stability of hip + shoulder

A 
hip = highly congruent = very stable
shoulder = less congruent = less stable but more mobile
41
Q

How can the mechanism of ligament spiralling during hip extension be useful when standing?

A

when standing, leaning back slightly will allow the ligaments to tighten
means weight of body can be supported without using much muscular energy

42
Q

What is the risk in pinning a neck of femur fracture instead of replacing the head?

A

fracture could have broken the retinacular arteries, reducing blood supply to femoral head
lack of blood supply could cause avascular necrosis

43
Q

When would a dynamic hip screw be used?

A

inter-trochanteric fractures
blood supply not affected
screwed into femoral head but can slide in bone
allows femoral head to move/fracture to compress

44
Q

What knee injury would occur if a patient is thrown forward while leg remained static (eg. skiing accident)?

A

posterior cruciate ligament damage

leg static, body thrown forward = anterior displacement of femur in relation to tibia

45
Q

How can haemarthrosis occur in the knee?

A

popliteal artery pulled + damaged

46
Q

The lateral femoral condyle projects further anteriorly than the medial condyle, resisting lateral movement + facilitating normal tracking of the patella. What causes the patella to be pulled laterally?

A

oblique angle of femur means quadriceps pull patella superiorly but also slightly laterally

47
Q

What occurs to femur when you fully extend it?

A

at full extension, femur rotates medially, ‘locking’ knee in extended position

48
Q

What is the usual function of the collateral ligaments?

A

prevent abduction + adduction of knee joint

49
Q

What action could damage the medial collateral ligament?

A

impact to lateral side

50
Q

What are 3 functions of the menisci?

A

increased surface area of contact between femoral condyles and tibial plateau
cushioning effect when weight loaded on joint
spread synovial fluid over articular surfaces

51
Q

Why is the medial meniscus more likely to be damaged than the lateral?

A

medial is attached to medial collateral ligament and tethered to tibial plateau by ligaments
lateral meniscus = free-moving

52
Q

What is the normal function of the anterior cruciate ligament (ACL)?

A

prevent femur from slipping posterior on tibia

53
Q

What is the normal function of the posterior cruciate ligament (PCL)?

A

prevent femur from slipping anterior on tibia

54
Q

What clinical test tests the patency of the ACL?

A

anterior drawer test

55
Q

What is the general structure and function of a bursa?

A

2 serous (fluid-filled) membranes
small amount of synovial fluid between them
can be found between 2 structures moving past each other (eg skin + patella)
reduce friction during movement

56
Q

When does a bursa become fluid-filled?

A

when inflamed

excess fluid produced to try and reduce friction between 2 membrane layers

57
Q

Why is the foot more likely to invert and damage the lateral ligaments than evert and damage the medial ligaments?

A

the malleoli that form the joint are different shapes
lateral malleolus extends further distally
this reduces the range of movement in eversion relative to inversion
medial collateral ligaments also stronger and limit eversion

58
Q

If an ankle twists in eversion, which ligaments and joints would likely be affected?

A 
medial collateral (deltoid) ligament
talocrural joints
59
Q

How are the arches of the foot formed?

A

by shape + arrangement of tarsal + metatarsal bones
medial longitudinal = between talus, calcaneus, navicular, cuneiforms + metatarsals 1-3 (highest of longitudinal arches)
lateral longitudinal = calcaneus, cuboid, metatarsals 4-5
transverse = cuboid + cuneiforms, metatarsal bases

60
Q

The arrangement of the arches of the foot provide 3 points where weight is loaded onto the foot. Why is this advantageous?

A

as weight is loaded onto the foot, the 3 points move apart, allowing the foot to act as a spring to improve walking and running, reducing wear and tear, acting as a shock absorber

61
Q

What can a medial longitudinal arch deficiency cause in the longer term?

A

knee, hip + back pain
medial longitudinal arch is most effective
deficiency causes more wear + tear on bones and will alter dynamics of entire lower limb due to forefoot pronating on hindfoot when weight-bearing

62
Q

Anterior compartment of the lower limb contents (nerve, muscles, blood supply)

A

nerve = deep peroneal nerve
muscles = tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius
blood supply = anterior tibial artery

63
Q

Lateral compartment of the lower limb contents (muscles, nerve)

A 
muscles = peroneus longus, peroneus brevis
nerve = superficial peroneal nerve
64
Q

Superficial posterior compartment of the lower limb contents (nerve, muscles)

A 
muscles = gastrocnemius, plantaris, soleus
nerve = sural nerve
65
Q

Deep posterior compartment of the lower limb contents (nerve, muscles, blood supply)

A

muscles = tibialis posterior, flexor hallucis longus, flexor digitorum longus, popliteus
nerve = tibial nerve
blood supply = posterior tibial artery

Year 1 (41 decks)

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