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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
What is the main action of gluteus medius and gluteus minimus at the hip joint of a weight-bearing (fixed) lower limb?
pull centre of gravity over weight-bearing limb by pulling pelvis (and therefore trunk) over stance leg
26
Damage to which nerve will cause loss of function to gluteus medius and gluteus minimus?
superior gluteal nerve
27
What procedure can affect the superior gluteal nerve?
intramuscular injections
28
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?
fall to right side | nothing pulling centre of gravity over stance leg
29
What 3 gaits may a patient adopt to compensate for gluteus minimus and gluteus medius weakness? (trendelenburg gait presentations)
waddling gait stepping gait swing gait
30
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?
ask patient to flex knee fascia around space should relax popliteal artery can be palpated
31
How can you confirm that a popliteal pulse is present (other than palpation)?
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
What does simmonds-thompson test test for and how does it indicate this?
achilles tendon rupture | squeezing muscles causes them to contract which should result in plantar flexion of ankle joint
33
Why is achilles tendon rupture treatment to put them in a heeled boot?
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
Why is the arterial supply to head of femur initially from the obturator artery instead of the retinacular vessels?
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
Why do the retinacular vessels need to take over supplying the head of femur?
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
Compare depth of socket of hip and shoulder
``` hip = deep, made deeper by labrum of acetabulum shoulder = shallow depression (smaller + less rounded) ```
37
Compare relative size of head to socket of hip + shoulder
``` hip = very similar, head fits snugly in socket shoulder = big head, small socket ```
38
Compare capsule of hip + shoulder
``` hip = tight shoulder = loose ```
39
Compare extra-capsular ligaments of hip + shoulder
``` hip = strong + tightly wound (pubofemoral, iliofemoral + ischiofemoral) + surround joint shoulder = loose + weak (glenohumeral), deficient inferiorly ```
40
Compare mobility/stability of hip + shoulder
``` hip = highly congruent = very stable shoulder = less congruent = less stable but more mobile ```
41
How can the mechanism of ligament spiralling during hip extension be useful when standing?
when standing, leaning back slightly will allow the ligaments to tighten means weight of body can be supported without using much muscular energy
42
What is the risk in pinning a neck of femur fracture instead of replacing the head?
fracture could have broken the retinacular arteries, reducing blood supply to femoral head lack of blood supply could cause avascular necrosis
43
When would a dynamic hip screw be used?
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
What knee injury would occur if a patient is thrown forward while leg remained static (eg. skiing accident)?
posterior cruciate ligament damage | leg static, body thrown forward = anterior displacement of femur in relation to tibia
45
How can haemarthrosis occur in the knee?
popliteal artery pulled + damaged
46
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?
oblique angle of femur means quadriceps pull patella superiorly but also slightly laterally
47
What occurs to femur when you fully extend it?
at full extension, femur rotates medially, 'locking' knee in extended position
48
What is the usual function of the collateral ligaments?
prevent abduction + adduction of knee joint
49
What action could damage the medial collateral ligament?
impact to lateral side
50
What are 3 functions of the menisci?
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
Why is the medial meniscus more likely to be damaged than the lateral?
medial is attached to medial collateral ligament and tethered to tibial plateau by ligaments lateral meniscus = free-moving
52
What is the normal function of the anterior cruciate ligament (ACL)?
prevent femur from slipping posterior on tibia
53
What is the normal function of the posterior cruciate ligament (PCL)?
prevent femur from slipping anterior on tibia
54
What clinical test tests the patency of the ACL?
anterior drawer test
55
What is the general structure and function of a bursa?
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
When does a bursa become fluid-filled?
when inflamed | excess fluid produced to try and reduce friction between 2 membrane layers
57
Why is the foot more likely to invert and damage the lateral ligaments than evert and damage the medial ligaments?
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
If an ankle twists in eversion, which ligaments and joints would likely be affected?
``` medial collateral (deltoid) ligament talocrural joints ```
59
How are the arches of the foot formed?
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
The arrangement of the arches of the foot provide 3 points where weight is loaded onto the foot. Why is this advantageous?
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
What can a medial longitudinal arch deficiency cause in the longer term?
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
Anterior compartment of the lower limb contents (nerve, muscles, blood supply)
nerve = deep peroneal nerve muscles = tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius blood supply = anterior tibial artery
63
Lateral compartment of the lower limb contents (muscles, nerve)
``` muscles = peroneus longus, peroneus brevis nerve = superficial peroneal nerve ```
64
Superficial posterior compartment of the lower limb contents (nerve, muscles)
``` muscles = gastrocnemius, plantaris, soleus nerve = sural nerve ```
65
Deep posterior compartment of the lower limb contents (nerve, muscles, blood supply)
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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