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Musculoskeletal Block Module > Bones and Joints of the Lower Limb > Flashcards

Bones and Joints of the Lower Limb Flashcards

1
Q

What is the function of the lower limb?

A

Minimizing energy expenditure when standing and walking
Locomotion - walking, running, propulsion
Weight bearing - standing, control advance of the body over the foot

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2
Q

What are the bones of the lower limb (major)?

A 
Pelvic/hip/innominate bone (gluteal)
Femur 
Tibia 
Fibula 
Bones of the foot
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3
Q

What is another name for the pelvic bone?

A

Hip/innominate bone, gluteal

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4
Q

What are the different regions of the pelvic bone called?

A

Ilium, pubis, ischium

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5
Q

Which leg bone is medial?

A

Tibia

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6
Q

Which leg bone is lateral?

A

Fibula

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7
Q

What are the bones of the foot called?

A

Tarsals, metatarsals, phalanges

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8
Q

How many tarsals are there in the foot?

A

7

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9
Q

How many metatarsals are there in the foot?

A

5

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10
Q

How many phalanges are there in the foot?

A

14

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11
Q

What is a sesamoid bone?

A

Bone embedded within a tendon or muscle

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12
Q

What is an example of a sesamoid bone?

A

Knee

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13
Q

What forms the pelvic girdle?

A

Formed by two hip bones and sacrum

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14
Q

What does the pelvic girdle connect?

A

Connects lower limb to vertebral column

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15
Q

What forms the acetabulum?

A

Ischium and pubis

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16
Q

When does the acetabulum complete ossification?

A

20 yrs

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17
Q

What are the types of joints?

A

Fibrous
Cartilaginous
Synovial

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18
Q

What is the most stable joint?

A

Fibrous joints

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19
Q

Describe the movement of a cartilaginous joint.

A

Small movement

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20
Q

Describe the movement of synovial joints and the various classes classified according to shape.

A

Very mobile.

Plane, pivot, hinge, ball and socket, condylar, ellipsoid, saddle

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21
Q

What are the joints of the pelvis?

A

Sacroiliac joint and pubic symphysis

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22
Q

What type/s of joint is the sacroiliac joints?

A

Synovial anteriorly

Fibrous posteriorly

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23
Q

What type of joint is the pubic symphysis?

A

Fibrocartilaginous

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24
Q

What happens to the joints around the pelvis during pregnancy?

A

They soften due to the hormone relaxin.

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25
Q

What are the ligaments of the pelvis?

A

Sacrospinous ligament
Sacrotuberous ligament
Obturator membrane

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26
Q

What are the general features of the hip joint?

A

Ball and socket synovial joint (multiaxial)
Stable: good bony congruence/fit
Wide range of movement - circumduction and rotation

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27
Q

What passes through the obturator canal?

A

Blood vessels

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28
Q

What forms the hip joint?

A

Acetabulum and head of the femur

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29
Q

What are ligaments?

A

Thickenings of various capsules

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30
Q

Where is the pubofemoral ligament located?

A

Pubis to femur

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31
Q

Where is the iliofemoral ligament?

A

Ilium to femur

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32
Q

Where is the ischiofemoral ligament?

A

Ischium to femur

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33
Q

Name three main ligaments of hip/femur

A

Iliofemoral
Ischiofemoral
Pubofemoral

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34
Q

What are the arteries in the hip joint?

A

Obturator artery
Reniarticular artery
Medial circumflex femoral artery
Lateral circumflex femoral artery

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35
Q

What type of hip fractures occur?

A

Trochanteric (pins, plates)

Intracapsular (avascular necrosis)

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36
Q

What are the features of the knee joint?

A

Bicondylar synovial joint (condylar type)
Poor bony fit
Stability depends on ligaments and muscles

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37
Q

What bones make up the knee joint?

A

Femoral condyles

Tibial condyles and patella

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38
Q

What are the menisci and associated functions?

A

Fibrocartilaginous peripheral discs

Improve fit & reduce wear/tear

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39
Q

What are the joint surfaces of the knee joint?

A

Femoral condyles
Tibial condyles
Patella surface
Menisci (medial and lateral meniscus)

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40
Q

What two layers make up the joint capsule of the knee?

A

Synovial layer and fibrous layer

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41
Q

What makes up the synovial layer of the joint capsule of the knee?

A

Bursae

Fat pads

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42
Q

What are bursae?

A

Synovial fluid pockets

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43
Q

What makes up the fibrous layer of the joint capsule of the knee?

A

Ligaments

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44
Q

How does the medial meniscus differ from the lateral meniscus?

A

The medial meniscus is more c-shaped.

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45
Q

What is the name of the inflammation of bursae?

A

Bursitis

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46
Q

What does bursitis consist of?

A

Swelling involving fluid, blood, pus

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47
Q

What causes bursitis?

A

Injury - meniscus, bone, ligaments
Gradual - arthritis
Other - infection, gout, tumors, DVT

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48
Q

Name the different bursae.

A

Suprapatellar bursa
Prepatellar bursa
Infrapatellar bursa (superficial and deep)

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49
Q

What does the stability of the knee rely on?

A

Ligaments, muscles, tendons and menisci

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50
Q

What are the different types of ligaments found in the knee?

A

Intracapsular
Extracapsular
Capsular

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51
Q

What are the intracapsular ligaments?

A

Anterior cruciate ligament (ACL)

Posterior cruciate ligament (PCL)

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52
Q

What is the extracapsular ligament of the knee?

A

Fibular (lateral) collateral ligament (LCL)

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53
Q

What is the capsular ligament of the knee?

A

Medial collateral ligament

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54
Q

What does the medial collateral ligament attach to?

A

Medial meniscus and anterior cruciate

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55
Q

What tendons are found in the knee?

A

Patellar ligament

Popliteus tendon

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56
Q

Where does the ACL run from?

A

Anterior of tibial intercondylar eminence to lateral condyle of femur

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57
Q

Where does the PCL run from?

A

Posterior of the tibial intercondylar eminence to medial condyle of femur

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58
Q

What are valgus forces?

A

Lateral forces

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59
Q

What are varus forces?

A

Medial forces

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60
Q

What does the MCL prevent?

A

Prevents valgus forces/abduction

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61
Q

What does the LCL prevent?

A

Prevents varus forces/adduction

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62
Q

What is the function of the cruciate ligaments?

A

Prevent anterior and posterior displacement of tibia

63
Q

Where is the proximal tibiofibular joint?

A

Outside the knee

64
Q

What type of joint is the tibiofibular joint?

A

Synovial joint

65
Q

What is the tibiofibular joint supported by?

A

LCL

66
Q

Does the fibula have articulation with the femur?

A

No

67
Q

What is the distal end of the fibula?

A

Lateral malleolus

68
Q

Does the fibula have a weight bearing function?

A

No

69
Q

What does the fibular articulate with?

A

Talus and tibia

70
Q

In how many places is the fibula attached to the tibia?

A

3 places - superior and inferior via tibiofibular joints

In middle by interosseous membrane

71
Q

What is the membrane called that connects the tibia and fibula?

A

Interosseous membrane

72
Q

What is the function of the tibia?

A

Transfers weight from knee to ankle

73
Q

What does the tibia articulate with?

A

Talus, femur and fibula

74
Q

What are the main functions of the interosseous membrane?

A

Holds tibia and fibula together
Provides muscle attachments
Provides force transmission
Separates compartments

75
Q

What is the ankle joint called?

A

Talocrural joint

76
Q

What type of joint is the ankle joint?

A

Hinge joint

77
Q

What bones are involved in the talocrural joint?

A

Distal ends of the tibia (medial) & fibula (lateral) with the trochlear surface of talus.

78
Q

What movements occur at the talocrural joint?

A

Dorsiflexion and plantarflexion

79
Q

Where is the capsule of the ankle joint looser and why?

A

Looser anteriorly, can perform more plantarflexion

80
Q

Which movement is the ankle more stable in and why?

A

Dorsiflexion because the trochlear surface is broader anteriorly (better bony congruence)

81
Q

What are the names of the lateral ligaments in the foot?

A

Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament

82
Q

What are the seven tarsal bones?

A

Calcaneus, talus, cuboid, navicular, 3 cuneiforms (medial, intermediate, lateral)

83
Q

How many metatarsals are there?

A

5

84
Q

How many phalanges does the helux have?

A

2

85
Q

What are the different regions of the phalanges called?

A

Distal, middle, proximal

86
Q

Where does eversion and inversion occur?

A

Subtalar joint

87
Q

What are the weight bearing points of the foot?

A

Tuberosity of the calcaneus

Metatarsal heads

88
Q

What are the different arches of the foot?

A

Transverse, medial and lateral longitudinal

89
Q

What is the function of the arches?

A

Act as shock absorbers

90
Q

What maintains the arches of the foot?

A

Maintained by the shape of interlocking bones and ligaments

91
Q

What makes up the pelvic girdle?

A

Hip bones and sacrum

92
Q

Name what the apertures in the interosseous membrane are used for.

A

Aperture for anterior tibial artery/vein

Aperture for branch of fibular artery

93
Q

Name the movements associated with the different surfaces of the hip, knee and ankle.

A

Hip: anterior flexion, posterior extension, lateral abduction, medial adduction
Knee: anterior extension, posterior flexion
Ankle: anterior dorsiflexion, posterior plantarflexion

94
Q

Name the tissue layers of the lower limb.

A 
Skin 
Superficial fascia (hypodermis) 
Deep fascia 
Muscle 
Bone
95
Q

What is the morphology and function of superficial fascia?

A

Innermost layer of skin, mainly made from adipose tissue, contains sensory receptors.
Attaches the dermis to the underlying tissue, shock absorption, nerve and vessel passage.

96
Q

Describe the morphology and function of deep fascia.

A

Encloses muscles of the limbs, trunk , composed of dense CT
Decreases friction, nerve and blood vessel passage, muscle attachment site, aids venous return, forms intramuscular septa

97
Q

Name the different types of fascia found in the lower limb.

A

Fascia lata (thigh), crural fasica (leg), plantar fascia and retinaculum (foot)

98
Q

What is the iliotibial band?

A

A lateral thickening of deep fascia that extends from the iliac crest to the lateral tibial condyle

99
Q

What does the iliotibial band serve as a site of attachment for?

A 
Tensor fascia lata (abductor) 
Gluteus maximus (fibres insert into band and bones)
100
Q

What is iliotibial band friction syndrome?

A

Occurs near the knee, where the band attaches to the knee. Common in cyclists.
An irritation of the tissue due to friction causing knee pain.

101
Q

What is the retinacula?

A

Thickening of the deep fascia that holds all the components coming into the ankle.

102
Q

Where does the retinacula occur?

A

Regions where tendons change direction - binds tendons down to the bone (malleolus) so that they don’t bowstring & can allow tension.
Named according to compartment.

103
Q

What is compartment syndrome?

A

Intracompartmental pressure > venous capillary pressure

104
Q

What causes compartment syndrome? What are the symptoms?

A

Trauma (a fracture), or by overuse (excess long distance exercise)
Pain, pulselessness, paraesthesia, pallor (pale skin), paralysis

105
Q

What is the lower limb nerve supply and what are its levels?

A

Lumbosacral plexus (L1-S4)

106
Q

Name the three main nerves supplying the lower limb.

A

Sciatic/Posterior (tibial and common fibular, pass into leg)
Femoral (anterior)
Obturator (medial)

107
Q

Which nerve supplies the anterior, medial and posterior thigh?

A

Anterior thigh - femoral nerve
Medial thigh - obturator nerve
Posterior thigh - tibial nerve (with one exception)

108
Q

Which nerve supplies the anterior, posterior and lateral leg?

A

Anterior: deep fibular (peroneal) nerve
Posterior: tibial nerve
Lateral: superficial fibular (peroneal) nerve

109
Q

What is cutaneous innervation?

A

Peripheral nerves which have branches that supply the skin (cutaneous)

110
Q

When does the external iliac become the femoral artery?

A

As it passes under the inguinal ligament

111
Q

What is the blood supply of the muscles of the thigh?

A

Deep femoral artery and vein

112
Q

What does the femoral artery change to when it passes through the adductor hiatus/adductor magnus?

A

Popliteal artery (branches to the knee joint)

113
Q

What supplies the knee joint?

A

Popliteal artery

114
Q

What branches does the popliteal split into?

A

Anterior and posterior tibial arteries

115
Q

What artery supplies the anterior leg?

A

Anterior tibial

116
Q

What artery supplies the posterior leg?

A

Posterior tibial

117
Q

What artery supplies the lateral compartment of the leg?

A

Fibular (a branch of the posterior tibial)

118
Q

What artery/ies supply the foot?

A

Anterior tibial artery passes into the foot and is then the dorsalis pedis

119
Q

Describe the movements/divisions of the posterior tibial artery as it nears the foot.

A

PTA runs behind the ankle joint, through the tarsal tunnel and splits into medial and lateral plantar arteries.

120
Q

What arteries supply the plantar foot?

A

Supplied by the plantar arch, medial plantar artery and lateral plantar artery

121
Q

What does the great saphenous vein drain into?

A

Femoral vein

122
Q

What does the small saphenous vein drain into?

A

Popliteal vein

123
Q

What causes varicose veins?

A

Failure of the valves, causing a pooling of blood

124
Q

What veins do varicose veins usually occur in? And what conditions cause this?

A 
Saphenous veins (superficial)
Obesity, pregnancy, menopause and aging
125
Q

NB: for coronary artery bypass grafts where arterial grafts are not available, they use the great saphenous vein from the leg to bypass the heart blockage

A

XXX

126
Q

Which rami form plexuses that innervate the limbs?

A

Ventral rami (except thoracic)

127
Q

Describe the movement of spinal nerves.

A

Spinal nerves exit through the intervertebral foramina and divide into dorsal and ventral rami.

128
Q

Describe the lumbosacral plexus.

A

Ventral rami L1-S4 innervates the lower limb

129
Q

What is the lumbosacral plexus formed of?

A 
Lumbar plexus (L1-L4) 
Lumbosacral trunk (part of L4 and L5 nerve roots) 
Sacral plexus (L4-S4)
130
Q

Where does the lumbosacral plexus lie?

A

Within the body of the psoas major

131
Q

What peripheral nerves arise from the lumbar plexus (L1-L4)?

A

Femoral (anterior)

Obturator (medial)

132
Q

What are the peripheral nerves of the sacral plexus (L4-S4)?

A

Sciatic (posterior), tibial and common fibular

133
Q

What levels does the superior gluteal nerve come from?

A

L4, L5, S1

134
Q

Where does the superior gluteal nerve travel?

A

Exits pelvis through greater sciatic foramen, superior to the piriformis

135
Q

What muscles does the superior gluteal nerve innervate?

A

Gluteus medius, gluteus minimus and tensor fascia lata

136
Q

What is the Trendelenburg gait due to?

A

Damage to the superior gluteal nerve
Due to weakening of the abductors. Unable to maintain pelvis level during single leg stance.
Compensation occurs through lateral trunk flexion.

137
Q

What levels does the inferior gluteal nerve come from?

A

L5, S1, S2

138
Q

Where does the inferior gluteal nerve exit?

A

Exits through the greater sciatic foramen, inferior to the piriformis.

139
Q

What muscle does the inferior gluteal nerve supply?

A

Gluteus maximus

140
Q

What levels does the femoral nerve come from?

A

L2-L4

141
Q

Describe the movement of the femoral nerve.

A

Descends within psoas major, posterior to the inguinal ligament.
Passes through the femoral triangle.
Courses through the anterior thigh.

142
Q

What muscles does the femoral nerve supply?

A

Psoas major, iliacus, pectineus, muscles of anterior thigh compartment

143
Q

What does the obturator nerve supply?

A

Obturator externus (external rotator muscle of the hip), medial compartment of thigh

144
Q

Where does the obturator nerve travel?

A

In the psoas major, out through the obturator canal (hole in obturator membrane) and into medial compartment of the thigh

145
Q

Which division of the sacral plexus is the tibial and common fibular nerve each part of?

A

Tibial - anterior division

Common fibular - posterior division

146
Q

What levels does the sciatic nerve arise from?

A

L4-S3

147
Q

What divisions does the sciatic nerve give arise to?

A

Tibial nerve - lateral/medial plantar nerves

Common fibular nerve - deep/superficial fibular nerves

148
Q

What does the tibial nerve supply?

A

All of the posterior compartment of the thigh except for the short head of the biceps femoris (part of the hamstrings)

149
Q

What supplies the short head of the biceps femoris?

A

Common fibular nerve

150
Q

Where does the tibial nerve run?

A

Passes through the popliteal fossa, between the superficial and deep calf muscles.
Carries on and passes through the tarsal tunnel and into the foot where it splits into medial/lateral plantar nerves.

151
Q

What muscles does the tibial nerve supply?

A

Posterior thigh muscles (except for short head of the biceps femoris)
Posterior superficial leg (gastrocnemius, soleus, plantaris)
Posterior deep leg (tibialis posterior, FDL, FHL)
Muscles of the foot (plantar nerves)

152
Q

What does the common fibular nerve innervate?

A

Short head of biceps femoris

153
Q

What does the superficial fibular nerve supply?

A

Fibular longus and fibular brevis

154
Q

What does the deep fibular nerve supply?

A

Tibialis anterior, EDL, EHL, peroneus tertius

Musculoskeletal Block Module (10 decks)

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