Case 1 - lower limb (knee) Flashcards
List the cartilages of the knee joint and their function
Articular cartilage
Medial meniscus
Lateral meniscus
- the menisci act as shock absorbers and deepen the articular surface of tibia thus increasing stability
- made up of fibrocartilage and attach onto the inter condylar area of tibia
What type of joint is the knee joint, name the 3 articulations.
- synovial hinge
- articulations
1) femoropatellar a between patella and femur
2) femorotibial - between lateral condyles of tibia and femur
3) femorotibial - between medial condyles of tibia and femur
Name the bursae and state their clinical relevance
You have supra patella, prepatellar and semi membranous bursae as well as others.
Bursae are lined with synovium which contains synovial fluid.
With increased irritation more fluid accumulates leading to significant swelling. This getting bursitis.
(Prepatellar “ housemaid’ knee “ or supra patellar)
List the ligaments of the knee
Extracapsular ligaments
- Patellar ligament
- fibular collateral ligament
- tibial collateral ligament
Intra capsular ligament
- anterior cruciate ligament (attached to anterior inter condylar region)
- posterior cruciate ligament (attached to posterior inter condylar region)
Explain how bone healing occurs
1- Inflammation - soon after fracture occurs large amounts of bleeding occurs, causing swelling and bruising known as “haematoma”
Macrophages and leukocytes move in and scavenge debris.. They begin to produce pro-inflammatory debris which initiates healing
2- Soft callus -
inflammation triggers cell division and growth of new blood vessels.
Collagen is secreted by chondrocytes, which creates fibrocartilage forming soft callus
3- hard callus - endochondral ossification, woven bone replaces soft callus with hard callus around broken bone fragments
4- remodelling - strong and highly organised cortical bone replaces weaker disorganised woven bone.
** bone is the only tissue to heal without a scar - as continually remodelled
What are the common injuries for each of these structures? Does tissue regeneration restore mechanical properties, how long is the healing time?
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What factors affects the healing process?
Age - children healing better than adults
Nutrition
Systemic diseases
Hormones - in menopausal women, lack of oestrogen affects osteoporosis healing
Degree of trauma
Infection
Name the borders and contents of the femoral triangle. Femoral hernias can occur from the abdomens to the femoral canal, why is this more common in women?
Borders:
Lateral- sartorius
Superior - Inguinal ligament
Medial- adductor longus
Contents
Lateral to medial ; (NAVY) femoral nerve, artery, vein
Femoral hernia
Abdominal contents up to femoral canal where lymphatic system usually are
More likely in women as their pelvis is wider
List the main features of the tibia, femur and fibular
See page 303, Mcminn’s atlas of anatomy
Name the veins of the lower limb. You have deep veins and superficial.
Add picture
Name the arteries of the lower limb
Add picture
Tendons.
What is their function?
what are the two different types?
list some features.
- Flexor tendons: round or oval allow gliding
- Extensor tendons: flat, allow rolling across convex surface
Functions;
1) increased efficiency of movement - keeps muscle belly away from site of action
2) Tendon elasticity allow them to act as springs, this prevents muscle fatigue
3) reinforces and replaces capsules e.g. At glenohumeral joint
4) passes through small spaces
Features;
- Made up of DENSE FIBROUS REGULAR CONNECTIVE TISSUE
- Type 1 collagen
- Visco-elastic slower stretch means more stretch
- Dynamic structure - more extra cellular matrix is produce in response to increased mechanical loading
Ligaments.
What is their function?
Also list some features.
Function;
Stabilise joint and guide movement
Hold tendons in place
Proprioception (mechanoreceptors found at knee, shoulder, ankle joints)
Features;
- Made up of DENSE FIBROUS REGULAR CONNECTIVE TISSUE
- Type 1 collagen
- Visco-elastic slower stretch means more stretch
- Dynamic structure - more extra cellular matrix is produce in response to increased mechanical loading
What one of these causes tendons to be more prone to pathology?
A - Age (more prone when younger)
B - Gender
C - Age (more prone when older)
D - Ethnicity
C - Age (more prone when older)
With age, less force is required to elongate tendon making it weaker.
A 67 year old lady has come into clinic suspecting there is something wrong with extending and flexing her legs, although not feeling any pain. The doctor does a test which proves that she has a ruptured Achilles’ tendon. What did the doctor do and what sign did the patient show?
A - negative Barbinski B - positive Smith test C- negative Thompson test D - positive Thompson test E - Thompson test
D - positive Thompson test
Doctor squeezed the calf muscles (gastrocnemius, soleus), and the Achilles’ tendon should plantar flex the foot. If there is no movement of the ankle, then this shows the tendon is ruptured = Positive Thompson test
Name the three specialised regions related to tendons and ligaments
- Myotendinous region
- Enthesis
- Wrap- around regions
Remember WEM!
What is Myotendinous junction?
Location?
Features?
- located at muscle- tendon interfaces
- important for transmitting muscle contractions to the tendon
** you can get muscle tears at this MT junction
What is an Enthesis?
Location?
Sites of insertion of tendons or ligaments onto bone
