Case 24- Imaging Flashcards by Jennifer Disley

Overview of femoral nerve function

Compartment- Anterior/extensors of the thigh
Muscles- 3 vasti muscles, rectus femoralis, sartorius
Function- Knee extension (Sartorius- knee flexion)

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When can ultrasound be used in trauma

Ultrasound can be used to identify sites of haemorrhagic, causes of non-haemorrhagic shock and also guide procedures such as vascular access

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Ultrasound principles

The greater the difference in the speed of sound between two adjacent structures, the greater the reflection where they meet

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Ultrasound- colour

White area- highly reflective

Black area- no reflection

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eFAST scan

Extended
Focused
Assessment
Sonography
Trauma

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Types of ligaments in the knee joint

1) Extracapsular ligament

2) Intracapsular ligament

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Extracapsular ligaments of the knee

Tight in knee extension (most stable position of the joint)
Slack in knee flexion
Lateral (fibular) collateral ligament
Arcuate popliteal ligament
Medial (tibial) collateral ligament
Oblique popliteal ligament

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Medial/tibial collateral ligament

At its midpoint, the deep fibers of the TCL are firmly attached to the medial meniscis
Between the medial epicondyle and the Medial condyle and superior part of the medial surface of the tibia

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Lateral/fibular collateral ligament

Between the Lateral epicondyle and the Lateral surface of the fibular head

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Arcuate Popliteal ligament

Arises from the posterior aspect of the fibular head and passes superomedial over the tendon of the popliteus
Strengthens the capsule posterolaterally

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Oblique popliteal ligament

An expansion of the semimembranosus that blends with the capsule reinforcing it posteriorly

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Oblique popliteal ligament

An expansion of the semimembranosus that blends with the capsule reinforcing it posteriorly

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Intracapsular (cruciate) ligament

Medial collateral ligament and capsule
Anterior cruciate ligament
Lateral collateral ligament
Posterior cruciate ligament
Medial collateral ligament and capsule
Both cruciate ligaments lie outside the synovial cavity (but inside the capsule) of the knee joint

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Anterior cruciate ligament (ACL)

Arises from the anterior part of the intercondylar area of the tibia
Passes to the medial side of the lateral femoral condyle
Helps to medially rotate femur to lock the knee into standing

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Posterior cruciate ligament

Arises from the posterior part of the intercondylar area of the tibia
Passes to the lateral side of the medial femoral condyle

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Cruciate ligaments

Tight when the knee is extended and slack when the knee is flexed

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Other structures which form the knee joint

Hyaline cartilage articular surfaces

Menisci: Deep fibrous articular cartilage

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Menisci

Dense fibrous articular cartilage
C-shapes (wedge-shaped in sagittal view)
Vascular at margins
Attached to the tibia by the meniscotibial ligaments
Inside the synovial cavity
Move in flexion, extension and rotation of the knee

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Role of the cruciate ligaments

Anterior cruciate ligament- the anterior cruciate ligament prevents the femur from sliding posteriorly on the tibia and hyperextension of the knee. Limits medial rotation of the femur when the foot is on the ground and the leg is flexed
Posterior cruciate ligament- the posterior cruciate ligament prevents the femur from sliding anteriorly of the tibia, particularly when the knee if flexed

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Injuries to the knee joint

3 C’s- Collaterals, Cruciates and Cartilages
Blow to the lateral side of the knee is a common sports injury, risk of ‘Terrible Triad.’
Tearing the lateral (fibular) collateral ligament is often associated with damage to the common peroneal (fibular) nerve

Knee- Terrible Triad

1) Rupture of medial (tibial) collateral ligament
2) Tearing the medial meniscus
3) Tearing the anterior cruciate ligament

Overview of the Sciatic nerve

Compartment- Posterior/flexor
Muscles- Hamstring (long head of the bicep, semimembranosus, semitendinosus) and short head of the biceps femoris
Function- Knee flexion

Pes anserinosus

The three muscles sartorius, gracilis and semitendinosus have a common insertion the pes anserinus into the superior part of the medial surface of the tibia

Overview of the obturator nerve

Compartment- Medial compartment/ adductors of the hip joint
Muscles- Gracilis
Function- Hip adduction (Gracilis- knee flexion)

Proximal attachments of the Quadricep muscles

Rectus femoris- anterior inferior iliac spine and ilium superior to the acetabulum Vastus lateralis- greater trochanter and the lateral lip of the linea aspera of the femur Vastus medialis- Intertrochanteric line and the medial lip of the linea aspera of the femur Vastus intermedius- anterior and lateral surfaces of the shaft of the femur

Blood supply to the thigh

Femoral artery- anterior compartment | Deep artery of the thigh- posterior compartment

Blood supply to the leg

Posterior compartment- Posterior tibial Lateral compartment- Fibular artery Anterior compartment- Anterior tibial, Dorsalis pedis artery

What nerve supplies the dorsum of the foot except for its medial and lateral borders

Superficial fibular nerve- runs along the lateral portion of their leg

What group of muscles are in the anterior compartment of the thigh

Quadriceps femoris, Iliopsoas, Sartorius

What ligament must the needle pass through when performing a lumbar puncture

Ligamentum flavum

Role of suxamethonium

Its a skeletal muscle relaxant

What muscle contributes to the floor of the femoral triangle

Pectineus

What bone is important in maintaining the stability of the lateral longitudinal arch

Cuboid The Talus forms part of the medial longitudinal arch

What muscle can flex the hip and the knee joint

Sartorius Semitendinosus- hip extension and knee flexion Rectus femoris- hip flexion and knee extension Gracilis- hip adduction and knee flexion Bicep femoris- hip extension and knee flexion

What muscle is capable of dorsiflexion of the foot

Tibialis anterior

What nerve supplies the flexor hallucis longus

Tibial- supplies the posterior aspect of the leg

Nerve supply to the anterior compartment of the thigh

The femoral nerve supplies the muscles of the anterior compartment of the thigh and gives off cutaneous branches namely the anterior femoral and saphenous nerves.

What muscle is a weak flexor of the knee joint

Gracilis

What nerve innervates the majority of muscles in the anterior compartment of the leg

Deep fibular (peroneal)

What region of the vertebral column does the vertebral artery pass through

Cervical

What muscle produces plantarflexion of the ankle joint

Tibialis posterior and the Extensor digitorum longus

What muscle lies medial to the femoral nerve as it passes over the iliac bone

Psoas major

What bone forms the lateral longitudinal arch

Calcaneus- forms both the lateral and medial longitudinal arch

Types of skin graft

Split thickness- only taking the top part of the skin, heals by it’s self doesn’t leave a scar Full thickness- goes through all layers of the skin but creates a wound which needs to be stitched together. Can only use small areas, contracts less so is better cosmetically. Tends to be used on the face and hand

Free flap

Involves micro vascular surgery You take an area of tissue and divide both the arteries and the veins Move it to another area and stitch the blood vessels back together, so you still have an inflow and outflow of blood

When do use a free flap

When you have exposed muscle and bone

Flexor tendons

Flexor digitorum superficialis- PIP | Flexor digitorum profundus- DIP

Classification of nerve injuries

Neurapeaxia- concussion, the nerve stops working for a bit but then goes back to normal Axonotmesis- sheath intact, axons cut Neurotmesis- sheath and axons cut