Clinical Anatomy

Question 1

What are the coverings of femoral hernia? Content of a hernia? Course of Femoral hernia?

Answer 1

A femoral hernia consists of a neck and a sac. The coverings of the sac are: (from outside inwards)

1. Skin
2. Superficial fascia
3. Cri reform fascia
4. Ant. Wall of femoral sheath
5. Femoral septum
6. Peritoneum of hernial sac

Content: usually a loop of intestine

Course:

1) Downwards through the femoral canal
2) Forwards through saphenous opening
3) Upwards towards the Inguinal ligament.

Question 2

Why is femoral hernia more common in women?

Answer 2

1) Wider pelvis in women
2) Narrower diameter of femoral vessels
— thus the femoral ring is wider, and herniation can occur more easily.

Question 3

Where is the Posterior Tibial Pulse felt?

Answer 3

2cm below and behind the medial malleolus.

Question 4

Name a tendon from the lower limb which is used for tendon transplantation?

Answer 4

Plantaris tendon.

Question 5

Why does an ovarian tumor cause pain in the knee?

Answer 5

The ovaries are situated in a peritoneal depression called the Ovarian fossa, on the lateral pelvic wall.
It’s boundaries are:
• Ant - Obliterated umbilical artery
• Post- Ureter, Internal iliac artery
•Superior- External iliac vein
• Floor- Formed by parietal peritoneum beneath which lie the Obturator nerve and vessels.

Thus an ovarian tumor can cause irritation of the obturator nerve.
This will cause referred pain along the medial side of thigh and the knee joint, as it’s the main nerve supplying the medial side of the thigh. It’s posterior division supplies the knee joint.

Question 6

What is Dorsalis Pedis Pulse?

Answer 6

Pulsations of the dorsalis pedis artery can be felt between — tendon of extensor digitorum longus and the extensor hallucis longus (midway between the two malleoli) on the dorsum of foot.

This artery is absent in 14% of subjects.

Question 7

Why is the medial meniscus of the knee joint more prone to injury?

Answer 7

Reasons:
1. Fixity of the medial meniscus to the TCL. It’s margins are also fused to the fibrous capsule by the coronary ligament. Due to this, it is more fixed in its position compared to the lateral meniscus, which is separated from the capsule by the Inferior lateral genicular nerve and vessels. Thus the medial is more prone to getting crush between the articular surfaces,

2. The medial femoral condyle rotates on the upper surface of the Ant horn of medial meniscus, during locking and unlocking of the knee joint.
3. The lateral meniscus is protected by the popliteus which is attached to its posterior horn. Contraction of the popliteus pulls the Lat. meniscus backwards and prevents it from getting trapped between the articular surfaces.

Question 8

What is Pes Planus? List its causes and effects.

Answer 8

Pes planus or flat foot is the commonest foot deformity, in which there is absence of the arches of foot.

CAUSE: May be congenital or acquired. Common causes are

1. Sudden weight gain
2. Loss of leg muscle tone due to prolonged standing or fatigue
3. Rapid growth of long slender feet in adolescents
4. Faulty foot-wear

EFFECTS:

1. Loss of spring action of the arches causes clumsy, shuffling gait.
2. Loss of shock absorbing function of arches makes foot more prone to osteoarthritis and trauma
3. Loss of concavity of sole can cause compression of plantar nerves and vessels. Compression of the communication between Lateral and medial plantar nerve causes Metatarsalgia. ( pain in forefoot)