Doctors Acadamy - Lower Limb COPY Flashcards
What structures are found in the anterior compartment of the lower leg?
Muscles:
- Tibialis Anterior
- Extensor Digitorum Longus
- Extensor Hallicus Longus
- Peroneus Tertius (Fubularis Tertius)
Nerves: Deep peroneal Nerve
Artery: Anterior Tibial Artery
What are the boundaries of the anterior compartment?
Posteriorally - Interosios Membrane (between the bone)
Medially - Tibia
Laterally - Anterior Intermuscular Septum (between anterior and lateral compartments)
What structures are found in the lateral compartment of the lower leg?
Muscles:
- Fibularis longus
- fibularis brevis
Nerve: Superficial Peroneal nerve
what are the boundaries of the lateral compartment?
Anterior - Anterior inter-muscular septum
Medial - fibula
Posterior = Posterior inter-musclar septum
What structures are found in the Deep posterior compartment of the lower leg?
Muscles:
- Tibialis posterior
- flexor hallicus longus
- flexor digitorum longus
- popliteus
Nerve: Tibial Nerve
Artery: posterial tibial artery
what are the boundaries of the deep posterior compartment?
anterior - interosis membrane
medial - tibia
lateral - fibula
posterior - flexor hallicus longus
What structures are found in the Superficial deep compartment of the lower leg and what the compartments nervous innervation?
Muscles:
- soleus
- plantaris
- gastroneumis (medial and lateral head)
Nerves in comparement: Sural Nerve
Vessels in the compartment: Long Saphenous vein
Nervous innervation: Tibial nerve
What does the sural nerve inovate?
The sural nerve does not innervate any muscles.
Supplies sensation to the skin of the lateral foot and lateral lower ankle.
damage to what nerve causes foot drop
common peroneal or sciatic nerve
What muscles are found in the Medial compartment of the thigh and what is their nerveous innervation?
- Pectineus
- Gracillis
- Obturator externus
- Adductor Longus
- Adductor Brevis
- Adductor Magnus
Innervation:
- Pectineus: Femoral Nerve
- Adductor Magnus: Sciatic Nerve
- All the rest are the obturator Nerve
What muscles are found in the Posterior Compartment of the thigh and what is their nervous innervation?
- Long and short head of the Biceps Femoris
- Semimembranous
- Semitendinous
Innervation: Sciatic Nerve
What Muscles are found in the Anterior compartment of the thigh and what is there nervous innervation?
- Vastas Lateralis
- Vastas Intermedius
- Vastas Medialis
- rectus Femoris
- Sartorius
(Psoas and Ileacus also terminate here at the top)
Innervation: Femoral Nerve (superficial branch)
(Psoas: anterior rami L1-L3)
(Ileacus: Femoral nerve)
Name the structures found within the popliteal fossa (posterior to anterior)
- Tibial Nerve
- Popliteal Vein
- Popliteal Artery
- Popliteus and capsule (inferiorlly)
- Oblique popliteal ligament (in the middle)
- posterior cruciate ligament
What are the boarders of the popliteal fossa?
Superior - lateral: Biceps femoris
Superior Medial: Semi tendinosus
Inferiorally: two heads of the gastroneumeus
What muscles are responsible for locking and unlocking the knee?
Locking: Tensor fascia lata
Unlocking: Popliteus
What ligaments make up the deltoid ligament?
- Anterior and posterior tibiotalar
- Tibionavicular
- Tibiocalconeal
what ligaments make up the lateral ankle ligaments?
- Anterior and posteria talofibular
- Calconeofibular
What three tendons make up the pes anserine?
sartorius, gracilis, and semitendinosus.
what is the petella tendon a continuation of
The quadraceps tendon
what symptoms do you get ina femoral nerve injury
- unablet to extend leg or knee
- loss of sensation to medial leg
what symptoms do you get in a common peroneal nerve injury
- foot drop
- reduced inversion of the foot (only tibialis anterior affected)
- eversion lost
- reduced sensation of dorsal surface of foot
what muscles are responsible for inversion of the foot
tibialis anterior and posterior
what muscles are responsible for eversion of the foot
fibularis longus and brevis
what symptoms do you get in deep peroneal nerve injury
- partial foot drop
- loss of sensation 1st dorsal webspace
what symptoms do you get in superficial peroneal nerve injury
- loss of sensation of 2/3/4th webspace
- loss of eversion
what syptoms do you get in tibial nerve injury
- loss of plantarflexion
- weak inversion
What are the treatment options for a femoral shaft fracture?
- IM nail and cannulated screws
- if fracture invovles the joint - plate and screws
What are the treatment options for patella fractures?
- If <2mm displacment and NO extensor lag = Conservative
- if >2mm displacement or extensor lag = tension wire banding
- if shattered = patellectomy
What are the features of an ACL tear and what is the typical mode of action?
- Immediate swelling (haemarthrosis)
- often a high twisting force applied to a bent knee
What are the features of an PCL tear and what is the typical mode of action?
- Immediate swelling (Haemarthrosis)
- hyperextension injuries
What is the typical mode of action of a medial colateral ligament tear
lef forced in to valgus via a force from outside the leg
What are the features of an meniscal tear and what is the typical mode of action?
Features:
- delayed onset of knee swelling
- joint locking
Mode of action: rotational sports injury
What are the common features of Chondromalacia patellae
- Common in teenage girls
- pain on walking down the stairs and at rest
- tenderness over patella and quadraceps wasting
What are the common features of Pes Anserine bursitis?
- Pain on medial side of knee approx. 2cm below joint
- pain on walking up or down stairs or on excersise
What nerves are at risk in following hip approaches?
1. Anterior
2 Anterior-lateral
3. Posterior
Anterior = lateral cutaneous nerve of the thigh
Anterio-lateral = superior gluteal nerve
Posterior = sciatic nerve
What happens in osteoporosis and what is the classical presentation?
what is the treatment?
what happens: Decrease in osteoid matrex but normal mineralisation. Therefore the bone trabeculae is significantly thinned and lacks strength.
Presentation: Pathological fractures
Treatment: Vitamin D, Calcium, Bisphosphonates
What happens in osteomalacia and what is the classical presentation?
what is the treatment?
What happens: normal boney tissue but decreased mineral cortex.
Features: Rickets, bone pain, fractures, muscle tenderness
Treatment: Vitamin D + calcium
What happens in osteopetrosis and what is the classical presentation?
what is the treatment?
What happens: Marble bone disease. Decfective osteoclasts - failure of bone reabsorbtion which leads to abnormally dense, brillte bone
treatment: Bone marrow transplant
What is osteogenisis imperfecta and wahat are the common features?
Features:
- Failure of maturation of collagen in connective tissue
- Vision problems (glaucoma)
- Patients may have hypermobile joints
Radiologically:
- translucent bone
- multiple fractures of long bones.
Ttreatment
- physiotherapy
What is perthes disease and what features are commonly associated with it?
What age dose it commonly occur?
Perthes: Avascular necrosis of the femoral head
Features: associated with being short and overactive
Age: 5-12yrs
What is the first sign of perthes disease on an xray?
1st sign = sclerosis
Then you get a flatterned or fragmented femoral head and subchondral collapse
What features are commonly associated with SUFE and what age does it occur?
Associciated Features: Obese children, hypothyroid and GH defficiency
Age: 13/14
What features do you see on an xray in a child with a SUFE?
displaced femoral head
What are the nerve roots of the sciatic nerve
L4-S3
Where does the common peroneal nerve bifurcate into the superficial and deep peroneal nerves
The common peroneal nerve bifurcates at the neck of the fibula (where it is most likely to be injured).
If an x ray showed brodies abscessess and sequestrium what condition would that indicate?
Osteomylitis
If an xray showed subchondral sclerosis what condition would that indicate
osteoartheritis
what biochemical changes do you get in osteomalacial
low calcium
low phosphate
high ALP
What biochemical changes do you get in Padgets
Calcium and Phosphate are normal
ALP high
on a dexa scan, what would the following values indicate:
- -1 to 1
- -1 to -2.5
*
- 1 to 1 = normal
- 1 to -2.5 = Osteopenia
less than -2.5 = osteoporosis
in what condition dobrowns tumours occur?
Hyperparathyroid
what can be seen on an x ray in a patient with osteopetrosis
lack of differentiation between the cortex and medulla
what are some of the features of rickets?
Large head
bowing of the legs
deformity of the chest wall
xray shows cupping
Describe a Smiths Fracture
Distal radius fracture with volar angulation
Descibe a Collies Fracture
Distal radius fracture + dorsal angulation
What is a Holstein Lewis Fracture
A HolsteinLewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve
Conservative treatment includes reduction and use of a functional brace
Vascular injury may require open surgery
What is a bennetts fracture
Compresesion fracture of the base of the first metacarpal
What structures pass posteriorally to the Medial Maleolus?
Tom Dick And Nervous Harry
- Tibailis Posterior Tendon
- Flexor Digitorum Longus
- Posterior Tibial Artery
- Tibial Nerve
- Halicus Longus
What structures pass posteriorally to the lateral maleolus
superficial to superior peroneal retinaculum
- Sural nerve
- Short saphenous vein
deep to superior peroneal retinaculum
- Peroneus longus tendon
- Peroneus brevis tendon
What is the blood supply to the scaphoid bone?
Dorsal carpal branches
What is the treatment for distal radial fractures?
Treatment is mostly conservative, if affecting the joint surface or angulated then for surgical fixation
What is the treatment for proximal humeral fractures?
- If impacted - Colar and cuff
- if displaced - ORIF
An 18 year old athlete attends orthopaedic clinic reporting pain and swelling over the medial aspect of the knee joint. The pain occurs when climbing the stairs, but is not present when walking on flat ground. Clinically there is pain over the medial, proximal tibia and the McMurray test is negative. What is the most likely cause of this patient’s symptoms?
Pes anserinus bursitis
what are the bounaries of the adductor canal?
Anterior Medially - Sartorius
Anterior Laterally - Vastas Medialis
Posteriorally - adductor longus and magnas
A decision is made to perform a hemi arthroplasty through a lateral approach. Which vessel will be divided to facilitate access?
Transverse branch of the lateral circumflex artery
Which ligament contains the artery supplying the head of femur in children
ligamentum teres
The foramen marking the termination of the adductor canal is located in which muscle
Abductor magnus
what is the contents of the adductor cannal?
saphenous nerve, femoral vein and the superficial branch of the femoral artery.
what are the boundaries of the adductor canal?
Medially: Sartorius
Posteriorally: Adductor longus and magnus
Antereolaterally: Vastus Medialis
what is the O’Donoghue’s triad / the unhappy triad
injury to the anterior cruciate ligament, medial collateral ligament, and meniscus.
what is lachmans test
this is a manouver used to test the integrity of the ACL
what is the function of the femoral canal
allows for expansion of the femoral vessels
what muscles cause hip abduction
Gluteus medius and minimus and TFL
what x ray signs do you get in osteoartheritis and what is the first of those sign to appear on an xray?
L - loss of joint space –> this is the first to appear
O - osteophytes
S - Subchondral sclerosis
S - Subchondral cysts
what fracture is most commonly associated with a posterior hip disolocation
acetabulum fracture
what is the blood supply of the long and short head of the biceps femoris
The short head of biceps femoris, is innervated by the common peroneal component of the sciatic nerve
The long head is innervated by the tibial division of the sciatic nerve.
What structures pass anterior to the medial maleolus?
Tibialis anterior
What nerve is most commonly damaged in varicose vein surgery
Sural nerve
If a young male has symptoms of lower limb ischaemia on exertion what is the top differential diagnosis
Adductor canal compression syndrome
What is the pathophysiology of osteopetrosis
Osteoclasts deformity
Which ligament connects the ulna to the radial notch
The annular ligament
What muscles insert in to the iliotibial tract?
Tensa Fascia Lata (TFL) + Gluteus maximums
