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MRCS Other > Doctors Acadamy - Lower Limb COPY > Flashcards

Doctors Acadamy - Lower Limb COPY Flashcards

1
Q

What structures are found in the anterior compartment of the lower leg?

A

Muscles:

  1. Tibialis Anterior
  2. Extensor Digitorum Longus
  3. Extensor Hallicus Longus
  4. Peroneus Tertius (Fubularis Tertius)

Nerves: Deep peroneal Nerve

Artery: Anterior Tibial Artery

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2
Q

What are the boundaries of the anterior compartment?

A

Posteriorally - Interosios Membrane (between the bone)
Medially - Tibia
Laterally - Anterior Intermuscular Septum (between anterior and lateral compartments)

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3
Q

What structures are found in the lateral compartment of the lower leg?

A

Muscles:

  1. Fibularis longus
  2. fibularis brevis

Nerve: Superficial Peroneal nerve

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4
Q

what are the boundaries of the lateral compartment?

A

Anterior - Anterior inter-muscular septum
Medial - fibula
Posterior = Posterior inter-musclar septum

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5
Q

What structures are found in the Deep posterior compartment of the lower leg?

A

Muscles:

  1. Tibialis posterior
  2. flexor hallicus longus
  3. flexor digitorum longus
  4. popliteus

Nerve: Tibial Nerve

Artery: posterial tibial artery

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6
Q

what are the boundaries of the deep posterior compartment?

A

anterior - interosis membrane
medial - tibia
lateral - fibula
posterior - flexor hallicus longus

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7
Q

What structures are found in the Superficial deep compartment of the lower leg and what the compartments nervous innervation?

A

Muscles:

  1. soleus
  2. plantaris
  3. gastroneumis (medial and lateral head)

Nerves in comparement: Sural Nerve

Vessels in the compartment: Long Saphenous vein

Nervous innervation: Tibial nerve

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8
Q

What does the sural nerve inovate?

A

The sural nerve does not innervate any muscles.

Supplies sensation to the skin of the lateral foot and lateral lower ankle.

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9
Q

damage to what nerve causes foot drop

A

common peroneal or sciatic nerve

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10
Q

What muscles are found in the Medial compartment of the thigh and what is their nerveous innervation?

A
  1. Pectineus
  2. Gracillis
  3. Obturator externus
  4. Adductor Longus
  5. Adductor Brevis
  6. Adductor Magnus

Innervation:

  • Pectineus: Femoral Nerve
  • Adductor Magnus: Sciatic Nerve
  • All the rest are the obturator Nerve
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11
Q

What muscles are found in the Posterior Compartment of the thigh and what is their nervous innervation?

A
  1. Long and short head of the Biceps Femoris
  2. Semimembranous
  3. Semitendinous

Innervation: Sciatic Nerve

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12
Q

What Muscles are found in the Anterior compartment of the thigh and what is there nervous innervation?

A
  1. Vastas Lateralis
  2. Vastas Intermedius
  3. Vastas Medialis
  4. rectus Femoris
  5. Sartorius

(Psoas and Ileacus also terminate here at the top)

Innervation: Femoral Nerve (superficial branch)

(Psoas: anterior rami L1-L3)

(Ileacus: Femoral nerve)

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13
Q

Name the structures found within the popliteal fossa (posterior to anterior)

A
  1. Tibial Nerve
  2. Popliteal Vein
  3. Popliteal Artery
  4. Popliteus and capsule (inferiorlly)
  5. Oblique popliteal ligament (in the middle)
  6. posterior cruciate ligament
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14
Q

What are the boarders of the popliteal fossa?

A

Superior - lateral: Biceps femoris

Superior Medial: Semi tendinosus

Inferiorally: two heads of the gastroneumeus

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15
Q

What muscles are responsible for locking and unlocking the knee?

A

Locking: Tensor fascia lata

Unlocking: Popliteus

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16
Q

What ligaments make up the deltoid ligament?

A
  • Anterior and posterior tibiotalar
  • Tibionavicular
  • Tibiocalconeal
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17
Q

what ligaments make up the lateral ankle ligaments?

A
  1. Anterior and posteria talofibular
  2. Calconeofibular
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18
Q

What three tendons make up the pes anserine?

A

sartorius, gracilis, and semitendinosus.

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19
Q

what is the petella tendon a continuation of

A

The quadraceps tendon

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20
Q

what symptoms do you get ina femoral nerve injury

A
  • unablet to extend leg or knee
  • loss of sensation to medial leg
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21
Q

what symptoms do you get in a common peroneal nerve injury

A
  • foot drop
  • reduced inversion of the foot (only tibialis anterior affected)
  • eversion lost
  • reduced sensation of dorsal surface of foot
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22
Q

what muscles are responsible for inversion of the foot

A

tibialis anterior and posterior

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23
Q

what muscles are responsible for eversion of the foot

A

fibularis longus and brevis

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24
Q

what symptoms do you get in deep peroneal nerve injury

A
  • partial foot drop
  • loss of sensation 1st dorsal webspace
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25
Q

what symptoms do you get in superficial peroneal nerve injury

A
  • loss of sensation of 2/3/4th webspace
  • loss of eversion
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26
Q

what syptoms do you get in tibial nerve injury

A
  • loss of plantarflexion
  • weak inversion
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27
Q

What are the treatment options for a femoral shaft fracture?

A
  1. IM nail and cannulated screws
  2. if fracture invovles the joint - plate and screws
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28
Q

What are the treatment options for patella fractures?

A
  • If <2mm displacment and NO extensor lag = Conservative
  • if >2mm displacement or extensor lag = tension wire banding
  • if shattered = patellectomy
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29
Q

What are the features of an ACL tear and what is the typical mode of action?

A
  • Immediate swelling (haemarthrosis)
  • often a high twisting force applied to a bent knee
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30
Q

What are the features of an PCL tear and what is the typical mode of action?

A
  • Immediate swelling (Haemarthrosis)
  • hyperextension injuries
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31
Q

What is the typical mode of action of a medial colateral ligament tear

A

lef forced in to valgus via a force from outside the leg

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32
Q

What are the features of an meniscal tear and what is the typical mode of action?

A

Features:

  • delayed onset of knee swelling
  • joint locking

Mode of action: rotational sports injury

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33
Q

What are the common features of Chondromalacia patellae

A
  • Common in teenage girls
  • pain on walking down the stairs and at rest
  • tenderness over patella and quadraceps wasting
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34
Q

What are the common features of Pes Anserine bursitis?

A
  • Pain on medial side of knee approx. 2cm below joint
  • pain on walking up or down stairs or on excersise
35
Q

What nerves are at risk in following hip approaches?
1. Anterior
2 Anterior-lateral
3. Posterior

A

Anterior = lateral cutaneous nerve of the thigh

Anterio-lateral = superior gluteal nerve

Posterior = sciatic nerve

36
Q

What happens in osteoporosis and what is the classical presentation?

what is the treatment?

A

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

37
Q

What happens in osteomalacia and what is the classical presentation?

what is the treatment?

A

What happens: normal boney tissue but decreased mineral cortex.

Features: Rickets, bone pain, fractures, muscle tenderness

Treatment: Vitamin D + calcium

38
Q

What happens in osteopetrosis and what is the classical presentation?

what is the treatment?

A

What happens: Marble bone disease. Decfective osteoclasts - failure of bone reabsorbtion which leads to abnormally dense, brillte bone

treatment: Bone marrow transplant

39
Q

What is osteogenisis imperfecta and wahat are the common features?

A

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
40
Q

What is perthes disease and what features are commonly associated with it?

What age dose it commonly occur?

A

Perthes: Avascular necrosis of the femoral head

Features: associated with being short and overactive

Age: 5-12yrs

41
Q

What is the first sign of perthes disease on an xray?

A

1st sign = sclerosis

Then you get a flatterned or fragmented femoral head and subchondral collapse

42
Q

What features are commonly associated with SUFE and what age does it occur?

A

Associciated Features: Obese children, hypothyroid and GH defficiency

Age: 13/14

43
Q

What features do you see on an xray in a child with a SUFE?

A

displaced femoral head

44
Q

What are the nerve roots of the sciatic nerve

A

L4-S3

45
Q

Where does the common peroneal nerve bifurcate into the superficial and deep peroneal nerves

A

The common peroneal nerve bifurcates at the neck of the fibula (where it is most likely to be injured).

46
Q

If an x ray showed brodies abscessess and sequestrium what condition would that indicate?

A

Osteomylitis

47
Q

If an xray showed subchondral sclerosis what condition would that indicate

A

osteoartheritis

48
Q

what biochemical changes do you get in osteomalacial

A

low calcium

low phosphate

high ALP

49
Q

What biochemical changes do you get in Padgets

A

Calcium and Phosphate are normal

ALP high

50
Q

on a dexa scan, what would the following values indicate:

  • -1 to 1
  • -1 to -2.5
    *
A
  • 1 to 1 = normal
  • 1 to -2.5 = Osteopenia

less than -2.5 = osteoporosis

51
Q

in what condition dobrowns tumours occur?

A

Hyperparathyroid

52
Q

what can be seen on an x ray in a patient with osteopetrosis

A

lack of differentiation between the cortex and medulla

53
Q

what are some of the features of rickets?

A

Large head

bowing of the legs

deformity of the chest wall

xray shows cupping

54
Q

Describe a Smiths Fracture

A

Distal radius fracture with volar angulation

55
Q

Descibe a Collies Fracture

A

Distal radius fracture + dorsal angulation

56
Q

What is a Holstein Lewis Fracture

A

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

57
Q

What is a bennetts fracture

A

Compresesion fracture of the base of the first metacarpal

58
Q

What structures pass posteriorally to the Medial Maleolus?

A

Tom Dick And Nervous Harry

  • Tibailis Posterior Tendon
  • Flexor Digitorum Longus
  • Posterior Tibial Artery
  • Tibial Nerve
  • Halicus Longus
59
Q

What structures pass posteriorally to the lateral maleolus

A

superficial to superior peroneal retinaculum

  • Sural nerve
  • Short saphenous vein

deep to superior peroneal retinaculum

  • Peroneus longus tendon
  • Peroneus brevis tendon
60
Q

What is the blood supply to the scaphoid bone?

A

Dorsal carpal branches

61
Q

What is the treatment for distal radial fractures?

A

Treatment is mostly conservative, if affecting the joint surface or angulated then for surgical fixation

62
Q

What is the treatment for proximal humeral fractures?

A
  1. If impacted - Colar and cuff
  2. if displaced - ORIF
63
Q

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?

A

Pes anserinus bursitis

64
Q

what are the bounaries of the adductor canal?

A

Anterior Medially - Sartorius

Anterior Laterally - Vastas Medialis

Posteriorally - adductor longus and magnas

65
Q

A decision is made to perform a hemi arthroplasty through a lateral approach. Which vessel will be divided to facilitate access?

A

Transverse branch of the lateral circumflex artery

66
Q

Which ligament contains the artery supplying the head of femur in children

A

ligamentum teres

67
Q

The foramen marking the termination of the adductor canal is located in which muscle

A

Abductor magnus

68
Q

what is the contents of the adductor cannal?

A

saphenous nerve, femoral vein and the superficial branch of the femoral artery.

69
Q

what are the boundaries of the adductor canal?

A

Medially: Sartorius

Posteriorally: Adductor longus and magnus

Antereolaterally: Vastus Medialis

70
Q

what is the O’Donoghue’s triad / the unhappy triad

A

injury to the anterior cruciate ligament, medial collateral ligament, and meniscus.

71
Q

what is lachmans test

A

this is a manouver used to test the integrity of the ACL

72
Q

what is the function of the femoral canal

A

allows for expansion of the femoral vessels

73
Q

what muscles cause hip abduction

A

Gluteus medius and minimus and TFL

74
Q

what x ray signs do you get in osteoartheritis and what is the first of those sign to appear on an xray?

A

L - loss of joint space –> this is the first to appear

O - osteophytes

S - Subchondral sclerosis

S - Subchondral cysts

75
Q

what fracture is most commonly associated with a posterior hip disolocation

A

acetabulum fracture

76
Q

what is the blood supply of the long and short head of the biceps femoris

A

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.

77
Q

What structures pass anterior to the medial maleolus?

A

Tibialis anterior

78
Q
A
79
Q

What nerve is most commonly damaged in varicose vein surgery

A

Sural nerve

80
Q

If a young male has symptoms of lower limb ischaemia on exertion what is the top differential diagnosis

A

Adductor canal compression syndrome

81
Q

What is the pathophysiology of osteopetrosis

A

Osteoclasts deformity

82
Q

Which ligament connects the ulna to the radial notch

A

The annular ligament

83
Q

What muscles insert in to the iliotibial tract?

A

Tensa Fascia Lata (TFL) + Gluteus maximums

MRCS Other (19 decks)

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