Lecture - MSK - Lower Limb and Back Flashcards

1
Q

Lower Limb (pelvis to distal ends of toes)

  1. What are the two main functions?
  2. What are the 8 types of bones in the lower limb?
A
  1. Locomotion (walking, running, propulsion) annnnd weight-bearing (standing, control advance of the body over the foot aka stop us falling over our foot sorta)
  2. PELVIC BONE (made up of three bones - illium, ischium and pubis)
    - FEMUR (called thigh region aka between the pelvis and the knee)
    - PATELLA (sesamoid bone)- part of knee joint
    - TIBIA (in the leg region aka between knee to ankle)
    - FIBULA (also in leg region but this bone has no weight bearing - just there for muscle attachments)
    - FOOT (so 7 tarsal bones, 5 metatarsals and 14 phalanges)

With the phalanges, you have 2 in big toe and 3 in the small toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does he lower limb minimise the energy expenditure when standing and walking?

A

The knee locks in place so like, the muscles don’t need to work

Centre of gravity pases post to hip, ant to knee and anterior to ankle

this keeps us upright and muscles on posterior aspect much bigger that counteract the gravity so we stay upright

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pelvic girdle

  1. How is the upper girdle different to this lower limb one?
  2. What two things are in the pelvic girdle?
  3. What does it connect? (aka it’s function)
A
  1. The upper one is completed with muscles but this lower one is fully completed with bone
  2. Two hip bones and one sacrum
  3. It connects the lower limb to the vertebral column.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pelvic orientation

  1. How is it tilted? Like what do you see?
  2. Where does the highest point of iliac crest level up to>
A
  1. The pubic tubercles and the anterior superior iliac spines should be in the same plane (coronal plane) and that’s what its orientation is.
  2. Highest point of illiac crest and if we draw a line from here to vertebrate column, it goes to L4 (supracrystal plane - dw about this)
    - Just remember the highest point reaches L4 vertebrate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Important landmarks of the hip bone (lateral view)

Where is the……on slide 9:

  1. Anterior superior iliac spine (spine = pointy bits)
  2. Anterior inferior iliac spine
  3. Pubic tubercule
  4. Acetabulum (These three bones (illium, isch and pubis that become ossified by 18-20 years) form the acetabulon for the hip joint. Was cartilage in kids)
  5. Obturator canal (obturator vessels and nerves - go through gap (canal) in the membrane since they can’t go through the actual ligaments etc)
  6. Obturator membrane
  7. Ischial tuberosity
  8. Lesser diatic notch
  9. Ischial spine
  10. Greater diabetic notch
  11. Gluteal surface
  12. Tell me whereabouts the pubis bone, ischium and allium are
  13. Why does it appear that there are cracks in kid legs?
A

0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Label on slide where the following are:

  1. Illiac crest
  2. Inguinal ligament
    - Ligament from anterior superior illiac spine to pubic tubercle = inguinal ligament - extension from anterior abdominal wall (imp gateway for strcutures leaving trunk to go to lower limb)
  3. Where is the ischiopubic ramus?
A

0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Joints of pelvis:

  1. Tell me about the sacroiliac joint
  2. What sort of joint is pubic symphysis?
  3. What hormone leads to the joints around pelvis soften in later stages of pregnancy?
A
  1. It is synovial anteriorly and then posteriorly it is fibrous (because support for the posterior needed)
  2. Fibrocartilage (allows some movement)
  3. Relaxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What us symphysiotomy?

A

Symphysiotomy is a surgical procedure in which the cartilage of the pubic symphysis is divided to widen the pelvis allowing childbirth when there is a mechanical problem.

If baby’s head got stuck then they used to make a cut in pubic symphysis so creates 2-3cm gap so baby’s hip can go through but dont need to do that anymore bc healing it is very hard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ligaments of the pelvis:

  1. Where is the anterior ligament
  2. Interosseous ligament (not the membrane bc interosseous membrane is bw tibia and fibula)
  3. What ligament forms the greater siatic foramen?
  4. What ligament forms the lesser siatic foramen?
  5. Where is the obturator membrane?
A
  1. In front of the sacroiliac joint sorta
  2. In between the sacrum and the allium
  3. Sacrospinous ligament (since it goes from sacrum to ischial spine)
  4. Sacrotuberous (since it goes from sacrum to ischial tuberosity)
  5. It covers the obturator foramen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the gateways to the lower limb?

A

Ligaments form formina so structures can go through

Well, there is underneath the inguinal ligament you have things that go from pelvis to the anterior part of the thigh

Then you have via the obturator canal
-Obturator strcutes go to medial side of thigh through the canal

Then via the greater and lesser sciatic foramen

  • Sciatic nerve goes through the greater sciatic foramen
  • The lesser siatic foramen also has strcutures leaving from pelvis into perineum (the region below pelvis) - that hole in pelvis bottom has musscles and that pelvic floor muscle (below this is the perineum)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Jointsssss

  1. What are the three types of joints?
  2. What are the types for each of these:
    - sacroilliac
    - symphysis pubis
    - hip
    - knee
    - ankle
    - intertarsal
    - tarsometatarsal
    - metatarsophalangeal
    - interphalangeal
A
  1. Fibrous (most stable aka no movement really)
    - Cartilaginous (has some movement)
    - Synovial (real mobile and you classify this according to the shape)
  2. Sacroilliac = fibrous and synovial both

Symphysis pubis = cartilaginous

Hip = synovial (ball and socket)

Knee = synovial (condylar)

Ankle = synovial (hinge)

Intertarsal = synovial (plane)

Tarsometatarsal = synovial (plane)

Metatarsophalangeal = synovial (ellipsoid = lexion, extension, add and abd)

Interphalangeal = synovial (hinge)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

General features of the hip joint:

  1. What sort of synovial joint is it?
  2. Is it stable? Why?
  3. Does it have a wider range of movement than the shoulder joint?
  4. Where is the greater trochanter?
  5. Where is the lesser trochanter?
  6. Which side (ant or post) do you see the intertrochanteric line and which side the intertrochanteric crest?
  7. What is the area between the head and the neck called?
  8. What is the fovea and what is attached there?
A
  1. Ball and socket
  2. Yes, bc good fit since good bony and strong liga and capsule (capsule is a dynamic ligament in synovial joints)
  3. Shoulder has bigger range bc hip wants to be stable so compensated by less movement
  4. Like the bump on the lateral side of the femur top
  5. The bump on the medial side
  6. Line is anterior (from greater to lesser) and crest is posterior
  7. Subcapital area (since capital is head)
  8. It’s a little dip in the head of the femur for the ligament of the femoral head to attach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hip joint: acetabulum + head of femur

Where is:

  1. Acetabular fossa
    - it’s filled with fat
  2. Acetabular foramen
  3. Transverse acetabular ligament - what does this do?
  4. Lunate surface and acetabular labrum
    - On the lunar surface is a fibrocartilagious structure called labrum - it deepens socket a little bit more and bc it’s fibrocartilage, it cushions the socket.
  5. What can you tell me about the arteries?
A
  1. Was the acetabular notch but in living, the gap (notch) filled with acetabular ligament and that completes this socket as a cicle
  2. In the first seven years of life, before ossifiction, this portion of femur head was fed by branches of obturator artery that came via this ligament.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

For the hip bone, where are the capsule attachments?

What are the three here ligaments? When are they taught?

A

On the hip bone, the capsule is attached to the edges of the acetabulum, around the labrum and transverse ligament

On the femur, it attaches anteriorly to the intertrochanteric line and posteriorly it attaches into the next, proximal the the intertrochanteric crest (so not on the crest but before it on the neck)

There is the pubofemoral, illiofemoral (has the two parts) and the ischiofemoral (posterior sorta) ligaments and they’re taught when extension of hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name the arteries involved in the blood supply of the hip joint

A

Side 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens if there is a hip fracture in the intracapsular region vs trochanteric region

A

So inside capsule:
-So the branches going to subcaptial area will get torn so no blood supply to head of femur so end up with avascular necrosis

If fracture here in trochanteric then can be fixed bc can then be pinned and plated and there is lots of blood supply and lots of bv anastomose here so can save the femur

17
Q

Features of knee joint:

  1. What sort of joint?
  2. What bones participate in knee joint?
  3. What’s the bony congruence like?
  4. What does stability depend on?
  5. What do menisci do? What are they?
  6. What are bursae?
A
  1. Bicondylar (condylar synovial)
  2. Femoral condyles, tibial plateau on tibial condyles, and patella
  3. Nah, poor BC
  4. Ligaments and muscles
  5. Fibrocartilage peripheral discs and they improve fit + reduce wear and tear
  6. Bursae = small pockts of synovial fluid. Bc there are so many tendons and ligament around joint, burssae help to reduce friction be the strcutures
18
Q

Bursae and fat pads

  1. What can cause swelling - what sort of fluid?
  2. What is bursitis in common slang?
A
  1. Fluid, blood and pus - can take fluid from knee to see what the fluid is
  2. Housemaid’s knee
19
Q

Stability of knee joint:

1. What stabilises it?

A
  1. Ligaments which are thickening of the fibrous capsule (capsular) or extra capsular and intracapsular ligaments. Muscles and tendons from thigh and leg too
20
Q

Ligaments:

  1. What are the two intra capsular ligaments of knee? And one more?
  2. What is the one extra capsular ligaments of the knee?
  3. What is the capsular ligament of the knee?
  4. What two tendons?
  5. What is posterior displacement of the tibia fixed on femur restricted by? What about anterior displacement?
  6. Is the proximal tibiofibular. joint in the knee joint? What is it supported by?
A
  1. Anterior cruciate ligament (attaches to front medial side from lateral posterior side) and posterior cruciate ligament (attaches from lateral post to anterior media) annnnnnd the transverse ligament exists
  2. Tibial (medial) collateral ligament is capsular but fibular (lateral) collateral ligament is extra capsular
  3. See above
  4. Popliteal ligament and popliteuqs tendon (tendon of popliteal muscle)
  5. Posterior displacement restricted by post and ant restricted by ant
  6. No and supported by fibular/lateral collateral ligament
21
Q

Fibula:

  1. Does it articulate with femur?
  2. Is it weight bearing?
  3. What malleolus does it form?
  4. What does it articulate with?
  5. Since it articulates with tibia superiorly and inferiorly, what is it connected in the middle by?
A
  1. No
  2. No
  3. Lateral mallelous
  4. Tibia and talus
  5. Interosseous membrane
22
Q

Tibia:

  1. Transfers weight from what to what?
  2. Areticulates where and with what?
  3. What malleolus does it form?
A
  1. Knee to ankle
  2. Femur, talus ans fibula
  3. Medial
23
Q

Interosseous membrane:

  1. What does it do? (4)
  2. It has apertures for what?
A
  1. Holds tibia and fibular together
  2. Potvides muscle attachments
  3. Provides force transmission
  4. Separates compartments
  5. Aperture at top for anterior tibia artery or vein and aperture at bottom for branch of fibular artery
24
Q

What is the talocrural joint?

A

Hinge joint bw talus + tib and fib. Allows doors and plantar. There are strong medial and lateral ligaments here but they can be torn

25
Q

Arches of foot:

  1. Weight is transmitted from the tibia to talus and then to the weight-bearing points which are?
  2. Where are there arches?
A
  1. Tuberosity of calcaneus and metatarsal heads

2. Between weight-bearing points

26
Q

Name the bones of the foot

Where do inversion and eversion occur?

A

7 tarsals: calcaneus, talus, navicular (moon-shaped), cuboid and 3 cuneiforms (media, intermediate and lateral)

5 metatarsals

14 phalanges - distal, middle and proximal but big toe only has 2 phalanges

Inversion and eversion occur at subtalar joint

27
Q

What are the arches of the foot?

What is their function?

What is it maintained by?

A
  1. Transverse, media and lateral
  2. Shock absorbers
  3. Shape of interlocking bones and ligaments