Limbs and Back: Week Six Flashcards
1
Q
What is Osteoarthritis?
A
Progressive disorder of the joint caused by gradual loss of cartilage and resulting in development of bony spurs and cysts at margins
2
Q
What is the difference between primary and secondary Osteoarthritis?
A
Primary: this is degenerative
Secondary: this is caused by trauma
3
Q
What are some of the risk factors of Osteoarthritis?
A
Systemic: genetics, gender (men more likely under 50
-and women more likely over 50), low vitamin C and low vitamin D
Joint biomechanics: joint trauma, obesity, occupation,
4
Q
What are some symptoms of Osteoarthritis?
A
- morning stiffness (< one hour)
- pain at the end of the day
- pain is sharp and burning
- pain with load-bearing
- difficultly moving
- decreased walking
- Trendelenburg sign
- pain worse during exercise
- abnormal alignment
- tenderness of palpation
- weakness and muscle wasting
- joints appear larger
5
Q
What are the four signs shown on an x-ray with a patient with Osteoarthritis?
A
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts
6
Q
What is involved in the non-operative treatment of Osteoarthritis?
A
- Medication: paracetamol, NSAIDs, alternative
- Physio: motion, weight loss, strengthening, aerobic conditioning
- Walking aids
- Joint injections
7
Q
What is involved in the operative treatment of Osteoarthritis?
A
- Arthroscopy
- Cartilage transplant
- Joint replacement
8
Q
In Osteoarthritis, tissue macrophages become activated due to trauma and the risk factors. What do they secrete and what is the cause of this?
A
- TNF, IL-1B, IL-6
- VEGF
VEGF will cause stimulate of E-selectin and this will increase blood supply and attract ore immune cells.
These molecules and cells will stimulate synoviocytes to produce proteases and this causes cartilage breakdown.
Cytokines will also stimulate osteoblasts to attempt to repair bone and this will result in the formation of Subchondral sclerosis.
9
Q
Which cytokines are pain stimulators?
A
Prostaglandins and bradykinin
10
Q
What molecules contribute to the elasticity and high tensile strength of the synovial fluid?
A
Type two collagen
Proteoglycans: hyaluronic acid, chondroitin sulphate and keratin sulphate
11
Q
When there is cartilage damage, there is an increase in proteoglycans and an increase in collagen II synthesis. Chondrocytes will then eventually switch to another collagen. What type of collagen is this and what is the effect?
A
Chondrocytes switch to type one collagen. This collagen does not have the same interaction with proteoglycans and hence the elasticity decreases.
12
Q
What will all decrease in osteoarthritis?
A
- water content (initial increase)
- proteoglycan synthesis
- collagen-x linking
- size of Aggrecan, hyaluronic acid and GAG
13
Q
During osteoarthritis, osteophytes will form. This will cause enlarged joints in the fingers. what is the name for the swellings in the distal and proximal joints?
A
Distal: Heberden node
Proximal: Bouchard node
14
Q
What is the difference in morning stiffness between rheumatoid arthritis and osteoarthritis?
A
Osteoarthritis stiffness lasts less than one hour whereas rheumatoid arthritis lasts more than one hour.
15
Q
What is the main blood supply to the hip joint?
A
Lateral and medial circumflex arteries
16
Q
What does an intracapsular fracture have a risk of?
A
Avascular necrosis
17
Q
Explain the garden classification of hip fractures.
A
Type One: incomplete, undisplaced
Type Two: complete, undisplaced
Type Three: complete, partially displaced
Type Four: complete, fully displaced
18
Q
What is the treatment for hip fractures, using the garden classification?
A
“One two pop in a screw, Three Four head to the floor”
19
Q
What are treatments for hip fracture?
A
- Dynamic hip screw
- Cannulated hip screw
- Hemi-arthroplasty (only head replaced)
- Total hip arthroplasty (acetabulum and head replaced)
20
Q
Name the roles and members of the multi-disciplinary team involved in hip surgery
A
- Physio: weight bearing exercises
- OTs: hand rails, walking aids, long-handled devices
- Social workers
- Orthopaedic surgeon
- Geriatrician
- Liaison nurse
- Dietarian
21
Q
What is the percentage of annular bone turnover cortical bone and trabecular bone?
A
- 4% for cortical
- 25% for trabeculae
22
Q
Give some examples of molecules that stimulate RANKL
A
PGE2, PTH, Glucocorticoids, vitamin D, IL-11, IL-1, PTH, TNF-alpha
23
Q
How much bone loss occurs after menopause?
A
2-3%
24
Q
What affect does glucocorticoids have on bone?
A
- increase RANKL production (there is a glucocorticoids receptor on osteoblasts)
- increased expression of RANK receptor ( glucocorticoids on osteoclasts)
- suppress OPG
- increase calcium excretion in urine
- decreased calcium absorption in GI tract
25
What are the serum results in primary hyperparathyroidism?
- hypercalcaemia
| - low phosphate
26
What are the serum results in secondary hyperparathyroidism?
- low calcium
| - high phosphate
27
What is Paget's disease?
There is a disruption of the bone remodelling cycle and this results in bone becoming weakened and deformed. There is an inappropriate activated of osteoclasts and osteoblasts leading to rapid bone remodelling and poor strucutre of affected bones.
There is a normal amount of PTH but there is elevated AKP levels.
28
What is Osteopetrosis?
There is defective osteoclasts. The bones become sclerotic and thick, but due to abnormal strucutre results in them being weak and brittle.
29
What is Fluorosis?
This is excessive accumulation of fluoride in bones. The bones therefore become hardened and less elastic.
30
What is Pels Cavus?
High arch
31
What is Pels Planus?
Low arch ( flat foot)
32
What is antalgic walk?
This is walking to avoid pain
33
What muscles are weak when there is the Trendelenburg sign?
The abductors.
34
What is the order of the structure of the tarsal tunnel (medial malleolus), anterior to posterior.
Tom Dick And Very Nervous Harry:
- tibialis posterior
- flexor digitorum longus
- artery: posterior tibial
- vein: posterior tibial
- nerve: tibial
- flexor halluces longus
35
Name three limiting structures of dorsiflexion
- anterior bony osteophytes
- tight Achilles tendon
- osteoarthritic ankle
36
What does the sciatic nerve split into just above the popliteal fossa?
The tibia nerve and the common peroneal. The common peroneal will then divide into a superficial and deep branch.
37
What is the nerve innervation of the anterior leg muscles?
deep peroneal nerve
38
What is the blood supply of the anterior leg muscles?
anterior tibia
39
What is the common action of the anterior leg muslces?
Dorisflexion
40
How many anterior leg muslces are there?
Four
41
What are the four anterior leg muslces?
Tibialis anterior
Extensor halluces longus
Extensor digitorum longus
peroneus tortious
42
Three of the anterior leg muslces originate from the fibula, which muscle arises from the tibia?
The tibialis anterior
43
Explain the mnemonic 'The Hospitals Are Not Dirty Place' for the anterior leg muslces
```
T: tibialis anterior
H: extensor halluces longus
A: anterior tibial is the artery
N: deep peroneal is the nerve
D: extensor digitorum longus
P: peroneus tortious
```
44
What nerve innervates all of the posterior leg muslces?
Tibial nerve
45
What is another name of the fibular nerve?
Peroneal nerve
46
What is the blood supply of the posterior leg muslces?
Posterior tibial artery
47
What is the common action of the posterior leg muslces?
Plantar flexion of the foot
48
What muslces are in the superficial layer of the posterior leg muslces?
Gastrocnemius
Soleus
Plantaris
49
What is insertion point for the three superficial posterior leg muslces?
The gastrocnemius, the plantaris and soleus insert into the calcaneus via the Achilles tendon.
50
What is the origin of the Gastrocnemius?
Medial and lateral condyle
51
What are the four deep posterior leg muslces?
Popliteus, Flexor halluces longus, flexor digitorum longus, tibialis posterior
52
Which muscle of the posterior leg compartment unlocks the knee during extension?
Popliteus
53
What is the nerve innervation for the lateral leg muslces?
Superficial fibular nerve
54
What is the blood supply for the lateral leg muscles?
Peroneal artery and anterior tibial
55
What is the common action of the lateral leg muscles?
Foot eversion
56
What are the two lateral leg muscles?
Fibularis longus and Fibularis brevis
57
What does the sciatic nerve divide into?
The tibial and common peroneal nerve
58
What does the common peroneal nerve divide into?
The superficial and deep peroneal nerve
59
What nerve gives the medial and lateral plantar nerves?
The tibial nerve
60
What bone is the superior part of the pelvis?
Ilium
61
How many iliac spines are there?
Four:
- posterior inferior
- posterior superior
- anterior superior
- anterior inferior
62
What is the joint between the sacrum and ilium called?
Sacroiliac joint.
63
How many gluteal lines are located on the ileum?
There are three gluteal lines.
- anterior
- posterior
- inferior
64
What type ligaments stabilize the sacroiliac joint?
The sacrospinous and the sacrotuberous ligaments. These ligaments connect the pelvis to the vertebra column. These ligaments also define the boundaries between the greater and lesser sciatic foramen.
65
What is the insertion point of the sacrospinous and sacrotuberous ligaments?
The sacrospinous inserts into the ischial spine and the sacrotuberous inserts into the ischial tuberosity.
66
What is the orientation of the sacrospinous and sacrotuberous ligaments?
The sacrospinous is horizontal and the sacrotuberous is vertical.
67
What is the name of the intracapsular ligaments of the hip joint?
Ligament of the head of the femur
68
What is the name of the three extracapsular ligaments and what is their function?
Iliofemoral: limits hyperextension
Pubofemoral: prevents hip hyperabduction
Ischiofemoral: prevents hip hyperflexion
69
Which artery can cause avascular necrosis?
The medial circumflex
70
What type of joint is the pubis symphysis?
Cartilaginous
71
Where do the meniscus of the knee attach?
Intercondylar region
72
What ligament connects the medial and lateral meniscus anteriorly?
The transverse ligament
73
Why is the medial meniscus less mobile?
It attaches to the medial collateral ligament and the joint capsule
74
Where do the collateral ligaments originate from?
The lateral and medial epicondyle of the femur
75
What is the origin and insertion of the posterior cruciate ligament?
Origin: medial condyle of femur
Insertion: posterior Intercondylar fossa
76
What is the origin and insertion of the anterior cruciate ligament?
Origin: lateral epicondyle of femur
Insertion: anterior Intercondylar fossa
77
Where does the patellar ligament attach?
Tibial tuberosity
78
Which foramen does the gluteal nerve, artery and vein go through?
The greater sciatic foramen above the piriformis
79
What muslce divides the greater sciatic foremen?
The piriformis
80
Which foramen does the sciatic nerve travel through?
The greater sciatic foramen below the piriformis
81
What does the sciatic nerve divide into?
The tibial and common peroneal. The peroneal then divides into the deep and superficial peroneal nerve.
82
What nerve gives of the lateral and medial planter nerves?
The tibial nerve
83
What tow branches does the popliteal artery give off?
The anterior tibial artery and the tibio-peroneal trunk. The trunk then divides into the posterior and peroneal artery.
84
How many Muslces are in the first (superficial) layer of the planter foot Muslces?
Three: abductor halluces, flexor digitorum brevis and abductor digiti minimi
85
How many Muslces are in the second layer of the planter foot Muslces?
Two: Quadratus plantae and lumbricals
86
How many Muslces are in the third layer of the planter foot Muslces?
Three: Flexor halluces brevis, adductor hallucis and flexor digiti minimi
87
How many Muslces are in the fourth layer of the planter foot Muslces?
Two: plantar and dorsal interossei
88
What is the common origin of the superficial muscle layer of the plantar foot?
Calcaneus
89
What is the nerve supply to the dorsal foot muscles?
Deep fibular
90
What is the nerve supply to the plantar foot Muslces?
Medial or lateral plantar nerve
91
What are the two foot muscles of the dorsal surface?
Extensor digitorum brevis and extensor hallucis brevis
92
What type of joint is the ankle joint?
Hinge joint
93
What is the function of the medial ligament?
Prevents eversion
94
How many lateral ankle ligaments are there?
Three: anterior talofibular, posterior talofibular and calcaneofibular
95
What is the function of the lateral ligaments of the ankle?
Prevent over-inversion
96
Which leg muscles are responsible for plantar-flexion?
Posterior leg compartment
97
Which leg muscles are responsible for dorsi-flexion?
Anterior leg compartment
98
What two nerve supply the ankle?
Tibial and deep fibular
99
What is the subtalar joint between?
Talus and Calcaneus
100
What type of joint is the subtalar?
Plane
101
How many ligaments does the subtalar joint have?
Three: posterior, medial and lateral talocalcaneal
102
Where is the Intercondylar eminence placed?
On the tibial plateau
103
Where is the tuberosity on the tibia?
Anterior side
104
Which surface of the tibia is the soleal line on?
Posterior border
105
Name the proximal row of the tarsals
Talus and Calcaneus
106
Name the intermediate row of the tarsals
Navicular
107
Name the distal row of the tarsals
Cuboid, medial cuneiform, lateral cuneiform, intermediate cuneiform
108
How long is the adductor canal and what does it contain?
15cm form the femoral triangle to the adductor hiatus.
| There is the femoral artery, femoral vein, nerve to vastus medialis and saphenous vein
109
What are the borders of the adductor canal?
Anterior: Sartorius
Lateral: vastus medialis
Posterior: adductor longus and magnus
110
Explain the course of deep veins of the leg
The medial and lateral plantar arteries combine to form the posterior tibia and fibular veins.
The anterior tibia, posterior tibia and fibular combine to form the popliteal vein. This becomes the femoral vain and the deep vein of the thigh drains into this vein. This artery then becomes the external iliac vein.
111
What are the two superficial veins of the leg?
The great saphenous and small saphenous vein.
112
What is the course of the great saphenous vein?
This is formed by the dorsal veins of the foot and the big toe. This terminates by draining into the femoral vein before the inguinal ligament.
113
What is the course of the small saphenous vein?
This is formed by the dorsal veins of the foot and the small toe. This empties into the popliteal vein.
114
What malleolus does the great saphenous vein travel next to?
The great saphenous vein travels anteriorly to the medial malleolus.
115
What malleolus does the small saphenous vein travel next to?
The small saphenous vein travels posteriorly to the lateral malleolus.
