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MRCS > Lower limb > Flashcards

Lower limb Flashcards

1
Q

What is the angle of the neck of femur to the shaft

A

135 degrees

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2
Q

When the intertrochanteric line continues past the lesser trochanter what is it known as

A

Pectineal line

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3
Q

The ileofemoral ligament attaches where

A

Intertrochanteric line

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4
Q

Intracapsular NOFs risk injury to which artery

A

Medial femoral circumflex artery

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5
Q

Where is the linea aspera found

A

On the posterior aspect of the shaft of the femur

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6
Q

Where is the adductor tubercle of the femur and what attaches there

A

At the end of the medial supracondylar line, the adductor Magnus attaches there

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7
Q

The intercondylar fossa at the distal end of the femur has facets for the attachment of what

A

ACL
PCL

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8
Q

What type of bone is the patella

A

Sesamoid bone

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9
Q

How many facets does the patella have and what do they articulate with

A

2 facets on the posterior surface
Medial facet - articulates with the medial condyle of the femur
Lateral facet - articulates with the lateral condyle of the femur

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10
Q

What are the two functions of the patella

A

Leg extension - enhances the leverage that the quadriceps tendon can exert on the femur, increasing the efficiency of the muscle
Protection - protects anterior aspect of joint

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11
Q

Describe the proximal tibia

A

Widened by medial and lateral condyles to aid weight bearing - these form a flat surface known as the tibial plateau which articulates with the femoral condyles
In-between the condyles is the intercondylar eminence which is the main site for the attachment of ligaments and menisci

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12
Q

What is the shape of the tibia

A

Prism shaped

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13
Q

Where is the soleal line found

A

On the posterior surface of the tibia
Where soleus inserts

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14
Q

Where does the patella ligament attachment

A

Onto the tibial tuberosity on the anterior surface of the tibia

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15
Q

Where on the tibia is appropriate for IO access

A

Anteromedial surface 2-3cm below the tibial tuberosity
Proximal to the medial malleolus

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16
Q

The tendon of tibialis posterior is found on a groove of which bone

A

Posterior surface of the tibia

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17
Q

What are the 3 articulations of the fibula

A

Proximal tibiofibular joint - articulates with the lateral condyle of the tibia
Distal tibiofibular joint - articulates with the fibular notch of the tibia
Ankle - articulates with the talus

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18
Q

Which malleolus is more prominent

A

Lateral malleolus

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19
Q

How many tarsal bones are there and what are they called

A

7
Talus
Calcaenus
Navicular
Cuboid
Lateral, intermediate and medial cuneiform

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20
Q

How are the tarsal bones organised

A

3 rows
Proximal - talus, calcaneus
Intermediate - navicular
Distal - cuboid + 3 cuneiforms

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21
Q

What are the 3 articulations of the talus

A

Ankle joint - between the talus and the bones of the leg
Subtalar joint - between the talus and the calcaneus
Talonavicular joint - between the talus and navicular

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22
Q

What is the main function of the talus

A

To transmit force to the calcaneus
It is wider anteriorly compared to posteriorly which gives additional stability

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23
Q

Which is the largest tarsal bone

A

Calcaneus

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24
Q

What are the articulations of calcaneus

A

Subtalar (talocalcaneal joint) - between the calcaneus and the talus
Calcaneocuboidal joint

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25
Q

Where does the Achilles tendon attach

A

The calcaneal tuberosity on the posterior aspect of the calcaneus

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26
Q

Tibialis posterior tendon inserts into which tarsal bone

A

Navicular

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27
Q

The plantar aspect of the cuboid has a groove for which tendon

A

Fibularis longus

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28
Q

Which muscles attach to the medial cuneiform

A

Tibialis anterior
Tibialis posterior
Fibularis longus

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29
Q

Which muscles attach to the lateral cuneiform

A

Flexor hallucis brevis

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30
Q

Stress fractures of the metatarsal bones commonly occur where

A

Necks of 2nd and 3rd metatarsal
Proximal 5th metatarsal

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31
Q

The fibrocartilaginous collar around the hip joint is what

A

Acetabular labrum

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32
Q

Where does the joint capsule of the hip extend to

A

Edge of acetabular proximally
Edge of intertrochanteric line anteriorly and femoral neck posteriorly distally

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33
Q

What are the intracapsular ligament of the hip joint

A

Ligament of head of femur

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34
Q

What are the extracapsular ligament of the hip joint

A

Ileofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament

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35
Q

Describe the ileofemoral ligament

A

Y shaped ligament
Arises form the anterior inferior iliac spine and then bifurcates before inserting into the intertrochanteric line of the femur
Prevents hyperextension

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36
Q

Describe the pubofemoral ligament

A

Spans between the superior pubic rami and intertrochanteric line of the femur reinforcing the joint anteriorly and inferiorly
Prevents abduction and extension

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37
Q

Describe the ischiofemoral ligament

A

Spans between the body of the ischium and the greater trochanteric line, reinforces the capsule posteriorly
Prevents hyperextension, holds femoral head in joint

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38
Q

What is the vascular supply of the hip

A

Medial and lateral circumflex femoral arteries
Branches of the profunda femoris arteries
Superior and inferior gluteal arteries also provide some supply

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39
Q

What does the spiral orientation of the external hip ligaments allow

A

For them to become tighter when the joint is extended

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40
Q

Describe the reciprocal fashion in which the ligaments and muscles of the hip joint work

A

Anteriorly - where the ligaments are strongest, the medial flexor are fewer and weaker
Posteriorly - where the ligaments are weakest, the medial rotators pull the head of the femur into the acetabulum

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41
Q

Which muscles are responsible for flexion of the hip

A

Iliopsoas
Rectus Femoris
Sartorius
Pectineus

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42
Q

Which muscles are responsible for extension of the hip

A

Gluteus maximus
Semimembranous
Semitendinous
Biceps femoris

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43
Q

Which muscles are responsible for abduction of the hip

A

Gluteus medius
Gluteus minimus
Piriformis
Tensor Fascia Latae

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44
Q

Which muscles are responsible for adduction of the hip

A

Adductors longus, brevis and Magnus
Pectineus
Gracilis

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45
Q

Which muscles are responsible for lateral rotation of the hip

A

Biceps femoris
Gluteus maximus
Piriformis
Assisted by Obturators, gemelli and quadratus femoris

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46
Q

Which muscles are responsible for medial rotation of the hip

A

Anterior fibres of gluteus medius and minimus, tensor fascia latae

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47
Q

What restricts extension at the hip

A

Iliofemoral ligament and the joint capsule

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48
Q

What kind of hip dislocation is most common and why

A

Posterior dislocation
Femoral head is forced posteriorly and tears through the posterior and inferior aspect of the joint capsule where it is weakest

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49
Q

Which nerve is at risk in a posterior dislocation

A

Sciatic nerve

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50
Q

What are the articulating surfaces of the knee

A

Tibiofemoral
Patellofemoral

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51
Q

What is the blood supply of the knee

A

Supplied by the genicular anastomosis which is formed from genicular branches of the femoral and popliteal arteries

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52
Q

What are the menisci of the knee formed from and what is their function

A

Fibrocartilage discs
2 functions - to deepen the articular surface of the tibia, increasing stability of the joint
To act as shock absorbers

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53
Q

What is the medial meniscus attached to

A

The tibial collateral ligament
The joint capsule
Intercondylar attachment

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54
Q

How many bursa are associated with the knee and what are they

A

4
Suprapatellar
Prepatellar
Infrapatellar
Semimebranous

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55
Q

Which bursa in the knee is split into two and where is it found

A

Infrapatellar bursa
Deep bursa - lies between the tibia and the patellar ligament
Superficial bursa - patella ligament and the skin

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56
Q

Which bursa is found at the posterior aspect of the knee joint

A

Semimembranous

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57
Q

Name the ligaments associated with the knee

A

Patellar ligament
Medial collateral ligament
Lateral collateral ligament
Anterior cruciate ligament
Posterior cruciate ligament

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58
Q

Where does the anterior cruciate ligament attach

A

Anterior intercondylar region of the tibia, blending with the medial meniscus
Ascends posteriorly to attach to the femur in the intercondylar fossa

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59
Q

What is the function of the ACL

A

Prevents anterior dislocation of the knee

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60
Q

Where does the posterior cruciate ligament attach

A

Attaches at the posterior intercondylar region of the tibia, ascends anteriorly to attach to the anteromedial condyle

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61
Q

What is the function of the PCL

A

Prevents posterior dislocation of the knee

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62
Q

What are the movements of the knee

A

Extension
Flexion
Lateral rotation
Medial rotation

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63
Q

Which muscles facilitate knee extension

A

Quadriceps femoris

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64
Q

Which muscles facilitate knee flexion

A

Hamstrings
Gracilis
Sartorius
Popliteus

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65
Q

Which muscles facilitate lateral rotation of the knee

A

Biceps femoris

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66
Q

Which muscles facilitate medial rotation of the knee

A

Semimembranous
Semitendinous
Gracilis
Sartorius
Popliteus

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67
Q

What is housemaids knee

A

Prepatellar bursitis
Caused by friction between the skin and the patella

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68
Q

What is clergyman knee

A

Infrapatellar bursitis
Caused by friction between the skin and the tibia

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69
Q

What is the unhappy triad of the knee

A

rupture of the medial meniscus, medial collateral ligament and ACL

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70
Q

What type of joint is the proximal tibiofibular joint

A

Plane type synovial joint - bones glide over each other to produce movement

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71
Q

Which structures support the proximal tibiofibular joint

A

Anterior and posterior superior tibiofibular ligaments
Lateral collateral ligament of the knee joint
Biceps femoris

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72
Q

What is the blood supply

A

Inferior genicular arteries and anterior tibial recurrent arteries

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73
Q

Which nerve innervates the proximal tibifibular joint

A

Common fibular nerve
Nerve to popliteus

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74
Q

What type of joint is the distal tibiofibular joint

A

Fibrous joint

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75
Q

What structures support the distal tibiofibular joint

A

Interosseous membrane
Anterior and posterior inferior tibiofibular ligaments
Inferior transverse tibiofibular ligament

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76
Q

What does the posterior inferior ligament continue as

A

Inferior transverse tibiofibular ligament

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77
Q

What is the arterial supply of the distal tibiofibular joint

A

Fibular artery
Anterior and posterior tibial arteries

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78
Q

What is the nerve supply of the distal tibiofibular joint

A

Deep peroneal nerves
Tibial nerve

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79
Q

Describe the ankle joint

A

Hinge joint
Formed by the tibia, fibula and talus
Tibia and fibula bound together by strong tibiofibular ligaments, forms a mortise which the body of the talus snugly fits in

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80
Q

What are the movements of the ankle joint

A

Dorsiflexion
Plantarflexion

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81
Q

In which movement is the ankle joint less stable

A

Plantarflexion

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82
Q

Describe the medial ligament of the ankle

A

Medial ligament arises from the medial malleolus, spans out to create four ligaments which attach to the talus, calcaneus and navicular bones

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83
Q

What is the function of the medial ligament

A

To resist over-eversion of the foot

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84
Q

Describe the lateral ligament of the ankle

A

Lateral ligametn arises from the lateral malleolus, it consists of 3 distinct ligaments
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament

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85
Q

What is the function of the lateral ligament

A

To resist over inversion of the foot

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86
Q

which muscles facilitate plantarflexion

A

Muscles in the posterior compartment of the the leg
Gastrocnemius
Soleus
Plantaris
Posterior Tibialis

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87
Q

Which muscles facilitate dorsiflexion

A

Muscles in the anterior compartment of the leg
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus

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88
Q

What is the arterial supply of the ankle

A

Malleolar branches of the anterior tibial, posterior tibial and fibular arteries

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89
Q

Why is the lateral ligament of the ankle more likely to be damaged

A

It is weaker than the medial ligament
It resists inversion

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90
Q

Which is the ligament most likely to be irreversibly damaged

A

Anterior talofibular ligament

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91
Q

What is a Potts fracture

A

A bimalleolar fracture (lat and medial malleolus)
Trimalleolar fracture (lat, medial malleoli and distal tibial fracture)

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92
Q

Which bones articulate in the subtalar joint

A

Posterior talar surface
Posterior calcaneal articular facet

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93
Q

Which 3 ligaments support the subtalar joint capsule

A

Posterior talocalcaneal ligament
Medial talocalcaneal ligament
Lateral talocalcaneal ligament

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94
Q

Which ligament supports the subtalar joint within the joint capsule and where is it found

A

Interossesous talocalcaneal ligament
Found in the sinus tarsi - small cavity between the talus and calcaneus

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95
Q

What is the movements of the subtalar joint

A

Eversion
Inversion

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96
Q

Which muscles produce the movements at the subtalar joint

A

Eversion - lateral compartment muscles
Inversion - tibialis anterior

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97
Q

What is the blood supply of the subtalar joint

A

Posterior tibial artery
Fibular artery

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98
Q

What is the nervous innveration of the subtalar joint

A

Plantar aspect - Medial or lateral plantar nerve
Dorsal aspect - Deep fibular nerve

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99
Q

The femoral artery is a continuation of which artery

A

External iliac artery

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100
Q

When does the external iliac artery form the femoral artery

A

When it crosses under the inguinal ligament and enters the femoral triangle

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101
Q

what is the first branch of the femoral artery and where does this arise

A

Profunda femoris
Arises from the posterolateral aspect of the femoral artery in teh femoral triangle

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102
Q

What are the 3 branches of the profunda femoris and what do they supply

A

Perforating branches - perforate adductor Magnus and supply the muscles in the medial and posterior thigh
Lateral femoral circumflex - wraps around anterior, lateral femur supplying some of lateral muscles
Medial femoral circumflex - posterior neck of femur, supplies head and neck

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103
Q

After the femoral triangle in which structure does the femoral artery travel

A

Adductor canal

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104
Q

Where does the femoral artery terminate and what does it become

A

The adductor canal ends at an opening in the adductor Magnus, the adductor hiatus, the femoral artery goes through this into the posterior compartment of the leg, becoming the popliteal arteyr

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105
Q

What does the obturator artery arise from and what does it branch into and supply

A

Internal iliac artery
Branches into
1. Anterior branch - pectinous, obturator externus, adductor muscles, gracilis
2. Posterior branch - Deep gluteal muscles

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106
Q

What supplies the gluteal region

A

Inferior gluteal artery

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107
Q

Which artery does the inferior gluteal artery arise from

A

External iliac artery

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108
Q

Where does the popliteal artery terminate and by dividing into what

A

At the inferior border of popliteus
Anterior tibial artery and tibioperoneal trunk

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109
Q

What does the tibialperoneal trunk divide into and what is there path

A

Posterior tibial artery - runs alongside the muscles in the deep posterior compartment of the leg, enters sole of foot via tarsal tunnel with the tibial nerve
Fibular artery - runs posterior to the fibula

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110
Q

What does the anterior tibilar artery become in the foot

A

Dorsalis pedis artery

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111
Q

Which nerve is susceptible to compression due to a politeal artery aneurysm, and how would this present

A

Tibial nerve
Weakened/absent plantar flexion
Paraesthesia of foot and posterolateral leg

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112
Q

What are the 2 main arteries in the foot

A

Dorsalis pedis
Posterior tibial artery

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113
Q

What does the posterior tibial artery divide into

A

Lateral and medial plantar arteries

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114
Q

What are the 2 venous drainage systems in the lower leg

A

Deep venous system
Superficial venous system

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115
Q

Where are the deep veins of the leg found

A

Underneath the deep fascia of the legs, accompanying the arteries

116
Q

Where are the superficial veins of the leg found

A

Subcutaneous tissue

117
Q

Describe the deep veins of the foot and leg

A

Dorsal venous arch is teh main structure in the foot, but it mainly drains to superficial veins
Some deep drainage to form the anterior tibial vein
Medial and lateral plantar veins combine to form the posterior tibial and fibular veins
On the posterior surface of the knee, the anterior tibial, posterior tibial and fibular veins unite to form the popliteal vein

118
Q

Through which structure does the popliteal vein enter the thigh

A

Adductor canal

119
Q

When the popliteal vein enters the thigh what is it known as

A

Femoral vein

120
Q

Other than the femoral vein, what other deep veins are in the thigh

A

Profunda femoris vein

121
Q

What does the femoral vein drain into

A

External iliac vein

122
Q

What is the gluteal region drained by and what does this drain into

A

Inferior and superior gluteal veins
Drains into internal iliac vein

123
Q

Describe the path of the great saphenous vein

A

Formed by dorsal venous arch of the foot
Ascends on medial side of leg, anterior to medial malleolus, posterior to medial condyle at knee
Terminates by draining into femoral vein immediately inferior to inguinal ligament

124
Q

Describe the path of the short saphenous vein

A

Formed by dorsal venous arch of foot and dorsal vein of little toe
Moves up posterior aspect of leg, posterioer aspect of lateral malleolus
Between 2 heads of gastrocnemius and drains into popliteal vein

125
Q

Describe the lymphatic drainage of the lower limb

A

Superficial vessels - which can be split into medial and lateral groups
Medial vessels - follow long saphenous vein drain into inguinal nodes
Lateral vessels - follow short saphenous vein drain into popliteal nodes
Deep lymphatic vessels - split into anterior tibial, posterior tibial and peroneal - they accompany the artery and drain into popliteal nodes

126
Q

Where are the inguinal lymph nodes found

A

In the femoral triangle

127
Q

How are the inguinal lymph nodes divided

A

Divided by their position in relation to the horizontal line drawn at the level of the termination of teh great saphenous vein
Above the line - superficial inguinal nodes
Below the line - sub-inguinal nodes (deep and superficial)

128
Q

Where would you find the superficial inguinal nodes and what drains to them

A

Form a line below the inguinal ligament
Drain penis, scrotum, perineum, buttock and abdominal wall

129
Q

Where would you find the superficial sub inguinal lymph nodes and what drains to them

A

Located on each side of the proximal section of the great saphenous vein.
They receive afferent input primarily from the superficial lymphatic vessels of the lower leg.

130
Q

The popliteal nodes drain to which nodes

A

Deep inguinal nodes

131
Q

What is the fascia lata

A

Deep fascial investment of the musculature of the thigh

132
Q

How does the fascia late split the thigh into compartments, and how many compartments will be formed

A

Gives rise to 3 inter muscular septae that attach centrally to the femur dividing it into 3 compartments - anterior medial and lateral

133
Q

Where is the fascia lata the thickest and why

A

Thickest along the superolateral aspect of the thigh, due to fascial condensations from gluteus Maximus and medius
Thick around the knee due to reinforcing fibres from the quadriceps tendon

134
Q

Which intermuscular septa of the fascia lata is the strongest

A

The lateral intermuscular septa

135
Q

What opening is found in the fascia lata and where is it

A

Saphenous opening
Just inferior to the inguinal ligament

136
Q

What is the iliotibial tract

A

Longitudinal thickening of the fascia lata, strengthened superioposteriorly by fibres from gluteus Maximus

137
Q

WHere does the IT tract extend from and to

A

Iliac tubercle to the lateral tibial condyle

138
Q

What movement does the IT tract facilitate

A

Extensor, abductors and lateral rotator of the hip
Also provides lateral stabilisation of the hip

139
Q

Where is tensor fascia lata found

A

From the iliac crest descending inferiorly to the super-lateral thigh
It inserts into the anterior aspect of the junction of the upper and middle third of the thigh

140
Q

What is the action of tensor fascia lata

A

Acts as a flexor, abductor and internal rotator of the hip
Helps reduce the overall force needed to move the hip joint
It functions to tighten the fascia lata, and so abducts and medially rotates the lower limb.

141
Q

What innervates tensor fascia lata

A

Superior gluteal nerve

142
Q

What is scarpas fascia and what does it blend with in the leg

A

Scarpas fascia is the superficial layer of fascia of the abdominal wall, it blends with the fascia lata just below the inguinal ligament

143
Q

What are the attachments of the fascia lata in the pelvis and hip region

A

Posterior- sacrum and coccyx
Lateral - iliac crest
Anterior - inguinal ligament, superior pubic rami
Medial - inferior ischiopubic rami, ischial tuberosity, sacrotuberous ligaments

144
Q

What are the 2 groups of gluteal muscles

A

Superficial abductors and extendors
Deep lateral rotators

145
Q

Which muscles are the superficial abductors and extendors of the gluteal region

A

Gluteus maximus, medius and minimis
Tensor fascia lata

146
Q

Which muscles are the deep lateral rotators of the gluteal region

A

Quadratus femoris
Piriformis
Gemellus superior and inferior
Obturator internus

147
Q

What is the blood supply of the gluteal muscles

A

Superior gluteal and inferior gluteal arteries - both branches of the external iliac artery

148
Q

Where does gluteus Maximus attach

A

Originates from the gluteal (posterior) surface of the ilium, sacrum and coccyx.
The fibres slope across the buttock at a 45 degree angle and insert onto the iliotibial tract and gluteal tuberosity of the femur.

149
Q

What is the action of gluteus Maximus

A

Main extensor of the thigh
Assists with lateral rotation

150
Q

What is the innervation of gluteus Maximus

A

Inferior gluteal nerve

151
Q

Where does gluteus medius attach

A

Originates from the gluteal surface of the ilium and inserts into the lateral surface of the greater trochanter.

152
Q

What is the action of gluteus medius

A

Abduction and medial rotation
Stabilisation of the pelvis, stops it dropping to one side

153
Q

What innervates gluteus medius

A

Superior gluteal nerve

154
Q

What is the attachment of gluteus minimus

A

Ilieum, converges to form a tendon attaching to the greater trochanter of the femur

155
Q

What is the action of gluteus minimus

A

Abduction and medial rotation
Stabilisation of the pelvis, stops it dropping to one side

156
Q

Which 2 gluteal muscles have the same action

A

Medius
Minimus

157
Q

What is Trendelenbrug positive and which nerve is injurid

A

Patient asked to stand unassisted on one leg, pelvic drop will occur on the unsupported leg
Due to weakness of gluteus medius and minimus following superior gluteal nerve injury

158
Q

Which deep gluteal muscle is the most superior

A

Piriformis

159
Q

where does piriformis attach

A

Anterior surface of sacrum
Greater trochanter of femur - fibres travels inferiorly and laterally through the greater sciatic foramen to insert here

160
Q

What is the action of piriformis

A

Lateral rotation and abduction

161
Q

What is the innervation of piriformis

A

Nerve to piriformis

162
Q

Where is obturator internus found and which structure does it form a wall of

A

Originates from the pubis and ischium at the obturator foramen.
Attaches to the greater trochanter of the femur, having travelled through the lesser sciatic foramen
Forms the lateral wall of the pelvic cavity

163
Q

What is the action of obturator internus

A

Lateral rotation and abduction

164
Q

What is the innervation of obturator internus

A

Nerve to obturator internus

165
Q

Where do the gemelli attach

A

Superior - from the ischial spine
Inferior - from the ischial tuberosity
They both attach onto the greater trochanter

166
Q

What is the action of the gemelli

A

Lateral rotation and abduction

167
Q

The gemelli have different nerve supplies, what are they

A

Superior - nerve to obturator internus
Inferior - nerve to quadratus femoris

168
Q

Where does quadratus femoris attach

A

From the lateral aspect of the ischial tuberosity
Attaches to the quadrate tuberosity on the intertrochanteric crest

169
Q

What is different about quadratus femoris compared to the other deep gluteal muscles

A

Only does lateral rotation
The others do lateral rotation and abduction

170
Q

What is the innervation of quadratus femoris

A

Nerve to quadratus femoris

171
Q

Summarise the anterior compartment of the upper limb (movement, innervation, blood supply)

A

Extend the lower limb at the knee
Innervation - femoral nerve
Blood supply - femoral artery

172
Q

List the muscles in the anterior compartment of the leg

A

Psoas Major
Iliacus
Rectus femoris
Vastus Medialis
Vastus lateralis
Sartorius
Pectineus

173
Q

What compromise Iliopsoas and where do they form a common tendon

A

Iliacus
Psoas
Form a common tendon under the inguinal ligament

174
Q

What is the action of iliopsoas

A

Flexion of the thigh at the hip

175
Q

What is the nerve supply to iliopsoas

A

Psoas - innervated by anterior rami of L1-3
Illacus - femoral nerve

176
Q

What makes up quadratus femoris

A

Vastus lateralis
Vastus Intermedius
Vastus medialis
Rectus femoris

177
Q

What innervates quadratus femoris

A

Femoral nerve

178
Q

What is the combined action of quadratus femoris

A

Extension of the knee joint, secondary function of stabilising the patella

179
Q

What is the additonal movement that rectus femoris facilitates

A

Flexion of the hip joint
It is the only quadriceps to cross both joints

180
Q

Where does Sartorius attach to

A

From the ASIS to the superior, medial surface of the tibia

181
Q

What is the action of sartorius

A

Flexor
Abductor
Lateral rotator

182
Q

What innervates sartorius

A

Femoral nerve

183
Q

Pectineus contributes to the floor of which structure

A

Femoral triangle

184
Q

What is the action of pectineus

A

Adduction and flexion at the hip joint

185
Q

What is the innervation of pectineus

A

Femoral nerve
May also get a branch from the obturator nerve

186
Q

What are the muscles of the medial compartment of the thigh, what are they collectively known as and what nerve innervates them

A

Gracilis
Obturator externus
Adductor brevis
Adductor Longus
Adductor Magnus
Adductors of the thigh
Innervated by obturator nerve

187
Q

Which is the largest muscle in the medial compartment

A

Adductor magnus

188
Q

What are the two components of the adductor Magnus and their actions

A

Adductor component - adducts and flexes the thigh
Hamstring component - Adducts and extends the thigh

189
Q

what is the innervation of adductor magnus

A

Adductor - obturator nerve
Hamstring - tibial component of sciatic nerve

190
Q

The adductors attach to which part of the femur

A

Linea Aspera

191
Q

Adductor longus forms the medial border of which structure

A

Femoral triangle

192
Q

Adductor brevis separates which structures

A

Anterior and posterior branches of the obturator nerve

193
Q

What are the actions of obturator externus

A

Adduction
Lateral rotaton

194
Q

What is the function of Gracilis

A

Adduction of the thigh
Flexion of the knee

195
Q

What are the muscles in the posterior compartment of the thigh, what is their action and innervation

A

Hamstrings - biceps femoris, semitendinous, semimembranous
Action - extend at the hip, flex at the knee
Innervation - sciatic nerve

196
Q

Where does the tendon of biceps femoris insert

A

Head of fibula

197
Q

What is the action of biceps femoris

A

Flexion at knee
Extension at hip
Lateral rotation of hip and knee

198
Q

What is the innervation of the two head of biceps femoris

A

Long head - tibial part of sciatic nerve
Short head - common fibular part of sciatic nerve

199
Q

Which hamstring is found on the medial aspect of the posterior thigh and what lies medial and deep to this

A

Semitendinous
Semimembranous

200
Q

What is the action of semitendinous and semimembranous

A

Flexion of knee
Extension of hip
Medial rotation of hip and knee

201
Q

The tibial part of the sciatic nerve supplies which hamstrings

A

Semitendinous
Semimembranous
Long head of biceps femoris

202
Q

Sudden and forceful contraction of the hamstrings can produce an avulsion fracture of which structure

A

Ischial tuberosity

203
Q

How many muscles are in the anterior compartment of the leg, what are they called, what is their combined function and what nerve supplies them

A

4
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Fibularis teritus
Dorsiflexion and inversion of the foot
Deep fibular nerve (L4-S1)

204
Q

Which is the strongest dorsiflexor of the foot

A

Tibialis anterior

205
Q

What lies deep to tibialis anterior

A

Extensor digitorum longus

206
Q

What is the action of extensor hallucis longus

A

Extension of the toe
Dorsiflexion of the foot

207
Q

Which of the dorsiflexors are not present in all individuals

A

Fibularis teritus

208
Q

What are the muscles in the lateral compartment of the leg, what is their action and what innervates them

A

Fibularis longus and brevis
Action - eversion
Supplied by the superficial fibular (peroneal) nerve

209
Q

Where does the tendon of fibularis longus insert

A

Posterior to the lateral malleolus

210
Q

The posterior compartment of the leg can be subdivided into how many compartments

A

2 - superficial and deep

211
Q

Which muscles are in the superficial posterior compartment

A

Gastrocnemius
Soleus
Plantaris

212
Q

Which two muscles converge to form the calcaneus tendon

A

Gastrocnemius and soleus

213
Q

What is the innervation of the superficial muscles of the posterior compartment

A

Tibial nerve

214
Q

What is the action of the muscles in the superficial posterior compartment of the leg

A

Plantarflexion at the ankle joint
Flexion at the knee joint from Gastrocnemius and planters

215
Q

Which 2 bursa lie in the superficial posterior compartment of the leg

A

Subcutaneous calcaneal bursa
Deep bursa of the calcaneal bursa

216
Q

Which muscles are in the deep posterior compartment of the leg

A

Popliteus
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior

217
Q

Which muscle in the deep posterior compartment of the leg acts on teh knee and what does it do

A

Popliteus
Laterally rotates the femur relative to the tibia - unlocking the knee so that flexion can occur

218
Q

Which of the muscles in teh deep posterior compartment of the leg contribute to plantarflexion

A

Tibialis posterior

219
Q

What is the innervation of the deep posterior compartment of the leg

A

Tibial nerve

220
Q

Which muscle in the deep posterior compartment of the leg contributes to the medial arch of the foot

A

Tibialis posterior

221
Q

Why is the position of flexor hallucis longus in the leg odd

A

it is found laterally in the leg, where it runs medially in the foot to the great toe

222
Q

What are the two muscles found on the dorsal aspect of the foot, what is their action and innervation

A

Extensor digitorum brevis
Extensor hallucis brevis
Responsible for extension of the great toe and the 4 toes,
Innervated by the deep fibular nerve

223
Q

How many intrinsic muscles of the foot are there on the plantar aspect, and across how many layers

A

10 intrinsic muscles of the foot
Across 4 layers

224
Q

Which muscles are found in the first (most superficial) layer of the plantar aspect of the foot

A

Abductor hallucis
Flexor digitorum brevis
Abductor digit minimi

225
Q

Which muscles are found in the second layer of the plantar aspects of the foot

A

Quadratus plantae
Lumbricals - 4 lumbricals, each found medial to their respective tendon of flexor digitorum longus

226
Q

Which muscles are in the thrid layer of the plantar aspect of the foot

A

Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis

227
Q

Which muscles are in teh fourth layer of the plantar aspect of the foot

A

Planatr and dorsal interossei

228
Q

What is the innervation of the plantar muscles of the foot and what is the general rule and exceptions

A

medial and lateral plantar nerves - branches of the fibular nerve
Muscles lateral - supplied by lateral plantar nerve, (medial = medial)
Interossei - all supplied by lateral plantar

229
Q

Which spinal roots form the lumbar plexus

A

L1-L4

230
Q

Which nerves arise from the lumbar plexus

A

Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral cutaneous
Femoral
Sciatic

231
Q

What is the root of the iliohypogastric nerve and what does it innervate

A

L1
Internal oblique and traverses abdominis
Posterolateral gluteal skin in pubic region

232
Q

What is the root of the ilioinguinal nerve and what does it innervate

A

L1
Internal oblique and transversus abdominis
Skin of superio-medial thigh
In men - skin over penis and anterior scrotum
In women - Skin over mons pubis and labia majora

233
Q

What is the root of the genitofemoral nerve and what does it innervate

A

L1 L2
Genital branch - cremasteric fascia, anterior scrotum/mons pubis and labia majora
Femoral branch - skin of upper anterior thigh

234
Q

Which muscle does the genitofemoral nerve leave

A

Psoas Major

235
Q

What is the root of the lateral cutaneous nerve and what does it innervate

A

L2, L3
Anterior and lateral thigh down to the level of the knee.

236
Q

What is the roots of the femoral nerve

A

L2- L4

237
Q

Which muscles are innervated by the femoral nerve

A

Anterior thigh muscles that flex the hip - Sartorius, Pectinous, Iliacus
Knee extenders - quads - rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

238
Q

Which area receives sensory innervation from the femoral nerve

A

Anteromedial thigh
Medial side of leg and foot

239
Q

Anterior cutaneous branch, branch to sartorial and branch to pectinous are anterior branches of which nerve

A

Femoral nerve

240
Q

The saphenous nerve and branch to quadriceps femoris are posterior branches of which nerve

A

Femoral nerve

241
Q

What are the nerve roots of the obturator nerve

A

L2-L4

242
Q

The muscles of medial compartment of the leg are innervated by which nerve

A

Obturator nerve

243
Q

Obturator nerve supplie sensation where

A

Medial thigh

244
Q

What are the branches of the obturator nerves and where are they found

A

Anterior branch (anterior to adductor brevis)
Posterior branch (posterior to adductor brevis)

245
Q

Which nerve roots form the sacral plexus

A

S1-S4

246
Q

Which nerves from from the sacral plexus

A

Superior gluteal
Inferior gluteal
Sciatic
Posterior femoral
Pudendal

247
Q

Which nerve roots form the superior gluteal nerve, and what does it supply

A

L4,L5, S1
Gluteus medius, gluteus minimus, tensor fascia lata

248
Q

Which nerve roots form the inferior gluteal nerve, and what does it supply

A

L5, S1, S2
Gluteus maximus

249
Q

Which nerve roots form the posterior femoral cutaneous nerve, and what does it supply

A

S1,2,3
Innervates the skin of the post thigh and leg and the perineum

250
Q

Which nerves leaves and then re-enters the sciatic foramen -

A

Pudendal nerve

251
Q

Which nerve roots form the pudendal nerve, and what does it supply

A

S2, S3, S4
Innervates the skeletal muscles in the perineum, external urethral sphincter, external anal sphincter and levator ani
Innervates the penis, clitoris most of the skin of the perineum

252
Q

The sciatic nerve can be described as which two nerves bundled togetehr adn where do they usually bifurcate

A

Tibial
Common fibular nerve
Bifurcates at the apex of the popliteal fossa

253
Q

The sciatic nerve passes through which quadrant of the buttock and why is this important

A

Lower medial quadrant
Important for giving IM injections - need to be given in the upper lateral quadrant

254
Q

What is piriformis syndrome

A

Compression of the sciatic nerve by piriformis muscle
Clinical features include radicular pain, numbness, muscle weakness and buttock tenderness.

255
Q

Summarise the motor innervations of the sciatic nerve

A

Posterior compartment of thigh - incl hamstring poriton of adductor magnus
Posterior calf muscles + some intrinsic feet muscles - via tibial nerve
Anterior lower leg, lateral lower leg + some intrinsic feet muscles - via common peroneal nerve

256
Q

Which branches of the sciatic nerve provide sensory innervation and to where

A

Tibial nerve – supplies the skin of the posterolateral leg, lateral foot and the sole of the foot.
Common fibular nerve – supplies the skin of the lateral leg and the dorsum of the foot.

257
Q

Which nerve roots form teh tibial nerve, and what does it supply

A

L4-S3
Sensory: Innervates the skin of the posterolateral leg, lateral foot and the sole of the foot.
Motor: Innervates the posterior compartment of the leg and the majority of the intrinsic foot muscles.

258
Q

List the muscles innervated by the tibial nerve

A

Gastrocnemius
Soleus
Plantaris
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

259
Q

Which is the only foot muscle to be innervated by the deep fibular nerve

A

extensor digitorum brevis

260
Q

What are the 3 sensory branches of the tibial nerve

A

Medial calcaneal branch
Medial plantar nerve
Lateral plantar nerve

261
Q

What is the sural nerve a branch of and what does it innervate

A

Tibial nerve - posterolateral side of the leg and the lateral side of the foot.

262
Q

What does the common fibular nerve provide motor innervation to

A

Short head of biceps femoris

263
Q

Superficial fibular nerve and deep fibular nerve are terminal branches of

A

Common fibular nerve

264
Q

Superficial fibular nerve and deep fibular nerve give motor innervation to which muscles

A

Superficial fibular nerve - lateral compartment - fibularis longus and brevis
Deep fibular nerve - anterior compartment - tibialis anterior, extensor digitorum longus and extensor hallucis longus

265
Q

What are the cutaneous branches of the common fibular nerve

A

Sural communicating nerve
Lateral sural cutaneous nerve

266
Q

Where does the rural communicating nerve innervate and after combining with what

A

Combines with a branch of the tibial nerve to form the sural nerve, which innervates the skin over the lower posterolateral leg.

267
Q

Where does the lateral sural cutaneous nerve supply

A

the skin over the upper lateral leg.

268
Q

Which nerve sipplie the skin of the first webbed space between hallux and toe 2

A

Deep fibular

269
Q

Where is the femoral triangle found

A

Superomedial aspect of the anterior triangle

270
Q

Which muscles make up the medial and lateral border of the femoral triangle

A

Lateral - medial border of sartorius
Medial - Medial border of adductor longus

271
Q

What makes up the floor of the femoral triangle

A

Pectineus
Iliopsoas
Adductor longus muscle

272
Q

What forms the superior border of the femoral triangle

A

Inguinal ligament

273
Q

What does the inguinal ligament act as during flexion of the hip

A

Flexor retinaculum - supports the contents of the femoral triangle

274
Q

What is the contents of the femoral triangle

A

Femoral nerve
Femoral artery
Femoral vein
Femoral canal

275
Q

What is found in the femoral canal

A

Lymph nodes and vessels

276
Q

What is enclosed femoral sheath

A

Femoral artery, femoral vein and canal

277
Q

What are the borders of the femoral canal

A

Medial - lacunar ligament
Lateral - Femoral vein
Anterior - Inguinal ligament
Posterior - Pectineal ligament

278
Q

What are the borders of the adductor canal

A

Anteromedial - Sartorius
Lateral - vastus medialis
Posterior - Adductor longus and adductor magnus

279
Q

What passes through the adductor canal

A

Femoral artery
Femoral vein
Nerve to vastus medialis
Saphenous nerve

280
Q

What is adductor canal syndrome

A

Compression of the femoral artery in the adductor canal by hypertrophy of the vastus medialis

281
Q

What are the borders of the popliteal fossa

A

Superomedial border - semimembranous
Superolateral border - biceps femoris
Inferomedial border - medial head of gastrocnemius
Inferolateral border - Lateral head of gastrocnemius and planters

282
Q

The popliteal fossa is continuous with what and forms the roof of which structure

A

Fascia lata
Popliteal fossa

283
Q

What is the contents of the popliteal fossa

A

Med - Lateral
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve (common peroneal)

284
Q

What is a bakers cyst

A

Semimembranous bursitis

285
Q

Which nerve can be compressed from a popliteal artery aneurysm and what are the clinical features

A

Tibial nerve
CF: Weakened or absent plantar flexion
Paraesthesia of foot

286
Q

What forms the tarsal tunnel

A

Medial malleolus
Medial tubercle of the calcaneus

287
Q

What travels through the tarsal tunnel

A

Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial artery and vein
Tibial nerve
Flexor hallucis longus tendon

MRCS (17 decks)

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