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Locomotion > Lower limb 2 (proximal neurovasculature, knee and leg) > Flashcards

Lower limb 2 (proximal neurovasculature, knee and leg) Flashcards

1
Q

Where does the sacral plexus sit?

A

On the postero-lateral pelvic wall, anterior to piriformis muscle

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2
Q

What spinal nerves contribute to the sacral plexus?

A

L4, L5, S1, S2, S3 and S4

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3
Q

What are the major branches of the sacral plexus? (Hint: some irish sailor pesters polly)

A

Superior gluteal n, Inferior gluteal n, sciatic n, pudendal n, posterior cutaneous n of thigh, lumbosacral trunk (L4 and L5)

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4
Q

Where does the lumbar plexus sit?

A

It is located in the lumbar region, within the substance of the psoas major muscle and anterior to the transverse processes of the lumbar vertebrae.

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5
Q

What spinal nerves contribute to the lumbar plexus?

A

T12, L1, L2, L3 and L4

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6
Q

What are the major branches of the lumbar plexus?

A

Subcostal n, iliohypogastric n, ilioinguinal n, lateral cutaneous n of thigh (LCNT), femoral n, genitofemoral n, obturator n, lumbosacral trunk

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7
Q

What muscles does the ilioinguinal n supply?

A

After innervating the muscles of the anterior abdominal wall, it passes through the superficial inguinal ring to innervate the skin of the genitalia and middle thigh.

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8
Q

What is Meralgia Paraesthetica (CALVIN KLEIN SYNDROME)?

A

When the lateral cutaneous n of the thigh enters the anterior thigh, close to the ASIS and so can get compressed. Can occur by wearing tight clothes or by running.

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9
Q

At what level does the aorta bifurcate?

A

L4

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10
Q

What can happen as a result of pelvic fractures?

A

Laceration of vessels

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11
Q

At what point does the femoral artery enter the femoral triangle?

A

At the midinguinal point plus/minus 1.5cm

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12
Q

Where does the femoral vein sit in relation to the femoral artery?

A

1cm medial to the pulsating femoral artery.

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13
Q

What is the adductor canal and where does it run?

A 
The adductor (subsartorial) canal runs deep to sartorius in the middle 1/3rd of the medial thigh to the adductor hiatus.
Contains superficial femoral artery, femoral vein and saphenous nerve
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14
Q

What does the saphenous n innervate?

A

knee and skin of medial leg and foot

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15
Q

What is compartment syndrome?

A

Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

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16
Q

Where do the horizontal group of the superficial inguinal nodes sit in relation to the inguinal ligaments?

A

Sit below the inguinal ligament

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17
Q

Where do the vertical group of the superficial inguinal nodes sit in relation to the great saphenous vein?

A

Follow the proximal part of the great saphenous vein

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18
Q

Where do the deep inguinal nodes sit?

A

Located in femoral canal and medial to femoral vein; Cloquet’s node sits in femoral canal

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19
Q

What do the inguinal lymph nodes drain?

A 
Lower limb
 Perineal region
 Penis
 Lower anal canal
 Lower vagina
 Anterior labia majora / scrotal skin
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20
Q

What can be confused with a lymph node and hernia in the inner thigh?

A

Saphena varix - can cause groin region swelling

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21
Q

What is the name of the fibrous joint between the tibia and fibula?

A

Interosseous membrane

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22
Q

What type of joint is the knee?

A

Synovial hinge joint

23
Q

What movements can the knee joint bring?

A

Flexion-extension
Rotation (medial and lateral)
Translocation (sliding)

24
Q

Where is the knee joint palpable?

A

Knee joint line is palpable anteriorly and sits ~2cm distal to the skin crease behind the joint

25
Q

Name the articulations of the knee joint!

A

The knee joint consists of x3 separate articulations (x2 femero-tibial, x1 femero-patellar)

26
Q

The two menisci of the knee (lateral and medial), what are they made of?

A

The menisci are crescent shaped pieces of fibrocartilage sat on the superior surface of the tibial condyles

27
Q

What are 4 functions of the menisci?

A

Increase contact area
weight-bearing
Act as shock absorbers
Participate in locking mechanism

28
Q

What are the 3 functions of the patella?

A

Reduces ligament and tendon wear
Spreads forces passing to femoral condyles
Increases the moment (mechanical bending force) of quadriceps muscles

29
Q

What prevents anterior-posterior translocation and rotation of the knee?

A

Anterior and posterior cruciate ligaments - ACL and PCL.

30
Q

What is the function of the Anterior/posterior cruciate ligament?

A

ACL prevents anterior tibial movement on femur. PCL prevents posterior tibial movement on femur

31
Q

What 2 tests can be used to examine the Cruciate ligament integrity/laxity by placing the ligaments under tension? Which is more sensitive?

A

The Drawer test (90 degree flexion) or Lachman test (20 degree flexion) may be used
Lachman is most sensitive test for anterior cruciate damage, reduces the chance of false negatives that may be associated with hamstring muscle tightness/tension

32
Q

What ligaments resit valus and varus forces at the knee?

A

Medial and lateral collateral ligaments

33
Q

What is the blood supply to the knee?

A

Extensive and anastomatic, avascular bone necrosis not likely to happen. Popliteal artery passes posterior to the knee

34
Q

What is the housemaid’s knee?

A

Prepatellar bursitis (on the patella)

35
Q

What is the clergyman’s knee?

A

Infrapatellar bursitis on the patellar ligament

36
Q

What is special about the suprapatellar bursa? (inflammation)

A

Bursa that communicates with the synovial joint space of the knee. Therefore, Knee joint inflammation/ effusion can extend into the suprapatellar bursa.

37
Q

How can we test for excess fluid/effusion in the knee?

A

Patella tap
Milk suprapatellar bursa inferiorly then press patella posteriorly. ‘Tap’ sensation felt if excess fluid (effusion) present

38
Q

What is close-packing of the knee upon full extension?

A

In close packing the femur rotates medially on tibia and ‘locks’; this passive movement tenses the ligaments of the knee; it is the position of greatest knee stability with the least muscle activity

39
Q

What does the politeus muscle do?

A

Unlocks a fully extended knee by laterally rotating the femur on the tibia
(Tibial nerve L5,S1)

40
Q

What is function of the tibialis anterior muscle?

A

Ankle dorsiflexion and foot inversion. Tibialis posterior also helps with foot inversion.

41
Q

What muscles conduct foot eversion?

A

Fibularis longus

Fibularis brevis

42
Q

What muscles help in ankle plantarflexion?

A

Gastrocnemius
Soleus
FDL and FHL
FL and FB

43
Q

What muscles conduct ankle dorsiflexion?

A

Tibialis anterior

EHL and EDL

44
Q

Name the function, nerve supply and arterial supply of the anterior compartment of the leg.

A

Foot and digit dorsiflexors and invertors
Deep fibular nerve (L4,5,S1)
Anterior tibial artery

45
Q

Name the function, nerve supply and arterial supply of the lateral compartment of the leg.

A

Lateral Compartment
Foot evertors
Superficial fibular nerve (L5,S1)
Fibular artery

46
Q

Name the function, nerve supply and arterial supply of the posterior compartment of the leg.

A

Foot and digit plantarflexors and invertors
Tibial nerve (L4,5, S1,2)
Posterior tibial artery

47
Q

Name the muscles of the anterior compartment of the leg. Mention what happens if these muscles are damaged.

A 
Tibialis anterior (LoF results in foot drop during the swing phase of gait)
Extensor digitorum longus and extensor hallucis longus ( LoF = inability to point toes at ceiling and foot drop (if tibialis anterior is also paralysed)
48
Q

What are the functions of the anterior compartment of the leg?

A

Guide foot placement during gait
Supports arches of the foot; weakness can cause arch collapse
Regional pain can be due to compartment syndrome, tibial stress # or chronic exertional stress on fascia

49
Q

What are the functions of the lateral compartment of the leg?

A

Resist excess foot inversion
Protect lateral collateral ligament from excess stress during inversion of the foot
Help balance body on foot during stance phase and help guide foot placement during gait

50
Q

Name the muscles of the lateral compartment of the leg.

A

Fibularis longus, brevis

51
Q

Name the muscles of the posterior compartment of the leg.

A 
Gatrocnemius
Plantaris
Soleus
Calcaneal tendon!
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
52
Q

What are the functions of the posterior compartment of the leg?

A

Support the arches of the foot; weakness = arch collapse
Neurovascular structures run anterior to soleus = deep and protected
Loss of function = weak/absent push-off

53
Q

Which of the following is deep and superficial?

Popliteal artery, vein and tibial nerve

A

Pop A is deep and tibial n is superficial

54
Q

What are some reasons of swellings in the popliteal fossa?

A

Popliteal cysts, Baker cyst and popliteal artery aneurysm, neuroma

Locomotion (26 decks)

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