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Backup Gen > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

Three ligaments reinforce the hip capsule

A

• Iliofemoral (Y-shaped): from anterior inferior iliac spine, bifurcates, to each end of the trochanteric line (resists hyperextension)
- by the far the strongest!

  • Pubofemoral: from iliopubic junction to blend with the medial aspect of the capsule (resists extension and abduction)
  • Ischiofemoral: from the ischium and inserts into the base of the greater trochanter (limits extension)
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2
Q

Describe the blood supply to head of the femur.

A
  • Extracapsular arterial ring at the base of the femoral neck - medial and lateral circumflex femoral arteries from Profunda Femoris with smaller contributions from superior and inferior gluteal arteries.
  • Retinacular arteries arising from the ascending cervical branches. They give rise to the subsynovial intra articular ring.
  • Artery of ligamentum teres - derived from obturator or medial circumflex femoral artery.
  • Epiphyseal blood supply — arising primarily from medial and lateral epiphyseal arteries.
  • Metaphyseal blood supply — arise from branches of ascending cervical arteries, & subsynovial intraarticular ring.
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3
Q

What are the principal hip flexors at the nerve supply?

A

Psoas Major - L1-3 Ventral Rami
(Tips of Transverse processes T12-L4)

Iliacus - Femoral Nerve - L2-4

Insert into the lesser trochanter

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4
Q

External Rotators

A 
Gemellus S/I
Obturator I (Joint tendon with above 2)/E
Piriformis
Quad Fem
Gluteus Maximus
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5
Q

Hip Flexion

A

Flexion Femoral nerve (L2-L4)

Psoas major (- L1-3 Ventral Rami )
Iliacus
Rectus femoris
Sartorius

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6
Q

Hip Extension

A

Extension Inferior Gluteal Nerve (L5-S2)

Gluteus maximus

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7
Q

Hip Adduction

A 
Adduction - Obturator nerve (L2-L4)
Adductor longus 
Adductor magnus 
Adductor brevis 
Gracilis
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8
Q

Hip Abduction

A

Abduction Superior Gluteal Nerve (L4-51

Gluteus medius and minimus

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9
Q

Hip External Rotation

A

External rotation

Piriformis - NT Piriformis (S1-S2)
Gemellus superior - Nt Ob Int (L5-S2)
Obturator internus  - Nt Ob Int (L5-S2)
Gemellus inferior - Nt Qf Int (L4-S1)
Quadratus femoris - Nt Qf Int (L4-S1)
Obturator extemus - Post. Branch of Obturator Nerve L3-L4
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10
Q

Lateral to psoas major muscle

A 
Subcostal nerve (L1) 
Iliohypcgastric nerve (L1) 
Ilinguinal nerve (L1)

Lateral femoral cutaneous nerve (L2, L3)

Femoral nerve (L2 — 4)

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11
Q

Anterior to psoas major muscle

A

Genitofemoral nerve (L1, L2)
Gen - Skin over scrotum
Fem - Skin over femoral triangle

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12
Q

Medial to psoas major muscle

A

Obturator nerve (L2 —4)

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13
Q

Through greater sciatic notch to enter gluteal region, inferior to piriformis muscle.

A

Sciatic nerve (L4 — S3)

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14
Q

Emerges from inferior border of gluteus maximus

A

Posterior femoral cutaneous nerve (S1, S2, S3)

posterior thigh and buttock

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15
Q

Femoral Triangle

A
  • Roof: Fascia lata
  • Apex: Points inferiorly and continues with the adductor canal
  • Superior: The inguinal ligament
  • Medial: Medial border of adductor longus • Lateral: Medial border of sartorius
  • Floor (medial to lateral): Adductor longus, pectineus and iliopsoas
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16
Q

Contents of femoral sheath

A

femoral artery, femoral vein and femoral canal. NOT femoral nerve

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17
Q

femoral canal

A

femoral canal - medial compartment of the femoral sheath, opens superiorly into fem rm ring - contains fat, lymphatics and Cloquet’s node.

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18
Q

Cloquet’s node signficance

A

Cloquet’s node drains the lower limb, perineum and anterior abdominal inferior to the umbilicus. It may be enlarged in cases of carcinoma or infection at these sites.

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19
Q

Femoral Ring

A

Femoral ring is the superior opening of the femoral canal.

LMAP/FLIP

  • L ateral: Fascia around femoral vein
  • M edial: Lacunar ligament
  • A nterior: Inguinal ligament
  • P osterior: Pectineal ligament

Femoral hernias occur at the femoral ring.

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20
Q

Name the nerve roots of the sacral plexus.

A

The sacral plexus is formed from the anterior primary rami of L4-5, S1-4.

Note: Sacral nerves from anterior sacral foramina, unite in front of piriformis + joined by lumbosacral trunk (L4, 5)

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21
Q

Name the boundaries of the greater sciatic foramen.

A
  • Anterolaterally: Greater sciatic notch of the ilium
  • Posteromedially: Sacrotuberous ligament •Inferiorly: Sacrospinous ligament and the Ischial spine
  • Superiorly: Anterior sacroiliac ligament
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22
Q

Name the structures passing through the greater sciatic foramen ABOVE pirifomis.

A
  • Superior gluteal vessels

* Superior gluteal nerve

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23
Q

Name the structures passing through the greater sciatic foramen BELOW piriformis.

A
  • Inferior gluteal nerve + vessels
  • Internal pudendal vessels + nerve
  • Sciatic nerve
  • Posterior cutaneous nerve of the thigh •Nerve to quadratus femoris
  • Nerve to obturator internus
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24
Q

Name the boundaries of the lesser sciatic foramen.

A
  • Anterior: Tuberosity of the ischium
  • Superior: Spine of the ischium and sacrospinous ligament
  • Posterior: Sacrotuberous ligament
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25
Q

Name the structures passing through the lesser sciatic foramen.

A
  • Tendon of obturator internus
  • Nerve to obturator internus
  • Internal pudendal vessels •Pudendal nerve
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26
Q

The Popliteal Fosse contains:

A
  • Popliteal artery
  • Popliteal vein
  • Tibial nerve
  • Common fibular (peroneal) nerve
  • Lymph nodes

The roof contains:
• Small saphenous vein
• Posterior cutaneous nerve of thigh

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27
Q

Great saphenous vein:

A

Begins at the medial margin of dorsum venous arch of the foot - to femoral vein 3 cm. below inguinal ligament.

  • It ascends in front of the medial malleolus and along medial side of the leg in relation with the saphenous nerve.
  • It runs upward behind the medial condyles of the tibia and femur and to end in the femoral vein.
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28
Q

Small saphenous vein:

A

• Begins behind lateral malleolus a continuation of lat dorsal venous foot arch.

It first ascends along the lateral margin of the achilles tendon, and than crosses it to reach the middle of the back of the leg.

Running upward, it perforates the deep fascia in the lower part of the popliteal fossa, ending in popliteal vein, between the medial and the lateral heads of the gastrocnemius.

The small saphenous vein possesses nine to twelve valves, one of which is always found near its termination in the popliteal vein. In the lower third of the leg the small saphenous vein is in dose relation with the sural nerve which is vulnerable to damage during varicose vein surgery.

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29
Q

Tendons cross ankle anteriorly medial to lateral

A 
(Tall Husbands Are Never Dear Persons) 
• Tiballs Anterior 
• Extensor Hallucis Longus tendon 
• Anterior tibial artery 
• Deep peroneal Nerve 
• Extensor Digitorum Longus 
• Peroneus Tertius
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30
Q

Tendons crossing the ankle Joint (Medially):

A 
Tendons crossing the ankle Joint (Medially): 
From anterior to posterior: 
(Tom, Dick, And a Very Naughty Harry) 
• Tendon of Tibialis Posterior 
• Tendon of Flexor Digitorum Longus 
• Posterior Tibial Artery 
• Vena commitantes 
• Tibial Nerve 
• Tendon of Flexor Hallucis Longus
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31
Q

Name the three groups of ligaments of the ankle joint.

A

The three groups of ligaments which support the ankle joint are the:
•Deltoid ligament
•Lateral collateral ligamentous complex
•Syndesmosis

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32
Q

Deltoid ligament

A

•Deltoid ligament Consists of a

Deep pad (between medial malleolus + talus)
+
Superficial part - weaker and from medial malleolus + talus, calcaneus and navicular

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33
Q

Lateral collateral ligamentous complex

A

Consists of three bands:
Anterior and posterior talofibular ligaments and the
Calcaneoflibular ligaments

34
Q

Syndesmosis

A

Syndesmosis
Consists of four parts and is the most important ligament in maintaining normal alignment of the ankle joint:

Anterior inferior talofibular ligament
Posterior inferior talofibular ligament
lnferior transverse talofibularligamemt lnterosseous ligament

35
Q

Name the arches of the feet.

A
  • Medial longitudinal arch
  • Lateral longitudinal arch
  • Transverse arch (each foot contributes half of the transverse arch)
36
Q

Name the ligament which supplies the main support of the medial longitudinal arch of the foot?

A

The plantar calcaneonavicular ligament (spring ligament)

connects the sustentaculumtali with the plantar surface of the navicular bone.

It provides the main support for the medial longitudinal arch of the foot.

37
Q

Dorsalis pedisis pulse

A

between the tendons of extensor hallucis longus and extensor digitorum on the dorsum of the foot

38
Q

The Posterior tibial artery

A

a finger’s breadth below and behind the medial malleolus

39
Q

Intrinsic muscle layers of the foot

1st Layer

A

1st Layer - Small side ABductors and the middle flexor

  • Abductor hallucis
  • Flexor digitorum brevis
  • Abductor digitiminimi
40
Q

Intrinsic muscle layers of the foot

2nd Layer

A

2nd Layer

  • Quadratus plantae
  • Lumbricals
41
Q

Intrinsic muscle layers of the foot

3rd Layer

A 
3rd Layer 
Small side flexors + AH
Flexor halluicis brevis 
Adductor hallucis  
•Flexor digiti minimi brevis
42
Q

Intrinsic muscle layers of the foot

4th Layer

A
  • Plantar interossei

* Dorsal interossei

43
Q

Lower limb dermatomes

A
  • L1- Below the inguinal ligament
  • L2- Mid thigh
  • L3- Around the knee
  • L4- Medial side of the leg
  • L5- Lateral aspect of the leg, medial side of the dorsum of the foot
  • S1.- Lateral aspect of the foot, the heel and most of the sole
  • S2 - Posterior aspect of the thigh
  • S3, S4, S5 concentric rings around the anus, the outermost of which is S3
44
Q

Ovarian cyst - medial thigh pain

A

obturator nerve compression

45
Q

Young heavy smoker leg cramps

A

Buergers disease

46
Q

Superior and Inferior gluteal arteries from…

A

Sup Glut Artery from post trunk of internal iliac. IGA from anterior trunk

47
Q

Trendelenburg gait: abduction loss

A

sup glut nerve + buttock wasting glut medius [min + TFL] without foot drop.

48
Q

Trendelenburg gait + foot drop

A

L5 radiculopathy or polio

49
Q

Lat cutaneous nerve of the thigh with respect to inguinal ligament

A

Lat cutaneous nerve of the thigh, lateral aspect of inguinal ligament

50
Q

Heads of Adductor Magnus:

A

Adductor Magnus:
Posterior by Obturator +
Hamstring/ Ischiocondylar by Sciatic

51
Q

Marks end of Hunter’s canal

A

Adductor Magnus marks end of Hunter’s canal

52
Q

Biceps Femoris-…

A

Both heads insert into fibula head
o Long head – ischial tuberosity – sciatic nerve
o Short head – linea aspera – common peroneal nerve

53
Q

Bone met in femur that is hypervascular –

A

renal primrary

54
Q

Sartorius - Forms the Pes anserinus with

A

Sartorius - Forms the Pes anserinus with Gracilis + semitendinous

55
Q

For intracapsular NOF, divide….

A

Divide transverse branch of lateral circumflex

56
Q

Ankle eversion occurs at the

A

Ankle eversion at subtalar joint

57
Q

Hunters canal:

A

Hunters canal: Saphenous Vein, superficial artery and vein

58
Q

Osteolytic lesion? Psoas major can avulse

A

Osteolytic lesion? Psoas major can avulse lesser trochanter!

59
Q

Young person with mid-thight mass

A

Young person with mid-thight mass – Ewing Sarcoma

60
Q

Psoas major inserts into

A

lesser trochanter

61
Q

Malunion – not typically in

A

NOFs

62
Q

lies under SFJ, damaged during varicose surgery

A

Deep External pudendal artery – lies under SFJ, damaged during varicose surgery

63
Q

Nerve to EHL

A

Extensor hallucis longus L5

64
Q

Tibialis anterior nerve root

A

L5

65
Q

McMurrays

A

McMurrays – flex the knee
– internal rotation = lat mesicus
extn = medial lemniscus

66
Q

Delayed swelling and locking… diagnosis and management

A

torn meniscus - Arthroscopic menisectomy – no conservative management

67
Q

female pain going downstairs, wasting of quads

A

Chondromalacial patalle

68
Q

Upper part of the popliteal fossa - tibial nerve lies …and then passes…

A

Upper part of the popliteal fossa - tibial nerve lies laterally to vessels, it then passes superficial to them to lie medially.

(like the median nerve!)

69
Q

Inferior aspect of the popliteal fossa - tibial nerve with respect to vessels

A

tibial nerve superior to vessels.

70
Q

Deepest structure in popliteal fossa.

A

Popliteal artery - deepest structure in popliteal fossa.

71
Q

Osgood-Schlatter

A

Patella tendon inflam at tibial tuberosity, overactivity – repeated growth plate stress

72
Q

GrittiStrokes

A

through knee amputation, replace condyles with patella.

73
Q

Pseudogout

A

Pseudogout: calcium pyrophosphate; positively birefringent; rhomboid-shaped

74
Q

Gout

A

Gout: yellow monosodium urate; negatively birefringent; needle-shaped

75
Q

Spontaneous haemoarthosis in

A

Spontaneous haemoarthosis in Haemophilia (not vW’s)

76
Q

Posterior cruciate ligament separated from popliteal vessels by

A

Posterior cruciate ligament separated from popliteal vessels by oblique popliteal ligament.

77
Q

Transverse ligament in the knee is located

A

Transverse ligament is located anteriorly. - connects the two meniscii

78
Q

Sportsman – medial knee pain up stairs but not on flat –

A

Sportsman – medial knee pain up stairs but not on flat – pes anserius bursitis

Sartorius, gracilis and semitendinous tendons inserting into the anteromedial proximal tibia.

79
Q

Knee flex and twist – crack and swelling –

A

Knee flex and twist – crack and swelling – ant cruciate ligament

80
Q

Cuboid

A

Cuboid -
4th + 5th MT’s
Calcaneus

Medially - 3rd cuneiform + navicular.

Tibialis posterior attached to under surface.

81
Q

Plantar Flexor weakness

A

Plantar Flexor weakness is S1

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