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FAB > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

What are the key functions of the upper and lower limbs respectively

A

Upper: designed to place and use the hand in as many positions as possible so requires more mobility than stability at its joints

Lower: requires greater stability in order to bear weight

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2
Q

Give 4 major differences between upper and lower limbs

A

Rotation

Pelvic girdle is fixed whereas pectoral girdle is mobile

Tibia and fibula are fixed whereas radius and ulnar have movement between them

Hand has substantial independent digital movement (especially the thumb) whereas the foot is adapted to act as a segmented arched structure with limited independent movement of toes

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3
Q

5 roles of the vertebral column

A

Protect spinal cord and nerves

Support weight of body above pelvis

Provide a rigid and flexible axis for body and pivot for head

Posture and locomotion

Shock absorber

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4
Q

Describe the primary curves of the spine (2)

A

Found in embryonic life and are concave anteriorly (kyphosis)

Present in thoracic and sacral regions

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5
Q

Describe the secondary curves of the spine

A

Develop after birth and is concave posteriorly (lordosis)

Present in cervical region and lumbar region

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6
Q

Why do we have lordosis in the cervical spine ?

What kind of curve is this

A

To support the head and for binocular vision

Secondary

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7
Q

What is the point of the body and neural arch of a vertebral body

A

Body- weight bearing

Arch- protection

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8
Q

What is the neural arch made of

A

Pericles joining it to the body and lamina connecting the pedicles posteriorly

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9
Q

Where are the articular facets in the vertebral body

What kind of joint exists here

A

At the junction of the transverse processes: 2 superior and 2 inferior

Synovial

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10
Q

Where is the intervertebral foramen

Why do we have this

A

Formed between the pedicles of adjacent vertebrae

Where spinal nerves pass through

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11
Q

How are adjacent vertebrae connected

What kind of joint is this

A

By intervertebral discs and 2 ligaments connecting the vertebral bodies

Secondary cartilaginous

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12
Q

What is a vertebral disc composed of

A

A central nucleus pulposus which becomes more solid with age

This is surrounded by concentric rings of fibrocartiledge (the annulus fibrosis)

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13
Q

What is the nucleus pulposus a remnant of

What is it like at birth

A

The notochord

The nucleus pulposus is fluid at birth

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14
Q

What is the point of the annulus fibrosis

A

Resists torsion movements between vertebral bodies

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15
Q

What are the ligaments called that connect the vertebral bodies

A

Anterior and posterior longitudinal ligaments

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16
Q

What is a prolapsed disc and where does it usually occur

A

Degeneration and rupture if the annulus fibrosis, leading to protrusion of the nucleus pulposus which may press on a spinal nerve or the spinal cord

Most commonly happens in the lower lumbar region

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17
Q

Where are ligaments connected to the vertebrae to strength the facet joints

Give the name of each ligament

A 
Spinous processes (supraspinous and infraspinous)
Transverse processes (intertransverse)
Laminae (ligamentum flavum)
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18
Q

Where is the human centre of gravity

A

~55% of the person’s height above the ground

Usually 3cm in front of the 2nd sacral vertebra

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19
Q

What are the movement tendencies for all lower limb joints

A

Extension

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20
Q

What are the tendencies of the cervical, thoracic and lumbar regions of the spine

A

Cervical- flexion
Thoracic- flexion
Lumbar - extension

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21
Q

What resists cervical tendency

A

Tendency is flexion

Erector spinae and ligamentum nuchae resist this

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22
Q

What resists thoracic tendency

A

Tendency is flexion

Resisted by erector spinae

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23
Q

What resists lumbar extension

A

There is little muscle action needed

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24
Q

What resists hip joint tendency

A

Tendency is extension

Resisted by tension in iliofemoral ligament

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25
Q

What resists knee tendency to fall

A

Locked knee position (most ligaments are taut) and tension in fascia lata (by glut max and tensor fascia lata)

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26
Q

What resists ankle tendency to fall

A

Soleus

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27
Q

What resists hip flexion

A

Glut max

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28
Q

What resists knee flexion

A

Quadriceps femoris

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29
Q

What is the name for muscles that resist a joints tendency

A

Postural/ antigravity muscles

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30
Q

All postural muscles are required during upright position. True or false?

A

False

They are all needed to attain this posture but not to maintain it

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31
Q

Which positions do people usually stand in

Why

A

Feet apart or one slightly in front of the other

These use minimum energy

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32
Q

How is the foot designed

How can this be seen

A

To adapt to uneven surfaces yet be converted into a rigid strut for walking

Tarsals are arranged in a bow forming both longitudinal and transverse arches

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33
Q

What are the passive elements holding the foot arches together

A

Fascia and ligaments

Eg plantar aponeurosis, spring ligament, and plantar interosseus ligament

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34
Q

What are the dynamic elements holding the foot arches together

A

Intrinsic foot muscles

Eg flexor digitorum brevis and adductor hallucis

Muscles with longitudinally running ligaments eg flexor hallucis longus

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35
Q

What are the suspensory elements supporting the foot arches

A

Tibialis anterior

Fibularis longus

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36
Q

How do the arches change when the foot is loaded

A

They give a little as muscles and ligaments tense

This reduces jarring and allows the foot to adapt to uneven surfaces

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37
Q

As the load on the foot increases what happens to the arches

What about when the foot is fully loaded

A

The arches become more resistant as ligaments become more taut

The foot is transformed into a rigid lever that acts in plantar flexion during locomotion

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38
Q

What is the benefit of the foot being adaptable

A

Can be flexible and absorb forces when unloaded yet can transmit forces when loaded

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39
Q

What happens when one leg is lifted

How do we do this

A

The centre of gravity shifts to the other leg

By lateral flexion of the spine and the action of the abductors of the hip (glut medius and minimus) at the side that is ground

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40
Q

What do the hip abductors do when lifting one leg

A

Prevent pelvis from tilting to the side off the ground but also tilt the hip upward and shift weight over the supporting limb

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41
Q

How is the ground foot stabilises when standing on one leg

A

Action of the inverters (tibialis anterior and posterior) and everters (fibularis longus and brevis)

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42
Q

What happens if the hip abduction is impaired

A

Pelvis tilts to side off the ground

Producing a waddling gait- Trendelenburg’s sign

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43
Q

How are arms used in walking

A

Weighted pendulums to increase impetus

Also swung as balancers

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44
Q

Where does the walking cycle go from

What are the 2 phases? Which phase is longer?

A

Toe off to toe off

Swing and stance (stance is longer in normal walking, but as speed increases swing time increases)

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45
Q

What are the 5 events of walking

A

Toe off, mid swing, heel contact, mid stance, heel off

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46
Q

There is a period when both feet are on the ground during normal walking. True or false?

A

True

The double stance phase

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47
Q

What is it called when both feet are off the ground when running

A

Double swing phase

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48
Q

Describe pelvic movement when walking

Why do we have this

A

Medial rotation at hip at the side in stance phase while there is lateral rotation at the side in swing phase

So one foot comes down in front of the other

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49
Q

Which muscles are used when rising up

A

Gluteus maximus (hip extension) and quadriceps femoris (knee extension)

Agnostic contraction must occur when sitting

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50
Q

What kind of walk might a patient get after a CVA (cerebrovascular accident)

A

Paralysis of one side or a shuffling gait in someone with Parkinson’s

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51
Q

What may lead to a waddling gait

A

Developmental dysplasia of the hip
Femur neck fracture
Muscle weakness following poliomyelitis

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52
Q

Which nerve is most frequently affected by trauma

What is the effect

What phase of walking is most affected

A

Common fibular

Weakness of dorsiflexion and in the fibularis muscles - drop foot

This has a key issue in dorsiflexion during swing phase

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53
Q

What connects the lower limb to the axial skeleton

A

The pelvic girdle

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54
Q

What forms the pelvic girdle

A

To hipbones and the sacrum

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55
Q

How does the bony pelvis transfer bodyweight to the lower limbs

A

Through the acetabula

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56
Q

What are the four ways for structures to pass from the pelvis to lower limb

A

The inguinal ligament,
through the obturator foramina,
and through the greater
and lesser sciatic foramina

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57
Q

How is the lower limb divided

A

Into four regions: the gluteal region, thigh, leg and foot

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58
Q

Name two important areas which convey structures between the regions of the lower limb

A

The femoral triangle

The popliteal fossa

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59
Q

Name the six bone groups of the lower limb

A 
Hipbone, 
femur and patella, 
tibia and fibula, 
tarsus
metatarsus
phalanges
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60
Q

Give the nine joints of the lower limb

A 
Sacroiliac joints and pubic symphysis 
Hip
Knee
Tibiofibular (superior, middle and inferior)
Ankle (talocrural)
Midtarsal
Tarsometacarpal
Metatarsophalangeal
Interphalangeal
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61
Q

Describe the sacroiliac joints

A

They are synovial joints but very stable due to a regular interlocking ridges and strong interosseous ligaments

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62
Q

Describe the hip joint

A

Synovial ball and socket joint

With a deep acetabulum into which the head of the femur sits

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63
Q

In Which kind of patients are femoral neck fractures particularly common

A

Elderly people with osteoporosis

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64
Q

What kind of joint is the knee

What are the articulations of this joint

A

A complex synovial joint

Tibiofemoral and patellofemoral articulations

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65
Q

What are the principal functions of the medial and lateral menisci

A

Load transmission and shock absorption

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66
Q

What maintains stability in the knee

A

The strong collateral and cruciate ligaments and powerful muscles which also flex and extend the joint

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67
Q

What kind of joint is the superior tibiofibula joint

A

Synovial

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68
Q

Which joint is vital for ankle stability

A

Strong fibrous inferior tibiofibular joint

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69
Q

What kind of joint is the tibiofibular joint

A

Fibrous

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70
Q

What do the distal ends of the tibia and fibula form

A

A deep mortise into which the body of the talus fits, forming the ankle joint

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71
Q

Give the other name of the ankle joint

A

Talocrural joint

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72
Q

What are the midtarsal joints concerned with

A

Inversion and eversion of foot

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73
Q

What kind of joint are the tarsometatarsal joints

What do they permit

A

Synovial plane joints

Gliding movements

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74
Q

How is the thumb different from the big toe

A

The big toe has almost no mobility at its tarsometatarsal joint

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75
Q

What kind of joint are the metatarsophalangeal joints

A

Hinge joints with strong collateral ligaments

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76
Q

What kind of joint are the interphalangeal joints

A

Hinge joints with strong collateral ligaments

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77
Q

What are the three gluteal region muscle groups

What do these muscles do

A

Gluteal muscles
Tensor fasciae Latae
Short rotators of the hip

Move the thigh and control the movement of the pelvis relative to the weight-bearing limb in locomotion.

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78
Q

How did the lower limb rotate in embryological development? What has this resulted in?

A

Internally rotated

Has resulted in the extensor compartment being located anteriorly and flexor compartments being rotated posteriorly

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79
Q

Where is the thigh

A

Between the inguinal ligament and the knee

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80
Q

What’s supplies the quadriceps femoris

A

Femoral nerve

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81
Q

What is in the anterior compartment of the thigh

A

Quadriceps femoris

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82
Q

What muscle group can be found in the medial compartment of the thigh and which nerve supplies it

A

Adductors

Obturator nerve

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83
Q

Which muscle group is in the posterior compartment of the thigh? What is their action and what supply them?

A

Hamstrings

Extend the hip and flex the knee

Sciatic nerve

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84
Q

Where is the leg

A

Between the knee and the ankle

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85
Q

What are the compartments of the leg

A

Anterior lateral and posterior

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86
Q

Below the knee all muscles are supplied by which nerves

A

Tibial or common fibular nerves

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87
Q

The muscles in the leg produce which actions at the ankle joint

A

Doris flexion and plantar flexion

Also maintain the arches of the foot

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88
Q

What results in foot drop

A

The common fibular nerve winds around the neck of the fibula where it is superficial and thus liable to injury

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89
Q

What do the intrinsic muscles of the foot provide

A

Dynamic support in weight-bearing and locomotion

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90
Q

The lower limb is innervated by branches from which plexus

A

Lumbosacral

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91
Q

What does the lumbosacral plexus consist of

A

The lumbar plexus: formed by the anterior rami of L1-4

And

Sacral plexus: formed by branches from the anterior rami of L4 and 5 and S1-4

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92
Q

What does the femoral nerve pass under

A

The inguinal ligament

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93
Q

Which foramen does the obturator nerve pass through

A

The obturator foramen

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94
Q

Name two nerves passing out of the pelvis through the greater sciatic foramen

What do these supply

A

Superior and inferior gluteal nerves

3 gluteals and tensor fasciae latiae

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95
Q

Briefly describe the course of the femoral artery

A

The external iliac artery continues as the femoral artery below the inguinal ligament in the groin, and gives off the profound femoris artery to supply the muscles of the sign for husband.
The femoral artery continues down the thigh and passes through adductor hiatus to continue as the popliteal artery posterior to the knee

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96
Q

Describe the course of the popliteal artery as it leaves the popliteal fossa

A

Divides into the anterior and posterior tibial arteries supply the respective compartments of the leg

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97
Q

Where are the anterior and posterior tibial arteries palpable

A

At the ankle and in the foot

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98
Q

Which arteries supply the gluteal region

A

Superior and inferior gluteal arteries

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99
Q

What are the gluteal arteries branches of

A

The internal iliac artery

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100
Q

What is present in the valves of the lower limb to ensure one-way flow of blood from superficial and deep pains and then backed a heart

A

Valves

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101
Q

What are the superficial veins of the lower limb

A 
Great saphenous 
Femoral
Small saphenous
Popliteal fossa
Perforating veins
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102
Q

Describe the course of the great saphenous vein

A

Ascends anterior to the medial malleolus and along medial thigh to drain into the femoral vein in the groin

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103
Q

Describe the course of the small saphenous vein

A

Runs posterior to the lateral malleolus to drain into the popliteal vein in the popliteal fossa

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104
Q

What do the perforating veins of the lower limb do

A

Connect the superficial and deep venous systems along the medial side of the calf

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105
Q

The deep lymphatics of the lower limb drain to where?

A

With the arteries

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106
Q

The superficial lymphatics of the lower limb drain with which vessels?

A

With the veins

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107
Q

To wear to both groups of lymphatics in the lower limb drain to

Where else drains to here

A

Inguinal lymph nodes

Abdominal wall and perineum

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108
Q

What are the bony landmarks of the lower limb important for

A

They are important point of attachment of muscles and tendons and are important in diagnosis of many musculoskeletal disorders

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109
Q

What do the superficial veins of the lower limb arise from

A

The dorsovenous arch of the foot

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110
Q

Deep to the skin, the muscles and other structures are enveloped by what in the lower limb

A

A layer of deep fascia, the fascia lata

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111
Q

Where is the fascia lata particularly thick and well-developed

A

In the thigh where it forms the iliotibial tract on the lateral aspect

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112
Q

Describe the intermuscular septum of the lower limb

A

Extends from the deep Fasher dividing the thigh into anterior and posterior compartments

It divides the leg into anterior, posterior, and lateral compartment

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113
Q

What is the os innominatum

A

The hipbone

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114
Q

What is the pubis

A

The tubular set of bones which are located anteriorly in the hipbone

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115
Q

What kind of joint is the pubic symphysis

A

Secondary cartilagineous

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116
Q

What kind of joints on the sacroiliac joints

A

Synovial

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117
Q

What form is the superior border of the ilium

A

The iliac crest

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118
Q

Where does the iliac crease run from

A

From the anterior superior iliac spine to the posterior superior iliac spine

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119
Q

The iliac fossa gives attachment to which muscle

A

Iliacus

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120
Q

What does the ischial spine demarcate

A

The greater and lesser sciatic notches

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121
Q

What is the ischial tuberosity

What does it do

A

A thickening inferiorly

Supports weight when sitting

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122
Q

What does the pubic body bear

A

The pubic crest and pubic tubercle superiorly

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123
Q

What is the obturator foramen

A

An opening bounded by the ischium and the superior and inferior pubic rami

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124
Q

What forms the ischiopubic ramus

A

The fusion of the inferior pubic ramus with the ischial ramus

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125
Q

What is the largest bone in the body

A

The femur

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126
Q

How does the head of the femur extend from the neck into the acetabulum

A

Immediately, anteriorly and superiorly

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127
Q

Describe an interesting detail on the head of the femur

A

There is a central depression to which the ligamentum teres is attached

This is called the fovea

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128
Q

Discuss the neck of the femur

A

The next form is an angle of 125° (the angle of inclination) with the shaft

There is a 12° angle of anteversion of the femoral neck in relation to the femoral condyle is at the level of knee

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129
Q

Note something interesting about the shape of the femoral shaft

A

There is a forward convexity to the shaft

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130
Q

What are the greater and lesser trochanters

A

Thickenings on the proximal end of the femoral shaft

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131
Q

What marks the junction between the neck and the shaft of the femur

A

Anteriorly and posteriorly by the trochanteric line and the trochanteric crest respectively

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132
Q

What is the linea aspera

A

A line running longitudinally along the posterior aspect of the shaft, dividing into supracondylar lines distally

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133
Q

Where does the medial suprachondylar line end

A

At the adductor tubercle

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134
Q

Describe the surface between the supracondylar lines

A

The popliteal surface: it is smooth

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135
Q

What comprises the distal end of the femur

A

The medial and lateral femoral condyles

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136
Q

Which condyle is more prominent

What separates them

A

The lateral

The intercondylar notch posteriorly

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137
Q

What is the largest sesamoid bone in the body

A

Patella

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138
Q

What is the shape of the patella

A

Triangular with the base facing proximally and the apex distally

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139
Q

What is the posterior surface of the patella covered with

A

Articular cartilage for articulation with the intercondylar groove of the femur

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140
Q

What is the patella divided into

A

The larger lateral and smaller medial facets

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141
Q

What comprises the proximal end of the tibia

What is it called

A

The medial and lateral tibial condyles

Tibial plateau

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142
Q

What do the tibial condyles articulate with

A

The respective femoral condyles

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143
Q

What interrupts the tibial plateau

A

The intercondylar eminence (with 2 projections)

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144
Q

What are the 2 projections of the intercondylar eminence

A

The medial and lateral intercondylar tubercles

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145
Q

What is well marked in the intercondylar area

A

Facets for attachments of the horns of the menisci of the knee and the cruciate ligaments

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146
Q

What is on the Anterior aspect of the proximal end of the tibia

What insert here

A

The prominent tibial tuberosity

Patellar ligament

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147
Q

The inferior aspect of the lateral condyle has a small articular surface for articulation with what

What joint does this form

A

Head of fibula

The synovial superior tibiofibular joint

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148
Q

Describe the shaft of the tibia

A

A narrowing of the bone with a sharp anterior border.

The shaft is vertical in the standing position.

Proximal on his posterior surface surface is a rough and area, the soleal line, which extends obliquely to give attachment to the soleus muscle

Above the ankle the shaft Splays out to form the medial malleolus, and and articular surface on the lateral aspect for the inferior tibiofibular joint

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149
Q

What is the medial malleolus

A

A horizontal articular surface on the tibia which articulates with the talus

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150
Q

What gives the origin of the interosseous membrane between the tibia and fibula

A

The sharp lateral margin of the tibia

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151
Q

Where is the head of the fibula? what does it articulate with?

A

Proximal end

Forms a synovial joint with the inferior facet on the lateral tibial condyle

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152
Q

What forms the lateral malleolus

A

A slight splaying of the Fibula What’s the distal and which forms the lateral buttress of the ankle joint

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153
Q

What are the two distal medial facets of the fibula

A

Articulations with the tibia and with the talus

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154
Q

What are the seven bones of the tarsus

A

Calcaneus , talus, cuboid, navicula, three cuneiforms “(medial, intermediate and lateral)

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155
Q

What is the largest tarsal bone

A

The calcareous

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156
Q

What does the calcaneous articulate with

A

The talus superiorly and with the cuboid anteriorly to form the calcaneocuboid joint

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157
Q

A shelf projects from the upper border of the calcaneus on its medial surface. What is this called

A

The sustentaculum tali

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158
Q

What muscle is related to the sustentaculum

A

The tendon of flexor hallucis longus inferiorly

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159
Q

What does the calcaneus have a facet for anteriorly

A

Articulation with the cuboid

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160
Q

Describe the posterior surface of the calcaneus

A

Has a smooth upper part into which the calcaneal tendon (tendo Achilles) inserts with an intervening bursa

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161
Q

Describe the inferior surface of calcaneus

A

Inferior surface has 2 tubercles (large medial and smaller lateral)

They form the weight bearing part to which the plantar aponeurosis attaches

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162
Q

Which bone carries the weight of the whole body

A

The talus

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163
Q

Which bone forms the ankle joint

A

Talus

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164
Q

What does the talus do

A

Lies on the calcaneus and communicates thrust from the calcaneus to the tibia

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165
Q

Describe the talus

A

Has a body, neck and a rounded head, which articulates with the navicular

The other surface of the body articulated the tibia as part of the ankle joint and forms lateral and medial articular facet which articulate with the fibula and articular surface of the medial malleolus

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166
Q

True or false: the body of the talus is wider anteriorly than posteriorly

Why

A

True

So the dorsiflexed foot is locked

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167
Q

The inferior surface of the talus has what?

What does this allow

A

A large posterior facet that articulates with the superior surface of the calcaneus to form part of the subtalar joint

Inversion and eversion of the foot

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168
Q

What form is the midfoot

A

Articulations of the navicula, cuboid, and three cuneiform bones

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169
Q

What forms the tarsometatarsal joints

A

The cuboid and three cunieforms articulate with that metatarsals

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170
Q

How is the midfoot arched

A

Longitudinally and transversely

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171
Q

How is the Longitudinal arch of the foot maintained medially

A

By the plantar calcaneonavicular ligament

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172
Q

Which ligament is the spring ligament

A

The plantar calcaneonavicular ligament

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173
Q

How is the longitudinal arch of the foot maintained laterally

A

Supported by the long plantar ligament which is attached to the calcaneus and cuboid

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174
Q

Where does the long plantar ligament continue to

A

The bases of the 2nd and 4th metatarsals

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175
Q

What does the long plantar ligament form

A

The roof of the tunnel for the fibularis longus tendon

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176
Q

What is Deep to the long plantar ligament

A

The shorter, wider short plantar ligament

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177
Q

What does the short plantar ligament stretch between

A

Between the Calcaneus and cuboid

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178
Q

How is the transverse arch of the foot maintained during weight-bearing

A

By the wedge shaped cuneiforms and the tendon of fibularis longus

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179
Q

How many animals have feet with arches

A

Only humans

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180
Q

Other than bones/ muscles/ ligaments, what is indispensable for maintainence of the arches of the foot

A

The windlass mechanism

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181
Q

Describe The windlass mechanism

A

As the great toe is flexed the plantar aponeurosis is drawn tightly around the joint of the great tail. The increased tension within the plantar fascia packs all the joints of the foot tightly together, converting the foot to a rigid structure for the forward thrust of propulsion

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182
Q

How is the first metacarpal different to the first metatarsal

A

The first metatarsal is a thick bone lying parallel with the other metatarsals and with limited mobility at it tarsometatarsal joint

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183
Q

What is the first metatarsal important for

A

Transmitting thrust in propulsion

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184
Q

Which is the longest metatarsal

A

2nd

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185
Q

What does the base of the second metatarsal fit into

A

A mortise formed by the cuneiforms

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186
Q

Describe the base of the fifth metatarsal

A

Prominent and has a styloid process for the attachment of the tendon of fibularis brevis

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187
Q

How do the phalanges of the foot compare to those of the hand

A

They’re much smaller than the hand and movements are much more restricted

Unlike in the hand, abduction and addiction of the toes are movements away from and towards the second toe

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188
Q

Where does the great saphenous vein begin

How does it end

A

At the medial end of the dorsovenous arch when it is accompanied by the saphenous nerve

By piercing the cribriform fascia to open into the medial side of the femoral vein

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189
Q

How far behind the knee does the great saphenous vein run

A

A handbreadth

190
Q

How many valves does the great saphenous vein contain

A

Over a dozen

191
Q

Where does the small saphenous vein arise

What nerve accompanies it

A

From the lateral part of the dorsovenous arch where it ascends posterior to the lateral malleolus

Sural nerve

192
Q

How does the small saphenous vein run after leaving the lateral malleolus

A

Upwards along the lateral border of the calcaneal tendon and pierces the deep Fascia in the lower part of the popliteal fossa to enter the popliteal vein

193
Q

The great and small saphenous veins are analogous to which veins in the upper limb? However?

A

The cephalic and basilic veins respectively

However the great saphenous vein is medial while the cephalic vein is lateral in the upper limb. The same applies for the other two veins

194
Q

How does Venus return to the heart differ between the arms and legs

A

Blood returned from the arm to the heart is largely via the superficial veins, while in the leg the perforating veins direct blood towards the deep veins, so the soleus muscle can act as a pump to return blood to the heart

195
Q

What are the deep veins of the lower limbs enclosed within

What does this mean

A

Fascial Compartment and are subject to pressure at rest and during exercise

Professions of neighbouring arteries help move the blood up with a limb. During exercise, muscle contractions within the compartment compress the deep veins to force blood up the limb

196
Q

What prevent back flow from the high-pressure deep veins to the low-pressure superficial veins in the legs

A

Valves

197
Q

Name five musculoskeletal disorders that can be identified using the bony landmarks of the lower limb

A 
Trochanteric bursitis
Meniscal tears
Tendinitis of the tibialis posterior muscle
Ankle fracture 
Patella dislocation
198
Q

How do varicose veins occur

A

They occur in superficial veins of the lower limb and may result from incompetent valves in the perforating beans or at the saphenofemoral junction

199
Q

What is a “cut down”

A

Exposure of the great saphenous vein through the skin incision

200
Q

How is a “cut down” performed

When is it done

Why is it feasible

Why must care be taken

A

Anterior to the medial malleolus in an emergency situation

When the patient is in clinical shock

As the position of the vein is constant

Not to damage the saphenous nerve

201
Q

How much bodyweight does the fibula take

A

25% on heel strike during walking

202
Q

How does the fibula move while walking

Therefore fractures of the fibula result in?

A

The fibula rotate axially to allow movement of the talus and therefore flexion and extension of the ankle

Result in problems with weight-bearing and ankle movement

203
Q

What is an important anatomical landmark at the proximal end of the fibula

A

Where the common fibular nerve winds laterally across the neck of the fibula

As the nerve lies on the lateral aspect of the neck of the fibula, it is subcutaneous and therefore vulnerable to injury due to direct trauma or in fractures of the proximal fibula

204
Q

What can injury to the common fibula nerve result in

A

Foot drop

205
Q

How is the talus unique

A

It does not provide attachment for any muscle tendons and is held in place by ligamentous and bony elements

206
Q

Describe the main blood supply to the talus

What does this mean for talus fractures

A

Diet the neck from the sinus tarsi, a fat filled the space between the Calcaneus and the neck of the Talus, and runs in a retrograde fashion to supply the body

Fractures can lead to avascular necrosis of the body of the talus

207
Q

Where does the anterior compartment of the thigh extend from

A

From the hip to the knee

208
Q

Name the three muscles that are contained within the anterior compartment of the thigh

A

Fascia lata
Quadriceps femoris
Sartorius

209
Q

Which arteries, veins and nerves are contained within the anterior compartment of the thigh

A

Arteries: femoral and profunda femoris
Veins: femoral
Nerve: femoral

210
Q

What muscles are contained within the medial compartment of the thigh

What nerve supplies all of these? What is the exception?

A

Obturator externus
Pectineus
Adductor Magnus, brevis and longus
Gracilis

Obturator nerve

The ischial head of adductor Magnus (supplied by sciatic nerve) and pectineus (femoral nerve)

211
Q

How does the femoral nerve enter the thigh

A

Deep to the inguinal ligament, lateral to the femoral sheath and divides into muscular and cutaneous branches

212
Q

Where does the femoral artery extend from

Which of its branches supply the thigh

A

From the inguinal ligament to the adductor hiatus where it becomes the popliteal artery

Profunda femoris

213
Q

Describe the course of the obturator nerve

A

Runs deep in a canal in the upper part of the obturator foramen and divides into anterior and posterior branches, which supply the muscles in the medial compartment of the thigh and skin on the medial aspect of the thigh

214
Q

What are the actions of the muscles of the anterior compartment of the Thigh

What are they supplied by

A

Dorsiflexors of the ankle and extensors of the toes

The deep branch of the common fibular nerve

215
Q

What are the muscles of the lateral compartment of the leg

What are their actions

What are they innervated by

A

Fibularis longus and brevis

Eversion of the foot and weak plantar flexion of the ankle

The superficial branch of the common fibular nerve

216
Q

Describe the fascia lata

A

The thick layer of deep fascia that encloses the thigh and send septa to divide the muscles into groups

Proximately it is attached to the iliac crest and inguinal ligament

217
Q

Where is the saphenous opening

A

3 cm below and lateral to the pubic tubercle

218
Q

What is the saphenous opening covered in

A

A loose connective tissue, the sieve like cribriform fascia

219
Q

What pierces the cribriform fascia

A

The great saphenous vein as it drains into the femoral vein

220
Q

What does the fascia lata attach to inferiorly

A

The inferior margins of the tibial condyles, the head of the fibula and the patella blending with the patellar retinacula

221
Q

What does the fascia lata form laterally

Describe

A

The iliotibial tract

This receives insertions of tensor fasciae latae and gluteus maximus
It passes vertically down the posterolateral aspect of the thigh to insert onto the anterior aspect of the lateral tibial condyle. It has an important role in stabilising the extended knee

222
Q

Fill in the blanks: three muscles of the quadriceps femoris arise from the a) blank and one from the b) blank

A

a) femur

b) hip bone

223
Q

Where does the common tendon of quadriceps femoris converge

A

Via the patella and ligamentum patellae onto the tibial tuberosity

224
Q

What is the action of quadriceps femoris

A

All muscles extend the knee with rectus femoris being a hip flexor as well

225
Q

What nerve supplies quadriceps femoris

A

Femoral nerve

226
Q

Describe rectus femoris

A

Originates from the anterior inferior iliac spine, with a reflected head arising from the upper acetabula margin and hip joint capsule. It attaches to the patella superiorly

227
Q

Describe vastus medialis

A

Arises from the medial lip of the linea aspera, an area inferior to the lesser trochanter, and the intertrochanteric line. Its lowest fibres are inserted into the medial border of the patella and are important in maintaining patella stability

228
Q

Describe vastus lateralis

A

Arises from the lateral lip of the linea aspera, extending up to the base of the greater trochanter. It attaches to the lateral aspect of the patella

229
Q

Describe vastus intermedius

A

Lies deepest of the quadriceps femoris muscles.

Originates from the upper 2/3 of the shaft of the femur.

It is attached to the deepest surface of the extensor quadriceps mechanism

230
Q

Describe how the patella moves during knee movement

A

The patellofemoral joint slides superiorly when the knee extends and inferiorly when the knee flexes. A slight amount of medial and lateral deviation, as well as tilting, takes place during normal movement.

231
Q

How does the pull of rectus femoris and vastus lateralis affect the patella

A

The lateral and upwards pull on the patella and but his counteracted by the lowest fibres of vastus medialis and the prominent lateral femoral Condyle

232
Q

From where does Sartorius arise.? Where does it insert?

A

Arises from the anterior Superior iliac spine and insert into the upper part the medial surface of the tibia

233
Q

How does the Sartorius insertion relate to the insertions of gracilis and semitendinosus

A

Sartorius insert anterior to the insertions of gracilis and semitendinosus

234
Q

Which nerve supply Sartorius

A

The femoral nerve

235
Q

What is the action of Sartorius

A

A combination of flexion and lateral rotation of the hip, knee flexion, and medial rotation of the flex knee

236
Q

What is Sartorius named after

Why

A

The Tailor – sartorial elegance

It’s action brings the lower limb to sit cross-legged

237
Q

What are the boundaries of the femoral triangle

What forms its floor

A

Superiorly: inguinal ligament,

laterally: medial border of Sartorius,
medially: the medial border of adductor longus

Floor: iliacus, psoas Major, pectineus

238
Q

What are the contents of the femoral triangle surrounded by

What is the exception

A

The femoral sheath

The femoral nerve lies lateral outside the sheath

239
Q

Describe the femoral canal

A

Femoral canal lies medial to the femoral vein within the femoral sheath and transmits all the lymphatics from the lower limb. It provides space into which the femoral vein can expand and is the site of a femoral hernia

240
Q

What are the six muscles of the medial compartment of the thigh

All except one perform the same action. What is this and what is the exception?

A

Obturator externus, pectineus, adductors longus, brevis, Magnus, and grisilis

They adduct the thigh, except obturator externus which is a lateral rotator of the hip

241
Q

Generally why did the three adductor muscles of the leg arise from and insert

A

Arise from the pubic bone and ischio pubic ramus to descend to the linea aspera of the femur

242
Q

What is the additional origin of adductor Magnus

What is its addition insertion

A

From the ischio tuberosity

It also sends a tendon distally to the adductor tubercle on the medial femoral condyle

243
Q

How does the femoral artery pass with respect to adductor Magnus

A

The femoral artery passes lateral to adductor Magnus’ separate tendon to the adductor tubercle and then the artery runs from the anteromedial thigh to the popliteal fossa but it is situated deeply, next to the bone

244
Q

Briefly discuss adductor brevis

A

Lies anterior to adductor Magnus and separates the two divisions of the obturator nerve

245
Q

Which muscle separates the two divisions of the obturator nerve

A

Adductor brevis

246
Q

Describe adductor longus in relation to the other adductors of the thigh

What other structure is it related to

A

It is longer and thinner. Life is more anteriorly and obliquely.

It’s medial border forms the medial boundary of the femoral triangle

247
Q

Describe gracilis

Discuss its insertion

What is its action

A

A ribbon like muscle running down the medial thigh to insert into the other part of the tibial shaft

Inserts posterior to Sartorius and superior to semitendinosus

Flexes knee

248
Q

Where does pectineus arise from

Where does it attach

What is its action

A

The pectineal line of the pubic bone

Attaches to the upper femur medial to the insertion of adductor brevis

Adducts and flexes the hip

249
Q

What are the three compartment of the leg

A

Anterior
Lateral
Posterior

250
Q

What does the anterior compartment of the leg lie between

Which compartment is this

A

The deep fascia and the interosseus membrane between the tibia and fibula

Extensor

251
Q

What is the origin of tibialis anterior

Insertion?

Function?

A

Rises from the upper part of the lateral tibial surface and the interosseous membrane

Inserts into the medial cuneiform on the first metacarpal

both Dorsi flexion and inversion

252
Q

Describe inversion of the foot

Which Joint does this occur at

A

The sole of the foot faces inwards and its inner border moves inwards and upwards. This action occurs at the subtalar joint

253
Q

What Is the origin of extensor hallucis longus?

Insertion?

Describe function

A

Medial part of the anterior surface of the fibula and the interosseous membrane

into the base of the distal phalanx of the great toe

Its actions are extension of the great toe and the weak dorsiflexion of the ankle.

254
Q

What is the hallux

A

Great toe

255
Q

The origin of extensor digitorum longus?

Insertion?

Action?

A

Arises from the upper 2/3 of the anterior surface of the fibula and the interosseous membrane

Four tendons into the base of the middle and distal phalanges of the four lesser toes

Extension of the toes and weak dorsiflexion of the ankle

256
Q

Describe fibularis tertius

A

Arises in continuity with extensor digitorum longus but insert into the dorsal surface of the base of the fifth metatarsal. As a result it dorsiflexes the ankle and everts the foot

257
Q

Give the nerve supply of the following muscles: tibialis anterior, extensor hallucis longus, extensor digitorum longus, and fibularis tertius

A

The deep branch of the common fibular nerve

258
Q

How are toe extensors and ankle Dorsiflexers useful when walking

What prevents bowstringing of these tendons

A

They help to keep the foot clear of the ground when walking

There are two extensor retinacula which span the bones

259
Q

Which functional compartment is the lateral compartment of the leg

What are the boundaries of this compartment

A

Evertor

Anterior and posterior inter muscular septa

260
Q

Describe eversion of the foot

A

The sole of the foot faces outwards, and the lateral border moves outwards and upwards.

261
Q

Why can the lateral compartment of the leg also act as weak ankle flexors

A

Their tendons run behind the lateral malleolus and hence posterior to the axis of the ankle joint

262
Q

Origin of fibularis longus

Describe the tendon’s course

A

Upper part of the lateral aspect of the fibula shaft

Passes behind the lateral malleolus, grooves the cuboid to cross the soul of the foot obliquely, and insert into the medial cuneiform and the base of the first metatarsal

263
Q

Describe The function of fibularis longus

A

Antagonist to tibialis anterior.

Supports the lateral longitudinal and transverse arches of the foot

264
Q

Origin of fibularis brevis

Insertion

A

Arises from the lower part of the lateral aspect of the fibula shaft, distal to the origin of fibularis longus.

Its tendon also runs behind the lateral malleolus, but lies closer to the bone and that of fibularis longus. It inserts into the tuberosity at the base of the fifth metatarsal

265
Q

Which Nerve supplies the lateral compartment of the leg

A

Common Fibula nerve

266
Q

How Could a femoral nerve injury occur and what does it result in

A

Penetrating trauma or during an operation on groin or hip

Can result in paralysis of the knee extensors and severe difficulty when walking or standing

267
Q

Discuss a femoral artery occlusion

A

Inclusion of the femoral artery due to thrombosis or embolism can result in limb loss as a result of impaired blood supply to the lower limb

268
Q

True or false:

swelling in the groin is a common presenting symptom

A

True

269
Q

Give possible causes of a groin swelling

A

Inguinal or femoral hernia, a femoral artery aneurysm, a variscosity of the termination of the great saphenous vein and enlarged lymph nodes

270
Q

What is a saphena varix

A

A variscosity of the great saphenous vein

271
Q

What can inflammation of the iliotibial tract lead to?

Where does this occur

When might this occur

A

PainFul tendinitis

Either in the distal portion as it rubs against the lateral femoral condyle or (less commonly) approximately over the greater trochanter of the femur.

This is often an overuse injury with repetitive flexion and extension of the knee or hip

272
Q

What does the stabilisation of the patella depend upon

A

The coordinated action of the vasti, rectus femoris, and the insertion of the patella ligament into the tibial tubercle

273
Q

Why might the patella dislocate

A

If on equal eccentric forces are applied to the patella, usually due to the loss of vastus medialis, the patella may dislocate laterally over the lateral femoral condyle

274
Q

When may compartment syndrome occur

A

When the pressure within the compartment rises as a result of bleeding or swelling after trauma. The raised pressure within the compartment leads to impaired blood supply to the muscles and nerve compression within the compartment, and muscle necrosis can occur

275
Q

How do you treat acute compartment syndrome

A

Urgent fasciotomy to relieve pressure within the compartment

276
Q

Where would the common fibular nerve often be injured

What can this result in

How does the patient present

A

As it winds around the neck of the fibula

Paralysis of the extensors and everters of the leg.

The patient presents with footdrop, and sensory loss of the anterolateral aspect of the leg and the dorsum of the foot.

277
Q

Describe the gluteal region

A

The region of the products, a transitional area between the trunk and lower limb. On either side it is bounded superiorly by the iliac crest and inferiorly for the gluteal fold, with intergluteal cleft in the midline.

278
Q

Where do the gluteal muscles arise from

A

The posterior aspect of the ala of the ilium

Gluteus maximus’ superficial fibres arise from the sacrotuberous ligament, the sacrum and the coccyx and the deep ones arise from the ala of the ilium

279
Q

Where do the gluteals insert

A

Maximus: gluteal tuberosity of the femur (distal) and the iliotibial tract (proximal)

Medius and minimus: greater trochanter

280
Q

Other Than the three gluteals, what are the other muscles of the gluteal region

What are they known as collectively

A

The piriformis, obturator internus,, the superior and inferior gemelli, quadratus femoris

The short lateral rotators of the hip

There is also tensor fasciae latae

281
Q

Is the sciatic nerve in relation to the short lateral rotators of the hip

How does the sciatic nerve leave the region

A

It lies deep to piriformis but superficial to all others, exiting the gluteal region deep to the hamstring muscles

282
Q

What Arteries from the trochanteric anastomosis

A

The superior and inferior gluteal arteries and their branches, along with the branches of the femoral and profunda femoris arteries

283
Q

Which Nerves can be observed in the gluteal region

A 
Superior and inferior gluteal nerves, 
sciatic nerve, 
posterior femoral cutaneous nerve, 
nerve to obturator internus, 
pudendal nerves
284
Q

How does the pudendal nerve leave the pelvis? what accompanies it?

A

By passing out of the greater sciatic foramen and then winding round the sacrospinous ligament to enter the perineum through the lesser sciatic foramen

Accompanied by the internal pudendal vessels

285
Q

What is the ala of the ilium

A

The wing of the ilium

286
Q

Where is the origin of the deep fibres of gluteus maximus in relation to the gluteal line

A

Posterior to the posterior gluteal line on the ala of the ilium

Also posterior to the fascia of gluteus medius and the sacrotuberous ligament

287
Q

Where can a bursa be found in the gluteal region

A

The bone and the insertion of gluteus maximus

288
Q

Describe the relationship between gluteus maximus and the ischial tuberosity

A

In the upright position, the ischial tuberosity is covered by gluteus maximus. In sitting, and muscle moves laterally to expose the tuberosity

289
Q

What Is the primary action of gluteus maximus

when is this important

A

A combination of extension and lateral rotation at the hip joint

When rising/straightening up from a bent position, and when climbing stairs and going off a slope as it prevents forward tilting of the pelvis on the upright legs

290
Q

What does the contraction of gluteus maximus do through the iliotibial tract

A

Supports the extended knee

291
Q

What is the gluteal fault and how does it relate to gluteus maximus

A

The gluteal fold is a transverse skin crease but does not correspond with the lower border of gluteus maximus which is oblique

292
Q

Where does gluteus medius medius arise from the gluteal surface of the ala of the ilium

A

Between the anterior and posterior gluteal lines i.e. between the origins of gluteus minimus and maximus

293
Q

What can the insertion of gluteus medius be compared to

A

It inserts onto the greater trochanter of the femur like a cap With a bursa lying underneath

294
Q

DeScribe the shape of gluteus medius

A

Fan shaped

295
Q

Describe the action of gluteus medius

Therefore when is it important

A

The whole muscle abducts the hip or, when the leg is on the ground, tilts the opposite side of the pelvis upwards by approximating the iliac crest to the greater trochanter

When walking as it supports the pelvis and prevent it from dropping on the unsupported side

296
Q

What can the anterior fibres of gluteus medius do

Posterior fibres?

A

Medially rotate the hip

the posterior fibres can laterally rotate the hip

297
Q

Where does gluteus minimus originate from on the wing of the ilium

A

Between the anterior and inferior gluteal lines and is inserted into the anterior part of the greater trochanter

298
Q

Describe the function of gluteus minimus

A

It is a abductor and medial rotator of the hip, and assists gluteus medius in walking.

299
Q

What is the origin of tensor fasciae latae?

Insertion?

A

The outer aspect of the ileum between the tubercle of the crest and the anterior Superior iliac spine

Iliotibial tract

300
Q

What is the primary function of tensor fasciae latae

Innervation?

A

Act primarily on the iliotibial tract to provide stability to the hip and knee in the upright posture

Superior gluteal nerve

301
Q

What about the position of the short lateral rotators of the hip makes them lateral rotators

A

The vertical axis of movement of the hip joint lies anterior to the line of these muscles

302
Q

Origin of piriformis and its course

Insertion?

A

Anterior aspect of the middle three pieces of the sake room within the pelvis and exits through the greater sciatic foramen

Inserts into the posterior extremity of the upper margin of the greater trochanter

303
Q

What supplies piriformis

A

Branches from L5, S1 and S2. It is the only short lateral rotator to lie superficial the sciatic nerve

304
Q

Origin of obturator internus

A

From the obturator membrane and the bone surrounding the obturator foramen.

305
Q

How does the tendon of obturator internus leave the pelvis

Where does it insert

What supplies it

A

Through the latter sciatic foramen, then turns at a right angle round the lesser sciatic notch where there is a bursa

Inserts into the greater trochanter above the trochanteric fossa

Nerve to obturator internus

306
Q

Describe the Gemelli

A

The superior and inferior gemelli are two small muscles arising from the upper and lower margins of the lesser sciatic foramen

Run Alongside obturator internus And insert into its tendon

307
Q

What supplies the Gemelli

A

Superior: nerve to obturator internus,

inferior:nerve to quadratus femoris

308
Q

What is the shape of quadratus femoris?

Origin?

A

Square

Outer border of the ischial tuberosity

309
Q

Describe the course of quadratus femoris

Nerve?

A

Its fibres run horizontally to insert into the quadrate tubercle on the upper aspect of the intertrochanteric crest of the femur

Nerve to quadratus femoris

310
Q

What forms the sacral plexus

A

The lumbosacral trunk and the anterior rami of S1-4

311
Q

What forms the lumbosacral truck

Describe its course

A

The anterior primary ramus of L5 with a branch from L4

Crosses the pelvic brim and joins the anterior Ramus of S1. On piriformis, they join the anterior rami of S2–4 to form the sacred plexus which gives a number of nerves which exit the greater sciatic foreman

312
Q

True or false

superior gluteal nerve exits below piriformis

A

False

Exits above

313
Q

What nerves exit below piriformis

A 
Sciatic nerve, 
inferior gluteal nerve, 
nerve to obturator internus, 
nerve to quadratus femoris, 
posterior femoral cutaneous nerve
314
Q

Which spinal roots are in the sciatic nerve

A

L4 – S3

Forms in the pelvis from L4-5 then joins lumbosacral trunk

315
Q

How does the sciatic nerve run after joining the lumbosacral plexus

A

It emerges into the buttock through the greater sciatic notch, deep to piriformis then run superficial to the remaining short lateral rotators. After crossing the quadriceps femoris, it emerges from the gluteal region deep to the inferior border of gluteus maximus and the hamstrings

316
Q

What accompanies the sciatic nerve

A

Inferior gluteal artery

317
Q

What does the sciatic nerve divide into

Where

A

Tibial and common fibular nerves

Usually mid thigh

318
Q

Which nerve is medial to the sciatic nerve (with spinal roots)

What does this supply

A

The posterior femoral cutaneous nerve (S2–3)

The skin of the buttock and posterior aspect of the thigh as far as the knee

(The pudendal nerve is also medial to the sciatic nerve and this passes out of the greater sciatic foramen with the internal pudendal vessels)

319
Q

The superior and inferior gluteal arteries are both branches of which artery?

A

Internal iliac

320
Q

Where do the superior and inferior gluteal arteries lie in relation to gluteus maximus medius and minimus

What do their branches contribute to

A

Superior: between gluteus medius and minimus

Inferior: deep to gluteus maximus

Branches of both arteries along with branches of the profunda femoris artery from the trochanteric and cruciate anastomoses.

321
Q

Which quadrant of the button should be given injections to

Why

A

The upper outer quadrant

To avoid sciatic nerve damage

322
Q

Do the gluteal muscles have any control over the anus

A

In the upright position the medial border of the gluteal muscles are close together. By clenching the buttocks when the gluteus maximus muscles are simultaneously contracted they have an accessory action on anal sphincter control.

323
Q

Do the gluteal muscles join together in the midline

A

No

324
Q

What is gluteal bursitis?

Presentation?

What is another name for this?

A

Inflammation of the bursa superficial to the greater trochanter of the femur.

Patients present with lateral hip pain but joint movements unaffected.

It is sometimes known as the greater trochanteric pain syndrome or trochanteric bursitis

325
Q

How might you manage gluteal bursitis

A

Conservative management includes rest, anti-inflammatory medication, corticosteroid injections and physiotherapy. In recalcitrant cases, the use of minimally invasive endoscopic trochanteric bursectomy and iliotibial tract release has been shown to produce good outcomes

326
Q

What can Paralysis of gluteus medius and minimus leads to?

A

Trendelenbug gait

A waddling gait

The drooping of the pelvis on the opposite side of the pelvis when the patient is asked to stand on one leg

327
Q

Cause of Trendelenburg gait

A

Paralysis of gluteus medius and minimus due to lesion of the superior gluteal nerve

Previously polio involving the lower lumbar and secret segments of the spinal cord used to be an important cause

328
Q

Why might the sciatic nerve be damaged in a dislocation of the hip

When might damage to this nerve be iatrogenic

A

The sciatic nerve runs posterior to the hip joint and is liable to injury during posterior dislocation of the hip

During hip replacements, particularly when posterior surgical approach is used

329
Q

Where is the sciatic nerve liable to penetrating trauma

A

As it emerges from the buttock before lying deep to the hamstrings

330
Q

How can ultrasound be used to trace the path of a sciatic nerve

A

An ultrasound probe maybe use to identify the greater trochanter and ischial tuberosity

331
Q

Generally what does the posterior compartment of the lower limb contain

A

The hamstrings
Branches of the profunda femoris artery
Sciatic nerve with its tibial and common fibular components

332
Q

What are the hamstrings

A

Semitendinosus
Semimembranosus
Biceps femoris

333
Q

Where do the hamstrings originate and what are they supplied by

What is the exception

A

From the ischial tuberosity and supplied by the tibial nerve

The short head of Biceps femoris is the exception arising from the linea aspera and is supplied by common fibular nerve

334
Q

What is the function of the hamstrings?with what exception?

A

The hamstrings extend the hip and flex the knee with the exception of the short head of biceps femoris

335
Q

Where do me hamstrings insert

A

The two heads of biceps insert as a common tendon into the head of the fibula, while semitendinosus and semimembranosus insert onto the proximal tibial shaft and medial tibial condyle respectively

336
Q

What at boundaries of the popliteal fossa

A

Proximately: the diverging hamstrings (semitendinosus and semimembranosus medially and biceps laterally)

distally: converging heads of gastrocnemius

Floor: popliteal surface of femur, knee joint capsule and popliteal fascia

Roof: fascia lata

337
Q

What does the popliteal fossa contain (6)

A 
Popliteal lymph nodes
Popliteal artery and vein
Tibial nerve
Sural nerve
Common fibular nerve
338
Q

How are the muscles of the posterior compartment of the leg divided

A

Superficial:
Gastrocnemius
Soleus
Plantaris

Deep: 
popliteus 
Flexor hallucis longus
Flexor digitorum longus
Tibialis anterior
339
Q

Which nerve supplies the bottom of the foot

A

The tibial nerve as it divides into the medial and lateral plantar nerves that supply the sole of the foot

340
Q

How does semimembranosus arise

A

From the posterolateral aspect of the ischial tuberosity

It arises as a long flat tendon (membrane)

341
Q

How does semimembranosus arise in relation to semitendinosus and biceps femoris’ long head

A

Deep to semitendinosus and the long head of biceps femoris

342
Q

Where does semimembranosus insert

A

into a groove on the posterior aspect of the medial tibial condyle with expansion is that diverge obliquely across the capsule of the name and inferiorly over t popliteus to soleal line on the tibia

343
Q

How does semitendinosus arise

How does it run

A

From the in the Faroe medial aspect of the ischio tuberosity

It decreases in size from above downwards so that midway down the thigh it is replaced by a cordlike tendon that lies in the gutter on semimembranosus.
It’s tendon passes behind the medial femoral condyle and curves forward to insert into the medial aspect of the upper tibial shaft posterior to Sartorius and inferior to grisilis

344
Q

What is pes anserinus

A

Goose’s foot

The insertions of semitendinosus, Sartorius and gracilis on the medial upper tibial shaft

Semitendinosus insert posterior to Sartorius and inferior to gracilis

345
Q

Which muscle does the long head of biceps femoris arise with

A

Semitendinosus

346
Q

How does the long head of biceps femoris run

A

Arises from the medial aspect of the ischial tuberosity and passes across the semimembranosus tendon to join the short head from the linea aspera in the distal thigh

the heads form a common tendon which insert into the lateral aspect of the head of Fibula

347
Q

Which tendon is easily palpable on the lateral aspect of the knee

A

Biceps femoris

348
Q

What pierces the fascia lata in the roof of the popliteal fossa

A

The small saphenous vein and posterior femoral cutaneous nerve

349
Q

What forms the calcaneal tendon

A

The joining of the superficial muscles of the posterior leg (gastrocnemius, plantaris and soleus )

350
Q

Which tendon is tendo Achilles

A

The calcaneal tendon

351
Q

What do you gastrocnemius and plantaris do

What are they supplied by

A

Flex the knee and plantarflex the ankle

Supplied by branches of the tibial nerve

352
Q

How does gastrocnemius arise

A

By two heads from the distal end of the posterior aspect of the femur.

The medial head arises just proximal to the medial condyle of the lateral head arises from the lateral aspect of the lateral condyle itself

353
Q

How does gastrocnemius run

A

The lateral and medial head converge to live side-by-side with a dense aponeurosis between them.

The fleshy part of the muscle extends to about the mid calf, where it forms the calcaneal tendon. A bursa separates the tendon from the bone

354
Q

What is the function of gastrocnemius

A

Strong plantar flexion of the foot and weak flexion of the knee

355
Q

Describe plantaris

A

A muscle with a short muscle belly and a very long tendon.

It arises from the distal end of the lateral supracondylar ridge of the femur.

Its tendon passes downwards and medially between soleus and gastrocnemius, blending with the medial part of the calcaneal tendon

356
Q

Where does soleus arise

A

The upper quarter of the posterior aspect of the fibula, the soleal kind of the tibia, and middle third of the medial border of tibia

357
Q

How does soleus run

A

Its fibres form a fibrous arch over the popliteal vessels. The muscle is flat and has a characteristic appearance with a dense aponeurosis on both sides

358
Q

Where does soleus insert

A

Into the deeper aspect of the calcaneal tendon

359
Q

True or false: Soleus is a uni pennate muscle

A

False

Is is a powerful multipennate muscle

360
Q

What is the function of soleus

A

Flexes foot at the ankle

It is also important Venous pump

361
Q

How does soleus act as a venous pump

A

perforating veins from the great saphenous vein enter into the soleus muscle and when the muscle contracts the veins are emptied, does aiding Venous return to the heart.

362
Q

Which of the deep three muscles in the posterior compartment of the leg that insert into the foot is deepest

What does this muscle lie on

A

Tibialis posterior

Almost entirely on interosseus membrane

363
Q

How do the three muscles from the deep group of the posterior leg insert into the foot

What supplies these 3

A

Under the flexor retinaculum

Tibial nerve

364
Q

What are the two proximal attachment of popliteus

A

The lateral part attaches as a round tendon to the anterior end of the popliteal groove on the lateral femoral condyle, while the medial part attaches as a flat aponeurosis to the lateral meniscus and capsule of the knee joint

365
Q

What is the distal attachment of popliteus

A

To the popliteal surface on the posterior tibia above the soleal line

366
Q

What supplies popliteus

How does it reach the muscle

A

Tibial nerve

A branch curves around the distal border of the muscle to enter it’s deep surface

367
Q

What is the action of popliteus

A

To stabilise and control the position of the lateral meniscus and to rotate the femur laterally on the tibia to unlock the knee

368
Q

What is the origin of flexor hallucis longus

Where does its tendon lie? How does it travel?

A

The distal 3/4 of the fibula and the interosseus membrane

Very deep at the ankle, grooving the talus and inferior surface of the sustentaculum tali of the calcaneus
It runs forward in the sole to insert into the plantar surface at the base of the distal phalanx of the great toe (hallux)

369
Q

What supplies flexor hallucis longus

What is the muscle’s action

A

Tibial nerve

To flex the great toe and maintain the medial longitudinal arch of the foot in running and walking

370
Q

Where does flexor digitorum longus arise from

A

The medial part of the posterior surface of the tibia below the soleal line

371
Q

How does the flexor digitorum longus travel after entering the sole of the foot

A

Crosses the flexor hallucis longus tendon and divides into four tendons, each inserting into the plantar surface of the respective bases of the four lateral toes and passing through a decussation of the tendons of the flexor digitorum brevis in a manner identical to that scene between flexor digitorum superficialis and profundus

372
Q

What nerve supplies flexor digitorum longus and what is its action

A

Supplied by Tibial nerve and the muscle’s action is to flex the toes when walking and running.

373
Q

Where does tibialis posterior arise from (3)

A

The lateral half of the posterior surface of the tibia below the soleal line,

the interosseous membrane,

the upper part of the medial surface of the fibula

374
Q

Where does tibialis posterior insert

A

Primarily into the tuberosity of the navicula with slips going into the cuboid, cuneiforms and bases of the four medial metatarsals

375
Q

What is the action of tibialis posterior

Innervation?

A

Flex and invert the foot and support the longitudinal arches

Tibial nerve

376
Q

What is the secondary action of the following muscles and why:
Flexor hallucis longus
flexor digitorum longus
tibialis posterior

A

Plantar flexion of the foot at the ankle

The tendons of the muscles all pass behind the medial malleolus

377
Q

Describe the flexor retinaculum of the foot

A

Extends from the medial malleolus of the tibia to the medial margin of the posterior part of the calcaneus.

378
Q

In what order do the tendons and nerves and vessels pass beneath the flexor retinaculum of the foot

A

From medial to lateral, they are tibialis posterior, flexor digitorum longus, the posterior tibial artery with venae comitantates, the tibial nerve, and flexor hallucis longus

379
Q

True or false: hamstring tears and athletes are usually midsubstance and heal spontaneously

A

True

380
Q

Which injury to the hamstrings is common in waterskiers

Which age group does this tend to be

Treatment?

A

Avulsion of the hamstrings from the ischial tuberosity

Middle age

Acute surgical repair

381
Q

In a knee ligament rupture what is used to augment the stability of the knee

A

The strong tendon of semitendinosus

for example can be used if there is a ruptured anterior cruciate ligament

382
Q

Why might that aneurysm of the popliteal artery or a cyst in the popliteal fossa cause neurological symptoms

A

Compression of the adjacent tibial nerve

383
Q

Where does a Baker’s cyst originate and what can happen

A

Within the knee joint

It can rupture into the popliteal fossa spreading fluid between the layers of muscles in the calf

384
Q

What do the symptoms of a Baker’s cyst mimic

Give examples

A

A deep vein thrombosis.

There is a sudden onset of severe calf pain, with increased pain on forced extension of the ankle which puts tension in these muscles and raises the intracompartmental pressure

385
Q

Why mate deep venous thrombosis happen

What happens

A

After prolonged inactivity e.g. immobilisation in bed or on long haul flights,

when blood pools in the lower limb due to interference with the action of the muscle pump in Venous return

386
Q

Is deep venous thrombosis dangerous?

A

Yes this condition is potentially life-threatening, as part of the thrombus may break off passing through the right side the heart into the lungs and cause a pulmonary embolism

387
Q

Which tendon in the leg is often ruptured

What will be the presentation
Why?

A

Tendo Achilles

A patient will present with an inability to initiate the gait(no spring in the step) having to depend on the toe flexors to weakly Flex the ankle when walking. There is usually a palpable gap in the tendon
This is because this is the common tendon of the ankle flexors

388
Q

What is interesting about a ruptured tendo Achilles

A

The plantaris tendon almost never ruptures, suggesting that it remain separate until just before inserting into the calcaneus

389
Q

When might the tibialis posterior tendon rupture

A

Due to age related degeneration, overuse, or chronic recurrent tenosynovitis
Spontaneous rupture may occur in overweight women

In children, the tibialis posterior tendon may be lacerated by glass fragments as they run barefoot on a sandy beach, producing an acute flat foot

390
Q

What do people with a ruptured tibialis posterior tendon present with

A

Pain and swelling along the medial aspect of the foot and ankle, as well as a gross flat foot deformity

391
Q

How does tarsal tunnel syndrome occur

A

The tibial nerve may be compressed as it passes through the tarsal tunnel posterior to the medial malleolus.

this is analogous to but much rarer than carpal tunnel syndrome

392
Q

Why might tarsal tunnel syndrome occur

A

It tends to occur currently in athletes due to chronic sustained overuse of the infected foot

Swelling of the tendons in the tunnel may also give rise to

393
Q

What gives the stability of the hip joint

A

Containment of the femoral head within the acetabulum however this also reduces movement

394
Q

True or false: the ligament surrounding the hip joint capsule are weak and accessory

A

False they are thick and strong to assist stability

395
Q

What do the ligaments of the knee control

A

Excessive collateral laxity and anteroposterior gliding, regardless of the angle of the flexion

396
Q

True or false:

there is no movement at the superior and inferior tibiofibular joints

A

False there is little movement but there is no movement of the leg that it is analogous to super nation and pronation of the forum

397
Q

How does the fibula rotate and why

A

The fibula rotates on its long access to allow the wedge shaped talus to remain stable within the ankle complex during flexion and extension of the ankle

398
Q

Which joint is crucial to the stability of the ankle joint

A

The fibrous inferior tibiofibula joint

399
Q

What kind of joint is the ankle

A

synovial hinge joint

400
Q

The combined movements of which joints give the foot its versatility to function as a weight-bearing pod on all surfaces while maintaining an upright posture

A

The ankle and subtalar joints With rotation in the midtarsal joints

401
Q

How is the function of the foot enhanced by the longitudinal arch

A

It acts as a spring with the aid of the plantar aponeurosis and ligaments

402
Q

How does the long femoral neck assist mobility

A

It laterally offsets the femoral shaft from the pelvis. As the neck is also narrower than the diameter of the head, considerable movement in all directions is possible before the femoral neck impinges on the acetabular labrum

403
Q

What shape is the articular surface of the acetabulum

A

Horse shoe shaped

404
Q

Discuss the structures associated with the horseshoe shape of the articular surface of the acetabulum

A

The tips of the horseshoe are connected by a transverse ligament

the whole of the rim is augmented by a fibrocartilaginous labrum.

The centre of the horseshoe is occupied by a ligament connecting the femoral head to the acetabulum: the ligament of the head of the femur/ligamentum teres

405
Q

How is the capsule of the hip joint attached

A

Proximally: Around the acetabular labrum and transverse ligament

Distally: To the neck of the femur

Anteriorly: to the inter trochanteric line

Posteriorly: attached halfway along the femoral neck, proximal to the trochanters

406
Q

Describe in further detail the distal attachment of the hip capsule to the femur

A

From the distant attachment, several fibres are affected upwards as longitudinal bands (Retinacular fibres) along the femoral neck to the articular margins of the head.

These fibres support nutrient carrying arteries from the trochanteric anastomoses, which extends along the femoral neck before supplying the main part of the head of the femur

407
Q

The capsule of the hip joint is strengthened by which three ligaments

A

Iliofemoral, ischiofemoral and pubofemoral ligaments

408
Q

Describe the iliofemoral ligament

A

Shaped in the form of an inverted “Y” with the stem arising from the anterior inferior iliac spine and the acetabula room and the two limbs of the “Y” diverging to be attached to the upper and lower into trochanteric line

it prevents hyper extension

409
Q

Which of the following ligaments is strongest
Iliofemoral,
ischiofemoral,
pubofemoral

A

Iliofemoral

410
Q

What are the movements of the hip joint

A

Flexion and extension, abduction and adduction, medial and lateral rotation

411
Q

Which muscles perform flexion at the hip joint

A

Psoas major and Iliacus

assisted by rectus femoris,
tensor fasciae latae,
Sartorius
and pectineus

412
Q

What limits flexion at the hip joint

A

Limited by the thigh touching the abdomen or by tension in the hamstrings when the knee is extended

413
Q

What performs extension at the hip joint

What limits extension?

A

Gluteus maximus and the hamstrings

The strong iliofemoral ligament

414
Q

What produces addiction at the hip

A

Pectineus,
adductors longest, brevis, Magnus,
gracilis

415
Q

What perform is abduction at the hip joint

A

Gluteus medius and minimus

416
Q

What produces medial rotation at the hip joint

A

The anterior fibres of gluteus medius and minimus

417
Q

What produces lateral rotation at the hip joint

A

Gluteus maximus with the other lateral rotators serving as stabilisers of the hip joint. These include the posterior fibres of gluteus medius and minimus, piriformis, obturator externus and internus , the Gemelli, and quadratus femoris

418
Q

Discuss the blood supply to the femoral head

A

Primarily from arteries running along the neck in the retinacular fibres of the capsule

The ligament of the head contains a branch of the obturator artery in children but this blood supply is negligible and adults

419
Q

What does the blood supply to the head of the femur mean for a femoral neck fracture

A

There is injury, which is common especially in elderly osteoporotic bones, may tear the retinacular vessels resulting in a vascular necrosis of the femoral head

420
Q

What kind of joint is the knee

A

A synovial complex hinge joint

421
Q

What movement is allowed at the knee joint

A

Flexion and extension with some rotation in flexion

422
Q

Does the patella articulate with the tibia

A

Know the femoral condyles articulate with a tibial condyles and the patella articulates with the anterior surface of the distal femur

423
Q

Do the bony contours of the knee joint confer stability

A

No stability depend on the strong medial and lateral collateral ligament and the two cruciate ligaments

424
Q

The cruciate orientation provides what in the knee

A

Anteroposterior stability in all positions of flexion

425
Q

How do the femoral condyles differ in shape from the tibial condyles

A

The femoral condyles are convex while the tibial condyles are flat

426
Q

As the tibial condyles are flat, what makes them concave to fit into the femoral condyles

A

Fibrocartilaginous menisci (medial and lateral)

427
Q

Which meniscus is popliteus attach to

A

Puppeteers is attached my fibres into the lateral meniscus and latterly by attendant passing through the capsule to the lateral femoral condyle

428
Q

The capsule of the knee is deficient anteriorly. How is it completed?

A

By quadriceps tendon

429
Q

How are the medial and lateral aspect of the knee capsule reinforced

A

By retinacular fibres originating by the vasti medialis and lateralis

430
Q

How does the synovial membrane of the knee extend superiorly

A

As the suprapatellar bursa/Pouch

431
Q

Describe the medial and lateral collateral ligaments of the knee.

A

extend from the femur to the tibia medially and to the head of the fibula laterally

The medial ligament is flat and attached to the capsule and medial meniscus. Its fibres run downwards and forwards

The lateral ligament is called like. It is quite free from the capsule and its fibres run downwards and backwards

432
Q

Describe the anterior cruciate ligament

What is its function

A

It connects the anterior aspect of the intercondylar eminence of the tibia to the posteromedial aspect of the lateral femoral condyle.

To prevent backwards displacement of the femur on the tibia, or forward displacement of the tibia on the femur

433
Q

Describe the posterior cruciate ligament

Functions?

A

Connects the posterior aspect of the intercondylar eminence to the anterolateral aspect of the medial femoral condyle

Prevent forward displacement of the femur on the tibia and is especially important when weight-bearing on a flex knee e.g. going downhill

434
Q

What are the primary extensors and flexors of the knee

A

Extensor: quadriceps

Flexor: hamstrings

435
Q

What produces medial rotation of the flexed knee

A

Mainly semimembranosus and semitendinosus

436
Q

What produces lateral rotation of the knee

A

Biceps femoris

437
Q

What does it mean to say the completely extended knee is physiologically locked?

A

It will maintain the body in an upright position without muscular effort

438
Q

What will help maintain the knee in the extended position

A

The iliotibial tract into which tensor fasciae latae and gluteus maximus are inserted

439
Q

How does the weight of the body pass in relation to the knee joint

What does this mean

A

The weight passes anterior to the centre of the knee and anterior to the medial and lateral ligaments

The collateral and cruciate ligaments can resist the weight and enable the muscles to relax

440
Q

How do you initiate flexion of the knee

A

Popliteus rotates the femur laterally on the tibia, unlocking the knee

441
Q

What kind of joint is the superior tibiofibular joint

Does it have a capsule

What is the movement

A

A small synovial joint between a facet on the lateral tibial condyle and a corresponding facet on the fibula

There is a capsule with anterior and posterior ligaments

Movement is limited to a small degree of axial rotation of the fibula

442
Q

Describe the inferior tibiofibular joint

A

A fibrous joint (syndesmosis) with the opposing Ruffside surfaces of the bones connected by strong interosseous ligaments and augmented by anterior and posterior tibiofibula ligaments

443
Q

Define syndesmosis

A

A slightly movable fibrous joint e.g. tibia and fibula

444
Q

What do the ligaments of the inferior tibiofibular joint allow

A

Slight distraction of the tibia from the fibula during Dorsiflexion of the ankle when the wider anterior body of the talus comes between them

445
Q

Describe the ankle joint

A

A synovial hinge joint with a deep mortise formed by the distal tibia and fibula to house the body of the talus

446
Q

Which ligaments is the stability of the ankle joint dependent on

A

The ligaments that hold the tibia and fibula together as well as the collateral ligaments that keep the talus contained within the mortise

447
Q

What does the talus articulate with

A

Upper aspect: with tibia
Medially: medial malleolus
Lateral surface of the body: with the medial articular surface of the distal fibula

448
Q

What are the movements of the ankle joint

A

Plantarflexion and dorsiflexion

449
Q

What do the malleoli prevent

A

Inversion or eversion occurring at the ankle joint

450
Q

What are the main plantar flexors of the ankle joint

A

The posterior muscles whose tendons form the tendo Achilles (soleus, gastrocnemius, plantaris)

451
Q

What is the main extensor of the ankle

A

Tibialis anterior

452
Q

At which joint does inversion and eversion of the foot occur

A

Subtalar

453
Q

Describe the subtalar joint

A

A composite of the posterior talocalcaneal and the talocalcaneonavicular joints which function as 1 joint

454
Q

describe the talocalcaneonavicular joint

A

Consists of the convex head of the talus and a concave socket formed by calcaneus, navicular and ligaments

455
Q

How is the foot inverted and everted

A

By approximate ball and socket movements around the head of the talus by the talocalcaneonavicular joint, with gliding movements in the posterior talocalcaneal joint

456
Q

The hip joint is prone to which degenerative disease?

What happens in this disease?

A

Osteoarthritis

The movement of the hips are painful and restricted. The constrained nature of the joint and the presence of the osteophytes lead to reduce movement and makes walking difficult and running very difficult

457
Q

What are osteophytes in osteoarthritis

A

protrusions of sharp bone on the edges of the femoral head

458
Q

What can I help fracture of the femoral neck result in

A

External rotation and shortening of the affected limb due to the powerful action of Iliacus and psoas major on the lesser trochanter

Blood supply to the femoral head may be compromised

459
Q

What must happen if the blood supply to the femoral head is compromised in a femoral neck fracture

A

A prosthetic replacement of the femoral head becomes necessary

460
Q

Discuss developmental dysplasia of the hip

A

This term refers to a spectrum of pathology, ranging from mild acetabula dysplasia with a stable hip through to more severe forms of dysplasia, often associated with neonatal hip instability, to establish to hip dysplasia with or without later subluxation or dislocation

461
Q

What did developmental dysplasia of the hip used to be known as

A

Congenital dislocation of the hip

462
Q

What is the common knee injury

What does this result in

What is associated

A

It is common rupture the medial collateral ligament When a valgus strain is applied to the knee

This results in the knee giving way as a result of the lack of collateral stability

There is often an associated tear with the medial meniscus and a tear of the anterior cruciate ligament

463
Q

What is the unhappy triad of O’Donoghue

A

A rupture of the medial collateral ligament, attack of the medial meniscus and a tear of the anterior cruciate ligament

464
Q

What does a tear of the anterior cruciate ligament cause

A

Excessive anterior glide of the tibia on the femur

465
Q

Which knee injury combination put an end to many a promising sports career

A

The unhappy triad of O’Donoghue

466
Q

What do you twisted ankles commonly involve

What is a common result of this

A

A tear of the anterior talofibular band of the lateral ligament

Chronic pain and instability are often a result of these injuries as the nature and severity of the injury is frequently not appreciated

467
Q

What do ankle fractures often affect

A

Bones and soft tissue

They often involve the medial and lateral collateral ligament as well as the distal tibiofibular ligament

468
Q

One should only consider the bone injury in the ankle fracture

A

No! Simply dealing with a bony injury without consideration of the ligamentous injury will give a poor functional outcome

469
Q

What is the Maisonneuve fracture

A

One kind of ankle fracture that involves rotation eversion forces on the ankle that causes a rupture of the medial ligament in association with a fracture of the proximal shaft of the fibula, together with a tear of the length of the interosseous membrane

470
Q

Give the nerve roots of pudendal nerve

A

S234

471
Q

Give the nerve root of the femoral nerve

Obturator?

A

L234 posterior divisions

L234 anterior divisions

FAB (10 decks)

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