Lower limb anatomical regions

Question 1

What forms the superior boarder of the femoral triangle?

Answer 1

inguinal ligament (from superior iliac to pubis tubercle)

Question 2

What forms the lateral boarder of the femoral triangle?

Answer 2

the medial boarder of the satorius muscle

Question 3

What forms the medial boarder of the femoral triangle?

Answer 3

The adductor longus muscle- the rest of this muscle forms the floor of the triangle

Question 4

What forms the roof of the femoral triangle?

Answer 4

fascia lata

Question 5

What does the inguinal ligament do?

Answer 5

acts as a flexor retinaculum- supports the contents of the femoral triangle in hip flexion
also defines the superior boarder of the femoral triangle

Question 6

What is inside the femoral triangle from lateral to medial?

Answer 6

• femoral Nerve
• femoral Artery
• femoral Vein
• femoral canal- contains lymphnodes and vessels
  NAVY

Question 7

What is found within the femoral sheath?

Answer 7

femoral artery, fermoral vein and femoral canal

Question 8

What forms the superomedial boarder of the popliteal fossa?

Answer 8

semi membranosus

Question 9

What forms the superolateral boarder of the popliteal fossa?

Answer 9

biceps femoris

Question 10

What forms the inferomedial boarder of the popliteal fossa?

Answer 10

medial head of gastrocnemicus

Question 11

What forms the inferolateral boarder of the popliteal fossa?

Answer 11

lateral head of gastrocnemicus

Question 12

What are the popliteal fossas contents from medial to lateral?

Answer 12

• popliteal artery
• popliteal vein
• tibial nerve
• common fibular nerve

Question 13

What is usually the first movement to me lost on arthiritis of the hip?

Answer 13

Internal rotation

Question 14

How can intracapsular fractures of the femur occur?

Answer 14

in elderly- fall/ blow onto side of hip

teens- high energy collidions

Question 15

Which artery is most at risk when intracapsular fracture of femur?

Answer 15

medial circumflex artery

Question 16

What are 3 treatment options for femoral head/ neck fractures?

Answer 16

• total hip replacement (of head and acetabulum), always done when displaced due to necrosis risk. Often done in young people as lasts the longest
• Hemiarthoplasty- only femoral head replaced, most commonly done in elderly
• Dynamic hip screw- only done in young people and undisplaced fractures where there is good blood supply

Question 17

What is the appearance of a displaced femoral neck/ head fracture and why?

Answer 17

• leg shortened and externally rotated
• external rotator muscles all attach to intertrochantor crest and pull it laterally and upwards
• When head is displaced there is nothing to oppose this movement

Question 18

What events can cause hip dislocations?

Answer 18

car accidents, significant falls in children and elderly and those with prosthesis are more likely
Major force to a flexed knee and hip (car accident)

Question 19

In what direction are most hip dislocations?

Answer 19

posterior

Question 20

What does a posterior hip dislocation look like and why?

Answer 20

leg shortened, in flexion, internal rotation and adduction
This is due to glut medius and minimus acting unopposed to pull it up and in and also adductors action to pull it up and into adduction

Question 21

What does an anterior hip dislocation look like?

Answer 21

Hip is externally rotated, abducted and extended

Question 22

What is a major complication of a posterior hip dislocation?

Answer 22

high likelyhood of the sciatic nerve which runs behind it- leads to loss of sensation of posterior leg and foot and loss of dorsal and planter flexion and knee flexion

Question 23

How can you detect damage to the superior gluteal nerve?

Answer 23

Hip drop sign- ask them to stand on one leg and pelvis will drop when standing on affected leg

Question 24

What is affected in damage to the superior gluteal nerve?

Answer 24

• lack of motor control to glut medius and minimus and tensor fascia lata (loss of hip abduction and medial rotation.

Question 25

Where do you do an intramuscular injection into the gluteal region for someone over the age of 7?

Answer 25

The ventrogluteal site: Put hand on greater trochanter point thumb towards inguial region and index finger towards anterior superior iliac crest Spread index and middle fingers to make a V so that middle finger points upwards Inject between PIPJ of index and middle fingers

Question 26

Where would you do a gluteal intramusclar injection for someone between 3-7 yrs?

Answer 26

the dorsogluteal site | either one of the superior lateral quadrants of the buttocks below the illiac crest

Question 27

What causes a pulled hamstring?

Answer 27

rapid extension- running, jumping when not warmed up

Question 28

What nerves are at risk for gluteal IM injection?

Answer 28

sciatic | superior gluteal

Question 29

What is experienced in a achilles tendonitis? What causes it?

Answer 29

pain along back of leg near heel, worse in morning and with activity generally overuse and degradation with age means some fibres tear

Question 30

What causes an achilles tendon rupture? Where does it rupture, and in who?

Answer 30

- fast forceful dorsiflexion - about 6cm from insertion as there is a vascular watershed here making it weak - in 30-50 yr old active ppl

Question 31

What is experienced in an achilles tendon rupture?

Answer 31

- intense pain like being shot - popping heard they then walk flat flooted, unable to go onto tip toes, a gap may be seen and/ or felt but this may be hidden by bruising or swelling

Question 32

How can achilles tendon ruptures be diagnosed?

Answer 32

- positive thompsons test (squeeze calf of flexed knee that is resting on chair, if normal the ankle will planterflex) - MRI/ ultrasound scan

Question 33

What is a claw toe?

Answer 33

The MTP joint is permenantly hyperextended, the IPJs are flexed

Question 34

What is a hammer toe?

Answer 34

the MTP joint is permanently hyperextended, the PIPJ is flexed and the DIPJ is normal

Question 35

What causes claw/ hammertoes?

Answer 35

Not sure- genetic, high arched feet, poorly fitted shoes (too short), rheumatoid arthiritis, tendon imbalence or traumatic injuries

Question 36

What is flat footedness? Where is the pain and what causes is?

Answer 36

- Loss of the medial arch - more common in middle aged females but can be normal in children and will go away with development - pain in medial malleolus - Tibialis posterior dysfunctions cause it which is generally age related

Question 37

How can flat footedness be diagnosed on xray?

Answer 37

- The talus appears lower down - and pointing down rather than towards to toe - it will be inline with the metacarples and not below it

Question 38

How can a sprained ankle occur and what are symptoms?

Answer 38

Due to excessive inversion or eversion leading to ligament damage- usually inversion of a planterflexed foot tenderness, swelling, bruising, functional loss, mechanical instability

Question 39

What can cause a 5th metatarsal fracture?

Answer 39

- bone pulled off my metatarsal ligament (in ankle sprains) - repeated stress - trauma

Question 40

What is a hallux valgus and what causes it?

Answer 40

A bunion causing lump on outside of large toe due to its metatarsal being pushed out and the phalangies being pushed in (lateral deviation) Caused by wearing inappropriate footwear putting pressure where it shouldn't be. Also due to ligaments becoming lax in old age

Question 41

What is a talar shift?

Answer 41

There should be a equal distance between the talus and the tibia and fibula but in an unstable break (2 ligament/ bone breaks) there will not be an equal distance

Question 42

What actions can cause ankle fractures?

Answer 42

- excessive twisting, rotation, rolling, tripping, falling, impact

Question 43

What are ottowa rules on when to get an ankle xray?

Answer 43

- tenderness on posterior edge of lateral or medial malleolus - pain at base of 5th metatarsal - pain at navicular - unable to weight bear immediatly after injury - admittance to A&E

Question 44

Where is most common site of osteoarthiritis in foot?

Answer 44

Big toe

Question 45

Why do diabetics loose sensation in foot?

Answer 45

high blood glucose damages nerves in foot

Question 46

What is charcots arthropathy?

Answer 46

Where diabetics loose sensation in foot but they keep on using it as they done know and damage gets very severe