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MRCS part B > Lower limb anatomy deck > Flashcards

Lower limb anatomy deck Flashcards

1
Q

Structures that pass behind the medial malleolus

A

Tom, dick and very naughty harry

Tibial nerve, posterior tibial artery and vein, tibialis posterior tendon, tendon of flexor hallucis longus, flexor digitorum tendon

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2
Q

What is the nerve dermatomes in the lower limb

A

Look at photo on the internet and study

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3
Q

Where to inversion and eversion of the foot occour. What joint?

A

This occurs at the subtalar joint

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4
Q

Where does foot plantar and dorsiflexion occur

A

This occurs at the talus and tibio-fibular joint

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5
Q

What is the innervation to the first webspace of the foot

A

deep peroneal nerve

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6
Q

What is the garden classification of hip fractures

A

1: undisplaced and incomplete fracture
2: undisplaced and complete fracture
3: Discplased and incomplete fracture
4: Displaced and complete fracture

1,2 screw and 3,4 hemi
Subtrochanteric fractures are often managed with intramedullary nailing

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7
Q

What is the blood supply to the hip joint

A

Medial and lateral circumflex arteries that originate from the profunda as well as the artery to the femoral head in the ligamentum teres that originates from the obturator artery, this is negligible in adults

The blood supply is retrograde

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8
Q

Where does the psoas major originate and what is the action

A

L1-L4 and inserts into the lesser trochanter, causing flexion of the hip joint

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9
Q

Where does the iliotibial tract arise

A

Anterolateral iliac tubercle to the to the lateral condyle

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10
Q

What muscles insert onto the liotibial tract and what is the clinical significance

A

Glute max and tensor fascia lata, stabilises the knee in extension and partial flexion, it is important in running and walking

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11
Q

Where does the gluteus maximus muscle attach

A

Gluteal tuberosity of the femur, it is supplied by the inferior gluteal nerve and the nerve roots are L5,S1,S2

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12
Q

What nerve supplies the tensor fascia lata

A

Superior gluteal nerve L4,L5 and S1

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13
Q

Gluteus medias function

A

While standing, it is a hip abductor, while walking, supports the body with the minimus so that the hip does not fall to one side

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14
Q

What is the surface marking of the sciatic nerve

A

2 points
Halfway between PSIS and ischial tuberosity and halfway between the ischial tuberosity and the greater trochanter

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15
Q

What are the variations of the sciatic nerve exiting the pelvis

A

Normally goes from below the piriformis, but can also go through it or it may divide high with one division going through or around the piriformis

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16
Q

What is the blood supply to the knee joint

A

femoral, popliteal and crural arteries anastomose to form the blood supply to the knee

Medial and lateral superior genicular arteries: Supply the femoral condyles
Medial and lateral inferior genicular arteries: Supply the tibial condyles
Middle genicular artery: Supplies the ACL and PCL

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17
Q

How would one differentiate between the semimembranosus and the semitendinosus

A

The tendon one has a large tendon and the membrane one fans into an attachment

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18
Q

What are the possible causes for swelling in the back of the knee

A

Seb cyst, popliteal cyst (Bakers), abscess, DVT, varicose veins

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19
Q

What forms the pes anserius

A

Semitenndanosus, sartorius and gracilis

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20
Q

What is the iliotibial band

A

Longitudinal thickening of the tensor fascia lata extending from the iliac tubercle to the lateral tibial condyle. It is a dynamic stabilizer of the knee joint

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21
Q

How many arches does the foot have

A

Medial, lateral and transverse

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22
Q

What are the components of the medial longitudinal arch

A

Bones: Calcaneus, talus, navicular and all 3 cuniform bones and medial 3 metatarsals

Ligaments: Interosseous and spring ligament

Muscles: Flex hal long, flex dig long and brev, tib ant and post

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23
Q

What are the components of the lateral longitudinal arch

A

Bones: Calcaneus, cuboid and lateral 2 met

Ligaments: long and short plantar ligaments

Muscles: per long, flex dig long and brev

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24
Q

What are the components of the transverse arch

A

Bones: Bases of all 5 met

Ligaments: interosseous

Muscle: Peroneus longus

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25
Q

Which muscles form the inversion and eversion of the foot

A

Eversion: Per long and brev
Inversion: Tib ant and post along with some help from the extensors as well as flex hal long

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26
Q

What are the fascial compartments of the lower limb and their contents

A
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27
Q

Name the points of insertion of the extracapsular ligaments of the hip joint.

A

iliofemoral: Y shaped and arises from the anterior inferior iliac spine. Inserts into the trochanteric line. (resists hyperextension). One of the strongest in the body

Pubofemoral: Arises from the pubofemoral juntion and blends with the medial aspect of the capsule (resists extension and abduction)

Ischiofemoral: Ischium to the greater trochanter. Limits extension.

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28
Q

Blood supply to the hip joint and the head of the femur

A

Cruciate anastomoses: Inferior gluteal artery, the lateral and medial circumflex arteries, the first perforating artery of the profunda and the posterior branch of the obtruator artery

Trochanteric anastomosis: Superior gluteal artery and the medial and lateral superior circumflex artery.

Artery of ligamentum teres: branch of the obtruator artery.

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29
Q

What is the innervation of the hip joint

A

Sciatic, femoral and obtruator

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30
Q

What innervates the main flexors of the hip joint

A

Psoas major is ventral rami of L1, L2
Femoral nerve for the rest

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31
Q

What are the boundaries of the femoral triangle

A

Roof – fascia lata.
Floor – pectineus, iliopsoas, and adductor longus muscles.
Superior border – inguinal ligament (a ligament that runs from the anterior superior iliac spine to the pubic tubercle).
Lateral border – medial border of the sartorius muscle.
Medial border – medial border of the adductor longus muscle. The rest of this muscle forms part of the floor of the triangle.

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32
Q

What are the iliac and psoas major insertions and origins

A

Psoas originates T12 to L1-L5 and iliacus originates in the iliac fossa to lesser trochanter

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33
Q

What is the femoral sheath and what does it entail

A

The femoral sheath is a fascial tube that is the continuation of the transversalis fascia. It contains the femoral vessels and the canal but it DOES NOT contain the femoral nerve

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34
Q

What does the femoral canal contain

A

Fat, lymphatics and cloquets nodes. cloquets nodes drain the LL, perineum as well as the anterior abdominal wall. It may be enlarged in case of carcinoma

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35
Q

What is the femoral ring and what are the boundaries and significance

A

It is the superior aspect of the canal.

Ant: Inguinal lig
post: Pectineal ligament
medial: lacunar
lateral: femoral nerve

Femoral hernias enter the femoral triangle through the femoral ring

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36
Q

What is the action of the gluteal nerves

A

Gluteus medius and minimus abduct and medially rotate the thigh. Maximus extends and externally rotates

37
Q

Describe the Trendelenberg test

A

It is a superior gluteal nerve test. a hip drop indicates weakness in the weight-bearing side

38
Q

What are the surface markings of the piriformis?

A

The surface marking of the superior border of the piriformis is indicated by a line drawn from the posterior superior iliac spine to the superior border of the greater trochanter

39
Q

What nerves form the sacral plexus

A

L4-S4

40
Q

Name the boundaries of the greater sciatic foramen

A

Superiorly: Anterior sacroiliac ligament
Inf: Sacrospinous ligament
Posterior medially: Sacrotuberous ligament
Anterior laterally: Greater sciatic notch of ilium

41
Q

Boundaries of the lesser sciatic foramen

A

The ischial body anteriorly, the ischial spine and the sacrospinous ligament superiorly and the sacrotuberous ligament posteriorly.

42
Q

The landmarks for the sciatic nerve`

A

The anatomical course of the sciatic nerve must be considered when administering intramuscular injections into the gluteal region. The region can be divided into quadrants using 2 lines, marked by bony landmarks:

One line descends vertically from the highest point on the iliac crest.
The other horizontal line passes through the vertical line half way between the highest point on the iliac crest and ischial tuberosity.
The sciatic nerve passes through the lower medial quadrant. To avoid damaging the sciatic nerve therefore, intramuscular injections are given only in the upper lateral quadrant of the gluteal region.

43
Q

Describe the anatomical landmarks of the femoral bone

A
44
Q

Describe the stages of ossification of the femoral bone

A
45
Q

Coxa valga vs Coxa Vara

A

Femoral neck angle increased in Valga and decreased in vara

46
Q

Classification of femoral neck fractures

A

Intracapsular and extracapsular (sub, per and intertrochanteric )

47
Q

Garden classification of intracapsular fractures

A

Type 1: incomplete and undisplaced
Type 2: Complete and undisplaced
Types 3: Complete and partially displaced
Type 4: Complete and fully displaced

48
Q

Management of intra and extracapsular fractures

A

Intracapsular
Type 1 and 2 can be internal fixation with cannulated hip screws
Type 3 and 4 usually require hemi or total (hemi in old and total in young)

extra: DHS, below subtrochanteric line require intramedullary nailing

49
Q

What are the boundaries of the adductor canal

A

Anteromedial – Sartorius.
Lateral – Vastus medialis.
Posterior – Adductor longus and adductor magnus.

50
Q

What are the structures that would would encounter during arthroscopic surgery anterior approach

A

Tranverse meniscal ligament
Anterior horn of medial miniscus
ACL
Anterior horn of lateral miniscus
posterior horn of lateral miniscus
PCL

51
Q

What are the articular surfaces of the knee joint

A

Lateral and medial is with femoral and tibial condyles
Intermediate is with the patella and femus

52
Q

What are the salient differences between the medial and lateral meniscus

A

The medial meniscus is C shaped and the lateral is more circular
Medial meniscus is attached to the medial collateral lig but lateral is attached to nothing and is hence more mobile
Popliteus tendon runs between the joint capsule and the lateral meniscus

53
Q

Why is injury to the medial meniscus more common than the lateral

A

Attachment to the medial collateral ligament means that it is not as mobile and can tear in abnormal stress

54
Q

What is the role of meniscus

A

Shock absorber, joint stability and lubrication

55
Q

Describe the bursae of the knee

A

Suprapatellar: Lies between the inferior anterior surface of the femur and the deep surface of the quads
Pre-patella: Between patella and skin
Superficial and deep infrapatellar: Lies between patellar ligament and the skin and the tibia and the patellar ligament

56
Q

Describe the blood supply of the knee

A

Genicular arteries. There are 5 genicular branches of the popliteal artery

57
Q

What is the cutaneous innervation to the knee

A

L3 anteriorly and S1 and S2 posteriorly

58
Q

FACT

A

Sural nerve accompanies short saphenous vein and saphenous nerve accompanies the long saphenous vein

59
Q

Why is a saphenous vein considered suitable for a coronary artery graft

A

Superficial and therefore can easily be accessed
Has a consistent anatomical course
Walls have a higher muscle content
Sufficient length

60
Q

Describe the lymphatics of the lower limbs

A

Superficial and deep

Superficial follow saphenous and they end at superficial inguinal, then external iliac and the short saphenous and these drain into the popliteal.

Deep ones follow the deep veins and goes into the deep inguinal.

61
Q

What is the course of the anterior tibial artery

A

From tibioperoneal trunk to between extensor hallucis longs and tib ant and close to the interosseous membrane
In the ankle it can be palpated between the 2 malleoli just lateral to the tendon of EHL.
Deep peroneal nerve accompanies it and lies just lateral to the artery at the ankle
Runs beneath the extensor ret and then becomes DP and the distal edge of the retinaculum. This can be palpated between the 1st and 2nd mets

62
Q

Root values of the tibial nerve

A

L4-S3

63
Q

Root value of the common peroneal nerve

A

L4-S2

64
Q

How would you test the L5 nerve

A

Sensory would be the webspaces of 1st toth toes and motor would be testing the extension of the flexor hallucis longus

65
Q

What are the ligaments of the ankle joint

A

The deltoid ligament: tibio-calcaneo-talar ligament, deep posterior tibiotalar, superficial post tibtal and anterior tib tal lig

Laterally: Anterior and posterior talofibular ligaments

Calcaneofibular ligaments

66
Q

Plantar muscles

A

Intrinsic muscle layers of the foot

1st layer:
Abductor hallucis
Flex dig brev
abductor digiti minimi

2nd layer
Quadratus plantae
Lumbricals

3rd layer
Flex hal brev
Adductor hallucis
Flex dig mini brev

4th layer
Plantar interossei
dorsal interossei

67
Q

Which nerve innervates the dorsal and plantar interossei

A

Lateral plantar nerve

68
Q

What is the talofibular joint also called

A

The syndesmosis

69
Q

What is tarsal tunnel syndrome and what are the different kinds of tarsal tunnel syndromes

A

Pain and paresthesia due to entrapment of the contents of the tarsal tunnel. Commonly caused by compression of the tibial nerve or any of its branches. It is uncommon

Anterior: Deep peroneal nerve is affected
Posterior: Posterior tibial nerve is affected leading to pain and paraesthesia at the sole of the foot

Diagnose: Tinnels, US and/or MRI

Treatment:
Conservative: Rest, elevation, NSAIDS, analgesia
Medical: INjection of LA or steroid
Surgical: Excision of compression lesion

70
Q

Lumbar plexus

A
71
Q

Lumbosacral plexus

A
72
Q

Sacral plexus

A
73
Q

What is the dermatome distribution of the lateral cutaneous nerve

A

L2 and L3
The surface marking of this vessel is 1-2 cm below and medial to the ACIS as it passes below the inguinal ligament

74
Q

What is the femoral sheath formed by

A

Transversalis fascia anteriorly and the iliopsoas fascia posteriorly

75
Q

What sort of a bone is the patella

A

Sesamoid bone

76
Q

What is the function of the patella

A

To attach the quadriceps muscles to the tibial tuberosity via the patellar ligament and to increase its leverage and hence, power

77
Q

Which of the cruciate ligaments is stronger

A

PCL

78
Q

What is the unhappy triad of knee injury

A

Injury to ACL, MCL and Medial meniscus. Caused by a direct blow form the lateral aspect of the knee

79
Q

At what level does the popliteal artery bifurcate

A

Lower border of the popliteus muscle

80
Q

What is a baker cyst

A

Baker’s cyst is a fluid filled sack originating from the semimembranosus bursae. This is not a true cyst as there is usually some communication with the synovial sac

81
Q

What is the sustantaculum tali

A

Shelf-like projection of the talus that gives support to the calcaneous

82
Q

What arises from the linea aspera

A

The adductor muscles, Short head of biceps femoris. Vastus medialis and lateralis and the lateral and medial intermuscular septi

83
Q

What muscles attach to the medial cuneiform

A

Tib ant and post as well as per long

84
Q

What are the contents of the inguinal canal

A
  • Spermatic cord (biological males only)
  • Round ligament (biological females only) – originates from the uterine horn and travels through the inguinal canal to attach at the labia majora.
  • Ilioinguinal nerve – contributes towards the sensory innervation of the genitalia
    o Note: only travels through part of the inguinal canal, exiting via the superficial inguinal ring (it does not pass through the deep inguinal ring)
    o This is the nerve most at risk of damage during an inguinal hernia repair.
  • Genital branch of the genitofemoral nerve – supplies the cremaster muscle and anterior scrotal skin in males, and the skin of the mons pubis and labia majora in females.
85
Q

What are the contents of the inguinal canal

A
  • Spermatic cord (biological males only)
  • Round ligament (biological females only) – originates from the uterine horn and travels through the inguinal canal to attach at the labia majora.
  • Ilioinguinal nerve – contributes towards the sensory innervation of the genitalia
    o Note: only travels through part of the inguinal canal, exiting via the superficial inguinal ring (it does not pass through the deep inguinal ring)
    o This is the nerve most at risk of damage during an inguinal hernia repair.
  • Genital branch of the genitofemoral nerve – supplies the cremaster muscle and anterior scrotal skin in males, and the skin of the mons pubis and labia majora in females.
86
Q

How is the GOJ a physiological sphincter

A

The sphincter is classified as a physiological (or functional) sphincter, as it does not have any specific sphincteric muscle. Instead, the sphincter is maintained by four factors:
* Oesophagus enters the stomach at an acute angle.
* Walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
* Prominent mucosal folds at the gastro-oesophageal junction aid in occluding the lumen.
* Right crus of the diaphragm has a “pinch-cock” effect.

87
Q

What are the tributaries of the splenic vein

A
  • Short gastric veins – drain the fundus of the stomach.
  • Left gastro-omental vein – drains the greater curvature of the stomach.
  • Pancreatic veins – drain the pancreas.
  • Inferior mesenteric vein – drains the colon.
88
Q

What is the pressure needed to diagnose portal HT

A

Portal pressure greater than 20 mmHg is described as portal hypertension

89
Q
A

MRCS part B (10 decks)

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