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M2 MSK > lower limb bones and joints > Flashcards

lower limb bones and joints Flashcards

1
Q

parts of the femur

A

head (neck, greater and lesser trochanters), shaft (linea aspera, lateral and medial supracondylar ridges), end (medial and lateral condyles, patellar groove, intercondylar fossa, popliteal surface)

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2
Q

femoral injuries and common age group

A
  1. transcervical (common in elderly after falling): avascular necrosis of the head, leg shortening, lateral rotation of toes
  2. intertrochanteric (common in young after direct trauma): extracapsular fracture line, shortening and rotation of leg
  3. shaft: upper 1/3 has proximal fragment flexed, middle 1/3 and distal 1/3 has distal fragment rotated
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3
Q

parts of patella

A

posterior surface (covered with cartilage, lateral and medial facet articulate with femur condyles), anterior surface

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4
Q

cause of patellar dislocation

A

natural tendency of patella to dislocate laterally due to upward and lateral pull by quadriceps

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5
Q

parts of tibia

A

lateral and medial condyles, intercondylar eminence, fibula notch, triangular shaft, tibial tuberosity, soleal line, medial malleolus

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6
Q

parts of fibula

A

head w styloid process, shaft, lateral malleolus (extends further than medial malleolus of tibia)

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7
Q

types of tibia/fibula fractures

A
  1. tibial shaft fractures: most common
  2. transverse stress fractures of the inferior 1/3 of the tibia
  3. fibular fractures proximal to the lateral malleolus: assoc with dislocations of the ankle
  4. head and neck fibula fractures (subcutaneous bone) upon heavy lateral impact
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8
Q

name ALL the tarsals (tiger cubs need MILC)

A

talus, calcaneum, navicular, medical cuneiform, intermediate cuneiform, lateral cuneiform, cuboid

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9
Q

parts of the talus

A

head (articulates with navicular), neck (attachment for tendons), trochlea (two articular facets for tibial malleolus and fibular malleolus)

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10
Q

parts of the calcaneum

A

largest foot bone, forms the heel

anterior (articulates with cuboid), posterior (forms heel, attaches to Achilles tendon), superior (articulates with talus), inferior, medial (attachment for ankle ligaments), lateral

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11
Q

types of tarsal fractures

A
  1. talus fracture (swollen foot): neck due to violent dorsiflexion of ankle against anterior edge of tibia, body due to jumping from height
  2. calcaneum / don juan fracture: compression due to falls from height
  3. metatarsal fracture: stress fractures due to forced inversion of foot
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12
Q

toe bones

A

1-5th metatarsals, 1-5th proximal phalanges, 1-5th medial phalanges, 2-5th distal phalanges (big toe doesn’t have a distal phalange)

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13
Q

bones in the medial longitudinal foot arch

A

calcaneum, talus, navicular, 3 cuneiform bones, 1-3rd metatarsals

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14
Q

bones in the lateral longitudinal foot arch

A

calcaneum, cuboid, 4-5th metatarsal

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15
Q

bones in the transverse foot arch

A

metatarsal bones, cuboid, 3 cuneiform bones

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16
Q

function of foot arches

A

distribute weight over the foot, shock absorbing, propulsion of foot, concavity protects the nerves and vessels of the sole

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17
Q

principles supporting the foot arches

A
  1. key stone (keystone centre bone in the arch)
  2. staples (intersegmental ties w ligaments and muscles)
  3. tie beam (ends of the arch are tied together w muscles and aponeuroses)
  4. suspensory (arch is suspended from above by ligaments and muscles)
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18
Q

pes planus pathology

A

• medial longitudinal arch is collapsed or depressed
• forefoot is displaced laterally and everted due to excessive fatigue of muscles
• plantar, medial and lateral ligaments become permanently stretched in the long run causing bones to change shape

therefore flat foot

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19
Q

pes cavus pathology

A

• medial longitudinal arch is very high
• due to muscle imbalance
• nerves on the sole of the foot may be compressed, leading to pain

hence high arch

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20
Q

hip joint type of joint

A

ball and socket synovial joint (ball is femoral head, socket is acetabulum)

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21
Q

ligaments supporting the hip joint (PIITH)

A

pubofemoral ligament (prevents excessive lateral rotation), iliofemoral ligament (prevents hyperextension), ischiofemoral ligament (prevents hyperextension and medial rotation), transverse acetabular, head of femur ligament

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22
Q

joint capsule over hip joint anatomy

A

fibrous capsule from the acetabular labrum, through the intertrochanteric line, to the margin of articular hyaline cartilage

thickened by iliofemoral, pubofemoral, ischiofemoral ligaments forming a psoas bursa with outer longitudinal and inner circular fibres

23
Q

movements and nerve supply of hip joint

A

flexion (L2, L3), extension (L4, L5), adduction (L2, L3), abduction (L4, L5), medial rotation (L2, L3), lateral rotation (L4, L5)

24
Q

blood supply to femoral head

A

trochanteric anastomosis of lateral and medial circumflex arteries (mostly medial) + cruciate anastomosis

25
Q

blood supply to femoral head in children

A

obturator artery runs through epiphyseal growth plate + lateral and medial circumflex arteries (hence no avascular necrosis after fracture)

26
Q

hip joint injuries

A
  1. traumatic dislocation of head of femur: displaced posteriorly out of acetabulum, injuring sciatic nerve (paralysis of hamstrings and muscles distal to the knee)
  2. avascular necrosis: dislocation or fracture of femoral neck disrupting the anastomosis of the obturator artery and medial circumflex femoral artery
  3. joint pain: due to referred pain from femoral, obturator, sciatic nerves crossing the hip joint
27
Q

knee joint type of joint

A

modified synovial hinge joint (femoropatellar articulation in a synovial gliding joint + lateral and medial femorotibial condyles)

28
Q

knee joint innervation

A

femoral, tibial, common peroneal, obturator nerves

29
Q

extracapsular ligaments of the knee

A

ligamentum patellae, lateral fibular collateral ligament, medial tubular collateral ligament, oblique popliteal ligament

30
Q

intracapsular ligaments of the knee

A

anterior cruciate ligament (anterior intercondylar area of tibia to lateral condyle of the femur): prevents hyperextension
posterior cruciate ligament (posterior intercondylar area of tibia to medial condyle of femur): prevents hyperflexion

31
Q

anterior bursae of the knee

A

suprapatellar, prepatellar, superficial infrapatellar, deep infrapatellar

32
Q

posterior bursae of the knee

A

popliteal and semimembranosus

33
Q

attachment of the menisci of the knee joint

A

medial and lateral menisci are attached anteriorly by the transverse ligament of the knee, and also attached to the intercondylar area of the tibia and fibrous layer of the knee joint capsule

34
Q

medial vs lateral meniscus

A

c shaped vs circular
broader posteriorly vs smaller
attached to ACL and PCL vs more freely movable
more prone to injuries vs less prone to injuries

35
Q

locking and unlocking mechanism of the knee

A

locking = medial rotation of the femur on the tibia
unlocking = contraction of popliteus to laterally rotate the femur 5° on the tibial plateau

36
Q

movements of the knee

A

flexion (hamstrings), extension (quadriceps femoris), external rotation (biceps femoris), internal rotation (semimembranosus, semitendinosus, popliteus)

37
Q

blood supply to the knee

A

anastomosis of femoral, popliteal, anterior and posterior tibial arteries

38
Q

ligamentous injuries of the knee

A
  1. medial collateral ligament tear: during excessive abduction
  2. lateral collateral ligament tear: during excessive adduction
  3. anterior cruciate ligament tear (COMMON): leads to anterior drawer sign, femur slides forward
  4. posterior cruciate ligament tear (rare): leads to posterior drawer sign, femur slides backwards

cruciate ligament tears cause haemathrosis and swollen joint

39
Q

what is O’Donoghue’s triad?

A

ruptured MCL, ruptured ACL, and torn medial meniscus (due to force applied on a flexed and rotated knee)

40
Q

menisci injury of the knee

A

medial menisci more prone to damage due to connection to MCL (restricts its movement): leads to positive McMurray test (clunk and pain when knee is rotated externally and extended)

41
Q

proximal tibiofibular joint type of joint

A

synovial plane joint between lateral condyles of tibia and head of fibula

42
Q

distal tibiofibular joint type of joint

A

syndesmosis type of fibrous joint between lower end of tibia and lower end of fibula, strengthen by interosseous membrane

43
Q

ankle joint type of joint

A

synovial hinge joint between medial and lateral malleoli, lower end of tibia, talus body

44
Q

innervation of ankle joint

A

deep peroneal, tibial nerves

45
Q

ligaments in ankle joint

A

medial (deltoid) ligament, lateral ligaments, anterior talofibular ligament, posterior talofibular ligament, calcaneofibular ligament

46
Q

factors stabilizing the ankle joint

A
  1. close interlocking of articular surfaces
  2. strong medial and lateral collateral ligaments
  3. inferior transverse tibiofibular ligament
  4. tendons crossing in front and behind of ankle joint
47
Q

movements of ankle joint

A

dorsiflexion (tibialis anterior), plantar flexion (gastrocnemius, soleus)

48
Q

ankle injuries

A
  1. sprains of lateral ankle: caused by excessive inversion of the foot, usually anterior talofibular ligament
  2. sprains of medial ankle: caused by excessive eversion of the foot, less common due to strength of medial ligament
  3. fracture dislocations of ankle joint: caused by forced external rotation and overeversion of the foot
49
Q

talocalcaneal (subtalar) joint type of joint

A

plane synovial joint between talus and calcaneum, surrounded by medial, lateral, posterior and interosseous talocalcaneal ligaments

50
Q

talocalcaneonavicular joint

A

synovial joint between talus, calcaneum and navicular, forms part of the transverse tarsal joint

51
Q

calcaneocuboidal joint type of joint

A

synovial plane joint between calcaneus and cuboid, forms part of transverse tarsal joint

52
Q

significance of transverse tarsal joint

A

compound joint consisting of the talocalcaneonavicular joint and the calcaneocuboidal joint, transection across this joint is performed during surgical amputation of the foot

53
Q

movements of the subtalar joint

A

inversion (tibialis anterior, tibialis posterior), eversion (fibularis longus, fibularis brevis)

54
Q

gaits and their significance

A

• antalgic gait: limping gait
• Trendelenburg sign: waddling gait with hip elevated at the pathological side
• parkinsonian gait: shuffling, sometimes festinant gait
• ataxic gait: wide-based, unbalanced gait
• dorsal column injury: high-stepping gait due to foot drop

M2 MSK (5 decks)

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