Lower Limb Clinical Anatomy

Question 1

What is the usual demographic affected with Perthe’s disease?

Answer 1

Boy between the ages of 4-8 with delayed skeletal maturity

Question 2

How will a patient with Perthe’s Disease complain?

Answer 2

Complain of hip joint and start to limp
Joint will be irritable
Movements are diminished and painful at extremes

Question 3

What movements are most commonly affected in a patient with Perthe’s disease?

Answer 3

Abduction and internal rotation

Question 4

What is the femoral head dependent on for blood supply between the ages of 4-7?

Answer 4

Lateral epiphyseal vessels

Question 5

How may the lateral epiphyseal vessels be occluded?

Answer 5

Pressure from effusion around the hip

Question 6

What is the pathology of Perthe’s disease?

Answer 6

Three-stage process
One or more episodes of ischaemia causing bone death
Revascularisations and repair then occur
Distortions and remodelling of femoral head and neck

Question 7

What can Perthe’s disease lead to?

Answer 7

Incomplete covering of the femoral head by the acetabulum

Question 8

What is the purpose of Ottawa Ankle Rules?

Answer 8

Determine the need for radiographs in acute ankle injuries

Question 9

What are the 5 components of the Ottawa Ankle Test?

Answer 9

Bony tenderness along distal 6cm of posterior edge of fibula or tip of lateral malleolus
Bony tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus
Bony tenderness at base of 5th metatarsal
Bony tenderness at navicular
Inability to bear weight both immediately after injury and for 4 steps during initial evaluation

Question 10

When is an ankle X-ray required?

Answer 10

Pain in malleolar zone
Bony tenderness @ 6cm….
Inability to bear weight immediately and four steps

Question 11

When is a foot x-ray indicated?

Answer 11

Pain in midfoot zone
Bony tenderness @ navicular or base of 5th metatarsal
or Inability to bear weight immediately and four steps

Question 12

What demographic are the Ottawa Ankle rules used on?

Answer 12

Those over 18

Question 13

How does one attain a positive Trendelenburg Test?

Answer 13

Hip drop on opposite side to supporting leg
Muscles of opposite side dropped leg are affected

Question 14

Define Perthe’s Disease.

Answer 14

Idiopathic Avascular Necrosis of head of femur in children ages 4-8

Question 15

How do we measure true limb length?

Answer 15

ASIS to just below medial malleolus

Question 16

When is the anterior cruciate ligament usually injured?

Answer 16

Landing on one foot while the trunk is rotating

Question 17

How do we check if the ACL and PCL are intact?

Answer 17

ACL - anterior drawer test
PCL - posterior drawer test
Knee bent, ACL prevents the tibia being pulled anteriorly

Question 18

How can we distinguish if there is a problem in the PNS or CNS with the knee reflex?

Answer 18

Increased/brief reflex means CNS
Decreased/absent reflex means PNS

Question 19

How is an intraosseous needle inserted?

Answer 19

Anteromedial surface of proximal tibia - easy to locate and presents a flat, wide surface for insertion with minimal subcutaneous layers overlying the bone
Insert needle 1 fingerbreadth medial to tibial tuberosity

Question 20

What deformity is associated with damage to the common peroneal nerve?

Answer 20

Footdrop

Question 21

Where is the common peroneal nerve liable to injury?

Answer 21

As it passes under the head of the fibula

Question 22

What is the Thompson/Simmonds Test?

Answer 22

Squeeze gastrocnemius/tendocalcaneus and should cause plantarflexion

Question 23

What is plantar fasciitis?

Answer 23

Inflammation of the ligament that connects the calcaneus to the Phalanges

Question 24

What movement causes an ankle sprain?

Answer 24

Inversion