Lower limb further study

Question 1

Define a hinge joint. Name some hinge joints in lower limb

Answer 1

Hinge joint definition:
-Allows movement only in one plane

Classical: talofibular, tibiotalar
-Interphalangeal joints (also in upper limb)
Modified: Knee (allows slight degree of rotation)

Question 2

Define and name some gliding joints

Answer 2

Definition: articular surfaces are nearly flat, allowing bones to glide over one another

Patello-femoral
Talo-calcaneal

Question 3

Nerve root gluteal nerves

Answer 3

Superior: L4-S1
inferior: L5-S2

Question 4

Pudendal nerve root

Answer 4

S2-S4

Question 5

Name muscles that attach to linea aspera

Answer 5

Adductors longus, brevis, magnus
Short head biceps femoris
Vastus medialis
Gluteus maximus: gluteal tuberosity at superior surface

Question 6

Name structures that attach to anterior superior iliac spine

Answer 6

-Inguinal ligament
-Sartorius
-Tensor fascia lata

Question 7

Name structures that attach to anterior inferior iliac spine

Answer 7

Straight head rectus femoris

Question 8

Where does rectus femoris attach?

Answer 8

Straight head:
-anterior inferior iliac spine

Reflected head:
-Top of acetabulum

Question 9

What structures are attached to iliotibial band?

Answer 9

Tensor fascia lata
Gluteus maximus

Question 10

What is the function of iliotibial band?

Answer 10

Stabilises knee with knee extended (gluteus maximus, tensor fascia lata)

Question 11

What are the main extensors of the hip?

Answer 11

Gluteus maximus
True hamstrings
Hamstring part of adductor magnus

Question 12

What muscles cause internal rotation of hip?

Answer 12

-Pectineus
-Gracilis
-Adductors

Question 13

Describe innervation of hamstring muscles

Answer 13

Semitendanosis, semimembranosus, biceps femoris long head: tibial division sciatic nerve
Hamstring part of adductor magnus: tibial division sciatic nerve
Short head biceps femoris: peroneal nerve

Question 14

How is the thigh divided into thirds?

Answer 14

Upper 1/3rd: femoral triangle
Middle 1/3rd: hunter’s canal
Lower 1/3rd: popliteal fossa

Question 15

What tendons are inserted along the antero-medial surface of proximal tibia?

Answer 15

Sartorius, gracilis, semitendinosus (anterior to posterior)
–> pes anserinus

(say grace before ten)

Question 16

Describe the attachments of the anterior and posterior cruciate ligaments, and describe their orientation

Answer 16

Anterior:
–> O: medial tibial spine
–> I: lateral femoral condyle

Posterior:
–> O: medial tibial condyle
–> I: lateral femoral spine

ACL: front to back
PCL: back to front

Question 17

Indication for operative management patellar fracture

Answer 17

Extensor lag >20 degrees (lack of full knee extension with full contraction of quadriceps)
2-3mm displacement
Open #/loose bodies

Question 18

What is the course of the long saphenous vein?

Answer 18

-Formed by dorsal venous arch foot
-Ascends 2cm in front of medial malleolus, runs along medial border o tibia to knee
-Passes posterior to medial condyle at knee
-Empties into sapheno-femoral junction 4cm below and lateral to pubic tubercle

Question 19

What is the course of the short saphenous vein?

Answer 19

-Formed by dorsal venous arch
-Moves up posterior leg, passing posterior to lateral malleolus
-Runs along lateral border achilles tendon
-Moves between two heads gastrocnemius and empties into popliteal vein in popliteal fossa

Question 20

What nerve accompanies long saphenous vein?

Answer 20

Saphenous nerve

Question 21

What nerve accompanies short saphenous vein?

Answer 21

Sural nerve

Question 22

Describe action of muscles in lateral compartment of leg

Answer 22

Eversion of foot

Question 23

Describe management of compartment syndrome

Answer 23

-Take down dressing and cast
-Maintain BP
-Elevate leg to level of heart
-Analgesia
-Review neurovascular status
-Reassess

Compartment pressure monitoring–> for unconscious patients

Fasciotomy within 1 hr of diagnosis of compartment syndrome
–> 2 incisions 15cm long
–> 1 medial: 2cm behind medial border tibia (opens posterior superficial and deep compartments)
–> 1 lateral: 2cm lateral to lateral edge of tibia (opens anterior and lateral compartments)

Question 24

Name structures that run over extensor (anterior) aspect of ankle

Answer 24

TEA DEPt
Tibialis anterior
EHL
Anterior tibial artery
Deep peroneal nerve
EDL
Peroneus tertius

Question 25

Name structures that run behind medial malleolus

Answer 25

Tom, dick and very naughty harry (anterior to posterior)
Tibialis posterior
flexor Digitorum longus
posterior tibial Artery
posterior tibial Vein
tibial Nerve
flexor Hallucis longus

Question 26

What is the insertion of tibialis anterior muscle?

Answer 26

Base 1st metatarsal, medial cuneiform

Question 27

What is insertion of tibialis posterior?

Answer 27

Navicular bone, medial cuneiform

Question 28

What is the insertion of the three peroneus muscles?

Answer 28

Longus: under foot, attaches lateral surface medial cuneiform and first metatarsal (same as tibialis anterior)
Brevis: Base 5th metatarsal
Tertius: base 5th metatarsal (dorsal)

Question 29

Describe cuntaneous innervation to dorsal aspect of foot

Answer 29

Mostly superficial peroneal
1st webspace: deep peroneal
Lateral: sural nerve

Question 30

Describe cutaneous innervation to plantar aspect of foot

Answer 30

Medial: medial plantar
Lateral: lateral plantar
Calcaneal area: tibial
Saphenous: small amount posteromedial
Sural: small amount posterolateral

Question 31

Name structures in different layers of foot (plantar to dorsal)

Answer 31

1st: 3 small muscles
2nd: long flexor tendons and lumbricals (important)
3rd: small muscles
4th: peroneus longus, tibialis posterior tendon, interossei

Question 32

Myotomes lower limb

Answer 32

L2: hip flexors
L3: knee extensors
L4: ankle dorsiflexors
L5: Long toe extensors
S1: ankle plantarflexors