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6. MSK > Lower Limb Joints > Flashcards

Lower Limb Joints Flashcards

1
Q

What type of joint is the hip joint?

A

Ball and socket synovial joint type.

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2
Q

What articulation does the hip joint consist of?

A

The head of the femur with the acetabulum of the pelvis.

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3
Q

What about the articulation of the hip joint makes it stable?

A

The acetabulum is a cup-like depression and the head of the femur is hemispherical and fits completely into the acetabulum.

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4
Q

What are the acetabulum and head of femur covered in?

A

Articular cartilage. Thicker at weight bearing places.

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5
Q

What are the two groups of ligaments that increase the hip joint stability?

A

Intracapsular and extracapsular.

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6
Q

What is the intracapsular ligament of the hip joint?

A

The ligament of head of the femur.

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7
Q

Where does the ligament of the head of the femur run from and to?

A

From the acetabular fossa to the fovea of the femur.

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8
Q

What are the extracapsular ligaments of the hip joint?

A

Iliofemoral, pubofemoral and ischiofemoral.

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9
Q

What is the location of the iliofemoral ligament of the hip joint?

A

Anteriorly located. It originates from the ilium (inferior to the anterior inferior iliac spine) and attaches to the intertrochanteric line in two places to give the Y shape.

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10
Q

What is the function of the iliofemoral ligament of the hip joint?

A

Prevents hyperextension of the hip joint.

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11
Q

What is the location of the pubofemoral ligament of the hip joint?

A

Anteriorly and inferiorly located. Attaches at the pelvis to the iliopubic eminance and obturator membrane, and blends with the articular capsule.

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12
Q

What is the function of the pubofemoral ligament of the hip joint?

A

Prevents excessive abduction and extension.

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13
Q

What is the location of the ischiofemoral ligament of the hip joint?

A

Posteriorly located. It originates from the ischium of the pelvis and attaches to the greater trochanter of the femur.

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14
Q

What is the function of the ischiofemoral ligament of the hip joint?

A

Prevents excessive extension of the femur at the hip joint.

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15
Q

Which artery supplies the hip joint?

A

The medial and lateral circumflex femoral arteries.

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16
Q

Why is damage to the medial circumflex artery a problem?

A

It can lead to avascular necrosis of the femoral head.

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17
Q

Which nerves innervate the hip joint?

A

The femoral nerve, obturator nerve, superior gluteal nerve, and nerve to quadratus femoris.

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18
Q

What is the primary function of the hip joint?

A

To bear weight.

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19
Q

What structures increase the stability of the hip joint?

A

Acetabulum, acetabular labrum, ligaments, muscles.

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20
Q

How does the acetabulum stabilise the hip joint?

A

It is deep and holds nearly all of the femoral head so decreases the chance of the head slipping out in hip dislocation.

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21
Q

How does the acetabular labrum increase hip joint stability?

A

It is a fibrocartilaginous collar around the acetabulum that increases its depth. So there is a larger articular surface to increase joint stability.

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22
Q

How are the ligaments of the hip joint arranged and why?

A

Spinal orientation to make the ligament tighter when extended to stabilise the joint further.

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23
Q

How do the strength of ligaments and muscles of the hip joint match each other?

A

Anteriorly - the ligaments are stronger and the medial flexors are weaker and fewer.
Posteriorly - the ligaments are weakest, so the medial rotators are greater in number and strength so pull the head of the femur into the acetabulum.

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24
Q

What are the movements possible at the hip joint?

A

Flexion, extension, abduction, adduction and medial/laterla rotation.

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25
Q

How does the degree of flexion at the knee affect the range of movement able at the hip?

A

If the knee if flexed, the hamstrings are relaxed so there is a greater range of flexion at the hip joint and vice versa.

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26
Q

How is extension at the hip joint limited?

A

By the joint capsule - especially the iliofemoral ligament.. The structures become taut in extension to limit further movement.

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27
Q

What muscles are responsible for the following movements at the hip joint?

a. flexion
b. extension
c. abduction
d. adduction
e. lateral rotation
f. medial rotation

A

a. Iliosoas, rectus femoris, sartorius.
b. gluteus maximus, semimembranosus, semitendinosus, biceps femoris.
c. gluteus medius, gluteus minimus, deep gluteals (piriformis, gemelli etc.)
d. adductor longus, adductor brevis, adductor magnus, pectineus, gracilis.
e. biceps femoris, gluteus maximus, deep gluteals.
f. gluteus medius, gluteus minimus, semitendinosus, semimembranosus.

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28
Q

What causes fractures to the neck of the femur in 40 year olds?

A

40 - from falls.

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29
Q

What is the possible consequence of a fracture to the neck of the femur?

A

The arteries arising from the medial circumflex artery are torn, this disrupts the blood supply and can lead to avascular necrosis of the femoral head and neck.

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30
Q

What is replaced with what in hip replacements?

A

The acetabulum is replaced with a plastic socket and the femoral head and stem are replaced by stainless steel.

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31
Q

What is the difference between congenital and acquired hip dislocations?

A

Congenital - in development the femoral head is not placed within the acetabulum.
Acquired - traumatic accidents dislocate the hip.

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32
Q

What are the most commonly affected groups for congenital hip dislocations?

A

Girls.

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33
Q

What are some symptoms of congenital hip dislocation?

A

Inability to abduct at the hip joint, affected limb is shorter, positive Trendelenburg sign.

34
Q

What does congenital hip dislocations predispose patients to?

A

Arthritis.

35
Q

Why are acquired hip dislocations uncommon?

A

The joint is strong and stable. Requires traumatic accidents to dislocate the joint.

36
Q

What are the two types of acquired hip dislocation?

A

Posterior (common type) and anterior.

37
Q

What happens in acquired posterior hip dislocation?

A

The femoral hip is forced posteriorly and tears through the inferior and posterior part of the joint capsule (weakest part). The limb becomes shortened and rotated medially.

38
Q

How is the sciatic nerve affected in acquired posterior hip dislocation?

A

The sciatic nerve runs posteriorly to the hip joint and gets damaged in this injury. This leads to paralysis of the hamstrings and the muscles distal to the knee.

39
Q

What causes anterior acquired hip dislocation?

A

Extension, abduction or lateral rotation. The femoral head ends up anterior and inferior to the acetabulum and can pull the labrum with it.

40
Q

What type of joint is the knee joint?

A

Bicondylar synovial joint.

41
Q

What are the articulating surfaces of the knee joint?

A

Tibiofemoral - medial and lateral condyles of the femur articulate with the tibia.
Patellofemoral - anterior and distal part of the femur articulares with the patella.

42
Q

Which is the weightbearing joint of the knee?

A

The tibiofemoral.

43
Q

What is the purpose of the patellofemoral joint?

A

Allows the tendon of the quadriceps femoris to insert directly over the knee to increase its efficiency.

44
Q

What are the functions of the menisci?

A

To deepen the articular surface of the tibia, thus its stability. And to act as shock absorbers.

45
Q

Where do the menisci attach?

A

At both ends of the intercondylar area of the tibia. The medial meniscus fixes to the tibial collateral ligament and the joint capsule.

46
Q

What are bursae?

A

Synovial fluid filled sacs between moving structures in joints.

47
Q

What are the four bursae in the knee joint?

A

Suprapatella bursa - extension of synovial cavity of knee, between quadriceps femoris and femur.
Prepatellar bursa - between apex of patella and skin.
Infrapatellar bursa - deep and superficial slit, deep lies between tibia and patella ligament, superficial lies between patella ligament and skin.
Semimembranosus bursa - posteriorly in knee joint, between semimembranosus muscle and medial head of gastrocnemius.

48
Q

What are the three types of ligaments in the knee joint?

A

Patellar ligament, collateral ligament - tibial and fibular, and cruciate ligaments - anterior and posterior

49
Q

Where does the patellar ligament attach?

A

To the tibial tuberosity.

50
Q

What is the function of the collateral ligaments?

A

They stabilise the hinge motion of the knee and prevent medial and lateral movement.

51
Q

Where do the tibial and fibular collateral ligaments of the knee attach?

A

Tibial - on medial side of joint, attaches proximally to medial epicondyle of the femur and distally to medial surface of tibia.
Fibular - attaches proximally to lateral epicondyle of the femur, and distally to a depression on the lateral surface of the fibular head.

52
Q

Where do the anterior and posterior cruciate ligaments of the knee attach?

A

Anterior - attaches at the anterior intercondylar region of the tibia and ascends posteriorly to attach to the femur in the intercondylar fossa.
Posterior - attaches at the posterior intercondylar region of the tibia, and ascends anteriorly to attach to the femur in the intercondylar fossa.

53
Q

What are the roles of the anterior and posterior cruciate ligaments?

A

Anterior - prevents anterior dislocation of the tibia onto the femur.
Posterior - prevents posterior dislocation of the tibia onto the femur.

54
Q

What are the movements at the knee joint?

A

Extension, flexion, lateral rotation, and medial rotation.

55
Q

What are the muscles producing the movements at the knee joint?

A

Extension - quadriceps femoris.
Flexion - hamstrings, gracilis, sartorius and popliteus.
Lateral rotation - biceps femoris.
Medial rotation - semimembranosus, semitendinosus, gracilis, sartorius and popliteus.

56
Q

What causes damage to the collateral ligaments of the knee joint?

A

Force being applied to the side of the knee when the foot is placed on the ground.

57
Q

How can it be tested if the medial or lateral collateral ligament is damaged in the knee?

A

Ask the patient to medially rotate and laterally rotate the leg, pain on medial rotation indicated medial ligament damage and vice versa.

58
Q

How can the anterior cruciate ligament be torn?

A

With hyperextension of the knee joint or application of a large force to the back of the knee with the joint partly flexed.

59
Q

How can the anterior cruciate ligament of the knee be tested for damage?

A

Anterior drawer test - attempt to pull the tibia forward, if it moves the ligament has been torn.

60
Q

How can the posterior cruciate ligament be torn?

A

In ‘dashboard’ injury - knee if flexed and a large force is applied to the shin that pushes the tibia posteriorly. Or in hyperextension of the knee joint, or damage to the upper part of the tibial tuberosity.

61
Q

How can the posterior cruciate ligament be tested for damage?

A

Posterior drawer test -knee held in flexed position and shin pushed posteriorly. If it moves, the ligament has been torn.

62
Q

What causes housemaids knee?

A

Friction between the skin and the patella causing the prepatellar bursa to become inflammed.

63
Q

What causes clergyman’s knee?

A

Friction between the skin and tibia can cause infrapatella bursa to become inflamed.

64
Q

What causes the unhappy triad?

A

The attachment of the medial collateral ligament to the medial meniscus means damage to the medial collateral ligament affect the important medial meniscus. Also lateral force to an extended knee can rupture the medial collateral ligament and damage the medial meniscus.

65
Q

What type of joint is the ankle joint?

A

A synovial hinge joint.

66
Q

What are the bones that form the ankle joint?

A

The tibia and fibula of the leg and the talus of the foot.

67
Q

What is the mortise?

A

The bracket shaped socket covered in hyaline cartilage that the tibia and fibula make whilst bound by strong tibiofibular ligaments.

68
Q

What are the two sets of ligaments of the ankle joint?

A

Medial ligament (made of four ligaments) attached to medial malleolus and lateral ligament from the lateral ligament (made of three ligaments).

69
Q

What is the function of the medial ligament of the ankle?

A

To resist overeversion of the foot.

70
Q

Where do the medial ligaments of the ankle attach?

A

Talus, calcaneus, and navicular bones.

71
Q

What is the function of the lateral ligament of the ankle?

A

To resist overinversion of the foot.

72
Q

What are the three ligaments of the lateral ligament of the ankle?

A

Anterior talofibular - between lateral melleolus and lateral aspect of the talus.
Posterior talofibular - between lateral malleolus and posterior aspect of talus.
Calcaneofibular - between lateral malleolus and calcaneus.

73
Q

What makes up the ankle ring?

A

Upper part - articular surfaces of the tibia and fibula.
Lower part - subtalar joint.
Sides of the ring - medial and lateral ligaments.

74
Q

What is the clinical importance of the ankle ring when looking at X rays?

A

As it is a ring, it is unlikely to only fracture in one part, so look for two fractures of the ring.

75
Q

What are the movements of the ankle joint?

A

Plantarflexion and dorsiflexion.

76
Q

What muscles produce the movements of the ankle joint?

A

Plantarflexion - muscles in the posterior compartment of the leg: gastrocnemius, soleus, plantaris, and posterior tibialis.
Dorsiflexion - muscles in the anterior compartment of the leg: tibialis anterior, extensor hallucis longus, and extensor digitorum longus.

77
Q

What is a sprain of the ankle?

A

Partial or complete tears in the ligaments of the ankle joint.

78
Q

What causes sprained ankles?

A

Plantarflexed weight bearing foot is excessively inverted.

79
Q

Why is the lateral ligament likely to be damaged in ankle sprains?

A

It is weaker than the medial ligament, and resists inversion.

80
Q

What is the lateral ligament in the ankle most susceptible to irreversible damage?

A

Anterior talofibular.

81
Q

What is a Pott’s fracture?

A

A bimalleolar or trimalleolar fracture.

82
Q

How do Pott’s fractures happen?

A

Forced eversion pulls on the medial ligaments and produces avulsion fracture of the medial malleolus. Then the talus moves laterally and breaks off the lateral malleolus. The tibia is then forced anteriorly and shears off the distal and posterior part against the talus.

6. MSK (30 decks)

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