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MSK > lower limb (more impt) > Flashcards

lower limb (more impt) Flashcards

1
Q

What are the 5 ligaments stabilising the hip joint?

A

Pubofemoral
Ischiofemoral
Iliofemoral
Transverse acetabular
Ligament of the head of femur

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2
Q

** Describe the course of the femoral artery, starting from where it branches from

A

External iliac artery -> femoral artery which crosses posterior to inguinal ligament

At the thigh level, it branches out into medial and lateral circumflex femoral artery.

Enters the adductor hiatus (within the adductor magnus) into the popliteal fossa at the back of the knee -> popliteal artery.

Popliteal artery -> anterior, posterior tibial artery and peroneal artery

Anterior tibial artery enters the front through the interosseus membrane between the tibia and fibula.

Peroneal artery supplies lateral leg.

Anterior tibial artery -> dorsalis pedis artery at the dorsum of foot

Posterior tibial artery -> lateral and medial plantar arteries

Dorsalis pedis artery and lateral plantar artery converge to form the plantar arch.

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3
Q

**Where can the femoral artery be palpated?

A

Inferior to the midpoint of the inguinal ligament

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4
Q

Where can the dorsalis pedis pulse be palpated?

A

In between the tendons of the extensor hallucis longus and extensor digitorum longus

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5
Q

Borders of the popliteal fossa

A

Superomedial: Semimembranosus
Superolateral: Biceps femoris
Lateral and medial head of gastrocnemius

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6
Q

Contents of the popliteal fossa

A

Popliteal artery
Popliteal vein
Tibial and common peroneal nerve

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7
Q

Borders of the femoral triangle

A

Superior: inguinal ligament
Lateral: sartorius muscle
Medial: adductor longus

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8
Q

Contents of the femoral triangle

A

Femoral NAV (nerve, artery, vein) from lateral to medial.

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9
Q

Name 3 bursae in the knee and explain their functions

A

The bursae in the knee are small, fluid-filled sacs that cushion and reduce friction between the bones, muscles, tendons, and skin around the knee joint.

Suprapatellar bursa
Semimembranosus bursa
Popliteal bursa (*most commonly infected/damaged -> bursitis)

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10
Q

Name the extracapsular ligaments of the knee

A

Ligamentum patellae
Lateral collateral ligament
Medial collateral ligament
Oblique popliteal ligament

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11
Q

***Name the intracapsular ligaments of the knee

A

Anterior cruciate ligament
Posterior cruciate ligament

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12
Q

Where does the ACL and PCL attach to respectively?

A

LAMP

Lateral femoral condyle _ACL
Medial “ - PCL

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13
Q

Name the 2 meinisci of the knee

A

Medial meniscus
Lateral meniscus

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14
Q

**What does the ACL prevent in the knee?

A

Prevents the posterior displacement of the femur on the tibia and hyperextension of the knee joint

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15
Q

**What does the PCL prevent in the knee?

A

Prevents the anterior displacement of the femur on the tibia and hyperflexion of knee joint

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16
Q

What happens during an ACL tear

A

Free tibia slides anteriorly under the femur

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17
Q

What happens during a PCL tear

A

Free tibia slides posteriorly under the femur

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18
Q

Name the types of joint that hip, knee and ankle joint are

A

Hip - socket
Knee & ankle - hinge

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19
Q

Name the ligaments of the ankle

A

Deltoid ligament
Lateral ligament: anterior talofibular, posterior talofibular and calcaneofibular

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20
Q

***Name as many pathological findings in a patient with OA I would expect to see in their Xray (hint: theres 6)

A
  1. Thinning, erosion and fibrillation ‘cracking’ leading to narrowing of joint space
  2. Presence of osteophytes
  3. Eburnation - exposed bones with smooth surface due to constant friction
  4. Formation of subchondral cysts
  5. Reactive thickening of synovium
  6. Surrounding muscle/tissue atrophy
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21
Q

RA is associated with

A

HLA-DR4

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22
Q

Describe some pathological features of RA

A
  1. Synovial inflammation with chronic inflammatory lymphocytic infiltration seen during joint aspiration
  2. Formation of pannus - granulation tissue that grows and destroys articular cartilage
  3. Rheumatoid nodules (more common in the hands)
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23
Q

For what conditions will you take a joint aspirate?

A

Septic arthritis - patient presents with joint pain and fever. Recent bacterial or viral infection in other part of body.

Rheumatoid arthritis - to check for chronic lymphocytic infiltration

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24
Q

How does gout happen?

A

Reduced uric acid excretion or increase in uric acid production = either or both causing increase in uric acid levels in the body

High uric acid favours urate crystal formation -> deposits in the joints

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25
Q

What is gout associated with?

A

Seafood diet, obesity, alcohol, hypertension

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26
Q

Where is gout most commonly found?

A

Big toe

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27
Q

When fluid is aspirated from suspect gout nodules, what will I expect to see?

Compare this to what I will see in pseudogout patients.

A

Gout: Needle shaped crystals

Pseudogout: Rhomboid shaped crystals

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28
Q

Describe the pathogenesis of gout

A
  1. High uric acid causes urate crystal formation
  2. Urate crystals are phagocytosed by macrophages
  3. Activation of inflammatory mediators -> recruit more macrophages and neutrophils
  4. Neutrophils also phagocytose the crystals -> releasing lysosomal enzymes in the process
  5. Inflammatory mediators cause tissue injury and inflammation
29
Q

Differentiate between gout and pseudogout

A

Gout: crystal made of URIC ACID; needle shaped crystals

Pseudogout: crystals made of CALCIUM; rhomboid shaped crystals

30
Q

What thyroid condition is pseudogout associated with?

A

Hyperparathyroidism -> hypercalcemia

31
Q

What is the most common infective agent causing septic arthritis?

A

Staph aureus via skin and soft tissue infections

32
Q

What is the main causative agent of osteomyelitis?

A

Staph aureus

33
Q

What is osteomyelitis?

A

Infection of the bone involving the cortex, medulla and periosteum.

Bacteria proliferates in the bone inducing acute inflammation -> bone abscess formation -> bone (avascular) necrosis -> sequestrum -> rupture of periosteum

Bacteria spreads to joints or synovium -> can cause secondary septic arthritis

34
Q

Name the most common malignant bone tumour

A

Metastatic secondary

35
Q

Name the most common primary malignant bone tumour

A

Osteosarcoma
Chondrosarcoma
Ewing sarcoma

36
Q

Name the most common benign bone tumour

A

Osteochondroma

37
Q

What age groups does the primary malignant bone tumours affected?

A

Osteosarcoma & Ewing sarcoma affect children and young adults while chondrosarcoma affects older patients.

38
Q

Which of the primary malignant bone tumours respond and don’t respond to chemotherapy?

A

Osteosarcoma & Ewing sarcoma - respond
Chondrosarcoma - NO RESPONSE

39
Q

Describe an osteosarcoma tumour (Xray, gross & microscopically)

A

Xray
1. Sunburst pattern due to new bone formation
2. Permeative margins - multiple small holes in the bone
3. Bone destruction

Gross
Fleshly apperance with areas of necrosis and haemorrhage

Microscopically
*Lace-like pattern of osteoid (thick solid pink curved lines)

40
Q

Describe the apperance of a chondrosarcoma tumour

A

Since chondro means that the tumour produces cartilage, the tumour has a pearly white/light blue appearance.

41
Q

Describe the apperance of an osteochondroma tumour

A

Overgrowth of cartilage and bone which will cause a protrusion out of the bone (look like a mushroom growing out)

42
Q

What artery is related to a fracture of the femoral neck?

A

Medial circumflex femoral artery which supplies most of the head and neck of femur.

Disruption of blood supply -> avascular necrosis -> bone death and fracture

43
Q

What nerve is closely related to the neck of fibula?

A

Common peroneal nerve which innervates most of the foot and leg

Lead to foot drop, inability to dorsiflex and plantar flex ankle

44
Q

Which type of meniscal tear is more common and why?

A

Medial more common because of it moves to a greater degree during rotatory movements.

Lateral is protected by popliteus muscle

45
Q

Patient comes in complaining of pain radiating from posterior thigh to leg. What nerve do you suspect?

A

Sciatic nerve

Commonly sciatica caused by bulging or herniated disk that compress on the L4,L5,S1-S4 nerve roots

46
Q

What is the tarsal tunnel and what passes through it?

A

Passageway for tendons, nerves and vessels to travel between the posterior leg and the foot.

Contents:
Tibialis posterior tendon
Flexor digitorum longus tendon
Flexor hallucis longus tendon
Posterior tibial artery and vein
Tibial nerve

Covering all of the contents passing through: flexor retinaculum

47
Q

Contents of tarsal tunnel

A

Tibialis posterior tendon
Flexor digitorum longus tendon
Flexor hallucis longus tendon
Posterior tibial artery and vein
Tibial nerve

48
Q

Describe tarsal tunnel syndrome

A

Compression of tibial nerve as it passes through the tarsal tunnel - loss of sensations in the sole of the foot as well as weakness and wasting of intrinsic foot muscles

49
Q

How to surgically correct tarsal tunnel syndrome?

A

Cut through the flexor retinaculum to decompress the tunnel (similar to carpal tunnel)

50
Q

Nerve innervating anterior thigh - name the muscles too

A

Anterior thigh:
Psoas major; Iliacus; Sartorius; Quadriceps femoris

Femoral nerve (except psoas major which is anterior rami of L1-3)

51
Q

Nerve innervating posterior thigh - name the muscles too

A

Posterior thigh:
Biceps femoris; semitendinosus; semimembranosus

Tibial part of sciatic nerve

52
Q

Nerve innervating lateral thigh

A

Femoral nerve

53
Q

Nerve innervating medial thigh - name the muscles too

A

Medial adductors of the thigh:
Gracilis; obturator externus; adductor longus, brevis & magnus

Obtruator nerve

54
Q

Nerve innervating anterior leg - name the muscles & movement too

A

Tibialis anterior; extensor digitorum longus; extensor hallucis longus

Dorsiflexion of foot

Deep peroneal nerve

55
Q

What are the 2 branches of the common peroneal nerve and what do they supply?

A

Deep and superficial peroneal nerve.

Deep -> anterior leg compartment
Superficial -> lateral leg compartment

56
Q

Nerve innervating posterior leg - name the muscles & movement too

A

Deep: tibialis posterior; flexor digitorum & hallucis longus; popliteus
Superficial: gastrocnemius; soleus; plantaris

Plantar flexion of foot

Tibial nerve

57
Q

Nerve innervating lateral leg - name the muscles too

A

Fibularis longus and brevis

Superficial peroneal nerve

58
Q

Patient collapses after a long haul flight. Before collapsing, he complains of sudden severe pain in his legs.

Describe the pathophysiology of his condition

A

Patient has deep vein thrombosis where a thrombus has formed in the deep veins of his leg.

In his case, he had high risk of thrombus formation according to Virchow’s traid which highlights stasis of blood as a risk factor.

Hence, he will have unilateral leg swelling and acute tenderness.

The thrombus has likely embolised to the lungs (pulmonary embolism) and hence occluded blood flow to the lungs -> respiratory arrest -> patient collapsed.

59
Q

Why are ulcers and gangrene more common in diabetic patients?

A

Due to hyperglycaemic blood (ie. blood is thicker), perfusion is reduced hence the first limbs to be affected the most are the extremities (usually feet).

Reduced perfusion -> ischemia -> tissue dies off gradually -> ulcers (cavities)

Gangrene usually happens if there is sudden reduction in perfusion to a large area of tissue -> blackened, necrotic tissue with foul smell

60
Q

What are the 2 most common causes of peripheral neuropathy?

A

Diabetic neuropathy and Vitamin B12 deficiency

61
Q

Patient has a fracture of the fibular neck. What other symptoms will I expect to see?

A

Common peroneal nerve injury

Weakness in dorsiflexion and eversion of foot. FOOT DROP!

Sensory loss over the lateral leg and dorsum of foot.

62
Q

What is the medical name for flat foot and high arch?

For flat foot, specify its cause.

A

Flat foot - pes planus; High arch - pes cavus

Pes planus is usually caused by weakening/insufficiency of the posterior tibial tendon which provides support to the medial and longitudinal arches of the foot
-> progressive flattening of the arch.

The arch normally provides shock absorption to the feet and reduces the mechanical load on ball of feet and heel.

63
Q

Which is the strongest ligament in the hip joint?

What movement does it prevent?

A

Iliofemoral ligament

Hyperextension of the hip joint when standing

64
Q

What movement of the hip does the iliofemoral ligament prevent?

A

Hyperextension of the hip joint when standing

65
Q

Explain why the medial meniscus is more likely to be damaged compared to the lateral

A

The medial meniscus is attached to the medial collateral ligament -> less mobile and hence more prone to injury during sudden/excessive rotational forces

The lateral meniscus is supported by the popliteus muscle and is not attached to any ligament -> greater mobility

66
Q

What type of cartilage are the meniscus made of?

A

Fibrocartilage

67
Q

Sciatic runs midway between the

A

Ischial tuberosity and greater trochanter

68
Q

A quick way to check the function a one of the nerves of the leg is to pinch the skin between the big
toe and 2nd toe.

Which nerve are you checking?

A

Deep peroneal nerve

MSK (4 decks)

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