Lower limb problems I Flashcards
1
Q
Name A-G
A
A- ilium
B- ischium
C- pubis
D- acetabulum
E- obturator foramen
F- Ischial tuberosity
G- Ischial spine
2
Q
Name A-G
A
A- posterior superior iliac spine
B- iliac crest
C- sacroiliac joint
D- pubic tubercle
E- pubic symphysis
F- anterior superior iliac spine
G- acetabulum
3
Q
Name A-E
A
A- greater sciatic foramen
B- lesser sciatic foramen
C- piriformis muscle
D- sacrospinous ligament
E- sacrotuberous ligament
4
Q
Function of greater sciatic foramen
A
Allows structures into the pelvis
5
Q
Function of lesser sciatic foramen
A
Allows structures into the perineum
6
Q
The lesser and greater sciatic foramen are formed by
A
Sacrospinous ligament and sacrotuberous ligament
7
Q
The greater sciatic foramen can be divided into suprapiriform and infrapiriform fossa by
A
piriformis muscle
8
Q
Energy of injury that can cause pelvic fracture
A
High energy for young people
Low energy for older, osteoporotic bone
9
Q
The pelvis forms a bony ring. This means that a pelvic fracture will
A
Cause fractures in more than 1 site - at bones/symphysis/joints
10
Q
What classification is used to classify pelvic ring fractures
A
Young-Burgess classification
11
Q
Symptoms of pelvic fracture
A
Pain
Unable to bear weight
12
Q
Investigations for high energy pelvic fracture
A
Xray if the pelvis is the only site of injury
CT if polytraumatic
13
Q
Investigations for low energy pelvic fracture
A
Xray
CT
MRI (most sensitive)
14
Q
Management of pelvic fracture
A
Rest
Pelvic binder
Analgesia
Surgery if severe - ORIF / external fixation
15
Q
Complications of pelvic fractures
A
Haemodynamically unstable since pelvic fracture is usually associated with other injuries
Rectal tear
Bladder and urethral injuries
16
Q
Causes of pelvic soft tissue injury
A
Sports - muscle tear / tendon avulsion
Chronic overuse
Secondary to pelvic fracture
17
Q
Investigations for pelvic soft tissue injury
A
US
MRI - treatment of choice since it looks at soft tissue and bones
18
Q
Management of pelvic soft tissue injury
A
RICE
Rest
Ice
Compression
Elevation
19
Q
Hip joint is a type of
A
Ball and socket synovial joint
20
Q
Extracapsular ligaments of the hip joint are formed by
A
Thickened part of joint capsule
21
Q
What are the extracapsular ligaments of the hip joint
A
Iliofemoral
Pubofemoral
Ischiofemoral (seen in posterior aspect)
22
Q
What is the intracapsular ligament of the hip joint
A
Ligamentum teres - ligament to head of femur
23
Q
Name A and B
A
A- acetabular labrum
B- ligamentum teres
24
Q
The ligamentum teres encloses a
A
branch of obturator artery which is an artery supplying the head of femur
25
Function of acetabular labrum
Increases the depth of acetabulum to increase stability of the joint
26
Blood supply to the hip joint
Medial and lateral circumflex arteries from deep femoral artery
Branch of obturator artery travels in ligamentum teres to head of femur
27
Medial and lateral circumflex arteries are branches of
Deep femoral artery
28
Medial / Lateral circumflex femoral artery is responsible for the majority of arterial supply
Medial
29
Branch of obturator artery to head of femur is more important in adults / children
Children, because it usually disappears in adults
30
Which part of femur is the most commonly fractured and why
Neck of femur because it is the narrowest part of femur and lies at an angle to the direction of weight bearing (weaker)
31
Pain from hip joint can radiate to the knee as sole knee pain. Why is that
HIp joint is innervated by sciatic, femoral and obturator nerves which also innervate the knee
32
Name A-D
A- Neck
B- Greater trochanter
C- Intertrochanteric line
D- lesser trochanter
33
Name A-D (posterior femur)
A- trochanteric crest
B- Pectineal line
C- Linea aspera
D- Gluteal tuberosity
34
What is trochanteric crest
Ridge on posterior aspect of femur, a posterior point of attachment for the joint capsule of the hip
35
What is the linea aspera
Roughed edges of bone on the posterior surface of femoral shaft then splits into medial and lateral supracondylar line
36
The proximal medial border of linea aspera becomes
Pectineal line
37
The proximal lateral border of linea aspera becomes
Glutea tuberosity
38
Gluteal tuberosity is the attachment point for
Gluteus maximus
39
The medial supracondylar line ends at
Adductor tubercle
40
Adductor tubercle is an attachment point for
Adductor magnus
41
Name A-E
A- lateral epicondyle
B- Lateral condyle
C- Medial condyle
D- Medial epicondyle
E- Adductor tubercle
42
Name A-E
A- Medial epicondyle
B- Medial condyle
C- Intercondylar fossa
D- Lateral condyle
E- Lateral epicondyle
43
injury mechanism of hip dislocation
Road traffic accidents
Contact sports with hip flexed
44
Most common type of hip dislocation
Posterior hip dislocation
45
Associated lesions with hip dislocation
Acetabular rim fracture
Posterior acetabular wall fracture
Femoral fracture
46
Clinical presentation of posterior hip dislocation
Hip is
- Flexed
- Internally rotated
- Adducted
- Shortened
47
Clinical presentation of anterior hip dislocation
Hip is
- extended
- externally rotated
- abducted
48
Investigations for hip dislocation
Neurovascular assessment - sciatic nerve
Xray
CT after reduction if acetabular fracture suspected
49
Management for hip dislocation
Urgent reduction
Fixation of other injuries/associated pelvic fractures
50
Complications of hip dislocation
AVN of femoral head
Sciatic nerve palsy
Secondary OA of hip
51
Mechanism of injury for hip fracture
Low impact fall in elderly (main)
High energy in young adults
52
Risk factors for hip fracture
Elderly
Female
Osteoporosis
Smoking
Malnutrition
Co-morbidities that increases risk of falling
Low BMI
53
Examples of co-morbidities that increases risk of falling
postural hypotension
cardiac arrhythmias
impaired vision
cerebrovascular insufficiency
54
Existence of co-morbidities does not only increase the risk of falling, it also increases the risk of
Complications during surgery - MI/ renal failure/ resp failure/ infections
55
Types of hip fractures
Intracapsular
Extracapsular
56
Intracapsular hip fracture =
Occur proximal to intertrochanteric line -> femoral head and neck
57
Subtypes of Intracapsular hip fracture
Subcapital = at the junction between head and neck
Transcervical = mid portion of femur neck
58
Complications of intracapsular hip fractures
Femoral head AVN
Non union
59
Intracapsular fractures are classified by
Garden classification = predicts union and risk of AVN
60
What is extracapsular hip fracture
Hip fracture occurring distal to intertrochanteric line
61
Subtypes of extra capsular hip fracture
Intertrochanteric = at intertrochanteric line
Subtrochanteric = below intertrochanteric line
62
Does extracapsular hip fracture cause AVN or non-union
No, blood supply is rarely disrupted
63
Apart from assessing neruovascular status of lower limb in a patient with hip fracture, what else should be assessed
Assess for dehydration - patient may have been on the floor for a long time
Assess for cognitive impairment due to fall
64
Investigations for hip fractures
Xray - most are easy to see
MRI
65
Management for extra capsular hip fracture at intertrochanteric line
DHS screw
66
Management for subtrochanteric extra capsular hip fracture
IM nail
67
Management for intracapsular hip fracture in high function patient
If displaced -> Total hip replacement
If not displaced -> Cannulated hip screw (CHS)
68
Management for intracapsular hip fracture in Low function patient
Hemi-arthroplasty
69
Management for intracapsular hip fracture in Low function patient
Hemi-arthroplasty
70
Post-sugery management for hip fractures
Early mobilisation
Local nerve blocks (analgesia)
71
Superficial muscles of the gluteal region
Gluteus maximus
Gluteus medius
Gluteus minimus
72
Name A-C
A- Gluteus medius
B- Gluteus maximus
C- Gluteus minimus
73
Function of gluteus Maximus
Most powerful extensor of the hip
74
Innervation of the gluteus Maximus
Inferior gluteal nerve L5-S2
75
Function of gluteus medius
Abduct and medially rotate the thigh at hip joint
76
Innervation of gluteus medius
Superior gluteal nerve L4-S1
77
Function of gluteus minimus
Abduct and medially rotate the thigh at hip
78
Innervation of gluteus minimus
Superior gluteal nerve L4-S1
79
What are the deep muscles of the gluteal region
Piriformis
Superior and inferior gemelli
Obturator internus
Obturator femoris (quadratura femoris)
80
Name A-G
A- Tensor fascia latae
B- Gluteus maximus
C- Gluteus medius
D- Piriformis
E- Superior and inferior gemelli
F- Quadratus femoris
G- Obturator internus
81
Function of piriformis
Laterally rotate the extended thigh
Abduct the flexed thigh
82
Function of piriformis in anatomy
Divides the greater sciatic foramen into suprapiriform and infrapiriform foramina
83
Innervation of piriformis
Anterior (ventral) ramus of S1 S2
84
Function of superior and inferior gemelli
Laterally rotate the extended thigh
Abduct the flexed thigh
85
Innervation of superior and inferior gemelli
Superior - nerve to obturator internus L5-S2
Inferior - nerve to quadratus femoris L4-S1
86
Function of obturator internus
Laterally rotate the extended thigh
Abduct the flexed thigh
87
Innervation of obturator internus
Nerve to obturator internus L5-S2
88
Function of quadratus femoris
Laterally rotate the thigh
89
Innervation of quadratus femoris
Nerve to quadratus femoris L4-S1
90
What is the neurovascular bundle deep to gluteal Maximus
Inferior gluteal neurovascular bundle
- inferior gluteal nerve (L5-S2)
- inferior gluteal artery and vein
91
What is the neurovascular bundle deep to gluteal medius
Superior gluteal neurovascular bundle
- superior gluteal nerve (L4-S1)
- superior gluteal artery and vein
92
Name A-F
A- Inferior gluteal nerve
B- Pudendal nerve
C- Nerve to obturator internus
D- Superior gluteal nerve
E- Sciatic nerve
F- Tibial nerve
93
Damage to gluteus medius / minimus can cause which clinical sign
Trendelenburg's gait
94
Left gluteal medius / minimus muscle weakness causes
Right side of pelvis to drop when standing on left leg
95
Gluteal medius / minimus muscle weakness can be caused by
Superior gluteal nerve damage
96
Sacral plexus origins
L4-S4
97
Main branches of sacral plexus
Pudendal nerve
Superior gluteal
Inferior gluteal
Nerve to obturator internus
Nerve to quadratus femoris
Sciatic nerve
98
Pudendal nerve roots
S2-S4
99
Motor functions of the pudendal nerve
External urethral sphincter
External anal sphincter
100
Sensory innervation of pudendal nerve
Perineum
external genitalia
Skin around the anus and anal canal
101
Sciatic nerve innervates
All posterior compartment of the thigh
All of the leg (through its branches)
102
Nerve roots of sciatic nerve
L4-S3
103
Main branches of sciatic nerve
Tibial nerve
Common fibular nerve
104
Where does the sciatic nerve branch off into tibial and common fibular nerves
Anywhere between gluteal region and popliteal fossa
Most commonly inferior 1/3 of thigh
105
Anatomical course of sciatic nerve
1. from sacral plexus
2. exits greater sciatic foramen
3. inferior to piriformis
4. travels down the thigh and branch off into common fibular and tibial nerves at inferior 1/3 of thigh
106
Does the sciatic nerve innervate the gluteal region
No, it supplies nothing in gluteal region
107
Tibial nerve anatomical course
Descends vertically through popliteal fossa
108
Tibial nerve motor innervation
All muscles in the posterior compartment of the leg
109
Common fibular nerve anatomical course
1. Descends along the lateral border of the popliteal fossa
2. Deep to biceps femoris tendon
3. Then leaves the popliteal fossa to reach the fibular neck
4. Winds around the fibular neck
5. Then divides into deep and superficial fibular branches
110
Common fibular nerve motor innervation
Superficial fibular nerve - lateral compartment of the leg
Deep fibular nerve - anterior compartment of the leg
111
Common fibular nerve sensory innervation
Superficial fibular nerve - anterolateral aspect of distal leg + dorsal of foot
Deep fibular nerve - skin of webbing between 1st and 2nd toes
Sural - posterolateral aspect of distal third of the leg, ankle, foot and heel
Lateral sural - upper lateral aspect of leg
112
What injuries can damage the common fibular nerve?
Compression injury against neck of fibula
E.g. tight plaster cast
Fractures of fibular neck
113
What is sciatica
Compression / irritation of sciatic nerve causing pain that travels along the path of sciatic nerve (from lower back to leg)
114
Causes of sciatica
Lumbar slipped discs
Nerve root compression due to malignant metastases
Hypertrophy of piriformis muscle - bc sciatic nerve is behind piriformis hence hypertrophy can compress it
115
When administering IM injections in gluteal region, what should be considered
Position of sciatic nerve - avoid sciatic nerve
116
How do you avoid damaging the sciatic nerve when giving IM injections
Only inject it in upper lateral quadrant
117
the lumbar plexus is formed by _______ rami of L_ -L_
Formed by the anterior rami of L1-L4 spinal nerves
118
Main branches of the lumbar plexus
Lateral cutaneous
Obturator nerve
Femoral nerve
119
Origin of lateral cutaneous nerve
L2, L3
120
Function of lateral cutaneous nerve
Sensory - lateral thigh down to the level of the knee
No motor innervation
121
Origin of obturator nerve
L2-L4
122
Function of obturator nerve
Motor - muscles of the medial thigh
Sensory - skin over the medial thigh
123
Anatomical course of obturator nerve
Exits the pelvis by passing through the obturator foramen at ischium
Enters the medial compartment of thigh
Branches off into anterior and posterior branches at adductor brevis
124
Origin of femoral nerve
L2-L4
125
Function of femoral nerve
Motor - anterior thigh muscles
Sensory - skin of anterior thigh (via anterior cutaneous branch)
and medial leg and foot (via saphenous)
126
Anatomical course of femoral nerve
Enters the thigh by passing under the inguinal ligament
Enters the femoral triangle of the thigh
Then divides into anterior and posterior branches
127
What are the main branches of femoral nerve that supplies sensory innervation
Saphenous nerve (posterior branch)
Anterior cutaneous branch
128
Anterior cutaneous branch of femoral nerve supplies
Sensory innervation to anterior thigh
129
Saphenous nerve (branch of femoral nerve) supplies
Sensory innervation to medial leg and foot
130
What is the fascia lata
Fascial plane that surrounds the deep tissues of the thigh
131
What is the iliotibial tract
Thickening of the fascia lata at the lateral side of the thigh
132
What is tensor fascia lata
The muscle that inserts onto the anterior aspect of iliotibial tract
133
Function of iliotibial tract
Protects the knee
134
Function of tensor fascia lata
Tightens the iliotibial band and strengthen the knee joint
135
Name A-C
A- gluteus maximus
B- Iliotibial band
C- Tensor fascia lata
136
Innervation of tensor fascia lata
Superior gluteal nerve
137
What is trochanteric bursitis
inflammation of the bursa overlying the greater trochanter of the femur.
138
Which muscles attach to the greater trochanter of the femur
Gluteus medius
Gluteus minimus
139
Risk factors for trochanteric bursitis
Female
Young and older patients
Hiking
Excessive running
fall onto the hip
140
Symptoms of trochanteric bursitis
Pain on the lateral aspect of the hip
Pain worse at night
141
Clinical signs of trochanteric bursitis
- Pain on palpation of the greater trochanter
- Pain on restricted abduction
- Trendelenburg's gait or difficulty walking due to pain
142
Investigations for trochanteric bursitis
Clinical
Xray doesn't show anything significant
143
Management for trochanteric bursitis
Analgesia
Steroid injections
Physiotherapy
