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Y2 MSK > Lower limb problems I > Flashcards

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

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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

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3
Q

Name A-E

A

A- greater sciatic foramen
B- lesser sciatic foramen
C- piriformis muscle
D- sacrospinous ligament
E- sacrotuberous ligament

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4
Q

Function of greater sciatic foramen

A

Allows structures into the pelvis

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5
Q

Function of lesser sciatic foramen

A

Allows structures into the perineum

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6
Q

The lesser and greater sciatic foramen are formed by

A

Sacrospinous ligament and sacrotuberous ligament

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7
Q

The greater sciatic foramen can be divided into suprapiriform and infrapiriform fossa by

A

piriformis muscle

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8
Q

Energy of injury that can cause pelvic fracture

A

High energy for young people
Low energy for older, osteoporotic bone

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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

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10
Q

What classification is used to classify pelvic ring fractures

A

Young-Burgess classification

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11
Q

Symptoms of pelvic fracture

A

Pain
Unable to bear weight

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12
Q

Investigations for high energy pelvic fracture

A

Xray if the pelvis is the only site of injury
CT if polytraumatic

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13
Q

Investigations for low energy pelvic fracture

A

Xray
CT
MRI (most sensitive)

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14
Q

Management of pelvic fracture

A

Rest
Pelvic binder
Analgesia
Surgery if severe - ORIF / external fixation

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15
Q

Complications of pelvic fractures

A

Haemodynamically unstable since pelvic fracture is usually associated with other injuries
Rectal tear
Bladder and urethral injuries

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16
Q

Causes of pelvic soft tissue injury

A

Sports - muscle tear / tendon avulsion
Chronic overuse
Secondary to pelvic fracture

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17
Q

Investigations for pelvic soft tissue injury

A

US
MRI - treatment of choice since it looks at soft tissue and bones

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18
Q

Management of pelvic soft tissue injury

A

RICE
Rest
Ice
Compression
Elevation

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19
Q

Hip joint is a type of

A

Ball and socket synovial joint

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20
Q

Extracapsular ligaments of the hip joint are formed by

A

Thickened part of joint capsule

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21
Q

What are the extracapsular ligaments of the hip joint

A

Iliofemoral
Pubofemoral
Ischiofemoral (seen in posterior aspect)

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22
Q

What is the intracapsular ligament of the hip joint

A

Ligamentum teres - ligament to head of femur

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23
Q

Name A and B

A

A- acetabular labrum
B- ligamentum teres

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24
Q

The ligamentum teres encloses a

A

branch of obturator artery which is an artery supplying the head of femur

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25
Q

Function of acetabular labrum

A

Increases the depth of acetabulum to increase stability of the joint

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26
Q

Blood supply to the hip joint

A

Medial and lateral circumflex arteries from deep femoral artery
Branch of obturator artery travels in ligamentum teres to head of femur

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27
Q

Medial and lateral circumflex arteries are branches of

A

Deep femoral artery

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28
Q

Medial / Lateral circumflex femoral artery is responsible for the majority of arterial supply

A

Medial

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29
Q

Branch of obturator artery to head of femur is more important in adults / children

A

Children, because it usually disappears in adults

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30
Q

Which part of femur is the most commonly fractured and why

A

Neck of femur because it is the narrowest part of femur and lies at an angle to the direction of weight bearing (weaker)

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31
Q

Pain from hip joint can radiate to the knee as sole knee pain. Why is that

A

HIp joint is innervated by sciatic, femoral and obturator nerves which also innervate the knee

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32
Q

Name A-D

A

A- Neck
B- Greater trochanter
C- Intertrochanteric line
D- lesser trochanter

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33
Q

Name A-D (posterior femur)

A

A- trochanteric crest
B- Pectineal line
C- Linea aspera
D- Gluteal tuberosity

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34
Q

What is trochanteric crest

A

Ridge on posterior aspect of femur, a posterior point of attachment for the joint capsule of the hip

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35
Q

What is the linea aspera

A

Roughed edges of bone on the posterior surface of femoral shaft then splits into medial and lateral supracondylar line

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36
Q

The proximal medial border of linea aspera becomes

A

Pectineal line

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37
Q

The proximal lateral border of linea aspera becomes

A

Glutea tuberosity

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38
Q

Gluteal tuberosity is the attachment point for

A

Gluteus maximus

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39
Q

The medial supracondylar line ends at

A

Adductor tubercle

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40
Q

Adductor tubercle is an attachment point for

A

Adductor magnus

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41
Q

Name A-E

A

A- lateral epicondyle
B- Lateral condyle
C- Medial condyle
D- Medial epicondyle
E- Adductor tubercle

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42
Q

Name A-E

A

A- Medial epicondyle
B- Medial condyle
C- Intercondylar fossa
D- Lateral condyle
E- Lateral epicondyle

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43
Q

injury mechanism of hip dislocation

A

Road traffic accidents
Contact sports with hip flexed

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44
Q

Most common type of hip dislocation

A

Posterior hip dislocation

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45
Q

Associated lesions with hip dislocation

A

Acetabular rim fracture
Posterior acetabular wall fracture
Femoral fracture

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46
Q

Clinical presentation of posterior hip dislocation

A

Hip is
- Flexed
- Internally rotated
- Adducted
- Shortened

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47
Q

Clinical presentation of anterior hip dislocation

A

Hip is
- extended
- externally rotated
- abducted

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48
Q

Investigations for hip dislocation

A

Neurovascular assessment - sciatic nerve
Xray
CT after reduction if acetabular fracture suspected

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49
Q

Management for hip dislocation

A

Urgent reduction
Fixation of other injuries/associated pelvic fractures

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50
Q

Complications of hip dislocation

A

AVN of femoral head
Sciatic nerve palsy
Secondary OA of hip

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51
Q

Mechanism of injury for hip fracture

A

Low impact fall in elderly (main)
High energy in young adults

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52
Q

Risk factors for hip fracture

A

Elderly
Female
Osteoporosis
Smoking
Malnutrition
Co-morbidities that increases risk of falling
Low BMI

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53
Q

Examples of co-morbidities that increases risk of falling

A

postural hypotension
cardiac arrhythmias
impaired vision
cerebrovascular insufficiency

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54
Q

Existence of co-morbidities does not only increase the risk of falling, it also increases the risk of

A

Complications during surgery - MI/ renal failure/ resp failure/ infections

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55
Q

Types of hip fractures

A

Intracapsular
Extracapsular

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56
Q

Intracapsular hip fracture =

A

Occur proximal to intertrochanteric line -> femoral head and neck

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57
Q

Subtypes of Intracapsular hip fracture

A

Subcapital = at the junction between head and neck
Transcervical = mid portion of femur neck

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58
Q

Complications of intracapsular hip fractures

A

Femoral head AVN
Non union

59
Q

Intracapsular fractures are classified by

A

Garden classification = predicts union and risk of AVN

60
Q

What is extracapsular hip fracture

A

Hip fracture occurring distal to intertrochanteric line

61
Q

Subtypes of extra capsular hip fracture

A

Intertrochanteric = at intertrochanteric line
Subtrochanteric = below intertrochanteric line

62
Q

Does extracapsular hip fracture cause AVN or non-union

A

No, blood supply is rarely disrupted

63
Q

Apart from assessing neruovascular status of lower limb in a patient with hip fracture, what else should be assessed

A

Assess for dehydration - patient may have been on the floor for a long time
Assess for cognitive impairment due to fall

64
Q

Investigations for hip fractures

A

Xray - most are easy to see
MRI

65
Q

Management for extra capsular hip fracture at intertrochanteric line

A

DHS screw

66
Q

Management for subtrochanteric extra capsular hip fracture

A

IM nail

67
Q

Management for intracapsular hip fracture in high function patient

A

If displaced -> Total hip replacement
If not displaced -> Cannulated hip screw (CHS)

68
Q

Management for intracapsular hip fracture in Low function patient

A

Hemi-arthroplasty

69
Q

Management for intracapsular hip fracture in Low function patient

A

Hemi-arthroplasty

70
Q

Post-sugery management for hip fractures

A

Early mobilisation
Local nerve blocks (analgesia)

71
Q

Superficial muscles of the gluteal region

A

Gluteus maximus
Gluteus medius
Gluteus minimus

72
Q

Name A-C

A

A- Gluteus medius
B- Gluteus maximus
C- Gluteus minimus

73
Q

Function of gluteus Maximus

A

Most powerful extensor of the hip

74
Q

Innervation of the gluteus Maximus

A

Inferior gluteal nerve L5-S2

75
Q

Function of gluteus medius

A

Abduct and medially rotate the thigh at hip joint

76
Q

Innervation of gluteus medius

A

Superior gluteal nerve L4-S1

77
Q

Function of gluteus minimus

A

Abduct and medially rotate the thigh at hip

78
Q

Innervation of gluteus minimus

A

Superior gluteal nerve L4-S1

79
Q

What are the deep muscles of the gluteal region

A

Piriformis
Superior and inferior gemelli
Obturator internus
Obturator femoris (quadratura femoris)

80
Q

Name A-G

A

A- Tensor fascia latae
B- Gluteus maximus
C- Gluteus medius
D- Piriformis
E- Superior and inferior gemelli
F- Quadratus femoris
G- Obturator internus

81
Q

Function of piriformis

A

Laterally rotate the extended thigh
Abduct the flexed thigh

82
Q

Function of piriformis in anatomy

A

Divides the greater sciatic foramen into suprapiriform and infrapiriform foramina

83
Q

Innervation of piriformis

A

Anterior (ventral) ramus of S1 S2

84
Q

Function of superior and inferior gemelli

A

Laterally rotate the extended thigh
Abduct the flexed thigh

85
Q

Innervation of superior and inferior gemelli

A

Superior - nerve to obturator internus L5-S2
Inferior - nerve to quadratus femoris L4-S1

86
Q

Function of obturator internus

A

Laterally rotate the extended thigh
Abduct the flexed thigh

87
Q

Innervation of obturator internus

A

Nerve to obturator internus L5-S2

88
Q

Function of quadratus femoris

A

Laterally rotate the thigh

89
Q

Innervation of quadratus femoris

A

Nerve to quadratus femoris L4-S1

90
Q

What is the neurovascular bundle deep to gluteal Maximus

A

Inferior gluteal neurovascular bundle
- inferior gluteal nerve (L5-S2)
- inferior gluteal artery and vein

91
Q

What is the neurovascular bundle deep to gluteal medius

A

Superior gluteal neurovascular bundle
- superior gluteal nerve (L4-S1)
- superior gluteal artery and vein

92
Q

Name A-F

A

A- Inferior gluteal nerve
B- Pudendal nerve
C- Nerve to obturator internus
D- Superior gluteal nerve
E- Sciatic nerve
F- Tibial nerve

93
Q

Damage to gluteus medius / minimus can cause which clinical sign

A

Trendelenburg’s gait

94
Q

Left gluteal medius / minimus muscle weakness causes

A

Right side of pelvis to drop when standing on left leg

95
Q

Gluteal medius / minimus muscle weakness can be caused by

A

Superior gluteal nerve damage

96
Q

Sacral plexus origins

A

L4-S4

97
Q

Main branches of sacral plexus

A

Pudendal nerve
Superior gluteal
Inferior gluteal
Nerve to obturator internus
Nerve to quadratus femoris
Sciatic nerve

98
Q

Pudendal nerve roots

A

S2-S4

99
Q

Motor functions of the pudendal nerve

A

External urethral sphincter
External anal sphincter

100
Q

Sensory innervation of pudendal nerve

A

Perineum
external genitalia
Skin around the anus and anal canal

101
Q

Sciatic nerve innervates

A

All posterior compartment of the thigh
All of the leg (through its branches)

102
Q

Nerve roots of sciatic nerve

A

L4-S3

103
Q

Main branches of sciatic nerve

A

Tibial nerve
Common fibular nerve

104
Q

Where does the sciatic nerve branch off into tibial and common fibular nerves

A

Anywhere between gluteal region and popliteal fossa
Most commonly inferior 1/3 of thigh

105
Q

Anatomical course of sciatic nerve

A
  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
Q

Does the sciatic nerve innervate the gluteal region

A

No, it supplies nothing in gluteal region

107
Q

Tibial nerve anatomical course

A

Descends vertically through popliteal fossa

108
Q

Tibial nerve motor innervation

A

All muscles in the posterior compartment of the leg

109
Q

Common fibular nerve anatomical course

A
  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
Q

Common fibular nerve motor innervation

A

Superficial fibular nerve - lateral compartment of the leg
Deep fibular nerve - anterior compartment of the leg

111
Q

Common fibular nerve sensory innervation

A

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
Q

What injuries can damage the common fibular nerve?

A

Compression injury against neck of fibula
E.g. tight plaster cast
Fractures of fibular neck

113
Q

What is sciatica

A

Compression / irritation of sciatic nerve causing pain that travels along the path of sciatic nerve (from lower back to leg)

114
Q

Causes of sciatica

A

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
Q

When administering IM injections in gluteal region, what should be considered

A

Position of sciatic nerve - avoid sciatic nerve

116
Q

How do you avoid damaging the sciatic nerve when giving IM injections

A

Only inject it in upper lateral quadrant

117
Q

the lumbar plexus is formed by _______ rami of L_ -L_

A

Formed by the anterior rami of L1-L4 spinal nerves

118
Q

Main branches of the lumbar plexus

A

Lateral cutaneous
Obturator nerve
Femoral nerve

119
Q

Origin of lateral cutaneous nerve

A

L2, L3

120
Q

Function of lateral cutaneous nerve

A

Sensory - lateral thigh down to the level of the knee

No motor innervation

121
Q

Origin of obturator nerve

A

L2-L4

122
Q

Function of obturator nerve

A

Motor - muscles of the medial thigh
Sensory - skin over the medial thigh

123
Q

Anatomical course of obturator nerve

A

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
Q

Origin of femoral nerve

A

L2-L4

125
Q

Function of femoral nerve

A

Motor - anterior thigh muscles
Sensory - skin of anterior thigh (via anterior cutaneous branch)
and medial leg and foot (via saphenous)

126
Q

Anatomical course of femoral nerve

A

Enters the thigh by passing under the inguinal ligament
Enters the femoral triangle of the thigh
Then divides into anterior and posterior branches

127
Q

What are the main branches of femoral nerve that supplies sensory innervation

A

Saphenous nerve (posterior branch)
Anterior cutaneous branch

128
Q

Anterior cutaneous branch of femoral nerve supplies

A

Sensory innervation to anterior thigh

129
Q

Saphenous nerve (branch of femoral nerve) supplies

A

Sensory innervation to medial leg and foot

130
Q

What is the fascia lata

A

Fascial plane that surrounds the deep tissues of the thigh

131
Q

What is the iliotibial tract

A

Thickening of the fascia lata at the lateral side of the thigh

132
Q

What is tensor fascia lata

A

The muscle that inserts onto the anterior aspect of iliotibial tract

133
Q

Function of iliotibial tract

A

Protects the knee

134
Q

Function of tensor fascia lata

A

Tightens the iliotibial band and strengthen the knee joint

135
Q

Name A-C

A

A- gluteus maximus
B- Iliotibial band
C- Tensor fascia lata

136
Q

Innervation of tensor fascia lata

A

Superior gluteal nerve

137
Q

What is trochanteric bursitis

A

inflammation of the bursa overlying the greater trochanter of the femur.

138
Q

Which muscles attach to the greater trochanter of the femur

A

Gluteus medius
Gluteus minimus

139
Q

Risk factors for trochanteric bursitis

A

Female
Young and older patients
Hiking
Excessive running
fall onto the hip

140
Q

Symptoms of trochanteric bursitis

A

Pain on the lateral aspect of the hip
Pain worse at night

141
Q

Clinical signs of trochanteric bursitis

A
  • Pain on palpation of the greater trochanter
  • Pain on restricted abduction
  • Trendelenburg’s gait or difficulty walking due to pain
142
Q

Investigations for trochanteric bursitis

A

Clinical
Xray doesn’t show anything significant

143
Q

Management for trochanteric bursitis

A

Analgesia
Steroid injections
Physiotherapy

Y2 MSK (19 decks)

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