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Y2 MSK > Lower limb problems III > Flashcards

Lower limb problems III Flashcards

1
Q

What does the extensor mechanism of the knee consist of

A

Tibial tuberosity
Patellar tendon
Patella
Quadriceps tendon
Quadriceps muscles

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2
Q

What are the muscles in the anterior compartment of the thigh

A

Pectineus
Iliopsoas (Iliac, psoas major)
Sartorius
Quadricep femoris (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)

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3
Q

Iliopsoas =

A

Iliacus + psoas major

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4
Q

What are the quadricep muscles

A

Rectus femoris
Vastus lateralis
Vastus intermedius (deep to rectus femoris)
Vastus medialis

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5
Q

Name the flexors of the thigh

A

Pectineus
Iliopsoas
Sartorius

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6
Q

Function of the quadriceps femoris

A

Extension of the leg
Rectus femoris weakly assists with flexion at hip

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7
Q

Attachment of iliacus

A

Origin: Iliac fossa
Attachment: Lesser trochanter of femur

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8
Q

Attachment of psoas major

A

Origin: Lumbar vertebrae T12-L4
Attachment: Lesser trochanter of femur

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9
Q

Function of iliopsoas

A

Flexion of the thigh at hip joint

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10
Q

Innervation of iliacus

A

Femoral nerve (L2-L4)

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11
Q

Innervation of psoas major

A

Anterior rami of L1-L3

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12
Q

Attachment of sartorius

A

Origin: ASIS
Attachment: Superior medial surface of tibia via pes anserinus bursa

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13
Q

Function of sartorius

A

Flexion, abduction, lateral rotation of the hip joint
Flexion at the knee joint

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14
Q

Innervation of sartorius

A

Femoral nerve (L2-L4)

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15
Q

Origin of rectus femoris

A

AIIS (anterior inferior iliac spine)

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16
Q

All muscles of the quadricep femoris attach to

A

Patella via quadriceps tendon then to tibial tuberosity via patella tendon

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17
Q

Function of quadriceps femoris

A

Extension of the leg at knee

Rectus femoris assists with flexion of the hip

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18
Q

Innervation of quadriceps femoris

A

Femoral nerve

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19
Q

Name A-I

A

A- Psoas major
B- Pectineus
C- Tensor fascia lata
D- Sartorius
E- Vastus medialis
F- Quadriceps tendon
G- Patellar tendon
H- Rectus femoris
I- Vastus lateralis

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20
Q

Extensor mechanism rupture commonly occurs in

A

Middle aged who does running / jumping sports

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21
Q

Extensor mechanism rupture =

A

Patellar tendon / quadriceps tendon rupture

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22
Q

Patellar tendon rupture commonly occurs in

A

Younger patients <40

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23
Q

Quadriceps tendon rupture commonly occurs in

A

Older patients >40

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24
Q

Risk factors of extensor mechanism rupture

A

Previous tendonitis
Steroids (body builders)
Chronic renal failure
Ciprofloxacin / quinolone antibiotics (can cause tendonitis)
Diabetes
RA

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25
Q

Symptoms of extensor mechanism rupture

A

Knee pain and weakness
Positive straight leg raise test

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26
Q

Clinical signs of extensor mechanism rupture

A

Positive straight leg raise test
Palpable gap in extensor mechanism

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27
Q

Describe the straight leg raise test for extensor mechanism rupture

A
  1. Patient supine, knee fully extended
  2. Raise the patient’s leg by holding their ankle and one hand stabilising the knee to prevent flexion

Positive = pain

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28
Q

A positive straight leg raise test can also indicate

A

Lumbar nerve root compression pain

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29
Q

Investigations for extensor mechanism rupture

A

Xray
US
MRI
Straight leg raise test
Palpable gap

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30
Q

What may xray show in extensor mechanism rupture

A

High or low lying patella, depending on the rupture

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31
Q

Low lying patella suggests _____ rupture
High lying patella suggests _____ rupture

A

Low lying patella = quadricep tendon rupture
High lying patella = Patellar tendon rupture

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32
Q

Palpable gap in extensor mechanism may not be present / obvious in _____. What is the solution

A

Obese patients
Use US to determine the extent of injury

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33
Q

Management of extensor mechanism rupture

A

Urgent surgical repair
Physio

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34
Q

What should be avoided in extensor mechanism rupture

A

Steroid injection for tendonitis of the extensor mechanism

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35
Q

What is patellofemoral dysfunction

A

Disorders of the patellofemoral articulation causing anterior knee pain

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36
Q

Risk factors of patellofemoral dysfunction

A

Females
Adolescents
Joint hyper mobility
Valgus knee

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37
Q

Cause of patellofemoral dysfunction

A

Excessive lateral pull of patella due to quadriceps muscles, causing the lateral facet of patella to be compressed against the lateral wall of distal femoral trochlea

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38
Q

Why are females more at risk of patellofemoral dysfunction

A

Due to wider hips hence more lateral pull of the patella from the quadriceps

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39
Q

Why are adolescents more at risk of patellofemoral dysfunction

A

Due to ligamentous laxity

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40
Q

Symptoms of patellofemoral dysfunction

A

Anterior knee pain
Pain worse going downhill
Grinding / clicking sensation
Stiffness after prolonged sitting -> pseudolocking

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41
Q

investigations for patellofemoral dysfunction

A

Clinical

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42
Q

Management of patellofemoral dysfunction

A

Physiotherapy
Taping around anterior knee

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43
Q

What are the muscles in the medial compartment of the thigh

A

Adductor Magnus
Adductor longus
Adductor brevis
Obturator externus
Gracialis

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44
Q

Adductor Magnus can be divided into 2 parts. Which two?

A

Adductor part
Ischiocondylar part

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45
Q

Attachment of adductor part of adductor Magnus

A

Origin: Inferior pubic rami
Attachment: Linea aspera, Medial supracondylar line

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46
Q

Attachment of ischiocondylar part of adductor Magnus

A

Origin: Ischial tuberosity
Attachment: Adductor tubercle of femur

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47
Q

Function of adductor part of adductor Magnus

A

Adduct the thigh
Flexes the thigh

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48
Q

Function of hamstring part of adductor Magnus

A

Adduct the thigh
Extends the thigh

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49
Q

Innervation of adductor Magnus

A

Adductor part - tibial component of sciatic nerve

Ischiocondylar part - obturator nerve

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50
Q

Function of medial compartment of the thigh

A

All adduct the thigh
(some has other functions)

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51
Q

Innervation of medial compartment of thigh

A

Obturator nerve except adductor part of adductor Magnus

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52
Q

Function of obturator externs

A

Adduct the thigh
Lateral rotation of the thigh

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53
Q

Function of gracilis

A

Adduct the thigh
Weak flexion of leg at knee

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54
Q

Position of adductor brevis in relation to pectineus, adductor Magnus and adductor longus

A

Adductor brevis is
- deep to Pectineus
- superior and partially deep to adductor longus
- anterior to adductor Magnus

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55
Q

Name A-F

A

A- Pectineus
B- Adductor brevis
C- Adductor longus
D- Adductor Magnus
E- Adductor brevis
F- Openings for perforating arteries

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56
Q

Name A-G (D= muscle in green)

A

A- Tensor fascia lata
B- Pectineus
C- Adductor longus
D- Adductor Magnus
E- Vastus lateralis
F- Vastus medialis
G- Gracialis

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57
Q

Name A-G

A

A- Adductor tubercle
B- Medial epicondyle
C- Intercondylar fossa of femur
D- Medial intercondylar tubercle
E- Intercondylar eminence of tibia
F- Lateral intercondylar tubercle
G- Tibial tuberosity

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58
Q

What are the features of tibia shaft

A

Anterior - tibial tuberosity, Gerdy’s tubercle
Posterior - soleal line , groove for tendon of tibialis posterior
Lateral- Attachment to interosseous membrane that binds with fibula

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59
Q

What attaches to Gerdy’s tubercle

A

Iliotibial band

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60
Q

What attaches to the soleal line

A

Soleus muscle of the posterior compartment of leg

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61
Q

Name A-C

A

A- Tibial tuberosity (where the patellar tendon attaches)
B- Soleal line
C- Medial malleolus

62
Q

At the posterior distal tibial surface, there is a groove for

A

A groove for tendon of Tibialis posterior

63
Q

Name A-E

A

A- Soleal line
B- Groove for tendon of tibialis posterior
C- Medial malleolus
D- Articular facet of medial malleolus
E- Lateral malleolus

64
Q

Which nerve winds around the neck of fibula

A

Common fibular nerve

65
Q

Describe the articulations of the ankle joint

A

Tibia and fibula are bound together by tibiogibular ligaments which allows them to form a socket called mortise

The body of talus fits into the mortise = ankle joint

66
Q

What type of joint is the ankle joint

A

Hinge type synovial joint

67
Q

What are the movements of the ankle joint

A

Dorsiflexion of the foot
Plantarflexion of the foot

68
Q

Which compartment of the leg produces dorsiflexion of the foot

A

Anterior compartment

69
Q

Which compartment of the leg produces plantar flexion of the foot

A

Posterior compartment

70
Q

Ankle can invert and evert as well. Which joint does these movements occur at?

A

Subtalar joint

71
Q

Which bones articulate at the subtalar joint

A

Talus and calcaneus

72
Q

What type of joint is the subtalar joint

A

Synovial joint

73
Q

The body of the talus moves to allow movement. Describe the movement of the talus during dorsi/plantar flexion

A

Dorsiflexion - anterior part of body of talus in the mortise
Plantarflexion - posterior part of body of talus in the mortise

74
Q

During which movement of the ankle joint is the joint less stable

A

Plantarflexion - posterior body of talus in mortise

75
Q

Name A-F

A

A- anterior inferior tibiofibular ligament
B- Lateral malleolus
C- Posterior inferior tibiofibular ligament
D- Mortise
E- Medial malleolus
F- Talus

76
Q

What are the 2 sets of ligaments of the ankle and where do they originate from

A

Medial ligament - from medial malleolus
Lateral ligament - from lateral malleolus

77
Q

How many ligaments does the medial set consist of

A

4 ligaments

78
Q

Function of medial ligament

A

Resist over-eversion of foot

79
Q

What are the lateral ligaments of the ankle

A

Anterior talofibular
Posterior talofibular
Calcaneofibular

80
Q

Name A-D

A

A- Deltoid ligament (medial ligament)
B- Posterior talofibular ligament
C- Anterior talofibular ligament
D- Calcaneofibular ligament

81
Q

Function of lateral ligaments of the ankle

A

Resist over-inversion of the foot

82
Q

Describe the arterial supply to the ankle joint

A

Malleolar branches of anterior tibial, posterior tibial and fibular arteries

83
Q

Name A-F

A

A- fibular (peroneal) artery
B- Anterior tibial artery
C- Anterior medial malleolar artery
D- Anterior lateral malleolar artery
E- Posterior tibial artery
F- Posterior medial malleolar artery

84
Q

Name A-G

A

A- Medial tarsal artery
B- Dorsalis pedis artery
C- Anterior medial malleolar artery
D- Anterior tibial artery
E- Arcutate artery
F- Lateral tarsal artery
G- Anterior lateral malleolar artery

85
Q

Articulations of the midtarsal joint

A

Calcaneocuboid and talocalcaneonavicular

86
Q

What type of joint is mid tarsal joint

A

Synovial joint

87
Q

Midtarsal joint allows which movements

A

Inversion and eversion

88
Q

Name A-L

A

A- Lateral malleolus
B- Calcaneus
C- Cuboid
D- Proximal phalanx
E- Middle phalanx
F- Medial malleolus
G- Talus
H- Navicular
I- Lateral cuneiform
J- Middle cuneiform
K- Medial cuneiform
L- Proximal phalanx of big toe

89
Q

What is the tarsometatarsal joint

A

Synovial joint between the cuneiforms / cuboid and the metatarsals

90
Q

What are the metatarsophalangeal joints (MTP)

A

Synovial joints between the metatarsals and the proximal phalanx

91
Q

What movements do the MTP joints allow

A

Flexion, Extension, Abduction, Adduction, Circumduction of the toes

92
Q

What are the interphalangeal joints (IP)

A

Synovial hinge joints between the phalanx
For 2nd - 5th toes - PIP and DIP
For big toe - IP

93
Q

What movements do the IP joints allow

A

Flexion and extension of the toes

94
Q

What are the arches of the foot

A

Medial longitudinal arch
Lateral longitudinal arch
Transverse arch

95
Q

Function of the arches of the foot

A

Shock absorption
Allow you to push off
Increase weight bearing capacity

96
Q

What structures support the arches of the foot

A

Plantar aponeurosis
Plantar ligaments
Tendons of the muscles of the leg

97
Q

What structures support the medial longitudinal arch

A

Tendon of flexor hallucis longus
Tendon of tibialis anterior
Tendon of tibialis posterior
Tendon of fibularis longus
Plantar ligaments
Plantar aponeurosis

98
Q

Which compartment is tibialis anterior muscle in

A

Anterior compartment of the leg

99
Q

Which compartment is fibularis longus in

A

Posterior compartment of the leg

100
Q

Which compartment is flexor hallicus longus in

A

Posterior compartment of the leg

101
Q

Name A-E

A

A- Tendon of tibialis anterior
B- Tendon of fibularis longus
C- Tendon of flexor hallicus longus
D- Plantar aponeurosis
E- Tendon of tibialis posterior

102
Q

Which arch of the foot is more important

A

Medial longitudinal arch

103
Q

What structures support the transverse arch

A

Tendon of fibularis longus
Tendon of tibialis posterior
Plantar aponeurosis
Plantar ligaments

104
Q

What is pes cavus

A

Unusually high medial longitudinal arch

105
Q

Symptoms of pes cavus

A

Pain
Pain transmitted up to lower limb
Claw toes

106
Q

Why does pain in pes cavus transmit up to the lower limb

A

Because of the higher arch, there is an increased stress placed on the heel of the foot during walking

107
Q

Causes of pes cavus

A

Idiopathic
Hereditary
Secondary to neuromuscular damage

108
Q

Management of pes cavus

A

Special shoes or sole
Weight loss can reduce stress placed on foot
Physiotherapy
Surgery if severe symptoms

109
Q

What are claw toes

A

Hyperextension at MTP joint
Flexion at PIP DIP joints

110
Q

What are hammer toes

A

Flexion at PIP joint
Extension at DIP joint
Neutral MTP joint

111
Q

Which condition can cause hammer toes

A

Rheumatoid arthritis

112
Q

What feet deformities can RA cause

A

Hallux valgus
Hammer toes
MTP subluxation

113
Q

What is hallux valgus

A

Medial deviation of the 1st metatarsal
Lateral deviation of the toe

114
Q

Which conditions can cause hallux valgus

A

RA
Cerebral palsy
Multiple sclerosis

115
Q

Symptoms of hallux valgus

A

Bilateral
Bunion
May be painful
May be unable to wear closed shoes
Toes rubbing causing ulcers / skin breakdowns

116
Q

Management of hallux valgus

A

Wear wider and deeper shoes
Use spacer in first web space to stop rubbing of the toes
Osteotomy if indicated

117
Q

When is osteotomy indicated in hallux valgus

A

Failure of conservative management
Lesser toe deformities
Lifestyle/functional limitation

118
Q

What is hallux rigidus

A

OA of the 1st MTP joint

119
Q

Symptoms of hallux rigidus

A

Pain at 1st MTP
Stiffness
Pain worse with activity / wearing shoes
Dorsal bone spurs
IP joint hyperextension

120
Q

Management of hallux rigidus

A

Weight loss if needed
Analgesia
NSAID
Wear stiff soled shoes to limit motion at MTP joint
Surgery

121
Q

What are the surgical options for hallux rigidus

A

Arthrodesis
Removal of osteophytes
MTP joint replacement (controversial)

122
Q

How does ankle fractures usually occur

A

Inversion injury with twisting forces
Fall from height

123
Q

Ankle fracture often has one / more than one fracture sites

A

More than one fracture sites - lateral/medial/posterior malleolus (back of tibia)

124
Q

What classification is used to assess ankle fractures

A

Weber classification

125
Q

What is Weber’s classification

A

Classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle and tibiofibular syndesmosis (where tibiofibular ligament is)

126
Q

Describe Weber A ankle fracture

A

Lateral malleolar fracture below the level of syndesmosis
May have fracture of medial malleolus
Stable fracture
Can be treated conservatively

127
Q

Describe Weber B ankle fracture

A

Lateral malleolar fracture at the level of syndesmosis
Syndesmosis still intact
May be stable / unstable
May be treated conservatively if there is no talar shift

128
Q

Describe Weber C ankle fracture

A

Lateral malleolar fracture above the level of syndesmosis
Syndesmosis disrupted
Medial malleolus often fractured
Unstable
Requires open reduction and internal fixation

129
Q

Investigations for ankle fractures

A

Xray - AP and lateral
CT - esp for Pilon fractures
US / MRI for soft tissue injuries

130
Q

What are Pilon fractures

A

High energy fractures at the bottom of tibia and involving the ankle joint

131
Q

Management of ankle fractures

A

Cast / moon boot - Weber A and B
ORIF - Weber C

132
Q

Which tarsal bone is the most frequently fractured

133
Q

Injury mechanism of calcaneus fracture

A

Axial compression - falling from height onto heel

134
Q

Symptoms of calcaneus fracture

A

Pain
Unable to bear weight
Significant ankle swelling

135
Q

Investigations for calcaneus fracture

136
Q

What may be seen on xray for calcaneus fracture

A

Loss of central peak - measured by Bohler’s angle
Increase in bone density

137
Q

Management of calcaneus fracture

A

Cast
Non-weight bearing for 6-12 weeks

138
Q

Injury mechanism of talus fractures

A

Forced dorsiflexion
Rapid deceleration

139
Q

Displaced talus fractures can cause

A

AVN of talus

140
Q

What arteries supply the talus

A

Anterior tibial
Posterior tibial
Perforating peroneal artery

141
Q

What is Lisfranc injury

A

Dislocation of tarsometatarsal joint between the articulation of medial cuneiform and base of second metatarsal

142
Q

Symptoms of Lisfranc injury

A

Severe midfoot pain
Inability to bear weight

143
Q

Investigations for Lisfranc injury

A

Xray- AP and oblique
CT - identify ligamentous avulsion fractures

144
Q

Management of Lisfranc injury

145
Q

Most common type of ankle sprain

A

Lateral ankle sprain

146
Q

Injury mechanism of lateral ankle sprain

A

Forced inversion of plantar-flexed foot

147
Q

Which lateral ligament is the most likely to be injured in an ankle sprain

A

Anterior talofibular ligament

148
Q

Symptoms of ankle sprain

A

Tenderness
Swelling
Bruising
Pain on weight bearing
Instability

149
Q

Investigations of ankle sprain

150
Q

Management for ankle sprain

A

RICE- rest, ice, compression, elevation
Physiotherapy
Reconstruction if needed

Y2 MSK (19 decks)

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