MSK 3 - Lower Limbs

Question 1

a

Answer 1

Proximal tibiofibular joint

Question 2

b

Answer 2

Tibial tuberosity

Question 3

c

Answer 3

Head of fibula

Question 4

d

Answer 4

Interosseous membrane

Question 5

e

Answer 5

Distal tibiofibular joint

Question 6

f

Answer 6

Groove for tibialis posterior

Medial malleolus tendon

Question 7

g

Answer 7

Lateral malleolus

Question 8

The tibia and fibula are held together by sheet of fibrous material called the _________ membrane. This provides additional stability to the skeletal bones

Answer 8

interosseous

Question 9

The tibia and fibula are joined at the proximal and distal aspects

The superior or proximal tibio-fibular joint is a _____ type of synovial joint

The inferior or distal tibio- fibular joint is a type of _______ joint

Answer 9

plane

fibrous

Question 10

The musculature of the leg is built around this framework and is divided into 3 compartments

Identify these compartments on the cross section

Answer 10

1. Green = lateral compartment

2. Blue = anterior compartment
3. Yellow and Red = posterior superficial and deep compartment

Question 11

What is the anterior bony prominence you can feel about 3 to 4 cm below the knee joint?

Answer 11

tibial tuberosity

Question 12

Straighten your leg – which tendon attaches onto the superior aspect of this? (tibial tuberosity)

Answer 12

Patellar tendon

Question 13

Feel for the malleoli at the distal aspect of the leg as it reaches the ankle

What bone makes up the medial malleolus?

What bone makes up the lateral malleolus?

Answer 13

Tibia

Fibula

Question 14

_________ is the movement of the ankle upwards

Answer 14

Dorsiflexion

Question 15

_________ flexion is the movement of the ankle downwards

Answer 15

Plantarflexion

Question 16

Eversion is the movement of the ankle ________

Answer 16

outwards

Question 17

Inversion is the movement of the ankle ________

Answer 17

inwards

Question 18

Identify the 4 muscles in the anterior compartment of the leg:

1

Answer 18

1. Tibialis anterior

Question 19

Identify the 4 muscles in the anterior compartment of the leg:

2.

Answer 19

Extensor Digitorum longus

Question 20

Identify the 4 muscles in the anterior compartment of the leg:

3

Answer 20

3. Extensor Hallucis longus

Question 21

Identify the 4 muscles in the anterior compartment of the leg:

4.

Answer 21

Fibularis Tertius – this is a small muscle found at the distal aspect of the leg

Question 22

Muscles of anterior compartment of leg:

1. Tibialis anterior

2. Extensor Digitorum longus

3. Extensor Hallucis longus

4. Fibularis Tertius – this is a small muscle found at the distal aspect of the leg

These muscles are mainly __________ of the ankle joint and ________ of the toes.

Answer 22

dorsiflexors

extensors

Question 23

Clinical – Fibular or Peroneal (or both?):

whats the difference?

Answer 23

Within the leg the terms ‘peroneus/peroneal’ and ‘fibularis/fibular’ are interchangeable when referring to muscles and nerves.
For the purposes of this workbook we are sticking to ‘fibularis or fibular’ for description

Importantly please don’t get peroneal mixed up with perineal…these refer to very different anatomical areas!

Question 24

Neurovascular Structures of the Anterior Leg

The neurovascular structures of the leg are continuations with structures in the thigh as they continue distal through the popliteal fossa

What are the two divisions of sciatic nerve?

Answer 24

1. Tibial nerve
2. Common fibular nerve

Question 25

What are the two divisions of the popliteal artery as it enters the leg?

Answer 25

1. Anterior tibial artery 2. Posterior tibial artery

Question 26

The common fibular nerve further divides in the leg into the ________ fibular and ____ fibular nerves

Answer 26

superficial deep

Question 27

Which branch (of the common fibular nerve) innervates the muscles in the anterior compartment of the thigh?

Answer 27

Deep fibular nerve

Question 28

a

Answer 28

Superficial fibular nerve

Question 29

b

Answer 29

Deep fibular nerve

Question 30

c

Answer 30

Anterior tibial artery

Question 31

d

Answer 31

Dorsalis pedis artery

Question 32

The lateral compartment of the leg contains two muscles, what are they?

Answer 32

1. Fibularis longus 2. Fibularis brevis

Question 33

Muscles in the lateral compartment of the leg ________ the foot and weakly ________ the ankle joint.

Answer 33

eversion plantarflex

Question 34

Which fibular nerve supplies the muscles of the lateral compartment?

Answer 34

Superficial fibular nerve

Question 35

**_Clinical Case_** A 24-year-old man presents to the A+E department with new foot drop (inability to dorsiflex the ankle) following being tackled in a game of football. The tackle occurred on the lateral aspect of his leg Specifically, where has the injury occurred? Which letter does it correspond to on the diagram? Why has the foot drop occurred?

Answer 35

Deep fibular nerve B C is tibial nerve, A is superficial fibular nerve and D is the common fibular nerve Loss of innervation of the anterior muscles of the leg

Question 36

The dorsum of the foot (anterior aspect) is similar to that found in the upper limb. what is it like?

Answer 36

It has loose skin, compared to the plantar surface, and has a number of structures passing through the area heading distally to the foot and ankle.

Question 37

The lesser saphenous vein ascends on the _________ aspect of the leg, and drains into the _______ vein The greater saphenous vein ascends on the ______ aspect of the leg and thigh and drains into the _______ vein.

Answer 37

posterior popliteal medial femoral

Question 38

a

Answer 38

Tibialis anterior

Question 39

b

Answer 39

Dorsalis pedis

Question 40

c

Answer 40

Extensor digitorum longus tendons

Question 41

**Clinical – Pulses** 2 pulses can be felt in and around the foot and ankle area. what are they?

Answer 41

The dorsalis pedis is the continuation of the anterior tibial artery and is palpated between the 1^st and 2^nd metatarsal bones. Feel for it on your foot, and try and trace it proximally as it heads deep into the anterior compartment of the leg The posterior tibial pulse is palpated behind the medial malleolus it is the continuation of the posterior tibial artery.

Question 42

what type of joint is the ankle joint?

Answer 42

The ankle joint is a hinge type of synovial joint

Question 43

The ankle is a type of mortise joint - what does this mean?

Answer 43

meaning that the bones at the superior aspect of the joint provide a socket in which the talus fits into and can fit into a move.

Question 44

model the superior (articular surface of the talus is covered with what?

Answer 44

hyaline cartilage

Question 45

The articular surfaces of the ankle are: The distal end of the ____ and ______ with the superior part of the _____ bone. The malleoli grip the _____ tightly during the movements of the ankle joint The malleolar grip is strongest during __________ movement of the ankle joint. The ankle joint is unstable during _________ movement of the ankle joint.

Answer 45

tibia fibula talus talus dorsiflexion plantarflexion

Question 46

1

Answer 46

Tibionavicular

Question 47

2

Answer 47

Tibiocalcaneal

Question 48

3

Answer 48

Posterior talofibular

Question 49

4

Answer 49

Anterior tibiofibular

Question 50

5

Answer 50

Calcaeofibular

Question 51

6

Answer 51

Anterior talofibular

Question 52

Which ligament of ankle joint is the weakest?

Answer 52

Lateral ligament – anterior talofibular

Question 53

Which ligament of the ankle joint is named the deltoid ligament?

Answer 53

Medial ligament

Question 54

During which movements of the subtalar joint are ankle sprains more common?

Answer 54

Inversion Because of the strength of these ligaments both over inversion and eversion of the ankle joint can cause fractures to the either the medial or lateral malleoli

Question 55

Movement of the nakle joint - dorsiflexion what muscles are involved in this movement?

Answer 55

Tibiails anterior, extensor digitorum longus, extensor hallucis longus

Question 56

Movement of the nakle joint - Plantar flexion what muscles are involved in this movement?

Answer 56

Plantaris, soleus, fibularis longus, gastrocnemius, flexor hallucis longus, flexor digitorum longus