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ESA2 > MSK -Lower Limb > Flashcards

MSK -Lower Limb Flashcards

1
Q

What is in the femoral triangle?

A

NAVY

Nerve - femoral
Artery - femoral
Vein - femoral
Y fronts (shows its lateral to medial)

Also femoral canal

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2
Q

What is in the femoral canal and why is there space?

A

Lymph nodes
Connective tissue
Space for distension on increase venous return e.g. with exercise

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3
Q

What is the femoral sheath covering?

A

Femoral artery and vein

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4
Q

What is the role of the fascia lata? What is the thickening at the upper part and the lateral longitudinal reinforcement?

A
  • Band of thick connective tissue that encircles thigh - keeps muscles bound tightly together
  • Tensor fascia lata is a muscle between it’s layers
  • Iliotibial tract is a longitudinal reinforcement of the fascia lata
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5
Q

What is the order of the thigh adductors from lateral to medial?

A

Brevis
Longus
Magnus
Gracilis

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6
Q

What is the chief flexor of the thigh and what muscles is it made up of? Which two other muscles flex at the hip?

A

Iliopsoas

Iliacus
Posts major

Also pectineus
Sartorius

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7
Q

Why can sartorius muscle do both hip and knee flexion?

A

As it crosses the anterior aspect of the hip but the posterior aspect of the knee

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8
Q

What are the 7 anterior superficial thigh muscles?

A 
Sartorius
Pectineus 
Iliacus
Psoas major
Rectus femoris
Vastus medialis
Vastus lateralis
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9
Q

What are the quadriceps made up of?

A

Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedialis

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10
Q

What are the 5 muscles of the medial thigh?

A 
Obturator Externus
Adductor Brevis 
Adductor Longus
Adductor Magnus
Adductor Gracilis
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11
Q

Which is the only quadricep to flex the hip and extend the knee and why?

A

Rectus femoris as only one that originates from the hip so crosses the hip and the knee. The other 3 vastus originate from the femur.

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12
Q

Which 4 muscles attach to the quadriceps femoris tendon that attaches to the patella?

A

The quadriceps

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13
Q

What are the roles of the 3 vastus muscles?

A

They extend at the knee and stabilise patella

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14
Q

How do the quadriceps extend at the knee if they insert above it?

A

Cross the knee via the quadriceps tendon –> patella –> patella ligament/tendon –> tibia

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15
Q

Which nerves supply most of anterior muscles of thigh, medial muscles, posterior muscles?

A
  • Femoral
  • Obturator
  • Sciactic
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16
Q

Which muscle of the medial compartment of the thigh is the exception and not innervated by the obturator nerve?

A

Adductor Magnus - the hamstring portion of it is innervated by the sciatic nerve

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17
Q

What do the muscles in the post compartment of the thigh all do except one part?

A

All extend the hip and flex the knee apart from the short head of the biceps femoris which originates on the line aspera of the femur so doesn’t have action at the hip.

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18
Q

Where do all the hip extensors originate - apart from the short head of the biceps femoris?

A

On the ischial tuberosity

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19
Q

What are the borders of the femoral triangle?

A

Superior - inguinal ligament
Lateral - medial portion of the sartorius muscle
- Medial - medial border of adductor longus muscle
- Base is pectinius
- Roof is fascia lata

20
Q

What are four signs of osteoarthritis on X-ray?

A

Reduced joint space
Sclerosis
Osteophytes
Cysts

21
Q

What is sclerosis see on Xray in osteoarthritis? What are osteophytes?

A

Increased bone formation at joints

Bony spurs

22
Q

What is the trendleburg test for OA of hip?

A

Dropped hip on walking

23
Q

What is a clinical sign of NOF fracture? Why?

A

Shortened, abducted and externally rotated hip. Shortened due to impaction of bone, laterally rotated due to iliopsoas being attached to lesser trochanter and externally rotating distal fragment. Abducted due to the gluteus medius and minimum attaching to the greater trochanter abducting the distal fragment

24
Q

What is the worry with a NOF (4)? Is intra or extra capsular fracture more prone to this?

A

The head of femur relies on the blood supply from the medial circumflex artery of the femoral artery - avascular necrosis. Intracapsular more prone to avascular necrosis.

Can damage sciatic nerve, femoral artery, can get compartment syndrome due to build up of pressure around the bones

25
Q

Why is there shortening and rotation of the hip in dislocation? What is the clinical presentation of posterior vs anterior dislocation?

A

Limb shorter as extensors and adductors pull femur up

Posterior - flexed and internally rotated

Anterior - Minimally flexed, externally rotated and abducted

26
Q

What are two common causes of OA

A
  • Wear and tear with age

- Previous bony injury

27
Q

What are 4 symptoms/signs of OA?

A

Pain
Stiffness
Swelling
Deformity

28
Q

Why does wear and tear happen with age leading to OA in some cases?

A

Cartilage thins - loss of ECM which exposes bone - mechanical grinding

29
Q

What is rheumatoid arthritis caused by?

A

Autoimmune destruction of the synovium.

30
Q

What are the characteristics of RA? What are the most common joints affected?

A

Normally younger - 40-50yrs
More common in females
Narrowing of joint space

Most commonly in MCP and IP joints, Cspine and feet

31
Q

Define compartment syndrome

On doing what is the pain aggravated?

A

Increased pressure within a fascia leading to ischaemia of tissues

Pain aggravated by passive stretch of muscle

32
Q

Is OA or RA more likely to be symmetrical?

A

RA

33
Q

Where is the best place to perform a gluteal muscle injection and why?

A

Upper outer quadrant of gluteal area. Avoid superior gluteal nerve and artery and sciatic nerve

34
Q

Why is the popliteal fossa clinically important?

A

Contains artery, vein, common fibular nerve both branches of sciatic nerve - can get bakers cysts, aneurysms

35
Q

What can happen with an aneurysm in the popliteal fossa?

A

It can compress tibial nerve - weakened or absent plantar flexion, parasthaesia of the foot and posterolateral leg

36
Q

Where would you find the femoral artery to palpate?

A

Half way between the ASIS and public symphysis (mid-inguinal point)

37
Q

What can happen with a superior gluteal nerve injury (e.g. injection)

A

Positive trendleberg sign - paralysis of gluteus medium and minimum that means pressure on the unaffected side when walking causes the affected hip to drop

38
Q

Apart from the muscles around the hip joint what else contributes to it’s stability?

A

Iliofemoral ligament
 Ischiofemoral ligament
 Pubofemoral ligament
 Joint capsule

39
Q

Where does the sciatic nerve cross through the pelvis?

A

Through the greater sciatic foramen (an opening)

40
Q

Which muscle does the sciatic nerve arise inferior to?

A

Piriformis

41
Q

Inferior to the piriformis which artery does the sciatic nerve run next to?

A

Inferior gluteal nerve (as superior gluteal nerve is above piriformis)

42
Q

What does the sciatic nerve divide into in the back of the knee?

A

Tibial and common peroneal

43
Q

Which of the gluts is unaffected by sciatic nerve injury? What does this mean for extension with sciatic nerve injury?

A

The gluteus maximus

Extension will be compromised but still possible as glut max still in tact

44
Q

Which nerve innervates the gluteus maximus?

A

Inferior gluteal nerve

45
Q

What sensory loss below the knee do you get with sciatic nerve injury? Why can sciatic nerve injury patients be susceptible to trophic ulcers on the foot?

A

All sensation below the knee except the medial aspect of the leg and foot up to the ball of the big toe

Because loss of sensation of sole of food makes patient vulnerable to ulcers

46
Q

Where would sciatic nerve pain distribution be (3)

A

Posterior thigh
Posterior/lateral part of leg
Lateral part of foot

ESA2 (37 decks)

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