MSK -Lower Limb Flashcards
What is in the femoral triangle?
NAVY
Nerve - femoral
Artery - femoral
Vein - femoral
Y fronts (shows its lateral to medial)
Also femoral canal
What is in the femoral canal and why is there space?
Lymph nodes
Connective tissue
Space for distension on increase venous return e.g. with exercise
What is the femoral sheath covering?
Femoral artery and vein
What is the role of the fascia lata? What is the thickening at the upper part and the lateral longitudinal reinforcement?
- 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
What is the order of the thigh adductors from lateral to medial?
Brevis
Longus
Magnus
Gracilis
What is the chief flexor of the thigh and what muscles is it made up of? Which two other muscles flex at the hip?
Iliopsoas
Iliacus
Posts major
Also pectineus
Sartorius
Why can sartorius muscle do both hip and knee flexion?
As it crosses the anterior aspect of the hip but the posterior aspect of the knee
What are the 7 anterior superficial thigh muscles?
Sartorius Pectineus Iliacus Psoas major Rectus femoris Vastus medialis Vastus lateralis
What are the quadriceps made up of?
Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedialis
What are the 5 muscles of the medial thigh?
Obturator Externus Adductor Brevis Adductor Longus Adductor Magnus Adductor Gracilis
Which is the only quadricep to flex the hip and extend the knee and why?
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.
Which 4 muscles attach to the quadriceps femoris tendon that attaches to the patella?
The quadriceps
What are the roles of the 3 vastus muscles?
They extend at the knee and stabilise patella
How do the quadriceps extend at the knee if they insert above it?
Cross the knee via the quadriceps tendon –> patella –> patella ligament/tendon –> tibia
Which nerves supply most of anterior muscles of thigh, medial muscles, posterior muscles?
- Femoral
- Obturator
- Sciactic
Which muscle of the medial compartment of the thigh is the exception and not innervated by the obturator nerve?
Adductor Magnus - the hamstring portion of it is innervated by the sciatic nerve
What do the muscles in the post compartment of the thigh all do except one part?
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.
Where do all the hip extensors originate - apart from the short head of the biceps femoris?
On the ischial tuberosity
What are the borders of the femoral triangle?
Superior - inguinal ligament
Lateral - medial portion of the sartorius muscle
- Medial - medial border of adductor longus muscle
- Base is pectinius
- Roof is fascia lata
What are four signs of osteoarthritis on X-ray?
Reduced joint space
Sclerosis
Osteophytes
Cysts
What is sclerosis see on Xray in osteoarthritis? What are osteophytes?
Increased bone formation at joints
Bony spurs
What is the trendleburg test for OA of hip?
Dropped hip on walking
What is a clinical sign of NOF fracture? Why?
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
What is the worry with a NOF (4)? Is intra or extra capsular fracture more prone to this?
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
Why is there shortening and rotation of the hip in dislocation? What is the clinical presentation of posterior vs anterior dislocation?
Limb shorter as extensors and adductors pull femur up
Posterior - flexed and internally rotated
Anterior - Minimally flexed, externally rotated and abducted
What are two common causes of OA
- Wear and tear with age
- Previous bony injury
What are 4 symptoms/signs of OA?
Pain
Stiffness
Swelling
Deformity
Why does wear and tear happen with age leading to OA in some cases?
Cartilage thins - loss of ECM which exposes bone - mechanical grinding
What is rheumatoid arthritis caused by?
Autoimmune destruction of the synovium.
What are the characteristics of RA? What are the most common joints affected?
Normally younger - 40-50yrs
More common in females
Narrowing of joint space
Most commonly in MCP and IP joints, Cspine and feet
Define compartment syndrome
On doing what is the pain aggravated?
Increased pressure within a fascia leading to ischaemia of tissues
Pain aggravated by passive stretch of muscle
Is OA or RA more likely to be symmetrical?
RA
Where is the best place to perform a gluteal muscle injection and why?
Upper outer quadrant of gluteal area. Avoid superior gluteal nerve and artery and sciatic nerve
Why is the popliteal fossa clinically important?
Contains artery, vein, common fibular nerve both branches of sciatic nerve - can get bakers cysts, aneurysms
What can happen with an aneurysm in the popliteal fossa?
It can compress tibial nerve - weakened or absent plantar flexion, parasthaesia of the foot and posterolateral leg
Where would you find the femoral artery to palpate?
Half way between the ASIS and public symphysis (mid-inguinal point)
What can happen with a superior gluteal nerve injury (e.g. injection)
Positive trendleberg sign - paralysis of gluteus medium and minimum that means pressure on the unaffected side when walking causes the affected hip to drop
Apart from the muscles around the hip joint what else contributes to it’s stability?
Iliofemoral ligament
Ischiofemoral ligament
Pubofemoral ligament
Joint capsule
Where does the sciatic nerve cross through the pelvis?
Through the greater sciatic foramen (an opening)
Which muscle does the sciatic nerve arise inferior to?
Piriformis
Inferior to the piriformis which artery does the sciatic nerve run next to?
Inferior gluteal nerve (as superior gluteal nerve is above piriformis)
What does the sciatic nerve divide into in the back of the knee?
Tibial and common peroneal
Which of the gluts is unaffected by sciatic nerve injury? What does this mean for extension with sciatic nerve injury?
The gluteus maximus
Extension will be compromised but still possible as glut max still in tact
Which nerve innervates the gluteus maximus?
Inferior gluteal nerve
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?
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
Where would sciatic nerve pain distribution be (3)
Posterior thigh
Posterior/lateral part of leg
Lateral part of foot
