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MSK - Lower Limb Flashcards

1
Q

What is the intertrochanteric line vs intertrochanteric crest of femur? What ligament attaches at the intertrohanteric line?

A

Intertrochanteric line is anterior
Intertrochanteric crest is at the posterior

Iliofemoral ligament - strong hip ligament

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2
Q

What else is down the posterior of the femur?

A

Gluteal tuberosity

Linea aspera

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3
Q

What is the artery damages in intracapsular prox femoral fracture? What can happen? What is the clinical presentation of this fracture and why?

A

Medial femoral circumflex artery
Avascular necrosis of femoral head

Shortened rotated leg
Distal fragment pulled up and rotated laterally

Find out why - put muscles that cause it here

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4
Q

Why does shaft of femur descend in medial direction?

A

To bring the knees closer to the body’s centre of gravity increasing stability

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5
Q

Do you get avascular necrosis in extra capsular fractures? How do these type of fractures present clinically?

A

No

Same as intra shortened and rotated

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6
Q

What does the linea aspera on the back of femur widen and become?

A

Floor of popliteal fossa

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7
Q

Are femoral shaft fractures common? Why? What nerve could be damaged? What usually happens alongside due to mechanism?

A

No as require a lot of force
Femoral nerve and artery damage
Soft tissue damage due to force required

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8
Q

What is the epiphyseal plate? What can occur in fast growing adolescents?

A

Growth plate
Hyaline cartilage
Allows long bone growth
Bone can grow faster than muscle - osteochondrosis

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9
Q

Two main functions of patella?

A

Leg extension

Protection of anterior aspect of knee joint from physical trauma

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10
Q

Where does patella sit? What happens in dislocation?

Is dislocation more commonly lateral or medial? What kind of mechanism can cause dislocation?

A

Femoropatella groove
Comes out
Lateral more common
High force impact on patella or sudden twisting

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11
Q

How do patella fractures occur? What happens if the patella separates into 2 fragments superior and inferior?

A

Normall direct trauma to bone
Or sudden contraction of quadriceps muscle
Prox fragment superiorly displaced by quadriceps tendon
Distal fragment inferiorly displaced by patellar ligament

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12
Q

Where does tibia articulate?

A

Knee and ankle joints

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13
Q

What is a role of the tibial bone?

A

Weight bearing - second biggest bone in body

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14
Q

What bone is the medial malleolus on?

A

Tibial

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15
Q

Where does the meniscus and ligaments of knee joint attach?

A

Intercondylar eminance

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16
Q

How does the femur attach to the tibia?

A

Via the intercodular tubercles fitting into the intercondyla fossa of the femur

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17
Q

What is a major feature of anterior surface of tibia?

A

Tibial tuberosity - attaches patellar ligament

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18
Q

What is a major feature of the posterior surface of the tibia?

A

Soleal line - where part of soleus muscle originates

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19
Q

How do the tibia and fibula bind together?

A

Via the interosseous membrane on the lateral border of the tibia - interosseous border
At distal end via fibular notch

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20
Q

What are the functions of the widenings at the prox and distal ends of tibia?

A

Helps with weight bearing

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21
Q

Where on the tibia is most vulnerable to injury?

A

Prox end - e.g. condylar fractures

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22
Q

What often goes with condylar fractures

A

Damage to ligaments of the knee

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23
Q

What happens with displacement if the fibular is NOT also fractured

A

Fibula supports tibia and therefore minimally displaced

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24
Q

How can you get a medial malleolus fracture?

A

Over inversion

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25
Are tibia fractures common? In who/mechanism?
Usually trauma - middle aged | Common
26
Does the fibula articulate with the femur at the knee joint?
No
27
What is its main function
Attachment for muscles
28
Is it a weight bearer?
No
29
What are two types of fracture at the lateral malleolus and how do they occur?
Spiral - twisting - forced external rotation | Transverse - eversion - less common
30
What is the importance of the piriformis muscle?
Sciatic nerve enters the gluteal region directly behind it Also it divides the superior and inferior parts of gluteal region Above is super gluteal artery and nerve Below is inferior gluteal artery and nerve
31
How can sciatic pain be caused by a muscle?
Some variants of sciatic nerve involve some or all of it going through piriformis muscle - can give sciatic pain if piriformis muscle contracts
32
Where does obturator arise from? What other nerve arises from here?
L2-L4 | Femoral
33
Whats its course? What does it innervate (5)? What about cutaneous? What if it is damaged?
Runs with common iliac artery Then goes through obturator foramen Then supplies adductors, and obturator externus and gracilis Cutaneous is medial aspect of thigh Damage is pain paraesthesia in medial aspect and weak adduction or gait/posture problems
34
Where does the sciatic nerve originate from?
L4-S3
35
What is its course? What is an anatomical variant of bifurcation?
Arises inferior to piriformis muscle, passes posteriorly to the superior gemellus, obturator internus, inferior gemellus and quadrates femoris muscles Enters thigh by passing deep to long head of biceps femoris Bifurcates in popliteal fossa to tibial artery (central) and common peroneal (lateral) - these are technically in a sheath together making up the sciatic nerve so they can bifurcate anywhere up the lower limb
36
What does the sciatic nerve innervate? What does sensory?
Innervates posterior muscles of thigh - hamstrings And hamstring portion of adductor magnus Sensory - not directly but it's branches do e.g. sural nerve (plus other branches) that comes off the tibial and common peroneal branches does the lateral side of leg and heel, dorsal and plantar surfaces of the foot.
37
What is piriformis syndrome?
Spasm of piriformis - can affect sciatic nerve esp if variant that goes through piriformis instead of inferior to it - can cause pain and parasthaesia in region of sciatic nerve
38
Where do IM gluteal injections and why?
Upper lateral quadrant to avoid sciatic nerve which is in lower medial quadrant
39
Which nerve innervates the posterior compartment of thigh?
Sciatic
40
Which nerve innervates the medial compartment of thigh? Which type of muscles are here?
Obturator | Adductors
41
Which muscles does the obturator innervate?
``` Obturator externus Adductor longus Adductor brevis Gracilis Adductor magnus (not hamstring portion) ```
42
What happens if obturator nerve damaged?
pain paraesthesia medial thigh and weak adduction
43
What femoral artery branch can be severed in intracapsular fracture?
Medial femoral circumflex artery
44
Where do you find femoral pulse? Where would you puncture for arterial blood test/coronary angioplasty etc
Mid inguinal point (MIPA) | 1cm below that as that is in line with the ligament so need to go below to actually puncture the artery
45
What is the course from the femoral artery to LAD for coronary angioplasty?
``` Femoral artery External iliac artery Common iliac artery Abdominal aorta Thoracic aorta Aortic sinus Left coronary artery LAD ```
46
What does the femoral nerve innervate? Sensory?
Anterior muscles of thigh - hip flexors and knee extensors (and knee flexor sartorius) ``` Rectus femoris Vastus lateralis Vastus medialis Vastus intermidius Sartorius ``` Anteromedial part of thigh apart from small medial part that obturator innervates
47
Which muscle both flexes the hip and extends the knee
Biceps femoris
48
Which muscle both flexes the hip and flexes the knee
Sartorius
49
What are the roots of the femoral nerve?
L2-L4
50
What is the terminal cutaneous branches of the femoral nerve?
Saphenous nerve
51
What is the sensory distribution of the cutaneous branches of femoral nerve (thigh) /saphenous nerve (leg)
Anteromedial thigh and medial leg inc medial malleolus
52
What complication can occur with saphenous vein stripping?
Damage to saphenous nerve which runs with it. Does cutaneous part of medial lower leg so may get pain parasthaesia or complete loss of sensation there
53
When would you do a femoral nerve block (alongside sciatic nerve block?)
Patients who need operation but can't tolerate general anaesthetic - e.g. too unwell etc Also analgesia
54
What is the difference between the femoral sheath, canal, triangle?
Lymph nodes and lymph vessels make up canal Canal artery and vein make up sheath NAVEL makes up triangle NERVE IS NOT in sheath
55
What are the borders of the femoral triangle?
Superior - inguinal ligament Lateral - medial border or sartorius Medial - medial border of adductor longus Floor - rest of adductor longus, pectinius and iliopsoas. Roof - fascia lata
56
Where does the inguinal ligament go to from? Where does the inguinal line go to from?
Ligament - from ASIS to pubis tubercle | Line - from ?ASIS to pubis symphysis (so is longer)
57
Where does femoral nerve run in comparison with femoral artery
Runs slightly laterally so is mid point of inguinal ligament whereas femoral artery is more mid inguinal point (of line)
58
What is the course of the femoral nerve?
From abdomen goes down through psoas major muscle roughly to midpoint of inguinal ligament then passes behind inguinal ligament through femoral triangle and down to branches
59
What pathology could you have in the femoral triangle?
Femoral hernia - bowl protruding into the femoral canal underneath the inguinal ligament
60
What three parts is the hip made up of? When do they fuse? Whats between them before this? What does the fusion form? What is the role of this thing?
Ilium Ischium Pubis Separated with cartilage Fuse at puberty Forms acetabulum - head of femur articulates with acetabulum to form the hip joint
61
What are the three articulations of the hip?
Sacroiliac Public symphysis Hip - head of femur
62
Where does the femur articular with the pelvis?
Acetabulum
63
What is the posterior counterpart of the iliac crest (anterior)
Gluteal surface
64
What bony landmark are you sitting on when you sit down?
Ischial tuberosities
65
What are two important ligaments coming from the sacrum to the pelvis? What do they form?
Sacrospinous - from sacrum to ischial spine - creates greater sciatic foramen through which lower limb neurovasculature including sciatic nerve transcends Sacrotuberous - from sacrum to ischial tuberosity - forms the lesser sciatic foramen
66
3 roles of pelvis?
Transfer of weight from upper skeleton Attachment - for muscles ligaments Protection - of abdo/pelvic organs
67
Is the gluteus minimums superior or inferior to piriformis?
Superior
68
What is the glut max, medius, minimus and piriformis innervated by?
Max - inferior gluteal Medius - superior gluteal Minimis - superior gluteal Piriformis - nerve to piriformis
69
What three muscles are innervated by the superior gluteal nerve?
Gluteus maximus Minimus Tensor fascia lata
70
What does the tensor fascia lata do?
Abducts and medially rotates
71
What happens with damage to superior gluteal nerve? Why?
Trendlebergs sign - drop hip on opposite side to damage. But Trendleberg gait is called the side of the damage nerve so right trendleberg gait is right superior gluteal nerve damage but left hip drop Because loss of gluteus medius and minimus that have an important role in hip stabilisation during locomotion. They contract when the contralateral leg is raised to prevent the pelvis dropping on that side
72
What are the three 'nerve - to's of the gluteal region? | What do they innervate?
Nerve to piriformis - piriformis Nerve to obturator internus - obturator internus and superior gemellus Nerve to quadratus femoris - inferior gemellus and quadratus femoris
73
What do the superficial and deep muscles do of the gluteal region?
Superficial - abductors and extensors | Deep - lateral rotators (and extensors)
74
One of these muscles only does external rotation not abduction which is it ``` Piriformis Quadratus femoris Superior gemellus Inferior gemellus Obturator internus ```
Quadratus femoris only laterally rotates
75
What arises above the piriformis and what below?
Above - superior gluteal nerve and artery | Below - sciatic nerve interior gluteal nerve and artery
76
Which three bones articulate forming the knee?
Patella Femur Tibia
77
What kind of joint is the knee and what movements?
Synovial Flexion extension Small amount of lateral and medial rotation
78
What are the two articulations called at the knee? What are the roles of them?
Patellofemoral - allows for the biceps tendon to go directly over knee enhancing the efficiency of this muscle Femorotibial - weight bearing articulation
79
What is the blood supply of the knee? Nerve supply?
Blood supply is genicular anastomoses from the femoral and popliteal arteries Nerves are the ones of muscles around it - femoral, tibial and common fibular
80
What are the roles of the medial and lateral meniscus? What are they made of? What shape are they?
Fibrocartilagenous They 1) deepen the articular surface of the tibia increasing stability of the knee joint 2) shock absorbers Both C shaped as you look down on them from above one medial one lateral
81
Which of the menisci is attached to something else? What is it? What does this mean if damaged?
Medial meniscus is attached to the tibial collateral ligament - means if this ligament is damaged the medial meniscus will tear
82
What is a bursa? What's their roles? How many in the knee? names?
A synovial fluid filled sac found between moving structures in a joint Aim to reduce wear and tear on that joint 4 Infra patellar Supra patella Prepatellar Semimembranosus
83
Name 5 ligaments of the knee and what they attach to
Patellar - continuation of quadriceps femoris tendon that attaches into the tibial tuberosity Medial collateral - medial epicondyle of the femur to the medial surface of tibia Lateral collateral - lateral epicondyle of the femur to the lateral surface of the tibia Anterior cruciate - from anterior intercondylar region of tibia to posterior intercondylar fossa of femur Posterior cruciate - from posterior intercondylar region of tibia to anterior intercondylar fossa of femur
84
What do the anterior and posterior cruciate ligaments do?
Anterior - prevents anterior dislocation of the tibia onto the femur Posterior - prevents posterior dislocation of the tibia onto the femur
85
What locks and unlocks the knee
Locks - medial movement of the femur on the tibia | Pops - popliteus
86
What muscles do extension at the knee
Quadriceps femoris
87
Which muscles do flexion at the knee
Hamstrings Gracilis Sartorius Popliteus
88
Which muscle does lateral rotation of the knee
Biceps femoris
89
Which muscles do medial rotation of the knee
``` Semimembranosis Semitendinosis Gracilis Sartorius Popliteus ```
90
What is the most common pathology to knee joint? How does this occur?
Collateral ligament damage | Force to side of knee when foot on ground
91
What is the unhappy triad?
ACL Medial meniscus Medial collateral
92
Which bursa is housemaids knee
prepatella
93
Which bursa is clergymans knee
infrapatella

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