MSK System - Lower Limb Flashcards

1
Q

What three bones form the hip bone?

A

Ilium

Ischium

Pubis

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2
Q

What foreamen is found within the hip bone?

A

Obturator foreamen

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3
Q

What is the longest bone in the body?

A

Femur

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4
Q

Where is the femur located?

A

In the thigh, between the hip joint to the knee joint

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5
Q

What is the name of the femur head depression? What ligament attaches to this area?

A

Fovea

Ligament of the femur head

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6
Q

Where does the ligament of the femur head extend from?

A

It extends from the fovea to the transverse acetabular ligament

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7
Q

What three arteries supply the head of the femur?

A

Obturator nerve

Medial circumflex femoral artery

Lateral circumflex femoral artery

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8
Q

Which vessel is the main blood supply to the femoral head?

A

Medial femoral circumflex artery

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9
Q

In which patients does femur neck fractures tend to occur in?

A

Older female with osteoporosis

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10
Q

What line exists between the greater and lesser trochanter of the femur?

A

Intertrochanteric

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11
Q

What line exists in the shaft of the femur?

A

Linea aspera

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12
Q

What does the femoral head articulate with? What joint does this form?

A

The acetabulum of the hip

Hip joint

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13
Q

Where do the two hemi-pelvises articulate?

A

Pubic symphysis

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14
Q

What two superficial veins drain the lower limb?

A

Great saphenous vein

Lesser saphenous vein

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15
Q

Where do the great and lesser saphenous veins arise?

A

Dorsal venous arch of the foot

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16
Q

What vein does the great saphenous vein drain into?

A

Femoral vein

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17
Q

On what aspect of the lower limb is the great saphenous vein located?

A

Medial

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18
Q

What vein does the lesser saphenous vein drain into?

A

Popliteal vein

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19
Q

On what aspect of the lower limb is the lesser saphenous vein located?

A

Posterior

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20
Q

Which superficial vein ascends anterior to the medial malleolus of the tibia?

A

Great saphenous vein

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21
Q

Which superficial vein ascends posterior to the lateral malleolus of the tibia?

A

Lesser saphenous vein

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22
Q

What are varicose veins?

A

A condition in which the valves within the leg become incompetent, causing the vessels to dilate and become tortuous

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23
Q

What is thrombophlebitis?

A

A condition in which varicose veins become inflamed

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24
Q

What pushes blood upwards in the veins of the lower limb?

A

Muscle contraction

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25
Q

What is deep vein thrombosis?

A

A condition in which venous stagnation occurs due to thrombus formation in the deep veins of the lower leg

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26
Q

What is a complication of deep vein thrombosis?

A

It can dislodge and migrate away from its source. It can then lodge in the lungs - pulmonary embolus

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27
Q

What three lymph nodes drain the lower limb?

A

Superficial inguinal

Deep inguinal

Popliteal

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28
Q

On what aspect of the lower limb are superficial inguinal lymph nodes located? Where are they located in relation to the deep inguinal lymph nodes?

A

Medial

Superior

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29
Q

On what aspect of the lower limb are deep inguinal lymph nodes located? Where are they located in relation to the superficial inguinal lymph nodes?

A

Medial

Inferior

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30
Q

On what aspect of the lower limb are popliteal lymph nodes located?

A

Posterior

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31
Q

What lymph vessels drain into the superficial inguinal lymph nodes?

A

Those accompanying the great saphenous vein

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32
Q

What lymph vessels drain into the popliteal lymph nodes?

A

Those accompanying the lesser saphenous vein

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33
Q

What causes enlargement of the inguinal lymph nodes?

A

Infection inferior to the level of the umbilicus, including the lower limb

Intra-abdominal/pelvic malignancies

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34
Q

What plexus supplies sensory sensation to the lower limb?

A

Lumbar plexus

Sacral plexus

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35
Q

What dermatome supplies the anterior aspect of the knee?

A

L3

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36
Q

What dermatome supplies the big toe of the foot?

A

L5

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37
Q

What dermatome supplies the little toe of the foot?

A

S1

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38
Q

What type of joint is the hip joint?

A

Synovial ball and socket

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39
Q

Why is the hip joint more stable than the shoulder joint?

A

It has a deeper socket

The ligaments are stronger and bigger

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40
Q

Describe the articulation of the hip joint

A

Socket - Acetabular labrum

Ball - Femoral head

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41
Q

What does the acetabular labrum cover? What is its function?

A

Femoral head

To add stability to the hip joint by deepening the socket

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42
Q

What are the three ligaments of the hip joint?

A

Iliofemoral ligament

Pubofemoral ligament

Ischiofemoral ligament

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43
Q

What is the strongest ligament of the hip joint?

A

Iliofemoral

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44
Q

Where is the iliofemoral ligament located?

A

It is located between the ilium of the hip and the femoral head

Anterior aspect of hip joint

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45
Q

Where is the pubofemoral ligament located?

A

It is located between the pubis of the hip and the femoral head

Anterior aspect of hip joint

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46
Q

Where is the ischiofemoral ligament located?

A

It is located between the ischium of the hip and the femoral head

Posterior aspect of hip joint

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47
Q

What is the function of the iliofemoral ligament?

A

It prevents hyperextension of the hip joint

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48
Q

What is the function of the pubofemoral ligament?

A

It prevents hyperabduction of the hip joint

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49
Q

What are the three main hip flexors?

A

Iliacus

Psoas major

Pectineus

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50
Q

What is the collective name used to refer to the iliac and psoas major?

A

Iliopsoas

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51
Q

Where does the iliopsoas arise from and extend to?

A

It arises from the inner pelvis and posterior abdominal wall

It extends to the lesser trochanter of the femur

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52
Q

What nerve lies between the psoas major and the iliacus?

A

Femoral nerve

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53
Q

What nerve runs on the surface of the iliopsoas?

A

Genitofemoral nerve

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54
Q

Where does the pectineus arise from and extend to?

A

It arises from the pubis bone

It extends to the femur

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55
Q

What nerve supplies the pectineus muscle?

A

Obturator nerve

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56
Q

What plexus supplies the anterior and medial aspects of the pelvis and thigh?

A

Lumbar

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57
Q

What component of the thigh are the hip flexors contained within?

A

Anterior

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58
Q

What is the main flexor of the thigh?

A

Iliopsoas muscle

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59
Q

What are the three extensors of the hip joint?

A

Gluteus maximus

Hamstrings

Adductor magnus - posterior aspect

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60
Q

What three muscles make up the hamstrings?

A

Semitendinous

Semimembranous

Biceps femoris (long head)

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61
Q

What is the main extensor of the hip joint?

A

Gluteus maximus

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62
Q

What component of the thigh are the hip extensors contained within?

A

Posteior

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63
Q

What plexus supplies the posterior aspects of the pelvis and thigh?

A

Sacral plexus

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64
Q

What is the action of the posterior thigh compartment on the knee joint?

A

Flexion

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65
Q

What component of the thigh are the hip adductors contained within?

A

Medial

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66
Q

What is adduction of the hip?

A

Movement of a straightened leg inwards crossing the axis of the other leg

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67
Q

What nerve supplies the adductors of the hip?

A

Obturator nerve from lumbar plexus

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68
Q

How does the obturator nerve exit the pelvis?

A

Via the obturator canal

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69
Q

Where is the obturator canal located?

A

It is located lateral to the pubic symphysis

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70
Q

What two muscles form the obturator canal?

A

Obturator externus

Obturator internus

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71
Q

What are the five hip adductors?

A

Adductor longus

Adductor brevis

Adductor magnus

Gracilis

Obturator externus

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72
Q

What hip adductor runs down the medial aspect of the thigh?

A

Gracilis

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73
Q

What thigh muscle can be used for transplantation to replace damaged muscles due to its lack of function?

A

Gracilis

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74
Q

What muscle is more superior - adductor brevis or longus?

A

Adductor brevis

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75
Q

What muscle is more anterior - adductor brevis or longus?

A

Adductor longus

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76
Q

What hip adductor is largest and most posterior?

A

Adductor magnus

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77
Q

What two nerves supply the adductor magnus muscle?

A

Obturator nerve

The tibial branch of the sciatic nerve

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78
Q

What muscles conduct hip abduction?

A

Deep gluteal muscles, which are located on the posterior aspect of the thigh under the gluteus maximus

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79
Q

Where do hip abductors attach to?

A

The greater trochanter of the femur

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80
Q

What are the three main hip abductors?

A

Gluteus medius

Gluteus minimus

Piriformis

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81
Q

What hip abductor is most deep - gluteus medius or minimus?

A

Gluteus minimus

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82
Q

What is the action of the hip abductors?

A

Each time you raise one leg off the ground, the abductors of the opposite side of the pelvis contract to provide stability

Involved in climbing stairs rather than walking

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83
Q

What occurs when there is injury to the abductor muscles of the thigh?

A

Trendelenburg gait

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84
Q

What plexus supplies the hip abductors? What nerve innervates the thigh abductors?

A

Sacral

Superior gluteal nerve

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85
Q

Which nerve damage causes a positive Trendelenburg sign?

A

Superior gluteal nerve

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86
Q

What is external rotation of the hip?

A

Turning the inside of the foot to face backwards

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87
Q

What five muscles are involved in external rotation of the hip?

A

Piriformis

Obturator internus

Gluteus minimus

Superior and inferior gamelli

Quadratus femoris

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88
Q

Where do the external rotators of the hip cross the joint? Where do they attach to?

A

Posterior aspect

Greater trochanter of femoral head

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89
Q

Where are the superior and inferior gamelli located?

A

They are located above and below the obturator internus muscle

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90
Q

What three muscles are involved in internal rotation of the hip?

A

Gluteus medius

Gluteus minimus

Tensor fascia lata

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91
Q

What is internal rotation of the hip?

A

Turning the inside of the foot to face forward

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92
Q

Where do the internal rotators of the hip lie? Which aspect of the hip joint do they cross?

A

Posterior aspect

Anterior aspect

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93
Q

What is the quadriceps femoris?

A

A four-headed muscle which forms the main bulk of the anterior thigh region

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94
Q

What are the four heads of the quadriceps femoris?

A

Rectus femoris

Vastus lateralis

Vastus intermedius

Vastus medialis

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95
Q

On what aspect of the thigh does the vastus lateralis muscle lie?

A

Anterior, lateral

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96
Q

On what aspect of the thigh does the vastus medalis muscle lie?

A

Anterior, medial

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97
Q

Where does the vastus intermedius lie?

A

Between the vastus lateralis and vastus medialis

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98
Q

What muscle is more anterior - vastus lateralis or medialis?

A

Vastus lateralis

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99
Q

What nerve innervates the anterior thigh muscles?

A

Femoral

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100
Q

What is the action of the rectus femoris muscle on the hip joint?

A

Flexion of the hip joint

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101
Q

What do the heads of the quadriceps femoris muscle form? Where do they unite?

A

Quadriceps tendon

Proximal to the patella

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102
Q

What does the quadriceps tendon continue as once it passes the patella?

A

Patellar ligament

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103
Q

Where does the patellar tendon attach?

A

The tibial tuberosity

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104
Q

What is the action of the quadriceps femoris on the hip joint and the knee joint?

A

It flexes the hip joint

It extends the knee joint

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105
Q

What muscle lies on top of the vastus intermedius?

A

Rectus femoris

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106
Q

What is the longest muscle in the body?

A

Sartorius

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107
Q

What is the most superficial muscle in the anterior compartment of the thigh?

A

Sartorius

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108
Q

What are the four functions of the sartorius muscle?

A

Flexion of the hip joint

Flexion of the knee joint

External rotation of the hip joint

Abduction of the hip joint

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109
Q

What muscle is used to place your right foot on your left knee and then slide the foot down your leg? Why?

A

Sartorius

It assist with medial rotation of the tibia on the femur

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110
Q

What nerve supplies the sartorius?

A

Anterior division of the femoral nerve

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111
Q

Where does the sartorius muscle arise and extend to?

A

It arises in the ASIS

It extends to the pes anserinus on the medial aspect of the tibia

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112
Q

Which three thigh muscles extend to the pes anserinus of the tibia?

A

Sartorius

Gracilis

Semimembranous

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113
Q

What are the clinical features of pes anserinus bursitis?

A

Pain on the medial, proximal aspect of the tibia

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114
Q

What are the three actions of the sartorius on the hip joint?

A

Flexion

Abduction

External rotation

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115
Q

What is the action of the sartorius on the knee joint?

A

Flexion

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116
Q

How does the sartorius exert flexion on both the hip and knee joint?

A

It spirals around the thigh from lateral to medial, crossing the hip joint anteriorly and the knee joint posterior-medially

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117
Q

What three neurovascular structures pass through the obturator canal?

A

Obturator artery

Obturator vein

Obturator nerve

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118
Q

Which fossa do the neurovascular structures pass through after the obturator canal?

A

Popliteal fossa

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119
Q

What do the neurovascular structures of the anterior aspect of the lower limb enter through?

A

Femoral triangle

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120
Q

What muscle forms the medial border of the femoral triangle?

A

Adductor longus

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121
Q

What muscle forms the lateral border of the femoral triangle?

A

Sartorius

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122
Q

What structure forms the base of the femoral triangle?

A

Inguinal ligament

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123
Q

Which vessel is located at the midpoint of the inguinal ligament?

A

Femoral artery

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124
Q

What two muscles forms the floor of the femoral triangle?

A

Iliopsoas

Pectineus

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125
Q

What three structures pass through the femoral triangle?

A

Femoral artery

Femoral vein

Femoral nerve

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126
Q

What is the femoral sheath?

A

A funnel shaped connective tissue tube which surrounds the proximal part of the femoral vessels (but not the nerve)

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127
Q

What is contained within the femoral canal?

A

Lymphatic vessels

Fat and loose connective tissue

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128
Q

What are the three compartments of the femoral sheath?

A

Lateral

Intermediate

Medial

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129
Q

What is contained within the lateral compartment of the femoral sheath?

A

Femoral artery

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130
Q

What is contained within the intermediate compartment of the femoral sheath?

A

Femoral vein

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131
Q

What is contained within the medial compartment of the femoral sheath?

A

Femoral canal

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132
Q

What is a femoral hernia?

A

A condition in which an increase in abdominal pressure can cause abdominal contents to push into the femoral ring and become trapped

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133
Q

Which gender is most commonly affected by femoral hernias?

A

Females

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134
Q

What is the main artery of the lower limb?

A

Femoral artery

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135
Q

Where does the femoral artery begin?

A

Inguinal ligament

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136
Q

What is the femoral artery a continuation of?

A

External iliac artery

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137
Q

Between which two bony landmarks does the femoral artery enter the thigh?

A

ASIS

Pubic symphysis

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138
Q

What is the deep artery of the lower limb?

A

Profunda femoris

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139
Q

What is the profounda femoris artery a branch of?

A

External iliac artery

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140
Q

What is the main vein of the lower limb?

A

Femoral vein

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141
Q

What is the femoral vein a continuation of?

A

Great saphenous vein

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142
Q

What does the femoral vein drain into? Where?

A

External iliac vein

As it passes under the inguinal ligament

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143
Q

What two veins drain into the femoral triangle?

A

Profunda femoris

Greater saphenous

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144
Q

Which vein is cannulated for a right cardiac angiography?

A

Femoral vein

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145
Q

What is the largest nerve of the lumbar plexus?

A

Femoral nerve

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146
Q

Where does the femoral nerve enter the femoral triangle in relation to to the femoral vessels?

A

Laterally

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147
Q

What is the main branch of the femoral nerve?

A

Saphenous nerve

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148
Q

What aspect of the leg and foot does the saphenous nerve supply?

A

Medial aspect

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149
Q

Where do the neurovascular structures of the anterior thigh pass after the femoral triangle?

A

Adductor canal

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150
Q

Where does the adductor canal originate and extend?

A

It arises from the apex of the femoral triangle to the adductor hiatus of the adductor magnus

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151
Q

In which muscle is the adductor canal located in?

A

Adductor magnus

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152
Q

Where do the neurovascular structures of the anterior thigh pass after the adductor canal?

A

Adductor hiatus, which is an opening in the adductor magnus tendon

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153
Q

What happens to the anterior femoral artery as it passes through the adductor hiatus?

A

It becomes the popliteal artery

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154
Q

What are the four contents of the adductor canal?

A

Femoral artery

Femoral vein

Saphenous nerve

Vastus medialis nerve

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155
Q

What canal lies underneath the sartorius muscle?

A

Adductor canal

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156
Q

What roots form the lumbar plexus?

A

The ventral roots of L1 - L4

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157
Q

Where do the roots of the lumbar plexus emerge?

A

Through the psoas major muscle on the posterior abdominal wall

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158
Q

What are the three terminal branches of the lumbar plexus that innervate the lower limb?

A

Lateral cutaneous nerve

Femoral nerve

Obturator nerve

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159
Q

What are the two motor nerves of the lumbar plexus supplying the lower limb? What are their nerve roots?

A

Femoral nerve

Obturator nerve

L2-L4

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160
Q

What sensory nerve of the lumbar plexus supplies the lower limb? What is its nerve roots?

A

Lateral cutaneous nerve

L2-L3

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161
Q

What lumbar plexus nerve is most medial?

A

Obturator nerve

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162
Q

What lower limb nerve is most lateral?

A

Lateral cutaneous nerve

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163
Q

What is the pelvic girdle?

A

A bony ring consisting of the sacrum and both hip bones

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164
Q

What joins the pelvic girdle anteriorly?

A

The pubic symphysis

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165
Q

What type of joint is the pubic symphysis?

A

Secondary cartilaginous joint

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166
Q

What joins the pelvic girdle posteriorly?

A

The sacroiliac joints

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167
Q

What type of joint are the sacroiliac joints?

A

Synovial plane joint

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168
Q

What are the two ligaments of the pelvic girdle?

A

Sacrotuberous ligament

Sacrospinous ligament

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169
Q

What are the two sciatic foramen?

A

Greater sciatic foramen

Lesser sciatic foramen

170
Q

What is the function of the greater sciatic foramen?

A

The route for structures to enter or leave the pelvis

171
Q

What is the function of the lesser sciatic foramen?

A

The route for structures to enter or leave the perineum

172
Q

Where does the sacrotuberous ligament extend?

A

It extends from the sacrum to the ischial tuberosity

173
Q

Where does the sacrospinous ligament extend?

A

It extends from the sacrum to the ischial spine

174
Q

Which ligament does the lesser sciatic foramen sit behind?

A

Sacrotuberous ligament

175
Q

Where are the pelvic girdle ligament seen best?

A

Posteriorly

176
Q

What nerve innervates the gluteus maximus?

A

Inferior gluteal nerve

177
Q

What nerve innervates the gluteus medius and minimus?

A

Superior gluteal nerve

178
Q

What posterior thigh muscle lies most laterally?

A

Tensor fasciae latae

179
Q

What nerve innervates the tensor fasciae latae?

A

Superior gluteal nerve

180
Q

What plexus are the superior and inferior gluteal nerves a branch of?

A

Sacral plexus

181
Q

What are the actions of the gluteus maximus?

A

It extends the hip

182
Q

What are the actions of the gluteus medius, gluteus minimus and tensor fascia latae?

A

They abductors and internal rotators of the hip

183
Q

What is the deep fascia of the thigh?

A

Fascia lata

184
Q

Where is the fascia lata located?

A

It extends posteriorly from the ilium to the tibia

It is thickened laterally

185
Q

What does the fascia lata form?

A

The iliotibial tract

186
Q

What two muscles attach to the fascia lata?

A

Tensor fascia lata

Gluteus maximus

187
Q

What is the function of the iliotibial tract?

A

To stabilise the lateral aspect of the knee joint

188
Q

What are the roots of the sacral plexus?

A

The ventral rami of L4-S4

189
Q

What muscle does the sacral plexus lie on?

A

Piriformis

190
Q

What does the sacral plexus supply?

A

The posterior aspect of the lower limb

The perineum

191
Q

What is the main branch of the sacral plexus, that supplies the lower limb?

A

Sciatic nerve

192
Q

What is the main branch of the sacral plexus, that supplies the perineum?

A

Pudenal nerve

193
Q

What are two smaller motor branches of the sacral plexus?

A

Superior gluteal nerve

Inferior gluteal nerve

194
Q

What is the root value of the superior gluteal nerve?

A

L4-S1

195
Q

What is the root value of the inferior gluteal nerve?

A

L5-S2

196
Q

What is the largest nerve of the body?

A

Sciatic nerve

197
Q

What are the root values of the sciatic nerve?

A

L4 to S3

198
Q

What foramen does the sciatic nerve pass through?

A

Greater sciatic foramen

199
Q

How does the sciatic nerve pass in relation to the piriformis muscle?

A

Inferior

200
Q

Which compartment of the thigh does the sciatic nerve run?

A

Posterior

201
Q

What two nerves does the sciatic nerve divide into? Where?

A

Tibial nerve

Common fibular nerve

Popliteal fossa

202
Q

Is the common fibular nerve lateral or medial?

A

Lateral

203
Q

Is the tibial nerve lateral or medial?

A

Medial

204
Q

What is sciatica?

A

A condition in which the sciatic nerve is compressed, causing an electric shock pain passing from the back down to the toes

205
Q

Does the sciatic nerve supply any muscles in the gluteal region?

A

No

206
Q

What two joints do the hamstrings act on?

A

Hip joint

Knee joint

207
Q

What is the most medial hamstring muscle?

A

Semimembranosus

208
Q

How can we remember the aspect of the thigh in which the semimembranous muscle lies?

A

semiMembranosus

Medial

209
Q

What is the intermediate hamstring muscle?

A

Semitendinosus

210
Q

What is the most lateral hamstring muscle?

A

Biceps femoris (long head)

211
Q

Where does the long and short head of biceps femoris insert?

A

Head of the fibula

212
Q

Which hamstring is most commonly injured in sports?

A

Biceps femoris

213
Q

Which nerve innervates the long head of the biceps femoris muscle?

A

Tibial division of the sciatic nerve

214
Q

Which nerve innervates the short head of the biceps femoris muscle?

A

Common fibular nerve of the sciatic nerve

215
Q

What is the action of the hamstrings on the hip joint?

A

Extension

216
Q

What is the action of the hamstrings on the knee joint?

A

Flexion

217
Q

Which artery supplies the posterior compartment of the thigh?

A

Profunda femoris artery

218
Q

Which nerve supplies the posterior compartment of the thigh?

A

Sciatic nerve

219
Q

What type of joint is the knee joint?

A

Synovial hinge

220
Q

What is the largest synovial joint in the body?

A

Knee joint

221
Q

What two movements occur at the knee joint?

A

Flexion

Extension

222
Q

Describe the articulation of the knee joint

A

The medial epicondyle of the femur articulates with the medial epicondyle of the tibia

The lateral epicondyle of the femur articulates with the lateral epicondyle of the tibia

223
Q

What is the most important muscle that stabilises the knee joint?

A

Quadriceps femoris

224
Q

What three nerves innervate the knee joint?

A

Femoral

Sciatic

Obturator

225
Q

What are the four ligaments of the knee joint?

A

Fibular collateral ligament

Tibial collateral ligament

Anterior cruciate ligament

Posterior cruciate ligament

226
Q

What is another name for the fibular collateral ligament?

A

Lateral collateral ligament

227
Q

Where does the FCL arise and extend to?

A

It arises from the lateral epicondyle of the femur

It extends to the lateral surface of the head of the fibula

228
Q

What muscle tendon passes deep to the FCL?

A

Popliteus

229
Q

Why is the FCL not attached to the lateral meniscus?

A

Popliteus muscle passes deep to the FCL

230
Q

What is another name for the tibial collateral ligament?

A

Medial collateral ligament

231
Q

Where does the TCL arise and extend to?

A

It arises from the medial epicondyle of the femur

It extends to the medial surface of the head of the tibia

232
Q

What does the TCL attach to?

A

Medial meniscus

233
Q

Where is the TCL commonly torn?

A

At its attachment to the medial meniscus

234
Q

Where does the ACL originate and extend?

A

Origin - The medial surface of the lateral femoral condyle

Insertion - The anterior intercondylar area of the tibial plateau

We can remember this by putting our hands in out pocket - superolateral to inferomedial

235
Q

What is the action of the ACL?

A

It prevents the femur from sliding posterior on the tibia, preventing hyperextension

236
Q

What artery supplies the ACL?

A

Middle genicular artery

237
Q

Where does the PCL originate and extend?

A

Origin - The lateral surface of the medial femoral condyle

Insertion - The posterior intercondylar area of the tibial plateau

238
Q

Which structure separates the posterior cruciate ligament from the popliteal artery?

A

Oblique popliteal ligament

239
Q

What is the action of the PCL?

A

It prevents the femur from sliding anterior on the tibia - preventing hyperflexion

240
Q

What is more common - ACL or PCL tear?

A

ACL

241
Q

What condition may develop if rupture of the ACL is untreated for a prolonged period?

A

Osteoarthritis

242
Q

What immediate condition occurs when the ACL is ruptures?

A

Haemarthrosis

243
Q

What is the ‘unhappy triad’ when it comes to knee injuries?

A

Torn ACL

Torn TCL

Torn medial meniscus

244
Q

What is the function of the popliteus?

A

It helps release the fully extended knee - conducting the first 15 degrees of flexion

Specifically, when flexing the knee from a fully extended position, this muscle rotates the femur laterally on the tibia

245
Q

What are the menisci of the knee joint?

A

They are crescent shaped plates of fibrocartilage directly on the articular surface of tibia

246
Q

What are the functions of the menisci?

A

To increase stability of the knee

To provide lubrication and shock

247
Q

What is the largest sesamoid bone in the body?

A

Patella

248
Q

Where is the patella positioned?

A

Anterior of the knee joint

249
Q

What attaches to the patella superiorly?

A

Quadratus femoris tendon

250
Q

What attaches to the patella inferiorly?

A

Patellar ligament

251
Q

What causes movement of the patella?

A

Flexion

252
Q

What are the four bursae of the knee joint?

A

Suprapatellar bursa

Subtendinous bursa

Subcutaneous prepatellar bursa

Subcutaneous infrapatellar bursa

253
Q

Where is the suprapatellar bursa located?

A

Above the patella

254
Q

Where is the subtendinous bursa located?

A

Infront of the patella

255
Q

Where is the subcutaneous prepatellar bursa located?

A

Below patella, behind the patellar ligament

256
Q

Where is the subcutaneous infrapatellar bursa located?

A

Below patella, infront of the patellar ligament

257
Q

Which bursa communicates with the articulatr cavity of the knee joint? What is the clinical significance of this?

A

Suprapatellar bursa

It helps to allow the quadriceps tendons to move more easily over the femur during knee movements

258
Q

What is housemaid’s knee?

A

The inflammation of the subcutaneous prepatellar bursa

259
Q

What two muscles are involved in knee flexion?

A

Hamstrings

Sartorius

260
Q

What muscles are involved in knee extension?

A

Quadriceps femoris

261
Q

Which lymph nodes receive lymph from external genitalia?

A

Superficial inguinal

262
Q

What muscle damage causes a right-sided “dipping gait”?

A

Left gluteus medius

Left gluteus minimus

263
Q

Which nerve supplies the adductor group of muscles that act on the hip joint?

A

Obturator

264
Q

What is the name of the tubercle situated on the anterior, proximal tibia?

A

Gerdy tubercle

265
Q

On which bone is the medial malleolus situated on?

A

Tibia

266
Q

On which bone is the lateral malleolus situated on?

A

Fibula

267
Q

What holds the tibia and fibula together?

A

Interosseous membrane

268
Q

What is the role of the interoesseous membrane?

A

To provide stability to skeletal bones

269
Q

What are the two joints that hold the tibia and fibula in place?

A

Superior (proximal) tibia-fibular joint

Inferior (distal) tibia-fibular joint

270
Q

What type of joint is the superior (proximal) tibia-fibular joint?

A

Synovial plane

271
Q

What type of joint is the inferior (distal) tibia-fibular joint?

A

Syndesmosis plane

272
Q

Which bone is more anterior - tibia or fibula?

A

Tibia

273
Q

What is the anterior bony prominence felt 3 to 4cm below the knee joint?

A

Tibial tuberosity

274
Q

Which tendon attaches to the superior aspect of the tibial tuberosity?

A

Patellar

275
Q

What is dorsiflexion?

A

Movement of the ankle upwards

276
Q

What is plantarflexion?

A

Movement of the ankle downwards

277
Q

What is eversion?

A

Movement of the ankle outwards

278
Q

What is inversion?

A

Movement of the ankle inwards

279
Q

What are the four muscles in the anterior compartment of the leg?

A

Tibialis anterior

Extensor digitorum longus

Extensor hallucis longus

Fibularis tertius

280
Q

What is the function of the muscles in the anterior compartment of the leg?

A

Dorsiflexors of the ankle joint

Extensors of the toes

281
Q

What is the combined function of the tibialis anterior and tibialis posterior?

A

Inversion of the foot

282
Q

What foot arch does the tibialis anterior support?

A

Medial longitudinal foot arch

283
Q

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

A

Anterior tibial artery

Posterior tibial artery

284
Q

What does the common fibular nerve divide into within the leg?

A

Deep fibular nerve

Superficial fibular nerve

285
Q

What nerve innervates the muscles in the anterior compartment of the leg?

A

Deep fibular nerve

286
Q

What is the sural nerve formed of?

A

Common Fibular Nerve

Tibial Nerve

287
Q

What does the sural nerve supply?

A

Cutaneous innervation to the lateral foot

Posterolateral aspect of the leg

288
Q

Where does the sural nerve lie?

A

It lies posterior to the lateral malleolus

289
Q

Where does the tibialis anterior insert?

A

Base of 1st metatarsal

290
Q

Where does the extensor digitorum longus insert?

A

Distal phalanges of the the lateral four digits

291
Q

Where does the extensor hallucis longus insert?

A

Distal phalanx of big toe

292
Q

Where does the extensor digitorum/hallucis brevis insert?

A

Proximal phalanx

293
Q

What is stronger EHL or EDL?

A

EHL

294
Q

Where does the fibulas tertius insert?

A

Dorsum of 5th metatarsal base

295
Q

What artery is associated with the anterior compartment of the leg?

A

Anterior tibial artery

296
Q

What does the anterior tibial artery continue into?

A

Dorsalis pedis artery

297
Q

How do we palpate the dorsalis pedis artery?

A

The feet need to be slightly dorsiflexed.

We then pass along a line from the extensor retinaculum to a point just lateral to the tendon of extensor hallucis longus

298
Q

What nerve is most lateral - superficial fibular nerve or deep fibular nerve?

A

Superficial fibular nerve

299
Q

What are the two muscles in the lateral leg?

A

Fibularis longus

Fibularis brevis

300
Q

What are the actions of the lateral compartment of the leg?

A

Eversion of the foot (weak)

Plantarfelxion of the ankle joint

301
Q

What nerve supplies the muscles in the lateral compartment of the leg?

A

Superficial fibular nerve

302
Q

What nerve damage causes foot drop (inability to dorsiflex)?

A

Common fibular nerve

303
Q

Which nerve is affected by fractures to the neck of the fibula?

A

Common fibular nerve

304
Q

What muscle is more lateral - fibularis longus or fibularis brevis?

A

Fibularis longus

305
Q

What two muscles lie behind the lateral malleolus?

A

Fibularis longus

Fibularis brevis

306
Q

What is the combined action of the fiburalis tertius and lateral compartment (fibularis longus, fibularis brevis)?

A

Eversion

307
Q

What is the dorsum of the foot - anterior or posterior aspect?

A

Anterior

308
Q

What two pulses can be felt around the foot and ankle area?

A

Dorsalis pedis

Posterior tibial

309
Q

Where is the posterior tibial pulse felt?

A

Behind the medial malleolus

310
Q

What type of joint is the ankle joint?

A

Synovial hinge

Mortise

311
Q

Describe the articulation of the ankle joint

A

The distal ends of the tibia and fibula and the transverse part of the posterior tibia-fibular ligament form a malleolar mortise (deep socket) to which the superior aspect of the talus fits into

312
Q

What is the surface of the talus covered in?

A

Articular cartilage

313
Q

What grips the talus tightly during movements of the ankle joint?

A

Malleoli

314
Q

When is the malleolar grip on the ankle strongest?

A

Dorsiflexion

315
Q

When is the ankle joint the most unstable?

A

Plantarflexion

316
Q

What retinaculum is found on the anterior aspect of the foot? What are the two subtypes?

A

Extensor retinaculum

Superior, inferior

317
Q

Which extensor retinaculum is Y-shaped?

A

Inferior

318
Q

What retinaculum is found on the posterior aspect of the foot?

A

Flexor retinaculum

319
Q

What are the seven ligaments of the ankle joint?

A

Tibionacivular ligament

Tibiocalcaneal ligament

Posterior talofibular ligament

Anterior talofibular ligament

Anterior tibiofibular ligament

Posterior tibiofibular ligament

Calcaneofibular ligament

320
Q

Where does the tibionavicular ligament extend?

A

It extends from the medial aspect of the tibia to the navicular bone

321
Q

Where does the tibiocalcaneal ligament extend?

A

It extends from the medial aspect of the tibia to the calcaneus bone

322
Q

Where does the posterior talofibular ligament extend?

A

It extends posteriorly from the lateral aspect of the fibula to the talus bone

323
Q

Where does the anterior talofibular ligament extend?

A

It extends anteriorly from the lateral aspect of the fibula to the talus bone

324
Q

Where does the posterior tibiofibular ligament extend?

A

It extends posteriorly from the lateral aspect of the fibula to the tibia

325
Q

Where does the anterior tibiofibular ligament extend?

A

It extends anteriorly from the lateral aspect of the fibula to the tibia

326
Q

Where does the calcaneofibular ligament extend?

A

It extends from the lateral aspect of the fibula to the calcaneus bone

327
Q

What ankle ligament is the weakest?

A

Anterior talofibualr ligament

328
Q

What three ligaments are classed as the lateral ligaments of the ankle joint?

A

Anterior talofibular

Posterior talofibular

Calcaneofibular

329
Q

What five ligaments are classed as the medial ligaments of the ankle joint?

A

Anterior tibiotalar

Posterior tibiotalar

Tibiocalcaneal

Tibionavicular

Spring

330
Q

What ligaments of the ankle joint is named the deltoid ligament - medial or lateral?

A

Medial ligament of the ankle

331
Q

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

A

Inversion

332
Q

What can inversion and eversion of the ankle joint fracture?

A

Medial or lateral malleoli

333
Q

What muscles cause dorsiflexion of the foot?

A

Anterior compartment of leg - tibias anterior, EDL, EHL and fibular tertius

334
Q

What muscles cause plantarflexion of the foot?

A

Posterior compartment of leg - soleus, gastrocnemius and plantaris

Fibularis longus

Fibularis brevis

335
Q

What is the popliteal fossa?

A

A fat-filled diamond shape located posterior to the knee joint

336
Q

What are the six contents of the popliteal fossa?

A

Fat

Popliteal artery

Popliteal vein

Popliteal lymph vessels

Tibial nerve

Common fibular nerve

337
Q

What is the relation of the popliteal artery to the popliteal vein?

A

It lies deeply to it

338
Q

What two muscles form the medial border of the popliteal fossa?

A

Semimembranosus

Semitendinosus

339
Q

What muscle forms the lateral border of the popliteal fossa?

A

Biceps femoris

340
Q

What muscle forms the inferior border of the popliteal fossa?

A

Gastrocnemius

341
Q

What is the popliteal artery a continuation of?

A

Femoral artery

342
Q

Where does the femoral artery become the popliteal artery?

A

As it passes the adductor hiatus

343
Q

How do we palpate the popliteal pulse?

A

We place the knee in a flexed position to relax the surrounding fascia and muscles. We use both hands to palpate the vessel on the back of the knee joint

344
Q

What muscle compartment of the leg is largest?

A

Posterior

345
Q

What are the two divisions of the posterior muscle compartment of the leg?

A

Superficial

Deep

346
Q

What are the three superficial posterior muscles of the leg?

A

Soleus

Plantaris

Gastrocnemius

347
Q

What are the two heads of the gastrocnemius?

A

Medial head

Lateral head

348
Q

What is the function of the gastrocnemius?

A

It plantarflexes the ankle

It is essential for a walking gait

349
Q

What nerve innervates the gastrocnemius?

A

Tibial nerve

350
Q

Which muscles does the tibial nerve lie between?

A

The lateral and medial heads of the gastrocnemius muscle

351
Q

What is the plantaris?

A

A small muscle with a very long tendon that runs on the lateral aspect of the leg

352
Q

What is the function of the plantaris?

A

It plantarflexes the ankle

353
Q

What is the most superficial posterior muscle of the leg?

A

Gastrocnemius

354
Q

What muscle lies underneath the gastrocnemius?

A

Soleus

355
Q

Where does the gastrocnemius muscle insert?

A

Achilles tendon

356
Q

What forms the achilles tendon?

A

Gastrocnemius, soleus and plantaris tendons

357
Q

What are the four deep posterior leg muscles?

A

Popliteus

Flexor hallucis longus

Tibialis posterior

Flexor digitorum longus

358
Q

Where do the deep posterior leg muscles pass to?

A

The sole of the foot, but don’t travel around the calcaneus

They pass medially to the door of the foot, posterior to the medial malleolus

359
Q

What are the actions of the deep posterior leg muscles?

A

They flex the toes and/or the ankle

360
Q

Where does the popliteus muscle originate from?

A

The lateral condyle of the femur

361
Q

Which nerve accompanies the deep posterior leg muscles through the door to the foot?

A

Tibial nerve

362
Q

Which artery accompanies the deep posterior leg muscles through the door to the foot?

A

Posterior tibial artery

363
Q

List the structures passing behind the medial malleolus from anterior to posterior

A

TOM DICK AND HARRY

Tibialis posterior

Flexor digitorum longus

Posterior tibial vein

Posterior tibial artery

Tibial nerve

Flexor hallucis longus

364
Q

Which nerve innervates all the muscles of the posterior compartment of the leg?

A

Tibial nerve

365
Q

Which artery innervates all the muscles of the posterior compartment of the leg?

A

Posterior tibial artery

366
Q

How is the posterior tibial artery palpated?

A

It is palpated between the posterior surface of the medial malleolus and the medial border of the calcaneal tendon

367
Q

What artery is found medially in the posterior leg?

A

Posterior tibial artery

368
Q

What artery is found laterally in the posterior leg?

A

Fibular artery

369
Q

What are the six bones of the foot?

A

Talus

Calcaneus

Navicular

Cuboid

Cuneiform

Metatarsal

370
Q

What is the deep fascia of the foot known as?

A

Plantar fascia

371
Q

What is the function of the plantar fascia?

A

It supports the arches of the foot

It acts as a spring when pushing off in normal walking gait

372
Q

What is a clinical feature of plantar fasciitis?

A

Heel pain

373
Q

What causes plantar fasciitis?

A

Overuse

Increase in weight

Increase in age

374
Q

What movements of the ankle are achieved at the mortise joint of the ankle?

A

Dorsiflexion

Plantarflexion

375
Q

Where does eversion and inversion of the foot occur?

A

Subtalar joints

376
Q

What ligaments are damaged when there is constant inversion of the foot?

A

Lateral ligaments of the ankle

377
Q

What are the two subtalar joints?

A

Talonavicular

Talocalcaneal

378
Q

What type of joint is the talonavicular joint?

A

Ball and socket

379
Q

What is the action of the subtalar foot joints?

A

Weight distribution

Walking on uneven ground

Balancing on one leg

380
Q

Where does the talonavicular ligament exist?

A

Between the talus and navicular bones

381
Q

Where does the talocalcaneal ligament exist?

A

Between the talus and calcaneus bones

382
Q

What are the three arches of the foot?

A

Two Longitudinal (medial and lateral)

One Transverse

383
Q

What is the function of the foot arches?

A

They distribute body weight on to the main fat pads

Shock absorption

384
Q

What is another name for the spring ligament?

A

Plantar calcaneo-navicular

385
Q

What is the function of the spring ligament?

A

To maintain the medial longitudinal arch and contribute to the subtalar joints

386
Q

Where does the spring ligament extend?

A

It arises from the calcaneus to the navicular bone

387
Q

What are the four passive factors that maintain the foot arches?

A

Shape of the united bones

Plantar fascia

Long plantar ligament

Short plantar ligament

388
Q

Where is the long plantar ligament located?

A

It extends from the calcaneus to the cuboid bones

389
Q

Where is the short plantar ligament located?

A

It runs from the calcaneus to the cuboid bone but deeper to the long plantar ligament

390
Q

What nerve supplies the long plantar ligament?

A

Lateral plantar nerve

391
Q

What are the four dynamic factors that maintain the foot arches?

A

Intrinsic muscles of the foot

Long flexor tendons

Tendon of tibialis posterior

Tendon of fibularis longus

392
Q

What is another name for high foot arches?

A

Pes cavus

393
Q

What is the cause for high foot arches?

A

Congenital abnormalities (cerebral palsy) that cause fixed contractions of the flexor muscles

394
Q

What is another name for flat feet?

A

Pes planus

395
Q

What is the cause for flat feet?

A

Dysfunction of one or more of the dynamic or passive factors that maintain the foot arches

396
Q

How many muscles layers are there of the foot?

A

Four

397
Q

What four foot muscles are contained within layer one?

A

Flexor digitorum brevis

Abductor hallucis longus

Abductor digiti minimi

Lumbricals

398
Q

Where does the abductor digiti minimi insert?

A

Onto the little toe

399
Q

Where does the abductor hallucis longus insert?

A

Onto the big toe

400
Q

Where does the flexor digitorum brevis insert?

A

Onto the proximal phalanx of the second to fourth toes

401
Q

What is the function of the lumbricals?

A

They flex the metatarsophalangeal joints

They extend the proximal and distal interphalangeal joints

402
Q

What three foot muscles are contained within layer two?

A

Flexor hallucis longus tendon

Flexor digitorum longus tendon

Flexor digitorum accessoris tendon

403
Q

What two nerves and arteries are found within layer two of the foot?

A

Medial plantar nerve and artery

Lateral plantar nerve and artery

404
Q

What are the medial and lateral plantar arteries a branch of?

A

Posterior tibial artery

405
Q

What aspects of the leg and foot does the posterior tibial artery supply?

A

Posterior compartment of the leg

Plantar surface of the foot

406
Q

Where does the flexor hallucis longus tendon insert?

A

Distal phalanx of the big toe

407
Q

Where does the flexor digitorum longus tendon insert?

A

Distal phalanx of the second to fifth toes

408
Q

What muscle attaches to the flexor digitorum longus tendon?

A

Quadratus plantae

409
Q

What is the function of the first foot layer?

A

They flex the toes

They initiate the first part of the gait cycle

410
Q

What are the medial and lateral plantar nerves a branch of?

A

Tibial nerve

411
Q

Which nerve supplies the majority of muscles in the sole of the foot?

A

Lateral plantar nerve

412
Q

What is the function of the second foot layer?

A

They flex the toes

413
Q

What is the function of the third foot layer?

A

They adduct and flex the toes

414
Q

What is the function of the fourth foot layer?

A

Abduction and adduction

415
Q

What makes up the fourth foot layer?

A

Interossei

416
Q

What are the actions of the plantar interossei?

A

Adduct the digits

417
Q

What are the actions of the dorsal interossei?

A

Abduct the digits

418
Q

What aspect of the foot does the superficial fibular nerve supply?

A

Dorsum of the foot

419
Q

What aspect of the foot does the deep fibular nerve supply?

A

Web space between the first and second toes

420
Q

What type of joint is the interphalangeal joint?

A

Synovial hinge

421
Q

What is the transverse tarsal joint?

A

It is formed by the articulation of the calcaneus with the cuboid (the calcaneocuboid joint) and the articulation of the talus with the navicular (the talocalcaneonavicular joint)

422
Q

Where does the extensor digitorum/hallucis brevis insert?

A

Proximal phalanx