Review of lower limb Flashcards
Shenton’s line is between which two areas of the hip joint? [2]
Superior pubic ramus - inferomedial border of the neck offemur
L has neck of femur fracture: shenton line not normal
The hip joint’s stability is increased by which three ligaments [3]
Which is the strongest? [1] - Why is this clinically significant? [1]
Pubo-femoral ligament
Ilio-femoral ligament- strongest & found on anterior aspect of the joint - so anterior more strong than posterior
Ischio-femoral ligament
Together - they push the head of the femur into the hip
Which is the ligament found within the hip joint that strengthens the joint? [1]
Ligamentum teres
Describe the blood supply to the head and neck of femur [
Profunda femoris: give off medial and lateral circumflex arteries
- from these two arteries get Retinacular arteries- majority of blood to head and neck
Obturator artery: Artery to the head of the femur
The obturator artery is important for which patient population & why? [2]
Paedatric population: important for ossification for head of femur
line things
Which qudrant do you used for IM injection?
A
B
C
D
Which qudrant do you used for IM injection?
A - avoid sciatic nerve
B
C
D
nerve supply in the pelvis
Gluteus maximis inserts onto which structure? [1]
Which nerve supplies gluteus maximus? [1]
Inserts onto iliotibial band
Supplied by inferior gluteal nerve
Which nerve supplies gluteus medius and minimus? [1]
What movement do they cause? [1]
Superior gluteal nerve
Hip abduct and internally rotate the thigh
Tensor fascia lata
Lateral rotators
How do gluteus minimus and medius work to provide hip stablity? [1]
How does gluteus minimus and medius damage present? [1]
Opposite side contract when you walk to stop hip dropping,
Damage to them causes contralateral hip drop / Positive Trendelenburg test
thigh compartments
Sciatic nerve
What are the borders of the femoral triangle? [3]
Superior border: inguinal ligament
Lateral border – medial border of the sartorius muscle.
Medial border medial border of the adductor longus muscle. The rest of this muscle forms part of the floor of the triangle.
Order of neurovascular in femoral triangle? [4]
NAVL:
Nerve
Artery
Vein
Lymphatics
What are the borders of the popliteal fossa? [3]
Medial superior: semimembranosus and semitendinosus
Medial inferior: Gastrocnemius
Medial lateral: bicep femoris
Medial inferior: Gastrocnemius
After leading the popliteal artery
- what is the anteiror segment?
- what is the lateral sgement?
- what is the posterior segment?
Anterior
* anterior tibial: dorsalis pedis
Lateral
* perforating branches of deep penoneal (fibular)
Posterior
* posterior tibial: medial and lateral plantar
Neck of femur fractures (typically with significant displacement) will classically present with a [] and [] rotated limb.
Neck of femur fractures (typically with significant displacement) will classically present with a shortened and externally rotated limb.
NICE recommends offering total hip replacement over hemiarthroplasty in patients whom are [3]
- Able to walk independently outdoors with no more that one stick
- Not cognitively impaired
- Medically fit for the operation
Which muscle is responsible for shortening of the limb and external rotation following a NoF fracture? [1]
Iliopsoas
Common complication of posterior hip dislocation? [1]
Sciatic nerve involvement
Presentation of patellar dislocation? [1]
Knee held in flexion
How to reduce a patellar dislocation? [1]
Push patella medially whilst extending knee
Structures at risk in an anterior dislocation of the tibiofemoral joint? [3]
Popliteal artery
Tibial nerve
Common peroneal nerve
In which direction is the patella usually dislocated? [1]
Laterally due to pull of quadriceps
What is a bimalleolar fracture (Pott’s fracture)? [1]
fracture involving the lateral and medial ankle
Explain which malleolar fracture is more common [2]
Lateral malleolar:
lateral malleolar fractures as they result from forced inversion, which is easier as the lateral ankle ligaments are weaker
Lateral malleolar ligaments? [3]
Anterior talofibular
Posterior talofibular
Calcaneofibular
Which three muscles of the thigh form pes anserinus?
Obturator internus, gracilis and sartorius
Sartorius, rectus femoris, vastus medialis
Sartorius, gracilis and semitendinosus
Biceps brachii, brachialis, triceps brachii
Gracilis, pectineus, adductor magnus
Which three muscles of the thigh form pes anserinus?
Obsartorius, gracilis and semitendinosus
State the role of sartorius in moving hip and knee joints [2]
Sartorius can flex the hip AND flex the knee joint.
The unhappy triad is made from which 3 ligaments? [3]
Medial collateral ligament, lateral meniscus and anterior cruciate ligament
Which of the following muscles is the strongest flexor of the hip joint?
Sartorious
Iliopsoas
External oblique
Rectus femoris
Which of the following muscles is the strongest flexor of the hip joint?
Sartorious
Iliopsoas
External oblique
Rectus femoris
What is the insertion of the gluteus minimus muscle?
Femoral neck
Lesser trochanter
Femoral head
Greater trochanter
What is the insertion of the gluteus minimus muscle?
Femoral neck
Lesser trochanter
Femoral head
Greater trochanter
What nerve supplies the anterior compartment of the lower leg?
Superficial fibular nerve
Deep fibular nerve
Posterior tibial nerve
Femoral nerve
What nerve supplies the anterior compartment of the lower leg?
Superficial fibular nerve
Deep fibular nerve
Posterior tibial nerve
Femoral nerve
Apart from the anterior cruciate ligament, which other structure prevents overextension of the knee joint?
Meniscus
Posterior cruciate ligament
Arcuate popliteal ligament
Medial collateral ligament
Apart from the anterior cruciate ligament, which other structure prevents overextension of the knee joint?
Meniscus
Posterior cruciate ligament
Arcuate popliteal ligament
Medial collateral ligament
Which statement about the posterior cruciate ligament is true?
It prevents overextension of the knee joint
It restricts internal and external rotation of the extended knee
It prevents anterior rolling and displacement of the femoral condyle
It prevents posterior rolling and displacement of the femoral condyle
It is a shock absorber
It prevents anterior rolling and displacement of the femoral condyle
Which of the following nerves is involved in tarsal tunnel syndrome?
Deep peroneal nerve
Femoral nerve
Tibial nerve
Common peroneal nerve
Superficial peroneal nerve
Which of the following nerves is involved in tarsal tunnel syndrome?
Deep peroneal nerve
Femoral nerve
Tibial nerve
Common peroneal nerve
Superficial peroneal nerve
Contents of the tarsal tunnel? [5]
TARSAL TUNNEL
The tarsal tunnel is described as a region posterior to the medial malleolus and is bounded by the flexor retinaculum, turning it into a ‘tunnel’ through which important structures run. It is a useful landmark as it is where a clinician palpates the posterior tibial pulse and is the site of tarsal tunnel syndrome.
Contents of the tarsal tunnel:
Tendon of tibialis posterior
Tendon of flexor digitorum longus
Posterior tibial artery (and venae comitantes)
Tibial nerve
Flexor hallucis longus
“Tom Dick And Very Nervous Harry” is a useful way to remember it!
“The hamstrings are made up of the semimembranosus, semitendinosus and the ______________ muscles.”
Vastus intermedius
Biceps brachii
Rectus femoris
Psoas major
Biceps femoris
“The hamstrings are made up of the semimembranosus, semitendinosus and the ______________ muscles.”
Vastus intermedius
Biceps brachii
Rectus femoris
Psoas major
Biceps femoris
Which of the following muscles inserts onto the most superior aspect of the greater trochanter of the femur?
Obturator externus
Gluteus medius
Piriformis
Gluteus minimus
Obturator internus
Which of the following muscles inserts onto the most superior aspect of the greater trochanter of the femur?
Obturator externus
Gluteus medius
Piriformis
Gluteus minimus
Obturator internus
What is the medial border of the femoral triangle?
Medial border of adductor magnus
Medial border of adductor longus
Lateral border of adductor magnus
Lateral border of adductor longus
Medial border of sartorius
What is the medial border of the femoral triangle?
Medial border of adductor magnus
Medial border of adductor longus
Lateral border of adductor magnus
Lateral border of adductor longus
Medial border of sartorius
Which of the following is not a recognised region of an adult long bone?
Endophysis
Epiphysis
Diaphysis
Metaphysis
Synostosis
Which of the following is not a recognised region of an adult long bone?
Endophysis
Epiphysis
Diaphysis
Metaphysis
Synostosis
Which of the following collection of bones constitute the ankle joint?
Tibia fibula
Tibia, fibula, and talus
Tibia and talus only
Tibia, fibula, talus and calcaneus
Which of the following collection of bones constitute the ankle joint?
Tibia fibula
Tibia, fibula, and talus
Tibia and talus only
Tibia, fibula, talus and calcaneus
Which muscles comprise the deep posterior compartment of the leg?
Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and plantaris
Flexor hallucis brevis, flexor digitorum longus, tibialis posterior, and popliteus
Gastrocnemius, soleus, and plantaris
Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and popliteus
Which muscles comprise the deep posterior compartment of the leg?
Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and plantaris
Flexor hallucis brevis, flexor digitorum longus, tibialis posterior, and popliteus
Gastrocnemius, soleus, and plantaris
Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and popliteus
The femoral artery is palpable at the mid-inguinal point, which is halfway between which two structures?
Pubic symphysis and anterior superior iliac spine
Pubic symphysis and anterior inferior iliac spine
Pubic tubercle and lesser trochanter of the femur
Pubic tubercle and anterior superior iliac spine
Pubic tubercle and anterior inferior iliac spine
The femoral artery is palpable at the mid-inguinal point, which is halfway between which two structures?
Pubic symphysis and anterior superior iliac spine
Pubic symphysis and anterior inferior iliac spine
Pubic tubercle and lesser trochanter of the femur
Pubic tubercle and anterior superior iliac spine
Pubic tubercle and anterior inferior iliac spine
What type of hip dislocation would occur because of a car accident like this? [1]
How would a patient present prior to treatment?
What type of hip dislocation has occured? [1]
In which leg? [1]
Describe how you can tell [1]
Right posterior hip dislocation:
Right limb adducted, flexed, internally rotated, and shortened.