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Locomotor 2 > Review of the Lower Limb > Flashcards

Review of the Lower Limb Flashcards

1
Q

what is shentons line

A

Shenton lineis an imaginary curved line drawn along the inferior border of the superior pubic ramus (superior border of theobturator foramen) and along the inferomedial border of the neck offemur

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2
Q

what does interruption of Shentons line mean

A
  • interruption of the shenton line can indicate a fracture of the neck of the femur
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3
Q

what type of joint is the hip joint

A

ball and socket synovial joint

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4
Q

what is the acetabulum made up of

A
  • ilum
  • Ischium
  • pubis
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5
Q

describe the hip joint

A
  • made out of the acetabulum which is where the head of the femur sits into the hip
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6
Q

describe what the top part of the femur is made out of

A
  • femoral head
  • femoral neck
  • greater and lesser trochanters
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7
Q

what three ligaments surround the hip joint

A
  • pubo-femoral ligament
  • Iilo- femoral ligament
  • ishcio-femoral ligament
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8
Q

what is the strongest ligament supporting the hip joint

A
  • Iilo-femoral ligament

- crosses the anterior aspect of hip joint therefore the anterior part is reinforced more than the posterior part

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9
Q

what is the ligament in the hip joint itself

A

ligamentum teres

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10
Q

what are ligaments supporting the hip joint like in flexion and extension

A

Flexion
- lax - fibres are straight

extension
- taut - fibres are twisted

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11
Q

when is the hip most stable

A

= extension - all the ligaments supporting the hip are taut when the hip is in extension

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12
Q

in which direction do the vast majority of hip dislocations occur

A
  • they occur posteriorly when the hip is flexed
  • for example in a car crash where the dash board hits the knee and this can push the femur out of hte hip joint posteriolry
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13
Q

what percentage of hip dislocations are posterior

A

86-90%

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14
Q

what is more common hip dislocation or fracture

A

Hip fractures are more common

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15
Q

describe the blood supply of the femur

A
  • The femoral artery gives of the perfunda femoris
  • the perfunda femoris gives on the medial and lateral circumflex artery
  • the medial and lateral circumflex arteries give of retinacular arteries which pierce the femoral neck and go into the femur and supply the bone with blood
  • also have an branch of thee obturator artery which supplies the head of the femur
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16
Q

describe what direction the medial and lateral circumflex go

A 
medial = wraps anteriorly around 
lateral = wraps posteriorly around
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17
Q

what arteires are important to the supply of the femur neck and head

A
  • the medial and lateral circumflex arteries give of retinacular arteries which pierce the femoral neck and go into the femur and supply the bone with blood
  • also have an branch of thee obturator artery which supplies the head of the femur
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18
Q

what are the two types of femoral head and neck fractures

A

= intracaspular fracture and extracapsular fracture

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19
Q

what is the difference between intracapsular fracture and extracapsular fracture

A

Intracapsular

  • Intracapsular femoral fracture happens in the capsule part
  • higher risk of avascular necrosis

extracapsular

  • outside of the capsule part
  • happens lower in the neck
  • lack of risk of avascular necrosis - arteries will be in tact
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20
Q

in a hip dislocation posteriorly what structures are at risk

A

sciatic nerve

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21
Q

in a hip dislocation anterior what structures are at risk

A

femoral artery

obturator artery and nerve

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22
Q

what makes up the greater sciatic foramen

A

– sacrotuberus and the illiac crest

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23
Q

What makes up the lesser sciatic foramen

A

= sacrospinous and sacrotuberous

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24
Q

What does the sacrospinous ligament attach to

A
  • attaches to the sacrum and the ischial spine
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25
Q

What does the sacrotuberous ligament attach to

A
  • attaches to the sacrum and the ischial tuberosity
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26
Q

what leaves the greater sciatic foramen

A
  • superior gluteal neurovascular
  • inferior gluteal neurovascular
  • piriformis
  • sciatic nerve
  • pudendal
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27
Q

What leaves the lesser sciatic foramen

A

Pundendal nerve

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28
Q

where do you do an IM injection

A

high up in the hip in order to avoid all of this neurovascular within the gluteal region

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29
Q

when are the three muscles that make up the gluteals

A
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
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30
Q

Describe the gluteus Maximus

  • innervation
  • movement
  • insertion point
A
  • largest and most superficial
  • innervated by the inferior gluteal nerve
  • hip extensor and lateral rotator
  • inserted 3/4 iliotibial band and 1/4 of gluteal tuberosity of femur
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31
Q

describe the tensor fascia lata

  • innervation
  • movement
A

Tensor fascia lata

  • innervation= superior gluteal nerve
  • abduction of the hip
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32
Q

Describe gluteus medius

  • innervation
  • movement
A
  • innervation= superior gluteal nerve

- abduction of the hip and stabilization of the pelvis

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33
Q

Describe gluteus minimus

    • innervation
  • movement
A
  • innervation= superior gluteal nerve

- abduction of the hip and stabilization of the pelvis

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34
Q

What muscles do abduction of the hip

A
  • tensor fascia lata
  • gluteus medius
  • gluteus minimus
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35
Q

what do the lateral rotators do

- innervation

A
  • these are involved in the lateral rotation of the hip

- L5, S1, S2 - have there own individual branches

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36
Q

what does piriformis do and what is it supplied by

A
  • lateral rotation of the hip

- nerve piriformis

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37
Q

name the lateral rotators

A

Superior gemellus

inferior gemellus

obturator inturnus

quadratus femoris

piriformis

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38
Q

describe the trendeleburg test

A
  • idea that gluteus medius and minimus keep the pelvis straight when standing on one leg by contracting on the opposite side to which the leg is elevated.
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39
Q

what does damage to the gluteus medius and minimus result in

A
  • results in a positive trendeleburg test
  • the gluteal nerve can cause contralateral hip drop as the gluteus medius and minimus can no longer support the hip on the opposite side
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40
Q

what three compartments is the thigh divided into

A

anterior
medial
posterior

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41
Q

describe the anterior compartment of the thigh

  • innervation
  • muscle
  • movement
A

Femoral nerve (L2,3,4)

Quadriceps

Knee extension and hip flexion (a bit)

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42
Q

describe the medial compartment of the thigh

  • innervation
  • muscle
  • movement
A

Obturator nerve (L2,3,4)

Adductors

Hip adduction

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43
Q

describe the posterior compartment of the thigh

  • innervation
  • muscle
  • movement
A

Sciatic nerve- Tibial branch (L5,S1,S2)

Hamstrings

Knee flexion and a bit of hip extension

44
Q

What is at the midpoint on the inguinal ligament

A

femoral artery

45
Q

what muscles are in the anterior compartment of the hip

A

Iliopsoas (Psoas major and Iliacus)

sartorius

Qaudriceps

46
Q

What movement does illiopsoas do

A

(Psoas major and Iliacus)

Major flexor of the hip joint

47
Q

What movement does sartorius do

A

flexes hip and knee

48
Q

Name the four quadriceps

A

Vastus medialis,

Vastus lateralis

medialis

Rectus femoris

49
Q

where do all hamstrings originate from

A

the ischial tuberosity and they attach onto the tibia (only long head of bicep femoris not the short head)

50
Q

what movement do hamstrings do

A

flex the knee joint

51
Q

what are the three hamstrings

A

Semitendinosus

Semimembranosus

Biceps femoris (long head and short head)

52
Q

what are the hamstrings innnervated from

A

Innervated by tibial division of the sciatic nerve

53
Q

What makes up the medial compartment

A

adductors

54
Q

name the 4 adductors

A

Adductor Magnus

Adductor Longus

Adductor Brevis

Gracilis

55
Q

What are the adductors innervated by

A
  • innervated by the obturator nerve (other than the hamstring part of adductor magnus)
56
Q

What are the attachment point of the adductor muscles

A

In general they attach to the pelvis and distally to linea asperea.

57
Q

What three muscles is the pes anserinus an attachment point for

A

Sartorius

Gracilis

Semitendinosus

58
Q

what are the nerve roots of the obturator nerve

A

L2-4

59
Q

What are the nerve roots of the femoral nerve

A

L2-4

60
Q

What is the femoral triangle made up of

A
  • Superior inguinal ligament
  • laterally Sartorius
  • inferiorly adductor longus
61
Q

what is in the femoral triangle

A
  • femoral Nerve
  • femoral artery
  • femoral vein
  • lymphatics
62
Q

who is more likely to get a femoral hernia

A

= Women

- this is because the inguinal canal is not as developed

63
Q

what passes through the adductor canal

A
  • the femoral artery passes through the adductor hiatus and becomes the popliteal artery
64
Q

what are the three articulations in the knee

A

lateral femoral and tibial condyles with corresponding meniscus

medial femoral and tibial condyles with corresponding meniscus

patella and femur

65
Q

what is the largest joint in the body

A

The knee

66
Q

what bone is not involved in the knee

A
  • fibula
67
Q

What does the knee depend on for strength

A
  • relatively weak joint on its own so it depends on ..
    1. Strength and actions of surrounding muscles and their tendons
    2. The ligaments that connect the femur and tibia
68
Q

describe the medial meniscus

A

larger than the lateral meniscus

C-shaped

Broader posteriorly than anteriorly

Anteriorly attached to ACL

Firmly adhered to the tibial collateral ligament

69
Q

describe the lateral meniscus

A

Nearly circular

Smaller and more freely movable than medial meniscus

Attached to the PCL.

70
Q

what are the two collateral ligaments supporting the knee

A
  • fibular collateral ligament (lateral side) - independent of the knee joint capsule
  • tibial collateral ligament (medial side)
71
Q

describe the attachement point of the PCL

A

Runs from posterior aspect of intercondylar area of tibia and ascends anteriorly to attach to the medial wall of the femoral intercondylar fossa

72
Q

What does the PCL do

A

Stops tibia moving backward on femur

Helps stabilise knee especially in flexion

Also prevents tibia twisting outward (external rotation)

73
Q

what is stronger the PCL or ACL

A

PCL

74
Q

describe the attachment points of the ACL

A

Runs from facet on the anterior part of the intercondylar area of tibia and ascends posteriorly to attach to the back of the lateral wall of the intercondylar fossa of the femur

75
Q

What does the ACL do

A

Stops tibia moving forward on femur

Stabilise knee in extension and prevents hyperextension and excessive internal rotation

76
Q

What is the unhappy triad

A

Made up of the:

  • medial mensici
  • ACL
  • tibial collateral ligaments
  • this is because they are all attached to each other therefore if you tear one then the others are likely to be torn
77
Q

When does a ACL tear often occur

A

ACL tearing often occurs when the knee is twisted whilst that limb is weight bearing with the foot fixed on the ground

78
Q

what resutls from an anterior and posterior drawer sign

A

Anterior drawer sign
- ACL prevents the femur sliding posterior on the tibia so rupture results in the anterior drawer sign

Posterior drawer sign
- The PCL prevents the femur sliding anteriorly on the tibia, so rupture results in the posterior drawer sign

79
Q

what are the borders of the popliteal fossa

A

= semimembranous and semitendinous

- gastrocnemius

80
Q

What goes through the popliteal fossa

A
  • common peroneal nerve
  • tibial nerve
  • sural nerve
  • small saphenous vein
  • popliteal artery and vein
81
Q

where does the small saphenous vein drain into

A
  • the popliteal vein
82
Q

describe the blood supply to the knee

A
  • have the popliteal artery and this gives of the superior and inferior genicular artery
83
Q

what compartments is the leg made out of

A
  • anterior
  • lateral
  • posterior
84
Q

describe the anterior compartment of the leg

A

Deep peroneal nerve

Dorsiflexion

Extension of digits

85
Q

describe the lateral compartment of the leg

A

Superficial peroneal nerve

Eversion

86
Q

Describe the posterior compartment of the leg

A

Tibial nerve

Plantarflexion

Flexion of digits

87
Q

describe the blood supply to the leg

A

popliteal artery then divides into an anterior and posterior tibial

Anterior tibial goes through interssous membrane into anterior comarpetmn of the leg and anterior part of the ankle and becomes the dorsalis pedis

posterior tibial goes into the posterior compartment and behind the medial malleolus into the sole of the foot where it becomes the medial and lateral plantar artiereis

lateral compartment
- perforating branches of the deep peroneal (fibular)

88
Q

where is the dorsalis pedis pulse

A
  • lateral to flexor hallicus longus
89
Q

describe the nerve supply of the lower leg

A

the sciatic nerve divides into the tibial and common peroneal nerve
- the common peroneal divides into the superficial personal nerve and deep peroneal nerve

90
Q

what does the superficial and deep peroneal nerve supply

A

Superficial peroneal nerve = lateral compartment

Deep peroneal nerve = anterior compartment

91
Q

what does the tibial nerve supply

A

Tibial nerve – continues in posterior compartment and innervates it

92
Q

what bone does the common peroneal wrap around

A

fibular - gets damaged if the fibular bone gets damaged

93
Q

what happens if you have a common peroneal injury

A

foot drop

94
Q

what does the common peroneal nerve innervate

A

The common peroneal nerve innervates the muscles of the anterior compartment of the leg (dorsiflexion) and the lateral compartment of the leg (eversion).

95
Q

what causes a common peroneal nerve injury

A

damage to the head of the fibular

96
Q

what supplies the sensory innervation to the sole of the foot

A

tibial nevre

97
Q

what type of joint is the ankle joint

A

hinge synovial joint

98
Q

what is the ankle joint formed from

A

synovial joint between tibia, fibula and talus bones.

99
Q

what movements can the ankle joint do

A
  • plantarflexion and dorsiflextion
100
Q

What movements does the subtalor joint do

A

eversion and inversion

101
Q

what are the two types of ligament of the ankle joint

A

lateral and medial

102
Q

name the 3 lateral ligaments

A

Anterior talofibular ligament

Posterior talofibular ligament

Calcaneofibular ligament

103
Q

name the medial ligament

A

deltoid

104
Q

what is the most common ligament to be sprained

A

Anterior talofibular ligament

105
Q

what joint does eversion and inversion

A

subtalor joint

Locomotor 2 (30 decks)

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