Session 4 - Lower Limb Part 1 Flashcards
What is the linea aspera?
Roughened ridge of bone on the posterior surface of the femoral shaft
What is the pectineal line?
Medial border of the linea aspera proximally
Where is the gluteal tuberosity?
Lateral border of linea aspera proximally
Where are the medial and lateral supracondylar lines?
Medial and lateral borders of linea aspera distally
Where is the trochlear groove?
Anterior surface of distal femur, where it articulates with patella
What are medial and lateral epicondyles?
Bony elevations above non-articular areas of condyles
Where is the patella located?
Anterior aspect of knee joint, within trochlear groove of femur
What is the superior aspect of the patella attached to?
Quadriceps tendon
What is the inferior aspect of the patellar attached to?
Patellar ligament
What is the tibial plateau?
Flat surface of condyles
What is the proximal tibiofibular joint made of?
Head of fibula articulating with proximal tibia
What is the intercondylar eminence?
Centre of intercondylar area between the tibial condyles
What is the function of the tibia?
Weight bearing
What is the function of the fibula?
Attachment for muscles
What are 3 main articulations of the fibula?
Proximal tibiofibular joint
Distal tibiofibular joint
Ankle joint
Where is the proximal tibiofibular joint?
Where the fibula articulates with the lateral condyle of tibia
Where is the distal tibiofibular joint?
Where fibula articulates with the fibular notch of tibia
Where is the ankle joint?
Where the fibular articulates with talus bone of foot
Where is the common peroneal or fibular nerve located on the fibula?
Winds around posterior and lateral surface of the neck of the fibula
What are the 3 surfaces of the fibular shaft?
Anterior lateral and posterior
What type of joint is the knee joint?
Hinge type synovial joint
What are the 2 articulations of the knee joint?
Tibiofemoral
Patellofemoral
Which joint is the weight bearing joint of the knee?
Tibiofemoral joint
What are the 4 factors contributing to the stability of the knee joint?
Tibial articular surface deepened by menisci
Joint capsule
Ligaments
Musculature
What are the 2 functions of the medial and lateral menisci?
Deepen articular surface of tibia to increase stability
Act as shock absorber by increasing surface area to further dissipate forces
What connects the 2 menisci?
Transverse ligament of the knee
What stabilizes the posterior horn of lateral meniscus by attaching to the medial femoral condyle?
Posterior meniscofemoral ligament
What are the 3 major types of ligaments in the knee joint?
Intracapsular
Extracapsular
Ligaments that strengthen the capsule
What are the 2 intracapsular ligaments?
Anterior cruciate ligament
Posterior cruciate ligament
What does the cruciate ligaments connect?
Femur and tibia
How are the anterior and posterior cruciate ligaments oriented?
PAMs APpLes
Posterior passes anterior inserts medially
Anterior passes posterior inserts laterally
What does the anterior cruciate ligament do?
Attached towards lateral side, so resists anterior translation and medial rotation of tibia
What does the PCL do?
Stabilizes weight bearing flexed knee and prevents femur from sliding off anterior edge of tibia, prevents posterior dislocation
Which ligament strengthens the joint capsule?
Oblique popliteal ligament posteriorly
What are the 2 extracapsular ligaments?
Collateral ligaments and patellar ligament
What is the function of the collateral ligaments?
Stabilize hinge motions of knee, prevents excessive medial or lateral angulation of tibia on femur
Where does medial collateral ligament attach to?
Medial epicondyle of femur and medial condyle of tibia
What is the function of medial collateral ligament?
Resist lateral angulation of tibia on femur
Where does the lateral collateral ligament attach to?
Lateral epicondyle of femur and depression on lateral surface of fibular head
What is the function of the lateral collateral ligament?
Resist medial angulation of tibia
What is a bursa?
A small sac lined by synovial membrane, contains a thin layer of synovial fluid
What is the function of a bursa?
Provides a cushion between bones and soft tissues allowing free movement
What are the 6 bursae of the knee joint?
Suprapatellar Prepatellar Superficial infrapatellar Deep infrapatellar Semimembranosus Subsartorial or pes anserinus
What are the 4 movements that the knee joint permits?
Extension
Flexion
Lateral rotation
Medial rotation
What are the 4 muscles that produces knee extension?
Quadriceps femoris - rectus femoris, vastus medialis, vastus lateralis, vastus intermedius
What are the 3 muscles that produces knee flexion?
Biceps femoris
Semimembranosus
Semitendinosus
What muscle produces lateral rotation?
Biceps femoris
What are the 5 muscles that produces knee medial rotation?
Semimembranosus Semitendinosus Gracilis Sartorius Popliteus
How does the knee lock?
Medial rotation of femoral condyles on the tibial plateau and cruciate ligaments tighten
How does the knee unlock?
Popliteus contracts, rotates femur laterally by 5 degrees on tibial plateau so flexion of knee can occur
Which nerve is the anterior thigh innervates by?
Femoral nerve
Which branches and which artery supplies the anterior thigh?
Lateral and medial femoral circumflex arteries
Profunda femoris
What are the 4 muscles on the anterior thigh?
Pectineus
Sartorius
Quadriceps femoris
Iliopsoas
What are the 2 muscles of the iliopsoas?
Papas major
Iliacus
What is the action of the iliopsoas?
Flex lower limb at hip joint
Assist in lateral rotation of femur at hip joint
What is psoas major innervated by?
Anterior rami of L1-3
What is the iliacus innervated by?
Femoral nerve
What are the 4 muscles of quadriceps femoris?
Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedius
What is the function of the quadriceps femoris?
Main extensor of knee
What is the action of vastus lateralis?
Extends knee joint and stabilize patella
What is the function of vastus intermedius?
Extends knee joint and stabilize patella
What is the function of vastus medialis?
Extends knee joint and stabilize patella
What is the action of vastus medialis obliquus?
Resist lateral displacement of patella
What is the function of rectus femoris?
Flex thigh at hip joint
Extends leg at knee joint
What is the action of sartorius?
Flexes, abduct and externally rotate thigh
Flexes and internally rotate tibia at knee joint
What is the function of pectineus?
Adduct and flex thigh at hip joint
What is the function of medial thigh muscles?
Hip adductors
What are the 5 medial muscles?
Gracilis Obturator externus Adductor brevis Adductor longus Adductor magnus
Which artery supplies the medial thigh?
Obturator artery
What are the 2 parts of the adductor magnus?
Adductor and hamstring
What is the actions of the adductor component of the adductor magnus?
Adduct thigh
Flex thigh
What are the actions of the hamstring component of the thigh?
Adduct thigh
Extend thigh
What is the adductor component of the thigh innervated by?
Obturator nerve
What is the hamstring component of the adductor magnus innervated by?
Tibial component of sciatic nerve
What is the action of adductor longus?
Adduct thigh
What is the adductor longus innervated by?
Obturator nerve
What is the action of adductor brevis?
Adduct thigh
What is the adductor brevis innervated by?
Obturator nerve
What is the action of the gracilis?
Adduct thigh at hip
Flex leg at knee
What is the action of obturator externus?
Adduct and lateral rotation of thigh
What are the 3 borders of the femoral triangle?
Inguinal ligament
Medial border of sartorius
Medial border of adductor longus
What are the 4 contents of the femoral triangle?
Femoral nerve
Femoral artery
Femoral vein
Femoral canal
What is the femoral canal?
Structure containing deep lymph nodes and vessels
What is the femoral sheath?
Fascial compartment containing artery, vein and canal
How to remember contents of femoral triangle form lateral to medial?
NAVEL Nerve Artery Vein Empty space Lymph
How do you mark the femoral artery on the surface?
MIPA
Mid inguinal point is the artery / midway between anterior superior iliac spine and symphysis pubis
What is the 4 borders of the femoral canal?
Lacunar ligament
Femoral vein
Inguinal ligament
Pectineal ligament
What is the femoral ring?
Opening to femoral canal
What is the femoral septum?
Connective tissue layer closing the ring pierced by lymphatic vessels exiting the femoral canal
What is the adductor canal?
Passageway for structures passing between anterior thigh and posterior leg
What is the adductor canal bordered by?
Sartorius
Vastus medialis
Adductor longus
Adductor magnus
What are the first cutaneous branches to arise from femoral nerve?
Anterior cutaneous branches
What is the terminal cutaneous branch of the femoral nerve?
Saphenous nerve
What does the anterior cutaneous branch of femoral nerve supply?
Anteromedial thigh
What does the saphenous nerve supply?
Medial side of leg and foot
What is the main artery of the lower limb?
Femoral artery
What is the artery in the femoral triangle?
Profunda femoris artery
What are the 3 branches of the profunda femoris artery?
Lateral femoral circumflex
Medial femoral circumflex
Perforating branches
What is the artery after the common femoral artery gives off profunda femoris branch?
Superficial femoral artery
What does the superficial femoral artery become after going through adductor canal?
Popliteal artery
Which artery supplies the medial thigh?
Obturator
What artery is the gluteal region supplied by?
Superior and inferior gluteal arteries
What are the 5 deep veins involved in the thigh and gluteal region?
Femoral vein Profunda femoris vein External iliac vein Gluteal vein Obturator vein
What are the 2 major superficial veins?
Great saphenous
Small saphenous
What are the 2 types of superficial lymphatic vessels?
Medial vessels
Lateral vessels
What does the medial vessels drain into?
Inferior group of superficial inguinal lymph nodes in femoral triangle
What does the lateral vessels drain into?
Popliteal lymph nodes in popliteal fossa then deep inguinal nodes or join medial group
What are the 3 main groups of deep lymphatic vessels?
Anterior tibial
Posterior tibial
Peroneal
What do deep lymphatic vessels drain into?
Popliteal lymph nodes
How do femoral shaft fractures occur?
Usually high velocity trauma
What is a symptom of femoral shaft fracture?
Swollen and tense thigh
What is a risk of femoral shaft fracture?
Blood lose in closed femoral shaft fractures can be very high and may develop hyovolaemic shock
How do you treat femoral shaft fracture?
Surgical fixation
What are tibial plateau fractures?
Fracture of articulating surface of the tibia within knee joint
How to diagnose patellar fractures using physical examination?
Palpable defect in patella
Cannot do straight leg raise
How to treat displaced patellar fractures?
Reduction and surgical fixation
How to treat undisplaced patellar fractures?
Protect for it to heal
What is patella dislocation?
Patella completely displaced out of its normal alignment
How to treat patella dislocation?
Extend knee then manually reducing patella
Immobilize while healing takes place then physiotherapy
How do meniscal injuries occur?
Sudden twisting motion of weight bearing knee in high degree of flexion
How to treat acute traumatic meniscal tears?
Surgically through meniscectomy or meniscal repair
What is the unhappy triad?
Injury to the anterior cruciate ligament, medial collateral ligament and medial meniscus
How is the unhappy triad caused?
Strong force applied to lateral aspect of knee
How to dislocate the knee?
3/4 ligaments rupture
What is a knee effusion?
Accumulation of fluid inside knee joint
What are the 2 types of knee effusions?
Acute and delayed
What are 2 types of acute knee effusions?
Haemarthrosis - blood in joint
Lipo-haemarthrosis - blood and fat in the joint
What is knee bursitis?
Inflammation of bursa
What are the 4 most commonly inflamed bursa of the knee?
Prepatellar bursa
Infrapatellar bursa
Pes anserinus bursa
Suprapatellar bursa
What is pre-patellar bursa?
Superficial bursa with thin synovial lining located between skin and patella
What is Housemaid’s Knee?
Pre-patellar bursa becomes inflamed
What is infrapatellar bursa?
One bursa superficially between patella tendon and skin
Another bursa between patella tendon and tibia bone
What is cleryman’s knee?
Infrapatellar bursitis
What is popliteal cyst or Baker’s cyst?
Swelling in popliteal fossa or semimembranosus bursitis
What is Osgood-Schlatter’s Disease?
Inflammation of apophysis of patellar ligament into tibial tuberosity
What are the 3 symptoms of osteoarthritis of the knee?
Knee pain
Stiffness
Swelling
What is crepitus?
Grating sound and cracking sensation on movement of joint
What is septic arthritis?
Invasion of joint space by micro organisms usually bacteria
What is reactive arthritis?
Sterile inflammatory process that result from extra articular infection
What are the 3 symptoms of septic arthritis?
Fever
Pain
Reduced range of motion
What to do if septic arthritis is suspected?
Aspiration of joint immediately
Aspirate sent for urgent microscopy, culture and sensitivities