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ACE Unit 1 > TBL 7 - Anterior & Medial Thigh and Anterior & Lateral Leg > Flashcards

TBL 7 - Anterior & Medial Thigh and Anterior & Lateral Leg Flashcards

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1
Q

What mesoderm layer forms chondroblasts and osteoblasts of the hip bones and bones of the lower limb?

A

Parietal layer of lateral plate mesoderm

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2
Q

What is the difference in morphogenesis between the upper and lower limbs?

A

The upper limb rotates 90 degrees laterally, the lower limb rotates 90 degrees medially.

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3
Q

Bones that make up the hip joint

A

Acetabulum composed of the ilium, pubis, and ischium along with the head of femur

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4
Q

What three ligaments hold the hip joint together and what do they do? Which one is strongest and which one is weakest? How do they hold the joint together to enable extension and flexion

A

Iliofemoral - strongest - prevents hyperextension
Ischiofemoral - weakest - most hip dislocations are posterior
Pubofemoral - prevents overabduction
They spiral around. They tighten during extension (less mobility) and unwind during flexion (more mobility)

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5
Q

What are avulsion fractures of the hip bone?

A

Small piece of bone with some ligament or tendon is torn away. Occurs at apophyses (no secondary ossification centers) and occurs where muscles are attached (ASIS, AIIS, ischial tuberosities, ischiopubic rami)

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6
Q

How do spiral fractures and comminuted fractures of the femur differ?

A

Spiral is where there is foreshortening as the fragments override
Comminuted is where the bone is broken into several pieces. Way worse

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7
Q

Bones that make up the knee joint

A

articulation of the femoral and tibial condyles

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8
Q

What causes Osgood-Schlatter disease and what are its symptoms?

A

It is where the epiphysial plate at the tibial tuberosity is disrupted resulting in inflammation at the tuberosity. Common in young athletes who get chronic recurring pain.

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9
Q

How does angle of inclination change with age and what is the effect?

A

The angle becomes more acute which increases the strain on the neck of the femur resulting in more fractures

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10
Q

Most stable position of knee is

A

Erect, extended position. Contact of articular surfaces is maximized and ligaments are taut

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11
Q

Lateral collateral ligament attachments and what separates it from the lateral meniscus

A

lateral epicondyle of femur to fibular head. The popliteus muscle

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12
Q

Medial collateral ligament attachments

A

medial epicondyle of femur to superomedial surface of tibia. Also connected to medial meniscus. Stronger than LCL

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13
Q

posterior cruciate ligament

A

posterior intercondylar area of tibia to the anterior medial condyle of the femur. Prevents anterior displacement and hyper flexion of leg and is stronger than the ACL

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14
Q

anterior cruciate ligament

A

anterior intercondylar area of tibia to the posterior lateral condyle of the femur. Prevents posterior displacement and hyperextension of leg.

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15
Q

How can twisting of the flexed knee create the “unhappy triad” injury?

A

MCL is torn and with it goes the medial meniscus since they are connected. The ACL is taut during flexion and is vulnerable to being torn once the medial meniscus is torn

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16
Q

What are the anterior and posterior drawer signs?

A

Anterior drawer sign is where the tibia slides anterior of the femur when the ACL is ruptured.
Posterior drawer sign is where the tibia slides posterior to femur when PCL is ruptured

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17
Q

What is the articular cartilage and what function does the meniscus perform?

A

Articular cartilage is hyaline cartilage with no perichondrium. The meniscus projects into the synovial cavity and provides shock absorption and load distribution for the knee

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18
Q

What characterizes all joints of the upper and lower limbs

A

Synovial cavities, synovial membranes (cuboidal epithelium that produces synovial fluid for lubrication), and articular cartilage

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19
Q

What is the pathogenesis of osteoarthritis, the most common form of arthritis?

A

ECM degradation and chondrocyte metabolism. Decreases glycosaminoglycan content and increased water content. Disease of the articular cartilage

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20
Q

What forms the great saphenous vein and what forms the small saphenous vein and describe their course up the leg.

A

Great - dorsal vein of big toe and dorsal venous arch. anterior to medial malleolus, posterior to medial condyle of femur and into femoral vein
Small - dorsal vein of little toe and dorsal venous arch. posterior to lateral malleolus, lateral border of calcanea tendon and into the popliteal vein

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21
Q

where do the lymphatic vessels drain in the leg

A

The one following the great saphenous vein drains into the inguinal lymph nodes and the small drains into the popliteal lymph nodes

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22
Q

Which nerves innervate which part of the cutaneous thigh

A

Femoral = anterior
Obturator = medial
Lateral cutaneous nerve of thigh = lateral
Posterior cutaneous nerve of thigh = posterior

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23
Q

Which nerves innervate which part of leg

A

Saphenous = anteromedial leg and medial of ankle
common fibular = inferolateral leg
Superficial fibular = lateral side of ankle

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24
Q

Why does the great saphenous vein or its tributaries often become varicose? Why can a deep vein thrombus in the lower limb be fatal?

A

The valves in the veins become dilated or rotated and therefore ineffective. The clot in the lower limb can travel to the small capillaries in the lungs and cause a pulmonary thromboembolism

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25
Q

When is a saphenous cutdown required and where can sensory loss occur after the procedure?

A

Used to insert a cannula for prolonged administration of blood, plasma expanders, electrolytes, or drugs. Sensory loss can occur on medial border of foot

26
Q

Iliopsoas muscle

A

formed by union of posts major and iliacus. Distal attachment is the lesser trochanter of the femur

27
Q

What muscles flex the thigh

A

Iliopsoas (chief) and sartorius and gracilis help

28
Q

Sartorius

A

ASIS to superomedial tibia

29
Q

What muscles flex the knee

A

Sartorius helps

30
Q

Four quadricep muscles and its tendon

A

Rectus femoris - ASIS - flex thigh and extend knee
rest extend leg
vastus medialis (intertrochanteric line and medial lip of linea aspera)
vastus intermedius (anterior and lateral surface of shaft of femur)
vastus lateralis (greater trochanter and lateral lip of linea aspera
Tendon continues as patellar ligament attaching to the tibial tuberosity

31
Q

Function of patella

A

Bony surface that withstands compression on quadriceps tendon and the friction when knee is flexed and extended. Also provides leverage for quadriceps by moving tendon more anteriorly and farther from joint axis

32
Q

What is the kicking a soccer ball muscle?

A

Rectus femoris

33
Q

What does the supra patellar bursa do?

A

It is continuous with the synovial cavity of the knee joint and is between the femur and quadriceps tendon to cushion it

34
Q

How is suprapatellar bursitis related to popliteal (Baker) cysts?

A

suprapatellar bursitis is caused by infection and could result in leakage of synovial fluid which is what the popliteal cysts consist of

35
Q

Adductor longus and adductor portion of adductor magnus attachments and what else adducts

A

Longus - body of pubis
Magnus - ischiopubic ramus
Distal - linea aspera
Gracilis

36
Q

What attaches to the ischial tuberosity?

A

hamstring portion of adductor magnus

37
Q

Gracilis

A

Ischiopublic ramus to superomedial tibia

38
Q

Where is the gracilis muscle used for transplantation and why is lower limb function not noticeably compromised?

A

The muscle with nerves and blood vessels can replace hand muscles or external anal sphincter. It is a synergist so it is not essential to lower limb function

39
Q

Hip pointer

A

contusion of iliac crest

40
Q

Charley horses

A

cramping on thigh muscle due to ischemia or contusion that forms a hematoma. Usually tears of the rectus femoris. Direct trauma is usually the cause

41
Q

Groin pulls

A

Tearing of proximal attachments of anteromedial thigh muscles

42
Q

Boundaries of femoral triangle

A

Superior = inguinal ligament (ASIS to body of pubis)
Lateral - Sartorius
Medial - Adductor longus

43
Q

Origin and course of femoral nerve

A

Spinal cord L2-L4, lateral aspect of femoral triangle, innervates anterior thigh muscles, saphenous nerve is terminal cutaneous branch

44
Q

What lesions might cause diminution or loss of the patellar tendon reflex?

A

Lesions that disrupts innervation of quadriceps, like those affecting the femoral nerve

45
Q

Origin and course of obturator nerve

A

Spinal cord L2-L4, through the obturator foramen to innervate medial thigh muscles

46
Q

Role and what is inside the femoral sheath

A

The femoral vein, artery, and lymphatic vessels that enter the abdominopelvic cavity and the sheath allows them to glide under the inguinal ligament while the hip joint moves

47
Q

Course of the femoral artery

A

External iliac artery becomes this and the femoral artery supplies the anterior and anteromedial thigh. Early on, the deep artery of the thigh branches from it

48
Q

Course of the obturator artery

A

Along obturator nerve into the medial thigh

49
Q

What branches off the deep artery of the thigh

A

Medial circumflex femoral artery supplies the head and neck of femur

50
Q

How does palpation of the femoral arterial pulse differ from palpation of an enlarged femoral hernia?

A

Palpation of the femoral arterial pulse requires firm pressing between the ASIS and pubic symphysis. Palpation of a hernia is easier and the area is tender

51
Q

Why can aseptic vascular necrosis of the displaced femoral head occur after femoral neck fractures?

A

The medial circumflex femoral artery could be damaged and the blood supply from the artery into the ligament of the femoral head is not enough to supply the bone

52
Q

What are compartment syndromes and how are prolonged symptoms relieved?

A

There are two compartments in the leg and trauma or inflammation or something that increases the size of the muscles or builds pressure in a compartment can compress structures or impede circulation in that compartment. A fasciotomy would relieve the pressure

53
Q

How are tibialis anterior muscle strains and deep fibular nerve entrapment distinguished by their symptoms?

A

tibialis anterior muscle strains - pain in distal two thirds of tibia and muscles are swollen/tender
Deep fibular nerve entrapment - pain in dorsum of foot that radiates between the first two toes

54
Q

Tibialis anterior attachments/function

A

tibia to plantar surface of medial foot - dorsiflexes ankle and inverts foot

55
Q

Extensor digitorum longus and extensor hallucis longus

A

tibia to dorsal of the toes - extends lateral four digits and dorsiflexes ankle and the hallucis muscle extends the big toe and also dorsiflexes ankle

56
Q

What does the deep fibular nerve innervate?

A

The tibialis anterior, extensor digitorum longus and extensor hallucis longus

57
Q

Fibularis longus and fibularis brevis

A

Longus - fibula to the plantar surface
Brevis - fibula to the lateral side of foot
Longus is posterior around the lateral malleolus

58
Q

What does the superficial fibular nerve innervate?

A

Fibularis longus and fibularis brevis

59
Q

How does the femoral artery divide?

A

It becomes the political artery in the proximal leg and then bifurcates into the anterior tibial and posterior tibial arteries

60
Q

What does the anterior tibial artery become

A

The dorsal pedis artery on the dorsum of the foot to the first interosseous space leading to the digital arteries to the big toe

61
Q

Why is the common fibular (peroneal) nerve frequently injured and what are the symptoms after its injury?

A

It is superficial around the fibular neck. Causes footdrop because all the dorsiflexors are knocked out (they are all controlled by the deep fibular nerve). Some loss of sensation on the anterolateral leg and dorsum of foot

62
Q

Where is the dorsal pedis pulse palpated and what is the most common cause of its diminution or absence?

A

Palpated just lateral to EHL tendon. Diminution of pulse is sign of arterial disease

ACE Unit 1 (8 decks)

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