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MSCT-LM > W4 lower leg > Flashcards

W4 lower leg Flashcards

1
Q

• Regions of the lower limb

A 
o	Gluteal region
o	Anterior thigh
o	Posterior thigh
o	Leg
o	Foot
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2
Q

• Gluteal region

A

o Posterolateral and between iliac crest and gluteal fold of lower buttocks
o Bones are two pelvic bones each formed by ilium, ischium, and pubis
o These bones fuse during childhood

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3
Q

• Anterior thigh

A

o Between inguinal ligament and knee joint

o Bone of the thigh is femur

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4
Q

• Posterior thigh

A

o Between gluteal fold and knee

o Bone of the thigh is femur

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5
Q

• Leg

A

o Between knee and ankle joint

o Bones are tibia and fibula

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6
Q

• Foot

A

o Distal to ankle joint

o Bones are tarsals, metatarsals and phalanges

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7
Q

• Hip movements

A 
o	Flexion
o	Extension
o	Abduction 
o	Adduction
o	Medial and lateral rotation
o	Circumduction (combination of other four motions)
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8
Q

• Abduction of hip

A

o Can be abduction of femur on fixed pelvis
o Abduction of pelvis on fixed femur
o In both, angle between pelvis and femur decreases
o When taking a step, the high of the leg that is grounded abducts

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9
Q

• Knee joint

A

o Hinge joint
o Flexion
o Extension

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10
Q

• Ankle joint

A 
o	Hinge joint
o	Dorsiflexion (toes toward shin)
o	Plantarflexion (toes away from shin)
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11
Q

• Hip joint

A

o Synovial joint
o Head of femur and acetabulum on lateral pelvic bone
o Multi-axial
o Stability and weight bearing

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12
Q

• Acetabular labrum

A

o Fibrocartilaginous collar on the rim of acetabulum
o Prevents head of femur from moving inferiorly and deepening acetabulum
o Common site of injury: pain on weightbearing, flexion, internal rotation

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13
Q

• Ligament of the head of the femur

A

o Connective tissue that attaches the head of the femur to the acetabular fossa
o Obturator artery runs with this ligament and supplies femoral head
o Synovial membrane attaches to the margins of the articular surfaces of femur and acetabulum

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14
Q

• Fibrous capsule or membrane

A

o Surrounds synovial head
o Holds femoral neck in acetabulum
o Three ligaments
 Iliofemoral – anterior to the hip joint
 Pubofemoral ligament – anteroinferior to hip joint
 Ischiofemoral ligament – posteroinferiorly to the hip joint

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15
Q

• Knee joint

A

o Primarily hinge joint
o Biggest synovial joint in the body
 Articulation between femur and tibia is weight bearing
 Articulation between patella and femur pulls quadriceps femoris muscle over the knee to tibia without tendon wear

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16
Q

• Lateral and medial meniscus

A

o Fibrocartilaginous
o Cushion knee and accommodate changes in shape of articular surfaces during movement
o Femoral condyles are flat during flexion, round during extension

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17
Q

• Synovial membrane of the knee

A

o Attaches to the margins of the articular surfaces and menisci
o forms two pouches (suprapatellar bursa and subpopliteal recess

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18
Q

• Fibrous capsule or membrane

A

o Encloses articular cavity

o Partly formed and reinforced by muscle tendons

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19
Q

• Patellar ligament

A

o Continuation of quadriceps femoris tendon

o Connects the patella to the tibia

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20
Q

• Collateral ligaments

A

o Medial or tibial (MCL or TCL) and lateral or fibular (LCL or FCL)
o Stabilize the hinge like motion of knee
o Medial meniscus attaches to MCL

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21
Q

• ACL

A

o Anterior cruciate ligament
o Crosses with PCL in intercondylar region of knee
o Connect tibia and femur and restrict movement
o Keeps tibia from moving anteriorly on the fixed femur
o Extends from lateral femoral condyle to the anterior tibia

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22
Q

• PCL

A

o Posterior cruciate ligament
o Crosses with ACL in intercondylar region of knee
o Connect tibia and femur and restrict movement
o Keeps tibia from moving posteriorly on fixed femur
o Extends from medial femoral condyle to posterior tibia

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23
Q

• Unhappy triad

A

o ACL, MCL, and medial meniscus tear
o Caused by lateral force applied to planted leg
o Audible snap and immediate pain and swelling

24
Q

• Movements of the gluteal region

A

o Abduct, extend, and laterally rotate the femur relative to pelvic bone

25
Q

• Deep muscles of gluteal

A 
o	Lateral rotators of the femur
o	Piriformis
o	Obturator internus
o	The gemelli
o	Quadratus femoris
26
Q

• Superficial muscles of the gluteal

A 
o	Abduct (Gluteus mimimus and maximus)
o	Extend hip (gluteus maximus)
27
Q

• Tensor fasciae latae

A

o stabilizes knee in extension by acting on iliotibial tract

o IL tract is a band of deep fascia that passes down lateral side of thigh to attach to proximal end of tibia

28
Q

• Iliotibial tract

A

o Band of deep fascia that passes down lateral side of thigh to attach to proximal end of tibia

29
Q

• Nerves of gluteal

A

o Enter from pelvis through greater sciatic foramen
o Most are in between superficial and deep muscles
o Superior gluteal nerve passes superior to piriformis muscle
o Others pass inferior to piriformis muscle

30
Q

• Superior gluteal nerve

A

o L4, L5, S1

o Innervates gluteus miminus and medius muscles and tensor fascia latae

31
Q

• Nerve to quadratus femoris

A

o L5, S1

o Supplies gamellus inferior

32
Q

• Nerve to obturator internus

A

o L5, S1
o Supplies gemellus superior
o Then passes through lesser sciatic foramen to innervate obturator internus

33
Q

• Posterior cutaneous nerve of the thigh

A

o Innervates the skin of the gluteal region the posterior thigh and posterior leg

34
Q

• Inferior gluteal nerve

A

o L5,S1,S2

o Supplies gluteus maximus muscle

35
Q

• Piriformis muscle innervation

A

o Innervated by branches of S1,S2

36
Q

• Pudendal nerve

A

o S2-S4

37
Q

• Trendelenburg sign/gait

A

o Superior gluteal nerve injury (innervates hip abductors, gluteus minimus and medius
o Sign: when patient stands on affected limb, pelvis drops over swing limb and abduction of pelvis on fixed femur does not occur
o Gait: when pelvis tilts over the swing limb patient compensates by lurching trunk to affected side to maintain level of pelvis during gait
o Contraction of gluteus minimus and medius on stance side prevents excessive pelvic tilt during swing phase on opposite side

38
Q

• Gluteal blood supply

A

o Superior and inferior gluteal arteries

o Originate in iliac artery (a terminal branch of the aorta)

39
Q

• Anterior compartment of the thigh

A

o Femoral nerve
o Branches of femoral artery
o Extension of leg
o Quadriceps femoris
 Rectus femoris flexes the thig at hip and extends leg
 Vastus lateralis, vastus medialis, and vastus intermedius extend leg
o Sartorius muscle flexes thigh and flexes leg
o Psoas major and iliacus pass into upper part of anterior compartment from posterior abdominal wall and flex thigh

40
Q

• Medial compartment

A

o Obturator nerve
o Branches of the deep femoral artery and obturator artery
o Adduction of the thigh (and medially rotate)
o Gracilis
o Pectineus
o Adductor longus and brevis
o Adductor magnus
o Obturator externus lateral rotates thigh

41
Q

• Posterior compartment

A

o Tibial division of sciatic nerve (common fibular division of sciatic nerve to short head of biceps femoris)
o Perforating branches of deep femoral artery
o Flexion of leg, extension of thigh
o Can rotate hip and knee joint
o Biceps femoris, semitendinosus, and semimembranosus (hamstrings)
o All but biceps femoris cross both hip and knee joints

42
Q

• Pes anserinus

A

o Goose’s foot

o Common insertion of tendons of sartorius, gracilis, and semitendious muscles on proximal tibia

43
Q

• Femoral artery

A

o Continuation of external iliac artery
o begins as external iliac artery passes under inguinal ligament to enter femoral triangle on anterior aspect of upper thigh
o middle branch is deep artery of the thigh (profundal femoris)

44
Q

• deep artery of thigh

A

o major blood supply to thigh
o branches into
 medial and lateral circumflex femoral arteries – medial compartment
 perforating branches – posterior compartment

45
Q

• obturator artery

A

o branch of internal iliac artery
o branches anastomose with inferior gluteal and medial circumflex arteries
 anterior or superficial branch
 a posterior or deep branch – near head of femur

46
Q

• valgus

A

o bowing of a shaft of bone

o distal part is more lateral

47
Q

• valrus

A

o bowing of shaft of bone

 distal part is more medial

48
Q

• Lachman

A 
o	Test for ACL
o	Patient is supine with knee flexed at 30 degrees
o	Grasp and stabilize thigh
o	Move proximal leg anteriorly
o	Positive is excessive forward motion
49
Q

• Anterior drawer

A

o Test for ACL
o Patient supine with knee flexed at 90 degrees
o Sit on dorsum of foot
o Place hands behind knee and move proximal leg anteriorly
o Positive test is excessive forward motion of tibia
o Less sensitive than Lachman’s test

50
Q

• Posterior drawer

A

o Test for PCL
o Patient supine with knee flexed at 90 degrees
o Palms of hands push proximal leg posteriorly

51
Q

• Valgus stress

A

o MCL test
o Patient supine with knee extended or flexed 30 degrees
o Stabilize lateral aspect of knee and push ankle laterally
o Estimate medial joint space
o Positive test is significant gap in medial joint space

52
Q

• Varus stress

A

o LCL
o Patient supine with knee extended or flexed 30 degrees
o Stabilize medial aspect of knee
o Push ankle medially
o Estimate lateral joint space
o Positive test is significant gap in lateral joint space

53
Q

• McMurray

A

o Examiner passively flexes the knee with rotation of tibia or foot
o Or have patient do a two-legged squat
o Pain or popping on external rotation is medial meniscus
o Pain or popping during internal rotation is lateral meniscus
o Joint line tenderness

54
Q

• Patellar apprehension test

A

o Apply lateral directed force toward medial aspect of patella
o Positive is apprehension from patient that it will dislocate

55
Q

• Patellofemoral grind

A

o Apply downward and inferior pressure on patella while patient contracts quadriceps on extended knee.
o Pain with movement or unable to complete test shows patellofemoral pathology

MSCT-LM (14 decks)

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