Week 3

Question 1

Trendelenburg test

• nerve affected
• positive; muscles affected
• other causes

Answer 1

• lesion to superior gluteal nerve
• when patient is asked to stand on one leg, the pelvis on the unsupported side descends, indicating gluteus medius and minimus on the supported side are weak or non-functional.
• Other causes of this sign include fracture of the greater trochanter and dislocation of the hip joint.

Question 2

Intragluteal injections

• why?
• where?

Answer 2

• common site for IM injection because thick and large muscles which allows substantial volume for absorption
• injection should be given on lateral side in summit of illiac crest to avoid sciatic and superior gluteal nerve

Question 3

Trochanteric bursitis

• how is it caused
• characterized by?

Answer 3

• caused by movements that involve the gluteus maximus moving the superior tendinous fibers repeatedly back and forth over the bursea of the greater trochanter. (slimbing stairs, running on steep treadmill)
• characterized by point tenderness over the greater trochanter with radiation down IT band

Question 4

Piriformis syndrome

-how is is caused?

Answer 4

• when sciatic nerve is compressed by piriformis causing a pain to the buttocks
• caused by excessive use of gluteal muscles causing hypertrophy or spasm of piriformis

Question 5

Organization of thigh

• number of compartments and name
• how separated
• main nerve in each

Answer 5

• 3 compartments
• Anterior (femoral), medial (obturator), posterior (sciatic)
• Separated by intermuscular fascia

Question 6

Anterior compartment function

Answer 6

flexion of hip, extension of knee

Question 7

Medial compartment function

Answer 7

adduction of the thigh

Question 8

What three muscles connect at medial aspect of distal femur and what is the intersection called?

Answer 8

• Pes anserinus

- Gracilus, semitendinous, sartorius

Question 9

Femoral triangle

• boundaries
• contents

Answer 9

• inguinal ligament, sartorius muscle, and adductor longus

- contains femoral nerve, artery, vein, and lymph (NAVEL)

Question 10

Femoral hernia

Answer 10

-part of bowel pushes into femoral canal underneath inguinal ligament

Question 11

Adductor canal

• boundaries
• contents

Answer 11

-Vastus medialis, sartorius, and adductor longus
-Femoral artery and vein
Saphenous nerve

Question 12

Femoral artery

Answer 12

• primary artery of lower limb
• palpable in the femoral triangle
• origin is from abdominal aorta

Question 13

Femoral palpation

Answer 13

placing tip of same sided hand on ASIS and tip of thumb on pubic tubercle, pulse can be palpated with midpalm inferior to inguinal ligament

Question 14

Frog leg x-ray

• other name
• instructions to patient

Answer 14

• also called lateral view

- externally rotate hip and flex knee to 30 degrees

Question 15

Comminuted fracture

Answer 15

-when bone is broken into several pieces

Question 16

Advantage of MRI for fractures?

Answer 16

-very good at detecting occult fractures

Question 17

How do osteoclasts reabsorb bone?

Answer 17

• forms sealing zone and ruffle border
• pumps protons to acidify and promote dissolution of the adjacent hydroxyapatite, and releases matrix metalloproteinases for the localized digestion of matrix proteins.

Question 18

How do Osteoblasts make bone?

Answer 18

• osteoid is laid down on pre-existing bone matrix
• then osteoblasts secrete osteocalcinin to bind and raise concentration of Ca in area. Secrete alkaline phosphatase to hydrolyze PO4 and increase their concentration locally.
• High Ca and PO4 begin to bind causing calcified nanocrystals. Crystals grow and form masses of hyrdoxy apatite which surround collagen and other macromolecules making a solid bony matrix

Question 19

Woven bone

• hito
• location
• other names

Answer 19

• irregular and random arrangment of cells and collagen, lightly calcified
• developing and growing bones, hard callus or bone fracture
• immature bone

Question 20

Lamellar bone

Answer 20

• parallel bundles of collagen in thin layers with regularly spaced cells between, heavily calcified
• inner region of bone
• spongy bone, trabecular bone

Question 21

Difference between spongy and compact bone?

Answer 21

• spongy bone has more space between trabeculae

- compact bone has trabeculae tight compact

Question 22

Difference in construction between epiphysis and diaphysis of long bone

Answer 22

• epiphysis: majority trabecular bone with thin layer of compact bone on outside
• diaphysis: majority of compact bone with a thin layer of spongy bone in middle for bone marrow to reside

Question 23

Composition of

• short bones
• flat bones

Answer 23

• core of spongy surrounded by compact

- sandwich, two layers of compact, one on each side with spongy in the middle.

Question 24

Which muscles make up hamstring?

Answer 24

-semitendinous, semimembranous, long head of bicep femoris

Question 25

Movement of hamstring

Answer 25

extension of hip

Question 26

How is hamstring length assessed?

Answer 26

• 90-90 test: have patient flex 90 degrees at hip and knee, the ask them to extend at hip
• continue to ask them to extend at hip throughout visit to check whether extension is increasing which will tell you whether hamstring length has increased or not

Question 27

Lymph drainage of glutes

Answer 27

• Lymph from the deep tissues of the gluteal region enters the pelvis along the gluteal veins, draining to the superior and inferior gluteal lymph nodes;
• gluteal lymph nodes then go to the iliac and lateral lumbar (caval/aortic) lymph nodes.