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MSK > Week 3 > Flashcards

Week 3 Flashcards

1
Q

The acetabular labrum encircles the acetabulum, it deepens it providing a more secure fit for the femoral head. By what percentage does it increase the articulate contact area of the femoral head with the socket?

A

10% - explanation - so that more than 50% of the femoral head is in contact with the socket at any one time

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2
Q

What is the small depression in the femoral head called, and what attaches here?

A

Fovea capitis - liganentum teres (ligament of the femoral head) attaches here

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3
Q

What is the only intracapsular ligament in the hip joint?

A

Ligamentum teres

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4
Q

Name the three extracapsular ligaments in the hip joint

A

Iliofemoral Ischiofemoral Pubofemoral

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5
Q

Which of the hip joints ligaments is the strongest?

A

Iliofemoral

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6
Q

What is the function of the iliofemoral ligament?

A

To prevent hyperextension of the hip

Note - looks like an inverted Y

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7
Q

Which ligament acts to prevent hyper extension of the hip

A

Mainly the iliofemoral joint, the pubofemoral joint also contributes to this somewhat

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8
Q

What are the functions of a) the ischiofemoral ligament b) the pubofemoral ligament

A

a) prevents excessive medial rotation b) prevent excessive abduction and hyperextension

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9
Q

What structure bridges across the acetabular notch (inferior part of acetabulum) and forms a tunnel through which blood vessels enter the hip joint?

A

The transverse acetabular ligament

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10
Q

The ligaments of the hip joint are weaker posteriorly, how does the body compensate for this in terms of stability

A

The strong hamstrings are located posteriorly and thus pull the head of the head into the acetabulum

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11
Q

Give three factors which increase the stability of the hip joint

A

The cup shaped acetabulum/ The acetabular labrum/ The capsule/ The intracapsular ligament (ligamentum teres)/ The extracapsular ligaments /The muscles surrounding the hip joint

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12
Q

What nerve innervates the hip joint a) anteriorly b) posteriorly c) inferiorly

A

a) femoral nerve b) sciatic nerve c) obturator nerve

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13
Q

What arteries form the extracapsular ring of the femoral neck?

A

The medial femoral circumflex artery and lateral femoral circumflex artery which are both branches of the profunda (deep) femoris artery

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14
Q

What arteries are the major blood supply to the head of the femur in the adult?

A

Retinacular arteries - branches of the femoris profunda artery

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15
Q

What risk does an intracapsular fracture of the femoral neck carry in an adult and why?

A

Avascular necrosis of the bone because of the severing of the retinacular arteries Explanation - this wouldn’t be the case in a child because the artery of the ligamentum teres is still the major blood supply to the femoral head

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16
Q

State the nerve roots of the lumbar plexus and the corresponding nerves

A

Ilioinguinal - L1 Genitofemoral - L1, L2 Lateral femoral cutaneous - L2, L3 Obturator - L2, L3, L4 Femoral - L2, L3, L4

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17
Q

State the nerve roots and corresponding nerves of the sacral plexus

A

Superior gluteal - L4, L5, S1 Inferior gluteal - L5, S1, S2 Sciatic - L4, L5, S1, S2, S3 Posterior femoral cutaneous - S1, S2, S3

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18
Q

Name two structures that pass through the greater sciatic foramen

A

Superior gluteal neurovascular bundle (vein artery and nerve)/ Inferior gluteal neurovascular bundle/ Sciatic nerve/ Posterior femoral cutaneous nerve/ Nerve to quadrator femoris/ Nerve to obturator internus

(all the elements of the sacral nerve plexus SISP)

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19
Q

Where do the following structures exist a) sacrospinous ligament b) sacrotuberous ligament

A

a) sacrum to ischial spine b) sacrum to ischial tuberosity

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20
Q

What two structures run through the lesser sciatic foramen?

A

Tendon and nerve to the obturator internus

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21
Q

What bony landmarks demarkate where the sciatic nerve leaves the hip and enters the thigh?

A

Leaves midway between the posterior superior iliac spine and the ischial thberosity via the greater sciatic foramen Then after going over it’s muscles it passes midway between the greater trochanter of the femur and the ischial tuberosity

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22
Q

There are two sites that are used for intramuscular injections in the hip to avoid injury to the sciatic nerve. These two sites are the dorsogluteal site and the ventrogluteal site. Which is used in adults and children over 7 and why

A

Ventrogluteal because it is further from neurovascular structures. It isn’t used in younger patients because it requires better patient compliance

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23
Q

What muscle are we trying to inject into At the ventrogluteal injection site?

A

Gluteus medius

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24
Q

The fascia lata encloses the thigh muscles and is the site of attachment for the intermuscular septae that separates the thigh into its three compartments - the anterior, medial and posterior compartments. The saphenous vein penetrates it. It is thickest laterally where it forms what?

A

The IT band

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25
Q

What is the iliotibial tract/band?

A

A thickening if the fascia lata on the lateral aspect of the thigh

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26
Q

Where does the IT band run from?

A

The Iliac crest to the lateral tibial condyle

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27
Q

State the origin, insertion and action of the tensor fascia latae

A

Origin - anterior superior iliac spine Insertion - IT band at upper 1/3 of thigh Action - stabilises the hip in extension. Also helps stabilises the Knee, and assist in abduction Also has a minor role in compressing the deep veins to improve venous return from the lower limbs

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28
Q

The gluteal muscles are divided into superficial and deep muscles. The superficial muscles act to abduct and extend the thigh The deep muscles act to laterally rotate and abduct the thigh. List the muscles that comprise each group

A

Superficial - gluteus maximus, medius, minimus and tensor fascia latae Deep - piriformis, Gemellus superior, obturator internus, gemellus inferior, obturator externus (aDDucts and laterally rotates) and quadratus femoris

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29
Q

What is the blood supply to the gluteal muscles?

A

Superior and inferior gluteal arteries

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30
Q

What is the nerve innervation of a) the gluteus maximus b) the gluteus minimus c) gluteus medius

A

a) inferior gluteal nerve b and c) superior gluteal nerve

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31
Q

Origin and insertion of the piriformis muscle

A

Origin - anterior sacrum Insertion - medial greater trochanter Don’t need to know nerve

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32
Q

What important structure emerges just inferior to the piriformis

A

Sciatic nerve

33
Q

Damage to the inferior gluteal nerve or gluteus maximus what actions could be made difficult

A

Climbing the stairs and running (innervates gluteus maximus only)

34
Q

What is seen in someone with superior gluteal nerve injury?

A

A positive trendelenburg sign - the contralateral pelvis descends when the individual is standing on one leg. This is due to difficulty abducting

35
Q

Origin and insertion of obturator internus

A

Origin - obturator membrane Insertion - medial greater trochanter

36
Q

What are the superior and inferior gemelli separated by?

A

The obturator internus tendon

37
Q

What muscles do the hamstrings consist of?

A

Semitendinosus, biceps femoris, semimembranosus

38
Q

Origin and insertion of biceps femoris

A

Origin - long head - ischial tuberosity of pelvis Short head - linea aspera of femur Insertion fibula

39
Q

Origin and insertion of semitendinosus

A

Origin - ischial tuberosity Insertion - pes anserinus (medial tibia)

40
Q

Origin and insertion of semimembranosus

A

Origin - ischial tuberosity Insertion - medial tibial epicondyle

41
Q

In a child what separates the three components of the hip joint

A

The triradiate cartilage

42
Q

What percentage of people over the age of 70 suffer with osteoarthritis?

A

30%

43
Q

What is osteoarthritis specifically explaining the differences to rheumatoid arthritis

A

Breakdown of articular cartilage accompanied by functional limitation. It is non-inflammatory and is without systemic involvement. Occurs at hips, knees, spine and joints in the hand

44
Q

What is the difference between primary and secondary osteoarthritis?

A

Primary we do not know the cause Secondary is secondary to a known cause

45
Q

Give some examples of risk factors for primary osteoarthritis and causes of secondary osteoarthritis

A

Risk - age/sex (female)/ African American ethnicity/genetics/under or over nutrition Secondary causes - obesity, trauma, infection, inflammatory arthritis, diabetes/ haemophilia/

46
Q

What are the symptoms of osteoarthritis

A

A deep aching joint pain, reduced range of motion, grinding of bones (crepitus), stiffness during rest

47
Q

Explain the basic aetiology behind osteoarthritis

A

Risk factors cause excessive loading on the joint -> da,age of the articular cartilage -> increased chondrocyte activity initialyl -> eventually cartilage softens -> damage to articular surface and loss of joint space

48
Q

Give two of the four cardinal signs of osteoarthritis that can be seen on an x-Ray

A

Reduced joint space/ Subchondral sclerosis/ bone cysts (black areas in the main bone due to hyaline cartilage penetrating)/ Osteophytes

49
Q

Give some potential treatments of OA of hip

A

Weight management if overweight Nutritional supplementation Walking aids Analgesia Steroid injections Hyaluronic acid injections to mimic synovial fluid Surgery

50
Q

Why are intracapsular fractures of the NOF more dangerous than extracapsular ones?

A

Intracapsular ones likely will disrupt the blood supply to the femoral head from the retinacular arteries. The artery of the ligamentum teres will not be sufficient to supply the heads of femur and avascular necrosis can occur

51
Q

What signs may indicate a displaced NOF

Brielfy explain the signs

A

Affected leg is usually shortened, abducted and laterally rotated

Shortened - hamstring muscles pull the distal frament upward

Abducted = Strong abductors (gluteus medius and minimus) abduct the femur disal to the fracture site

Laterally rotated - Lateral rotators (piriformis etc.) contract and laterally rotate the hip

52
Q

Posterior hip dislocations are more common because the posterior ligaments are weaker, what is the sign of. Posterior dislocation

A

Affected limb will be shortened and medially rotated Note - sciatic nerve palsy seen in 20% of cases

53
Q

Signs of anterior hip dislocation

A

Limb held laterally rotated, abducted with slight flexion

54
Q

Sings of centrally dislocated hip

A

Femoral head is palpable on rectal examination it has been driven through the acetabulum

55
Q

the hip bone or ‘innominate bone’ is made up of the ischium, pubis and ileum. What are the three articulations it makes?

A

Sacroiliac joint - articulation with the sacrum pubic symphysis - articulation between the pubis’ of both the hip bones hip joint - articulation with the head of the femur

56
Q

what muscles orginate from the gluteal surface of the ilium? Which muscle originates on the iliac fossa?

A

The gluteal muscles iliacus

57
Q

What part of the innominate bone is most anterior?

A

pubis

58
Q

What structure is formed by the superior and inferior pubic rami?

A

Obturator foramen (obturator nerve, artery and vein pass through here to enter the lower limb)

59
Q

What are you sitting on when you’re sat upright in a chair?

A

Your ischial tuberosities

60
Q

What two important ligaments attach to the ischium and what is their function?

A

sacrospinous - sacrum to ischial spine Sacrotuberous - sacrum to ischial tuberosity These act to limit rotation of the sacrum when weight bearing

61
Q

What forms the greater and lesser sciatic foramina?

A

Greater - sacrospinous and ileum lesser - between sacrospinous and sacrotuberous

62
Q

Where does the intertrochanteric line run?

A

Between the greater and lesser trochanter’s on the anterior side of the femur

Note the equivalent the intertrochanteric crest lies on the posterior side

63
Q
A
64
Q

What runs in the ligamentum teres?

A

The artery of the ligamentum teres which supplies the majority of the blood supply to the femoral head in a child but only a minimal amount in an adult

65
Q

What does the linea aspera diverge to form at the distal ends of the femur?

A

Medial and lateral supracondylar ridges

66
Q

What are the principal muscles involved in the following movements of the hip?

a) flexion
b) extension
c) abduction
d) adduction
e) lateral rotation
f) medial rotation

A

Flexion - iliopsoas (psoas major and iliacus) (and sartorius, pectineus and rectus femoris)

Extension - Gluteus maximus and hamstrings (semimembranosus, semitendinosus, biceps femoris long head)

Abduction - Gluteus medius and minimus

Adduction - Adductor longus, brevis and magnus

Lateral rotation Obturator externus, piriformis, obturator internus, superior and inferior gemelli, quadratus femoris

Medial roation - Gluteus medius, minimus and tensor fascia latae

67
Q

Explain why knee pain can be referred to the hip and vice versa

A

Sciatic and femoral nerve innervate skin in both regions

68
Q

What regions do the following nerves supply

a) ilioinguinal
b) genitofemoral
c) lateral (femoral) cutaneous
d) obturator
e) femoral

I Get Loads Of Fanny (Mnemonic for remembering)

A

Ilioinguional (L1) - skin of genitalia and upper medial thigh

genitofemoral (L1, L2) - Upper anterior thigh

Lateral (femoral) cutaneous (L2, L3) - lateral thigh

d) obturator (L2, L3, L4) - medial thigh
e) Femoral (L2, L3, L4) - anterior thigh also has a ‘saphenous’ branch which innervates the medial leg

69
Q

What are the nerves of the sacral plexus top to bottom

(anatomically and nerve roots)

A

Superior gluteal (L4, L5, S1)

Inferior gluteal (L5, S1, S2)

sciatic (L4 - S3)

Posterior femoral cutaneous (S1-3)

(salmon is so perfect)

70
Q

,What do the tibial and common peroneal components of the sciatic nerve supply in the hip?

A

Tibial - hamstrings (semimembranosus, semitendinosus, biceps femoris long head, hamstring half of adductor magnus

Common peroneal - short head of biceps femoris

71
Q

What are the functions of the hamstrings?

A

Flexion of the knee, exten the hip and medial rotation the hip (apart from biceps femoris which does lateral not medial rotation)

72
Q

What tendon runs in between the superior and inferior gamelli?

A

Tendon of the obturator internus

73
Q

Mnemonic for deep gluteal muscles is PGOGOQ what does this mean (superior to inferior

A

Piriformis

Superior gamellus

Obturator internus tendon

Inferior gamellus

obturator externus

Quadrator femoris

These all abduct and externally rotate apart from Obturator externus which adducts and laterally rotates

74
Q

Medially to laterally what are the muscles of the posterior thigh? (hamstrings)

A

semimembranosus

semitendinosus

biceps femoris (long head)

biceps femoris (short head)

75
Q

Where do the hamstrings originate and what nerve supplies them. Clue - the odd one out is the short head of the biceps femoris

A

Ischial tuberosity and tibial nerve

except short head of biceps femoris originates at linea aspera and is innervated by the common peroneal nerve

76
Q

How do you locate the site for a ventrogluteal intramuscular injection?

A

Place the palm of one hand over the greater trochanter of the femur, point your thumb

towards the inguinal region and your index

finger towards the anterior superior iliac crest.

Spread the index and middle fingers to make a V and inject between the proximal

interphalangeal joints of your fingers into the gluteus medius muscle.

77
Q

Name four muscles involved in hip flexion

A

sartorius/rectus femoris/iliopsoas/adductor magnus/adductor longus/pectineus/gracilis/tensor fascia latae

78
Q

Name two muscles involvedi in flexion of the hip

A

Pectineus/iliopsoas/sartorius/rectus femoris

MSK (11 decks)

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