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MSK > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Proximally the pectineal line (medial) and gluteal tuberosity (lateral) form the linea aspera on the dorsal surface of the femur. Which supercondylar line at the distal end ends at the adductor tubercule where the adductor magnus inserts?

A

Medial

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2
Q

Which femoral condyle is bigger because of the way the centre of mass lies?

A

Medial

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3
Q

Which surface does the trochlear groove lie on the femur which articulates with the patella?

A

anterior

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4
Q

Where do the medial and lateral collateral ligaments of the knee originate from?

A

Their respective epicondyles which lie above the condyles.

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5
Q

Which condyles do the anterior and posterior cruciate ligaments attach to?

A

ACL attaches to the medial aspect of the LATERAL femoral condyle. The PCL attaches to the lateral aspect of the MEDIAL condyle

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6
Q

What two structures attach the patella to the femur and tibia?

A

Quadriceps TENDON (femur) and patellar LIGAMENT (tibia)

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7
Q

what are the three functions of the patella?

A

Extension of the leg/protection of the joint/stablises the knee

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8
Q

The tibial condyles form a flat surface known as the tibial plateau which is a major articulation of the knee joint, what joint binds the fibula and proximal tibia, is this part of the knee joint?

A

Proximal tibiofibular joint - Not part of the knee joint

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9
Q

Within the tibial plateau there is a raised area which is where the ACL attaches , what is this called?
(note the ligamentes don’t involve the patella, they are between the femur and tibia)

A

the intracondylar eminence (posterior)

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10
Q

What is the main function of the fibula?

A

An attachment for muscles, not weight-bearing

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11
Q

What are the three main articulations of the fibula?

A

Proximal tibiofibular joint/distal tibiofibular joint/ankle joint (with the talus of the foot)

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12
Q

The lateral malleolus of the fibula is more prominent and can be palpated at the ankle on the lateral side of the leg, T/F

A

T

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13
Q

Which joint is the weight-bearing joint of the knee?

A

Tibiofemoral joint

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14
Q

What are the two articulations of the knee joint?

A

Patellofemoral/tibiofemoral

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15
Q

What are the two functions of the fibrocartilagenous knee joint menisci (menisci cover the articuar surface of the tibia)?

A

Increase joint stability (by deepening tibial articular surface)/to act as shock absorbers

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16
Q

What differences are there between the menisci? What attaches the menisci to one another?

A

Medial meniscus is larger and attached to it’s collateral ligament (medial)

They are connected by the transverse ligament of the knee

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17
Q

The major ligaments of the knee can be divided into: Intracepsular ligaments/ligaments which strengthen the capsule and/extracapsular ligaments. Give an example of each

A

Intracapsular - cruciate ligaments
Ligaments which strengthen the capsule - Oblique politeal ligament
Extracapsular ligaments - collateral ligaments/patellar ligament

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18
Q

What is the major function of the PCL?

A

Main stabiliser of the knee when flexed (so in use when walking down the stairs etc.)

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19
Q

The way the cruciate ligaments run can be remembered by the the idea of putting your hands in your pockets with the thumbs out. The direction the thumbs face are the way the ACL goes (considering proximally). Given this explain the path of both cruciate ligaments

A

if you think proximally to distally

ACL - Passes anteriorly to insert medially onto the patella

PCL - Passes posteriorly and inserts laterally onto the patella

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20
Q

What is the function of the ACL?

A

Resists anterior translation

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21
Q

The joint capsule of the knee is deficient anteriorly. What is the point in this?

A

Alows the synovial membrane to extend beneath the patella and form the suprapatellar bursa

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22
Q

What is the function of each collateral ligament?

A

Medial - resists valgus (lateral) deviation of the tibia on the femur

Lateral - Resists varus (medial) deviation of the tibia on the femur

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23
Q

The medial collateral ligaments is larger but weaker than the lateral, thus excessive ____ force can lead the medial collateral ligament to tear

A

valgus

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24
Q

What is a bursa?

A

A small sac containing synovial fluid which reduces friction and allows free movement at joint

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25
Q

List the six bursae found at the knee joint (be able to identify/label where they should be too)
PRINT OFF PIC

A

Suprapatellar bursa
Prepatellar bursa (between anterior patella and skin)
superficial infrapatellar bursa (between patellar ligament and skin)
deep infrapatellar bursa (between tibia and patellar ligament)
semimbranosus bursa
pes anserinus (subsartorial) bursa

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26
Q

What four movement occur at the knee - list one muscle involved in each

A

Extension - quadriceps (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius

flexion - hamstrings (biceps femoris, semimembranosus, semitendinosus)

Lateral rotation (only possible in flexed knee) - biceps femoris

Medial rotation (only possible in a flexed knee) - semimembranosus, semitendinosus, gracilis, sartorius, popliteus

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27
Q

When the knee is fully extended with the foot on the ground, the knee passively locks using the screw home mechanise, explain this.

How does the knee unlock

A

The femoral condyes medially rotate on the tibia.

Unlocking is done by the popliteus contracting and laterally rotating the knee to allow flexion of the knee to occur

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28
Q

Due to the angle that the quadriceps pull on (the Q angle) the patella tends to try to be displaced laterally, what stops this from happening?

A

The deep trochlear groove has a more prominent lateral femoral condyle anteriorly. Also the inferior fibres of the vastus medialis (also known as the vastus medialis obliquus)

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29
Q

Which three muscles insert onto the pes anserinus of the tibia?

A

gracilis, semitendinosus, sartorius

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30
Q

What are the actions of the sartorius?

A

Flexion and medial rotation of the knee

Flexion, abduction and lateral rotation of the hip

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31
Q

What is the function of all the quadriceps apart from rectus femoris, what is it’s function?

A

knee extension and patella stabilisation

Knee extension and hip flexion

32
Q

What is the general function of the anterior compartment of the thigh?

A

Knee extension

33
Q

What is the function of the iliopsoas mucles?

A

Hip flexion

34
Q

What is the function of the pectineus

A

adduction and hip flexion

35
Q

What is the only muscle in the anterior thigh compartment that ISN’T innervated by the femoral nerve?

A

psoas major

36
Q

All the components of the medial compartment of the thigh adduct the thigh, which ones cross the knee joint and flex the knee?

A

adductor magnus and gracilis

37
Q

All the muscles in the medial compartment of the thigh are innervated by the obturator nerve, which has a dual supply of the obturator nerve AND the tibial nerve?

A

adductor magnus

38
Q

Give the borders of the femoral triangle, as well as the floor and the roof

A

Superior - Inguinal ligament

Lateral - medial border of sartorius

Medial - medial border of adductor longus

Floor - pectineus, iliopsoas and adductor longus

roof - fascia lata

39
Q

What are the four structures that lie in the femoral triangle, medial to lateral

A

Femoral canal - lymph nodes and vessels

Femoral vein

Femoral artery

Femoral nerve

NOTE - mnemonic is canal VAN

40
Q

The surface marking of the femoral artery within the femoral triangle can be remembered using the mmnemonic MIPA. Explain

A

Mid-inguinal point = artery - this is midway between the ASIS and the pubic symphysis

41
Q

What are the contents of the femoral canal?

What is it’s main function?

A

Lymphatics/empty space/connective tissue

Empty space allows distension of the femoral vein so that it can cope with increased venous return

42
Q

The adductor canal (subsartorial canal) runs from the apex of the femoral traingle to the adductor hiatus of the adductor magnus. Name some of it’s constituents

A

femoral artery/femoral vein/saphenous nerve

Note - femoral artery and vein become the popliteal artery and vein as they exits the adductor hiatus into the popliteal fossa

43
Q

Briefly describe the path of the femoral nerve

A

Enters the abdomen through the psoas major -> passes through the inguinal ligament to enter the thigh -> through the femoral triangle -> gives off branches and continues within the adductor canal as the saphenous nerve where it terminates

44
Q

What areas does the saphenous nerve give sensation to?

A

Medial leg and foot

NOTE - the anterior cutaneous branches supply the medial thigh

45
Q

The popliteal vein becomes the femoral vein once it has entered the adductor canal and goes onto becomes ie external iliac vein. The profunda femoris vein follows the same course as the profunda femoris artery . Where do the obturator vessels lie?

A

Obturator artery arises from the internal iliac and enters via the obturator foramen, vein follows the same course

46
Q

The great saphenous vein drains into the femoral vein as it passes up the medial leg through the saphenous opening in the fascia lata. What about the short saphenous vein?

A

Runs psterior to the lateral malleolus from the dorsal venous arch -> between the two heads of the gastrocnemius into the popliteal vein

47
Q

AP, lateral and skyline X-rays are all standard for views of the patella. The most common cause of femoral shaft fractures are RTA’s. Give two other causes

A

Osteoperotic bones in the elderly mean can occur from falling/child abuse in children/bone metasteses

48
Q

What would the leg look like in a fracture of the shaft of the femur and why

A

Proximal fraction will be abducted due to gluteal muscles and flexed due to iliopsoas.
The distal segment will be adducted due to the adductor muscles and extended due to the gastrocnemius

NOTE - hypovolaemic shock is likely due to it being such a large bone and patient will have a tense swollen thigh

49
Q

What are the most common causes of distal femur fractures in the young and the elderly?

A

Young - high energy sporting injuries

elderly - falling with osteoporotic bones

50
Q

Tibial plateau fractures are most likely the result of high energy sporting injuries due to excess varus or valgus angulation (abnormal medial or lateral flexion of the knee) . Be able to recognise. See doc. These are often associated with meniscal tears and ACL injuries

A

T

51
Q

What test should you do on someone you suspect a patellar fracture has completely split the patella and disrupted the quadriceps tendon?

A

Ask them to raise a straight leg whilst lying down. They won’t be able to

52
Q

It is importnt to remember that 8% of the population have a bipartite patella and this can be mistaken for a fracture on an x-ray, be careful.

A

T

53
Q

In patella dislocation, which direction is it displaced and why?

A

Lateral, Because of the Q angle - the direction of pull of the quadriceps

54
Q

Patella dislocation is normally due to trauma, often a twisting injury during slight flexion. Name two factors which can predispose to a patellar dislocation

A

Weak ligaments/
weak quads particularly the VMO (resists lateral dislocation)/shallow trochlear groove with a flat lateral lip/long patellar ligament/previous dislocations

NOTE - treatment involves extending the knee and then manually reducing the patella folowed by physio

55
Q

______ tears are the most common type of knee injury. They occur during a sudden twisting motion of a weight bearing knee

A

Meniscal

56
Q

Give two symptoms and a sign of a meniscal tear

A

intermittent pain localised to the joint/knee clicking or locking/potentially swelling
sign - effusion in the joint/inflammation of the synovial joint

Treated mainly with conservative management or surgery

57
Q

Medial collateral ligament injury is caused by acute _____ force to the knee. Lateral collateral ligament injury is the result of acute _____ force to the knee .

Which is more common?

How would the patient present?

A

Valgus (vaLgus)
Varus

MCL injury

Patient will complain of the joint being unstable and not supporting their body weight

58
Q

The unhappy triad results to an injury to the lateral aspect of the knee. Which three elements comprise this and why

A

damage to the ACL, medial collateral ligament and medial meniscus because it is firmly adhered to the medial collateral ligament

59
Q

The ACL is weaker than the PCL and is thus more commonly injured. Describe the common mechanism

A

Torn as the result of a sudden change of direction during sport or a large force to the back of the knee

60
Q

Describe the common presentation of a torn ACL

A

Patient heads a pop in the knee with immediate swelling. The knee gives way - this is due to the tibia sliding anteriorly under the femur/ commonly ahaemarthrosis (bleeding within the joint)

61
Q

What is the most common mechanism for PCL injury

A

‘dashboard injury’ direct force to a flexed knee

62
Q

What tests can be used to detect ACL and PCL injuries respectively? NOTE - you only need to know the names

A

anterior drawer test

posterior drawer test

63
Q

At least three of the four knee joint ligaments must be injured (MCL, LCL, ACL, PCL) to cause a dislocation of the knee joint. Which artery is commonly injured in this dislocation causing a haematoma?

A

popliteal artery - thus anigography of the joint is important in this injury

64
Q

There are three types of swelling around the knee, give an example of a cause of each

1) bony
2) soft tissue
3) fluid

A

1) Osgood schlatter’s disease (inflammation of patellar ligament insertion)
2) popliteal aneurysm/lymphoedema
3) inside the joint = effusion
outside the joint = haematoma

65
Q

Acute knee effusions can be divided into haemarthrosis (blood in the joint) and a lipo-haemarthrosis (blood and fat in the joint). What are each of these until proven otherwise?

A

Haemarthrosis - ACL rupture

Lipo-haemarthrosis - fracture (fat released from bone marrow) - look at workbook to see this!

66
Q

Prepatellar bursitis is often termed ‘_____ ____’ because of the type of lifestyle that can lead to it

A

housemaids knee - leaning forwards on knees/fall onto the knee

67
Q

Infrapatellar bursitis normally affects the superficial infrapatellar bursa. What ‘name’ is associated with this any why?

A

‘Clergyman’s knee’ - more upright position of kneeling - NOTE be able to point on a surface anatomy to where each if the bursa lie/ describe their position

68
Q

The suprapatellar bursa is an extension of the synovial cavity of the knee and this it present with a knee effusion too. It is normally a sign of pathology. Suggest some

A

Osteoarthritis/RA/infection/gout

69
Q

Semimembranosus bursitis or ‘popliteal cysts’ is the result of a knee effusion and forms at the posterior popliteal fossa.

A

T

70
Q

Osgood-schlatter’s disease is an inflammation of the patellar ligament insertion, this most commonly occurs in teens due to playing sport. Resolves with rest and ice however the bony prominence will normally remain.

A

T

71
Q

Name three symptoms of osteoarthritis of the knee

A

Loss of mobility at the joint/crepitus/knee pain/pain worsened on movement/stiffness in the morning

72
Q

Describe some elements of the treatment regime for OA of the knee

A

Strenghtening the vastus medialis/weight loss/ analgesia/surgery

73
Q

Septic arthritis differs from reactive arthritis in that micro-organisms invade the joint space causing inflammation rather than the sterile enviromnent in reactive. What is the most common organism in natural joints?

A

S. aureus

74
Q

What is the most common organism causing septic arthritis in prosthetic joints?

A

S. epidermis (coagulase negative staph_

75
Q

What are some symptoms of septic arthritis?

What should be done immediately/

A

triad of Fever, pain, reduced range of motion
also redness, swelling

Aspirate the joint and culture

76
Q

Why do some patients ith osteoarthritis of the knee describe their knee giving way or buckling?

A

Patients with painful osteoarthritis tend to avoid using it -> quads get weakr -> extension gets weaker -> buckling

MSK (11 decks)

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