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MSK > Week 5 > Flashcards

Week 5 Flashcards

1
Q

Why is there a high risk of avascular necrosis if the talus is fractured?

A

It has a retrograde blood supply and has no muscle attachments to improve it’s vascularity

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2
Q

What is the main function of the talus (medial)?

A

To transmit forces from the tibia to the calcaneus

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3
Q

What are the bones of the midfoot?

A

The navicular (medial), cuboid and cuneiforms (in front of navicular)

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4
Q

What are the three articulations of the talus?

A

Ankle joint - talus to fibula and tibia
Subtalar - talus and calcaneus
Talonavicular - talus and navicular

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5
Q

What are the two joints of the calcaenus

A

Subtalar

Calcaneocuboid

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6
Q

What inserts into the calcaneal tuberosity

A

The Achilles’ tendon

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7
Q

How many tarsal bones are there (proximal foot)?

A

7 - irregularly shaped

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8
Q

The tendon of which muscle inserts onto the plantar surface of the navicular?

A

Tibialis posterior

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9
Q

The tendon of which muscle passes through a groove in the plantar surface of the cuboid bone?

A

Peroneus (fibularis) longus

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10
Q

Which muscles insert into the medial cuneiform?

A

Peroneus (fibularis) longus
Tibialis anterior
Tibialis posterior

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11
Q

The metatarsals are numbered 1 - 5 in which direction?

A

Medically to laterally

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12
Q

All the toes but one have proximal, medial and distal phalanges, which only has proximal and distal ones?

A

The great toe

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13
Q

What movements of the foot are permitted by the ankle joint (talus to fibula and tibia)

A

Dorsiflexion and plantarflexion

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14
Q

The talus is held in the mortise of the ankle joint by it’s trochlea. Why is the joint more stable in dorsiflexion than plantarflexion?

A

The trochlea of the talus is wider anteriorly than posteriorly. In dorsiflexion the anterior portion is held in the mortise and thus there is more in there and the joint is more stable

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15
Q

Muscles of which compartment of the leg are responsible for

a) dorsiflexion
b) plantarflexion

A

a) anterior compartment

b) posterior compartment

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16
Q

The lateral ligament of the ankle has three parts - the anterior talofibular ligament, the posterior talofibular ligament and the ——— ligament

A

Calcaneofibular

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17
Q

What is the function of the lateral ligaments of the ankle?

A

To resist inversion of the foot

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18
Q

What is the function of the medial ligament of the ankle and is it stronger or weaker than the lateral?

A

To resist eversion of the foot. Stronger

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19
Q

What movements occur at the subtalar joint?

A

Eversion and inversion

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20
Q

Which muscles are responsible for eversion of the foot

A

Lateral compartment - peroneus longus and peroneus brevis
Anterior compartment - peroneus Tertius

IMP - these are the only muscles with peroneus in the name so the peroneus’ are responsible for eversion

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21
Q

Which muscles are responsible for inversion of the foot?

A

Tibialis anterior and tibialis posterior

Important - the tibialis’ are resonsible for inversion of the foot

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22
Q

What bones form the medial arch of the foot?

A

Think logicallly, medial bones

Calcaneus, Talus, navicular, three cuneiforms and medial three metatarsals

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23
Q

What is the role of the foot arches?

A

To maintain the body’s weight in the erect position with the least possible weight

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24
Q

describe the test used to test the strength of the tibialis anterior

A

Stand on heels with forefeet raised off of ground - this muscle is the strongest dorsiflexor of the foot

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25
Q

Which muscle in the anterior compartment of the leg is responsible for eversion of the foot as well as dorsiflexion

A

Peroneus tertius

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26
Q

Which compartments of muscles prevent excessive inversion whilst running?

A

Lateral compartment of leg

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27
Q

What are the two bursae in the superficial compartment of the lower limb, these minimise friction during movement

A

Subcutaneous calcaneal bursa

Deep calcaneal bursa

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28
Q

At what level does the tibial nerve arise from the sciatic nerve?

A

The apex of the popliteal fossa

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29
Q

What are the root values of the tibial nerve?

A

L4-S3 (it is a continuation of the sciatic and thus has the same roots)

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30
Q

The common peroneal nerve also arises at the level of the popliteal fossa, before interacting them muscles of the anterior and lateral compartments of the leg what muscle does it run over to supply?

A

The short head of the biceps femoris

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31
Q

The common peroneal divides at what level into its superficial and deep branches?

A

Neck of fibula

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32
Q

What are the nerve roots of the common peroneal nerve?

A

L4 - S2

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33
Q

Which interweb space of the foot is the only one not supplied by the superficil peroneal nerve and what nerve cutaneously does supply it?

A

The first - this is supplied by the deep peroneal nerve

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34
Q

What blood vessel does the deep peroneal nerve travel with in the anterior compartment of the leg?

A

The anterior tibial artery

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35
Q

What is the arrangement of the structures posterior to the medial malleolus?

A 
Tibialis posterior tendon
flexor Digitorum longus tendon 
posterior tibial Artery
posterior tibial Vein
Tibial nerve 
flexor Hallicus longus

Mnemonic - Tom, Dick, And Very Nervous Harry

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36
Q

What are the four pulses of the lower limb?

A

Femoral pulse - palpated in femoral triangle
Popliteal artery - deep in popliteal fossa
Dorsal pedis artery - lateral to the extensor hallucis longus tendon on the dorsum of foot
Posterior tibial pulse - behind medial malleolus

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37
Q

What form the four borders of the popliteal fossa (diamond shape)

A

Superomedial - semimembranosus
Superolateral - biceps femoris
Inferomedial - medial head of gastrocnemius
Inferolateral - lateral head of gastrocnemius and plantaris

38
Q

What is the pathogenesis of compartment syndrome

A

Trauma to a fasciae compartment -> haemorrhage or oedema in compartment -> rise in intracompartmental pressure

39
Q

Give the symptoms and treatment of compartment syndrome

A

Symptoms - Severe pain in limb that worsens on stretch and is not relieved by analgesia

Treatment - fasciotomy of suspected compartment

40
Q

What are the short and long term consequences of untreated compartment syndrome

A

short term
Loss of peripheral pulses
Increased capillary refill time

Long term untreated
Rhabdomyolysis and acute kidney injury in severe cases
Permanent painful contracture of affected muscle groups

41
Q

List some co-morbidities we need to consider in patients with ankle injuries and why

A

Diabetics/vascular disease/smoking - these all affect fracture healing time

42
Q

What is the normal mechanism of ankle fracture

A

Excessive inversion or eversion

43
Q

The ankle joint can be visualised as a ring in the coronal plane. What make up the following

  • proximal ring
  • medial ring
  • lateral ring
  • inferior
A
  • proximal - articulations surfaces of fibula and tibia
  • medial - medial ligament
  • lateral - lateral ligament complex (anterior and posterior talofibular and talocalcaneal)
  • inferior - subtalar
44
Q

What is meant by talar shift?

A

When two of the components of the ankle joint ‘ring’ are disrupted the ankle mortise becomes unstable and widens so that the talus can shift the way the joint has been displaced

45
Q

How are the following fractures treated

a) stable ankle fracture
b) unstable ankle fracture

A

a) aircast boot, weight bearing is safe

b) surgical stabilisation

46
Q

An ankle sprain refers to a partial or complete tear of one or more of the ligaments of the ankle joint, in a severe sprain of the ankle why is it not uncommon to find the patient has an avulsion (torn off) fracture of their fifth metatarsal tuberosity

A

Because the peroneus brevis tendon is attached to a tubercule at the base of the fifth metatarsal. The most common ankle sprain injury is an inversion injury, in this this muscle is under tension and can pull a fragment of bone from the insertion site

47
Q

Give some signs on an Achilles’ tendon rupture

A

Sudden or severe pain in the back of the ankle or calf/ a loud pop or snap/ a visible depression in the tendon/inability to stand on tip toe or push off whilst walking

48
Q

Thompson’s test is used to diagnose an Achilles’ tendon rupture, explain it

A

The patient lies prone, squeeze calf muscle it should plantar flex if it remains dorsiflexed I.e. no movement then the test is positive - the tendon is ruptured

Note - most ruptures are treated with an aircast boot

49
Q

What is the clinical presentation of Hallux Valgus

A

Varus deviation of the distal metatarsal accompanied by by valgus deviation of the big toe

50
Q

What is hallux valgus the most common cause of and what is the treatment if it is painful

A

A bunion at the first MTPJ (metatarsophalangeal joint)

Treatment is realignment surgery

51
Q

What is hallux rigidus?

A

Osteoarthritis at the 1st MTPJ resulting in stiffness of the joint

52
Q

Patients tend to compensate in hallux rigidus by walking on the outside of their feet. The range of dorsiflexion becomes very restricted, what can sometimes develop at the affected joint

A

A bunion (osteophyte)

Note - difference between this and hallux valgus is it lacks the varus deviation at the first metatarsal

53
Q

What are the conservative and then surgical treatments for hallux rigidis?

A

Conservative - orthotic to prevent movement at the 1st MTPJ

SURGICAL - arthrodesis (joint fusion) at the joint

54
Q

Osteoarthritis of the ankle is most commonly the result of primary or secondary arthritis?

A

Secondary - e.g to ankle injury/rheumatoid arthritis

55
Q

What is the preferred treatment for OA of the ankle?

A

Arthrodesis

56
Q

What is the clinical presentation of ‘claw toe’

A

Hyperextension of the MTPJ and flexed at PIP and sometimes DIP of the four smaller toes

57
Q

What is the normal cause of claw toe

A

Secondary to neurological damage e.g. stroke/cerebral palsy etc

58
Q

What’s the difference between hammer and mallet toe

A

Hammer toe is flexed at the PIPJ whilst mallet toe
Mallet toe is flexed at the DIPJ
Again not affecting the big toes

59
Q

What’s the main cause for hammer and mallet toe?

A

Tight fitting shoes

60
Q

Curly toes is a congenital condition affecting the third to fifth toes normally affecting children, it is the result of one of either the flexor digitorum brevis or longus being too tight. Treatment is usually

A

Passive extension of the toes to stretch out the tendons

61
Q

Where is the watershed area of the Achilles’ tendon?

A

About 6cm proximal (above) it’s insertion into the calcaneal tuberosity - this is an area of decreased thickness and vascularity of the tendon and is where Achilles heel ruptured normally occur as well as non-insertionsl Achilles tension patchy

62
Q

What has happened in flat foot?

A

The medial arch of the foot has collapsed so that the medial border of the foot almost touched the ground and we also see a valgus angulation of the hindfoot

63
Q

What is the difference between rigid and flexible flatfoot?

A

Flexible - medial arch is present when on tip toes but not flat

Rigid - medial arch is still not present when on tip toes

64
Q

The tendon of which muscle that supports the medial arch is dysfunctional in flatfoot? What is the treatment normally?

A

Tibialis posterior

Orthotics

65
Q

Foot disease which describes infection, ulceration and destruction of the foots tissues is a common complication of people with which condition?

A

Diabetes

66
Q

Untreated diabetes means high blood sugar which can damage peripheral nerves causing peripheral neuropathy and ischaemia from artery damage. Poorly controlled diabetes can lead to ______ _______ which involves progressive destruction of the bones, joints and soft tissues as above. Other symptoms are abnormal loading of the foot due to reduced sensation, micro trauma (small cracture) and osteoclasts.

A

Charcot arthropathy

67
Q

Describe what is meant by ‘gait’

A

Gait is the mechanism by which the body is transported using co-ordinated movements of the major lower limb joints

68
Q

Describe the two phases of the gait cycle and explain by how much they contribute to the cycle

A

Stance phase - the time in which the foot is in contact with the ground and bearing weight (60%)
Swing phase - time when the foot is not on the ground (40%)

69
Q

When is running defined as compared to walking

A

When there is a period of time when neither of the feet are in contact with the ground - the double float

70
Q

Which muscles are used in normal gait?

A

Initial contact - tibialis anterior (dorsiflexion)

Stance phase - gastrocnemius and soleus (plantar flexion)

71
Q

Define the difference between stride, step and cadence

A

Stride - the distance from initial contact with one leg to the next initial contact with the same leg

Step - the distance from initial contact with one leg to initial contact with opposite leg

Cadence - the number of steps per minute

Note - so there are two steps to every stride

72
Q

In antalgic gait patients walk in a manner which reduces pain, they walk with a limp to shorten the amount of time spent on the painful limb. Osteoarthritis of the hip is a common cause of this, should a walking stick been given on the same side or opposite side to the affected limb?

A

Opposite, they can lean into this when putting pressure on the affected limb to shift centre of gravity and reduce load through leg

73
Q

Waddling describes the movement of people with Trendelenburg gait, in a positivite Trendelenburg sign the pelvis drops on the unaffected side because of weak hip abductors which normally prevent this, what is the most common cause of this?

A

Superior gluteal nerve lesions

But also… trauma/muscle pain

74
Q

What is hemiplegic gait due to?

A

Paralysis of one side of the body

75
Q

Describe the presentation of a hemiplegic gait

A

Flexed upper limb and extended lower limb on one side, patients have to lean whole body toward affected side when stepping.

76
Q

Common cause of hemiplegic gate

A

Stroke/cerebral palsy/spinal cord injury

77
Q

What is spasticity

A

Describes muscles which are permanently contracted

78
Q

Scissoring describes the movement seen in what kind of gait?

A

Diplegic gate - both lower limbs are spastic. Commonly seen in cerebral palsy

79
Q

What structure is damaged in patients with high steppage gait meaning the foot makes initial contact on tip toe because of weak/absent ability to dorsiflex the foot?

A

Common peroneal nerve/ sciatica (L4 nerve dorsilfexes)

80
Q

What are the four borders of the popliteal fossa?

A

Superomedial - semimembranosus
Superolateral - biceps femoris
Inferomedial - medial head gastrocnemius
Lateromedial - lateral head gastrocnemius

81
Q

Contents of the popliteal fossa w

A 
S’s p’s and a tis 
Sural branch of tibial nerve 
Lateral sural branch of common peroneal nerve 
Tibial nerve 
Common peroneal nerve 
Popliteal vein, artery and lymph nodes
Short saphenous vein

Floor is femur
Roof is skin and fascia

82
Q

deep posterior leg muscles - Down The Hatch (medial to lateral)

anterior leg muscles, nerve and artery - The Hospitals Are Not Dirty Places

A

t

83
Q

Which nerve supplies the lateral compartment, anterior compartment and posterior compartment of the leg?

A

anterior - deep peroneal
lateral - superficial peroneal
posterior - tibial

84
Q

a general rule for the nerves - PED - common peroneal everts and dorsiflexes

TIP - tibial, inverts and plantar flexes not all muscles will do both but its a starting point to work them out

ODD ONE OUT IS TIBIALIS ANTERIOR - DEEP peroneal nerve but its INVERTS and dorsiflexes

A

t

85
Q

Give 4 differential diagonses for a mass in the popliteal fossa

A

popliteal aneurysm/semimembranosus bursitis (baker’s cyst)/abcess/popliteal lymphadenopathy/ thrombosis in one of the veins that pass through (popliteal/short saphenous)

86
Q

At what joints does inversion and eversion of the foot occur?

A

subtalar, calcaneocuboid, talocalcaneonavicular

87
Q

Which ligament is most commonly injured in inversion injuries?

A

anterior talofibular ligament

88
Q

What makes up the lateral ligament complex in the ankle?

A

anterior and posterior talofibular ligaments and the calcaneofibular ligament

89
Q

Where are the surface markings for the great and short saphenous veins?

A

Great - anterior to medial malleolus

short - posterior to lateral malleolus

90
Q

Describe parkansonian gait

A

Short, shuffling steps with body leant forwards

91
Q

Describe ataxic gait, what are the causes?

A

Patient struggles to balance, staggering movements, arms held out at side for balance

Vesibular damage, ataxia, being drunk, stroke affecting the cerebellum

MSK (11 decks)

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