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85 Cards in this Set

  • Front
  • Back
What are the two joints which form the pelvic girdle and what kind of joints are they?
Pubic symphysis - Secondary cartilagenous)
Sacroiliac - Synovial, although they may fibrose in later life
What creates the greater and lesser sciatic fossae?
Greater - Sacrospinous ligament
Lesser - Sacrotuberous ligament
Name the deep fascia of the leg and thigh, and give the two openings to allow lymphatic drainage and cutaneous innervation into the superficial region.
Leg: Crural
Thigh: Fascia Lata

Saphenous opening (top of thigh), and Popliteal opening (back of knee)
Describe the test points for the lower limb dermatomes L1 - S2.
L1 - Inguinal ligament
L2 - Outside upper thigh, front
L3 - Inside lower thigh, front
L4 - Big toe, below nail
L5 - Middle toe, below nail
S1 - Little toe, below nail
S2 - Back of thigh, middle
Describe the myotomes for the lower limb.
Hip flexion - L2,3
Hip extension - L4,5
Knee extension - L3,4
Knee flexion - L5,S1
Ankle extension - L4,5
Ankle flexion - S1,2
Inversion - L4,5
Eversion - L5,S1
What are the main nerves supplying:
Anterior thigh
Medial thigh
Posterior thigh
Anterior leg
Lateral leg
Posterior leg?
Anterior thigh - Femoral (L2-4)
Medial thigh - Obturator (L2-4)
Posterior thigh - Tibial
Anterior leg - Deep branch of Fibular nerve
Lateral leg - Superficial branch of Fibular nerve
Posterior leg - Tibial
Thigh vasculature:
Give the origin, course and distribution of the main arteries in the thigh.
External iliac artery becomes the Femoral artery after passing the inguinal ligament at the mid-inguinal point.

It becomes the Popliteal artery after passing through the Adductor Hiatus (Adductor Magnus).

It supplies the entire thigh either itself (anteriorly) or via it's main division, Profunda Brachii (posterior and medial compartments).

Profunda brachii gives 6 branches, 2 x circumflex supply the hip joint, and 4 x perforating arteries
What are the four pulse points in the lower limb, and where are they felt?
Femoral pulse - 2-3cms below the mid-inguinal point
Deep popliteal - Hard to palpate
Posterior tibial - Medial ankle
Dorsalis pedis - Top of foot, feint and hard to feel
Give the origin and end points of the two main superficial veins in the leg?
The great saphenous vein:
Begins in the medial venous arch in the foot, anterior to the medial malleolus, ends top of thigh at saphenous opening
The short saphenous vein:
Begins at the lateral venous arch in the foot, posterior to lateral malleolus, ends in the popliteal fossa as the popliteal vein
What causes varicose veins?
Incompetence of the valves in veins
What are the deep and superficial lymph nodes of the lower limb?
Deep:
Popliteal nodes - behind the knee
Deep inguinal - medial to femoral nerve
Cloquet's node - deep inguinal, found in the femoral canal

Superficial:
Superficial inguinal nodes, arranged in a 'T' shape
Where is Cloquet's node?
One of the deep inguinal nodes, found in the femoral canal
Where do the superficial nodes receive lymph from?
The lateral aspect of the 'T' - lower back/gluteal
Medial aspect of the 'T'- anterior abdominal wall/external genitalia
Name the 'U' shaped part of the acetabulum and the part of bone that crosses it.
Lunate surface, the bone is called the acetabular notch
What lies between the two trochanters anteriorly and posteriorly?
Anteriorly - Intertrochanteric line
Posteriorly - Intertrochanteric crest
Where is the linea aspera and what happens when it splits?
Posterior aspect of the femur. It divides to give:
Laterally, the gluteal tuberosity
Medially, spiral line
What is the normal angle of inclination for the head and neck of the femur relative to the shaft, and what constitutes a coxa vara and a coxa valga?
Normal angle of inclination is 125⁰
Coxa Vara, less than 120⁰
Coxa Valga, over 135⁰
What is a typical angle of inclination for a new-born, a 3 year old, and an elderly patient?
New-born, 160⁰
3 year old, 140⁰
Elderly, 120⁰
What is a typical angle of anteversion/declination?
12⁰ anterior
What is Shenton's line, and why is it important?
It is a line on x-ray extending from the medial border of the femur, around the superior margin of the superior pubic ramus. If the line is broken, this would indicate a fracture or dislocation
Which ligament bridges the lunate surface of the acetabulum?
Transverse acetabular ligament
What does the ligament of the head of the femur connect, and what runs within it?
Attaches the fovea on the head of the femur to the floor of the acetabulum. A branch of the obturator artery and nerve run within it
Which structure increases the depth of the hip joint?
The acetabular labrum
What are the sites of attachment for the capsule of the hip joint?
Proximally to the acetabular labrum
Inferiorly to the transverse acetabular ligament
Distally the intertrochanteric line and neck of femur
Is the ligament of the hip joint in the synovium?
No, it is extrasynovial (as the synovium attaches to the fovea)
Name the three capsular ligaments and give their attachments
Iliofemoral - 'upsidedown Y', attaches to acetabular labrum, AIIS, greater and lesser trochanters and the intertrochanteric line
Pubofemoral - acetabulum and superior ramus of pubis to lesser trochanter
Ischiofemoral - ischial margin of the acetabulum and inserts onto the iliofemoral ligament and greater trochanter
What is the name given to the circular ligament of the hip joint?
Zona orbicularis
Which muscles flex the hip?
Iliopsoas, Sartorius, Pectineus, Rectus femoris, Adductor Magnus (anterior part), Adductor longus, Adductor brevis, Gracilis
Which muscles extend the hip?
Gluteus maximus, biceps femoris (long head), semitendinosus and semimembranosus, adductor magnus (posterior part)
Which muscles medially rotate the hip?
Gluteus medius and minimis (anterior parts of both) and tensor fascia lata
Which muscles laterally rotate the hip?
Gluteus maximus, piriformis and superior and inferior gemellis, quadratus femoris and obturator internus and externus
Which type of dislocation of the hip is most popular and what are the clinical signs?
Posterior dislocation. Leg is foreshortened, and medially rotated (lateral rotator muscles ineffective)
Describe the clinical signs for a femoral neck fracture.
Limb foreshortened, and laterally rotated (medial rotators made ineffective)
Which two anastamoses supply the hip joint and which two arteries make important contribute to them?
Cruciate and trochanteric anastomoses, from the lateral and medial circumflex femoral arteries
Where does the cruciate anastamoses lie and what contributions does it receive?
Cruciate anastomoses - lesser trochanter. Receives both circumflex, plus the first perforating artery and inferior gluteal
Where does the trochanteric anastamoses lie and what contributions does it receive?
Trochanteric anastomoses - Greater trochanter. Receives both circumflex and a superior gluteal
Which hip condition commonly arises from a loss of blood supply to the femoral head? (NB. not avascular necrosis!)
Legge-Calve-Perthe's disease
Which muscles abduct the hip?
Gluteus medius, minimis and tensor fascia lata
Which muscles adduct the hip?
Adductor longus, adductor brevis, adductor magnus, gracilis, pectineus, obturator externus
What attaches to the crest of the iliac bone and what is the iliac a good source of?
Fascia lata. The iliac bone is a good source of bone marrow for transplantation
What are the three lines on the posterior surface of the iliac bone, and which muscles attach there?
Posterior, anterior and inferior
Gluteus maximus attaches posterior to the posterior line
Gluteus medius attaches between the anterior and posterior lines
Gluteus minimis attaches between the anterior and inferior lines
What demarks the superior border of the gluteal region, and what forms these landmarks?
Skin dimples created by the PSIS
Which muscles extend the hip?
Gluteus maximus and the hamstrings
What effect does gluteus maximus have on the knee, and how is this effect achieved?
Stabilises the knee via insertion to the iliotibial band. When gluteus maximus is tensed, this pulls the iliotibial band, extending the knee.
Is tensor fascia lata an extensor of the knee?
No, it is primarily a flexor of the hip
Which muscles abduct the hip and why are they important in walking?
Gluteus medius and minimis.
In walking they act oppose the loss of weight as one leg is lifted to place in front of the other.
What is Trendelenburg's sign, and how is it tested?
Lower spinal nerves are commonly injured by slipped discs:
The disc herniates, and its centre - nucleus pulposus crushes the spinal nerves on the affected side
This affects supply to stablising muscles such as gluteus medius and minimis
To perform the test, ask the patient to raise one leg. A positive test presents as the raised leg sags down, demonstrating weakness in the abductor muscles on the other side
"Sound goes down"
Which muscles laterally rotate the hip?
Piriformis, the Gemellis, Obturator Internus and Quadratus Femoris
What is the nerve and vascular supply to the gluteal region, where do they come from and how are they organised?
Nerves: Divided by piriformis
Above piriformis - Superior gluteal (L4-S1)
Below piriformis - Inferior gluteal (L5-S2), Pudendal (S2-4), Sciatic (L4-S3)
(also posterior and perforating cutaneous)
Vascular: Also divided by piriformis
Above: Superior gluteal artery
Below: Inferior gluteal artery and internal pudendal artery
(All are branches of the Internal Iliac)
Sciatic nerve:
Describe the surface anatomy of the origin of the sciatic nerve and a safe area for administering a gluteal injection?
The sciatic nerve enters the gluteal region between the PSIS and the ischial tuberosity, and leaves between the ischial tuberosity and the greater trochanter of the femur.

Injections are best given by placing your index finger on the ASIS and middle finger on the iliac tuberosity, and injecting between the two.

If administered incorrectly, the patient will report tingling/pain and you may observe 'drop foot'.
List the muscles of the posterior thigh and describe their orientation, giving their blood and nerve supply. Describe what gives the oblique popliteal ligament.
Semitendinosus is the most superficial, medial hamstring.
Semimembranosus lies deep and medial
Biceps lies more lateral (long head from ischial tuberosity, short head from lateral femur)

Blood supply to all is Profunda Femoris.

The oblique popliteal ligament is from semimembranosus and gives support to the back of the knee.
Give the origin and distribution of the nerves of the posterior thigh.
The posterior cutaneous nerve (S2-3) supplies the skin of the posterior thigh and leg.
The Sciatic (L4-S3 is actually the Tibial and Common Fibular nerve in a single sheath).
Give the muscles of the anterior compartment of the thigh, their attachments, blood and nerve supply. Say if they are flexors or extensors. Also give the main cutaneous nerve for the compartment.
Anterior compartment blood and nerve supply = Femoral
Main flexor of hip is Psoas Major, main extensors of the knee are the quadriceps

Cutaneous nerve is the lateral cutaneous (L2,3)
Give the muscles of the medial compartment of the thigh, their attachments, blood and nerve supply.
Define the femoral triangle and subsartorial canal. Give their boundaries and contents.
Femoral triangle:
Superiorly: Inguinal ligament
Laterally: Sartorius
Medially: Adductor Longus
Floor: Iliopsoas, Pectineus and Adductor Longus
Contents: Femoral nerve, Femoral sheath (Artery, Vein, Lymphatics)

Subsartorial canal:
Anteriorly: Sartorius
Posteriorly: Adductor Longus
Floor: Vastus medialis
Contents: Saphenous nerve and femoral vessels
What does the femoral sheath descend from and what is there a risk of due to this? Explain fully, giving the reason why this may become strangulated.
Femoral sheath is a continuation of pelvic fascia.
Risk of a femoral hernia through the Saphenous opening - this can be strangled by the lacunar ligament, which is bad news.
Give the boundaries and contents of the popliteal fossa.
Popliteal fossa is diamond shaped:
Medial: Semitendinosus/membranosus + Gastrocnemius
Lateral: Biceps femoris + Gastrocnemius
Floor: Femur, oblique popliteal ligament and Popliteus

Contents: Popliteal artery (deep) and vein, tibial and common fibular nerves, obturator nerve and posterior cutaneous nerve of thigh.
Give 4 reasons for a swelling in the popliteal fossa.
1) Popliteal aneurysm (pulsatile)
2) Venous thrombosis
3) Enlarged popliteal nodes (hard)
4) Baker's cyst (escaped synovium)
Describe the knee joint, its articulations, nerve and blood supply, action and mechanism for unlocking.
Synovial joint with 3 articulations;
Medial and Lateral Tibio-femoral, plus a Patellar Femoral
2 menisci (discs) supporting the joint
Blood from 5 arteries forming the Genicular anastamoses
Nerve supply from 4 nerves (femoral, obturator, tibial and common fibular)
Action is glide and roll.
Locking is because medial 'C' is bigger than lateral 'O'
Popliteus tendon, with inserts into back of knee in the capsule unlocks the joint as it rotates the femur laterally
Describe the support afforded to the knee joint by the surrounding ligaments (intra- or extracapsular) and menisci
Ligaments - Intracapsular:
Anterior cruciate: Anterior tibial to medial surface of lateral condyle (thinner, damaged more often)
Posterior cruciate: Posterior tibial to lateral surface of medial condyle (thicker, damaged less often)
Meniscofemorals (anterior and posterior)

Ligaments - Extracapsular:
Medial collateral: Inserts onto medial meniscus (damaged more often)
Lateral collateral: Inserts onto fibula
Also Oblique Popliteal and Arcuate

Menisci attached to tibia via Coronary Ligament
Describe the support given to the knee joint by the surrounding muscles.
Lateral muscles:
Biceps, Popliteus, Vastus Lateralis and Iliotibial tract

Medial muscles:
Pes anserinus and Vastus Medialis
What is the 'unhappy triad'?
ACL tear caused by a force exerted lateral to medial on an already weight bearing and extended knee

This in turn also ruptures the medial collateral as this is outside the joint and is already stretched in extension.

The medial collateral inserts onto the medial meniscus, so this also ruptures.
What are the two most important bursae in the knee?
The supra- and infrapatellar.
Where is the ankle joint more stable and why?
In dorsiflexion, due to the shape of the articular surface of the Talus - wider at the front - it is less stable in plantarflexion.
What are the main ligaments supporting the ankle?
Laterally:
Calcaneofibular
Anterior and Posterior Talofibular
Medially:
Deltoid (Tibia to Calcaneus, Navicular and Talus)
Describe the injuries caused by typical 'forced inversions' and 'forced eversions' and state why they happen as they do and which is more common.
Forced inversions most common:
Ruptures lateral ligaments; Calcaneofibular, anterior talofibular and sometimes the lateral malleolus
Less common is the forced eversion:
Here the deltoid is so strong, that the medial malleolus will actually break before the ligament does.
List the keystones of the three arches in the feet.
Medial longitudinal is the biggest:
Calcaneus, Talus, Navicular, Cuneiforms and M1-3

Lateral longitudinal is the less big:
Calcaneus, Cuboid, and M4 and 5

Transverse is the least big:
Cuneiforms, cuboid, and the 5M
Describe ligament support for the arches of the foot and give the bones and corner stones of the longitudinal arches
1. Spring "Plantarcalceonavicular"
2. Long and short medial ligaments
3. Bifurcate - Calcaneus, navicular and cuboid

Most important structure supporting the longitudinal arches is the Plantar Aponeurosis
Arches:
Medial - Calcaneus, Talus, Navicular, Cuneiforms and first three metatarsals
Lateral - Calcaneus, Cuboid and 4th/5th metatarsals
As well as ligaments, what else supports the ankle?
Tendons:
Laterally and transversly the Peroneus longus
Medially the Tibialis Posterior and Flexor Hallucis Longus
What are the muscles of the anterior leg, with their blood and nerve supply?
Blood - Anterior Tibial
Nerve - Deep fibular (L1-4)
What are the muscles of the lateral leg, with their blood and nerve supply?
Blood - Anterior Tibial and Fibular arteries give branches, no inherent supply
Nerve - Superficial fibular (L1-4)
What are the muscles of the posterior deep leg, with their blood and nerve supply?
Blood - Sural arteries
Nerve - Tibial
What are the muscles of the posterior superficial leg, with their blood and nerve supply?
Blood - Sural arteries
Nerve - Tibial nerve (L5-S1)
What are the contents of the tarsal tunnel?
Tom, Dick and A Very Naughty Harry

Tibialis Posterior
Flexor Digitorum Longus
Artery (Posterior Tibial)
Veins
Nerve (Tibial)
Flexor Hallucis Longus
What is the nerve supply to the foot?
Sole:
Medial plantar (Tibial) medial 3.5
Lateral plantar (Tibial) lateral 1.5

Dorsum:
Superficial peroneal (except bit between big toe and 2 toe)

Lateral foot - Sural
Medial foot - Saphenous nerve
What is the arterial supply to the foot?
Anterior and posterior tibial

Anterior becomes Dorsalis Pedis
Posterior gives medial and lateral plantar

Fibular does the posterior and lateral leg

Plantar (from posterior tibial) does sole of foot
Describe venous drainage of the foot and leg.
Venous blood form the superficial fascia travels from the dorsum of the foot, and either travels:

Medially - Great Saphenous Vein
Laterally - Small Saphenous Vein

Terminates by piercing deep fascia at the top of the thigh (Saphenous Opening) to join the femoral vein. Short Saphenous pierces deep fascia to join the Popliteal Vein at the back of the knee.
1. Lateral Cutaneous Femoral (L2-3)
2. Obturator
3. Anterior Femoral Cutaneous (L2-3)
4. Posterior Femoral Cutaneous (S1-3)
5. Middle Cluneal (S1-3)
6. Saphenous Medial (L3-4)
7. Common Fibular Lateral (L4-S2)
8. Superficial Fibular (L4-S1)
9. Deep Peroneal (L4-5)
10. Sural (S1-2)
Lumbar plexus: Give the two nerves, how they branch from the Lumbar plexus and what they supply.
Anterior lumbar plexus - Obturator (L2-4)
Supplies medial muscles

Posterior lumbar plexus - Femoral (L2-4)
Supplies anterior leg, skin (intermediate and femoral cutaneous)
Gives Saphenous to leg and foot

Both arise from in Psoas Major
Describe the Saphenous nerve
Saphenous nerve L3-4
from Cutaneous Femoral
Passes through the adductor canal, supplies skin of knee leg and foot
Injury causes loss of sensation from knee down
Describe the lateral femoral cutaneous nerve
Exits lateral Psoas, enters leg near ASIS under inguinal ligament, supplies lateral thigh
Describe the Sciatic nerve
Two nerves:
Common Fibular (L4-S2), short head of biceps and anterolateral leg
Tibial (L4-S3), hamstrings and sole of foot
Describe the Superior and Inferior Gluteal nerves
Superior (L4-S1)
Supplies Gluteus Medius, Minimis, Tensor Fascia Lata and Hip Joint

Inferior gluteal (L5-S2) supplies Gluteus Maximus
How do you test for sciatica, and what is it?
Damage to the Sciatic nerve, caused by slipped disc or bone damage.
Test, raise leg straight, push on foot (dorsiflexion)
What two factors are said to influence poor communication in health care consultations, which study represents these findings, and what is the result?
Message and relationship:

Message - insufficient info, complexity, poor understanding and lack of organisation of info given.

Leads to poor understanding, recall and satisfaction, ultimately to non-adherence

Relationship - insufficient interest, lack of empathy and involvement in decision making, failure to acknowledge ICE.

Leads to low satisfaction, credibility, poor recall and non-adherence