1. Review of the lower limb

Question 1

What is the hip joint composed of?

Answer 1

The femoral head and the acetabulum

Question 2

What is the relative stability of the hip joint?

Answer 2

This is a very very stable joint

Question 3

What is the difference between the surgical neck and the anatomical neck?

Answer 3

Anatomical neck - region located just inferior to the anatomical head
Surgical neck - the area of the bone that breaks most often

Question 4

Where are the anatomical and the surgical necks of the femur located?

Answer 4

The anatomical and surgical necks of the femur are both the same

Question 5

Where on the femur do muscles attach?

Answer 5

Greater and lesser trochanter

Question 6

What is shenton’s line?

Answer 6

Continuous arch drawn underneath the superior pubic ramus and the inferomedial border of the neck of the femur

Question 7

What dislocation generally occurs at the hip and why is this more common?

Answer 7

Posterior dislocation due to the very strong ilio-femoral ligament which is anterior to the hip joint
This is one of the strongest ligaments of the body

Question 8

What are the three major ligaments of the hip joint?

Answer 8

Ilio-femoral ligament - main one to be aware of:
Anterior to the hip joint
Y-shaped ligament

Pubo-femoral ligament

Ischo-femoral ligament

Question 9

What is the ligamentum teres of the hip?

Answer 9

This is a ligament within the hop joint itself - within the acetabulum (to the head of the femur)
This ligaments helps to keep the femoral head in the socket

Question 10

Which muscles attach to the greater trochanter of the femur?

Answer 10

Tendons of the:
Gluteus medius 
Gluteus minimus 
Piriformis 
Obturator internus 
Gemelli

Question 11

Which muscles attach to the lesser trochanter of the femur?

Answer 11

Tendons of the:
Iliacus
Psoas major

Question 12

How do the ligaments of the hip work to ensure stability and allow movement of the hip joint?

Answer 12

When the leg moves anteriorly and is flexed, these ligaments are relaxed and slack
When the leg moves backwards, the ligaments twist and turn and this moves the femoral head further into the acetabulum

Question 13

What is the blood supply to the lower limb?

Answer 13

External iliac artery from the common iliac artery (also have the internal iliac artery)
Continues on as the femoral artery to the popliteal artery
Splits to the anterior and posterior tibial arteries
(Very good explanation in the anatomy colouring book)

Question 14

What is the blood supply to the hip joint?

Answer 14

Deep artery of the thigh branches early from the femoral artery (aka. profunda femoris artery)
Medial circumflex artery branch from the femoral
Lateral circumflex artery branch from the femoral
Artery to the head of the femur

The majority of the blood supply to the hip joint is from the circumflex arteries

Question 15

What is the issue with artery to the head of the femur?

Answer 15

This is not very important in adults - does not provide enough blood supply to the head of the femur by itself

Question 16

What is the clinical significance of a fracture to the neck of the femur?

Answer 16

A fracture to the neck of the femur can result in avascular necrosis to the head of the femur
This is because the fracture can disrupt the blood supply from the profunda femori and the circumflex arteries and the artery to the head of the femur does not supply enough blood to compensate for this

Question 17

Which ligaments result in the formation of the greater and lesser foramina?

Answer 17

The sacrospinous ligament - superior

The sacrotuberous ligament - inferior

Question 18

What passes through the greater scaitic foramen?

Answer 18

7 nerves:
Sciatic Nerve:
Superior Gluteal Nerve:
Inferior Gluteal Nerve:
Pudendal Nerve:
Posterior Femoral Cutaneous Nerve
Nerve to Quadratus Femoris
Nerve to Obturator Internus

3 Vessel Sets:
Superior Gluteal Artery & Vein
Inferior Gluteal Artery & vein
Internal Pudendal Artery & vein

1 Muscle:
Piriformis

Question 19

Where in the bum would you apply an intramuscular injection to the gluteus maximus muscle and why?

Answer 19

In the upper outer quadrant of the gluteal quadrants

Apply here to ensure you avoid the sciatic nerve (also to avoid the inferior and superior gluteal nerves but not as major)

Question 20

What is the function of the gluteus maximus?

Answer 20

Extension of the hip

Lateral rotation of the hip

Question 21

What is the function of the gluteus minimus and medius?

Answer 21

Abduction of the hip

Question 22

What is the innervation of the gluteus maximus?

Answer 22

Inferior gluteal nerve

Question 23

What is the innervation of the gluteus minimus and medius?

Answer 23

Superior gluteal nerve

Question 24

Where does the gluteus maximus insert into?

Answer 24

3/4 inserts into the iliotibial tract

1/4 inserts into the gluteal tuberosity of the femur

Question 25

What is the function of the piriformis muscle and what is the nerve root for this?

Answer 25

Aids the gluteus maximus with lateral rotation of the hip - also done by other lateral rotator muscles Nerve root for this group of muscles: L5, S1, S2

Question 26

What is the trendelenburg test?

Answer 26

To test for damage to the hip abductors i.e. the superior gluteal nerve going to the gluteus minimus and maximus If there is damage then the hip will drop on the unaffected side

Question 27

What are the different compartments of the thigh?

Answer 27

Anterior compartment Medial compartment Posterior compartment

Question 28

What muscles are contained in the anterior compartment of the thigh, what is their function and what is the nerve supply?

Answer 28

Quads - hip flexion and knee extension Also iliopsoas (psoas major and iliacus) and sartorius Femoral nerve - L2, 3, 4

Question 29

What muscles are contained in the medial compartment of the thigh and what is the nerve supply?

Answer 29

Adductors (adductor magnus, longus, brevis) (biggest to smallest) and gracilis - hip adduction Obturator nerve - L2, L3, L4

Question 30

What muscles are contained in the posterior compartment of the thigh and what is the nerve supply?

Answer 30

Hamstrings - hip extension and knee flexion Sciatic nerve (tibial division) - L5, S1, S2

Question 31

What are the nerves coming off of the lumbar plexus?

Answer 31

``` Subcostal Iliohypogastric Ilioinguinal Genitofemoral Lateral cutaneous nerve of the thigh Obturator Femoral ```

Question 32

What are the motor nerves of the lumbar plexus?

Answer 32

Obturator | Femoral

Question 33

What are the nerve roots of the lumbar plexus?

Answer 33

L1-L4

Question 34

Where is the inguinal ligament located?

Answer 34

At the border of the external oblique muscle

Question 35

What is found just inferior to the inguinal ligament?

Answer 35

The femoral NAVL - passes through here to move into the anterior compartment

Question 36

What are the common attachments of the hamstring muscles?

Answer 36

Hamstrings origin at the ischial tuberosity Distal attachment on the tibia

Question 37

What are the different hamstring muscles and how can you tell these apart from each other?

Answer 37

Semitendinosus Semimembrnosus Biceps femoris (long head) Semembranosus is more medially located with a larger membranous part superiorly Semitendinosus - more laterally located with a longer tendon Biceps femoris has a long head and a short head

Question 38

What is the 'pes anserinus'?

Answer 38

This is the insertion of the sartorius, gracilis and the semitendinosus - located medially just inferiolaterally to the patella

Question 39

What are the borders of the femoral triangle? What is the clinical significance of the femoral triangle?

Answer 39

Inguinal ligament - superior Sartorius - lateral Adductor longus - medial Hernias are common through here in women

Question 40

What passes through the femoral triangle?

Answer 40

``` NAVL Femoral nerve Femoral artery Femoral vein Deep inguinal nodes and lymphatics ```

Question 41

What are the three bones that compose the knee joint?

Answer 41

Femur Tibia Patella

Question 42

What are the three articulations of the knee joint?

Answer 42

Patella and femur Lateral femoral and tibial condyles - meniscus Medial femoral and tibial condyles - meniscus

Question 43

What does the stability of the knee depend on?

Answer 43

Surrounding muscles and tendons | Ligaments joining the femur and the tibia

Question 44

What are the menisci of the knee and what is their function?

Answer 44

Lateral and medial menisci to increase the strength of the knee joint Increase strength and important for shock absorption

Question 45

What is the difference between the medial and the lateral menisci?

Answer 45

Medial is C-shaped Broad posteriorly Anterior attached to the ACL Lateral is nearly circular Smaller and more freely movable Attached to the PCL

Question 46

What are the collateral ligaments of the knee and what is their function?

Answer 46

These are lateral and medial ligaments of the knee that act to stabilise the hinge-like movement of the joint Fibular/lateral collateral ligament Tibial/medial collateral ligament

Question 47

What is the posterior cruciate ligament and what is it's function?

Answer 47

Internal ligament of the knee at the posterior aspect Stops the tibia from moving back on the femur Helps to stabilise the knee, especially in flexion Prevents the tibia from twisting outwards in external rotation

Question 48

What is the anterior cruciate ligament and what is it's function?

Answer 48

Internal ligament of the knee at the anterior aspect Stops the tibia from moving forward on the femur Stabilises the knee in extension and prevents hyperextension and excessive internal rotation

Question 49

Which is the stronger cruciate ligament of the knee?

Answer 49

The posterior cruciate ligament

Question 50

What is the unhappy triad?

Answer 50

Three common knee injuries: Anterior cruciate ligament (ACL) Medial collateral ligament (MCL) Medial meniscus

Question 51

What are the clinical tests to assess the cruciate ligaments?

Answer 51

The anterior and the posterior draw tests

Question 52

What are the two nerves resulting from the sciatic nerve and where does this occur?

Answer 52

Sciatic nerve splits to the common peroneal nerve and the tibial nerve just above the popliteal fossa

Question 53

What is the sural nerve?

Answer 53

This is a small nerve forming from the joining of the peroneal nerve and the tibial nerve

Question 54

What structures pass through the popliteal fossa?

Answer 54

Popliteal artery (deep) and vein Sciatic nerve - bifurcates at the superior angle of the popliteal fossa to the tibial and the common fibular/common peroneal nerve Tibial nerve continues through popliteal fossa Small saphenous vein terminates here

Question 55

What are the borders of the popliteal fossa?

Answer 55

Medial: semi-membranosus and gastrocnemus Lateral: Biceps femoris and plantaris Roof: deep/popliteal fascia, superficial fascia, skin Floor: Popliteal surface of femur, capsule of knee joint, strong fascia of popliteus muscle

Question 56

Which muscle is located anterior to the popliteal fossa?

Answer 56

Popliteus muscle

Question 57

What are the different compartment of the leg?

Answer 57

Anterior compartment Posterior compartment Lateral compartment

Question 58

What is the function of the anterior compartment of the leg and what is the nerve and blood supply?

Answer 58

Dorsiflexion and extension of digits Deep peroneal nerve Anterior tibial artery

Question 59

What is the function of the posterior compartment of the leg and what is the nerve and blood supply?

Answer 59

Plantarflexion and flexion of digits Tibial nerve Posterior tibial artery

Question 60

What is the function of the lateral compartment of the leg and what is the nerve and blood supply?

Answer 60

Eversion Superficial peroneal nerve Fibular artery

Question 61

What are the two branches of the sciatic nerve?

Answer 61

``` Tibial nerve (posterior comp) Common fibular/common peroneal nerve (anterior and lateral compartments of leg) ```

Question 62

What are the three bones involved in the ankle joint?

Answer 62

Tibia Fibula Talus

Question 63

What bone forms the heel of the foot?

Answer 63

Calcaneus

Question 64

What are the ligaments of the ankle?

Answer 64

Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament (lateral) Deltoid ligament (medial)

Question 65

What is the blood supply to the neck and the head of the femur?

Answer 65

The medial circumflex artery

Question 66

Avascular necrosis to the femoral head can occur when which artery is damaged?

Answer 66

The medial circumflex artery