Lower limb problems III Flashcards
What does the extensor mechanism of the knee consist of
Tibial tuberosity
Patellar tendon
Patella
Quadriceps tendon
Quadriceps muscles
What are the muscles in the anterior compartment of the thigh
Pectineus
Iliopsoas (Iliac, psoas major)
Sartorius
Quadricep femoris (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)
Iliopsoas =
Iliacus + psoas major
What are the quadricep muscles
Rectus femoris
Vastus lateralis
Vastus intermedius (deep to rectus femoris)
Vastus medialis
Name the flexors of the thigh
Pectineus
Iliopsoas
Sartorius
Function of the quadriceps femoris
Extension of the leg
Rectus femoris weakly assists with flexion at hip
Attachment of iliacus
Origin: Iliac fossa
Attachment: Lesser trochanter of femur
Attachment of psoas major
Origin: Lumbar vertebrae T12-L4
Attachment: Lesser trochanter of femur
Function of iliopsoas
Flexion of the thigh at hip joint
Innervation of iliacus
Femoral nerve (L2-L4)
Innervation of psoas major
Anterior rami of L1-L3
Attachment of sartorius
Origin: ASIS
Attachment: Superior medial surface of tibia via pes anserinus bursa
Function of sartorius
Flexion, abduction, lateral rotation of the hip joint
Flexion at the knee joint
Innervation of sartorius
Femoral nerve (L2-L4)
Origin of rectus femoris
AIIS (anterior inferior iliac spine)
All muscles of the quadricep femoris attach to
Patella via quadriceps tendon then to tibial tuberosity via patella tendon
Function of quadriceps femoris
Extension of the leg at knee
Rectus femoris assists with flexion of the hip
Innervation of quadriceps femoris
Femoral nerve
Name A-I
A- Psoas major
B- Pectineus
C- Tensor fascia lata
D- Sartorius
E- Vastus medialis
F- Quadriceps tendon
G- Patellar tendon
H- Rectus femoris
I- Vastus lateralis
Extensor mechanism rupture commonly occurs in
Middle aged who does running / jumping sports
Extensor mechanism rupture =
Patellar tendon / quadriceps tendon rupture
Patellar tendon rupture commonly occurs in
Younger patients <40
Quadriceps tendon rupture commonly occurs in
Older patients >40
Risk factors of extensor mechanism rupture
Previous tendonitis
Steroids (body builders)
Chronic renal failure
Ciprofloxacin / quinolone antibiotics (can cause tendonitis)
Diabetes
RA
Symptoms of extensor mechanism rupture
Knee pain and weakness
Positive straight leg raise test
Clinical signs of extensor mechanism rupture
Positive straight leg raise test
Palpable gap in extensor mechanism
Describe the straight leg raise test for extensor mechanism rupture
- Patient supine, knee fully extended
- Raise the patient’s leg by holding their ankle and one hand stabilising the knee to prevent flexion
Positive = pain
A positive straight leg raise test can also indicate
Lumbar nerve root compression pain
Investigations for extensor mechanism rupture
Xray
US
MRI
Straight leg raise test
Palpable gap
What may xray show in extensor mechanism rupture
High or low lying patella, depending on the rupture
Low lying patella suggests _____ rupture
High lying patella suggests _____ rupture
Low lying patella = quadricep tendon rupture
High lying patella = Patellar tendon rupture
Palpable gap in extensor mechanism may not be present / obvious in _____. What is the solution
Obese patients
Use US to determine the extent of injury
Management of extensor mechanism rupture
Urgent surgical repair
Physio
What should be avoided in extensor mechanism rupture
Steroid injection for tendonitis of the extensor mechanism
What is patellofemoral dysfunction
Disorders of the patellofemoral articulation causing anterior knee pain
Risk factors of patellofemoral dysfunction
Females
Adolescents
Joint hyper mobility
Valgus knee
Cause of patellofemoral dysfunction
Excessive lateral pull of patella due to quadriceps muscles, causing the lateral facet of patella to be compressed against the lateral wall of distal femoral trochlea
Why are females more at risk of patellofemoral dysfunction
Due to wider hips hence more lateral pull of the patella from the quadriceps
Why are adolescents more at risk of patellofemoral dysfunction
Due to ligamentous laxity
Symptoms of patellofemoral dysfunction
Anterior knee pain
Pain worse going downhill
Grinding / clicking sensation
Stiffness after prolonged sitting -> pseudolocking
investigations for patellofemoral dysfunction
Clinical
Management of patellofemoral dysfunction
Physiotherapy
Taping around anterior knee
What are the muscles in the medial compartment of the thigh
Adductor Magnus
Adductor longus
Adductor brevis
Obturator externus
Gracialis
Adductor Magnus can be divided into 2 parts. Which two?
Adductor part
Ischiocondylar part
Attachment of adductor part of adductor Magnus
Origin: Inferior pubic rami
Attachment: Linea aspera, Medial supracondylar line
Attachment of ischiocondylar part of adductor Magnus
Origin: Ischial tuberosity
Attachment: Adductor tubercle of femur
Function of adductor part of adductor Magnus
Adduct the thigh
Flexes the thigh
Function of hamstring part of adductor Magnus
Adduct the thigh
Extends the thigh
Innervation of adductor Magnus
Adductor part - tibial component of sciatic nerve
Ischiocondylar part - obturator nerve
Function of medial compartment of the thigh
All adduct the thigh
(some has other functions)
Innervation of medial compartment of thigh
Obturator nerve except adductor part of adductor Magnus
Function of obturator externs
Adduct the thigh
Lateral rotation of the thigh
Function of gracilis
Adduct the thigh
Weak flexion of leg at knee
Position of adductor brevis in relation to pectineus, adductor Magnus and adductor longus
Adductor brevis is
- deep to Pectineus
- superior and partially deep to adductor longus
- anterior to adductor Magnus
Name A-F
A- Pectineus
B- Adductor brevis
C- Adductor longus
D- Adductor Magnus
E- Adductor brevis
F- Openings for perforating arteries
Name A-G (D= muscle in green)
A- Tensor fascia lata
B- Pectineus
C- Adductor longus
D- Adductor Magnus
E- Vastus lateralis
F- Vastus medialis
G- Gracialis
Name A-G
A- Adductor tubercle
B- Medial epicondyle
C- Intercondylar fossa of femur
D- Medial intercondylar tubercle
E- Intercondylar eminence of tibia
F- Lateral intercondylar tubercle
G- Tibial tuberosity
What are the features of tibia shaft
Anterior - tibial tuberosity, Gerdy’s tubercle
Posterior - soleal line , groove for tendon of tibialis posterior
Lateral- Attachment to interosseous membrane that binds with fibula
What attaches to Gerdy’s tubercle
Iliotibial band
What attaches to the soleal line
Soleus muscle of the posterior compartment of leg