Lower limb - hip/ femur

Question 1

there is a fovea on the head of the femur. what is this for?

Answer 1

Ligamentum teres (intra-articular) passes through - containing obturator artery

Question 2

what is the consequence of an intracapsular femoral neck fracture?

Answer 2

avascular necrosis

Question 3

which structures pass through the greater foramen of the hip?

Answer 3

sciatic nerve which is posterior to the piriformis muscle

Question 4

what are the extra-articular ligaments of the hip joint?

Answer 4

iliofemoral (Y-shaped inserts into intertrochanteric line)
- prevents hyperextension of the hip
pubofemoral - resists excessive abduction
(also inserts on intertrochanteric line)
ischiofemoral - found posteriorly inserts on neck of femur - resists internal rotation

Question 5

where is the capsule of the hip joint attached?

Answer 5

all the way round the acetabular labrum

Question 6

what type of joint is the hip joint?

Answer 6

ball & socket - multiaxial more limited range of motion

Question 7

what is the action of the gluteus maximus muscle and give its innervation

Answer 7

main extensor of the thigh and assists with lateral rotation

- inferior gluteal nerve (L5, S1, 2)

Question 8

what is the action of the gluteus medius muscle and give its innervation

Answer 8

medial rotation and abduction
(posterior fibres - lateral rotation)
- superior gluteal nerve

Question 9

what is the action of the gluteus minimus muscle and give its innervation

Answer 9

medial rotation and abduction

- superior gluteal nerve

Question 10

what is the effect of damage to superior gluteal nerve?

Answer 10

paralysis of gluteus minimus and medius

• pelvic drop (positive trendelenburg)
• gluteal gait (waddle)

Question 11

what is the effect of damage to inferior gluteal nerve?

Answer 11

paralysis of gluteus maximus

- unable to stand up from sitting

Question 12

what is the action of tensor fasciae latae?

Answer 12

assists gluteus medius and minimus in abduction and medial rotation
(superior gluteal nerve - L4,5, S1)

Question 13

what are the short hip rotator muscles?

Answer 13

obturator internus
quadrator femoris
superior/ inferior gemellus
piriformis

Question 14

give origin/ insertion/action of quadrator femoris

Answer 14

arise from ischial tuberosity and isnerts into intertrochanteric crest

• lateral rotation only
• innervated by nerve to quadrator femoris

Question 15

give origin/ insertion/action of gemelli superior/ inferior

Answer 15

arise from ischium and inserts on greater trochanter of femur

• separated by tendon of obturator internus
• The superior gemellus muscle is innervated by the nerve to obturator internus, the inferior gemellus is innervated by the nerve to quadratus femoris.
• lateral rotation and abduction at hip joint

Question 16

give origin/ insertion/action of piriformis

Answer 16

arises from sacrum (passes through greater sciatic foramen) and inserts on greater trochanter of femur

• lateral rotation of hip and abduction
• innervated by nerve to piriformis

Question 17

give origin/ insertion/action of obturator internus

Answer 17

arise from the pubis and ischium at the obturator foramen, travels through the lesser sciatic foramen, and attaches to the greater trochanter of the femur
- lateral rotation and abduction

Question 18

what could pain in the buttock indicate?

Answer 18

compression of sciatic nerve by piriformis

Question 19

what muscles form the hamstrings?

Answer 19

biceps femoris (long head)
semimembranous
semitendinous

Question 20

give origin/ insertions/ action/ innervation of long head of biceps femoris

Answer 20

arises from ischial tuberosity and inserts on lateral side of head of fibula

• innervated by tibial nerve
• produces flexion of knee joint/ extension of hip joint - lateral rotation when knee is flexed

Question 21

give origin/ insertions/ action/ innervation of short head of biceps femoris

Answer 21

arises from the linea aspera and inserts on head of fibula

- innervated by common fibular nerve and produces knee flexion and hip extension

Question 22

give origin/ insertions/ action/ innervation of semimembranous

Answer 22

arise from ischial tuberosity and inserts on medial tibial condyle

• innervated by tibial nerve
• extension at hip joint/ flexion at knee joint

Question 23

give origin/ insertions/ action/ innervation of semitendinous

Answer 23

arise from ischial tuberosity and inserts on medial surface of tibia

• innervated by tibial nerve
• extension at hip joint/ flexion at knee joint, also rotates medially when knee is flexed

Question 24

which nerves supply the skin of the gluteal region?

Answer 24

superior/ middle/ inferior cluneal nerves

Question 25

which nerve supplies the skin of the posterior thigh and calf?

Answer 25

posterior cutaneous nerve

Question 26

what muscles form the borders of the popliteal fossa?

Answer 26

semimembranous (superomedial)
biceps femoris (superolateral)
gastrocnemius - medial head (inferomedial)
gastrocnemius - lateral head (inferolateral)

Question 27

what forms the roof and floor of the popliteal fossa?

Answer 27

roof - popliteal fascia and skin

floor - posterior surface of knee capsule and posterior surface of femur

Question 28

what is found in the popliteal fossa?

Answer 28

popliteal artery
popliteal vein
tibial and common fibular nerve
(small saphenous vein)

Question 29

what is the effect of a popliteal aneurysm?

Answer 29

dilation of popliteal artery

compression of tibial nerve - paresthesia/ weakened plantar flexion

Question 30

what is a baker’s cyst?

Answer 30

inflammation/ swelling of semimembranous bursa -which can rupture leading to similar symptoms of DVT

Question 31

where is the lateral malleolus?

Answer 31

end of fibula

Question 32

what are the superficial muscles of the posterior compartment in the leg?

Answer 32

gastrocnemius (medial/ lateral head) - arises from medial/ lateral condyle of femur and insert into posterior calcaeus via tendon = plantarflexion of ankle when knee extended
plantaris - minor role- proprioception
soleus - plantarflexion

Question 33

what are the deep muscles of the posterior compartment in the leg?

Answer 33

popliteus
flexor digitorum longus - flexes lateral 4 digits/ plantarflexion of ankle
tibialis posterior - plantarflexion of ankle
flexor hallucis longus - flexor of joints in big toe

Question 34

which two muscles form the lateral compartment of the leg?

Answer 34

fibularis longus - eversion/ plantarflexion
fibularis brevis - eversion
(innervated by superior fibular nerve)

Question 35

how does foot drop occur?

Answer 35

fracture to fibular neck - severs the common fibular(peroneal) nerve so paralysis of anterior/ lateral compartments so loss of dorsiflexion = foot drop/ gait

Question 36

what is the effect of entrapment of the superior fibular nerve?

Answer 36

pain on lateral side of ankle - numbness / paresthesia