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MSK > The thigh and leg > Flashcards

The thigh and leg Flashcards

1
Q

Where are they hamstrings located?
What is their main function?
Which muscles are included?

A 
Posterior thigh 
To extend the hip and flex the knee
Semimembranosus 
Semitendinosus 
Biceps femoris
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2
Q

Which nerve innervate most of the hamstrings?

What’s the exception?

A

The tibial (medial) division of the sciatic nerve

The short head of the biceps femoris is innervated by the common fibular/peroneal division (because it’s more lateral)

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3
Q

Which muscle has a hamstrings component, but is not classed as belonging to the hamstrings?

Why is this the case?

A

Adductor magnus

  • Shares the same common embryonic origin as the hamstrings
  • the hamstrings component originates from the ischial tuberosity
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4
Q

What’s the common origin of the hamstrings?

What’s the exception?

A

Ischial tuberosity

The short head of the biceps femoris originates form the linea aspera on the back of the femur

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5
Q

Which tendon can be palpated laterally at the back of the knee?

A

Common (insertion) tendon of the long and short head of biceps femoris

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6
Q

Where do semimembranosus and semitendinosus insert?

Which action do they perform in addition to the shared role of the quadriceps?

A

The medial tibial condyle

Medially rotate the thigh at the hip and the leg at the knee

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7
Q

Which muscles
extend the knee
flex the knee

A

quadriceps extend the knee

hamstrings flex the knee

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8
Q

Which muscle of the hamstrings is part of pes anserinus?
What is this?
What does it literally mean?
Where is it?

A

semitendinosus

it means goose’s foot and refers to the common insertion of three muscles by their conjoined tendons

  • sartorius
  • gracilis
  • semitendinosus

anteromedial aspect of the tibia

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9
Q

How can sprinting without warming up cause an avulsion?

A

Sprinting, lunging and jumping engage the hamstrings muscles which extend the hip and flex the knee

Sudden tension can cause a complete tear from the ischial tuberosity and a fragment of bone to be torn off when the tendon is ripped free

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10
Q

How do tendons and ligaments attach?

A

tendon- muscle to bone

ligament- bone to bone

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11
Q

What causes osteoarthritis?

How is it defined clinically?

A

Breakdown of hyaline cartilage coating the articular surfaces of synovial joints

Joint pain with limited function and a reduced quality of life

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12
Q

Primary vs secondary osteoarthritis?

A

Primary has an unknown cause

Secondary is caused by a pre-existing condition. E.g obesity, infection, malalignment or inflammatory arthritis

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13
Q

How can haemophilia cause osteoarthritis?

A

bleeding into the joints

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14
Q

What is charcot joint?

What is ankylosing spondylitis?

A

Progressive degeneration of a weight bearing joint (usually the foot) due to neuropathy and loss of sensation

Type of inflammatory arthritis characterised by bony fusion across the joints (bamboo spine)

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15
Q

Crepitus is a common symptom of OA, what is it?

A

grinding of the joint

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16
Q

4 signs of OA on an X-ray?

A 
- subchondral sclerosis 
(very white due to increased bone density)
- reduced joint space 
- osteophytes 
- bone cysts
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17
Q

What is eburnation?

What do osteophytes develop from?

A

process where the subchondral bone becomes thickened and denser at areas of pressure. (Ebony-like)
Seen as subchondral sclerosis on X ray

connective tissue along the edges of the joint (articular margins) undergoes osseous metaplasia

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18
Q

Why do subchondral bone cysts develop in OA?

A

(fluid filled sacs)

  • Either due to osseous necrosis due to chronic impaction
  • or intrusion of synovial fluid as the subchondral bone is damaged
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19
Q

Explain how the cartilage is gradually worn away in osteoarthritis

A
  • precipitating risk factors causes excessive or uneven loading of the joint
  • damages the hyaline cartilage
  • chondrocytes increase proteoglycan synthesis and in number. The cartilage is swollen
  • eventually the proteoglycan content falls and cartilage softens and loses elasticity. Flaking and fibrillation of cartilage
  • cartilage is eroded down to the subchondral bone, causing loss of joint space
20
Q

Osteorthritis of the hip is most common in who?
What are the symptoms?
What is the cure?

A

Men over 40 years old

Mechanical pain- worse with movement 
Stiffness
Crepitus (grinding)
Reduced mobility 
Pain in the hip radiating to knee (obturator nerve)

The only cure is a hip replacement
Note; hemiarthroplasty is the femoral head only

21
Q

How can orthotic footwear help an osteoarthritic hip?

Why is weight loss important if the patient is obese?

A

Rebalance a misaligned load through the joint

A force equivalent to 6x body weight passes through the hips and knees

22
Q

What do steroid injections do in OA?

What is viscosupplementation?

A

They reduce inflammation/ swelling in the joint to ease pain and stiffness

Injections of hyaluronic acid to increase lubrication of the joint

23
Q

NOF means?

A

fractured Neck Of Femur

- fracture in the proximal femur (the inferior margin is 5cm below the lesser trochanter)

24
Q

Two types of extracapsular neck of femur fractures?

Avascular necrosis of the femoral head is extermely likely in _____ ___-capsular fractures.
Why?
How is this fracture treated?

A

intertrochanteric- between the tubercles (oblique)
subtrochanteric- below the tubercles

Displaced, intracapsular fractures of the femoral head are likely to disrupt the ascending cervical branches of the MFCA (lead to the head). Ligamentum teres is unable to sustain the metabolic demand of the femoral head
*medial femoral circumflex artery

Femoral head/ full hip replacement (head and acetabulum) due to the rick of necrosis

25
Q

Who is more likely to experience an

  • intracapsular fracture
  • extracapsular fracture
A
  • the elderly after a fall, especially women (post-menopausal with osteoperosis)
  • young and middle aged due to excessive force. E.g. a road traffic collision
26
Q

What does the leg look like in a displaced, fractured neck of femur? (#NOF)
Why?

How does the axis of rotation change? What does this cause?

A

shortened, abducted, externally rotated
The fracture causes the femoral shaft to move independently to the hip joint.

The axis of rotation now passes vertically down the shaft, inferior to the greater trochanter (instead of obliquely through the femoral head and neck).

  • Causes external rotation about the new axis
  • The deep gluteal muscles/ short rotators contract and the shaft laterally rotates
  • Iliapsoas (inserts on the lesser trochanter) pulls the femur anteriorly about the new axis, causing lateral rotation
  • the abductors (gluteus minimus and medius) insert on the greater trochanter and cause lateral rotation about the new axis (usually cause medial rotation)
27
Q

In a displaced #NOF the limb is shortened, abducted and externally rotated?
Why is it shortened?
Why abducted?

A

The fracture allows the femur to move independently to the hip joint

Shortened bc strong muscles of the thigh pull the distal fragment upwards.
E.g., rectus femoris, adductor magnus, hamstrings

Femur is abducted by the gluteus medius and minimus (abductors) which attach to the greater trochanter

28
Q 
Actions of the deep gluteal muscles; 
Tensor fascia lata 
Gluteus maximus 
Gluteus minimus 
Gluteus medialis

Which muscle does not share the same innervation?

A

Tensor fascia lata

  • Stabilises the knee
  • Assists with hip extension and abduction

Maximus
Hip extension, assists with abduction

Medialis and Minimus
- abduct and medially rotate the thigh

Gluteus maximus is innervated by the inferior gluteal nerve, whilst the others are the superior gluteal nerve

29
Q

Anterior/ posterior- which hip dislocation is more common?

In which is the limb

  • externally rotated
  • internally rotated

How is the limb rotated after a displaced #NOF?

A

Posterior dislocations account for 90% of total

  • anterior dislocation / a displaced fractured neck of femur
  • posterior dislocation
30
Q

What is DDH in children?

A

Developmental dysplasia of the hip; the joint doesn’t form properly and can cause dislocations

31
Q

How do hip dislocations most often occur?

What does central dislocation mean?
Why can it be life threatening?

A

road traffic collisions (lots of force)

The femoral head has been driven through the acetabulum and into the pelvis- a fracture disclocation
(palpable on rectal examination).

High risk of intrapelvic haemorrhage due to disruption of the pelvic venous plexuses

32
Q

What does the limb look like after a posterior hip dislocation?
Explain why

Which nerve palsy can occur?

A

Shortened, adducted and internally rotated

Femoral head pushed backwards to lie on the lateral surface of the ilium

  • Extensors (hamstrings, gluteus maximus) pull the femur upwards
  • Anterior fibres of gluteus minimus and medialis pull on the posteriorly displaced greater trochanter to cause internal rotation

sciatic nerve palsy (posterior)

33
Q

Where does the anterior cruciate ligament attach on the femur and tibia?

Where does the posterior cruciate ligament attach on the femur and tibia?

A

Femur- Medial aspect of the lateral condyle
Tibia- intercondylar eminence

Femur- lateral aspect of the medial femoral condyle and the posterior aspect of the intercondylar area

PaM’s AppLes

  • posterior attaches to medial condyle
  • anterior attaches to lateral condyle
34
Q

Why does the shaft of the femur descend medially?

What does the linea aspera become proximally?

A

to bring the knees closer to the body’s centre of gravity; increasing body stability

medially- pectineal line
laterally- gluteal tuberosity

35
Q

Which muscle inserts on the adductor tubercle?

Where is this?

A

Adductor magnus

The adductor tubercle is at the end of the medial supracondylar line of the posterior femur

36
Q

Why is the medial femoral condyle larger than the lateral condyle?

The lateral condyle is more ___, why is this advantageous?

A

Because it bears more weight in the standing position as the body’s centre of gravity passes medially to the knee

more prominent which prevents lateral displacement of the patellar. People with flatter lateral condyles have greater patellar instability

37
Q

The patellar is what type of bone?

What does the patellar apex and base attach to?

A

sesamoid because it is within the quadriceps tendon

apex is inferior
quadriceps tendon inserts on the base
patellar ligament attaches to the apex

38
Q

How does the patellar articulate with the femur?

A

posterior surface of the femur has two facets; the medial facet (larger) articulates with the (larger medial condyle of the femur and vice versa

39
Q

Three main functions of the patella?

A

Protects the anterior knee

Stabilises- reduces frictional forces on the epicondyles

(Major function) leg extension
- Increases the leverage the quadriceps can exert on the femur bc quadriceps tendon crosses over it (acts as a fulcrum)
‘increase the mechanical efficiency of the muscle’

40
Q

Articulations of the tibia?

A

Tibia and femur
- tibial plateau (tibial condyles) articulate with femoral condyles
Note; this is the main articulation of the knee joint
- intercondylar tubercles of the tibia and the intercondylar fossa of the femur

Tibia and fibular 
- proximal tibiofibular joint 
(lateral condyle of tibia)
- inferior tibiofibular joint  
(fibular notch of the tibia)
41
Q

What are the intercondylar tubercles of the tibia?

What do they articulate with?

A

Raised portions either side of the intercondylar eminence and medial to the condyles
The intercondylar fossa of the femur

42
Q

The tibia and fibula are shaped like ___?

They have how many borders?

A

prisms

three borders- anterior, posterior, lateral

43
Q

Medial malleolus
Lateral malleolus
Which bones are they on?
What do they articulate with?

A

tibia
fibula

medial malleolus- tarsal bones to form ankle joint
lateral malleolus- talus bone of foot

44
Q

What markings are on the tibial borders?

A

Anterior border-
tibial tuberosity where the patellar ligament inserts

Posterior- soleal line which blends into the medial edge; attachment for the soleus muscle

Lateral border/ interosseus border (faces the fibula) where the interosseus membrane attaches which binds the tibia and fibula together

45
Q

What happens at the fibula notch?

A

The fibula notch of the tibia is where the tibia and femur articulate- the inferior tibiofibular joint

46
Q

What’s the main function of the fibula?

3 articulations?

A

Muscle attachment NOT weight bearing

Proximal tibiofibular joint
Inferior tibiofibular joint
Articulates with talus bone in ankle joint

47
Q

Which nerve is vulnerable to damage in a proximal fibular fracture?
Why?

A

common peroneal/fibular nerve

bc it winds round the posterior and lateral surface of the neck of the fibula

MSK (10 decks)

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