Clinical anatomy of the hip and knee

Question 1

what are the hip extensors? ?

Answer 1

gluteus maximus 
hamstrings;
- semitendinous 
- semimembranous
- biceps femoris

Question 2

what is the nerve supply of the gluteus maximus and what is its action?

Answer 2

hip extensor, abductor and externally rotates hip

inferior gluteal nerve

Question 3

what is the nerve supply of the semitendinous muscle and what is its function?

Answer 3

hip extensor

sciatic nerve

Question 4

what is the nerve supply of the semimembranous muscle and what is its function?

Answer 4

hip extensor

sciatic nerve

Question 5

what is the nerve supply of the biceps femurs and what is its function?

Answer 5

hip extensor

sciatic nerve

Question 6

what are the hamstring muscles and what is their nerve supply?

Answer 6

semitendinous
semimembranous
biceps femoris
- sciatic nerve

Question 7

what are the hip flexors?

Answer 7

psoas major 
iliac 
rectus femoris 
sartorius 
pectineus

Question 8

what is the nerve supply of the psoas major and what is its function?

Answer 8

hip flexor

femoral nerve - L1 ventral ramus

Question 9

what is the nerve supply of the rectus femoris and what is its function ?

Answer 9

femoral nerve

hip flexor

Question 10

what is the nerve supply of the sartorius and what is its function?

Answer 10

hip flexor

femoral nerve

Question 11

what is the nerve supply of the pectineus and what is its function?

Answer 11

hip flexor

femoral nerve

Question 12

what are the hip abductors and what is their nerve supply?

Answer 12

gluteus medius 
gluteus minimus 
gluteus maximus 
tensor fascia latae 
- all superior gluteal nerve

Question 13

what is a clinical sign of damage to the gluteus medius and how does this occur?

Answer 13

gluteus medius is the most important hip abductor
- Trendelenberg sign

when you stand on one leg, if G.M. isn’t working then the hip with the pathology will drop and you have to physically swing your body over to the opposite side to prevent from falling over

Question 14

what are the hip adductors and what is their blood supply?

Answer 14

adductor longus
adductor brevis
adductor magnus (+ sciatic nerve)
graciali

• all obturator nerve

Question 15

what are the hip internal rotators and their nerve supply?

Answer 15

anterior fibres of gluteus medius
tensor fascia latae
- superior gluteal nerve

Question 16

what are the hip external rotators?

Answer 16

gluteus maximus 
piriformis 
superior gemellus 
inferior gemellus 
obturator internus
obturator externus
obturator femoris

Question 17

what is a sign on x-ray of a fractured neck of femur?

Answer 17

loss of shenton’s line

- but not all fractures of the neck of femur cause loss of shentons line

Question 18

what is the most common location of dislocation of the hip?

Answer 18

posterior

Question 19

what is the blood supply to the head of the femur?

Answer 19

capsule; medial and lateral circumflex femoral arteries (branch of profunda femoris)
ligamentum teres via acetabular branch of obturator artery
intramedullary

Question 20

in what type of fracture is the blood supply to the head of the femur compromised?

Answer 20

intra capsular

Question 21

what is the angle of the neck shaft of the femur?

Answer 21

130 degrees

126-139

Question 22

what is the acetubular ante version and femoral ante version angle of the femur?

Answer 22

20 degrees - acetabular

15 degrees - femoral

Question 23

what factors help to stabilise the hip joint?

Answer 23

• Deep socket for joint
• Anteversion of ball and socket
• Acetubular Labrum
• Negative intra articular pressure
• Musculature

Question 24

what is the difference in the management of someone with an intra-capsular fracture compared to someone with an extra-capsular fracture?

Answer 24

with an extra articular fracture the blood sup will still be intact therefore always fix

if its intra capsular then the blood supply is compromised
treat on an individual basis: 
undisplayed = fix
displaced and young = fix 
displaced and old = replace

Question 25

what type of bone is the patella?

Answer 25

sesamoid

Question 26

are people more prone to getting arthritis in the medial or lateral side of the knee joint and why?

Answer 26

medial | when weight bearing 60% goes to the medial side and only 40% to the lateral

Question 27

what ligaments are found within the knee joint ?

Answer 27

anterior and posterior cruciate ligaments medial and lateral collateral ligaments medial and lateral menisci

Question 28

what is responsible for shock absorption in the knee joint?

Answer 28

medial and lateral menisci | fibrocartilage

Question 29

what are the extensors of the knee?

Answer 29

``` (quadriceps) rectus femoris vastus medialis vastus lateralis vastus intermedius ```

Question 30

what are the flexors of the knee?

Answer 30

hamstrings: - biceps femoris - semitendinosus - semimembranosus - gastrocnemius (S1 nerve innervation)

Question 31

what is the functions of the menisci of the knee joint?

Answer 31

shock absorption proprioception load transmission stability

Question 32

give examples of knee injuries.

Answer 32

``` meniscal tears ligament injuries Oosteochondral defect lesions loose bodies fractures quadriceps/patellar tendon ruptures ```

Question 33

what is an evulsion fracture?

Answer 33

when soft tissues tear off bit of their bony attachment

Question 34

what would you see on an X-ray of an anterior cruciate ligament (ACL) injury?

Answer 34

haemarthrosis (bleeding into joint space) | segond fracture

Question 35

what is a second fracture?

Answer 35

a type of avulsion fracture occurs at the lateral epicondyle of the tibia usually due to ACL injuries

Question 36

how does an ACL injury typically occur?

Answer 36

knee buckles during pivot

Question 37

what are the 4 signs of osteoarthritis on x-ray?

Answer 37

reduced joint space sub chondral sclerosis sub chondral cysts osteophytes

Question 38

with a knee dislocation what are you most worried about and what is the immediate actions?

Answer 38

worried about damage to the popliteal artery and neurological impairment reduce it first then x-ray (don't wait to reduce the dislocation)