Inside major lower limb joints

Question 1

Teres

Answer 1

Sausage-shaped

Question 2

Valgus

Answer 2

Deformity away from midline

Question 3

Varus

Answer 3

Deformity towards midline

Question 4

Genu valgus

Answer 4

Knock-knees

Question 5

Genu varus

Answer 5

Bow legs

Question 6

Coxa valgus

Answer 6

Increased angle between femoral neck and shaft

Question 7

Coxa varus

Answer 7

Angle between femoral head and shaft is less than 120 degrees

Question 8

Ligaments

Answer 8

Connect bone to bone

Question 9

What is the innominate bone made from?

Answer 9

Ischium, ilium and pubic bone

Question 10

What is the acetabulum fossa?

Answer 10

Depressed articular surface where bones meet

Question 11

What are the trochanters?

Answer 11

Two tubercles, have greater and lesser trochanters

Question 12

What is the trochanteric crest?

Answer 12

Connects trochanters

Question 13

What is the intertrochanteric fossa?

Answer 13

Gap between condyles

Question 14

Key features of innominate bone

Answer 14

• Acetabular fossa
• U-shaped articular surface
• Superior pubic ramus
• Anterior iliac spine
• Ischial tuberosity

Question 15

Key features of femur

Answer 15

• Head
• Neck
• Greater and lesser trochanters
• Intertrochanteric line
• Intertrochanteric crest
• Linear aspera
• Medial and lateral condyles
• Medial and lateral epicondyles
• Intercondylar notch

Question 16

What are the two intracapsular hip ligaments?

Answer 16

Transverse acetabulum ligament

Ligamentum teres

Question 17

Where is the ligamentum teres?

Answer 17

Behind transverse acetabular ligament, supplies blood to femoral head and connects it to hip

Question 18

What does transverse acetabular ligament do?

Answer 18

Joins acetabulum together

Question 19

What are the extra capsular hip ligaments?

Answer 19

Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament

Question 20

What does iliofemoral ligament do?

Answer 20

Prevents hyperextension of the hip

Question 21

What does pubofemoral ligament do?

Answer 21

Reinforces capsule, limits abduction

Question 22

What does ischiofemoral ligament do?

Answer 22

Holds femoral head in acetabulum, extension to 20 degrees

Question 23

What are the main sources of blood to the head of the femur?

Answer 23

Artery inside ligamentum teres
Reticular branches
Osteological arteries

Question 24

What is the main blood supply of the head of the demur in children?

Answer 24

Artery inside ligamentum teres - growth plate blocks reticular branches

Question 25

What is the main blood supply of the head of the femur in adults?

Answer 25

Reticular branches - growth plate replaced by Haversian bone

Question 26

From what type of fractures does AVN of the femoral head commonly occur?

Answer 26

Subcapital neck, transcervical and intertrochanteric fractures

Question 27

What happens when the neck of the femur is fractured?

Answer 27

Proximal femur: no movement | Distal femur: pulled proximally (quadriceps and hamstrings) and laterally (lateral rotators and gluteus Maximus)

Question 28

What happens when the shaft of the femur is fractured?

Answer 28

Proximal femur: generally neutral | Distal femur: pulled proximally (quadriceps and hamstrings) and posteriorly (gastrocnemius)

Question 29

What is Legg-Cathe-Perthes disease?

Answer 29

- Idiopathic osteonecrosis of capital femoral epiphysis | - Idiopathic avascular necrosis of femoral head

Question 30

Characteristics of Legg-Cathes-Perthes disease

Answer 30

- Common between 5-10 years - First symptoms include pain and a limp - Shortening of leg - Osteoarthritis develops later - More common in males than females - One leg starts and the other follows - Limited range of motion

Question 31

Key features of the knee

Answer 31

- Medial and lateral supracondylar ridges - Medial and lateral condyles - Medial and lateral epicondyles - Popliteal surface - Intercondylar notch - Medial and lateral tibial plateaus, anterior and posterior intercondylar areas - Intercondylar eminece - Facet for head of fibula - Tibial tuberosity - caused by quads pulling on tibia

Question 32

What is Osgood-Schlatter syndrome?

Answer 32

Inflammation of patellae ligament at tibial tuberosity

Question 33

What are the boundaries of the joint capsule?

Answer 33

- Proximal femoral condyles and intercondylar fossa posteriorly - Patellar retinaculum anteriorly - Articular margin of femur marginally - Femur laterally

Question 34

What are the five ligaments in the knee?

Answer 34

- Patella ligament - Anterior cruciate ligament - Posterior cruciate ligament - Medial collateral ligament - Lateral collateral ligament

Question 35

What does patella ligament do?

Answer 35

Attaches patella to tibial tuberosity

Question 36

How is patella ligament injured?

Answer 36

Direct impact to front of knee

Question 37

How to test integrity of patella ligament

Answer 37

Tense and relax quads

Question 38

What does ACL connect?

Answer 38

Femur to tibia

Question 39

What does ACL do?

Answer 39

Restricts anterior movement of tibia relative to femur

Question 40

How to test ACL?

Answer 40

Pull tibia anteriorly

Question 41

How is ACL torn?

Answer 41

Sport

Question 42

What does PCL connect?

Answer 42

Femur to tibia

Question 43

What does PCL do?

Answer 43

Restricts posterior movement of tibia relative to femur

Question 44

How to test PCL?

Answer 44

Holding knees and hips at 90 degrees with foot in the air. Posterior sag in knee indicated PCL tear

Question 45

How to tear PCL?

Answer 45

Direct blow to front of knee when it is bent

Question 46

What does the medial collateral ligament connect?

Answer 46

Femur to tibia

Question 47

How is medial collateral ligament torn?

Answer 47

Direct blow to knee

Question 48

How is medial collateral ligament tested?

Answer 48

Bend affected leg to 30 degrees of flexion whilst applying valgus force. Positive test occurs when pain occurs

Question 49

What does medial collateral ligament do?

Answer 49

Prevents leg extending inwards, keeps knee stable and allows it to rotate

Question 50

How is lateral collateral ligament torn?

Answer 50

Twisting on side of foot

Question 51

What does lateral collateral ligament connect?

Answer 51

Femur to fibula

Question 52

What does lateral collateral ligament do?

Answer 52

Provides knee with stability

Question 53

How to test integrity of lateral collateral ligament

Answer 53

Varus stress test - bend knee to 30 degrees flexion whilst applying varus force. Positive test occurs when pain occurs

Question 54

Which muscles are used to extend the knee?

Answer 54

Quadriceps femoris

Question 55

Which muscles are used to flex the knee?

Answer 55

Hamstrings and gracilis, gastrocnemius and sartorius

Question 56

Where is the cartilage in the knee?

Answer 56

Meniscus behind patella

Question 57

Function of meniscus

Answer 57

Donut shaped to increase surface area between condyles and tibial plateaus

Question 58

How can you damage cartilage in knee?

Answer 58

Twist knee whilst bearing weight on it

Question 59

What are the two meniscus in the knee?

Answer 59

Medial and lateral (medial more susceptible to injury)