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MSK > Knee and thigh continued > Flashcards

Knee and thigh continued Flashcards

1
Q

The knee joint has two articulations. What are they?

A

Tibiofemoral (condyles of each)

Patellofemoral (patella and trochlear groove)

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2
Q

Functions of the patella?

A
  • Acts as a fulcrum for the quadriceps muscle, increasing its efficiency. Thus increases the power of knee extension (quadriceps).
  • Protection for anterior knee
  • Stabilises the knee joint, reducing frictional forces placed on femoral condyles
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3
Q

Which blood vessels supply the knee?
Which artery do they branch from?
What do they compensate for?

A

genicular arteries which make up the genicular anastomoses (circular network)

femoral and popliteal artery

narrowing of the popliteal artery during knee flexion

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4
Q

Where is the popliteal artery?

A

Continuation of the femoral artery below the adductor hiatus (gap between adductor magnus and femur).

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5
Q

Functions of the tibial menisci?

A
  • Deepen the articular surface of the tibia to increase stability of knee joint
  • Act as shock absorbers; increase surface area to further dissipate forces
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6
Q

Damage to the medial collateral ligament can also cause tearing of ____?
What could damage the medial collateral ligament? Explain.

A

The medial meniscus because the MCL adheres to it

Excessive lateral displacement of the tibia (valgus angulation). The medial collateral ligament prevents outward/ Lateral angulation of the tibia (vaLgus angulation).

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7
Q

Which tibial menisci is larger?
What shape are they?
How are they connected anteriorly?

A

Medial
Both C -shaped (crescentic)
Transverse ligament of the knee

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8
Q

What are the ligaments of the knee?

A
  • cruciate ligaments
  • collateral ligaments
  • oblique popliteal ligament
    (inserts on medial tibial condyle)
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9
Q

How does blood flow to the tibial menisci change with age?

A

Reduces so that the central meniscus is avascular by adulthood which impairs healing

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10
Q

What movement does the anterior cruciate ligament resist?

A
  • medial rotation of the tibia relative to the femur

- anterior translation

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11
Q

Where do the cruciate ligaments insert on the femur?

A

A- lateral border of intercondylar fossa

P- medial border and roof of intercondylar fossa

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12
Q

Main functions of the posterior cruciate ligament? (2)

A
  • prevents posterior dislocation of the tibia on the femur
  • Main stabiliser of the weight-bearing flexed knee; prevents the femur sliding anteriorly off the edge of the tibia when walking down stairs/ a slope
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13
Q

The joint capsule of the knee is deficient where?
What does this allow?

The knee capsule is strengthened medially and laterally by which muscles fibres?

A

Anteriorly
Allows synovial membrane to extend upwards, forming the suprapatellar bursa

Fibres of the vastus medialis and lateralis (medial compartment of thigh).

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14
Q

What do the collateral ligaments do?

Which is stronger?

A
  • Stabilise the hinge movement
  • Prevent excessive lateral/ medial angulation of tibia on the femur (valgus/ varus angulation)

Lateral bc its reinforced by the iliotibial tract and works as 1/3rd of the posterolateral corner

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15
Q

Which knee ligament resists valgus angulation of the tibia?

And which resists varus?

A

Medial collateral ligament

Lateral collateral ligament

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16
Q

What is the posterolateral corner of the knee?

A

Three ligaments on the lateral side of the knee which extend over the joint.

  • lateral collateral ligament
  • popliteus muscle tendon
  • arcuate ligament
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17
Q

How many bursae are there in the knee?

Where is the subsartorial/ pes anserinus bursa?

A

6

Between insertion of the pes anserinus tendon (anteromedial surface of tibia) and the medial condyle

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18
Q

By what mechanism does the knee passively lock?

Which muscles can now relax?

A

‘scre home mechanism’,
5 degree medial rotation of the femoral condyles on the tibial plateau

thigh and leg muscles without destabilising the knee joint

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19
Q

How does the (passively) locked knee unlock?

A

Popliteus muscle contracts to cause 5 degree lateral rotation of femur on the tibial plateau

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20
Q

During knee extension, the patella is naturally inclined to displace ____y?
Why?

A

laterally

Q angle between direction of pull from quadriceps muscle and patellar ligament

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21
Q

What stops lateral displacement of the patella during knee extension?

A
  • contraction of inferior fibres of the vastus medialis

- deep trochlear groove with a more prominent lateral condyle

22
Q

Common insertion of the iliapsoas muscle?

Origins?

A

Lesser trochanter of femur
Iliacus - iliac fossa
Psoas major- transverse processes of T12-L5 and the lateral margins of the intervertebral disc between

23
Q

Most of the anterior muscles of the thigh are innervated by which nerve?
Blood supply?

A

Femoral nerve (L2-4)

Branches of femoral artery- lateral and medial femoral circumflex arteries and profunda femoris

24
Q

Psoas major is not innervated by the femoral nerve, but by ____?

A

anterior rami of L1-L3

25
Q

Where do vastus lateralis and vastus medialis originate?

A

Lateralis- greater trochanter and lateral lip of linea aspera
Medialis- medial lip of line aspera and intertrochanteric line

(all quadriceps insert on quadriceps tendon)

26
Q

Where does sartorius insert?

Where does rectus femoris insert?

A
  • Anterior superior iliac spine
  • Anterior inferior iliac spine
    AND the groove above the rim of the acetabulum
27
Q

Which muscles actions are explained by a sailor dancing the hornpipe?
Explain

A

Sartorius
Flexes, abducts and laterally rotates the lower limb at the hip joint
Flexes, internally rotates the tibia at the knee joint

28
Q

Where is the pectineus muscle?

A

Origin: pectineal line on anterior surface of the superior pubic ramus
Insertion: pectineal line on back of the femur, just below the lesser trochanter

29
Q

Hamstring muscles originate from where?

Which muscle has a hamstring component and also originates here?

A 
Ischial tuberosity 
Adductor magnus (medial compartment)
30
Q

Muscles of the medial thigh do what function?

They are supplied by which nerve and which artery?

A

Hip adductors
Obturator nerve
Obturator artery

31
Q

Where does adductor magnus originate and insert?

Te insertions are separated by what?

A

Adductor component
O: Inferior ischial and pubic ramus
I : linea aspera of femur

Hamstring component:
O: ischial tuberosity
I: adductor tubercle and medial supracondylar line of the femur

The adductor hiatus

32
Q

The hamstring component of adductor magnus is not innervated by the same nerve as its adductor component. Which are these nerve?

A
  • Hamstring = tibial branch of sciatic

- Adductor = obturator nerve

33
Q

Which muscles of the anterior compartment cross the hip and knee?

A

rectus femoris

sartorius

34
Q

Which muscle of the medial compartment crosses the hip and knee joints?
What does it do?

A

gracilis
Hip - adducts limb
Knee- flexes leg

35
Q

What is the skyline X ray view?

A

patellar axial view

inferior- superior view (from below)

36
Q

What type of shock could the patient develop after femoral shaft fracture?

A

hypovolaemic due to blood loss (1000-1500ml)

37
Q

What condition usually develops after a tibial plateau fracture?

A

Osteoarthritis because the articular cartilage is always damaged

38
Q

How does a patellar fracture feel?

A

Palpable defect

Haemoarthrisis (blood in joint)

39
Q

How can leg movement be affected by patellar fracture?

A

If the fracture is below the quadriceps tendon, the patient can’t perform a straight leg raise
(can’t extend the knee with hip flexed)

40
Q

Patellar dislocation occurs when?

How do you treat it?

A

Often in sporty teenagers due to a sudden change of direction
- internal rotation of femur on a planted foot

Extend the leg and manually reduce it

41
Q

Why can’t the patient fully extend leg in a meniscal tear?

What symptoms might the patient describe?

A

Intra articular foreign body
(something in the joint) causes locking (block to movement)

Clicking, catching, locking of the knee (can’t extend)

42
Q

How do you treat meniscal tears?

A

Surgery- menisectomy or meniscal repair

43
Q

A torn left collateral ligament often occurs due to what?

Why is a LCL injury more serious than damage to the right collateral ligament?

What symptoms might the patient complain of?

A

Varus angulation (inwards) of the tibia

The left collateral ligament is more important in maintaining knee stability because the left tibial condyle is more shallow and thus less stable

knee instability; giving way/ not supporting their body weight

44
Q

What is the unhappy triad and what causes it?

A

Damage to the ACL, medial menisci and medial collateral ligament
Caused by a strong force to the lateral aspect of the knee

45
Q

How can you detect ACL and PCL injuries?

anterior/ posterior cruciate ligament

A
  • anterior and posterior drawers tests for both

- Lachman’s test for ACL only

46
Q

Tearing of the ACL /PCL affects movement of the tibia- how?

How are they both torn?

How are they both treated?

A

ACL tear- tibia slides forward (anteriorly)
PCL tear- tibia slides backwards

ACL- sudden change of direction (sports)
PCL- dashboard injury (flexed knee and a large force applied to the top of tibia)

ACL - surgery for sportsperson/ muscles compensate to stabilise knee
PCL- bracing and rehabilitation

47
Q

3 borders of the femoral triangle?

Roof and base?

A

superior- inguinal ligament

lateral- medial border of sartorius muscle

medial- medial border of aductor longus

Roof (anterior) fascia lata
Base (posterior) popliteus

48
Q

What’s in the femoral triangle?

A 
NAVEL
(lateral to medial)
femoral nerve
femoral artery
femoral vein
empty space
lymphatics
49
Q

Where is the surface marking for the femoral artery?

A

MIPA
mid inguinal point = artery
position midway between the pubis symphysis and the superior iliac spine

50
Q

What does the femoral canal contain?

A

lymphatic vessels
lacunar lymph node
empty space
loose connective tissue

MSK (10 decks)

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