Lecture 4: Lower Limb/Knee

Question 1

Popliteal Fossa (3)

Answer 1

1. posterior aspect of knee
2. main path by which vessles and nerves pass between thigh and leg
3. feel for politeal artery
   - divides into anterior and posterior tibial artery

Question 2

Popliteal artery becomes… (2)

Answer 2

1. anterior tibial artery

2. posterial tibial artery

Question 3

Bones of knee (3)

Answer 3

1. Patella
2. Tibia
3. Fibula

Question 4

Patella (3)

fractures?

Answer 4

1. Kneecap
2. sesamoid bone
3. patellar fractures usually result from direct trauma to bones or sudden contraction of quadriceps muscles

Question 5

Tibia

location
key landmarks (2)

Answer 5

main bone of lower leg, shin bone, medial to fibula

2nd largest bone- key weight bearing structure

key locations: tibial tuberosity, medial malleolus

Question 6

Fibula (3)

Answer 6

lateral aspect

more for attachment site of muscles

lateral malleolus

Question 7

Muscles of lower leg (3 types )

Answer 7

1. Anterior leg muscles
2. Posterior leg muscles
3. lateral leg muscles

Question 8

Knee Joint

type/ROM
3 bones involved
2 articulations

Answer 8

synovial hinge, allows for flexion and extension

patella, femur, tibia + 2 minisci

articulations:
1. tibiofemoral: medial and lateral condyles of femur articulating with tibial condyles

2. Patellofemoral: anterior aspect of distal femur articulating with patella

Question 9

Tibiofemoral articulation in knee joint

Answer 9

1. tibiofemoral: medial and lateral condyles of femur articulating with tibial condyles

Question 10

Patellofemoral articulation in knee joint

Answer 10

anterior aspect of distal femur articulating with patella

Question 11

Menisci (2 types)

Answer 11

in knee joint

shock absorbers

1. lateral
2. medial

Question 12

2 Ligaments of Knee Joint

Answer 12

1. cruciate
   - connect femur and tibia- cross eachother=cruciate
   - ACL (ANT.)
   - PCL (POST)
2. collateral
   - sabilize hing motion of knee, preventing excessive medial or lateral movement
   - LCL (LAT.)
   - MCL (med.)

Question 13

ACL rupture

Method of injury
dx (3)
manage
triad

Answer 13

common athletic injury

MOI: usually related to sharp turns when knee is twisted while foot is firmly on the ground

dx: radiographs can dx rupture, US accurate to dx complete tears, MRI sensitive and specific

can be managed operatively, and non op

unhappy triad: ACL, MCL, medial meniscus

Question 14

ROM of knee (4)

Answer 14

1. extension
2. flexion
3. lateral rotation
4. medial rotation

Question 15

Bursa of Knee (4)

Answer 15

1. Suprapatella
2. Perpatella
3. Infrapatella
4. Semimembranosus

Question 16

Pes anserinus

what (3) muscles
where?

Answer 16

also called “goose foot’

isterts on:

1. sartorius
2. gracillis
3. semitendinosus

*conjoining proximally on medial side of tibia

Question 17

Osgood-Schlatter Disease

Answer 17

partial avulsion of tibial tuberosity

-repetative stress on tuberosity may cause it to separate from tibia.
avulsed fragment continues to grow with intervening space filled with new bone of fribrous connective tissue so tibial tuberosity is enlarged

*more common in children who play sports

Question 18

Deep Vein Drainage of LE: foot & leg

Answer 18

1. Dorsal venous arch=main structure
2. arch drains into superficial veins
3. anterior tibial vein formed when veins from the arch penetrate deep into the leg

Question 19

Deep vein drainage of Le: thigh

Answer 19

popliteal vein enters thigh it is called femoral vein

deep vein of thigh is other main venous structure in the thigh

femoral vein leaves thigh by running underneath inguinal ligament, at which point, it is known as external iliac vein

politeal -> femorus -> external iliac

Question 20

Deep vein drainage of LE: gluteal reagion

Answer 20

drained by inferior and superior gluteal veins, empty into the internal iliac vein

Question 21

Superficial Venous drainage of LE: great saphenous vein

Answer 21

formed by doral venous arch of foot and dorsal vein of big toe

ascends the medial side of leg, passing anteriorly to the medial malleolus at the ankle and posteriorly to the medial condyle at the knee

as vein moves up leg, it receives tributaries from other superficial veins- great saphenous vein terminates by draining into the femoral vein immediately inferior to the inguinal ligament

-great saphenous vein can be harvestes and used as a vessel in coronary artery bypass

Question 22

Superficial venous drainage of the LE: small saphenous vein

Answer 22

formed by doral venous arch of foot, dorsal vein of the little toe.

moves up posterior side of led, passes posteriorly the lateral malleolus, along lateral border of the calcaneal tendon. moves between two heads of gastrocnemius muscle and empties into the politeal vein in popliteal fossa

Question 23

Deep vein thrombosis

Answer 23

formation of blood clott within deep veins of lower limbs, causing blockage of vessel

cause: veous stasis, hypercoaguability, endothelial injury

casues pain sweeling and tenderness of affected limbs

main complication of PE thrombus can become dislodged and travel into pulmonary circulation to prevent blood from returning to heart

Question 24

Genu valgum

Answer 24

angular deformity at knee where the the apex of the deformity points towards the midline

Question 25

Genu Valrum

Answer 25

is an angular deformity at the knee where the apex of the deformity point away from the midline

Question 26

Anterior Leg Muscles movement (2) components (2) muscles (3)

Answer 26

1. dorsiflexion/extension 2. deep fibular nerve - anterior tibial artery 3. muscles a. extensor digitorum longus b. extensor hallicus longus c. tibialis anterior

Question 27

Posterior Leg Muscles movement (2) components (4)

Answer 27

1) plantarflexion and flexion 2) tibial nerve - popliteal artery, post tibular and fibular arties ``` 3. muscles DEEP -flexor hallicus longus -flexor digitorum longus -tibialis posterior SUPERFICIAL -gastrocnemius -soleus ```

Question 28

Lateral Leg Muscles movement (2) components (2) muscles (2)

Answer 28

1. evert foot and weakly plantarflex 2. superficial fibular nerve - fibular artery 3. muscles - fibularis longus - fibularis brevis

Question 29

Anterior muscles (3)

Answer 29

1. tibialis anterior 2. extensor hallicus longus 3. extensor digotrum longus

Question 30

Lateral Muscles (2)

Answer 30

1. fibularis longus | 2. fibuaris brevis

Question 31

Posterior muscles(5)

Answer 31

DEEP 1. Tibialis posterior 2. flexor hallicus longus 3. flexor digitorum longus SUPERFICIAL 1. soleus 2. gastrocnemius

Question 32

Cruciate ligaments 2 types

Answer 32

2 ligaments connect femur and tibia, cross each other 1. ACL-anterior 2. PCL-posterior

Question 33

Collateral ligaments 2 types

Answer 33

1. act to stabilize the hinge motion of the know, preventing excessive medial or lateral movement 1. LCL-lateral 2. MCL-medial

Question 34

Extension Knee (1)

Answer 34

1. quadriceps femoris | - I: tibial tuberosity

Question 35

Flexion Knee (4)

Answer 35

1. hamstrings 2. gracillis 3. popliteus 4. sartorius

Question 36

Lateral roation (1)

Answer 36

1. biceps femoris when knee is flexed

Question 37

Medial rotation (5)

Answer 37

1. semimebranosus 2. semitendinosus 3. gracilis 4. sartorius 5. popliteus * when knee is flexed

Question 38

Suprapatella bursa

Answer 38

1. extension of synovial cavity of the knee | 2. locate between the quadriceps femoris and the femur

Question 39

Prepatella bursa

Answer 39

1. between apex of patella and skin

Question 40

Infrapatella bursa

Answer 40

1. Deep bursa - lies between tibia and patella ligament 2. superficial - lies between the patella ligament and the skin

Question 41

semimembranosus bursa

Answer 41

1. posteriorly in the knee joint | 2. between the semi membranous muscle and the medial head of the gastrocnemius

Question 42

Posterior tibial and fibular veins

Answer 42

1. of the foot and leg | 2. formed when plantar veins on foot combine

Question 43

Popliteal vein comprised of what 3 veins?

Answer 43

posterior surface knee anterior tibial + posterior tibial + fibular veins