Lower limb conditions 2

Question 1

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Question 4

‘unhappy triad?

where is it most commonly seen?

Answer 4

Question 5

Which meniscus is most commonly torn and why?

Answer 5

Medial meniscus, cuz its firmly attachted to the medial collateral ligament! and joint capsule!

so if ligament tears, it pulls the menisci with it!

Question 6

housemaids knee

Answer 6

suprapatellar bursitis

Question 7

clergy mans knee

Question 8

what keeps the patella irs groove?

Answer 8

Vastus medialis

that why when ppl who stopped excerising for a while, suddenly go for a jog, they can feel pain in their knee,

cuz vastas medialis is not that strong enough to hold the patella in place!

Question 9

what is so special about the patella?

hint: it s sesamoid bone…

Answer 9

it develops intratendinously

Question 10

a valgus force on a leg may cause injury to which ligaments?

Answer 10

-medial collateral ligaments

Question 11

what is a baker’s cyst?

Answer 11

cystic outpouching of the joint capsule “synovial popliteal cyst”

this result mostly from joint effusion ex: RA causing a rise of intra-articular pressure

between the semimembranous tendon and head of gastrocnemius.

Question 12

name the different bursitis of the knee

Answer 12

Question 13

difference btw intracapsular and extracapsular

Answer 13

anything above the intertrochanteric line > intracapsular

Anything below it> extracapsualr

Question 14

Describe the anatomical attacthments of he capsule of the joint!

Answer 14

Question 15

what causes trendenburgs gait?

Answer 15

weakness or parlays pf the small gluteus muscles (gluteus medius and minimus), the pelvis can no longer be stabilised and is tilted towards the unaffected side.

Question 16

normal, trendelburg and compensated

show the 3 moves

Answer 16

Question 17

Types of hip fractures?

Answer 17

Question 18

what does this fracture carry a risk of?

tratment

Answer 18

displaced Subacpital fracture

Avascular necrosis!

DHS

Question 19

what is avascular necrosis?

Answer 19

Death of a segment of the bone

Question 20

where is the important blood supply for the femoral neck located?

Answer 20

Question 21

what type of fracture carries a high risk of Avascular necrosis?

Answer 21

Question 22

Why is the risk of avascular necrosis of the femoral head much lower for an intertrochanteric fracture than a subcapital fracture?

Question 23

In a patient with an intertrochanteric fracture of the femur, why do you often find shortening and external (lateral) rotation of the limb?

(Hint: think about the origins, insertions and the subsequent ‘line of pull’ of the muscles around the femoral trochanters and shaft)

Answer 23

Question 24

What type of fixation is most often performed for an intertrochanteric fracture. Why?

Answer 24

DHS

Question 25

Question 26

posterioir dislocation of hip, how will the patients present? ## Footnote Which peripheral nerve is most at risk of damage during posterior dislocation of the hip?

Answer 26

Shortened and internally/medially rotated Sciatic

Question 27

anterior dislocation of hip, how will the patients present?

Answer 27

Question 28

Why, on examination of a patient with a posterior dislocation of the hip, will you often find shortening and internal (medial) rotation of the limb?

Answer 28

Question 29

What is the most likely cause of this patient's positive Trendelenburg sign?

Answer 29

L5 radiculopathy secondary to osteoarthritis

Question 30

What course do the gluteal nerves follow to reach the muscles they innervate?

Answer 30

They leave the pelvis via the greater sciatic foramen. Superior gluteal nerve passes **superior** to the **piriformis** muscle inferior gluteal nerve passes **inferior** to the **piriformis** muscle

Question 31

What types of activities are most likely to result in a pulled hamstring? In anatomical terms, what is the nature of this injury?

Answer 31

jumping, sprinting and lunging.

Question 32

What is the differential diagnosis for a mass (swelling) in the popliteal fossa? State 4 diagnoses.

Answer 32

1) Popliteal aneurysm 2) Baker’s cyst: herniation of the synovial membrane of the knee joint, usually in association with 3) osteoarthritis 4) Abscess 5) Enlarged lymph nodes 6) Thrombophlebitis of the popliteal vein or short saphenous vein 7) Any benign or malignant tumour of muscle, bone (femur or tibia) or connective tissue

Question 33

Answer 33

Question 34

Answer 34

Question 35

shade areas affected in sciatic nerve injury

Answer 35

Question 36

The axons of the sciatic nerve distal to the injury would undergo **degeneration**. What is the name given to this type of degeneration? Describe what happens to the proximal axons as they attempt to reinervate the affected muscles

Answer 36

***Wallerian*** ( picture 3) Axons sprout from the **proximal** part of the severed nerve.  the **shwann cells** then help guide the sprouting axons to the denervated muscle

Question 37

The patient develops a nodule at the site of the injury and is told they have a traumatic neuroma. **What is a traumatic neuroma?** Apart from the presence of a nodule what is the commonest symptom associated with this lesion?

Answer 37

A disordered proliferation of axons resulting in a tangled mass Pain