MSK Session 8 Flashcards Preview

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Flashcards in MSK Session 8 Deck (111):
0

What is in the acetabular fossa?

Fat pad covered by synovial membrane

1

What bridges the acetabular notch?

Transverse acetabular ligament

2

What is the articular area of the acetabulum?

Lunate surface

3

What are the flexor muscles of the hip?

Iliopsoas
Rectus femoris
Sartorius
Pectineus
Adductor brevis and longus

4

Which muscles are the adductors of the hip?

Pectineus
Adductor brevis and longus
Adductor magnus
Obturator externus

5

Which muscles are the lateral rotators of the hip?

Piriformis
Gluteus maximus
Obturator internus
Gemellin
Quadratus femoris
Obturator externus

6

Which are the extensors of the hip?

Gluteus maximus
Hamstrings
Adductor magnus

7

Which are the abductors of the hip?

Gluteus medius
Gluteus minimus

8

Which are the medial rotators of the hip?

Gluteus medius and minimus

9

What supplies blood to the hip joint?

Medial and lateral circumflex femoral arteries

10

Where do the circumflex femoral arteries arise from?

Usually profunda femoris artery
Occasionally femoral artery

11

Can the artery to the head of the femur support the hip joint alone?

No - will cause AVN

12

Where is the acetabulum not complete?

Inferiorly at the acetabular notch

13

What is the acetabular labrum?

Fibrocartilaginous rim attached to the margin of the acetabulum

14

What is the function of the acetabular labrum?

Increase articular contact area by 10% so more than half the femoral head fits in

15

What innervates the hip joint?

Anterior: femoral nerve
Inferior: obturator nerve
Posterior: nerve to femoris
Superior: superior gluteal

16

Where can pain in the hip be referred from?

Vertebral column

17

How does Hilton's law apply to the hip joint?

Nerves supplying the muscles across the joint supply the joint too

18

What forms the joint capsule in the hip?

Loose external fibrous layer and internal synovial membrane

19

Where does the joint capsular of the hip attach?

Periphery of acetabular rim
Intertrochanteric line
Proximal to intertrochanteric crest

20

What path do most fibres of the joint capsule of the hip take?

Spiral

21

What forms the orbicular zone?

Deep fibres of the joint capsule passing circularly around the femoral neck

22

What restricts extension of the hip to 10-20 degrees beyond vertical?

Joint capsule of hip

23

What happens to the spiralling fibres in the joint capsule of the hip upon flexion?

Unwind

24

What pulls the femoral head medially into the acetabulum?

Muscles and ligaments

25

What is the structure of the iliofemoral ligament?

Anterior and superior
Y shaped

26

What is the function of the iliofemoral ligament?

Prevent hyperextension of the hip during standing by screwing femoral head into acetabulum

27

Which is the strongest ligament in the body?

Iliofemoral

28

What is the structure of the pubofemoral ligament?

Interior and inferior
Blends w/medial part of iliofemoral ligament

29

What is the function of the pubofemoral ligament?

Prevent overabduction of the hip by tightening during both extension and abduction

30

What is the structure of the ischiofemoral ligament?

Posterior
Spirals superolaterally to the femoral neck

31

Which of the three ligaments in the hip is the weakest?

Ischiofemoral

32

What is seen in congenital dislocation of the hip?

Femoral head superior
+ve Trendelenburg sign
Arthritis in adulthood

33

What is seen in acquired posterior hip dislocation?

Femoral head inferior and posterior on lateral surface of ilium
Shortened leg
Medial rotation

34

What is vulnerable to damage in acquired posterior dislocation of the hip?

Sciatic nerve

35

What is seen in acquired anterior hip dislocation?

Femoral head inferior to acetabulum
Acetabulum margin fracture

36

Which muscles make up the superficial layer of the buttock and gluteal region?

Gluteus maximus, medius and minimus

37

What is the main action of gluteus maximus?

Extension
Lateral rotation
Assist in rising from sitting

38

What is the main action of gluteus medius?

Abduction
Medial rotation
Pelvic stability

39

What is the main action of gluteus minimus?

Abduction
Medial rotation
Pelvic stability

40

What innervated gluteus maximus?

Inferior gluteal nerve

41

What innervates gluteus medius?

Superior gluteal nerve

42

What innervates gluteus minimus?

Superior gluteal nerve

43

What is the main action of piriformis?

Lateral rotation of extended thigh
Abduct flexed thigh
Steady femoral head in acetabulum

44

What innervates piriformis?

Branches of anterior rami of S1 and 2

45

What is the main action of obturator internus, superior gemelli, and inferior gemelli?

Laterally rotate extended thigh
Abduct flexed thigh
Steady femoral head in acetabulum

46

What innervates obturator internus?

Nerve to obturator internus

47

What innervates superior gemelli?

Nerve to obturator internus

48

What innervates inferior gemelli?

Nerve to quadratus femoris

49

What innervates quadratus femoris?

Nerve to quadratus femoris

50

What is the main action of quadratus femoris?

Laterally rotate thigh
Steady femoral head in acetabulum

51

What is the function of the superficial layer of buttock and gluteal region muscles?

Extension, abduction and medial rotation of femur
Prevent pelvic drop on opposite side to the flexed leg when walking

52

What is the general function of the deep layer muscles of the buttock and gluteal region?

Abduct flexed femur
Laterally rotate femur
Keep femur within joint
Main plain pelvic stability during walking

53

Which muscles form the deep layer of the buttock and gluteal region?

Piriformis
Obturator internus
Superior gemelli
Inferior gemelli
Quadratus femoris

54

Which muscle divides the greater sciatic foramen into two?

Piriformis

55

What is hip dysplasia?

abnormal relationship b/w femoral head and acetabulum

56

What can be abnormal in hip dysplasia?

Neck and shaft angle

57

Who is more affected by hip dysplasia?

Higher incidence in females

58

Which hip is more often affected in hip dysplasia?

Left

59

Why does hip dysplasia lead to dislocation at birth?

Abnormal forces experienced

60

What is the Ortolani test?

Forward pressure on femoral heads to move posteriorly dislocated into acetabulum

61

What does movement in the Ortolani test indicate?

Subluxation/dislocation that can be reduced

62

What is the Barlow test?

Backward pressure applied to femoral heads to feel for complete/partial displacement

63

What is the Galeazzi test used at 3-6 months?

Lie supine w/hips and knees flexed to 90 degrees and look for discrepancy in length and asymmetry

64

What are the treatments for hip dysplasia?

Harness if 6 months or harness ineffective

65

What is hip dysplasia often associated with in adulthood?

Arthritis

66

What is slipped upper femoral epiphysis?

Fracture through physis allowing femur to ride up and forward in relation to the epiphysis so the shaft moves superiorly but articulation with the hip is maintained

67

If slipped upper femoral epiphysis is not caught early what can develop?

Leg length discrepancy
Arthritis

68

What is the typical age of a patient presenting with slipped upper femoral epiphysis?

10-16 y.o.

69

What is the treatment for slipped upper femoral epiphysis?

Internal fixation w/single cannulated screw

70

Why should you look carefully for other injuries in acquired hip dislocation?

Due to stability of joint if dislocation is caused force must have been large and likely to have caused other damage

71

Which is the more common type of hip dislocation?

Posterior

72

What happens in posterior hip dislocation?

Femoral head forced posteriorly tearing through inferior and posterior joint capsule

73

What is anterior hip dislocation a consequence of?

Extension, abduction and lateral rotation

74

What is anterior hip dislocation associated with?

Fracture

75

What must occur for femoral neck fracture in a patient less that 40 y.o.?

High energy collision w/lower limb extension

76

If an elderly patient become confused following femoral neck fracture what is the associated mortality rate?

50%

77

Why are women >40 y.o. more likely to obtain femoral neck fracture than men?

Effects of osteoporosis

78

Why do femoral neck fractures often lead to femoral head AVN?

Intracapsular so main blood supply is likely to be disrupted

79

How does the limb often appear in femoral neck fracture?

Shortened
Laterally rotated

80

What does treatment depend of femoral neck fracture depend on?

Age and health - would replacement be more effective?

81

Why must you fix femoral neck fracture even in immobile patients?

To reduce mortality

82

What causes trochanteric fracture?

Direct impact or torsional force

83

Why is trochanteric fracture less likely to disrupt the blood supply than femoral neck fracture?

Extra-capsular

84

Who are trochanteric fractures most common in?

Elderly

85

What are the treatments for trochanteric fracture?

Dynamic hip screw
Cephalomedullary fixation

86

What is cephalomedullary fixation?

Rod down centre of bone to prevent excessive shortening

87

How does the impact of trochanteric fracture compare to that of femoral neck fracture?

Lower associated mortality rate
Likely to decrease mobility

88

What are the three bursae of the hip?

Trochanteric
Iliopsoas
Ischiogluteal

89

Which is the largest bursa of the hip?

Trochanteric

90

Where is the trochanteric bursa located?

B/w gluteus maximus and greater trochanter

91

Where is the iliopsoas bursa located?

Deep to iliopsoas

92

Which is the most powerful flexor of the hip?

Iliopsoas

93

In 15% of people what does the iliopsoas bursa communicate with?

Hip joint

94

How is iliopsoas bursa inflammation confused with hernia?

Can present as swelling below inguinal ligament

95

Where is the ischiogluteal bursa located?

Near ischial tuberosity

96

What causes inflammation of the ischiogluteal bursa?

Cycling/horse riding

97

What is the treatment for bursitis in the hip?

Rest and physiotherapy to increase length of corresponding muscle and tendon units to prevent further aggrevation

98

What can arthritis of the hip be due to?

Inflammation of the joint in synovium
Damage to cartilage
Combination of the two

99

What is earl y onset pain in arthritis usually due to and subsequently followed by?

Inflammation w/mechanical process later

100

What is the progression of osteoarthritis?

Cartilaginous damage --> compromised cartilage repair --> mechanical grinding causing pain --> increased mechanical load worsens effects

101

What can predispose to development of arthritis?

Previous joint injuries

102

Why do bone spurs form in osteoarthritis?

Narrowed joint space due to loss of cartilage so spurs form to counteract bone changes

103

What are the treatments for osteoarthritis?

NSAIDs
Muscle relaxants
Inter-articular corticosteroid injections
Modify lifestyle

104

What is the progression of rheumatoid arthritis?

Inflammation in synovium --> destruction of cartilage --> mechanical problems --> v.deformed bones --> bone ankylosis --> fusion of bones

105

What are the stages of rheumatoid arthritis development?

Syvonitis
Pannus
Fibrous ankylosis
Bony ankylosis

106

What happens in syvonitis?

Synovium inflamed and thickened
Bone and cartilage gradually eroded

107

What is pannus?

Layer of vascularised fibrous tissue that extends over an organ/structure

108

What happens during pannus formation in rheumatoid arthritis?

Exposed and pitted bones, no cartilage left

109

What happens in fibrous ankylosis during rheumatoid arthritis?

Fibrous CT invades

110

What happens in bony ankylosis in rheumatoid arthritis?

Bones fused