PBL3

Question 1

what are the 3 articulates in the knee

Answer 1

• 3 articulations
• All share the same articular joint
• lateral femoral and tibial condyles with corresponding meniscus
• medial femoral and tibial condyles with corresponding meniscus
• patella and femur

Question 2

what type of bone is the patella

Answer 2

sesamoid

- It is a bone that it formed within a tendon

Question 3

describe the tendons involved with the patella

Answer 3

• Quadriceps tendon

- Patella tendon

Question 4

what happens when the quadriceps tendon and the patella tendon rupture

Answer 4

• If you rupture the patella ligament then the patella shoots up into the thigh
• If you rupture the qaudriceps tendon then the patella falls down in front of the articulating the knee

Question 5

what does stability in the knee joint depend on

Answer 5

1 Strength and actions of surrounding muscles and their tendons
2 The ligaments that connect the femur and tibia

Question 6

describe the Q line

Answer 6

• Drawn from ASIS to the centre of the patella
• 14° Men
• 17 ° Women
• Genu varum - small Q angle
• Genu vaigum – large Q angle
• In both of these casis the mechanical axis is either to one side or to the other side of the knee this provides unequal loading on the. Knee joitn and exposes you to arthritis on you knee joint

Question 7

what are the ligaments in the knee

Answer 7

• Fibular and tibia collateral ligaments
• Anterior cruciate ligament and posterior cruciate ligament
• Stabilise the joints

Question 8

what is the pelvic girdle made out of

Answer 8

• Ischium – sit on the ischium tuberosities
• Ileum
• Pubis
• These all meet in the acetabulum, there is an epipsymphial joint in children, don’t have much movement in adult skeleton thereof reforms a nice foundation to have a stable base for the lower limb

Question 9

describe the hip

Answer 9

• Ball and socket synovial joint
• Designed for stability whereas the glenohumeral joint is designed for motility
• Aceteabular labrum – cup shape and covers all of the femoral head
• Round head of femur articulates with cup shaped acetabulum of the pelvis
• Combines wide range of movement with great stability

Question 10

what is the stability in the hip due to

Answer 10

– Deep insertion of femoral head into acetabulum
– Strong tight articular capsule (glenohumeral joint has a loose articular capulse), articular capsule extends all the way down the femur as the neck of the femur is in the articular capsule
– Tight articular capsule limits movement
– Ligaments around the joint capsule (especially anteriorly)
– Large powerful muscles around joint these are tonically active
– ligament within articular capsule, ligamentum teres – this is the ligament in the head of the femur, in adults don’t really need it but in children they might not have the same articulalation and this stops the separation of the head of the femur
– Fat pad fills central region and adds cushioning for thinnest part of acetabulum, this is where the acetabulum might break, pushes head of femur into the acetabulum without damaging it
– Acetabular labrum – not complete in the hip joint, adds about 10% of the surface area of the acetabulum

Question 11

describe the ligaments of the hip

Answer 11

• Ligaments of the hip not only strengthen capsule
– When hip extended (for example when you stand up)ligament fibres become twisted and tighten (shorten) articular capsule pulling acetabulum and femur together\
– When hip sat down and flexed the ligament fibres are horizonal and looser, prevent the articular capsule from tearing

Question 12

describe the acetabular labrum

Answer 12

– Transverse acetabular ligament is a continuation of labrum and bridges acetabular notch
– Increases acetabular articular surface by 10%
– Have a horseshow rather than a complete ring because the Blood vessels that pass into joint through notch and via ligament of head of femur – thre is blood vessel running down the centre of the ligament of the head of the femur - this is more important in children as it is the blood supply to the femoral head, therefore they have a shallower root in

Question 13

describe what the aorta divides into

Answer 13

• the abdominal aorta divides into the common iliac at L4
• the common iliac then divides in the internal iliac and the external iliac arteries
• the external iliac artery continues and supplies the thigh when it turns in the femoral artery, it changes its name when it goes through the inguinal ligament

Question 14

describe the internal iliac artery

Answer 14

• 3 branches give of these are..
• Superior gluteal artery
• Inferior gluteal artery
• Obturatory artery
• Piriformis muscle – above piriformis there is the superior gluteal artery whereas below piriformis is the inferior gluteal artery

Question 15

describe the femoral artery

Answer 15

• Femoral artery = found in the femoral triangle
• When it is in the femoral triangle it gives off an important branch profunda femoris
• Profunda femoris – supplies the posterior and medial compartments of the thigh
• Profunda femoris gives of the lateral and medial circumflex arteries that wrap around the neck of the femur
• Lateral and medial circumflex arteries are important clinically as they give off branches that run up and supply both the neck and the head of the femur

Question 16

describe the obturator artery

Answer 16

• Obsturator artery gives of the branch to the artery of the head of the femur – it cant supply the whole of the head of the femur

Question 17

what happens if you get a femoral neck fracture

Answer 17

• Femoral fractures – can get a fracture within the hip joint at the femoral neck then you cut of the blood supply of the circumflex arteries, far more likely to have avascular necrosis of the femoral head

Question 18

when does the femoral artery become the popliteal artery

Answer 18

• The femoral artery runs between the anterior and medial compartmetns of the thigh, superior to the knee joint it runs through the adductor hiatus and emerges posterior to the knee joint this is where ti comes the popliteal artery

Question 19

describe the popliteal artery

Answer 19

• Runs through the popliteal fossa
• Branches into two main arteries the posterior and anterior tibial arteries
• They run in the posterior compartment and the anterior compartment

Question 20

describe the posterior tibial artery

Answer 20

• Gives of fibular branch – this is also in the posterior compartment of the leg but tends to supply the lateral compartment of the leg
• Posterior tibial – runs posterior to the medial malleolus and runs with 3 tendons a nerve and a vein
• Behind the medial malleolus is the tarsal tunnel which is where it runs through in order to reach the sole of the foot
• Posterior tibial breaks up into the medial and lateral plantar arteries

Question 21

describe the anterior tibial artery

Answer 21

• Branches from the popliteal artery and passes through the interosseous membrane to reach the anterior compartment, into the foot to become the dorsalis pedis artery.
• Dorsalis pedis pulse can be found lateral to Extensor hallucis longus tendon
• Gives of to the arcuate artery and the taral branches

Question 22

describe the veins

Answer 22

• Deep veins
• Same name
• Run with them
• Posterior tibial vein, anterior tibial vein, popliteal veina and femoral vein
• Superifical vein – great saphenous vein and small saphenous vein – drains into the popliteal vein and the popliteal fossa, great or long saphenous vein which goes into the femoral vein within the femoral triangle

Question 23

describe the short and great saphenous vein

Answer 23

• These veins can become varicose
• Veins in the leg and feet are at a greater risk of becoming varicose as standing and walking upright increases the pressure in the veins of your lower body
• Superficial veins are not in the deep fascia of the thigh therefore they are more unsupported than the deep veins

Question 24

what is the lumbar sacral plexus

Answer 24

• Lumbar plexus L1-L4
• Sacral plexus – S1-S4
• Lumbosacral trunk – L4-S4

Question 25

what are the nerves that originate from the lumbar plexus

Answer 25

- Femoral nerve L2-L4 - Obturator nerve – L4-S4 - Lateral cutaneous nerve of the thigh L2-L3

Question 26

describe the obtruatory plexus

Answer 26

- Runs around the medial aspect of the pelvis and passes through the obturator foramen and ends up in the medial aspect of the thigh - Adduction and hip adduction - Adductors: - Adductor Magnus – has a whole in it where the femoral artery passes through to become the popliteal artery (not the medial part of the adductor magnus is innervated by the obturator nerve) - Adductor Longus - Adductor Brevis - Gracilis

Question 27

describe the lateral cutaneous nerve of the thigh

Answer 27

- Provide sensory innervation to the lateral patch of the thigh

Question 28

describe what nerves originate from the sacral plexus

Answer 28

- Sciatic nerve (tibial and common peroneal nerves) – largest nerve in the body, emerges from the posterior aspect of the pelvis, runs in the gluteal region and runs in the posterior aspect of the thigh - Superior gluteal nerves - Inferior gluteal nerves

Question 29

describe the sciatic nerve

Answer 29

- Innervates the hamstrings - Knee flexion - Breaks up into the tibial nerve and common peroneal nerve - Does this before entering the popliteal fossa

Question 30

describe the posterior comapartment of the leg

Answer 30

``` - Largest compartment of muscles in the leg • Tibial nerve • Plantarflexion • Flexion of digits • Posterior tibial artery ```

Question 31

describe the anterior compartment of the leg

Answer 31

- Deep peroneal nerve - Dorsiflexion - Extneison of digits - Anterior tibial artery

Question 32

describe the lateral compartment of the leg

Answer 32

- Superifical peronaeal nerve - Eversion - Fibrular artery

Question 33

describe the posterior cruciate ligament

Answer 33

* Runs from posterior aspect of intercondylar area of tibia and ascends anteriorly to attach to the medial wall of the femoral intercondylar fossa * Stops tibia moving backward on femur * Stronger the ACL * Helps stabilise knee especially in flexion * Also prevents tibia twisting outward (external rotation) * Stops it moving posteriorly

Question 34

describe the anterior cruciate ligament

Answer 34

- Runs from facet on the anterior part of the intercondylar area of tibia and ascends posteriorly to attach to the back of the lateral wall of the intercondylar fossa of the femur - Stops tibia moving forward on femur - Stabilise knee in extension and prevents hyperextension and excessive internal rotation - Stops it moving anteriorly

Question 35

describe what the cruciate ligaments prevent

Answer 35

- The ACL prevents the femur sliding posterior on the tibia so rupture results in the anterior drawer sign – anterior draw test - The PCL prevents the femur sliding anteriorly on the tibia, so rupture results in the posterior drawer sign - if you push the tibia posterior with the respect of the femur then you have a PCL rupture

Question 36

describe the ACL grift

Answer 36

- BTB = bone tendon bone graft this can be inserted in to the knee joint – part on femur and part on the tibia, the tendon in between acts as the ACL - Hamstring tendon graft – hamstring tendons – semitendinous and gracilis tenodns are palteted together and they can be used as an ACL graft

Question 37

describe the Menisci

Answer 37

- Plates of fibrocartilage which help deepen the knee joint and help with shock absorption

Question 38

describe the medial meniscii

Answer 38

- C shaped - Broader posteriorly than anteriorly - Anteriorly attached to ACL - Firmly adhered to the tibial collateral ligament these attachments are important as if you tear the medial minscus then you end up tearing the medial mensicous, ACL, tibila collateral ligament as they are all anatomically linked to each toehr this is refered to as the unhappy triad - Cant move that well

Question 39

describe the lateral menisci

Answer 39

- Can move more than the medial mensicous - Nearly circular - Smaller and more freely movable than medial meniscus - Attached to the PCL.

Question 40

describe the bursae

Answer 40

* Almost all the bursa are extensions of the knee synovial cavity and are filled with synovial fluid. * They act as cushions against friction and rubbing of the tendons, ligaments and bones around the knee joint

Question 41

describe the examination of the lower limb pulses

Answer 41

- Can find the femoral pulse at the midinguinal point, this is the point between the ASIS and the pubic symphysis - Dorslilis pedis pulse = lateral to the extensor hallius longus - Popliteal puse in the popliteal fosssa

Question 42

describe treatment of hip discloation

Answer 42

- Depends on the age of the individual and the shape of the bone pelvis - For young people – pinned and this is healed in 6 months and then you can remove the screws in older - Usually linked to osteoporosis - Use screws and total hip replacement Usually - Joint reduction in order to reposition the hip and put the ball back in the socket this requires general anaesthesia - The doctors evaluate you for other injury such as injury to the bone, cartilage and ligaments - Might need hip replacement surgery - This is when the ball and socket of the damaged hip is replaced Physiotherapy - Lie on back or sitting down and bed and straighten the ankles briskly – repeat 20 times - Pll toes to the ceeling and push the knees down firmly against the bed hold for 5 seocnds and then repeat 10 times - Squeezing buttocks for 5 seocnds and then relax 10 times - Push back of knee into the pillow or towl and pull your toes up at the same time - Knee should stragithen and you heel raise of the beed - Lying on your back and bending and straightening the operated leg - Stand holding onto a chair or kitchen work surface – keep operatured leg straight and take it backwards - Then bend knee and leg up forwards