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MSK > Week 3 > Flashcards

Week 3 Flashcards

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1
Q

The acetabular labrum encircles the acetabulum, it deepens it providing a more secure fit for the femoral head. By what percentage does it increase the articulate contact area of the femoral head with the socket?

A

10% - explanation - so that more than 50% of the femoral head is in contact with the socket at any one time

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2
Q

What is the small depression in the femoral head called, and what attaches here?

A

Fovea capitis - liganentum teres (ligament of the femoral head) attaches here

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3
Q

What is the only intracapsular ligament in the hip joint?

A

Ligamentum teres

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4
Q

Name the three extracapsular ligaments in the hip joint

A

Iliofemoral Ischiofemoral Pubofemoral

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5
Q

Which of the hip joints ligaments is the strongest?

A

Iliofemoral

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6
Q

What is the function of the iliofemoral ligament?

A

To prevent hyperextension of the hip

Note - looks like an inverted Y

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7
Q

Which ligament acts to prevent hyper extension of the hip

A

Mainly the iliofemoral joint, the pubofemoral joint also contributes to this somewhat

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8
Q

What are the functions of a) the ischiofemoral ligament b) the pubofemoral ligament

A

a) prevents excessive medial rotation b) prevent excessive abduction and hyperextension

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9
Q

What structure bridges across the acetabular notch (inferior part of acetabulum) and forms a tunnel through which blood vessels enter the hip joint?

A

The transverse acetabular ligament

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10
Q

The ligaments of the hip joint are weaker posteriorly, how does the body compensate for this in terms of stability

A

The strong hamstrings are located posteriorly and thus pull the head of the head into the acetabulum

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11
Q

Give three factors which increase the stability of the hip joint

A

The cup shaped acetabulum/ The acetabular labrum/ The capsule/ The intracapsular ligament (ligamentum teres)/ The extracapsular ligaments /The muscles surrounding the hip joint

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12
Q

What nerve innervates the hip joint a) anteriorly b) posteriorly c) inferiorly

A

a) femoral nerve b) sciatic nerve c) obturator nerve

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13
Q

What arteries form the extracapsular ring of the femoral neck?

A

The medial femoral circumflex artery and lateral femoral circumflex artery which are both branches of the profunda (deep) femoris artery

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14
Q

What arteries are the major blood supply to the head of the femur in the adult?

A

Retinacular arteries - branches of the femoris profunda artery

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15
Q

What risk does an intracapsular fracture of the femoral neck carry in an adult and why?

A

Avascular necrosis of the bone because of the severing of the retinacular arteries Explanation - this wouldn’t be the case in a child because the artery of the ligamentum teres is still the major blood supply to the femoral head

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16
Q

State the nerve roots of the lumbar plexus and the corresponding nerves

A

Ilioinguinal - L1 Genitofemoral - L1, L2 Lateral femoral cutaneous - L2, L3 Obturator - L2, L3, L4 Femoral - L2, L3, L4

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17
Q

State the nerve roots and corresponding nerves of the sacral plexus

A

Superior gluteal - L4, L5, S1 Inferior gluteal - L5, S1, S2 Sciatic - L4, L5, S1, S2, S3 Posterior femoral cutaneous - S1, S2, S3

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18
Q

Name two structures that pass through the greater sciatic foramen

A

Superior gluteal neurovascular bundle (vein artery and nerve)/ Inferior gluteal neurovascular bundle/ Sciatic nerve/ Posterior femoral cutaneous nerve/ Nerve to quadrator femoris/ Nerve to obturator internus

(all the elements of the sacral nerve plexus SISP)

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19
Q

Where do the following structures exist a) sacrospinous ligament b) sacrotuberous ligament

A

a) sacrum to ischial spine b) sacrum to ischial tuberosity

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20
Q

What two structures run through the lesser sciatic foramen?

A

Tendon and nerve to the obturator internus

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21
Q

What bony landmarks demarkate where the sciatic nerve leaves the hip and enters the thigh?

A

Leaves midway between the posterior superior iliac spine and the ischial thberosity via the greater sciatic foramen Then after going over it’s muscles it passes midway between the greater trochanter of the femur and the ischial tuberosity

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22
Q

There are two sites that are used for intramuscular injections in the hip to avoid injury to the sciatic nerve. These two sites are the dorsogluteal site and the ventrogluteal site. Which is used in adults and children over 7 and why

A

Ventrogluteal because it is further from neurovascular structures. It isn’t used in younger patients because it requires better patient compliance

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23
Q

What muscle are we trying to inject into At the ventrogluteal injection site?

A

Gluteus medius

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24
Q

The fascia lata encloses the thigh muscles and is the site of attachment for the intermuscular septae that separates the thigh into its three compartments - the anterior, medial and posterior compartments. The saphenous vein penetrates it. It is thickest laterally where it forms what?

A

The IT band

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25
What is the iliotibial tract/band?
A thickening if the fascia lata on the lateral aspect of the thigh
26
Where does the IT band run from?
The Iliac crest to the lateral tibial condyle
27
State the origin, insertion and action of the tensor fascia latae
Origin - anterior superior iliac spine Insertion - IT band at upper 1/3 of thigh Action - stabilises the hip in extension. Also helps stabilises the Knee, and assist in abduction Also has a minor role in compressing the deep veins to improve venous return from the lower limbs
28
The gluteal muscles are divided into superficial and deep muscles. The superficial muscles act to abduct and extend the thigh The deep muscles act to laterally rotate and abduct the thigh. List the muscles that comprise each group
Superficial - gluteus maximus, medius, minimus and tensor fascia latae Deep - piriformis, Gemellus superior, obturator internus, gemellus inferior, obturator externus (aDDucts and laterally rotates) and quadratus femoris
29
What is the blood supply to the gluteal muscles?
Superior and inferior gluteal arteries
30
What is the nerve innervation of a) the gluteus maximus b) the gluteus minimus c) gluteus medius
a) inferior gluteal nerve b and c) superior gluteal nerve
31
Origin and insertion of the piriformis muscle
Origin - anterior sacrum Insertion - medial greater trochanter Don’t need to know nerve
32
What important structure emerges just inferior to the piriformis
Sciatic nerve
33
Damage to the inferior gluteal nerve or gluteus maximus what actions could be made difficult
Climbing the stairs and running (innervates gluteus maximus only)
34
What is seen in someone with superior gluteal nerve injury?
A positive trendelenburg sign - the contralateral pelvis descends when the individual is standing on one leg. This is due to difficulty abducting
35
Origin and insertion of obturator internus
Origin - obturator membrane Insertion - medial greater trochanter
36
What are the superior and inferior gemelli separated by?
The obturator internus tendon
37
What muscles do the hamstrings consist of?
Semitendinosus, biceps femoris, semimembranosus
38
Origin and insertion of biceps femoris
Origin - long head - ischial tuberosity of pelvis Short head - linea aspera of femur Insertion fibula
39
Origin and insertion of semitendinosus
Origin - ischial tuberosity Insertion - pes anserinus (medial tibia)
40
Origin and insertion of semimembranosus
Origin - ischial tuberosity Insertion - medial tibial epicondyle
41
In a child what separates the three components of the hip joint
The triradiate cartilage
42
What percentage of people over the age of 70 suffer with osteoarthritis?
30%
43
What is osteoarthritis specifically explaining the differences to rheumatoid arthritis
Breakdown of articular cartilage accompanied by functional limitation. It is non-inflammatory and is without systemic involvement. Occurs at hips, knees, spine and joints in the hand
44
What is the difference between primary and secondary osteoarthritis?
Primary we do not know the cause Secondary is secondary to a known cause
45
Give some examples of risk factors for primary osteoarthritis and causes of secondary osteoarthritis
Risk - age/sex (female)/ African American ethnicity/genetics/under or over nutrition Secondary causes - obesity, trauma, infection, inflammatory arthritis, diabetes/ haemophilia/
46
What are the symptoms of osteoarthritis
A deep aching joint pain, reduced range of motion, grinding of bones (crepitus), stiffness during rest
47
Explain the basic aetiology behind osteoarthritis
Risk factors cause excessive loading on the joint -\> da,age of the articular cartilage -\> increased chondrocyte activity initialyl -\> eventually cartilage softens -\> damage to articular surface and loss of joint space
48
Give two of the four cardinal signs of osteoarthritis that can be seen on an x-Ray
Reduced joint space/ Subchondral sclerosis/ bone cysts (black areas in the main bone due to hyaline cartilage penetrating)/ Osteophytes
49
Give some potential treatments of OA of hip
Weight management if overweight Nutritional supplementation Walking aids Analgesia Steroid injections Hyaluronic acid injections to mimic synovial fluid Surgery
50
Why are intracapsular fractures of the NOF more dangerous than extracapsular ones?
Intracapsular ones likely will disrupt the blood supply to the femoral head from the retinacular arteries. The artery of the ligamentum teres will not be sufficient to supply the heads of femur and avascular necrosis can occur
51
What signs may indicate a displaced NOF Brielfy explain the signs
Affected leg is usually shortened, abducted and laterally rotated Shortened - hamstring muscles pull the distal frament upward Abducted = Strong abductors (gluteus medius and minimus) abduct the femur disal to the fracture site Laterally rotated - Lateral rotators (piriformis etc.) contract and laterally rotate the hip
52
Posterior hip dislocations are more common because the posterior ligaments are weaker, what is the sign of. Posterior dislocation
Affected limb will be shortened and medially rotated Note - sciatic nerve palsy seen in 20% of cases
53
Signs of anterior hip dislocation
Limb held laterally rotated, abducted with slight flexion
54
Sings of centrally dislocated hip
Femoral head is palpable on rectal examination it has been driven through the acetabulum
55
the hip bone or 'innominate bone' is made up of the ischium, pubis and ileum. What are the three articulations it makes?
Sacroiliac joint - articulation with the sacrum pubic symphysis - articulation between the pubis' of both the hip bones hip joint - articulation with the head of the femur
56
what muscles orginate from the gluteal surface of the ilium? Which muscle originates on the iliac fossa?
The gluteal muscles iliacus
57
What part of the innominate bone is most anterior?
pubis
58
What structure is formed by the superior and inferior pubic rami?
Obturator foramen (obturator nerve, artery and vein pass through here to enter the lower limb)
59
What are you sitting on when you're sat upright in a chair?
Your ischial tuberosities
60
What two important ligaments attach to the ischium and what is their function?
sacrospinous - sacrum to ischial spine Sacrotuberous - sacrum to ischial tuberosity These act to limit rotation of the sacrum when weight bearing
61
What forms the greater and lesser sciatic foramina?
Greater - sacrospinous and ileum lesser - between sacrospinous and sacrotuberous
62
Where does the intertrochanteric line run?
Between the greater and lesser trochanter's on the anterior side of the femur Note the equivalent the intertrochanteric crest lies on the posterior side
63
64
What runs in the ligamentum teres?
The artery of the ligamentum teres which supplies the majority of the blood supply to the femoral head in a child but only a minimal amount in an adult
65
What does the linea aspera diverge to form at the distal ends of the femur?
Medial and lateral supracondylar ridges
66
What are the principal muscles involved in the following movements of the hip? a) flexion b) extension c) abduction d) adduction e) lateral rotation f) medial rotation
Flexion - iliopsoas (psoas major and iliacus) (and sartorius, pectineus and rectus femoris) Extension - Gluteus maximus and hamstrings (semimembranosus, semitendinosus, biceps femoris long head) Abduction - Gluteus medius and minimus Adduction - Adductor longus, brevis and magnus Lateral rotation Obturator externus, piriformis, obturator internus, superior and inferior gemelli, quadratus femoris Medial roation - Gluteus medius, minimus and tensor fascia latae
67
Explain why knee pain can be referred to the hip and vice versa
Sciatic and femoral nerve innervate skin in both regions
68
What regions do the following nerves supply a) ilioinguinal b) genitofemoral c) lateral (femoral) cutaneous d) obturator e) femoral I Get Loads Of Fanny (Mnemonic for remembering)
Ilioinguional (L1) - skin of genitalia and upper medial thigh genitofemoral (L1, L2) - Upper anterior thigh Lateral (femoral) cutaneous (L2, L3) - lateral thigh d) obturator (L2, L3, L4) - medial thigh e) Femoral (L2, L3, L4) - anterior thigh also has a 'saphenous' branch which innervates the medial leg
69
What are the nerves of the sacral plexus top to bottom (anatomically and nerve roots)
Superior gluteal (L4, L5, S1) Inferior gluteal (L5, S1, S2) sciatic (L4 - S3) Posterior femoral cutaneous (S1-3) (salmon is so perfect)
70
,What do the tibial and common peroneal components of the sciatic nerve supply in the hip?
Tibial - hamstrings (semimembranosus, semitendinosus, biceps femoris long head, hamstring half of adductor magnus Common peroneal - short head of biceps femoris
71
What are the functions of the hamstrings?
Flexion of the knee, exten the hip and medial rotation the hip (apart from biceps femoris which does lateral not medial rotation)
72
What tendon runs in between the superior and inferior gamelli?
Tendon of the obturator internus
73
Mnemonic for deep gluteal muscles is PGOGOQ what does this mean (superior to inferior
Piriformis Superior gamellus Obturator internus tendon Inferior gamellus obturator externus Quadrator femoris These all abduct and externally rotate apart from Obturator externus which adducts and laterally rotates
74
Medially to laterally what are the muscles of the posterior thigh? (hamstrings)
semimembranosus semitendinosus biceps femoris (long head) biceps femoris (short head)
75
Where do the hamstrings originate and what nerve supplies them. Clue - the odd one out is the short head of the biceps femoris
Ischial tuberosity and tibial nerve except short head of biceps femoris originates at linea aspera and is innervated by the common peroneal nerve
76
How do you locate the site for a ventrogluteal intramuscular injection?
Place the palm of one hand over the greater trochanter of the femur, point your thumb towards the inguinal region and your index finger towards the anterior superior iliac crest. Spread the index and middle fingers to make a V and inject between the proximal interphalangeal joints of your fingers into the gluteus medius muscle.
77
Name four muscles involved in hip flexion
sartorius/rectus femoris/iliopsoas/adductor magnus/adductor longus/pectineus/gracilis/tensor fascia latae
78
Name two muscles involvedi in flexion of the hip
Pectineus/iliopsoas/sartorius/rectus femoris

MSK (11 decks)

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