Term
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Definition
| It is a natural "knock knee" that occurs in humans due to the angle of the femur to the hip bone. The femur is angled medially so that the lower limb is directed underneath the individual's center of gravity. This angle is around 10 degrees for men and a little more for women due to their relatively wider hips. |
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Term
| What is the lumbosacral trunk (what does it connect)? |
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Definition
| Lumbosacral trunk is ventral rami of L5 spinal nerves that connect the lumbar plexus to the sacral plexus. |
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Term
| What innervates the developmentally dorsal muscles? |
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Definition
| Femoral nerve, gluteal nerves, and peroneal nerve |
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Term
| What is the ligamentum teres of the femur and what is its function? |
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Definition
| It is a ligament that attaches the head of the femur to the acetabellum. In childhood, it is important for the vascularization of the femoral head, however it serves no mechanical function |
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Term
| What is the function of the medial and lateral menisci of the tibial condyles? |
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Definition
| Act as a cushion to the weight the lower limb must bear |
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Term
| What are the patellar retinaculi? |
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Definition
| The medial and lateral patellar retinaculum are medial and lateral portions of the quadriceps femoris tendon that do not insert upon the patella |
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Term
| What is the function of the ACL? |
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Definition
| Prevents anterior sliding of the tibia on the femur |
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Term
| What is the function of the PCL? |
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Definition
| Prevents posterior sliding of the tibia on the femur |
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Term
| Why is it more difficult to extend the toes when standing than when sitting? |
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Definition
| Because the plantar aponeurosis is under tension and attaches to the digital flexor sheaths. When there is more weight on the arch (and therefore more tension), it becomes more difficult to extend the toes. |
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Term
| What is the Q angle and how is it circumvented? |
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Definition
| It is angle of pull the quadriceps femoris muscles have on the patella. It is slightly greater for females than males due to the relatively wider hips females have compared to males. The overall vector direction is laterally, and this is prevented by the action of the vastus medialis obliquus. It is calculated from 2 lines: one between the anterior superior iliac spine and the center of the patella, and the other between the center of the patella and the tibial tuberosity |
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Term
| What comprises the pes anserinus of the lower limb? |
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Definition
| The combination of the distal ligaments of the gracilis, sartorius, and semitendinosus. |
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Term
| What causes anterior tibial syndrome? |
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Definition
| Excessive pressure within the anterior tibial compartment. The first symptom is numbness on the cutaneous distribution of the deep peroneal nerve (dorsum of first and second toes). |
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Term
| Where can you palpate the dorsalis pedis artery? |
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Definition
| Palpable on the dorsum of the foot, just proximal to the first intermetatarsal space and just lateral to the extensor hallicus longus tendon. About 10-15% of the time it is too small to be palpated however. |
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Term
| Why must intergluteal injections be given in the upper outer quadrant of the gluteus maximus? |
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Definition
| So as to protect the sciatic nerve, whose proximal section runs underneath the middle portion of the gluteus maximus |
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Term
| How would you test the ACL of a patient (without using the Lachman test)? |
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Definition
1. Lay patient supine with knee flexed 90 degrees
2. Try to pull the tibia anteriorly
3. If tibia moves more than 3mm, it is known as a "positive anterior drawer sign" and indicates an injured ACL. |
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Term
| What is the most sensitive method of testing the ACL? |
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Definition
Lachman Test:
1. Lay patient supine with 20-30 degrees of flexion at the knee
2. Try to pull tibia anteriorly (should be able to do so a little normally)
3. There should be a normal stopping point, but if this is "mushy" then it is a positive test and the ACL is probably damaged. |
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Term
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Definition
| Automobile injury where the passenger is thrust forward into the dashboard. This results in a posteriorly-directed force that may result in damage to the PCL |
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Term
| How would you test the integrity of the PCL? |
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Definition
| In the same design as the Lachman test, however instead you try to push the tibia posteriorly rather than anteriorly. |
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Term
| What kind of injury would rupture the MCL? |
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Definition
| Lateral blow to the leg. Usually happens in football or soccer. |
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Term
| How would you test the anterior talofibular ligament? |
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Definition
1. Place one hand on the front of the leg and then attempt to pull the foot forward by pressure applied to the heel.
2. If the foot can be pulled forward relative to the leg, this is a positive anterior drawer sign of the ankle. |
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Term
| What is the average Q angle for men? |
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Definition
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Term
| What is the average Q angle for women? |
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Definition
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Term
| What is the plantaris tendon used for? |
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Definition
| Graft for the repair of badly damaged tendons of the hand |
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Term
| What is recommended if a lower limb is to be reattached after being amputated for up to 6 hours? |
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Definition
| Prophylactic fasciotomy so the soon-to-be swollen muscles do not succumb to compression syndromes. (Note: recall that for highly muscular structures the warm ischemia time is no more than 6 hours). |
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Term
| What is Medial Tibial Stress Syndrome (MTSS)? |
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Definition
"Shin Splints" There are two main theories:
1. Overuse of the soleus leads to inflammation of the tibial periosteum
2. Microfractures in the porous bone of the tibia in response to frequent and/or large loads on the limb (note: this is NOT the same a stress fractures, which are much larger and more focal in pain distribution) |
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Term
| Why do pregnant women sometimes get varicose veins? |
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Definition
| Because the enlarged uterus can compress the common iliac veins, leading to elevated venous pressure within the lower limb. |
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Term
| A CT surgeon wishes to perform a bypass surgery graft on the LAD. What vein is he/she going to use? Why? |
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Definition
| Great saphenous vein because it is long, easily located, and has large valves that can prevent retrograde flow of blood back into the coronary artery. |
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Term
| What is a possible treatment for the spasticity associated with cerebral palsy? |
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Definition
| Transection of the anterior obturator nerve, which controls the gracilis, adductor longus, and adductor brevis. This allows the gait to be more salutatory and smooth because the medial rotation spasms are prevented. |
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Term
| What is the Trendelenburg test? |
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Definition
| Tests damage to the gluteus medius and gluteus minimus, both of which abduct the thigh. Patient is told to lie on his/her side and attempt to abduct the leg. If unable to or greatly weakened, the sign is positive and the superior gluteal nerve is likely damaged. |
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Term
| How would you test the inferior gluteal nerve? |
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Definition
| Patient flexes knee and tries to lift thigh off of exam table. If cannot, infeior gluteal nerve may be damaged because gluteus maximus is weakened. |
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Term
| How would you test the strength of the gluteus maximus? |
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Definition
| Patient flexes knee and tries to lift thigh off of exam table. If cannot, infeior gluteal nerve may be damaged because gluteus maximus is weakened. |
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Term
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Definition
1. (Most common): L5/S1 slipped disc
2. "Piriformis syndrome": Compression of the sciatic nerve within the buttocks due to either a spasmatic piriformis or a hypertrophied piriformis. Usually with this type of sciatica there is no numbness or motor weakness and the straight leg raise test is negative (SLR). |
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Term
| How can you test the tibial nerve? |
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Definition
1. Plantarflex the foot
2. Invert the foot
3. Flex the toes against resistance
4. Walk on the toes (similar to #3) |
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Term
| What can damage the tibial nerve (aside from traumatic injury)? |
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Definition
| Baker's cyst (fluid-filled cyst derived from one of the bursae at the back of the knee). |
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Term
| How can you test the integrity of the superficial peroneal nerve? |
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Definition
| Evert the foot against resistance. Tests the lateral compartment muscles, which are innervated by the superficial peroneal nerve. |
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Term
| How can you test the integrity of the deep peroneal nerve? |
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Definition
| Dorsiflex the foot and toes against resistance and/or ask patient to walk on his/her heels. This tests the anterior tibial compartment muscles, which are innervated by the deep peroneal nerve. |
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Term
| In performing a catheterization surgery, why is it important to puncture the common femoral artery as it passes anterior to the femoral head? |
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Definition
| Because after the procedure is complete, the common femoral artery can be compressed against the femoral head in order to stop the bleeding. If the catheter is inserted too proximally there is no method to apply pressure to prevent bleeding and the result can be a very severe hematoma. |
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Term
| What are the branches of the lumbar plexus, from superior to inferior? |
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Definition
| Subcostal (T12), Iliohypograstric (L1-L2), Ilioinguinal (L1-L2), Genitofemoral (L1-L2), Lateral cutaneous nerve of the thigh (L2-L3), Femoral (L2-L4), Obturator (L2-L4) |
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Term
| What are the branches of the sacral plexus, from superior to inferior? |
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Definition
| Superior Gluteal (L5-S1), Inferior Gluteal (L5-S1), Sciatic nerve (tibial and common peroneal), nerve to quadratus femoris, and nerve to obturator internus |
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Term
| What innervates the biceps femoris? |
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Definition
| Long head is tibial. Short head is common peroneal |
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Term
| What structure prevents hyperextension of the hip while we are standing? |
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Definition
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Term
| If the iliofemoral ligament is loose what will contract to compensate? |
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Definition
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Term
| What muscle flexes the foot to keep the leg balanced during standing? |
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Definition
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Term
| What muscles are used during heel strike? |
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Definition
1. Lesser gluteals (abduction)
2. Gluteus maximus (extension of thigh)
3. Vasti (extension of leg)
4. Hamstrings (extension of thigh)
5. Anterior tibial muscles (dorsiflexion of foot) |
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Term
| What muscles are used during the support phase of walking? |
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Definition
1. Lesser gluteals (abduction of leg)
2. Triceps surae (plantar flexion) |
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Term
| What muscles are used during the toe off phase of walking? |
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Definition
1. Semitendinosus ONLY of the hamstrings (flexion of leg)
2. Iliopsoas and adductors (extension of thigh and adduction)
3. Rectus femoris (contributes to hip flexion phase during toe off)
4. Sartorius (Flexes hip and knee) |
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Term
| What muscles are used during the swing phase of walking? |
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Definition
1. Anterior tibial muscles (keeps foot off ground via dorsiflexion)
2. Sartorius (in the beginning used to flex thigh) |
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Term
| What is the function of the vastus medialis obliquus (VMO)? |
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Definition
| Muscle fiber part of vastus medialis (innervated by femoral nerve) that pulls the patella medially, resisting the normal lateral pull of the remaining quadriceps muscles on the patella |
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Term
| Which femoral condyle is more prominent? |
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Definition
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Term
| What provides more than 50% of the support of the arch while standing still? |
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Definition
| Plantar calcaneonavicular ligament ("Spring ligament") |
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Term
| What structure is important to maintaining the arch of the foot while standing on the toes? |
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Definition
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Term
| What gait results from damage to the superior gluteal nerve? |
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Definition
| Trendelenburg Gait: With each step there is a drop of the pelvis contralateral to the side of damage with lateral flexion of lumbar vertebral column towards the ipsilateral side (because do not want to abduct hips on damaged side) |
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Term
| What gait results from damage to the inferior gluteal nerve? |
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Definition
| Person leans backward during heel strike to position the center of gravity behind the hip joint to counteract the tendency to fall forward (because paralyzed gluteus maximus). Note: The patient will also complain of problems rising from a chair and climbing/descending stairs) |
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Term
| What gait results from damage to the sciatic nerve? |
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Definition
| Person leans backward during heel strike to position the center of gravity behind the hip joint to counteract the tendency to fall forward (because of paralyzed hamstrings). |
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Term
| What gait results from damage to the femoral nerve? |
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Definition
| Femoral nerve damage will damage the vasti, sartorius, and rectus femoris. The vasti are used in single-leg support phase by preventing flexion of the leg. Therefore, the person will lean forward during walking in order to place the center of gravity under the leg. Also keep the leg as straight as possible. |
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Term
| What can result from damage to the common peroneal nerve? |
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Definition
| Damage to the muscles innervated by the deep peroneal nerve (anterior tibial muscles), leading to foot drop |
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Term
| What can lead to damage to deep peroneal nerve? |
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Definition
| Anterior compartment syndrome (swelling of the anterior tibial muscles). This can be caused by sudden strenuous exercise in an overweight or obese person or by reattachment of an amputated limb. This damage will lead to foot drop. |
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Term
| What gait will result if the deep peroneal nerve is damaged? |
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Definition
| "High stepping gait" due to foot drop. The foot will also be seen to "slap" down on the ground during heel strike |
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Term
| What kind of gait results if the tibial nerve is paralyzed (distal to the knee)? |
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Definition
| Person takes short steps and puts weight on back of the heels (so as to not have to use the triceps surae muscles). OR: Person uses their peroneus longus and brevis and walk "like a ballerina" with alternating everting and inverting the foot |
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Term
| What muscles are innervated by the femoral nerve? |
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Definition
1. Iliopsoas
2. Rectus femoris
3. Vastus medialis, intermedius, lateralis
4. Sartorius
5. Pectinius |
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Term
| What muscles are innervated by the posterior division of the obturator nerve? |
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Definition
1. Obturator externus
2. Pubofemoral part of adductor magnus |
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Term
| What muscles are innervated by the anterior division of the obturator nerve? |
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Definition
1. Gracilis
2. Adductor brevis
3. Adductor longus |
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Term
| What muscle divides the anterior and posterior divisions of the obturator nerve? |
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Definition
| Adductor brevis (the nerve splits around it with posterior traveling underneath and the anterior over) |
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Term
| What muscles are innervated by the superior gluteal nerve? |
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Definition
1. Gluteus minimus
2. Gluteus medius
3. Tensor fasciae latae |
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Term
| What muscles are innervated by the inferior gluteal nerve? |
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Definition
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Term
| What muscles are innervated by the tibial nerve PROXIMAL to the knee? |
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Definition
1. Semitendinosus
2. Semimembranosus
3. Long head of the biceps femoris
4. Ischiocondylar part of the adductor magnus |
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Term
| What muscles are innervated by the common peroneal nerve? |
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Definition
| 1. Short head of biceps femoris |
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Term
| The ACL spans from the (1) to the (2) |
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Definition
| Lateral condyle of the femur to the medial articular surface of the tibia |
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Term
| The PCL spans from the (1) to the (2) |
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Definition
| Medial condyle of the femur to the lateral articular surface of the tibia |
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Term
| Where does the common peroneal nerve divide and what does it divide into? |
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Definition
| Just distal to the head of the fibula. It divides into superficial and deep peroneal nerves. |
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Term
| Where does the tibial nerve split and what does it split into? |
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Definition
| Splits just distal to the flexor retinaculum (on medial malleolus & associated with "Tom, Dick, and Harry"). Splits into medial plantar nerve and lateral plantar nerve |
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Term
| What does the tibial nerve innervate (distal to the knee and before it branches in the foot) |
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Definition
1. Popliteus
2. Gastrocnemius
3. Soleus
4. Plantaris longus
5. Tibialis posterior
6. Flexor hallucis longus
7. Flexor digitorum longus |
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Term
| What does the tibial nerve innervate (medial plantar division)? |
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Definition
1. Abductor hallucis
2. Flexor hallucis brevis
3. Flexor digitorum brevis
4. Medial pedal lumbricals |
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Term
| What does the tibial nerve innervate (lateral plantar division)? |
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Definition
1. Quadratus plantae
2. Abductor digiti quinti
3. Flexor digiti quinti brevis
4. Adductor hallucis
5. Plantar interossei
6. Dorsal pedal interossei
7. Lateral pedal lumbricals |
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Term
| What muscles are innervated by the superficial peroneal nerve? |
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Definition
1. Peroneus longus
2. Peroneus brevis |
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Term
| What muscles are innervated by the deep peroneal nerve? |
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Definition
1. Tibialis anterior
2. Extensor hallucis longus
3. Extensor digitorum longus
4. Peroneus tertius
5. Extensor digitorum brevis
6. Extensor hallucis brevis |
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