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Semester 2 > MSK Session 11 > Flashcards

MSK Session 11 Flashcards

1
Q

What do all of the superficial posterior leg muscles attach to distally?

A

Calcaneal tendon

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2
Q

What innervates the muscles in the posterior compartment of the leg?

A

Tibial nerve

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3
Q

What common function do all muscles in the superficial layer of the posterior compartment of the leg share?

A

Plantarflex ankle

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4
Q

What functions does gastrocnemius have in addition to plantarflexion of the ankle?

A

Raises heel while walking

Flexes knee

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5
Q

What function additional to plantarflexion of the ankle does soleus have?

A

Steadies leg on foot

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6
Q

Which muscles are in the deep layer of the posterior leg compartment?

A

Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

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7
Q

What is the main action of popliteus?

A

Weakly flex knee
Unlock knee by rotating femur
Medially rotate unplanted limb

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8
Q

What is the main action of flexor hallucis longus?

A

Flex all great toe joints
Weak plantarflexion
Support medial longitudinal arch of foot

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9
Q

What is the main action of flexor digitorum longus?

A

Flex lateral 4 digits
Plantarflexion
Support longitudinal arches of foot

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10
Q

What is the main action of tibialis posterior?

A

Plantarflex ankle

Invert foot

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11
Q

From which nerve does the tibial nerve originate?

A

Sciatic

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12
Q

Where can the tibial nerve be located at the ankle?

A

B/w tendons of FHL and FDL

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13
Q

How does the tibial nerve enter the posterior compartment of the leg?

A

Passes b/w heads of gastrocnemius

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14
Q

What happens to the tibial nerve at the ankle?

A

Divides into medial and lateral plantar nerves

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15
Q

What is the sensory distribution of the tibial nerve?

A

Knee joint
Lateral and posterior part of inferior 1/3 of leg
Lateral foot and heel

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16
Q

Which branch of the popliteal artery supplies the posterior leg and foot?

A

Posterior tibial

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17
Q

What accompanies the posterior tibial artery in the leg?

A

Tibial nerve and veins

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18
Q

Describe the path of the posterior tibial artery as it moves through the posterior compartment of the leg.

A

Posterior to medial malleolus
Runs b/w tendons of FHL and FDL
Divides into medial and lateral plantar arteries deep to flexor retinaculum

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19
Q

What is the largest tibial artery branch called?

A

Fibular artery

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20
Q

Describe the passage of the fibular artery in the posterior compartment of the leg.

A

Inferior to popliteus and tendinous soleus arch

Moves medially w/in FHL

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21
Q

What does the fibular artery give rise to?

A

Nutrient artery of fibula

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22
Q

What have their origin from the anterior and posterior tibial arteries?

A

Cx fibular artery

Nutrient artery of tibia

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23
Q

What branches off from the anterior and posterior tibial arteries and anastomoses around the knee?

A

Cx fibular artery

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24
Q

Which is the largest nutrient artery of the body?

A

Tibial

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25
Q

How are the veins of the posterior leg usually arranged?

A

As venae comitantes

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26
Q

What is present in all veins of the posterior leg to prevent back flow of blood?

A

Valves

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27
Q

What do veins in the posterior leg accompany?

A

All major arteries (so have same names)

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28
Q

Describe the veins through which blood in the posterior compartment of the leg drains.

A

Superficial –> perforating –> deep

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29
Q

How does calf muscle contraction aid venous return?

A

Propels blood to heart

Closes lower valve therefore preventing bloodflow away from heart

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30
Q

How is the passage of the great saphenous vein described?

A

Medial

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31
Q

How is the passage of the small saphenous vein described?

A

Lateral

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32
Q

Which muscles make up the superficial layer of the posterior compartment of the leg?

A

Plantaris
Gastrocnemius
Soleus

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33
Q

What is the WHO definition of old age?

A

> 65 y.o.

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34
Q

Why will 40% of all women >50 y.o. have a fracture?

A

Osteoporosis

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35
Q

At what rate does bone mineral content decline after the age of 30?

A

~1% per year

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36
Q

What accelerates bone mineral loss?

A 
Decreased reproductive hormone levels
Poor calcium
Poor vitamin D
Inactivity
Endocrine/GI pathologies
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37
Q

What causes a decrease in bone strength as both a material and a structure?

A

Loss of bone mineral

Changes in architectural structure

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38
Q

What is sarcopenia?

A

Decrease in muscle mass due to loss of muscle fibres and decreased muscle cross sectional area

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39
Q

What happens with muscle contractility with age?

A

Decreases

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40
Q

Which neuron fibres are most affected by loss of neuronal innervation?

A

Alpha-motor (type II fast twitch)

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41
Q

Does the fact that men have a greater muscle mass in proportion to fat than women alter the rate of muscle loss b/w genders?

A

Nope

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42
Q

How can ageing exacerbate injury to the rotator cuff muscles?

A

Muscles become marbled w/fat –> tear –> cannot repair due to fat content

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43
Q

What four factors can increase fall risk and combined with bone weakness lead to fracture?

A

Decreased mobility
MSK-related posture and gait changes
Neuro-related gait and proprioception changes
Environmental hazards

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44
Q

What is type 1 osteoporosis caused by?

A

Post menopausal loss of oestrogen

45
Q

What is type 2 osteoporosis caused by?

A

Old age
Hyperparathyroidism
Hypocalcaemia

46
Q

What are the risk factors for osteoporosis?

A 
Age
Decreased bone mass
Caucasian/Asian
Previous fragility fracture
\+ve FHx
Low BMI
Lifestyle
Early menopause
47
Q

What is the WHO definition of osteoporosis?

A

Skeletal disease characterised by decreased bone mass per unit volume
Deterioration of bone micro architecture leading to increased bone fragility and susceptibility to trauma #

48
Q

How do bisphosphonates prevent bone resorption?

A

Taken up by osteoclasts
Inhibits mevalonate pathway
Osteoclast loses ruffled border so cannot sit on bone lining
Undergoes apoptosis

49
Q

What effects do bisphosphonates have on bone turnover, mineralisation and bone volume?

A

Decreased turnover
Increased mineralisation
Minimal effect on volume

50
Q

Give some examples of types of bisphosphonates.

A

Alendronate
Pamidronate
Zoledronate

51
Q

What do bisphosphonates to do fragility fracture risk?

A

Decrease by 50%

52
Q

What is the most important source of blood to the femoral head?

A

Medial circumflex artery

53
Q

What will happen to 1 in 3 hip # patients?

A

Drop one level in mobility

54
Q

How is an intracapsular hip # fixed?

A

Hemi/total arthroplasty

55
Q

How is an extracapsular hip # fixed?

A

Dynamic hip screw

Intramedullary rod

56
Q

What is the NICE definition of osteoarthritis?

A

Disorder of synovial joints w/focal areas of damage to the articular cartilage, remodelling of underlying bone, formation of osteophytes and mild synovitis

57
Q

What percentage of cartilage loss prevents bone from healing in osteoarthritis?

A

90%

58
Q

How does osteoarthritis appear histiologically?

A

Loss of smoothness
Fibrillation and crevices present
Loss of cartilage means greater proportion of view is subchondral bone

59
Q

What are the four radiological features associated with osteoarthritis?

A

Decreased joint space
Sclerosis
Osteophytes
Bone cysts

60
Q

Where are bone cysts more commonly seen?

A

Shoulder

61
Q

How can osteoarthritis be treated?

A 
Weight loss
Physiotherapy (improves proprioception)
Analgesia
Joint injection
Arthroscopy
Osteotomies
Arthrodesis
Arthroplasty
62
Q

What is an osteotomy?

A

Procedure to cut bone to offset loading which has manifested as bowing of the legs

63
Q

What is arthrodesis?

A

Artificial joint ossification

64
Q

Give some examples of complications associated with osteoarthritis treatments.

A 
Leg length inequality
Dislocation
Loosening
Neurovascular damage
Infection
DVT (rare but treated prophylactically)
65
Q

What is the problem with using a metal on metal hip replacement?

A

Release of metal ions into blood causing large losses of soft tissue

66
Q

Give some examples of the type of joints that can be used for hip replacement.

A

Metal on polythene (mainly)
Ceramic
Highly X-linked polyethylene
Metal on metal

67
Q

Describe the passage of the arteries of the lower limb.

A

External iliac –> femoral artery (-> deep artery of thigh -> medial and lateral circumflex femoral) –> popliteal artery –> anterior tibial, posterior tibial and fibular

68
Q

Which arteries support the adductor muscles?

A

Deep artery of thigh

Obturator artery from internal iliac

69
Q

Where does the artery to head of femur arise from?

A

Obturator artery

70
Q

Is the artery to head of femur important in the blood supply of the adult femoral head?

A

Nope

71
Q

How can catheter access to the left side of the heart be achieved?

A

Femoral artery at mid-inguinal point

Brachial/radial arteries

72
Q

Where is the mid-inguinal point?

A

B/w ASIS and pubic tubercle

73
Q

Why can catheter access to the right side of the heart not use veins in the arms?

A

Venae comitantes are too small

74
Q

What venous access is used to access the right side of the heart with a catheter?

A

Neck

75
Q

What is the contents of the adductor canal?

A

Saphenous nerve
Femoral artery
Femoral vein

76
Q

What are the changes to the path of the femoral artery in the adductor canal?

A

Crosses to posterior aspect via adductor hiatus

77
Q

Why is the popliteal artery not easily felt?

A

Deepest structure in the popliteal fossa

Fascia surrounds fossa

78
Q

What are the arteries of the posterior knee?

A

Superior, middle and inferior genicular arteries

79
Q

Why are anastomoses needed in the anterior knee?

A

In full flexion the popliteal artery is obstructed so needed for sufficient blood supply

80
Q

What position would you ask a patient to assume in order to palpate the popliteal pulse?

A

Prone with knee flexed to relax fascia

81
Q

Why do you ask the patient to invert the foot when palpating the posterior tibial pulse posterior to the medial malleolus?

A

Relax flexor retinaculum

82
Q

How does the anterior tibial artery enter the anterior compartment?

A

Pierces interosseous membrane

83
Q

Where can the dorsalis pedis pulse be felt?

A

Just lateral to EHL tendon

84
Q

Which artery is bigger, posterior tibial or anterior tibial?

A

Posterior

85
Q

What are risk factors for formation of atherosclerotic plaque?

A

Uncontrolled DM
Hypertension
Dyslipidaemia
Smoking

86
Q

What are the 8 stages of atheromatous plaque formation?

A 
LDL through vascular endothelium
LDL oxidised
Cytokines released
Monocytes and macrophages migrate
Scavenger receptors activated
Smooth muscle migration
Foam cell formation
Cell apoptosis
87
Q

In which part of the BV wall do atheromatous plaques develop?

A

Intima

88
Q

Where are the 5 most common sites for atheromatous plaque formation, starting with the most common?

A 
Abdominal aorta and iliac arteries
Proximal coronary arteries
Thoracic aorta, femoral and popliteal arteries
Internal carotid arteries
Vertebral basilar and middle cerebral
89
Q

Why might you not be able to palpate a dorsalis pedis pulse in a patient?

A

Arterial occlusion in lower limb

They are one of the ~2% of population with no dorsalis pedis pulse

90
Q

What should an ankle brachial pressure index show if there is no arterial occlusion?

A

Similar blood pressures in arm and leg whilst lying down

91
Q

What imaging methods can be used to assess arterial occlusion?

A

Doppler ultrasound

Arteriogram

92
Q

If the radius of an artery decreases by a half, how much will the flow reduce by?

A

1/16

93
Q

What are the S/S of peripheral artery disease?

A 
Lack of hair
Skin problems
Ulcers
Improper healing after injury
Infection
Loss of pulses
Cold
94
Q

What are the Tx for peripheral artery disease?

A

Antiplatelets
Modify risk factors
Increase exercise to stimulate angiogenesis

95
Q

What occurs in atherosclerosis to cause acute ischaemia?

A

Plaque rupture

96
Q

How would a patient with a popliteal aneurysm present?

A

Oedema and pain in popliteal fossa with a palpable pulsatile mass

97
Q

In which two lower leg injuries is the popliteal artery at risk of rupture?

A 
# of distal femur
Dislocation of the knee
98
Q

What is the superficial venous drainage of the lower limb?

A

Great and small saphenous veins

99
Q

Describe the course of the great saphenous vein.

A 
Arises from dorsal venous arch of foot
Courses anterior to medial malleolus
Passes about a hand's breadth medially of the patella
Through fascia lata at saphenous opening
Drains into femoral vein
100
Q

What follows the great saphenous vein along its course?

A

Saphenous nerve

101
Q

Describe the passage of the small saphenous vein.

A

Arises from lateral marginal vein of foot
Passes posterior to lateral malleolus
Course up posterior aspect of calf
Drains into popliteal vein in popliteal fossa

102
Q

What is saphenous cut down?

A

Incision anterior to medial malleolus to gain access to great saphenous vein

103
Q

When is saphenous cutdown used?

A

Emergencies e.g. hypovolaemic shock when veins have collapsed and venepuncture/cannulation is required

104
Q

What is the pathogenesis of varicose veins?

A

Valve flaps become incompetent
Stasis of blood in veins
Dilated, tortuous superficial veins

105
Q

What is the pathogenesis of venous insufficiency?

A

Valvular incompetence –> dull, aching, tingling legs combined with ulcers and slow healing wounds

106
Q

What is postphlebitic syndrome a consequence of?

A

DVT

Chronic deep venous insufficiency

107
Q

What is the pathogenesis of postphlebitic syndrome?

A

Damage to venous valves –> lymphedema from high hydrostatic pressure in veins

108
Q

What do deep veins of the lower limb follow?

A

Major arteries

Semester 2 (45 decks)

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