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Semester 2 > MSK Session 8 > Flashcards

MSK Session 8 Flashcards

0
Q

What bridges the acetabular notch?

A

Transverse acetabular ligament

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1
Q

What is in the acetabular fossa?

A

Fat pad covered by synovial membrane

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2
Q

What is the articular area of the acetabulum?

A

Lunate surface

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3
Q

What are the flexor muscles of the hip?

A 
Iliopsoas
Rectus femoris
Sartorius
Pectineus
Adductor brevis and longus
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4
Q

Which muscles are the adductors of the hip?

A

Pectineus
Adductor brevis and longus
Adductor magnus
Obturator externus

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5
Q

Which muscles are the lateral rotators of the hip?

A 
Piriformis
Gluteus maximus
Obturator internus
Gemellin
Quadratus femoris
Obturator externus
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6
Q

Which are the extensors of the hip?

A

Gluteus maximus
Hamstrings
Adductor magnus

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7
Q

Which are the abductors of the hip?

A

Gluteus medius

Gluteus minimus

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8
Q

Which are the medial rotators of the hip?

A

Gluteus medius and minimus

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9
Q

What supplies blood to the hip joint?

A

Medial and lateral circumflex femoral arteries

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10
Q

Where do the circumflex femoral arteries arise from?

A

Usually profunda femoris artery

Occasionally femoral artery

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11
Q

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

A

No - will cause AVN

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12
Q

Where is the acetabulum not complete?

A

Inferiorly at the acetabular notch

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13
Q

What is the acetabular labrum?

A

Fibrocartilaginous rim attached to the margin of the acetabulum

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14
Q

What is the function of the acetabular labrum?

A

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

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15
Q

What innervates the hip joint?

A

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

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16
Q

Where can pain in the hip be referred from?

A

Vertebral column

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17
Q

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

A

Nerves supplying the muscles across the joint supply the joint too

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18
Q

What forms the joint capsule in the hip?

A

Loose external fibrous layer and internal synovial membrane

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19
Q

Where does the joint capsular of the hip attach?

A

Periphery of acetabular rim
Intertrochanteric line
Proximal to intertrochanteric crest

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20
Q

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

A

Spiral

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21
Q

What forms the orbicular zone?

A

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

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22
Q

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

A

Joint capsule of hip

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23
Q

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

A

Unwind

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24
Q

What pulls the femoral head medially into the acetabulum?

A

Muscles and ligaments

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25
Q

What is the structure of the iliofemoral ligament?

A

Anterior and superior

Y shaped

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26
Q

What is the function of the iliofemoral ligament?

A

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

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27
Q

Which is the strongest ligament in the body?

A

Iliofemoral

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28
Q

What is the structure of the pubofemoral ligament?

A

Interior and inferior

Blends w/medial part of iliofemoral ligament

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29
Q

What is the function of the pubofemoral ligament?

A

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

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30
Q

What is the structure of the ischiofemoral ligament?

A

Posterior

Spirals superolaterally to the femoral neck

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31
Q

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

A

Ischiofemoral

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32
Q

What is seen in congenital dislocation of the hip?

A

Femoral head superior
+ve Trendelenburg sign
Arthritis in adulthood

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33
Q

What is seen in acquired posterior hip dislocation?

A

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

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34
Q

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

A

Sciatic nerve

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35
Q

What is seen in acquired anterior hip dislocation?

A

Femoral head inferior to acetabulum

Acetabulum margin fracture

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36
Q

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

A

Gluteus maximus, medius and minimus

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37
Q

What is the main action of gluteus maximus?

A

Extension
Lateral rotation
Assist in rising from sitting

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38
Q

What is the main action of gluteus medius?

A

Abduction
Medial rotation
Pelvic stability

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39
Q

What is the main action of gluteus minimus?

A

Abduction
Medial rotation
Pelvic stability

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40
Q

What innervated gluteus maximus?

A

Inferior gluteal nerve

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41
Q

What innervates gluteus medius?

A

Superior gluteal nerve

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42
Q

What innervates gluteus minimus?

A

Superior gluteal nerve

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43
Q

What is the main action of piriformis?

A

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

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44
Q

What innervates piriformis?

A

Branches of anterior rami of S1 and 2

45
Q

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

A

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

46
Q

What innervates obturator internus?

A

Nerve to obturator internus

47
Q

What innervates superior gemelli?

A

Nerve to obturator internus

48
Q

What innervates inferior gemelli?

A

Nerve to quadratus femoris

49
Q

What innervates quadratus femoris?

A

Nerve to quadratus femoris

50
Q

What is the main action of quadratus femoris?

A

Laterally rotate thigh

Steady femoral head in acetabulum

51
Q

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

A

Extension, abduction and medial rotation of femur

Prevent pelvic drop on opposite side to the flexed leg when walking

52
Q

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

A

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

53
Q

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

A 
Piriformis
Obturator internus
Superior gemelli
Inferior gemelli
Quadratus femoris
54
Q

Which muscle divides the greater sciatic foramen into two?

A

Piriformis

55
Q

What is hip dysplasia?

A

abnormal relationship b/w femoral head and acetabulum

56
Q

What can be abnormal in hip dysplasia?

A

Neck and shaft angle

57
Q

Who is more affected by hip dysplasia?

A

Higher incidence in females

58
Q

Which hip is more often affected in hip dysplasia?

A

Left

59
Q

Why does hip dysplasia lead to dislocation at birth?

A

Abnormal forces experienced

60
Q

What is the Ortolani test?

A

Forward pressure on femoral heads to move posteriorly dislocated into acetabulum

61
Q

What does movement in the Ortolani test indicate?

A

Subluxation/dislocation that can be reduced

62
Q

What is the Barlow test?

A

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

63
Q

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

A

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

64
Q

What are the treatments for hip dysplasia?

A

Harness if 6 months or harness ineffective

65
Q

What is hip dysplasia often associated with in adulthood?

A

Arthritis

66
Q

What is slipped upper femoral epiphysis?

A

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
Q

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

A

Leg length discrepancy

Arthritis

68
Q

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

A

10-16 y.o.

69
Q

What is the treatment for slipped upper femoral epiphysis?

A

Internal fixation w/single cannulated screw

70
Q

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

A

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

71
Q

Which is the more common type of hip dislocation?

A

Posterior

72
Q

What happens in posterior hip dislocation?

A

Femoral head forced posteriorly tearing through inferior and posterior joint capsule

73
Q

What is anterior hip dislocation a consequence of?

A

Extension, abduction and lateral rotation

74
Q

What is anterior hip dislocation associated with?

A

Fracture

75
Q

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

A

High energy collision w/lower limb extension

76
Q

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

A

50%

77
Q

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

A

Effects of osteoporosis

78
Q

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

A

Intracapsular so main blood supply is likely to be disrupted

79
Q

How does the limb often appear in femoral neck fracture?

A

Shortened

Laterally rotated

80
Q

What does treatment depend of femoral neck fracture depend on?

A

Age and health - would replacement be more effective?

81
Q

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

A

To reduce mortality

82
Q

What causes trochanteric fracture?

A

Direct impact or torsional force

83
Q

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

A

Extra-capsular

84
Q

Who are trochanteric fractures most common in?

A

Elderly

85
Q

What are the treatments for trochanteric fracture?

A

Dynamic hip screw

Cephalomedullary fixation

86
Q

What is cephalomedullary fixation?

A

Rod down centre of bone to prevent excessive shortening

87
Q

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

A

Lower associated mortality rate

Likely to decrease mobility

88
Q

What are the three bursae of the hip?

A

Trochanteric
Iliopsoas
Ischiogluteal

89
Q

Which is the largest bursa of the hip?

A

Trochanteric

90
Q

Where is the trochanteric bursa located?

A

B/w gluteus maximus and greater trochanter

91
Q

Where is the iliopsoas bursa located?

A

Deep to iliopsoas

92
Q

Which is the most powerful flexor of the hip?

A

Iliopsoas

93
Q

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

A

Hip joint

94
Q

How is iliopsoas bursa inflammation confused with hernia?

A

Can present as swelling below inguinal ligament

95
Q

Where is the ischiogluteal bursa located?

A

Near ischial tuberosity

96
Q

What causes inflammation of the ischiogluteal bursa?

A

Cycling/horse riding

97
Q

What is the treatment for bursitis in the hip?

A

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

98
Q

What can arthritis of the hip be due to?

A

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

99
Q

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

A

Inflammation w/mechanical process later

100
Q

What is the progression of osteoarthritis?

A

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

101
Q

What can predispose to development of arthritis?

A

Previous joint injuries

102
Q

Why do bone spurs form in osteoarthritis?

A

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

103
Q

What are the treatments for osteoarthritis?

A

NSAIDs
Muscle relaxants
Inter-articular corticosteroid injections
Modify lifestyle

104
Q

What is the progression of rheumatoid arthritis?

A

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

105
Q

What are the stages of rheumatoid arthritis development?

A

Syvonitis
Pannus
Fibrous ankylosis
Bony ankylosis

106
Q

What happens in syvonitis?

A

Synovium inflamed and thickened

Bone and cartilage gradually eroded

107
Q

What is pannus?

A

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

108
Q

What happens during pannus formation in rheumatoid arthritis?

A

Exposed and pitted bones, no cartilage left

109
Q

What happens in fibrous ankylosis during rheumatoid arthritis?

A

Fibrous CT invades

110
Q

What happens in bony ankylosis in rheumatoid arthritis?

A

Bones fused

Semester 2 (45 decks)

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