Lower limb questionsADAM SMITH

What structures are within the femoral triangle?

Femoral nerve, artery and vein

Nerve most laterally

Mid-inguinal point +/- 1.5cm = artery

How do you find the mid-inguinal point?

Half way between ASIS and pubic tubercle

What passes through the lesser sciatic foramen?

Pudendal nerve

Internal pudendal vessels

Nerve to obturator internus

Which structures pass through the greater sciatic foramen?

Piriformis

Superior gluteal artery nerve and vein

Sciatic nerve, inferior gluteal nerve artery vein, pudendal nerve, inferior pudendal artery and vein, posterior femoral cutaneous nerve, nerves to lateral rotators

What contributes to hip joint stability?

Acetabular labrum

Ligaments – ischiofemoral, iliofemoral, pubofemoral, ligamentum teres

Why can avascular necrosis of the femoral head occur?

Interruption to blood supply due to fractured neck of femur

Leaves only branch from obturator artery (through ligamentum teres), as lateral and medial circumflex (femoral branches) and nutrient artery move proximally

What structures are in the popliteal fossa?

Popliteal artery is deep, popliteal vein, tibial nerve is superficial. Common fibular nerve is lateral

What structures run behind the medial malleolus?

Tarsal Tunnel

Tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor hallucis longus

What is the lymphatic drainage of the lower limb?

Superficial inguinal nodes

Deep inguinal nodes

External iliac nodes

Para-aortic nodes

Which blood vessel from the leg is commonly used in CABG?

Great saphenous vein

RTC where 1 car hits the other from the driver’s side, the driver is unable to dorsiflex, why?

Damage to common fibular nerve as it is compressed against head of fibular

What is housemaid’s knee? What is clergyman’s knee?

Pre-patellar bursitis

Infra-patellar bursitis

What is a valgus deformity of the knee?

Distal part of the joint is angled laterally

What does ACL do and how is it injured?

Prevents anterior movement of the tibia on the femur

Hyperextension or medial rotation of femoral condyles on the tibial plateau

May be contact causing hyperextension or valgus stress on the knee or non contact, classically sudden deceleration and pivoting movement whilst running (causing valgus stress)

What are the pulses of the lower limb? Femoral pulse

Mid-inguinal point

Popliteal pulse

Popliteal fossa, medial side, artery deepest structure in fossa so push hard

Posterior tibial pulse

Located posterior and inferior to medial malleolus

Dorsalis pedis pulse

Dorsum of foot, between tendons of extensor hallucis longus and extensor digitorum longus to second toe

Dorsalis pedis artery from anterior tibial artery

What are the reflexes of the lower limb?

S1,2 Achilles

L3,4 Patella

What is compartment syndrome? And why is it dangerous?

Increased pressure within a fascial compartment due to increased fluid

Often follows acute trauma, can be chronic

Signs

Pallor

Pulselessness

Parasthesia

Paralysis

Pain

Perishingly cold

Ischaemic injury to compartment and distal structures

Which side of the ankle is more likely to suffer a sprain?

Lateral as the lateral collateral ligament is weaker

What strucutres hold tedons to the ankle?

Flexor retinaculum

Extensor retinaculae – superior and inferior