Gross anatomy

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wolfgar
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Gross anatomy
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2011-11-12 19:57:32
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  1. Explain the two ways to measure lumbar sacral angle?
    • Lumber sacral angle or sacral base angle or ferguson's angle– is classified differently in different text. It is the angle at which the top of the sacrum points in relation to horizontal tends to be about 41 degrees on average. The flatter the sacral top is the less slippage there will be and the less back pain. Women can have problems due to pregnancy with this angle due to bulging bellies , extra weight and lax ligaments caused
    • by hormones.


    Lumbar sacral angle - Alternate way to calculate lumber sacral angle –you create a line through the lumbar vertebrea and aligned through the sacrum and this line creates the angle. So they look at the angle between the lumbar and the sacrum
  2. What is the average lumbar sacral angle, using the more standard method?
    41 degrees
  3. Explain what posterior, anterior and neutral pelvic tilt are?
    Posterior pelvic tilt is when the ASIS's are posterior to the pubic symphsis or pubic tubercle. When there in line with the pubic tubercle they are neutral and when the ASIS is anterior to the pubic tubercle this is anterior tilt.
  4. Does anterior or posterior pelvic tilt create greater lordosis of the lumbar spine?
    Anterior pelvic tilt creates greater lordosis of the lumbar spine.
  5. What way would the knee go in or out if you hav alot of coxa valgus?
    coxa valgus - would you make you bow legged, because the knee would be pushed in makiing the femur stick out.
  6. What is Femoral anteversion / retroversion?
    This is the angle that the head and neck of the femur make with regards to a table or imagiary plane that the femur is set upon. IF this angle is greater or less the 15 degrees you have anteversion or retroversion.

    Anteversion means rotated forwards (towards the front of the body)

    Retroversion means rotated backwards (towards the back of the body)
  7. What and were is the sacrotuberous ligamen?
    sacrotuberous ligament - (great or posterior sacrosciatic ligament) is situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends. It runs from the sacrum (the lower transverse sacral tubercles, the inferior margins sacrum and the upper coccyx) to the tuberosity of the ischium.
  8. What is Legg-Calve Perthes disease?
    Legg-Calve Perthes disease – is quite common in young children – it is degeneration of the head of the femur, osteochondrosis , so you get death and regeration over and over again leading to pain, in sever cases they will freeze it in the socket.
  9. What is Arthrogryposis?
    Arthrogryposis – child born with hips displaced and club feet and hands and some time there is shoulder issues, 1 in 3000 light births. These of these children 99% will be wheel chair bound for life. Think this caused do to lack of movement in the womb so muscle don't develop and they have all these contractures It is a genetic disease.
  10. What is Weavers bum?
    Weavers bum or Ischial bursitis - A person with ischial bursitis has inflammation of the bursa that lies over the ischial tuberosity. The ischial tuberosity is the bony prominence in the pelvis, on which you sit. The ischial bursa acts as a lubricating pad between tendons and the pelvic bone. The ischial bursa prevents destruction of the tendons as they move over the ischial tuberosity. A common cause of ischial bursitis is prolonged sitting. Inflammation around the ischial tuberosity can irritate the sciatic nerve, triggering symptoms that are very similar to acute sciatica.


    The ischial tuberosity is the origin of the hamstrings and abductors hence why this bursitis is such an issue.What are the symptoms of ischial bursitis?Symptoms of ischial bursitis include buttock pain or hip pain, and localized tenderness overlying the ischial tuberosity. Additional symptoms of ischial bursitis include numbness and tingling in the buttock that spreads down the leg. The symptoms usually worsen while sitting.
  11. What is the gluteal tuberosity?
    gluteal tuberosity - The lateral ridge of the linea aspera is very rough, and runs almost vertically upward to the base of the greater trochanter. It is termed the gluteal tuberosity, and gives attachment to part of the Glutæus maximus: its upper part is often elongated into a roughened crest, on which a more or less well-marked, rounded tubercle, the third trochanter, is occasionally developed.
  12. What are the two most important muscles in geriatrics and why?
    Pathology: hip abductors (gluteus medius, minimus) are the most important muscles in geriatrics because there reverse action is to stabilize the hips.

    • Gluteus medius
    • Gluteus minimus
  13. What is trochanteric bursiti?
    trochanteric bursitis, is inflammation of the trochanteric bursa, a part of the hip. This bursa is situated adjacent to the femur, between the insertion of the gluteus medius and gluteus minimus muscles into the greater trochanter of the femur and the femoral shaft. It has the function, in common with other bursae, of working as a shock absorber and as a lubricant for the movement of the muscles adjacent to it. Occasionally, this bursa can become inflamed and clinically painful and tender. This condition can be a manifestation of rheumatoid arthritis or of an injury (often resulting from a twisting motion or from overuse), but sometimes arises for no obviously definable cause. The symptoms are pain in the hip region on walking, and tenderness over the upper part of the femur, which may result in the inability to lie in comfort on the affected side. More often the lateral hip pain is caused by disease of the gluteal tendons which secondarily inflames the bursa. This is most common in middle-aged women and is associated with a chronic and debilitating pain which does not respond to conservative treatment. Other causes of trochanteric bursitis include uneven leg length, iliotibial band syndrome, and weakness of the hip abductor muscles.Greater trochanteric pain syndrome can remain incorrectly diagnosed for years, because it shares the same pattern of pain with many other musculoskeletal conditions. Thus people with this condition may be labeled malingerers, or may undergo many ineffective treatments due to misdiagnosis. It may also coexist with low back pain, arthritis, and obesity.
  14. Which side do you put a can on if the pt has a bad right side and why?
    Left side because it creates a longer lever arm for the hip abductors.
  15. What is gerdy's tubercle?
    Gerdy's tubercle - is a lateral tubercle of the tibia, located where the fascia lata or iliotibial band inserts. It is on the outside part of the tibia bone just below the knee joint, where the iliotibial band runs down the outside part of the thigh.
  16. How do you test for tight IT band?
    obers test – You have the pt side lying and you lift there leg, while keeping the pelvic girdle level and if they can't get there leg behind the other leg then the IT band is shrunk and tight, hence why it won't let the leg go down. This can cause trochancteric bursitis and bursitis of the IT band. IT band tightness is common in athletes and easily treated.
  17. Define Obers test?
    Ober's test is a test used in physical examination in order to identify contracture of the iliotibial band. During the test the patient lies on his/her side with the unaffected leg on bottom and bent and the affected leg on top and straight. The examiner places a stabilizing hand on the patient's upper iliac crest and then lifts the straight upper leg, extends it at the hip and slowly lowers it behind the bottom leg, allowing it to adduct below and behind the examining table. The test result is positive if the patient can't adduct the leg past the examination table.
  18. What is piriformis syndrome?
    piriformis syndrome – occurs when you get a contracted shortened piriformis and it presses in the siatic nerve. Which impinges the siatic nerve which innervates all the muscles down the back of the leg. So this causes pain down the back of the leg sometimes also in the but. Common sign of this that distingishes it from sliped disk is that the effected foot will be turned outward to cause the piriformis to rellax and hence stop impinging the siatic nerve, to decrease the pain. Sometimes this can be relived with massage on trigger points.
  19. What are the two causes of Sciatica?
    This can be caused by sliped disk or less often by piriformis syndrome.
  20. What is the inguinal ligament?
    Inguinal ligament is a band running from the pubic tubercle to the anterior superior iliac spine. Its anatomy is very important for operating on hernia patients. The inguinal ligament runs from the anterior superior iliac spine of the ilium to the pubic tubercle of the pubic bone. It is formed by the external abdominal oblique aponeurosis and is continuous with the fascia lata of the thigh. It really just made from a thin fold of fascia.
  21. If you want to do a sit up and not use the Psoas major how do you do it?
    You do this by bringing your knees to your chest so the muscle is slack and can't be used.
  22. What is the Thomas test?
    Thomas test (classic test for hip flexor tightness) you lie on your back and bring one leg up to 90 degrees and see if the other leg is flat on the plinth, if its of the plinth then there is tight hip flexors.
  23. What are the two major nerves of the lumbar plexus and what divisions do they come off of?
    • Lumbral sacral
    • plexus – separated into the

    • lumbar plexus (formed in psoas major) – made of L2,3,4
    • anterior division
    • obtuater nerve
    • Lateral femoral cutaneous nerve – purely a sensory nerve

    • posterior division
    • femoral nerve
  24. What is Meralgia paresthetica and how do you test for it?
    Meralgia paresthetica (skinny jeans syndrome) – you get impingement of the lateral femoral cutaneous nerve and burning pain going down the outside of the thigh. You often see this in people such a police or military who wear a thick belt with lot of heavy things on it due to it tendancy to compress this nerve. You also see this in pregnant women and over weight people. In one case this was caused by the cut of the bathing suit a competitive swimmer wore, so when you change the suit style it went away in a few weeks.

    Can be tested for with Tunnels test – so you tap the nerve right were it enter the thigh and see if there is pain.
  25. What is a classic clinical sign of a palsy to the Obtuater Nerve?
    Clinical sign of palsy to obtuater nerve is weak adduction of the hip.
  26. What is tendelburg gait?
    trendelenburg gait – if the gluteus medius and minimus (hip abductors) are weak then the hip will drop to the contralateral side in unilateral stance why the pt is walking. - this is due to the fact that by lifting their hip of the ground they put 2 1/2 times the body weight through the hip on the ground. This is do to the moment arm created around the hip joint and so using torques we can see why hips wear away.

    or


    Trendelenburg gait pattern (or gluteus medius lurch) is an abnormal gait (as with walking) caused by weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus. People with a lesion of superior gluteal nerve have weakness of abducting the thigh at the hip. During the stance phase, the weakened abductor muscles allow the pelvis to tilt down on the opposite side. To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle. The pelvis sags on the opposite side of the lesioned superior gluteal nerve.
  27. Pain in the ovaries refers through which nerve and to were in the leg?
    Referred pain from the ovaries will sometimes go to the obturator nerve innervated skin on the side of the leg and can create pain or other sensation issues.
  28. What muscles make up the Quads?
    Quadriceps – 3 big muscles (vastus) and the rectis femoris (means 4 big heads) – all extend the knee It is subdivided into four separate portions or 'heads', which have received distinctive names:

    Rectus femoris occupies the middle of the thigh, covering most of the other three quadriceps muscles. It originates on the ilium. It is named from its straight course. - only quad that crosses the knee. Also is the only quad that flexes the hip , but it not very good at this compared to ileopsoas muscles.

    The other three lie deep to rectus femoris and originate from the body of the femur, which they cover from the trochanters to the condyles:

    • Vastus lateralis is on the lateral side of the femur (i.e. on the outer side of the
    • thigh).

    Vastus medialis is on the medial side of the femur (i.e. on the inner part thigh).

    Vastus intermedius lies between vastus lateralis and vastus medialis on the front of the femur (i.e. on the top or front of the thigh), but deep to the rectus femoris. Typically, it cannot be seen without dissection of the rectus femoris.
  29. Were does the greater saphenous vein run? were does the lesser saphenous vein run?
    The GSV originates from where the dorsal vein of the first digit (the large toe) merges with the dorsal venous arch of the foot. After passing anterior to the medial malleolus (where it often can be visualized and palpated), it runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epicondyle of the femur bone. The great saphenous vein then courses medially to lie on the anterior surface of the thigh before entering an opening in the fascia lata called the saphenous opening. It joins with the femoral vein in the region of the femoral triangle at the saphenofemoral junction.

    lesser saphenous vein run -down the calf (or back of the lower leg)
  30. What is inervated by superior gluteal nerve?
    superior gluteal nerve L4-5 S1 – goes to TLF gluteus medius and minimus
  31. What two nerves come off the sacral plexus? What nerve roots make up the scaral plexus?
    tibial nerve – L4-5

    common peroneal nerve – L4-5 S 1-2 (sometimes called the fibula nerve) – no S3 going to the posterior division peroneal nerve

    Sacral plexus – is made of L5 S1 S2 S3 with only a little of L4 and S3 – it is down inside the pelvic girdle. L4-5 are a long way from the plexus below. So they join together and send a single trunk down into the plexus this is called the lumbrosacral trunk. - 2 major nerves come off this plexus

    When those two nerves are bundled together in the back of the thigh they are called the sciatic nerve.
  32. What are the most common causes of pain going down your leg?
    Common causes of pain going down your leg

    most common – slipped or herniated disks – most commonly at L4-5 or L5-S1 will slip and press on the nerve roots which go into the sciatic nerve - treatment : mckinsey approach

    tight piriformis – if this is shortened the the symptoms are pain down the back of the leg and maybe in the but, thigh and foot and when standing they will have lateral rotation of the leg to make the pirifomis slacken and increase the space for the nerve to pass under this normal.

    child birth – if the leg is pulled to hard can damage the sciatic nerve

    injection into the gluteus maxiumus can hit the sciatic nerve.
  33. What arte the dorsi flexors? What nerve supplies them?
    Deep peroneal nerve (also called anterior tibial nerve) – supplies dorsi flexors tom dick and harry


    • Tom – tibialis anterior
    • Dick - extensor digitorum longus
    • Harry – extensor hallucis longus
  34. What is foot drop gait?
    foot drop gait – this is when the person is walking and they can't dorsi flex the foot , so they drag there foot along the ground. This is due to damage to the deep peroneal and the loss of the dorsi flexors.
  35. What is foot slap gait and what three gaits might devolope?
    Foot Slap Gait – without dorsi flexors you can't isentricly use them to lower the foot down when you walk so as you walk the foot slaps the ground. To compensate you can develop have hip hike to shorten the leg or stepage gait which is were they will lift the knee up because the foot is functionally longer sense they can't flex the foot and so the pt picks the foot up very high to take a step, or circumduction gait were they swing the leg outward, though this is more common with contracture or can't bend the knee.
  36. What is the most important symptom of a femoral nerve lesion?
    A lesion in the femoral nerve stops or impairs knee flexion,

    • which means the pt can't bear weight on the knee,
    • because only the quads are holding/ flexing the knee. So you would keep your body weight in front of the axis of rotation of the knee, which uses the body weight to lock the knee or in other words to keep the knee extend (hyperextended). So there no way for you to ascend or descend stairs normally because your knee would buckle.
  37. What are the 6 deep lateral rotators of the thigh?
    There are 6 deep lateral rotators of the hip

    • Piriformis (means pear shaped) – is the most superiorly – under this this is the sciatic nerve, you can use this nerve to find this muscle.
    • Gemellus inferior
    • Gemellus superior – means twins – these may not be present
    • Obtuator internus
    • Quadratus femoris
    • Obturator externa
  38. What is sciatica?
    Sciatica - is pain in the sciatic nerve , and hence down the back of the leg, this can be caused by sliped disk or less often by piriformis syndrome.
  39. What is the Ileopsoas?
    Ileopsoas – is the combination of the Psoas major and the Iliacus
  40. What is the thomas test? Explain an alternate testf or the same thing?
    Thomas test (classic test for hip flexor tightness) you lie on your back and bring one leg up to 90 degrees and see if the other leg is flat on the plinth, if its of the plinth then there is tight hip flexors.

    Another test - Hip flexor test –L2-3 myotome - you have them sit and flex the thigh then you push down on the thigh and if they can hold it for 6-10 seconds then they fine otherwise they might have a problem.
  41. What are the major nerves of the lumbar plexus and what nerves do they branch into?
    • Anterior division
    • Obturator nerve – smaller then the femoral nerve and is composed of

    • anterior divisions of L2-4 - descend on the psoas major , then goes through the obtuator canal in the obtuator foramen, and right before it passes through it separates into and anterior and posterior branch. The anterior is usually the larger branch. Piece
    • of skin behind the knee is obtuater nerve supply.

    Posterior branch of the Obturator nerve – supplies the Obtuater externis and part of adductor magnus (also innervated by the sciatic nerve)

    Anterior branch of Obturator nerve - this larger branch supplies all the rest of the adductors, such as Gracilis, Adductor longus, brevis and sometimes the pectinius (pectinius can be innervated by either this or the femoral nerve)

    Lateral femoral cutaneous nerve – purely a sensory nerve

    • posterior division
    • femoral nerve – bigger nerve then obtuater – comes out into the femoral triangle – it is a multi forked mess that supplies all the quads, the sartorius and the ileoacus which is one of the ileopsoas muscles and usually but not always the pectinious.

    anterior femoral cutaneous nerve – comes out of the femoral triangle on top of the quads and innervates the skin
  42. What are the 2 dominate nerves of the sacral plexus?
    tibial nerve – L4-5 - all the hamstrings except the short head of the bicepsfemoris (which is common peroneal)

    common peroneal nerve – L4-5 S 1-2 (sometimes called the fibula nerve) – no S3 going to the posterior division peroneal nerve
  43. What muscles make up the quads?
    • Quadriceps – 3
    • big muscles (vastus) and the rectis femoris (means 4 big heads) – all extend the knee It is subdivided into four separate portions or 'heads', which have received distinctive names:
    • Rectus femoris occupies the middle of the thigh, covering most of the other three quadriceps muscles. It originates on the ilium. It is named from its straight course. - only quad that crosses the knee. Also is the only quad that flexes the hip , but it not very good at this compared to ileopsoas muscles.

    • The other three lie deep to rectus femoris and originate from the body of the femur, which they cover
    • from the trochanters to the condyles:

    • Vastus lateralis is on the lateral side of the femur (i.e. on the outer side of the thigh).
    • Vastus medialis is on the medial side of the femur (i.e. on the inner part thigh).
    • Vastus intermedius lies between vastus lateralis and vastus medialis on the front of the femur (i.e. on the top or front of the thigh), but deep to the rectus femoris. Typically, it cannot be seen without dissection of the rectus femoris.

    All four parts of the quadriceps muscle attach to the patella (knee cap) via the quadriceps tendon.
  44. The great saphenous vein (GSV) runs down the leg with the saphenous nerve, what is it commonly used for in surgery?
    great saphenous vein (GSV) – is often used as a graft in the heart. It is very superficial and runs down the whole inside of the leg.
  45. The common peroneol nerve goes under the head of the fibula and the splits name the branches it split sinto and what they supply?
    recurrent articular nerve innervates skin of knee joint (sensory branch)

    • Superfical peroneal nerve - goes down the outside of the lower leg and innervates the peroneal muscles of the lower leg peroneal longus and brevis– these muscle Evert the ankle, and there reverse action is
    • a stabilizer of the lower leg by pulling the fibula laterally tokeep the body weight over the foot. This nerve is also called the fibula nerve.

    Deep peroneal nerve (also called anterior tibial nerve) – supplies dorsi flexors tom dick and harry – palsy's of this nerve are common , most often due to a cast impinging the nerve.
  46. Name the dorsiflexors , tom , dick and harry?
    • Tom – tibialis anterior
    • Dick - extensor digitorum longus
    • Harry – extensor hallucis longus
  47. What is Tarsal tunnel syndrome?
    Tarsal tunnel – can cause burning pain down the big toe, due to impingement of the tibial nerve as it goes around the medial maleolus.
  48. What nerve primary nerve other then the tibial nerve goes into the foot?
    Sureal nerve goes down the lower leg and around the lateral maleolus and around to the little toe side of the foot.
  49. What is the Triceps surae?
    Triceps surae – is the name for gastonemieus and the soleus together – hence it is a three head muscle.
  50. What are the symptoms fo a tibial nerve lesion?
    Tibial nerve lesion – walking symptoms = flat foot or calcaneal gait - plantar flexion will be absent so the pt will walk with there foot totally flat , they will lift it and drop it in front of them. So there will be no push of when they take a step, this is because plantar flexion is the drive that lets you walk by pushing off the toes.
  51. What is calcaneal gait?
    calcaneal gait - a gait disturbance, characterized by walking on the heel, due to paralysis of the calf muscles. The calcaneous will come of the ground at the same time as the toes, instead of in normal step when the heel comes of first.
  52. Name the myotomes of the Leg and the primary test for each?
    Myotomes in the legs are in pairs

    • L2-3 test ileosoceus action – hip flexion – to test have them sit and lift up there thigh and you push down on there hip
    • 3-4 Knee extension – test the quads, try and break knee extension

    • 4-5 inversion – test the anterior tibilias – have them walk in inverted (Ben doesn't think 4-5 is dorsiflexion because though using the anterior tib to dorsi flex its 4-5 but if you use the extensor digitorum longus and
    • extensor hallicus longus then it 5-1)
    • 5-1 – many version including , eversion, knee flexion (hamstrings are tested) , hip extension – use which ever is easiest for the patients. Even hip abduction is 5-1.
    • S1-S2 – plantar flexion – have them go onto toes and down 20 times.
    • S2-S3 – big toe flexion
  53. What muscle smake up the hamstrings?
    Hamstrings – job of these muscles is to flex the knee

    • Medial Hamstrings
    • Semitendinous – inserts on to the front of the tibia onto the pes anserinus

    semimebranous – same action as the semitendinous same nerve roots and myotome – inserts onto medial epicondyle


    • Lateral hamstrings
    • Biceps femoris -short head comes off of the laterla head of the linea aspera
  54. What is the Pes anserinus, what tendons make it up?
    Pes anserinus – means goose foot –looks like a webed foot – made of the insertions of the semitendinous, gracilis and sartorius tendons which merge and then splay out into the webed foot like structure.
  55. What are Muscle energy techniques?
    Muscle energy techniques– use the contraction of specific muscles to force bones back into certain place.
  56. A varus force on the knee will do what? A valgus force on the knee will do what?
    Varus (pushing lower leg inwards and knee outward) force can damage the Lateral collateral ligament (LCL) do to side impacts.

    More commonly you can rip the MCL do to a massive valgus force which pushes the knee inward.
  57. Name two test for tight hamstrings?
    90-90 test - lie on your back and keep one leg flat and then raise one thigh to 90 and see if you can extend the knee , if you can't fully extended your hamstrings may be tight.

    Tripod sign – sit over the edge of a table and see if they can extend the knee, if they lean (rotate the pelvic girdle ) back and form a tripod with the arms then there hamstrings are tight.
  58. What and were is the VMO, why does it matter in regards to leg pain? What treatment are used for VMO issues?
    • Vastus medialis – lower fibers are at a oblique angle – this is the VMO or vastus medialis oblique – some the adducto tendons aductor longus and magnus attach to this.
    • VMO is quick to atrophy (may be cause of anterior knee pain) this can cause lateral tracking. For reason that are debated also a lot of hypertrophy in bycilce racers. VMO atrophy treatment is to tape it hold it or to cut the lateral retinaculium , cutting usually makes this worse. PT treatment is to strengthen the VMO without strengthening the VL. Classic exercise is a ball between the knees and do squats. This is done because the adductors attach to the VMO so if you use them to hold a ball then you stabilize the VMO and this can allow them to be strengthened easier.

    VMO is active the most in the last 15 degrees of extension – not proven – there is also a theory that due to this runners who run on there tip toes without fully extending the leg will suffer anterior knee pain due to the atrophy of the VMO and this makes them tip toe even more so it becomes a viscous cycle.
  59. What is Chrondromalacia pattela ?
    Chrondromalacia pattela – death of cartilage beneath the patella, so the patella starts to wear away and tries to pull out of the groove it rests in– called crab meat or frayed sections of this.

    Treatment - surgical shaving of the dead portions of the pattela or the drilling of holes in the patella to get blood to the area to begin regeneration.
  60. What are the lateral and medial retinaculium?
    lateral and medial retinaculium – are fascial sheaths around the vastus medialis and intermedialis and then go around the knee.
  61. What is the Articularis genus muscle?
    Articularis genus muscle – (knee joint muscle) small muscle under the quads (no slide for it) – this moves the synovial capsule out of the way when you move so you don't squash it when the knee moves. Inserts into the synovial capsule and the patella bursae.
  62. What is Heterotopic ossification (HO)?
    Heterotopic ossification (HO) is the process by which bone tissue forms outside of the skeleton.

    riders bones or calveries bone , or Heterotopic ossification – found a lot in stroke pt and in people who ride horses a lot. Bones growing some were they shouldn't be, often in the adductors do to horse ridding.
  63. What is the adductor hiatus?
    Adductor hiatus – is the hole in the adductor magnus were the femoral artery and vein pass through the muscle and around to the back of the knee and into the popiteal fossa, were it becomes the popliteal artery and vein. This is a common place for atherosclerosis, due to the increased turbulence which slows blood through there and lets plaques build up on the walls.
  64. Name the borders of the femoral traingle and what passes under it?
    • Top border - inguinal ligament – this is a small slender ligament made of a fold of fascia
    • laterally border - satorius
    • Medial border -adductor longus


    Under or within the femoral traingle is the pectineus and ileopsoas muscles and the femoral VAN (Vein Artery Nerve). The artery and vein are held together by the femoral sheath and there is space in this sheath (mostly filled with fat) called the femoral canal that lets them expand as blood flows through them. Beside this sheath and it contents are the lymph glands/vessels.
  65. Explain how the femoral canal can be a site of femoral hernias?
    This is because the femoral canal opening above the inguinal ligament creates a weak point were intestines can protrude throught he inguinal ligament.
  66. The external illiac artery is renamed several times, what does it become and were do these name changes happen?
    • External illiac artery/vein
    • (inguinal ligament)
    • femoral artery/vein
    • (adductor magnus and the adductor hiatis and were it goes into the back of the knee) –
    • popliteal artery/vein –
    • (bottom of popiteal fossa )
    • anterior and posterior tibial arteries
  67. What artery/ies supplies the head of the femur? and what artery do they come from? What arteries are these similiar to in the arm?
    femoral artery sends of a branch that goes backwards from were it comes off, this is the deep femoral artery. Arising from this you should find two arteries coming of left and right the medial and lateral circumflex femoral arteries which wrap around the neck , head and back of the femur and merge on the back of the femur, these arteries supply the head of the femur with blood. The lateral circumflex femoral artery is similar to the anterior circumflex artery of the humerus and the medial circumflex is the same as the posterior circumflex artery of the arm. If either the medial or lateral circumflex arteries die off then you get avascular necrosis of the head of the femur.
  68. What is Legg–Calvé–Perthes syndrome/disease?
    • Legg–Calvé–Perthes syndrome is a degenerative disease of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket. The disease is characterized by idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head leading to an interruption of the blood supply of the head of the femur close to the hip joint. The disease is typically found in young children, and it can lead to osteoarthritis in adults. The effects of the disease can sometimes continue into adulthood. It is also known more simply as Perthes disease,ischemic necrosis of the hip, coxa plana, osteochondritis and avascular necrosis of the femoral head, Legg–Perthes Disease or
    • Legg–Calve-Perthes Disease (LCPD).

    or


    Legg-Calve Perthes disease – is quite common in young children – it is degeneration of the head of the femur, osteochondrosis , so you get death and regeneration of the head of the femur over and over again leading to pain, in sever cases they will fuse the head in the socket.
  69. List some of the test for the thigh?
    ober test – test for tight IT band

    • thomas test – hip flexors – lie on the back with one thigh up to 90 degrees , does the other thigh touch
    • the table. The other similar test - Rectus femoris test - you put the thigh on the table and see if you can bend your knee around the edge of the table to 90.

    90-90 test – hamstrings – up to 90 degrees with the hip and can you get the lower leg straight up, twenty degrees off vertical is considered OK. More then 20 degrees is considered tightness in the hamstrings


    Rectus femoris test– a variation on the Thomas test except can you bend your knee around to 90 – hip extended and can I bend my knee to 90.

    tripod sign – stretch the hamsting and the person will rotate the pelvic girdle back to slacken the hamstrings.
  70. What is Coccydynia?
    Coccydynia – pain of the tail bone –treated by internal manipulation (put a rubber glove on and snap it back into place) or ice and not sitting on it.
  71. What causes a pigeon toed stance?
    Pigeon toed – a lot of femoral antiversion can lead to toes being turned in unless the knee and muscle compensate.
  72. what can't you do with a patient that had hip replacement?
    Hip precautions – – can't have pt adduct past neutral or internal rotate past neutral and can't flex past 90 degrees. So hard to prevent this even with good pt education.

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