1. Lower limb questions ADAM SMITH

2. What structures are within the femoral triangle?  Femoral nerve, artery and vein  Nerve most laterally  Mid-inguinal point +/- 1.5cm = artery

3. How do you find the mid-inguinal point?  Half way between ASIS and pubic tubercle

4. What passes through the lesser sciatic foramen?  Pudendal nerve  Internal pudendal vessels  Nerve to obturator internus

5. 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

6. What contributes to hip joint stability?  Acetabular labrum  Ligaments – ischiofemoral, iliofemoral, pubofemoral, ligamentum teres

7. 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

8. What structures are in the popliteal fossa?  Popliteal artery is deep, popliteal vein, tibial nerve is superficial. Common fibular nerve is lateral

9. What structures run behind the medial malleolus?  Tarsal Tunnel  Tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor hallucis longus

10. What is the lymphatic drainage of the lower limb?  Superficial inguinal nodes  Deep inguinal nodes  External iliac nodes  Para-aortic nodes

11. Which blood vessel from the leg is commonly used in CABG?  Great saphenous vein

12. 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

13. What is housemaid’s knee? What is clergyman’s knee?  Pre-patellar bursitis  Infra-patellar bursitis

14. What is a valgus deformity of the knee?  Distal part of the joint is angled laterally

15. 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)

16. 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

17. What are the reflexes of the lower limb?  S1,2 Achilles  L3,4 Patella

18. 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

19. Which side of the ankle is more likely to suffer a sprain?  Lateral as the lateral collateral ligament is weaker

20. What strucutres hold tedons to the ankle?  Flexor retinaculum  Extensor retinaculae – superior and inferior