OSPE – LOWER LIMB

SARTORIUS
1. Name the muscle responsible for this action.
Sartorius
2. Mention the attachments.
Origin : Anterior superior iliac spine.
Insertion : upper part of subcutaneous
medial surface of shaft of tibia.
3. Name the nerve supply.
Femoral nerve
4. What are the muscles constituting the guyropes?
Sartorius, Gracilis, semitendinosus
5. Name the bursa related to this muscle
Anserine bursa. It lies between the tibial collateral
ligament and the Guyropes.
NECK SHAFT ANGLE
1. What is the neck shaft angle?
The angle formed between femoral neck and shaft of
femur is called neck shaft angle. It is also called
angle of inclination.
2. What is the normal angulation in adult and children?
Normal angle in adult – 125°
Normal angle in children - 160°
3. What is Coxa-vara?
Reduced Neck-shaft angle is called coxa-vara. It is
seen in fracture of neck of femur.
4. What is Coxa-valga?
Increased Neck-shaft angle is called coxa-valga. It is
seen in congenital dislocation of hip joint.
5. Give its age related changes
The angle is widest in infancy, decreases during growth, and
forms a gentle curve from the axis of body of bone during
puberty.
VARICOSE VEINS OF LOWER LIMB
1. Name the clinical condition.
Varicose veins (varicosity) of lower limb is due
to the dilatation of long saphenous vein.

2. Name closely related cutaneous nerves along its

course.
In the leg - saphenous nerve and in the thigh -
medial femoral cutaneous nerve.

3. Name the perforating veins according to their

position.
Adductor canal perforator or Hunter’s perforator
in thigh, Boyd’s perforator near knee, three ankle
perforators in leg.
4. Name the terminal tributaries of this vein before it
pierces cribriform fascia.
Superficial epigastric vein, Superficial circumflex
iliac vein and Superficial external pudendal vein.

5.Write a note on saphenous vein graft.

Saphenous vein, being a muscular vein is ideal for
coronary artery graft. The blocked segment of the artery
is replaced by a segment of patient’s own saphenous vein
in the thigh. While suturing the venous graft, the venous
segment is reversed so that its valves do not impede the
arterial blood flow.
FRACTURE NECK OF FEMUR
1. How is the length of the lower limb measured?
From anterior superior iliac spine to medial malleolus.

2. What is the reason for shortening of right lower limb in this

fracture?
Contraction of hamstrings and adductor muscles pulls
the shaft of femur upwards.

3. Which anatomical factors are responsible for the characteristic

position of right foot?
The thigh is laterally rotated by contraction of gluteus
maximus and short lateral rotators of thigh. In fracture of
neck of femur, the psoas major muscle becomes lateral
rotator due to shift in its axis.
4. What is the serious complication of this type of
fracture? Give reason for the same.
Avascular necrosis of femur occurs due to
rupture of the retinacular arteries that pass along
the neck of femur.

5. Clinical importance of intra and extra capsular

fracture.
Intracapsular – proximal segment loses part of
its blood supply, hence non-union common.
Extracapsular - proximal segment retains its
blood supply, hence fracture unites faster
and has good healing.
MENISCUS TEAR
1. Which intra articular structure is torn in a sudden blow on the
lateral side of a flexed weight bearing knee?
Medial meniscus

2. Name the type of tear that usually occurs in it in the sports

injury.
Bucket handle tear

3. Why medial meniscus is more frequently injured than lateral

meniscus?
Medial menisci is fused with fibrous capsule and tibial
collateral ligament, which makes it less mobile and more
prone to tears. But the lateral meniscus is separated from
the capsule by popliteus tendon, which makes it more
mobile.
4. What is unhappy triad of knee joint?
A combination of injury to the tibial collateral ligament,
medial meniscus and anterior cruciate ligament is called
“unhappy triad’ of knee joint.

5. Mention the different types of meniscal tear.

1.Bucket – handle tear.
2.Flap tear
3.Degenerative tear of medial meniscus
4.Oblique “parrot-beak” tear of lateral meniscus.
 BURSAE AROUND KNEE JOINT

1. What is housemaid’s knee?

Inflammation of the subcutaneous prepatellar bursa
leads to housemaid’s knee.
2. What is clergyman’s knee?
Inflammation of the subcutaneous infrapatellar
bursa leads to clergyman’s knee.
3. What is supra patellar bursa? Which muscle is inserted in
it?
Suprapatellar bursa is an extension of the synovial
cavity above the patella & behind the quadriceps
tendon in the thigh. Articularis genu is inserted in to it.

4. Name the bursa which communicates with the joint cavity

Suprapatellar bursa, Popliteal bursa, Anserine
bursa(between Guyropes and tibial collateral ligament),
Brodie’s bursa(between medial head of gastrocnemius
and capsule of knee joint), Semimembranous bursa.
5. What is Baker’ s cyst?
A fluctuant cystic swelling in popliteal fossa due to
the inflammation of semimembranous bursa.
DRAWER’S SIGN
1. What is the Drawer’s sign?
This is a test for the integrity of the cruciate
ligaments.

2. What are the cruciate ligaments?

Anterior and posterior cruciate ligaments.

3. Mention its attachments.

Anterior cruciate ligament - Anterior part of
intercondylar area of tibia to posteromedial
surface of lateral femoral condyle.
Posterior cruciate ligament - Posterior part of
intercondylar area of tibia to anterolateral
surface of the medial femoral condyle.
4. What is the purpose of cruciate ligaments?

The point of crossing of the cruciate ligaments

serves as the pivot for rotatory movements at the knee.

5. Mention its development and their relation to capsule

and synovial membrane.

It is developed from the posterior part of primitive

intercondylar septum. Both are intracapsular but
extrasynovial.
ARCHES OF FOOT
1.What is Pes cavus?
High arched foot – associated with claw foot
2. What is Pes planus?
Pes planus means flat foot. In this condition,
there is collapse of medial longitudinal arch.
There are two reasons for it. Due to loss of
support to the head of the talus, it is pushed
downwards between navicular & calcaneum.
The ligaments supporting the arch are
overstreched.
3. Name the bones forming the medial
longitudinal arch?
From behind forward - Calcaneus, Talus,
Navicular, cuneiforms and medial three
metatarsal bones.
4. Name the bones forming the lateral
longitudinal arch?
From behind Forwards-Calcaneus, cuboid
and lateral two metatarsals
5. Mention the factors maintaining the
transverse arch of foot?
Summit of the arch – Head of Talus
Tie beams of the arch
- Plantar aponeurosis, Abductor
Hallucis, Flexor Hallucis brevis
FEMORAL HERNIA
1.Which hernia gives rise to swelling below and lateral
to pubic tubercle?
Femoral hernia.
2.Name the passage through which the hernia enters
thigh.
Femoral canal.

3.Give the name and the boundaries of the upper

opening of the passage.
Femoral ring. Its boundaries are, in front-inguinal
ligament, medially-lacunar ligament, laterally-femoral vein,
posteriorly-pectineus and fascia.
4.Describe the direction of the hernia and the importance of this
knowledge to the surgeon.
The femoral hernia, at first comes downwards in the femoral
canal then, it goes anteriorly in to the saphenous opening and
finally turns upwards against the falciform margin of the
saphenous opening. In manual reduction of the hernia, the
surgeon reverses the order by pushing the hernia, downwards,
posteriorly and upwards.

5.In case of strangulation of this hernia how is the upper opening

of the passage enlarged?
In case of strangulation of femoral hernia its medial
boundary (lacunar ligament) is cut.
TRENDELENBURG’S SIGN
1. What is this sign and explain?
Trendelenberg’s sign. When the gluteus
medius and minimus are paralyzed on one
side, the unsupported(normal) side sinks,
when the patient tries to stand on the limb
of affected side.
2. Identify the nerve of the gluteal region that
is injured.
Superior gluteal nerve ( L4, 5, S1)
3.Give the origin and branches of this nerve.
Superior gluteal nerve is a branch of sacral
plexus inside the pelvic cavity. It enters the
gluteal region above the pirifomis through
the greater sciatic foramen, accompanied by
superior gluteal artery. It supplies the
gluteus medius, gluteus minimus and
tensor fasciae latae.
4.Name the characteristic gait in unilateral
injury and in bilateral injury to the nerve.
Unilateral injury to superior gluteal nerve
results in lurching or dipping gait & bilateral
injury results in waddling gait.
5.Describe the actions of the muscles supplied
by this nerve.
Abduction and Medial Rotation of thigh at
hip joint.
ARTERIAL PULSATIONS IN LOWER LIMB
FEMORAL PULSE:

POLPLITEAL PULSE:
POSTERIOR TIBIAL PULSE

PALPATION OF DORSALIS PEDIS PULSE

1. Mention the site of palpation of the
following arteries

•Femoral artery

•Popliteal artery

•Posterior tibial artery

•Dorsalis pedis artery

Femoral pulse
It is felt in femoral triangle just below midinguinal point
by palpating against head of femur
Popliteal pulse
It is felt best in knee flexion at an angle of 125 .The
fingertips of both hands are placed in the popliteal fossa with
thumbs resting on patient’s patella.
Posterior Tibial pulse
It is felt behind and below medial malleolus between the
tendons of Flexor hallucis longus and Flexor digitorum longus.
Dorsalis pedis pulse
It is felt just lateral to the extensor hallucis longus tendon
against the tarsal bones.
THE
END