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MSK LE > 15. Joints of the Lower Extremity > Flashcards

15. Joints of the Lower Extremity Flashcards

1
Q

What happens in Pott’s Dislocation Fracture?

A

An eversion sprain causes the deltoid ligament to avulse the medial malleolus, and the resulting snap causes the talus to strike the fibula, breaking it through the shaft.

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2
Q

What ligament starts on the head of the fibula, crosses over the popliteus, and attaches to another ligament in the middle of the popliteal space?

A

Arcuate popliteal ligament

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3
Q

Which tendon does the lateral collateral ligament run through?

A

The tendon of the biceps femoris

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4
Q

What does McMurray’s Test check for, and how is it performed?

A

Test for the Meniscus. Pt lies supine, Knee is flexed at 90 degrees. Apply internal rotation (to load pressure on the Lateral Meniscus) or external rotation (to load pressure on the Medial Meniscus) and extend the Lower Extremity out straight. Check for pain.

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5
Q

How can you know which nerves innervate joints, generally speaking?

A

If a muscle crosses a joint, the nerve that innervates that muscle also innervates that joint.

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6
Q

What is the function of the transverse acetabular ligament?

A

Serves as a gateway for vessels

Connects the inferior aspect of the acetabulum

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7
Q

What is the function of the anterior cruciate ligament?

A

Limits rolling of the Femoral Condyles on the Tibial Plateau during flexion (forces sliding rather than rolling posteriorly), and prevents hyperextension of the knee.

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8
Q

What is the weakest intrinsic ligament of the hip?

What is that ligament’s function?

A

The ischifemoral ligament

Preventing posterior dislocation

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9
Q

What is the general cause for dense pes planus?

A

Deformity or fracture of the bones of the foot

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10
Q

What important ligament passes weight from the talus to the rest of the foot?

A

The calcaneonavicular (spring) ligament

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11
Q

Which collateral ligament of the knee connects to its meniscus?

A

The medial collateral ligament of the knee

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12
Q

Give the correct setup and execution for:

Labral Distraction

A

Pt supine. Flex the patient’s knee to 90 degrees as above, but then lift on the leg to take weight off of the acetabulum. Check for relief of pain

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13
Q

What can cause all the members of the Unhappy Triad of O’Donoghue to tear together?

A

Lateral impact

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14
Q

What is the function of the posterior cruciate ligament?

A

Prevents the Tibia from going anterior when the knee is flexed

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15
Q

What is the function of the zona orbicularis?

A

Support for the relatively weak femoral neck

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16
Q

What gives rise to the oblique popliteal ligament?

A

The tendon of the semimembranosus muscle

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17
Q

Which of the two collateral ligaments of the knee is most likely to tear?

A

The medial collateral ligament

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18
Q

Give the correct setup and execution for:

Quads active test

A

Pt supine, knee bent. Physician pushes on the Tibia (as in Posterior Drawer), and instructs the patient to flex their quadriceps femoris. If the Tibia pushes outwards, it shows that the quads were initially relaxed, are able to be activated, and that there is a laxity in the posterior cruciate ligament.

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19
Q

What are the four structures involved in the Deltoid ligament of the medial ankle?

A

Anterior tibiotalar ligament

Tibionavicular ligament

Tibiocalcaneal ligment

Posterior tibiotalar ligament

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20
Q

What are the structures of the transverse arch of the foot?

A

Heads of the metatarsals

Cuneiforms

Cuboid

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21
Q

Which intrinsic ligament of the hip prevents hyperabduction?

A

Pubofemoral ligament

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22
Q

The lateral meniscus is connected to the posterior cruciate ligament by what structure?

A

The posterior meniscofemoral ligament

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23
Q

Give the correct setup and execution for:

Labral Loading

A

Pt supine. Flex the patient’s knee to 90 degrees while the patient is supine and apply weight to the acetabulum by pressing down on the femur. Check for pain.

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24
Q

What structures make up the medial longitudinal arch of the foot?

A

Phalanges and Metatarsals of the first three digits

Cuneiforms

Navicular

Talus

Calcaneus

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25
Q

Which ligament is tested for laxity by a varus stress test?

A

Lateral collateral ligament

(the ligament that would be stretched by the movement)

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26
Q

What is the technique for the Apley Grind Test?

A

Pt prone with the knee bent at 90 degrees, press down on the foot, and internally and externally rotate - checking for pain. You can also lift up on the foot (distraction), and if that alleviates pain, it is indicative of some sort of pathology.

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27
Q

What is the general cause for loose pes planus?

A

Laxity in the intrinsic ligaments of the arch

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28
Q

What is the strongest intrinsic ligament of the hip?

What it that ligament’s function?

A

The iliofemoral ligament

Preventing anterior dislocation and hyperextension

29
Q

What is the most likely ligament to tear on an inversion ankle sprain?

A

Anterior TaloFibular ligament (ATF)

Always tears first

30
Q

What separates the lateral collateral ligament from the meniscus?

A

The popliteus muscle

31
Q

Generally speaking, what all make up the passive supports for the foot?

A

Ligaments of the foot

Plantar Aponeurosis

Shapes of the bones of the foot

32
Q

Which of the cruciate ligaments of the knee is stronger and more vascularized?

A

Posterior cruciate ligament

33
Q

What are the attachments for the anterolateral ligament?

A

Lateral condyle of the femur

Lateral to Gurdy’s tubercle

34
Q

What structure does the posterior meniscofemoral ligament connect to the lateral meniscus?

A

The posterior cruciate ligament

(not the femur)

35
Q

What ligament houses a branch of the obturator artery in childhood and in some adults?

A

The ligamentum teres / ligament of the head of the femur

36
Q

What structures make up the lateral longitudinal arch of the foot?

A

Phalanges and metatarsals of the lateral two digits

Cuboid

Calcaneus

37
Q

What is the function of the transverse ligament of the knee?

A

Connects the anterior portions of the medial and lateral menisci together to add strength to the knee joint.

38
Q

How will a patient’s lower extremity present if they have a posterior dislocation of the femur?

A

Shortened and internally rotated

39
Q

What part of the inner surfaces of a joint are not covered in the synovial membrane?

A

The parts that are covered in articular cartilage

40
Q

What contributes to the feeling of “catching” in some people’s knees?

A

The interior aspect of the menisci are not attached, and they can roll and fold, feeling like catching. Happens in a meniscal tear.

41
Q

What are the three intrinsic ligaments of the hip?

A

Iliofemoral l.

Ischiofemoral l.

Pubofemoral l.

42
Q

What is the possible clinical significance of the anterolateral ligament?

A

May tear along with the anterior cruciate ligament in injuries, and if reattached, may decrease the incidence of ACL re-tears.

(Zak’s research)

ALL rupture=ACL rupture

ACL rupture does not equal ALL rupture

43
Q

Give the correct setup and execution for:

Scour Maneuver

A

Pt supine. Rotate the patient’s thigh in circles at the hip joint. Check for pain.

44
Q

What is another name for the plantar calcaneocuboid ligament?

A

The short plantar ligament

45
Q

What makes up the (classical) “Unhappy Triad of O’Donoghue?”

A

Anterior cruciate ligament

Medial collateral ligament

Medial meniscus

46
Q

What is the general cause for acquired pes planus?

A

Laxity of tibialis posterior due to age

Denervation of the muscle

Many other reasons

(Most common type)

47
Q

What is Lachman’s test?

A

Same as Anterior / Posterior Drawer, except the patient’s knee is only slightly bent, instead of at 90 degrees.

48
Q

Give the correct setup and execution for:

Log roll test

A

Pt supine. Externally and internally rotate the hip and check for pain.

49
Q

Give the correct setup and execution for:

Faber (Apprehension) test

A

Pt supine. Flex the knee to 90 degrees and abduct, checking for apprehension.

50
Q

Fadir Test

A

Hip flex 90’, adduct, IR

+ if groin pain

indicates labral pathology

51
Q

Log Roll

A

Supine, IR and ER

+ if pain

determines if xray needed for possible hip fx

52
Q

Thomas test

A

supine, drips contralateral leg off table and pulls tested leg to chest

+ if contralateral thigh raises off table

indicates hip flexor contraction

53
Q

Ober’s Test

A

lateral recumbant with affected side up

extend hip/flex knee and allow to drop

+ if affected leg does not pass neutral adduction

54
Q

Stinchfield Test

A

Pt supine and resists hip flexion with straight leg raise at 45’

+ is pain

determinant for intraarticular pathology, osteoarthritis

55
Q

bipartite patella

A

failure of superolateral portion to fuse

commonly mistaken for fracture

8% pop.

50% of which have it bilaterally

56
Q

Segond Fracture

A

avulsion of ALL from tibial insertion

pathognomic for ACL rupture

57
Q

Screw Home (knee)

A

tibial externally rotates 5’ in last 15 degress extension

allows cruciate to tighten and decrease quads work while standing

popliteus “unlocks” extended knee/tibia via lateral rotation of the femur on tibia as it internally rotates

(4) The tibia must internally rotate slightly to allow for knee locking, and the femur must externally rotate for knee unlocking in a closed chain. (1) This mechanism of rotation contributes to proper movement at the knee.

(medial rotation allows knee to “lock” and lateral rotation allows it to “unlock” of the femur)

58
Q

Thessaly Test

A

pt stands on affected leg at 20’ flexion

rotates on leg

+ pain/click

testing meniscus?

59
Q

posterior sag test

A

pt supine hips 90’

examine posterior positioning of tibia relative to distal femur

60
Q

pivot shift

A

pt supine and fully trlaxed

proximal tibia is IR and valgus force placed to sublux lateral plateau anteriorly

knee is then flexed and turns IT band into reduction force that froces tibia back under distal femur

done in operations

61
Q

posteiorr drawer test

A

most accurate for lax PCL <<12mm)

62
Q

Tibilais posterior weakness is a contributor to what?

A

PLantar Faciatis

tightness in the achiles tendon can cause plantar facia tightness and calcaneal spurs. Stretching calf muslces helps

63
Q

Passive support of the arch is done by the following

A

plantar aponeurosis

short and long plantar ligaments

spring ligament

64
Q

Dynamic support of the arches of the foot are fone by the following

A

tibialis anterior and posterior

flexor hallucis longus

intrinsic plantar muscles

65
Q

Knee blood supply

A

middle genicular: cruciates, synovium, posterior horns of meniscus

medial inferior genicular: peripheral 25% medial meniscus

lateral inferior genicular: peripheral 25% of lateral meniscus

medial portions of meniscus are poorly vascularized, poor healing

66
Q

PCL is tight when?

A

anterolateral tight in flexion

posteromedial tight in extension

67
Q

ACL is tight when?

A

Anteromedial tightest in flexion

posterolateral tightest in extension

68
Q

ischiofemoral ligament keeps the posterior capsule from extending

A

as far lateral as it does anterior

(40-60 abduction, 125-135 in flexion with knee flexed, 90 straight leg)

69
Q

Where to amputate the foot

A

transverse tarsal joint

made up of

talonavicular joint

calcaneocuboid joint

MSK LE (7 decks)

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