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Anatomy Block 3 > 4 - Knee, Leg, Ankle Joint, and Foot > Flashcards

4 - Knee, Leg, Ankle Joint, and Foot Flashcards

1
Q

What is Genu Valgum of the medial condyle of the tibia?

A

Genu - knee
Valgus - turned outward, ankle relative to the knee.

Also called “knock-knees”

Exaggerated inward angling ankle at the knee.

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2
Q

What is Genu Varum of the medial condyle of the tibia?

A

Genu - knee
Varum - bent inward, ankle relative to the knee

“bow leg”

An exaggerating outward angling at the knee.

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3
Q

Where do supracondylar fractures of the distal femur go?

A

Distal fragment is displaced posteriorly by the gastrocnemius spasm.

This jeopardizes the large and important popliteal neuro-vascular structures, which lie adjacent to the femur.

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4
Q

What is “housemaid’s knee” and what is it caused by?

A

Prepatellar bursitis.

Inflammation due to repeated abuse of the prepatellar bursa, which is superficial to the patella and deep to the epithelium.

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5
Q

What causes reduced knee mobility upon extension (“stiff knee”)?

A

Postinflammatory adhesions in the suprapatellar bursa, located between the quadriceps femoris tendon and the femur.

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6
Q

What do effusions of the knee joint distend?

A

The The suprapatella bursa, between the quad femoris tendon and the femur.

Causes suprapatellar bursitis or “water on the knee” and on exam the patella appear to float over the femur.

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7
Q

What is the function of the posterior cruciate ligament (PCL)?

A

It’s the key stabilizer of the knee joint, and tightens maximally upon flexion.

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8
Q

Describe the PAIN acronym for the PCL?

A

It attaches to the:

P: posterior aspect of the tibia and courses
A: anteriorly and
IN: internally (medially) to attach to the medial condyle of the femur.

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9
Q

What happens when someone has a torn PCL? How can it be recognized?

A

Perceived instability; individual descending stairs will lead with the opposite leg for each step.

Abnormal passive posterior displacement of the tibia relative to the femur (posterior drawer sign).

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10
Q

What is the function of the anterior cruciate ligament (ACL)?

A

Key stabilizer of knee joint; inserts posteriorly on the femur and tightens maximally upon extension and provides a pivot around which rotation occurs during terminal phase of extension.

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11
Q

Explain the APEX acronym for the ACL?

A

It attaches to the

A: anterior aspect of the tibia and courses
P: posteriorly and
EX: externally (laterally) to attach to the medial condyle of the femur

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12
Q

What happens when the ACL is torn? How can this be recognized?

A

Often wont be noticed, except the knee suddenly gives way b/c the leg will not lock upon full extension.

Abnormal passive anterior displacement of the tibia relative to femur. (anterior drawer syndrome).

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13
Q

What is the “unhappy triad” caused by?

A

Semiflexed leg with violent abduction and lateral rotation that occurs as a result of “clipping” in football of the “caught edge” falling in skiing.

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14
Q

What are the three elements of the unhappy triad? What is each torn by?

A
  1. Medial collateral ligament: excessive abduction. Attached to joint capsule so medial capsular liaments are torn too.
  2. ACL: torn from displacement of tibia
  3. Lateral miniscus: compressive forces.
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15
Q

What are the two superficial veins of the leg and what do they each drain into?

A

Great saphenous: drains into the femoral vein

Small saphenous: drains into popliteal vein.

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16
Q

What are the major superficial nerves of the leg?

A

Saphenous nerve, which is the terminal branch of the femoral nerve, and the

Sural nerve, which is a branch of the tibial nerve.

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17
Q

What is the function of the superficial fibular nerve?

A

Provides primary nerve supply to the skin of the dorsum of the foot.

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18
Q

What are the muscles in the anterior compartment of the leg? What innervates them and what artery feeds them?

A

Tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius.

Nerve: deep fibular nerve (L4,5, S1)

Artery: Anterior tibial

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19
Q

What are the muscles in the lateral compartment of the leg? What innervates then and what artery feeds them?

A

The fibularis longus and fibularis brevis.

Nerve: Superficial fibular

Artery: Branches of the fibular

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20
Q

What are the muscles of the posterior/superficial muscles of the leg? What innervates then and what artery feeds them?

A

Gastrocnemius, soleus, plantaris. These three form the achilles tendon.

Nerve: Tibial (L5, S1, S2)

Artery: Posterior tibial

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21
Q

What are the muscles of the posterior/deep compartment of the leg?

A

Popliteus, flexor hallicus longus, flexor digitorum longus, and tibialis posterior.

Nerve: Tibial (L5, S1, S2)

Artery: posterior tibial

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22
Q

What is the action of the muscles in the anterior part of the leg?

A

Extensors.

Dorsiflex and invert the foot, and extend the toes.

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23
Q

What happens to the anterior tibial artery after it passes deep to the extensor retinaculum?

A

It becomes the dorsalic pedis artery.

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24
Q

What is the action of the muscles in the posterior compartment of the leg?

A

Flexors.

They plantar flex the ankle and flex the toes.

Some also invert the foot and flex the knee.

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25
Q

What bones make up the medial arch of the foot? What is its function? What ligament helps stabilize it?

A

Medial longitudinal: calcaneus, talus, all cunieforms, and 1, 2, and 3rd metatarsals. Highest, most mobile and shock absorbing.

Plantar calcaneonavicular (spring) ligament.

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26
Q

what bones make up the lateral longitudinal arch of the foot? What is it’s function? What ligaments help support this arch?

A

Lateral longitudinal: calcaneus, cuboid, 4 and 5th metatarsals. Weight bearing.

Long and short planter ligaments.

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27
Q

What bones make up the transverse posterior arch of the foot?

A

Transverse: posterior arch- distal row of tarsals and bases of all metatarsals. Anterior arch: heads of all five metatarsals.

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28
Q

What are the muscles in the dorsal (extensor) compartment of the foot?

A

Extensors digitorum brevis and hallucis brevis.

29
Q

What are the muscles in the first layer of the sole of the foot? What is their nerve supply?

A

Flexor digitorum brevis - medial plantar n.

Abductor hallucis - medial plantar n.

Abductor digiti minimi - lateral plantar n.

30
Q

What are the muscles in the second layer of the sole of the foot? What is their nerve supply?

A

Quadratus plantae - lateral plantar n.

Lumbricals (4):
#1 (most medial) - medial plantar n. 
#2-4 - lateral plantar
31
Q

What are the muscles in the third layer of the sole of the foot? What is their nerve supply?

A

Flexor hallucis brevis: medial plantar n.

Adductor hallucis - lateral plantar n.

Flexor digiti minimi - lateral plantar n.

32
Q

What are the muscles in the fourth layer of the sole of the foot? What is their nerve supply?

A

Plantar interossei (3) - lateral plantar n.

Dorsal interossei (4) - lateral plantar

33
Q

What is the arterial supply to the dorsal surface of the foot? what is the clinical significance of this vessel?

A

Dorsalis pedis artery - palpated to ensure sufficient blood supply to the foot.

34
Q

What veins drain the blood from the dorsal surface of the foot?

A

Dorsal digital and the dorsal metatarsal veins join to form the dorsal venous arch, which gives rise to the saphenous veins.

35
Q

What is the nerve supply to the dorsal surface of the foot?

A

Superficial fibular and deep fibular.

36
Q

What is the arterial blood supply to the plantar surface of the foot? Describe the venous return.

A

Posterior tibial artery divides into medial and lateral plantar arteries.

Venae comitantes surround the tibial artery and the great and small saphenous veins.

37
Q

What is the nerve supply to the plantar surface of the foot?

A

Lateral and medial plantar nerves (branches of tibial nerve).

38
Q

What is the function of intrinsic foot muscles?

A

Generally redundant to those of the extrinsic foot muscles and help make minor adjustments to the weight-bearing platform during stance and motion.

39
Q

What bones and ligaments make up the ankle joint? What movements does this joint allow?

A

Bones: tibia, fibula, and talus.

Ligaments: medial/deltoid ligament and lateral ligament.

Movement: dorsiflexion and plantarflexion.

40
Q

What nerve is involved in dorsiflexion of the ankle joint? What spinal segments does it come from?

A

Deep fibular nerve.

L4, L5, S1.

41
Q

What nerves are involved in plantarflexion of the ankle joint? What are their corresponding spinal segments?

A

Tibial nerve: L5, S1, and S2.

Superficial fibular nerve: L5 and S1.

42
Q

What movements do the tarsal joints allow?

A

Inversion and eversion.

43
Q

What nerves are involved in inversion of the tarsal joint? What spinal segments do they correspond with?

A

Deep fibular nerve - (L4 and L5)

Tibial nerve (L5 and S1).

44
Q

What nerves correspond with eversion of the tarsal joints? What spinal segments do they correspond with?

A

Superficial fibular nerve (L5 and S1)

Deep fibular nerve (L4, L5, and S1)

45
Q

How would you differentiate between a ruptured achilles tendon and a damaged plantaris longus tendon?

A

Thompson’s test:

Have patient lay prone, and squeeze the back of their calf. It the Achilles tendon is in tact, the foot should move slightly with each squeeze. If foot moves its probably a plantaris longus problem.

If foot doesn’t move it’s probably achilles.

46
Q

What are varicose veins?

A

Vein insufficiency with lower leg edema.

Vein valves can’t close completely and therefore blood pools in the veins of the lower limbs.

47
Q

What lower limb arterial problem is associated with diabetics and smokers.

A

Claudication pain: narrowed leg arteries and pain upon walking.

48
Q

What is tinea pedis?

A

Fungal infection of the foot.

49
Q

What is morton’s neuroma?

A

MTP joint irritation of the nearby nerve.

Can be caused by shoes that squeeze the bones of the feet and cause compressed of plantar nerve.

50
Q

What are bunions?

A

Bone growths that occur from rubbing.

51
Q

What are heel spurs caused by?

A

Plantar fasciitis lasting more than 6 months.

52
Q

What is a hammer toe?

A

Toe with metatarsophalangeal joint hyperextended and proximal interphalangeal join hyperflexed.

53
Q

What is Hallux Valgus? What can cause it?

A

Medial deviation of the first metatarsophalangeal joint.

Can be caused by wearing pointy-toed shoes.

54
Q

What is a Lis Franc joint fracture?

A

Fracture of the transverse tarsal joint.

55
Q

What is the axis of abd/adduction in the toes?

A

The second toe.

56
Q

Describe the arrangement of structures at the medial malleolus?

A

Tom, Dick, and Very Nervous Harry (anterior to posterior)

Tibialis posterior
D flexor digitorum longus 
Vein 
Nerve (tibial) 
H flexor hallicus longus
57
Q

What does the medial plantar nerve innervate in the foot?

A

3 1/4 mucles.

Abductor hallucis
Flexor digitorum brevis
Flexor hallucis brevis
1 of 4 lumbricals

58
Q

What is the function of the ACL?

A

Prevents the tibia from being displaced anteriorly.

59
Q

What does the femoral nerve innervate?

A

IPSquad

Iliacus
Pectineus
Sartorius
Quads

60
Q

What does the obturator nerve innervate?

A

POAAAG

Pectineus
Obturator externus
Adductors (brevis, longus, magnus)
Gracillis

61
Q

What does the sciatic nerve innervate before it splits?

A

BSASB

Biceps long head 
Semitendinosous 
Adductor magnus 
Semimembranoses 
Biceps short head
62
Q

What does the tibial nerve innervate?

A

PGPASTFF

Popliteus 
Gastrocnemius 
Plantaris 
Soleus 
Tib posterior 
Flexor digitorum longus 
Flexor hallucis longus
63
Q

What is the function of the popliteus muscle?

A

Unlocks the knee by laterally rotating the femur on the tibia to flex from fully extended.

64
Q

What is the relationship of the tendons and structures at the medial malleolus from anterior to posterior?

A

Tom, Dick, and Very Nervous Harry.

Tibialis posterior, Flexor Digitorum longus, flexor hallucis longus, tibial artery, vein, and nerve.

65
Q

What is innervated by the deep fibular nerve?

A 
Tibialis anterior 
Extensor digitorum longus 
Extensor hallucis longus 
Fib tertius 
Extensor digitorum brevis
Extensor hallucis brevis
66
Q

What does the tibial nerve split into?

A

Medial plantar and lateral plantar nerves.

67
Q

What does the medial plantar nerve innervate?

A

3 1/4 mm AFF

Abductor hallucis
Flexor digitorum brevis
Lumbrical (medial 1/4)
Flexor hallucis brevis

68
Q

What does the lateral plantar nerve innervate?

A

All muscles of the feet except 3 1/4 AFF.

Anatomy Block 3 (5 decks)

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