EXAM 2 - APPLIED AND GROSS Flashcards
pelvic girdle - lumbosacral joint
5th lumbar vertebra and 1st sacral vertebra
- articulation - same as all other vertebrae; bodies of the 2 bones separated by intervertebral disk and held together at bodies by the anterior and posterior longitudinal ligaments; vertebrae articulate at articular processes (inferior articular process of L5 and superior articular process of S1)
- ligaments holding together are supraspinal and interspinal ligaments and ligamentum flava
- angle responsible for creating lumbar lordosis, and indirectly for creating rest of the spinal curves; optimal lumbosacral angle generates optimal degree of curvature throughout the rest of the spine; determined by drawing one line parallel to ground and another line along base of sacrum; ~ 30 degrees.
- increase as the pelvis tilts anteriorly and will decrease as pelvis tilts posteriorly, lumbar lordosis increases, the angle increases - causes the shearing stresses of L5 on S1 to increase; forward movement of L5 on S1 is prevented by ligamentous restraint, and shape and fit of inferior articular process of L5 is seated inside and behind superior articular process of S1
- as the lumbar lordosis decreases, lumbosacral angle decreases.
pelvic girdle - lumbosacral joint ligaments - iliolumbar and lumbosacral
2 ligaments specifically hold lumbosacral joint together:
- iliolumbar ligament attaches on transverse process of L5; runs inferiorly and laterally to posterior portion of the inner lip of the iliac crest; limits the rotation of L5 on S1, and assists articular processes in preventing L5 from moving anteriorly on S1; extend from th transverse processes of L4 and L5 to to iliocrest
- lumbosacral ligament attaches on the transverse process of L5; runs inferiorly and laterally to attach on the ala of the sacrum, fibers intermingle with fibers of anterior sacroiliac ligament; thick, fibrous band that extends from anterior, inferior aspect of transverse process of L5 to lateral surface of sacrum
pelvic girdle - sacroiliac / SI joint
- synovial, nonaxial joint between sacrum and ilium
- plane joint, articular surfaces are very irregular - helps to lock two surfaces together; lined with hyaline cartilage; synovial membrane lines nonarticular portions of the joint; has a fibrous capsule reinforced by ligaments
- function transmit weight from upper body through vertebral column to innominate bones; designed for great stability and very little mobility
short - composed of horizontal fibers extending from the sacrum to the posterior part of the iliac bone
long - composed of fibers extending vertically from the sacrum to the posterior superior iliac spine
generally accepted motions are:
- nutation / sacral flexion, base of sacrum (on superior end) moves anteriorly and inferiorly; causes inferior portion of sacrum and coccyx to move posteriorly; pelvic outlet becomes larger and visualized by drawing a line from tip of coccyx to bottom surface of pubic symphysis; motion is minimal - occurs with trunk flexion or hip extension
- counternutation / sacral extension - the opposite motion; base of sacrum moves posteriorly and superiorly, causing tip of coccyx to move anteriorly; pelvic inlet becomes larger and visualized by drawing a line from base of sacrum across to top of symphysis pubis; motion is minimal - occurs with trunk extension or hip flexion
motions important during childbirth:
- when baby moves through pelvic inlet during early stages of labor, the anterior-posterior (A-P) diameter needs to be larger.SI joints are in counternutation
- in later stages of labor, when baby passes through pelvic outlet, this A-P diameter has increased; putting SI joints in nutation increases A-P diameter
pelvic girdle - sacroiliac / SI joint ligaments - anterior sacroiliac, interosseous sacroiliac, short posterior sacroiliac, long posterior sacroiliac, sacrotuberous, sacrospinous, iliolumbar
meant to absorb a great deal of stress while providing great stability
- anterior sacroiliac - broad, flat on anterior (pelvic) surface connecting ala and pelvic surface of sacrum to auricular surface of ilium; holds together anterior portion of joint
- interosseous sacroiliac - deepest, shortest, and strongest; fills roughened area immediately above and behind auricular surfaces and anterior sacroiliac ligament; also connects tuberosities of ilium to sacrum
- posterior sacroiliac - comprises 2 parts
- short - runs more obliquely between ilium and upper portion of sacrum on dorsal surface; prevents forward movement of sacrum
- long - runs more vertically between posterior superior iliac spine and lower portion of sacrum; prevents downward movement of sacrum
accessory ligaments further reinforce
- iliolumbar ligament connects transverse process of L5 with iliac crest
convert greater sciatic notch into a foramen through which sciatic nerve passes:
- sacrotuberous - is very strong, triangular; running from between PSIS and PIIS of ilium, from posterior and lateral side of sacrum inferior to auricular surface, and from coccyx; fibers come together to attach on ischial tuberosity; serves as attachment for gluteus maximus and prevents forward rotation of sacrum
- sacrospinous - triangular and lies deep to sacrotuberous; broad attachment from lower lateral sacrum and coccyx on posterior side; narrows to attach to spine of ischium
pelvic girdle - symphysis pubis joint
- located in midline of the body; right and left pubic bones joined anteriorly; fibrocartilage disk lies between the 2
- amphiarthrodial joint, with little movement; much more moveable in women during childbirth
pelvic girdle - symphysis pubis joint ligaments - superior pubic, inferior pubic
- superior pubic - attaches to pubic tubercles on each side of body and strengthens superior and anterior portions of joint
- inferior pubic - attaches between two inferior pubic rami; strengthens inferior portion of joint
sacroiliac / SI joint
anterior sacroiliac ligament
sacrotuberous ligament
sacrospinous ligament
short posterior sacroiliac and long posterior sacroiliac ligament
pelvic girdle landmarks - symphysis pubis
pelvic girdle landmarks - pelvis
pelvic girdle landmarks - sacrum
pelvic girdle landmarks - innominate / os coxae
- ilium
- ischium
- pubis
pelvic girdle tilt
pelvic girdle motion
pelvic girdle tilt - posterior
pelvic girdle tilt - anterior
hip joint
most proximal of the lower extremity joints, for weight-bearing and walking activities
- ball-and-socket joint - femoral head fits into and articulates with acetabulum; convex femoral head slides in direction opposite movement of thigh; stable joint and sacrifices some range of motion
- triaxial joint, the hip has motion in all three planes; end feel - firm; end feel for hip flexion - soft because of contact between anterior thigh and abdomen.
- open-packed position when it is in 30 degrees of flexion, 30 degrees of abduction, and a small degree of lateral rotation
lower extremity
hip and knee joint landmarks - femur
hip and knee joint landmarks - tibia
hip joint ligaments - iliofemoral / Y ligament / of Bigelow, pubofemoral, ischiofemoral; inguinal; iliotibial
- iliofemoral - reinforces capsule anteriorly by attaching proximally to AIIS and crossing joint anteriorly; splits into 2 parts distally to attach to intertrochanteric line of femur, often referred to as Y ligament or ligament of Bigelow; limits hyperextension
- pubofemoral - spans hip joint medially and inferiorly; attaches from medial part of acetabular rim and superior ramus of pubis and runs down and back to attach on neck of the femur; limits hyperextension and abduction
- ischiofemoral - covers capsule posteriorly; attaches on ischial portion of acetabulum, crosses the joint in a lateral and superior direction, and attaches on femoral neck; limits hyperextension and medial rotation
3 attach along rim of acetabulum and cross hip joint in a spiral fashion to attach on femoral neck; combined effect is to limit motion in one direction (hyperextension) while allowing full motion (flexion) in the other direction; are slack in flexion and become taut as hip joint moves into hyperextension.
inguinal - has no function at hip; runs from ASIS to pubic tubercle, landmark that separates anterior abdominal wall from thigh
iliotibial band / tract - long, tendinous portion of tensor fascia lata muscle; attaches to anterior portion of iliac crest and runs superficially down the lateral side of thigh to attach to tibia
hip joint - capsule
- synovial joints, has a fibrous joint capsule, strong and thick, and covers hip joint in a cylindrical fashion
- attaches proximally around lip of acetabulum and distally to neck of femur
- forms a cylindrical sleeve that encloses joint and most of femoral neck
hip joint prime mover - tensor fascia lata
combination of flexion and abduction
hip and knee joint prime mover - quadriceps - rectus femoris
hip - flexion
knee - extension
hip joint prime mover - sartorius
combination of flexion, abduction, and lateral rotation
hip joint prime mover - iliopsoas / iliacus and psoas major
flexion
hip joint prime mover - pectineus
- flexion
- adduction
hip joint prime mover - gluteus maximus
- extension
- hyperextension
- lateral rotation
hip and knee joint prime mover - hamstrings - semitendinosus
hip - extension
knee - flexion
hip and knee joint prime mover - hamstrings - semimembranosus
hip - extension
knee - flexion
hip and knee joint prime mover - hamstrings - biceps femoris
hip - long head - extension
knee - flexion
hip joint prime mover - gluteus medius
- abduction
hip joint prime mover - gluteus minimus
- abduction
- medial rotation
hip joint prime mover - adductor longus
- adduction
hip joint prime mover - adductor brevis
- adduction
hip joint prime mover - adductor magnus
- adduction
hip joint prime mover - gracilis
- adduction
hip joint prime mover - deep rotators - obturator externus, obturator internus, quadratus femoris, piriformis, gemellus superior, gemellus inferior
- lateral rotation
hip joint muscles - anterior
hip joint muscles - posterior
hip joint muscles - lateral
hip joint - movements
hip joint - acetabular labrum
- depth of acetabulum is increased by fibrocartilaginous acetabular labrum, which is located around rim
- free end surrounds femoral head and helps to hold head in acetabulum
hip joint nerves - lumbosacral, inferior gluteal, superior gluteal, sacral plexus, sciatic, lumbosacral plexus, obturator
pelvis - male vs female
hip and knee joint landmarks - patella
upper leg veins - common iliac, external iliac, internal iliac, femoral vein
hip arteries - common iliac, external iliac, internal iliac
hip joint ligament - transverse acetabular
hip joint ligament - ligamentum teres
genitourinary nerves - lumbar plexus, ilioinguinal, genitofemoral
genitourinary arteries - descending aorta (thoracic, abdominal), renal, common iliac
genitourinary organ - kidney, bladder, prostate, testis, ureter, urethra
genitourinary veins - inferior vena cava, hepatic, renal, common iliac
genitourinary nerves - iliohypogastric, lumbosacral
pelvic girdle - obturator membrane
genitourinary muscles - coccygeus, levator ani (puborectalis, pubococcygeus, iliococcygeus)
psoas minor
genitourinary organs - epididymis, penis, rectum, scrotum, seminal vesicle, sperm duct
urinary system
genitourinary organ - ovary, uterus, vagina, cervix, fallopian tube
MMT
palpate - iliac crest
palpate - anterior superior iliac spine (ASIS)
palpate - posterior superior iliac spine (PSIS)
palpate - ischial tuberosity
palpate - greater trochanter
palpate - patella
palpate - ligamentum patellae tendon
palpate - tibial tuberosity
palpate - tibial plateaus
palpate - fibula head
palpate - femur lateral epicondyle
palpate - tibia anterior border
palpate - lateral malleolus
palpate - achilles tendon
palpate - medial malleolus
palpate - navicular tuberosity
palpate - fifth metatarsal base
palpate - first metatarsal head
palpate - calcaneus
pelvic angle of inclination - neutral
pelvic angle of inclination - anterior
pelvic angle of inclination - posterior
palpate - lateral pelvic rotation from PSIS
knee joint
- largest joint - synovial hinge joint; unlike elbow, this is not a true hinge, because it has a rotational component - not a free but rather an accessory motion that accompanies flexion and extension
2 types of end feel
- knee flexion, end feel is soft due to contact between muscle bellies of thigh and leg
- knee extension, end feel is firm due to tension of joint capsule and ligaments
patellofemoral joint and patellar tendon / ligament
- articulation between femur and patell; patella glides over patellar surface of the femur; patella functions - increasing mechanical advantage of quadriceps muscle and protecting knee joint, achieved by lengthening quadriceps moment arm, action line of quadriceps muscles is farther away so moment arm lengthens, allowing muscle to have greater angular force; without patella, the moment arm would be shorter and much of muscle’s force would be a stabilizing force directed back into joint
Q / patellofemoral angle - between the quadriceps muscle (rectus femoris) and patellar tendon; drawing a line from ASIS to midpoint of patella, and from tibial tuberosity to midpoint of the patella; angle formed by the intersection of these lines represents the Q angle
- knee extension, angle ranges from 13 to 19 degrees in normal individuals; greater in females because pelvis is wider in women
knee joint ligaments - anterior cruciate, posterior cruciate, lateral collateral / fibular collateral, medial collateral / tibial collateral
cruciates / intracapsular - located within joint capsule; between medial and lateral condyles, cross each other obliquely; provide stability in sagittal plane
- anterior - attaches to anterior surface of tibia in intercondylar area just medial to medial meniscus; spans knee lateral to posterior cruciate, and runs in superior and posterior direction to attach posteriorly on lateral condyle of femur; keeps femur from being displaced posteriorly on tibia and keeps tibia from being displaced anteriorly on femur; tightens during extension, preventing excessive hyperextension of knee; when knee is partly flexed, keeps tibia from moving anteriorly
- posterior - attaches to posterior tibia in the intercondylar area, and runs in superior and anterior direction on medial side of anterior cruciate; attaches to anterior femur on medial condyle; keeps the femur from displacing anteriorly on tibia or tibia from displacing posteriorly on femur; tightens during flexion and is injured much less frequently anterior cruciate
collateral - supply stability in the frontal plane; attachments are offset posteriorly and superiorly to the knee joint axis, and tighten during extension, contributing to stability of knee, and slacken during flexion
- medial collateral / tibial collateral - flat, broad attaching to medial condyles of femur and tibia, medial meniscus fibes are attached - contributes to frequent tearing of medial meniscus during excessive stress to medial collateral; provides medial stability and prevents excessive motion if there is a blow to lateral side of knee (valgus force)
- lateral collateral / fibular collateral - round, cordlike attaches to lateral condyle of femur and runs down to head of fibula, independent; provides lateral stability and prevents excessive motion if there is a blow to the medial side of the knee (varus force)
medial and lateral meniscus - on superior surface of tibia, menisci are 2 half-moon, wedge-shaped fibrocartilage disks; designed to absorb shock; thicker laterally than medially and because proximal surfaces are concave, they deepen flat joint surface of tibia, because of attachment to medial collateral, medial meniscus is torn more frequently
knee joint - varus and valgus angles
- valgus - distal segment situated away from midline; calcaneal distal (inferior) part of the calcaneus is angled away
- varus - distal segment is located toward the midline
coxa valga / valgus - neck-shaft angle greater than 125 degrees; angle is “straighter,” make limb longer, placing hip in adduction at weight-bearing
genu varus / varum / bowlegs - distal segments are positioned more medially than normal; ankles tend to touch while knees are apart
coxa vara / varus - neck-shaft angle less than 125 degrees, “more bent, makes limb shorter, dropping pelvis on that side during weight-bearing
genu valgus /valgum / “knock knees,” - malalignment of lower extremity distal segments (ankles) positioned more laterally than normal; knees tend to touch while ankles are apart
genu recurvatum / “back knees,” - tibiofemoral joint in which range of motion goes beyond 0 degrees of extension.
knee joint - bursae
- bursa reduces friction, many tendons located around knee have a relatively vertical line of pull against bony areas or other tendons
knee joint ligaments - popliteal space and pes anserine muscle group
- popliteal space is behind the knee, and contains important nerves (tibial and common fibu- lar) and blood vessels (popliteal artery and vein); diamond-shaped fossa bound superiorly on medial side by semitendinosus and semimembranosus and by biceps femoris on the lateral side; inferior boundaries are medial and lateral heads of gastrocnemius
- pes anserine muscle group made up of sartorius, gracilis, and semitendinosus; all cross knee posteriorly and medially, then join together to attach distally on the anterior medial surface of the proximal tibia
knee joint prime mover - quadriceps - vastus medialis
extension
knee joint prime mover - quadriceps - vastus lateralis
extension
knee joint prime mover - quadriceps - vastus intermedialis / intermedius
knee joint prime mover - popliteus
flexion
knee and ankle joint prime mover - gastrocnemius and calcaneal / achilles tendon
knee - flexion
ankle - plantar flexion
knee joint muscles
ankle and foot joint landmark - tibia and fibula and interosseous membrane
ankle and foot joint landmark - foot
ankle / talocrural / talotibial / tibiotalar joint
true ankle / talocrural / talotibial - made up of distal tibia, sits on talus with medial malleolus of tibia fitting down around medial aspect of talus, and lateral malleolus of fibula, which fits down around lateral aspect of talus
tenon and mortise, uniaxial hinge joint; triplanar
- mortise - notch that is cut in a piece of wood to receive a projecting piece (tenon) shaped to fit; malleoli of tibia and fibula would be mortise, and talus would be tenon; connects leg and foot and is responsible for controlling majority of foot motion relative to leg
ankle joint landmark - calcaneal varus and valgus
describe a position, usually abnormal
- valgus - distal segment situated away from midline; calcaneal distal (inferior) part of the calcaneus is angled away
- varus - distal segment is located toward the midline
calcaneal valgus - distal (inferior) part of calcaneus is angled away from midline
ankle joint motion
- from above, finger on lateral malleolus side is more posterior
- from front, finger over lateral mallelous is more distal. Imagine the fingers as a straight rod passing through the joint
- at ankle dorsiflexion, foot comes up and moves out slightly (abduction)
- at ankle plantar flexion, foot moves down and in (adduction)
leg and feet joints - inferior tibiofibular, superior tibiofibular, subtalar / talocalcaneal, transverse tarsal / midtarsal, proximal interphalangeal 2-5 (PIP), distal interphalangeal 2-5 (DIP), interphalangeal joint 1 (IP), metatarsophalangeal (MTP)
tibiofibular
- superior - between head of fibula and posterior lateral aspect of proximal tibia; synovial plane joint allows small amount of gliding and rotation of fibula on tibia with joint capsule; dissipates torsional stresses applied at ankle
- inferior syndesmosis / fibrous joint between concave distal tibia and convex distal fibula; no joint capsule; fibrous tissue separates bones and several ligaments that hold joint together; ankle strength depends on strong union at this joint; allow slight movement to accommodate motion of talus
subtalar / talocalcaneal
- inferior surface of talus articulating with superior surface of calcaneus; plane synovial joint; inversion and eversion occur around an oblique axis
transverse tarsal / midtarsal (TCN and CC)
- anterior surfaces of talus and calcaneus with posterior surfaces of navicular and cuboid; very little movement occurs between navicular and cuboid; motions link hindfoot and forefoot in inversion and eversion
metatarsophalangeal (MTP)
- metatarsal heads with proximal phalanges; 1st is most mobile
(2 through 5) has proximal interphalangeal (PIP) and distal interphalangeal (DIP)
1 has only one phalangeal joint, the inter- phalangeal (IP) joint
ankle and feet arches
The arches are also supported by muscles, mainly the invertors and evertors of the foot. The tibialis posterior, the f lexor hallucis longus, and the f lexor digitorum longus muscles all span the ankle posteriorly on the medial side, passing under the sustentaculum tali of the calcaneus. Thus, they give some support to the medial
side of the foot. The flexor hallucis longus and flexor digitorum longus muscles span the medial longitudinal arch and help support it. The fibularis (aka peroneus) longus muscle spans the foot from the lateral to the medial side, providing support to the transverse and lat- eral longitudinal arches. The intrinsic muscles provide more support than the extrinsics, because any motion will involve them. However, the total muscular support to the arches has been estimated to bear only about 15% to 20% of the total stress to the arches.
ankle joint prime mover - soleus and calcaneal / achilles tendon
plantar flexion
ankle and feet joint ligament - deltoid (posterior tibiotalar, anterior tibiotalar, tibionavicular, tibiocalcaneal), lateral (anterior talofibular, posterior talofibular, calcaneofibular), spring ligament / plantar calcaneonavicular, long plantar, short plantar, plantar fascia
- triangular deltoid at medial side - apex is located along the tip of medial malleolus; anterior fibers to tibionavicular; middle to tibiocalcaneal; posterior to posterior tibiotalar; deep to anterior tibiotalar; strengthens medial side of ankle joint, holds calcaneus and navicular against talus, and helps maintain medial longitudinal arch
- lateral at lateral side - lateral malleolus to talus and calcaneus; anterior talofibular to lateral malleolus to talus, weak; posterior talofibular to connect lateral malleolus to talus, strong; middle calcaneofibular ligament that attaches malleolus to calcaneus
- spring ligament / plantar calcaneonavicular - to calcaneus and runs forward to navicular, short and wide, supports medial side of longitudinal arch
- long plantar - superficial; posteriorly to calcaneus and runs forward to cuboid and bases of 3, 3, and 5 metatarsals; support of the lateral longitudinal arch
- short plantar - calcaneus to cuboid; deep to long plantar
- plantar fascia - both longitudinal arches supported; from calcaneus to proximal phalanges; tie-rod, keeping posterior (calcaneus and talus) from separating from anterior (anterior tarsals and metatarsal heads); increases stability of foot and arches during weight-bearing and walking
ankle joint prime mover - stirrup - tibialis anterior
dorsiflexion, inversion
ankle joint prime mover - tibialis posterior
inversion
ankle joint prime mover - stirrup - fibularis / peroneus longus
eversion
ankle joint prime mover - fibularis / peroneus brevis
eversion
ankle joint accessory muscle - fibularis / peroneus tertius
ankle and foot joint accessory muscle - plantaris
foot joint prime mover - flexor digitorum longus
flexion of 2-5
foot joint prime mover - flexor hallucis longus
flexion of 1
foot joint prime mover - extensor digitorum longus
extension of 2- 5
foot joint prime mover - extensor hallucis longus
extension of 1
leg and foot muscle - posterior (
foot muscles
leg and foot muscle - anterior and lateral
foot muscles - action and nerve
knee joint - screw-home
non–weight-bearing extension (open-chain action), tibia rotates laterally on the femur; lock knee in extension; knee fully extended, can stand for a long time without using muscles.
- knee flexion - must “unlock” by laterally rotating femur on tibia; rotation of femur on tibia, or vice versa, keeps knee from being a true hinge joint
leg arteries - femoral artery, popliteal, anterior tibial, posterior tibial
feet arteries - dorsalis pedis
upper leg nerves - femoral, lateral femoral cutaneous
lower leg nerves - femoral, saphenous, superficial fibular/peroneal, common fibular/peroneal, deep fibular/peroneal, lateral plantar branch of tibial, medial plantar branch of tibial, tibial nerve
lower leg vein - anterior tibial, posterior tibial, great saphenous, small saphenous, dorsal venous arch
