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DPT 720 Gross Anatomy I > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Knee Complex

A
  • femoral tibial joint
  • patella femoral joint
  • within one joint capsule
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2
Q

Distal Femur

A
  • medial and lateral condyles
  • intercondylar fossa
  • medial and lateral epicondyles
  • medial and lateral supracondylar lines
  • adductor tubercle
  • popliteal surface
  • patella articulating surface
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3
Q

Femoral Condyles

A
  • two weight bearing condyles covered with articular cartilage
  • separated posteriorly by the intercondylar (femoral) notch: provides area for cruciate ligaments to pass
  • separated anteriorly by trochlear groove: the articulating surface with the patella
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4
Q

Femoral Epicondyles

A
  • lateral: proximal attachment for LCL and origin for gastrocnemius
  • medial: insertion adductor magnus, proximal attachment for MCL, extends further than lateral
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5
Q

Trochlear Groove

A
  • lies superior to medial and lateral condyles
  • articulation site for patella
  • lateral trochlear surface has increased height to prevent patella from excessively gliding lateral during knee extension-less likely to dislocate patella due to slight valgus force at our knees
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6
Q

How do ACL and PCL run?

A
  • ACL: superior, posterior and lateral
  • PCL: superior, anterior, and medial
  • cross each other in an angled way
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7
Q

Proximal Tibia: Landmarks

A
  • medial and lateral condyles are flat on top
  • intercondylar eminence (point of bone that sticks up in middle) attachment for ACL, PCL, and horns of medial and lateral menisci
  • tibial plateaus
  • gerdy’s tubercle: between tibial tuberosity and head of fibula
  • pes anserine
  • tibial tuberosity: attachment for patellar tendon
  • soleal line: soleus, popliteus, tibialis posterior, flexor digitorum longus
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8
Q

Proximal Tibia: Functions

A
  • transfers weight across knee to ankle
  • the flat plateaus articulate with femoral condyles
  • separated by intracondylar eminences (tibial spines)
  • attachment of cruciate ligaments and menisci
  • plateaus densely covered with articular cartilage
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9
Q

Menisci of Knee

A
  • medial is more C shaped (attaches to deep portion of MCL-semimembranosus sends attachments to posterior horn) and lateral is more O shaped (no attachment to LCL)
  • medial tibial condyle is larger and articulates with more of femur
  • wedge shaped fibrocartilage-improves joint congruency and stability and helps maintain joint space (load bearing and shock absorbing)
  • attached along periphery of tibial plateaus to medial and lateral superior facets by coronary ligaments
  • anchored at horns (on eminences)
  • blood supply only to periphery of outer 1/3-none on inner so nutrition comes from synovial fluid
  • do not attach to femur
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10
Q

Anterior Knee

A
  • most distal fibers of VM extend further than VL
  • VMO pulls patella up and out because it tends to drift laterally
  • retinaculum that stabilizes your patella is more stable/thicker/stronger laterally than medially
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11
Q

Patella

A
  • sesamoid bone of quadriceps
  • apex inferiorly
  • posterior surface is covered with articular cartilage in your body
  • does not articulate with tibia-only femur
  • posterior surface articulates with trochlear groove through facets
  • articular cartilage here is thickest in the body
  • odd facet is only in contact with femur when you’re in a deep squat
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12
Q

Articular Capsule

A
  • largest synovial capsule in body
  • superiorly attaches to femur above femoral condyles and intercondylar fossa
  • inferiorly attaches to proximal tibia and periphery of patella
  • cruciate ligaments are extra-synovial but intra-articular (inside capsule, outside synovial lining-so they don’t get bathed in synovial fluid)
  • capsule allows passage of popliteus muscle posteriorly
  • infrapatellar fat pad
  • suprapatellar bursa
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13
Q

Knee Retinaculum

A
  • fibrous tissue that has been described as extension of vastus medialis and vastus lateralis into patella and from patella into medial and lateral sides of tibial condyles
  • hold patella in place
  • medial and lateral portions
  • IT band and lateral retinaculum interconnect so patella is very stable laterally
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14
Q

What’s in the intercondylar region?

A
  • 6 structures
  • ACL
  • PCL
  • horns of meniscus
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15
Q

Cruciate Ligaments

A
  • within joint capsule but outside synovial cavity
  • anterior cruciate: anterior intercondylar area of tibia; runs superior, posterior, and lateral to posterior medial side of lateral femoral condyle
  • posterior cruciate: posterior intercondylar area of tibia; runs superior, anterior, and medial to anterior lateral side of medial femoral condyle
  • ACL becomes taut in extension
  • PCL becomes taut in flexion
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16
Q

Medial Collateral Ligament

A
  • broad and flat (makes it harder to tear completely) from medial epicondyle of femur to medial condyle of tibia
  • deep fibers attach to medial meniscus
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17
Q

Lateral Collateral Ligament

A
  • cord like from lateral epicondyle to fibular head
  • popliteus runs under and biceps femoris tendon splits around LCL-supports knee in varus force
  • IT Band also supports knee in varus force also on lateral side
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18
Q

Oblique Popliteal Ligament

A
  • expansion of semimembranosus: comes up and run laterally; strengthens capsule posteriorly (runs same way as popliteal muscle)
  • taut in hyperextension
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19
Q

Arcuate Ligament

A
  • runs along posterior aspect of fibular head
  • runs superior and medial over popliteus from lateral side and blends with posterior part of joint capsule
  • taut in hyperextension
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20
Q

What muscles cross knee joint?

A
  • quadriceps
  • popliteus
  • gastrocnemius
  • gracilis
  • hamstrings
  • plantaris
  • sartorius
  • semimembranosus
  • IT band
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21
Q

Nerves of Popliteal Region

A
  • sciatic splits into tibial and common fibular above knee
  • tibial goes straight behind knee
  • common fibular wraps behind neck of fibula and splits into superficial and deep fibular nerves
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22
Q

Popliteal Artery

A
  • continuation of femoral at adductor hiatus
  • passes through popliteal fossa
  • branches to knee joint and ends by dividing into anterior and posterior tibial arteries
  • ends as it goes under popliteus muscle
  • branches: superior, medial, and inferior geniculate arteries, medial and lateral to knee supplying cruciate ligaments and synovial membrane
  • splits into medial plantar and lateral plantar arteries behind medial malleolus
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23
Q

Interosseous Membrane

A
  • runs from fibula inferior and medially to tibia
  • tensile force through IO membrane to transfer force to tibia because fibula doesn’t articulate with femur
  • ties fibula and tibia together
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24
Q

Lower Leg Compartments

A
  • anterior
  • lateral
  • posterior superficial
  • posterior deep
  • each surrounded by strong layers of fascia
  • know which compartment the muscles are in
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25
Q

Posterior Lower Leg Muscles

A
  • superficial: gastroc, soleus, plantaris

- deep: flexor hallucis longus, flexor digitorum longus, tibialis posterior

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26
Q

Lower Legs, Medial/Lateral Beginning and Ending Points

A
  • one that finishes most medial (flexor hallucis longus) starts most lateral in deep leg compartment
  • one that ends most lateral (extensor digitorum) ends most medial
  • tibialis posterior is in middle
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27
Q

Arteries of Posterior Lower Leg

A
  • posterior tibial artery: from popliteal artery (after popliteal muscle and popliteal artery becomes posterior tibial artery)
  • travels to foot under flexor retinaculum
  • supplies posterior compartment
  • fibular artery: branches from posterior tibial and descends in posterior compartment along intermuscular septum, perforating branches to lateral compartment but artery never goes into compartment
28
Q

Lateral Compartment Muscles

A
  • fibularis longus

- fibularis brevis

29
Q

Tibial Nerve in Lower Leg

A
  • innervation to: popliteus, gastroc, soleus, plantaris, FHL, FDL, and tibialis posterior
  • becomes medial and lateral plantar nerves in foot
  • sensory branches: sural (all sensory) from tibial and common fibular nerves-supply posterior and lateral leg
30
Q

Superficial Fibular Nerve

A
  • travels around neck of fibula then cuts into lateral compartment to supply it
  • between fibularis longus and brevis
  • innervates fibularis longus and brevis
  • sensory to distal anterior surface of leg and dorsum of foot
31
Q

PICTURES

A
  • especially in Posterior leg power point

- look at one you drew as well

32
Q

Fibula

A
  • upper end=head
  • apex=styloid process
  • articular facet for tibia
  • neck
  • body
  • lower end=lateral malleolus
33
Q

Proximal (Superior) Tibiofibular Joint

A
  • arthrodial joint between lateral condyle and head of fibula
  • single facet on fibular head articulates with tibia
  • covered with articular cartilage and connected by joint capsule and anterior and posterior ligaments
  • synovial
34
Q

Tibiofibular Syndesmosis

A
  • distal tibia and fibular form osseous part of syndesmosis linked by: distal anterior and posterior tibiofibular ligament, transverse ligament (extension of IOM-internal to joint), interosseous ligament (extension of IOM-internal to joint)
  • nerves go around side, but artery and vein go through membrane
  • distal tib-fib joint is syndesmosis: fibrous joint fibers attach directly from tibia to fibula (should be no motion down low and only a tiny bit of gliding at top
35
Q

Syndesmotic or High Ankle Sprain

A
  • estimated 1-11% of all ankle sprains
  • due to widening of ankle mortise as a result of increased length of syndesmotic ligaments after acute ankle sprain
  • 40% of patients still have complaints of ankle instability 6 months after ankle sprain
  • tibia and fibula spread and now joint is unstable
36
Q

Deep Fibular Nerve

A
  • begins as branch of common fibular nerve
  • passes deep to EHL and anterior to IOM
  • travels around neck of fibula then cuts into anterior compartment to supply it
  • travels with anterior tibial artery down the middle of leg
  • divides into lateral and medial branches at ankle
  • supplies all 4 muslces in anterior compartment: tibialis anterior, EDL, EHL, fibularis tertius
  • does sensory of web space between toes 1 and 2
37
Q

Injury to Deep Fibular Nerve

A
  • most common LE neuropathy
  • damage can result from: lateral knee injury, inflammation, ischemia, diabetes
  • foot drop is often consequence: people drag toes because they can’t dorsiflex ankle
38
Q

Saphenous Nerve

A
  • cutaneous nerve of anterior compartment
  • largest cutaneous branch of femoral nerve
  • passes along tibial side of leg with great saphenous vein
  • descend behind medial border of tibia
39
Q

Blood Supply of Lower Leg

A
  • popliteal artery ends with two terminal branches
  • anterior tibial artery supplies anterior compartment
  • posterior tibial artery supplies posterior compartment
40
Q

Anterior Tibial Artery

A
  • supplies anterior compartment
  • smaller terminal branch
  • passes anteriorly through IOM and along anterior tibia
  • travels between tibialis anterior and EHL (deep fibular nerve can travel with anterior tibial artery)
  • ends between malleoli where it becomes dorsalis pedis artery
41
Q

Compartment Syndrome

A
  • compression of nerves, blood vessels, and muscle due to bleeding or swelling
  • leads to tissue death from lack of oxygenation due to blood vessels being compressed by raised pressure within compartment
  • can be divided into acute, subacute, and chronic compartment syndrome
42
Q

Compartment Syndrome Causes-Acute

A
  • can be medical emergency
  • blunt force trauma
  • fracture
  • vascular puncture
  • crush injuries
  • cast compression
43
Q

Compartment Syndrome Causes-Chronic

A
  • not usually medical emergency
  • AKA chronic exertional compartment syndrome
  • repetitive muscle use (cycling, soccer)
  • arterial inflow out paces venous outflow and pressure builds
  • eventually leads to ischemia
  • subsides with rest
44
Q

Flexor Retinaculum

A
  • structures that go underneath are Tom Dick and A Very Nervous Harry
  • tibialis posterior
  • flexor digitorum
  • posterior tibial artery
  • posterior tibial vein
  • tibial nerve
  • flexor hallucis longus
45
Q

Retinaculums

A
  • 2 extensors
  • 2 laterals
  • 1 flexor
  • synovial sheaths need to be able to slide underneath these smoothly
46
Q

Bones of Foot and Ankle

A
  • tarsals: talus, calcaneous, navicular, cuboid, cuneiforms (medial, lateral, middle)
  • metatarsals: 5 bases are proximal, heads are distal, shafts are in middle
  • phalanges: 1st toe has proximal and distal and 2-5 have proximal, middle, and distal
47
Q

Lisfranc Fracture

A

-one or more MT displace from tarsus

48
Q

Talus

A
  • convex dome
  • articulates with distal tibia and fibula (ankle mortis or ankle joint)
  • neck
  • head: articulates with navicular (part of trans tarsal joint)
  • subtalar joint: articulates with calcaneus (inversion and eversion)
49
Q

Calcaneus

A
  • heel bone (part of trans tarsal joint)
  • articulates with talus above and cuboid anteriorly
  • tuberosity
  • sustentaculum tali: medial (FHL tendon fits in groove) Identify this on a bone
50
Q

Tarsal Articulations

A
  • navicular: articulates with talus, cuboid and all 3 cuneiforms
  • cuboid: articulates with calcaneous, navicular, lateral cuneiform and base of MT 4 and 5
  • cuneiforms: articulate with bases of MT 1-3 and navicular
  • metatarsals 1-5: 1-3 articulate with medial middle and lateral cuneiforms; 4 and 5 with cuboid
51
Q

Talocrural Joint

A
  • distal tibia/fibula with talus

- dorsiflexon/plantar flexon

52
Q

Subtalar Joint

A
  • talus with calcaneus

- inversion/eversion

53
Q

Mid Tarsal (Transverse Tarsal) Joint

A

-navicular and cuboid with talus and calcaneous

54
Q

Tarsometatarsal Joint

A

-3 cuneiforms and cuboid with bases of MTs

55
Q

Plantar Surface Ligaments

A
  • support the arches
  • plantar aponeurosis
  • long plantar ligament
  • short plantar ligament
  • spring ligament
56
Q

Plantar Aponeurosis

A
  • from calcaneal tuberosity and across bottom of foot
  • crosses MTP joints to toes
  • taut with extension of MTP joints
57
Q

Long and Short Plantar Ligaments

A
  • long: calcaneus to cuboid and base of MTs (deep, lateral)

- short: calcaneus to cuboid (deep, lateral)

58
Q

Spring Ligament

A
  • aka plantar calcaneonavicular ligament

- medial

59
Q

Medial Collateral Ligament

A
  • deltoid
  • 4 parts that come together to act as one big fan shaped ligament
  • anterior and posterior tibiotalar, tibiocalcaneal, tibionavicular
60
Q

Lateral Collateral Ligament

A
  • anterior talofibular
  • calcaneofibular
  • posterior talofibular
  • usually sprain these from front to back
61
Q

Even More Ligaments of Ankle and Foot

A
  • collateral ligaments of MPT, PIP, DIP joints
  • transverse metatarsal ligament
  • plantar plates at MTP, PIP, DIP (same thing as volar plates-long flexor tendons can slide on them more easily)
  • also have cruciate and annular ligaments and an extensor mechanism
62
Q

4 Layers of Plantar Muscles

A
  • flexor digitorum brevis, abductor hallucis, abductor digiti minimi
  • quadratus plantae, lumbricals
  • flexor hallucis brevis (2 heads), flexor digiti minimi brevis, adductor hallucis (2 heads)
  • palmar interossei (3), dorsal interossei (4)
63
Q

Dorsalis Pedis Artery

A
  • branches off anterior tibail
  • under extensor retinaculum between EHL and EDL
  • divides into deep plantar artery: divides between 1st and 2nd MT and posterior to sole of foot
  • and lateral tarsal artery: runs across dorsum of foot on lateral side and under extensor digitorum longus: swings out laterally as arcuate then medially and comes back to dorsalis pedis-forms archway
64
Q

Nerves of Foot

A
  • saphenous: sensory to skin on medial ankle and foot
  • superficial fibular: dorsum of foot sensory
  • deep fibular: motion to EDB and EHB and sensory to skin between 1 and 2 web space
  • medial plantar: sensory to medial side of foot and medial 3 digits and motor to LAFF (lumbrical 1, abductor hallucis, flexor digitorum brevis, flexor hallucis brevis)
  • lateral plantar: everything else on bottom of foot and sensory to lateral side of foot 4th toe split with medial plantar
  • sural: sensory to skin on lateral foot and heel
  • heel is done by tibial nerve before it splits
65
Q

Archways of Foot

A
  • plantar: lateral plantar and medial plantar
  • dorsal: dorsalis pedis, lateral tarsal, arcuate
  • off of dorsalis pedis is lateral tarsal, to arcuate, then back to dorsalis pedis
  • on plantar side is posterior tibial which splits into lateral and medial which link up with each other
  • deep branches link the two arches together

DPT 720 Gross Anatomy I (8 decks)

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