Exam 3: Lower Extremities Flashcards
Osteology of the Pelvic Girdle
Innominate Bones:
Ilium
Ischium
Pubis
Sacrum
Arthrology of the Pelvic Girdle
Acetabulofemoral Joint: Ball & Socket
Pubic Symphysis: Cartilaginous/Fibrocartilaginous
Sacroiliac Joint: Combination Fibrous/Synovial
Ligaments of the Acetabulofemoral Joint
Iliofemoral: Ilium to Femur
Ischiofemoral: Ischium to Femur
Pubofemoral: Pubis to Femur
Ligamentum Teres: Center of the Acetabulum to the Center of the Femoral Head
Anterior/Posterior Pelvic Tilt
Anterior Pelvic Tilt: Butt sticks out (Beyonce)
Posterior Pelvic Tilt: Tucked Butt (Urkel)
Lateral Pelvic Tilt
Facing the same direction as the patient, like turning a steering wheel
Left Pelvic Tilt results in the right side rising and vice versa
Transverse Pelvic Tilt
Facing the same direction as the patient while looking from the top down
Like turning a steering wheel
Pelvic Tilt Coupling Pattern
Anterior Pelvic Tilt is coupled with Lumbar Extension
Posterior Pelvic Tilt is coupled with Lumbar Flexion
Iliacus
Superior Attachment: Posterior Internal Innominate Bones
Inferior Attachment: Proximal Anterior Medial Femur
Action: Hip Flexion
Innervation: L1, L2, Femoral Nerve
Psoas Major & Minor
Superior Attachment: Lateral Aspects of the T12-L5
Inferior Attachment: Proximal Anterior Medial Femur
Action: Hip Flexion
Rectus Femoris
Superior Attachment: Anterior Inferior Iliac Spine
Inferior Attachment: Anterior Tibia via Patellar Tendon
Actions: Hip Flexion, Knee Extension
Sartorius
Superior Attachment: Anterior Superior Iliac Spine
Inferior Attachment: Posterior Medial Tibia
Actions: Hip Flexion, Abduction, & External Rotation, Knee Flexion & Internal Rotation
Tensor Fascia Latae
Superior Attachment: Anterior Iliac Crest
Inferior Attachment: IT Band Connective Tissue (Lateral Thigh)
Actions: Hip Flexion & Abduction
Gluteus Maximus
Superior Attachment: Posterolateral Sacrum & Coccyx, Gluteal Aspect of the Ilium
Inferior Attachment: Gluteal Tuberosity of the Femur & between layers of Fascia Lata
Actions: Hip Extension, Abduction, External Rotation, & Adduction
Gluteus Medius
Superior Attachment: Outer Surface of the Ilium between Iliac Crest & Posterior Gluteal Line
Inferior Attachment: Lateral Aspect of the Greater Trochanter of the Femur
Actions: Hip Extension, Abduction, External Rotation (Flexion & Internal Rotation in some positions)
Gluteus Minimus
Superior Attachment: Gluteal Surface of the Ilium between Anterior & Inferior Gluteal Lines
Inferior Attachment: Anterolateral aspect of the Greater Trochanter of the Femur
Actions: Hip Extension, Abduction, & External Rotation (Flexion & Internal Rotation in some positions)
Piriformis
Superior Attachment: Anterior Sacrum & Sacroiliac Joint
Inferior Attachment: Superior Aspect of the Greater Trochanter
Actions: Hip Extension, External Rotation, & Abduction
Gemellus Superior
Superior Attachment: Gluteal Surface of the Ischial Spine
Inferior Attachment: Medial Surface of the Greater Trochanter
Actions: External Rotation
Gemellus Inferior
Superior Attachment: Lateral Surface of the Ischial Tuberosity
Inferior Attachment: Greater Trochanter of the Femur
Actions: External Rotation
Obturator Internus
Superior Attachment: Inferior Margin of the Superior Pubic Ramus
Inferior Attachment: Greater Trochanter of the Femur
Actions: External Rotation
Obturator Externus
Superior Attachment: Rami of the Pubis & Ischium
Inferior Attachment: Greater Trochanter of the Femur
Actions: External Rotation & Adduction
Quadratus Femoris
Superior Attachment: Superior Lateral Border of the Ischial Tuberosity
Inferior Attachment: Quadrate Tubercle of the Femur
Actions: External Rotation & Adduction
Biceps Femoris
Superior Attachments:
- Long Head: Posterior Inferior Ischial Tuberosity
- Short Head: Linea Aspera (Posterior Middle) of the Femur
Inferior Attachments: Lateral Head of the Fibula
Actions: Knee Flexion & External Rotation & the Long Head Extends the Hip
Semitendinosus
Superior Attachment: Ischial Tuberosity & Sacrotuberous Ligament
Inferior Attachment: Superior Medial Surface of the Tibia
Actions: Knee Flexion & Internal Rotation & Hip Extension
Semimembranosus
Superior Attachment: Ischial Tuberosity
Inferior Attachment: Medial condyle of the tibia
Actions: Knee Flexion & Internal Rotation & Hip Extension
Pectineus
Superior Attachment: Pectineal Line of the Pubic Bone
Inferior Attachment: Pectineal Line on the Posterior Femur (Inferior to the Lesser Trochanter)
Actions: Hip Adduction & Flexion
Tibiofemoral Joint
Modified Hinge Joint
Between the medial & lateral femoral condyles & the tibial plateau
The screw home mechanism allows for transverse plane movement during the end of knee extension
Patellofemoral Joint
Glide-type Joint
Between the patellar facets and patellar surface of the femur
Functions: Increases leverage of Quadriceps Femoris & protects the Patellar Tendon
Anterior Cruciate Ligament (ACL)
The primary restraint of anterior translation of the tibia relative to the femur
Resists tibiofemoral IR & Valgus forces (when the knee is flexed)
Posterior Cruciate Ligament (PCL)
The primary restraint of posterior translation of the tibia relative to the femur
Collateral Ligaments
Medial Collateral Ligament (MCL): Resists valgus forces
Lateral Collateral Ligament (LCL): Resists varus forces
Menisci
Medial & Lateral Menisci are crescent-shaped, semi-mobile “pads” that help to:
Absorb & Distribute Loads
Guide Motion
Improve Synovial Fluid Flow
Reduce Friction
Improve Congruence of the Tibiofemoral Joint
Rectus Femoris
Superior Attachment: Anterior Inferior Iliac Spine & Supraacetabular Groove
Inferior Attachment: Patellar Base via Quadriceps Tendon
Actions: Knee Extension & Hip Flexion
Innervation: L3
Vastus Medialis
Superior Attachment: Medial Linea Aspera & Distal Intertrochanteric Line
Inferior Attachment: Patellar Base via Quadriceps Tendon
Actions: Knee Extension
Innervation: L3
Vastus Lateralis
Superior Attachment: Lateral Linea Aspera & Lateral Greater Trochanter
Inferior Attachment: Patellar Base via Quadriceps Tendon
Actions: Knee Extension
Innervation: L3
Vastus Intermedius
Superior Attachment: Anterior Femoral Shaft
Inferior Attachment: Patellar Base via Quadriceps Tendon
Actions: Knee Extension
Innervation: L3
Popliteus
Superior Attachment: Lateral Surface of the Lateral Femoral Condyle & the Posterior Aspect of the Lateral Meniscus
Inferior Attachment: Proximal Posterior Tibia
Actions: Unlocking of the Screw Home Mechanism (Int. Rotation) & Knee Flexion
Plantaris
Superior Attachment: Inferior Aspect of the Lateral Supracondylar Ridge
Inferior Attachment: Posterior Surface of the Calcaneus via Plantaris Tendon
Actions: Knee Flexion & Plantarflexion
Gastrocnemius
Superior Attachment: Posterolateral surface of the Lateral Condyle & the Posterior surface of the Medial Condyle (Femur)
Inferior Attachment: Posterior Surface of the Calcaneus via Calcaneal (Achilles) Tendon
Actions: Knee Flexion, & Plantarflexion
Innervation: S1 & S2
Gracilis
Superior Attachment: Medial Aspect of the Ischiopubic Ramus
Inferior Attachment: Medial Tibia via Pes Anserinus
Actions: Knee Flexion & Internal Rotation & Hip Adduction & Flexion
Tibiofibular Joints
Proximal: Glide-type Joint
Distal: Syndesmosis (not Synovial)
Functions: Dissipate twisting & bending forces of the lower leg & foot
Talocrural Joint
Between the Distal Tibia & Distal Fibula (mortise) & the Talus
A Hinge-type Joint
Only 1 DOF in the Sagittal Plane
Subtalar Joint
Mixed-type Synovial Joint
Between the Talus & Calcaneus
Only 1 DOF around an Oblique Axis
The oblique axis allows for movement in all 3 planes
Supination & Pronation
Which Subtalar Movements are associated with Supination
Inversion, Adduction, & Plantar Flexion
Which Subtalar Movements are associated with Pronation
Eversion, Abduction, & Dorsiflexion
Soleus
Superior Attachment: Posterior & Medial Tibia, Posterior Border & Head of the Fibula
Inferior Attachment: Posterior Calcaneus via Calcaneal Tendon
Actions: Plantarflexion
Innervation: S1 & S2
Tibialis Anterior
Superior Attachment: Distal 1/3 of the Tibia
Inferior Attachment: Medial Cuneiform & Base of Metatarsal 1
Actions: Dorsiflexion, Inversion, & Supination
Innervation: L4
Extensor Hallucis Longus
Superior Attachment: Anterior 1/2 of the Fibula & Interosseous Membrane
Inferior Attachment: Dorsal Base of the Distal Phalange of the Hallux
Actions: Dorsiflexion, Eversion, & Pronation, Extension of Digit 1
Innervation: L5
Extensor Digitorum Longus
Superior Attachment: Anterior Lateral Condyle of the Tibia, Anterior Fibular Shaft, & Interosseous Membrane
Inferior Attachment: Dorsal Surfaces of the Middle & Distal Phalanges of Digits 2-5
Actions: Dorsiflexion, Eversion, & Pronation, Extension of MP, PIP, & DIP of Digits 2-5
Fibularis (Peroneus) Longus
Superior Attachment: Superior & Lateral Surface of the Fibula & Lateral Tibial Condyle
Inferior Attachment: Crosses the Plantar Surface of the Foot into the lateral aspect of the 1st Cuneiform & 1st Metatarsal
Actions: Plantarflexion, Eversion, & Pronation
Fibularis (Peroneus) Brevis
Superior Attachment: Distal 2/3 of the Lateral Surface of the Fibula & Anterior Interosseous Membrane
Inferior Attachment: Styloid Attachment of the Proximal 5th Metatarsal
Actions: Plantarflexion, Eversion, & Pronation
Fibularis (Peroneus) Tertius
Superior Attachment: Medial Surface of the Fibula & Interosseous Membrane
Inferior Attachment: Dorsal Surface of the 5th Metatarsal Base
Actions: Dorsiflexion, Eversion, & Pronation
Tibialis Posterior
Superior Attachment: Posterior Aspect of the Interosseous Membrane, Posteromedial Fibular Surface, & Superior Aspect of the Proximal Tibia
Inferior Attachment: Plantar Surface of the Medial Cuneiform, Bases of Metatarsals 2-4, Intermediate & Lateral Cuneiforms, & the Cuboid
Actions: Plantarflexion, Inversion, & Supination
Flexor Digitorum Longus
Superior Attachment: Medial Surface of the Tibia
Inferior Attachment: Plantar Surfaces of Distal Phalanges 2-5
Actions: Plantarflexion, Inversion, & Supination, MTP, PIP, & DIP Flexion of Phalanges 2-5
Flexor Hallucis Longus
Superior Attachment: Distal 2/3 of the Posterior Fibula, Interosseous Membrane, & Posterior Intermuscular Septum
Inferior Attachment: Base of Distal Phalanx 1
Actions: Plantarflexion, Inversion, & Supination, MTP & IP Flexion of Phalange 1
Lateral Ankle Ligaments
Anterior Talofibular Ligament
Calcaneofibular Ligament
Posterior Talofibular Ligament
Medial Ankle Ligaments
Deltoid Ligament Complex
High Ankle Ligaments
Tibiofibular “Syndesmotic’ Ligaments
Interosseous Membrane
Abductor Hallucis
Actions: MTP Flexion & Abduction of Digit 1
Flexor Hallucis Brevis
Actions: MTP Flexion of Digit 1
Abductor Digiti Minimi
Actions: MTP Flexion & Abduction of Digit 5
Flexor Digiti Minimi Brevis
Actions: MTP Flexion of Digit 5
Flexor Digitorum Brevis
Actions: MTP & PIP Flexion of Digits 2-5
Quadratus Plantae
Attachment to the Flexor Digitorum Longus Tendons & the Inferior Calcaneus
Actions: MTP, PIP, & DIP Flexion of Digits 2-5
Lumbricals
Attachments to the Flexor Digitorum Longus Tendons of Digits 2-5 & Extensor Expansions of Toes 2-5
Actions: MTP Flexion of Digits 2-5, PIP & DIP Extension of Digits 2-5, Adduction of Phalanges 3-5, Abduction of Phalange 2
Dorsal Interossei Abductors
Attachments to the 2nd Medial Metatarsal & Lateral Metatarsals 2-4 as well as the Extensor Expansion of Digits 2-5
Actions: MTP Flexion, PIP & DIP Extension, & Abduction of Digits 2-4
Plantar Interossei Adductors
Attachments to the Medial Metatarsals 3-5 & the Medial Proximal Phalanges 3-5
Actions: MTP Flexion, PIP & DIP Extension, & Adduction of Digits 3-5
Extensor Digitorum Brevis
Actions: MTP & PIP Extension of Digits 2-4
Extensor Hallucis Brevis
Actions: MTP Extension of Digit 1
Adductor Hallucis
Actions: MTP Adduction of Digit 1
Adductor Brevis
Superior Attachment: Anterior body of the pubis & lateral surface of the Inferior Pubic Ramus
Inferior Attachment: Proximal Linea Aspera, above the insertion of Adductor Longus
Actions: Hip Adduction & Flexion
Adductor Magnus
Superior Attachment: Pubic & Ischial Rami
Inferior Attachment: Medial Gluteal Tuberosity
Actions: Hip Adduction & Extension
Adductor Longus
Superior Attachment: Anterior Body of the Pubis
Inferior Attachment: Medial 1/3 of the Femur
Actions: Hip Adduction & Flexion
Which Knee Injuries Form an Unhappy Triad?
ACL
MCL
Medial Meniscus
Which 3 muscles insert into the Pes Anserinus?
Sartorius
Gracilis
Semitendinosus
Which Muscles & Ligament provide support to the Medial Longitudinal Arch?
Extrinsic:
- Tibialis Posterior
- Tibialis Anterior
- Flexor Hallucis Longus
Intrinsic:
- Flexor Hallucis Brevis
- Flexor Digitorum Brevis
- Abductor Hallucis
Ligament:
- Spring Ligament
Windlass Mechanism
The Plantar Fascia is stretched when the MTP joints extend. This tightness provides a spring-like quality to the feet for pushing off and producing more force. It also supports the many different joints within the ankle & foot.
