Exam 4 Flashcards
What are the bones of the leg?
- Tibia
- Fibula
- Tarsal bones
The tarsal bones consist of..?
– Talus – Calcaneus – Cuboid – Navicular – Three cuneiforms (Medial, Intermediate, Lateral) – Metatarsals – Phalanges
How many metatarsals are there?
5
The great/ big toe has how many phalanges, and each subsequent toes has how many?
Great toe: 2
Subsequent toes: 3
The fibula head sits _____ to the tibia
Sits behind/ posterior lateral
What are the blue surfaces on the posterior of the tibia?
The articular surfaces on the medial and lateral side of the tibia plateaus for the articulation of the medial and lateral condyles of the femur
What three structures form the ankle mortice for the articulation with the talus?
- Lateral malleolus
- Tibial pilon (plafond)
- Medial malleolus
The ____ passes below the peroneal trochlea and the ___ passes above it
- The peroneal longus passes below the peroneal trochlea
- The peroneal brevis passes above the peroneal trochlea
Where can we sometimes measure the navicular drop?
The navicular tuberosity
How to measure the navicular drop
If patients are sitting without any weight on their foot, you measure thee distance from the navicular tuberous to the floor and have the patient stand and put their boy weight through the lower extremity and remeasure the distance from the navicular tuberosity to the floor.
What does it mean if there’s a significant difference in the two navicular drop measurements?
It could indicate a navicular drop and a flat foot
The calcaneal tuberosity is the attachment of the ___
Achilles tendon
What is the projection of the calcaneus that forms the shelf for the tendon of flexialis longus?
Sustentaculum tali
What two bones form the transverse tarsal joints?
The navicular and cuboid
The connections between the mediate and intermediate lateral cuneiforms and the cuboid with the 1st-5th metatarsals is the…
Tarsometatarsal joint
The transverse tarsal joint is the joint between the ___ and the ___ and their articulation with the __ and the ____
The talus and the calcaneus and their articulations with the navicular and cuboid
The groove for peroneus longus passes ____
around the cuboid and inserts through the medial cuneiform and also the base of the 1st and 2nd metatarsal
What ligament covers the head of the talus and forms the inferior part of the joint surface for the talonavicular joint?
The plantar calcaneal navicular ligament (AKA spring ligament)
The leg runs from the ___ to the ____
Between the knee and ankle
The crural fascia has bony attachments that ____
divide the leg into 3 compartments
What are the three compartments of the leg?
- Anterior intermuscular septum
- Posterior intermuscular septum
- Transverse crural septum
The anterior intermuscular septum separates the ____
anterior and lateral compartments
The posterior intermuscular septum separates the ___
The lateral and posterior compartments
The transverse crural septum separates the _____
posterior septum into a superficial and deep layer
The anterior compartment is supplied by the ____ and innervated by the ____
Supplied by the anterior tibial artery and innervated by the deep peroneal nerve
What are the muscles of the anterior leg?
- Tibialis anterior
- Extensor digitorum longus
- Extensor hallicus longus
- Peroneus/ fibular tertius
What does dorsiflexion of the tibialis anterior do to the foot and why?
It will bring the foot up, because it attaches to the medial surface of the foot. It also inverts the foot. So it turns the sole of the foot upwards or medially
The extensor digitorum longus is on the __ side of the tibialis anterior
lateral side
The extensor hallucis longus is housed ___
between the the tibialis anterior and the extensor digitorum longus
What is the hallux?
The big toe
How is the peroneus tertius able to help with eversion of the foot?
Because of its attachment to the lateral side of the foot.
What muscle is the most lateral compartment of the extensor digitorum longus?
The peroneus/ fibularis tertius
What does the retinacula do?
Helps maintain the location of the tendons and provides some activity
The anterior tibial artery changes its name to the ___ once it passes ____
- Dorsalis pedia artery
- Once it passes underneath the retinacula and reaches the dorsum of the foot
Where can you take the pulse on the foot and how?
From the dorsalis pedis artery.
Put 3 fingers along the gap between the 1st and 2nd metatarsals. There is an ability to compare pulses and blood pressure by looking at the ankle brachial index to figure out what the compression is for the pressure within the dorsalis pedis compared to the arm
The dorsalis pedis artery supplies the dorsum of the foot, but it also pierces in between the ___
1st dorsal interosseous muscle
Where does the dorsalis pedis gain access to the sole of the foot?
The first dorsal interosseous muscle
What houses all the flexor compartments through the tarsal tunnel?
Flexor retinaculum
Extensor for peroneum/fibularis tertius is housed within the ____
Tendon synovial sheaths
The lateral compartment of the leg is supplied by the ____ and innervated by the ___
Supplied by peroneal artery (branch off posterior tibial artery) and superficial peroneal nerve
What are the muscles of the lateral compartment of the leg?
- Peroneus longus
- Peroneus brevis
Why can the peroneus longus cause eversion of the foot?
Becasue it passes behind the malleolus
What two muscles inserts at the base of the 1st metatarsal and the medial cuneiform to work like a sling for the sole of the foot?
The tibialis anterior and the peroneus longus
The peroneus brevis is deep to the _____
Peroneus longus
The tendon of the peroneus brevis forms a ____. One will pass inferior and the other superior to the ___
groove for the peroneus longus tendon. One will pass inferior and the other superior to the fibula trochlea or calcneal trochlea of the calcaneus bone
The posterior compartment of the leg is supplied by the ___ and innervated by the ____
Supplied by posterior tibial artery and innervated tibial nerve
What muscles are in the superficial compartment of the posterior compartment of the leg?
– Gastrocnemius
– Soleus
– Plantaris
What muscles are in the deep compartment of the posterior compartment of the leg?
– Flexor digitorum longus
– Flexor hallucis longus
– Tibialis posterior
– Popliteus
The ___ muscle is moreso in the popliteal fossa than in the posterior compartment of the leg
Popliteus
Unlike the gastrocnemius that helps with the flexion of the knee, the soleus doesn’t because it ____
Doesn’t pass behind the knee
This muscle is very short, with a very long tendon that travels all the way down to the calcaneus
The plantaris muscle
Why is the action of the flexor digitorum longus of the ankle plantarflexion?
Because it passes posterior to the medial malleolus
Unlike like in the anterior leg, the flexor hallicus in the posterior compartment is more ___ placed, so it is not sitting in the tibialis posterior, it is actually in the ___
- Laterally placed.
- In the middle of the flexor digitalis longus and the flexor flexor hallicus longus
Why is the tibialis posterior such an important muscle?
Because it helps to plantiflex the foor, because its passing behind the medial malleolus. Also because its on the medial side of the foot, it will put it into inversion.
The tibialis posterior works with the ____ to ___
Works with the tibialis anterior to invert the foot, but the tibialis anterior will tend to dorsiflex and the tibialis plantaris will plantarflex
Tom, Dick, and Naughty Harry is an analogy for…
- Tibialis posterior
- Flexor digitorum longus
- Posterior tibial artery/vein/tibial nerve
- Flexor hallicus longus
___ passes deep into the lateral collateral ligament
Popliteus
The anterior tibial artery passes between the __ and ___. It descends down the ___
Anterior tibial artery passes between the tibia and fibula. It descends down the anterior compartment of the leg
_____ changes name to the dorsalis pedis artery when it reaches the dorsum of the foot.
The anterior tibial artery
The ___ artery descends a short way and gives off the ____ artery.
The posterior tibial artery.
Gives off the peroneal artery
The peroneal artery descends the _____ and supplies _____ and ____of the leg
Descends the lateral aspect of the posterior compartment, and supplies posterior and lateral
compartments of the leg.
The posterior tibial artery descends down the ____ compartment passing ___ to the medial malleolus and divides into the __ and ____ plantar arteries
The posterior tibial artery descends down the posterior compartment passing posterior to the medial malleolus and divides into the medial and lateral plantar arteries
The ___ and ___ arteries supplies the sole of the foot
The medial and lateral plantar arteries
In rare occasions, the posterior tibial artery passes deep to the ____ then into the ___
Deep to the popliteal muscle then into the interosseus membrane
What could be a reason that the tibial artery passes deep to the popliteal muscle?
The athletes experience
What causes anterior shin pain>
The excessive use of the popliteal muscle. This prevents blood flow (lifting toes during running)
The ___ artery enters into the first dorsal interosseus to get to the sole of the foot
The dorsalis pedis artery
The saphenous nerve supplies the ____
skin on the medial side of the leg and foot
The saphenous nerve originates from the ____ and descends through the ____
Originates from the femoral nerve and descends through the adductor canal
The sural nerve originates from the ___ and ____
Originates from the Sciatic tibial and common peroneal nerves
The sural nerve supplies the skin of the ____
posterior and lateral aspects of the leg and foot
The superficial peroneal nerve innervates the ____
The skin on the distal third of the anterior surface of the leg and the dorsum of the foot
The deep peroneal nerve innervates the ____
The skin of the first interdigit space
The ____ nerve passes superficial to the gastrocnemius
The sural nerve
The sural nerve also supplies the ___ and the ____ border of the foot
The lateral achilles tendon and the lateral border of the foot
What are the cutaneous nerves of the leg?
Saphenous
Sural
Superficial peroneal
Deep peroneal
The motor tibial nerve travels with the _____ down the back of the leg
Posterior tibial artery
The tibial nerve passes posterior to the ____ and divides into ___ and ____ in the sole of the foot
Posterior to the medial malleolus and divides into medial and lateral plantar nerves in the sole of the foot
The deep peroneal nerve supplies ___ to the anterior compartment of the leg
Supplies muscular innervation to the anterior compartment of the leg
The deep peroneal nerve runs with the ____ artery and ends with branches innervating the ____
The deep peroneal nerve runs with the anterior tibial artery and ends with branches innervating the ankle joint and skin between the first and second digits
The tibial nerve passes under the soleus to innervate the ____
To the reflexor hallus longus, reflexor digitorium longus and the tibialis posterior
The tibial nerve goes through the ____ giving off the medial and lateral plantar nerve
Goes through the tarsal tunnel
The superficial branch goes to the ____ compartment
Anterior compartment
A common peroneal (fibular) nerve injury occurs with ___
Occurs with excessive valgus forces damage superficial and deep branches
A common peroneal (fibular) nerve injury prevents ____
Prevents eversion and dorsiflexion (AKA foot drop)
The superficial peroneal supplies innervation to the muscle of the ___ compartment of the leg
Lateral
The superficial peroneal nerve innervates the skin along the ____
The skin along the distal aspect of the anterior surface of the leg, dorsum of the foot and digits 3 to 5.
The motor nerves of the leg are…
The tibial nerve, deep and superficial peroneal nerves
What is plantar aponeurosis?
A thickening of the plantar fascia, similar to the found in the palm of the hand
The plantar fascia/aponeurosis acts as a ___
Strong tie for the longitudinal arches of the foot
The plantar fascia/aponeurosis attaches posteriorly to the ____ and anteriorly to the ____
- Posteriorly to the medial process of the calcaneus.
- Anteriorly to the heads of the metatarsals
____ forms a mini trampoline to give normal weight bearing surface of foot
Plantar aponeurosis/fascia
What is the windlass mechanism?
The mechanical model that describes the manner the plantar aponeurosis and the plantar fascia supports the foot during normal weight bearing activities and gives information on bio-mechanical stresses placed on the aponeurosis
A windlass test directly stretches the ____
The planrtar aponeurosis.
A windlass test is effective in examining dysfunction of the ____
Plantar fascia. (plantar fascitis)
What are the forces that contribute to the flattening of the medial longitudinal arch?
- Vertical forces from body weight
- Ground forces from the calcaneous
- Metatarsal heads
Why doesn’t the windlass mechanism occur when shoes are being worn?
Because shoes prevents toe flexion and extension
The plantar fascia has tensile strength which helps prevent ____ and helps maintain ____
- Spreading of calcaneus and metatarsals.
- Maintain medial longitudinal arch and prevents foot collapse
Great toe dorsiflexion and arch height increasing causes what in the plantar fascia?
Causes the plantar fascia to tighten like a cable, winding up around the metatarsal head. Shortening the distance between the calcaneous an d the metatarsals to elevate medial longitudinal arch
What all is part of the passive support for the arch of the foot
The plantar fascia, plantar aponeurosis, plantar calcaneonavicular ligament
The short plantar ligament is more ___ placed and the long plantar ligament is more ___ placed
The short plantar ligament is more laterally placed and the long plantar ligament is more medially placed
The short and long plantar ligament supports the ___
Medial longitudinal arch
What ligament is commonly known as the spring ligament?
The plantarcalconeonavicular ligament
What functions as active support of the foot?
The tibialis anterior and posterior tendon, and the peroneus longus tendon
What causes plantar fasciitis?
The failure of the arches of the foot, which leads an irritation of the plantar fascia and inflammation of the plantar fascia to the calcaneous
What muscles are in the first layer of the sole of the foot?
- Abductor hallucis (medial)
- Flexor digitorum brevis (intermediate)
- Abductor digiti (minimi) quinti (lateral)
The medial plantar nerve becomes the ___
Digital nerves to supply great, second, third, and half of the fourth toe
The lateral plantar nerve typically innervates the ___
Skin of the 5th toe and the other half of the fourth toe
What muscles and tendons are in the second layer of the sole of the foot?
- Flexor digitorum longus tendon
- Flexor hallicus longus tendon
- Quadratus plantae
- Lumbricals (4)
The flexor hallucis longus tendon passes through ___
A tunnel made by the flexor digitorum brevis in the 1st layer of the foot
What are the muscles of the 3rd layer of the sole of the foot?
- Flexor hallucis brevis
- Flexor digiti quinti
- Adductor hallucis
What are the muscles of the 4th layer of the sole of the foot?
- Plantar interossei (3)
- Dorsal interossei (4)
What does the sesamoid bones in the flexor hallucis brevis do?
Provide a cushion for the tendon of the flexor hallucis longus
The tendon of the flexor hallucis longus passes ___ to the flexor hallucis brevis
Superficial
____ to the medial malleolus, the tibial nerve divides into ___ and ____ plantar nerves
- Inferior
- Medial and lateral plantar nerves
The medial plantar nerves provides motor innervation to the __
- Abductor hallucis
- Flexor hallucis
- Flexor digitorum brevis
- Medial Lumbrical
The medial plantar nerves provides sensory innervation to the __
Skin of the medial sole and medial 3 and a half digits
The lateral plantar nerves provides motor innervation to the __
All other muscles of foot
The lateral plantar nerves provides sensory innervation to the __
Skin of the lateral sole and lateral 1½ digits
____ nerve provides cutaneous innervation the medial side of the dorsum of the foot
Saphenous nerve
What nerve innervates the medial side of the ankle and the medial dorsum of the foot?
Saphenous nerve
The ____ nerve innervates the space between the 1st and 2nd digits
Deep peroneal nerve
The ____ nerve innervates the dorsum of the foot, apart from a small lateral part that is innervated by the ___
Superficial peroneal nerve
Sural nerve
The heel is supplied by the _____
Calcaneal branch of the tibial nerve
The sural nerve travels along the medial side of the ____
Achilles tendon
The ____ nerves on the dorsum of the foot, are the ones that can be tweaked and played with
Intermediate dorsal cutaneous nerve
Inferior to the medial malleolus, the _____ artery divides into medial plantar and lateral plantar arteries
Posterior tibial artery
The ______ artery is a continuation of the anterior tibial artery supplying the dorsum of the foot
Dorsalis pedis artery
The dorsalis pedis artery divides into the ____
The deep plantar artery and the arcuate artery
The arcuate artery is on the ___ of the foot gives rise to the digital arteries for digits ___ on the dorsum of the foot
On the surface of the foot Digits 2-5
The anterior tibial artery has to pass underneath the ____ and the ____ into the ___- to become the dorsalis pedis artery
Underneath the extensor retinaculum and the ankle joint, into the dorsum of the foot
The deep plantar artery dives in between the ____ to get ____ and form the ___
Dives in between the 1st dorsai interossei muscle to get into the sole of the foot and form the deep plantar arch
The medial plantar artery supplies the ___
Medial side of the sole
The medial plantar artery runs___
distally between the abductor hallucis and the flexor digitorum brevis
The medial plantar artery is between layers ___ and ___ of the muscles of the foot
Between layers 1 and 2
The lateral plantar artery runs laterally between ___ to ___
Flexor digitorum breis and quadratus plantae (1st and 2nd muscle layers) to the base of the 5th metatarsal
The lateral plantar artery turns medially at ____ and heads between ____ to the ____ as the ___
The lateral plantar artery turns medially at the base of the 5th metatarsal and heads between the 3rd and 4th layers to the base of the 1st metatarsal as the plantar arch
What type of joint is the sacroiliac joint?
A synovial joint
___ is the articulation between the sacrum and ilium
The sacroiliac joint
The concave sacral surface of the SI joint is covered with ____ and its convex iliac surface line within ____
The concave sacral surface of the SI joint is covered with thick hyaline cartilage and its convex iliac surface line within fibrocartilage
The compression of the SI joint allows it to resist shear. What are the structures that compresses it?
The interosseus ligament, the joint capsule, and strong posterior ligaments protecting the networks of adjacent nerves.
What muscles contract and co-contract to provide stabilization for the SI joint during movement?
Gluteus medius, gluteus maximum, and hamstrings
What is the Interrosseous SI ligament?
A massive, strong ligament that unites the sacral and iliac tuberosities
What is the posterior sacroiliac ligament? AKA long/short dorsal SI
Composed of short and long fibers that connect the sacrum and ilic posteriorly. It blends with the sacrotuberous ligament
What is the anterior/ventral SI ligament
Tranverse fibers that support the anterior and inferior portion of the SI joint
____ ligament is an accessory ligament of the SI joint. It supports the L5-S1 joint.
Iliolumbar ligament
_____ & ____ ligaments helps support the SI joint by preventing upward/forward movement (nutation) of the sacrum
Sacrotuberous & sacrospinous ligament
The posterior SI ligament runs from the ____ to the ____
The posterior SI ligament runs from the PSIS to the sacrum
What happens to the SI joint when the tranverse abdominis muscle contracts?
It pulls the ilium together, and help close the SI joint down, providing some compression on the joint to overcome torque and shear forces
What is nutation and what causes it to want to happen?
The forward movement of the sacrum. This is caused by the body weight landing on the anterior surface of the sacrum and wanting to tilt it.
What is the ground reaction force and what does it do?
A force coming from the ground straight up to the femur, attaching to the acetabulum of the hip. Because it is anterior to the active motion, it forces the ilium to move in the opposite direction so in a sense there is a tightening up at the SI joint, because the sacrum nutates
What allows the SI joint to overcome shear forces?
The combination of form and force closure
Under normal circumstances, SI joint mobility is ____
Very limited
What is SI dysfunction?
A result of impaired load transfer through the SI joints
Why does a person with an SI joint injury have a problem standing on the affected side?
Because they need to tighten up their SI joint to allow it to transfer the load of their body through the SI joint down through the lower extremities to the floor and its that lack of transfer and load transfer that causes the signs and symptoms
How does the SI joint lock home and become solid to accept weight?
Nutation of the sacrum is restrained by the sacrotuberous ligament, and is further enhanced by the action of biceps femoris’ attachment to the ischial tuberosity. Also the semimembranosus and semitendinosus as they attach to the ischial tuberosity
What is counternutation of the sacrum?
The posterior motion of the sacrum relative to the iliac
Counternutation of the sacrum is restrianed by the ____ and is further enhanced by the action of the ____ through its attachment via thoracolumbar fascia
Long dorsal sacroiliac joint/ posterior sacroiliac joint.
By the action of latissimus dorsi
What happens to the SI joint while walking?
The leg that we are standing on has to have a tightened SI joint and the opposite leg has to have an unlocked SI joint, so it can be able to move freely
What is going on during heel strike?
Weight starts coming down through the leg and as it comes down through the spine, its going to force nutation of the sacrum, posterior movement of the iliac, and screwed on mechanism of the SI joint that is restrained. Also by the action of the bicep femoris which will help it pull back and provide some support
Load transfer through the pelvic girdle is more effective when the sacrum is ____
Nutated
Amplitude of sacral nutation is controlled by ____
Co-activation of the pelvic floor muscles and sacral multifidus.
____ can prevent the sacrum from moving too far back
The pelvic floor muscles
The cross bracing mechanism of the ___ and ___ muscles provide force closure for the SI joint
Latissimus dorsi and gluteus maximus
____ has a very large socket that completely covers the head (ball) of the femur. this is a joint that sacrifices mobility for stability. its a much more stable joint b/c its a small ball with a big socket.
The hip joint
The hip joint is a synovial joint of the ___ variety
Ball and socket
The hip joint is the articulation of the ____
Articulation of the head of the femur and the acetabulum of the os coxa
The acetabulum is deepened by the ____, which attaches to the bony rim at the SI joint and the transverse acetabular ligament
Acetabular labrum
The transverse acetabular ligament spans the acetabular notch creating the ____
The acetabular foramen
What is the acetabular foramen and what does it do?
The hollow opening underneath the transverse acetabulum ligament to get into the acetabulum fossa.
It provides passage of blood vessels and nerves to joint cavity
The femur is attached to the transverse acetabular ligament and the acetabular labrum by the ____. The attachment of the ligament is marked in the femur by a small depression called the ____
The femur is attached to the transverse acetabular ligament and the acetabular labrum by the ligament of the head of the femur/ligamentum teres femoris.
The attachment of the ligament is marked in the femur by a small depression called the fovea capitis
Extension of the of the hip is considered a _____ position for the joint
Close pack position
Flexion of the of the hip is considered a _____ position for the joint
Open- pack
What is retinacula?
The piece of synovial membrane that lines the neck of the femur
___ is where the attachment of the hip ligaments occur
The intertrochanteric line
____ is a fluid filled bursa(sac) that prevents rubbing of the bone
Bursa of the iliopsoas
____ extends from the anterior inferior iliac spine and acetabular rim to the intertrochanteric line anteriorly. It is taut in extension and prevents hyperextension of the hip in standing
Iliofemoral ligament / Y-ligament
____ extends from the cetabulum posteriorly and spirals superior-laterally to the neck of the femur and greater trochanter. It helps prevent hyperextension. and becomes taut in medial rotation and extension (it is superior and posterior to the Y-ligament)
Ischiofemoral ligament
_____ extends from the pubic part of the acetabulum and superior ramus to the lower part of the intertrochanteric line. It is taut in extension and abduction and helps prevent excessive abduction, but also prevents excessive extension
Pubofemoral ligament
____ are capsualr fibers that encircle the neck of the femur
Zona orbicularis
What are the 2 extensions of the hip joint synovial capsule that serve as bursae?
- Anterioly: the opening creates a bursa under the tendon of the iliapsoas
- Posterioly: the opening in the capsule creates a bursa for the tendon of obturator externus muscle
What supplies blood to the hip joint?
- Medial and lateral femoral circumflex arteries
- Artery to the head of the femur
What innervates the hip joint?
- Anterioly: femoral nerve
- Medially: obturator nerve
- Posterioly: superior gluteal nerve
- Posterioly and inferiorly: nerve to quadratus femoris
Where does the artery to the head of the femur come from and what does it line up with?
Comes from the obtuator artery via the acetabular branch and lines up with the fovea capitis
____ branch of the obturator artery passes underneath the transverse acetabulum ligament and winds its way through the ligament of the head of the femur
Acetabular branch
What is the deep socket and the small ball of the hip joint?
Acetabulum is the deep socket and the Femoral head is the small ball
____ joint is the largest synovial joint in the body and is of the hinge variety, with a small amount of rotation. It allows flexion and extension. It is the most frequently injured joint
The knee joint
The knee joint is the articulation between the __ and ___ condyles. The articular surface of the ___is larger than the surface of the ___. Therefore sliding must occur for them to maintain contact with one another
The knee joint is the articulation between the femoral and tibial condyles. The articular surface of the femur is larger than the surface of the tibia. Therefore sliding must occur for them to maintain contact with one another
What are the external (extracapsular: outside of the joint capsule) ligaments of the knee joint?
- Patellar ligament
- Fibular (lateral) collateral ligament
- Tibial (medial) collateral ligament
____ is a continuation of the quadriceps tendon. It strengthens the anterior capsule of the knee
The patellar ligament
____ extends from the lateral epicondyle of the femur to the lateral surface of the head of the fibula. It is only partially fused with the capsule on the superior end to allow structures pass underneath it and it strengthens the lateral capsule. It is a narrow and rounded ligament
Fibular (lateral) collateral ligament
____ extends from the medial epicondyle of the femur to the medial surface of the tibia. It strengthens the fibrous capsule and is completely intrinsic, meaning that it blends in with the fibrous capsule. It is a broad and flat ligament
Tibial (medial) collateral ligament
The ___ condlye is taller than the ___ condyle
The lateral femur condyle is taller than the medial tibial condyle
What is the location of the ACL and the PCL
In the midjoint space.
- Intercapsular: inside the joint
- Extrasynovial: outside the synovium
What do you use to test the ACL integrity and how is it done?
That anterior drawer test.
- Place thumbs on each side of the tendon
- Pull the proximal head of the tibia anteriorly
- If there is an excessive translation of the tibia(hard/firm end feel), then the ACL has an injury
What is a sag/lag sign?
When there is an excessive anterior glide, due to a lax PCL and fallen tibia
What do you use to test the PCL integrity and how is it done?
- Posterior drawer test.
- Same as the anterior drawer test, but the proximal head of the tibia will be pushed posteriorly
___ causes knee abduction and strain or a tear in the MCL. If enough force is applied along with or rotation, it can tear the ACL and damage the medial menincus
Valgus- producing force
____ is a blow to the medial knee that causes excessive adduction and LCL strain/tear and in rare occasions a PCL tear
Varus- producing force
____ strengthens the posterior capsule. It is a y-shaped ligament that inserts into the intercondylar area of the tibia and the posterior aspect fo the lateral epicondyle of the femur
Arcuate popliteal ligament
____ is an expansion of the tendon of the semimembranosus muscle. It strengthens the posterior capsule
Oblique popliteal ligament
____ capsular bursae is an extension of the synovial capsule between the femur and quadriceps tendon
Suprapatellar capsular bursae
____ capsular bursae is the extension of the synovial capsule between the popliteus and lateral condyle of the tibia. If swollen, it results in a baker’s cyst or popliteal bursitis
Popliteus capsular bursae
_____ capsular bursae is an extension of the synovial capsule between the medial head of the gastroc and femur. It is also the bursa over the lateral head of the gastroc
Gastrocnemius capsular bursa
_____ capsular bursae is between the skin and the patella
Subcutaneous prepatellar
_____ capsular bursa is between the skin and the tibial tuberosity
Subcutaneous infrapatellar capsular bursa
____ capsular bursa is between the patellar ligament and the tibia
Deep infrapatellar capsular bursa
What is a clergyman’s/housemaid’s knee?
Infrapatellar knee bursitis caused by kneeling and can be prevented with knee protection
What are the two internal (intracapsular) extrasynovial ligaments?
ACL and PCL
_____ arises from the anterior intercondylar area of the tibia and extends superiorly, posteriorly, and laterally to attach to the posterior part of the medial side of the lateral condyle of the femur. It prevents posterior displacement of the femur on the tibia and hyperextension of the knee joint
ACL
____ arises from the posterior aspect of the intercondylar are of the tibia and passes superiorly and anteriorly on the medial side of the ACL to the anterior part of the lateral side of the medial condyle of the femur. It prevents anterior displacement of the femur on the tibia or posterior displacement of the tibia.
PCL
____ is the main stabilizer of the flexed knee during gait
PCL
What is a menisci and what is its function?
Two fibrocartilaginous discs that functions to deepen the shallow articular fossae of the tibia
____ meniscus is C shaped, firmly attached to the tibial collateral ligament and is attached along the periphery of the tibial condyle by the coronary ligaments and to the joint capsule. It is also a site of common injury, because there is no freedom of movement during pinching down actions
Medial meniscus
What are the characteristics of the lateral meniscus?
- O shaped
- Attached to the tibial condyles via the coronary ligament
- Is separated away from the fibular collateral ligament by the tendon of popliteus muscle
_____ is a strong tendinous extension of the lateral meniscus that attaches to the PCL and medial condyle of the tibia
Posterior meniscofemoral ligament
The ___ third (pink zone) of each meniscus is well supplied with blood, while the ____ third (white zone) is not well supplied
The lateral third of each meniscus is well supplied with blood, while the medial third is not well supplied
What is typically done if there is an injury in the medial 1/3 of the meniscus?
A meniscectomy
What is typically done if there is an injury in the lateral 1/3 of the meniscus?
A meniscus repair
What artery supplies blood to the knee joint?
Genicular branches from the popliteal artery and the posterior tibial artery
What nerves innervate the knee joint?
- Obturator
- Femoral
- Tibial
- Common peroneal
____ is a true extension = plantarflexion, because of the extensor padding for the lower extremity
Talocrural (ankle) joint
____ joint is the articulation of the tibia and fibula with the talus. It is a synovial-hinge type joint that allows both dorsiflexion and plantarflexion. It is more stable in dorsiflexion than plantar flexion due to a wider talus bone anteriorly than posteriorly
Talocrural joint
What are the 2 places that the tibia articulates with the talus?
- Its inferior surface forms the roof of the malleolar(ankle) mortise, transferring the body’s weight to the talus.
- Its medial malleolus articulates with the medial surface of the talus; fibula articulates with the lateral talus
What does the extensor tone do?
- Extends the hip
- Extends the knee
- Plantarflex foot
What does the flexor withdrawal response do?
- Flex the hip
- Flex the knee
- Dorsiflex the ankle
What is the function of the wider part of the talus?
Dorsiflexion. It wedges to ankle mortice and stabilize it
What is the function of the narrower posterior part of the talus?
Plantarflexion. Narrower posterior part of the talus is between the ankle mortice, looser/ more lateral play
What two joints make up the transverse tarsal joint?
Talonavicular and calcaneocuboid joint
What is a midfoot-lisfranc injury/fracture?
A fracture through the metatarsal joint
What are the 3 ligaments that attach the lateral malleolus to the talus and calcaneus and are called the lateral collateral ligaments?
- Anterior talofibular ligament
- Posterior talofibular ligament
- Calcaneofibular ligament
____ runs from the lateral malleolus to the neck of the talus
Anterior talofibular ligament
____ runs from the lateral malleolus to the lateral tubercle of the posterior process of the talus
Posterior talofibular ligament
______ runs from the lateral malleolus to the lateral surface of the calcaneus
Calcaneofibular ligament
_____ consists of four parts that attach the medial malleolus to the talus, calcaneous, and navicular
Medial collateral ligaments (deltoid)
What are the parts of the medial collateral ligament (deltoid)
- Tibionavicular ligament
- Anterior tibiotalar ligament
- Posterior tibiotalar ligament
- Tibiocalcaneal ligament
What are the muscles that supports the medial ankle?
- Tibialis posterior
- Flexor digitorum longus
- Flexor hallucis longus
What supplies blood to the ankle?
Malleolar branches of the fibular, and anterior and posterior tibial arteries
What is the innervation of the ankle?
Tibial nerve and deep peroneal nerve(division of the common peroneal nerve)
What are the structures that many joints of the foot involve?
- Tarsals, metatarsals, and phalanges
What are the important intertarsal joints and what do they allow?
- Subtalar (talocalcaneal) joint.
They allow inversion and eversion of the foot. When combined with other joints, they allow pronation & supination, which allows for flexible, moldable platform for weight bearing, so it provides a good grip
Other intertarsal joints, tarsometatarsal joints, and intermetatarsal joints are relatively ____ and are so tightly joined by ligaments that ____ movement occurs between them
Other intertarsal joints, tarsometatarsal joints, and intermetatarsal joints are relatively small and are so tightly joined by ligaments that *only slight” movement occurs between them
A grade 1 lateral collateral ligament- inversion sprain is a tear to what ligament?
Anterior talofibular ligament tear
A grade 2 lateral collateral ligament- inversion sprain is a tear to what ligament?
Anterior calcaneofibular ligament tear
A grade 3 lateral collateral ligament- inversion sprain is a tear to what ligament?
Anterior talofibular ligament
- Posterior talofibular ligament
- Calcaneofibular ligament
____ joint is the articulation of the talus and calcaneous, is synovial, and permits the inversion and eversion of the foot, allows the calcaneous to rock underneath the talus
The subtalar joint
What are the two joints that the transverse/midtarsal joint consist of..?
Talocalcaneonavicular and calcaneocuboid joints
What type of joint is the talocalcaneonavicular joint?
Synovial ball and socket joint
What is the plantar calcaneonavicular ligament/spring ligament?
A subset of the talocalcaneonavicular joint, that is a band that extends from the sustentaculum tali to the posterior surface of the navicular bone
____ plays an important role in maintaining the longitudinal arch of the foot?
The plantar calcaneonavicular ligament or spring ligament
____ joint is a synovial joint that has a long plantar and short plantar component
Calcaneocuboid joint
Characteristics of the long plantar ligament of the calcaneocuboid joint
- Plantar surface of the calcaneous to the cuboid and second, third, and fourth metatarsal head
- It forms a tunnel for passing tendons and helps support the longitudinal arch of the foot
Characteristics of the short plantar ligament/ plantar calcaneocuboid ligament of the calcaneocuboid joint
- Plantar surface of the calcaneours to the cuboid
- Assists with longitudinal arch an joint support
The transverse tarsal joint is supported dorsally by the ___
By the bifurcated ligament and the dorsal talonavicular ligament
What are the bifurcated ligament?
- Calcaneocuboid
- Calcaneonavicular
Flexion and extension of the foot occur in the…
In the forefoot at the metatarsaphalangeal and interphalangeal joints
All bones of the foot proximal to the MTP joints are united by ___
United by dorsal and plantar ligaments
The bones of the MTP and IP joints are united by…
By the lateral and medial collateral ligaments
What is the blood supply of the foot/ joints in the foot
– Medial and Lateral Plantar Arteries – from posterior tibial artery
– Dorsalis pedis and arcuate arteries – from anterior tibial artery
What provides the innervation of the foot/ joints in the foot
– Medial and lateral plantar nerves – from tibial nerve
– Medial and intermediate dorsal cutaneous nerves – from superficial peroneal nerve
– Deep peroneal nerve
