Final Exam Flashcards
This joint forms the connection between the lower extremity and the pelvis and is subject to both inflammatory and degenerative diseases.
Hip joint
What are the articulating surfaces for the hip joint?
Head of the femur and the acetabulum of the pelvis
This structure deepens the cavity of the acetabulum, which increases the depth of the articulation.
Acetabular labrum
What type of joint is the hip joint classified as?
Ball and socket joint
What are the ligaments of the hip joint?
Capsular ligament, iliofemoral, pubofemoral, ischiofemoral, transverse acetabular, and the capitis femoris ligaments.
This ligament is considered to be the strongest in the body. It reinforces the joint capsule anteriorly and inferiorly, “screws” the head of the femur into the acetabulum, is extrinsic and acts like a rope.
Iliofemoral ligament
What are the attachments of the iliofemoral ligament?
Anterior inferior iliac spine and the intertrochanteric line
When bending backwards, what muscles are brought into action to prevent the body from falling backwards?
Anterior hip and abdominal muscles
When bending forwards, what muscles are brought into action to prevent the body from falling forwards?
Gluteal, hamstring, and spinal muscles
What is the nerve supply of the hip joint?
Femoral, obturator, and sciatic nerves
This ligament reinforces the joint capsule anteriorly and inferiorly. It prevents abduction at the hip joint, is extrinsic, and acts like a rope.
Pubofemoral ligament
What are the attachments of the pubofemoral ligament?
Superior ramus of the pubis and the intertrochanteric line
This ligament reinforces the joint capsule. It prevents hyperextension and abduction at the hip joint, is extrinsic, and acts like a rope.
Ischiofemoral ligament
What are the attachments of the ischiofemoral ligament?
Body of the ischium and the neck and greater trochanter of the femur
This is an intrinsic ligament, which is formed by the acetabular labrum as it bridges the acetabular notch. It converts the notch into a tunnel, through which blood vessels and nerves enter the joint.
Transverse acetabular ligament
This is a weak intrinsic ligament, which mainly functions to conduct blood vessels to the head of the femur. It is of little importance for strengthening the hip joint.
Capitis femoris ligament
Compared to the shoulder joint is the hip joint more or less mobile?
Less mobile. Some of the movements have been sacrificed in order to provide more strength and stability
This term is used to describe an ongoing process, which is variable in its manifestations and is not always detectable at birth. The majority of children with this condition have ligamentous laxity, which causes the hip to become unstable and slip out of position.
Developmental dysplasia (congenital dislocation)
This is another term for the twisting of the femur and can become a problem in people who have developmental dysplasia.
Femoral anteversion
Hip dislocations are rare, but the most common of them are what type? They allow the femoral head to pass through a tear in the capsular ligament and over the acetabulum, ending up on the ilium.
Posterior dislocations
Posterior dislocations of the hip may compromise what nerve?
Sciatic nerve
This type of hip dislocation is not as common, but still occurs. It allows the head of the femur to end up in the obturator foramen.
Anterior dislocation
Anterior dislocations of the hip may compromise what nerve?
Obturator nerve
This is the largest and most superficial joint in the body.
Knee joint
The knee joint is formed from the articulations of what?
Femur, tibia, and patella
During development, three separate joints become continuous with each other and form a single large joint cavity. Where are they found?
- Between the patella and femur
- Between the lateral condyles of the femur and tibia
- Between the medial condyles of the femur and tibia
What are the articulating surfaces of the tibial condyles often referred to as?
Lateral and medial tibial plateaus
The joint between the femur and tibia is classified as what type of joint?
Ginglymus (hinge) with some degrees of rotation when the joint is flexed
The joint between the patella and the femur is classified as what type of joint?
Plane gliding joint
What is the nerve supply of the knee joint?
Femoral, obturator, common fibular and tibial nerves
Within the capsular ligament of the knee there are a number of bursae, which are clinically significant. What are they and where do they lie?
- Subcutaneous prepatellar: between the patella and the skin
- Subcutaneous infrapatellar: between teh tibial tubercle and the skin
- Deep infrapatellar: between the ligamentum patella and the tibial tubercle
- Suprapatellar: between the femur and the common tendon of insertion of the quadriceps
What are the extrinsic ligaments of the knee joint?
Ligamentum patella, lateral (fibular) collateral, medial (tibial) collateral, oblique and arcuate popliteal
This is the anterior ligament of the knee joint and represents the original distal common tendon of insertion of the quadriceps. It runs from the apex of the patella to the tibial tubercle and plays an important role in maintaining the alignment of the patella relative to the articular surface of the femur. It is extrinsic
Ligamentrum patella
This ligament is located on the lateral side of the knee joint, it is superficial and separate from the articular capsule of the joint. It functions as a wall and prevents lateral movement (abduction) at the joint.
Lateral (fibular) collateral ligament
What are the attachments of the lateral (fibular) collateral ligament?
Lateral epicondyle of the femur (proximally) and the head of the fibula (distally)
This ligament is located on teh medial side of the knee joint. it blends with the articular capsule and is directly attached to the medial meniscus.. It functions as a wall and prevents medial movement (adduction) at the joint.
Medial (tibial) collateral ligament
What are the attachments of the medial (tibial) collateral ligament?
Medial epicondyle of the femur (proximally) and the medial side of the tibia, just below the medial condyle (distally)
These ligaments are found on the posterior aspect of the knee joint. They both function as walls to prevent hyperextension of the knee joint. They also stabilize the posterior aspect of the joint.
Oblique and arcuate popliteal
What are the intrinsic ligaments of the knee joint?
Anterior cruciate, posterior cruciate, medial meniscus, lateral meniscus, coronary ligaments, and the transverse ligament of the knee
These ligaments are the main bond between the femur and the tibia.
Cruciate ligaments
This ligament is the weaker of the two cruciate ligaments and prevents anterior displacement of the tibia under the femur and thus functions like a rope.
Anterior cruciate ligament
What are the attachments of the anterior cruciate ligament?
Lateral condyle of the femur (proximally) and the anterior intercondylar area of the tibia (distally)
This is the stronger of the two cruciate ligaments and prevents posterior displacement of the tibia under the femur. It functions as a rope.
Posterior cruciate ligament
What are the attachments of the posterior cruciate ligament?
Medial condyle of the femur (proximally) and to the posterior intercondylar area of the tibia (distally)
What are the main functions of the menisci?
- Deepen the articulating surface
- Act as a shock absorber
- Act as a mechanoreceptor (type of proprioceptor) to increase positional sense of the knee joint
This is “C” shaped and firmly adheres to the tibial collateral ligament. Its less mobile on the surface of the tibia.
Medial meniscus
It is nearly circular in shape and smaller than the other meniscus. It is more freely movable on the surface of the tibia.
Lateral meniscus
These ligaments are associated with the menisci. They are a portion of the joint capsular ligament, which attaches to the edge of the menisci and helps to hold them in place.
Coronary ligaments
This ligament joins the anterior edges of the medial and lateral menisci and allows them to work together.
Transverse ligament of the knee
What are the movements of the knee joint?
Mainly flexion and extension, but some rotation occurs when the joint is in a flexed position.
When the knee is fully extended it “locks” due to what? How does it “unlock”?
It “locks because of the lateral rotation of the tibia. It “unlocks” due to contraction of the popliteus muscle, which medially rotates the tibia.
This condition is caused by friction between the skin and the patella. It may also occur from a direct blow or falling on a flexed knee. If it becomes chronic, the bursae will become distended with fluid and form a swelling anterior to the knee.
Prepatellar (Housemaid’s) bursitis
This condition is caused by excessive friction between the skin and the tibial tubercle. This was once known as “clergyman’s knee”.
Subcutaneous infrapatellar bursitis
This condition is caused by bacteria from an abrasion or penetrating wound. The infection may spread to the knee joint cavity, causing local redness and pain as well as enlarged lymph nodes.
Suprapatellar bursitis
This type of knee injury is very common, especially when the foot is fixed on the ground.
Ligament sprains
What ligaments compose the Unhapy Triad?
Medial collateral, anterior cruciate, and medial meniscus
This is probably the most commonly injured ligament of the knee joint. Damage to this ligament can occur not only by a lateral blow to the joint, but also by rotational forces during trauma
Medial collateral ligament
Patients with this injury will complain of their knee “clicking”, locking up, having pain when going up stairs or getting up from a chair.
Damage to the medial meniscus
If large parts of the menisci are removed, forces are now transmitted to the condyles of the tibia and can lead to damage of the articular cartilage and to what condition?
Osteoarthritis
This ligament can be damaged in sports that require twisting or jumping. This type of injury will produce a condition in which the tibia can be pulled excessively forward under the femur (positive anterior drawer test)
Anterior cruciate ligament
Injury to this ligament is much rarer than its counterpart. With this type of injury, the tibia can be pulled or moved excessively backward under the femur (positive posterior drawer test)
Posterior cruciate ligament
Damage to the anterior cruciate ligament will produce a positive result with what test?
Anterior drawer test
Damage to the posterior cruciate ligament will produce a positive result with what test?
Posterior drawer test
What are the criteria for a knee replacement surgery?
- Pain cannot be controlled
- The individual is functionally disabled
What is the life span of a knee replacement?
15-20 years
What are the articulations of the tibia?
The condyles of the femur and head of the fibula (proximally) and with the talus and distal end of the fibula (distally)
How many ossification centers does the tibia have?
One primary (shaft) and three secondary (proximal end, distal end, and tibial tuberosity)
This condition is characterized by a disruption of the epiphyseal plate of the tibial tuberosity that occurs around puberty in active adolescents. It is commonly seen in adolescents and teenagers that participate in running and jumping sports. Avulsion fractures of the tibial tubercle are common.
Osgood-Schlatter’s disease
Osgood-Schlatter’s disease is an example of what type of injury?
Aphophyseal injury or traction apophysitis
This is another name for a secondary ossification center that develops with growth.
Apophyses
How many ossification centers does the fibula have?
One primary (shaft) and two secondary (distal and proximal ends)
These three bones are sources for bone grafting
Tibia, fibula, and the crest of the ilium
This condition characterized by a compound fracture of the tibia from direct trauma.
Bumper fracture
What is the most commonly fractured bone of the lower extremity?
Tibia
This bone fractures just proximal to the lateral malleolus or just distal to the head of the bone. Fractures to can be very painful due to the disruption of muscle attachments and locomotion.
Fibula
A fracture of the fibula has the potential to damage what nerve?
Common fibular
There are seven of these bones. They are comparable to the carpal bones of the hand, but they are more modified and specialized. They function in locomotion and support.
Tarsal bones
This is the largest and strongest of the tarsals. It articulates superiorly with the talus and anteriorly with the cuboid. It forms the heel.
Calcaneus
This feature of the calcaneus is a large prominence and allows for the insertion of the tendon calcaneus (Achilles tendon)
Calcaneal tuberosity
This feature of the calcaneus is found on the lateral side of the bone and separates the tendons of the fibularis longus and brevis from each other.
Fibular trochlear
This is a prominent “ledge” on the medial aspect of the calcaneus that has articular facets associated with it.
Sustentaculum tali
This is a deep groove of the calcaneus, which separates the articular facets of the bone.
Calcaneal sulcus
This is the only tarsal bone that articulates with the tibia and fibula to form the ankle joint. It articulates inferiorly with the calcaneus to form the subtalar joint and anteriorly with the navicular.
Talus
This condition is characterized by the development of a secondary ossification center for the lateral tubercle of the talus. It can be due to applied stresses to the bone at puberty or during trauma. It may be mistaken for a fracture on an x-ray.
Os Trigonum
This tarsal bone is boat shaped and is found on the medial side of the foot and articulates posteriorly with the talus, anteriorly with the 3 cuneiform bones and laterally with the cuboid.
Navicular
This tarsal bone is cuboidal shaped and is situated on the lateral border of the foot and articulates posteriorly with the calcaneus, anteriorly with the fifth metatarsal and medially with the lateral cuneiform and navicular.
Cuboid
These tarsal bones are wedge shaped. There are three of them named for their relative locations.
Cuneiforms (medial, intermediate, and lateral)
All the tarsal bones have a single center of ossification except which one?
The calcaneus has a second for the calcaneal tuberosity. The talus sometimes has a second one, but not always
A fracture of this bone usually occurs through the neck during severe dorsal flexion at the ankle. In some fractures the blood supply may become compromised and lead to avascular necrosis.
Talus
A fracture of this bone can result from a hard fall on the heel, can be comminuted, and are disabling due to disruption of the sutalar joint.
Calcaneus
These are the five long bones of the foot.
Metatarsals
This metatarsal is the largest, strongest, and plays an important role in supporting the body weight.
1st metatarsal
These are fine hairline fractures that appear without evidence of soft tissue damage.
Stress fractures
What are the two types of stress fractures?
- The bone is normal, but is overloaded as a result of a sudden increase in activity
- The bone is abnormal as a result of osteoporosis, drugs, or some other metabolic disorder (pathological fracture)
These are the bones of the digits of the foot and are similar in number and arrangement to those of the hand.
Phalanges
This is the term used to designate the deep and superficial fascia of the leg.
Crural fascia
This retinacula, which is derived from the crural fascia binds the tendons of the anterior leg muscles and prevents the tendons from bowstringing when the foot is dorsal flexed.
Superior and inferior extensor retinacula
This retinacula, which is derived from the crural fascia binds down the tendons of the lateral leg muscle.
Fibular retinacula
This retinacula, which is derived from the crural fascia binds down the tendons of the deep posterior leg muscles.
Flexor retinaculum
This is a thin, strong ligament which connects teh interosseous borders of the tibia and fibula.
Interosseous membrane
There is a large opening that is found in the upper portion of the interosseous membrane of the tibia and fibula, which permits what structure to enter the anterior compartment of the leg?
Anterior tibial artery
What are the functions of the interosseous membrane of the tibia and fibula?
- Serves as an attachment for the muscle
- Stabilizes the tibia and fibula
What movement are carried out by the foot at the ankle joint?
Plantar and dorsal flexion
What movements are carried out by the foot at the subtalar joint?
Eversion (pronation) and inversion (supination)
What are the arches of the foot?
Medial longitudinal, lateral longitudinal, and transverse
What muscles compose the anterior leg?
Tibialis anterior, extensor digitorum longus, fibularis tertius, extensor hallucis longus
The muscles of the anterior leg compartment are all supplied by what nerve?
Deep fibular nerve
What is the origin of the tibialis anterior?
- Shaft of the tibia
- Interosseous membrane
What is the insertion of the tibialis anterior?
- Medial cuneiform
- First metatarsal
What are the actions of the tibialis anterior?
- Dorsal flexion of the foot
- Inversion of the foot
- Supports the medial longitudinal arch
What is the origin of the extensor digitorum longus?
- Lateral condyle of the tibia
- Shaft of the fibula
What is the insertion of the extensor digitorum longus?
Distal phalanges of the digits 2-5
What are the actions of the extensor digitorum longus?
- Dorsal flexion of the foot
- Extension of digits 2-5
What is the origin of the fibularis tertius?
Shaft of the fibula
What is the insertion of the fibularis tertius?
Fifth metatarsal
What are the actions of the fibularis tertius?
- Dorsal flexion of the foot
- Eversion of the foot
What is the origin of the extensor hallucis longus?
- Shaft of the fibula
- Interosseous membrane
What is the insertion of the extensor hallucis longus?
Distal phalanx of digit one
What are the actions of extensor hallucis longus?
- Extends digit one
- Dorsal flexes the foot
This condition results from increased pressure within a myofacial compartment, resulting in ischemia and pain. It can be either acute or chronic.
Compartment Sydrome
This condition is often referred to as external compartment syndrome, typically occurs in runners or walkers with no history of trauma, and caused by sudden increases in intensity and duration of exercise, more time spent on hard surfaces, and shoes.
Chronic Compartment Syndrome