Final Exam Flashcards
Hip Joint- Articulation/Nerve Supply
Head of femur with acetabulum of pelvis -Femoral, Obturator, Sciatic nerves
Hip Joint- Ligaments
-Transverse Acetabular, Iliofemoral, Pubofemoral, Ischiofemoral, Capitis Femoris
Transverse Acetabular Ligament
-Intrinsic -Converts acetabular notch into acetabular tunnel
Iliofemoral Ligament
- Anterior inferior iliac spine to intertrochanteric line -Allows upright standing -When bending backward, anterior hip and abdominal muscles assist -When bending forward, gluteal, hamstring, and spinal muscles assist
- Extrinsic rope
Pubofemoral Ligament
- Superior ramus of pubis to intertrochanteric line -Reinforces capsule -Prevents abduction
- Extrinsic rope
Ischiofemoral Ligament
- Body of ischium to neck and greater trochanter of femur -Reinforces the capsule -Prevents hyperextension and abduction
- Extrinsic rope
Capitis Femors Ligament
- Conduct blood vessels to head of femur
- Weak intrinsic
Hip Joint- Clinical List
Developmental Dysplasia (congenital dislocation) -Acqured/traumatic dislocation
Developmental Dysplasia- Details
- Hip joints are found to be normal at birth can be abnormal later. Majority of children with the condition have ligamentous laxity. Majority of infants were in breech position
- Symptoms-Pain, abnormal gait, unequal leg length, osteoarthritis, twisting of femur (femoral anteversion), contracture of hip muscles
Acquired/ Traumatic Dislocation- Details
- Posterior dislocation most common, head of femur results on the ilium-tear capsular ligament, may compromise sciatic nerve
- Anterior dislocation, head of femur results in obturator foramen, may compromise obturator nerve
Knee Joint-Articulation/Nerve Supply
Femur, Tibia, Patella -3 Separate joints become continuous to form the joint cavity (patella/femur, lateral condyles of femur/tibia, medial condyles of femur/tibia) -Articulating surfaces of tibial condyles called lateral and medial tibial plateaus
-Femoral, Obturator, Common fibular, tibial nerves
Knee Joint- Ligaments
-Capsular (Extrinsic): Ligamentum Patella, Lateral (fibular) collateral, Medial (tibial) collateral, Oblique and arcuate popliteal
Intrinsic: Anterior Cruciate, Posterior Cruciate, Medial Meniscus, Lateral Meniscus, Coronary Ligaments, Transverse Ligament of the Knee
Capsular Ligament- Details
-Several openings for bursase (subcutaneous prepatellar, subcutaneous infrapatellar, deep infrapatellar, suprapatellar)
Ligamentum Patella- Details
-Apex of patella to tibial tubercle -Maintains alignment of patella relative to articular surface of femur
Lateral (fibular) Collateral Ligament- Details
-Lateral epicondyle of femur to head of fibula -Extrinsic wall -Prevents lateral movement (abduction)
Medial (tibial) Collateral Ligament- Details
-Medial epicondyle of femur to medial side of the tibia, just inferior to medial condyle -Extrinsic wall -Prevents medial movement (adduction)
Oblique and Arcuate Popliteal Ligaments- Details
-Posterior aspect of joint - Extrinsic walls -Prevent hyperextension
Anterior Cruciate Ligament- Details
Weaker of the two cruciate ligaments -lateral condyle of femur to anterior intercondylar area of tibia -Intrinsic rope -prevent anterior displacement of tibia
Posterior Cruciate Ligament- Details
-Stronger of cruciate ligaments -Medial condyle of femur to intercondylar area of tibia -Intrinsic rope -Prevents posterior displacement of femur
Menisci/Semilunar Cartilages- Details
-Good blood supply from birth to 18 months -vascular supply diminishes with age -Nutrition supplied by synovial fluid
Menisci/Semilunar Cartilages- Functions
-Deepen articulating surfac, shock absorber, mechanoreceptor (type of proprioceptor) to increase positional sense of knee joint
Medial Meniscus- Details
-“C” shaped and firmly attached to tibial collateral ligament -Less mobile on the surface of tibia
Lateral Meniscus- Details
-Nearly circular in shape and smaller than medial meniscus -More freely movable on the surface of tibia
Coronary Ligaments- Details
-Associated with menisci -Portion of the joint capsular ligament which attaches to the edge of the menisci and helps to hold them in place
Transverse Ligament of the Knee- Details
Joins the anterior edges of the medial and lateral menisci and allows them to work together
Movements of Knee Joint- Clinical Notes
Knees “lock” to provide better stability when standing. Popliteus muscle must unlock the knee by rotating the tibia medially to allow flexion
Knee Bursitis- List
- Prepatellar (Housemaid’s) Bursitis
- Subcutaneous Infrapatellar Bursitis
- Suprapatellar Bursitis
Prepatellar (Housemaid’s) Bursitis- Details
Caused by friction between skin and patella
Subcutaneous Infrapatellar Bursitis- Details
Caused by friction between skin and tibial tubercle
Suprapatellar Bursitis- Details
- Caused by bacteria from an abrasion or penetrating wound
- Due to bursa being continuous with synovial sheath, infection may spread to joint
Ligament Sprains-Details
-Very common -Unhappy Triad-Blow to the lateral aspect of the joint while it is in weight bearing that can cause damage to the medial collateral, anterior cruciate and medial meniscus
Damage to Medial Collateral Ligament- Details
-Most commonly injured ligament in joint -Can occur to lateral blow or rotational forces
Damage to Medial Meniscus- Details
-More vulnerable to injury than lateral meniscus -Symptoms- “Clicking,” locking up, pain while ascending stairs -Osteoarthritis results from menisci damage and removal
Damage to Anterior Cruciate Ligament- Details
-Damaged in sports with twisting/jumping -Sign as injury occurs, pop and knee “gives out” -Results in positive anterior drawer test (tibia can be pulled excessively forward)
Damage to Posterior Cruciate Ligament- Details
-Less commonly injured than anterior cruciate -Results in positive posterior drawer test (tibia can be pulled excessively backward)
Knee Replacements- Details
- Replace diseased portions of femur/tibia
- Criteria-Pain can’t be controlled or physically disabled
- Lifespan about 15-20 years
Tibia-Articulation
- Proximal- Condyle of femur and head of fibula
- Distal- Talus and distal end of fibula
Tibia- Ossification
-1 primary -3 secondary
Osgood-Schlatter’s Disease
-Apophyseal injury (traction apophysitis) -Disruption of epiphyseal plate of tibial tuberosity due to running/jumping sports
Fibula-Articulation
Tibia and Talus
Fibula Ossification
1 primary, 2 secondary
Fractures of Tibia- Details
-Bumper fracture -Often damaged along medial aspect -Relatively poor blood supply leads to long recovery
Fracture of Fibula- Details
-Usually fractures proximal to lateral malleolus -May lead to common fibular nerve damage
Calcaneus- Articulation
- Superior-Talus
- Anterior-Cuboid
Calcaneal Tuberosity
Fibular Trochlea
Sustentaculum Tali
Calcaneal Sulcus
Talus-Articulation
-Superior-Tibia and Fibula -Inferior- Calcaneus -Anterior-Navicular
Subtalar Joint
Talus and Calcaneus
Talus- Head, Neck and Body
Os Trigonum
Secondary ossification of talus of lateral tubercle -Common in teenage soccer players/ballet dancers
Navicular Tuberosity
Cuboid
.
Cuneiform Bones
Ossification of Tarsal Bones- Order
Calcaneus (only tarsal bone with secondary center), Talus, Cuboid, 1st cuneiform, 2nd cuneiform, 3rd cuneiform, Navicular
Fracture of Talus
-Occur in neck during severe dorsifexion -Blood supply may be compromised (avascular necrosis) of head of talus
Fracture of Calcaneus
-Occur from hard fall on tuberosity -May disrupt subtalar joint
Stress Fracture-Details
- Hairline fractures appear without soft tissue damage
- Commonly found on; shaft of tibia, metatarsal 2-4, navicular bone -2 types; Sudden increase in level of activity, and pathological (result of osteoporosis, drugs, etc)
Fascia of the Leg (Crural Fascia)
- Superior and inferior extensor retinacula (Anterior)
- Fibular retinaculum (Lateral)
- Flexor retinaculum (posterior)
Interosseous Membrane- Functions
-Serves as an attachment for muscles -Stabilizes the tibia and fibula
Medial Longitudinal Arch
Lateral longitudinal Arch
Transverse Arch
Tibialis Anterior- Origins
-Shaft of tibia -Interosseous membrane
Tibialis Anterior- Insertions
-Medial cuneiform -First Metatarsal
Tibialis Anterior- Actions
-Dorsiflex foot -Inversion of foot -Supports the medial longitudinal arch
Tibialis Anterior- Nerve Supply
Deep Fibular
Extensor Digitorum Longus- Origins
-Lateral condyle of tibia -Shaft of tibia -Interosseous Membrane
Extensor Digitorum Longus- Insertion
Distal phalanges 2-5
Extensor Digitorum Longus- Actions
-Dorsiflex foot -Extension of digits 2-5
Extensor Digitorum Longus- Nerve Supply
Deep Fibular
Fibularis Tertius- Origin
Shaft of fibula
Fibularis Tertius- Insertion
5th metatarsal
Fibularis Tertius- Actions
-Dorsiflex foot -Eversion of foot
Fibularis Tertius- Nerve Supply
Deep Fibular
Extensor Hallucis Longus- Origins
-Shaft of fibula -Interosseous membrane
Extensor Hallucis Longus- Insertion
Distal phalanx 1
Extensor Hallucis Longus- Actions
-Extend digit 1 -Dorsiflex foot
Extensor Hallucis Longus- Nerve Supply
Deep Fibular
External Compartment Syndrome (ECS)
-Increased pressure within myofascial compartment leads to ischemia -Ant/deep post muscles swell and are painful/tender -Causes-Sudden increases in intensity and duration of exercise, more time spent on hard surfaces, shoes
Shin Splints
-Pain along medial aspect of tibia -AKA medial tibial stress syndrome MTSS
Common Fibular Nerve- Details
-Fibers from L4-S2 -Divides to superficial and deep fibular nerve -branches- Sural communicating (joins sural branch of tibial), Lateral sural cutaneous, articular -Most commonly injured nerve in lower extremity
Common Fibular Nerve-Common causes of Injuries
-Plaster casts -Fractures at proximal end of fibula -Prolonged kneeling/squatting -Prolonged kneeling with cross legs -Stretched when knee joint is injured
Result of Injury to Common Fibular Nerve
-All anterior and lateral leg muscle may be involved -Loss of dorsal flexion of the foot causing foot drop -Loss of eversion of the foot -Loss of extension of the toes -Diminished foot inversion -Loss of sensation over the dorsum of the foot and lateral aspect of the leg
Deep Fibular Nerve- Details
-Fibers from L4-S1 -Terminates via medial and lateral branch -Branches-Muscular-ant compartment of leg and dorsum of foot, articular-inferior tibiofibular/ankle joint, cutaneous-skin at the webspace between 1st/2nd digits
Deep Fibular Nerve- Clinical Notes
Ski Boot Syndrome- motor –Loss of dorsiflexion of foot and extension of toes, diminished inversion of foot Sensory- Loss of sensation to skin in the webspace between digits one and two
Anterior Tibial Artery
-Terminal branch of popliteal artery -Passes through interosseous membrane -Becomes dorsal pedis artery