Final Exam Flashcards
Hip joint
This joint forms the connection between the lower extremity and the pelvis
Less; more
The hip joint is (more;less) moveable than the shoulder joint but is (more;less) stable
Inflammatory and degenerative diseases
What is the hip joint susceptible to?
The articulating surfaces of the hip joint
- ) the articulating surface of the acetabulum is horseshoe shaped and is deficient inferiorly at the acetabular notch
- ) the cavity of the acetabulum is deepened by the presence of the acetabular labrum, which increases the depth of the articulation by about 10%
- ) the part of the acetabular labrum which bridges the notch is known as the transverse acetabular ligament
Ball and socket
What is the hip joint classified as?
Capsular
The strong, fairly loose ______ _______ permits free movement at the joint but cannot maintain the integrity of the joint without reinforcing ligaments.
Iliofemoral
- A very strong ligament which reinforces the capsular ligament anteriorly and inferiorly
- strongest ligament in the body
Extrinsic
Rope
Nerve supply: femoral, obturator and sciatic nerves
Pubofemoral
- reinforces the capsule anterior and inferiorly
- attaches from the superior ramus of the pubis to the intertrochanteric line
- prevents abduction
- extrinsic
- rope
Ischiofemoral
- Reinforces the capsule posteriorly
- runs from the body of the ischium to the neck of the greater trochanter of the femur
- prevents hyperextension and abduction
- extrinsic
- rope
Transverse Acetabular ligament
- intrinsic
- formed by the acetabular labrum as its bridges the acetabular notch
- the ligament converts the notch into a tunnel, through which blood vessels and nerves enter the joint
Capitis Femoris Ligament (ligament of the head of the femur)
- weak intrinsic
- function mainly to conduct a blood vessel to the head of the femur
- it is of little importance in strengthening the joint
Movement of the hip joint
- when the leg is flexed at the knee joint, flexion at the hip joint is limited by the anterior surface of the thigh coming into contact with the anterior abdominal wall
- leg is extended at the knee joint, flexion at the hip is limited by the tendons of the hamstring muscles
Development Dysplasia (congenital dislocation)
Used to describe an ongoing process with is variable in its manifestations and not always detectable at brith. Hips can be found normal at brith and can be abnormal later in life
-more common if females
If not corrected this can occur:
- pain
- abnormal gait
- unequal leg length
- osteoarthritis
- twisting of the femur (femoral anteversion = knee turned medially)
- contracture of the hip muscle
Traumatic dislocations
This is rare because the articulation is so strong and stable however dislocation may occur during trauma
Posterior dislocation
This dislocation is the most common which allows the femoral head to pass through a tear in the capsular ligament and over the acetabulum, ending up on the ilium; These types of dislocations comprise the sciatic nerve
Anterior dislocation
This dislocation allows the head of the femur to end up in the obturator foramen; these types of dislocations may comprise the obturator nerve
- femur
- tibia
- patella
*NOT the FIBULA
What bones form the articulation of the knee joint?
Three separate joints that become the knee joint
- ) between the patella and femur
- ) between the lateral condyles of the femur and tibia
- ) between the medial condyles of the femur and tibia
Lateral and medial tibial plateaus
The articulating surfaces of the tibial condyles are often referred to as _______ _______.
Ginglymus (hinge)
What is the knee joint classified as?
- femoral nerve
- obturator nerve
- common fibular nerve
- tibial nerve
What is the nerve supply of the knee joint?
Capsular ligament
Forms a loose fibrous investment of the knee joint, completely surrounding it. There are a few openings found in the anterior aspect of the ______ ______, which allows the synovial membrane to pass through and form several bursae which are significant
Subcutaneous prepatellar
This bursae lies between the patella and the skin
Subcutaneous infrapatellear bursae
This bursae lies between the tibial tubercle and the skin
Deep infrapatellar bursae
This bursae is found between the ligamentum patella and the tibial tubercle
Suprapatellar bursae
This bursae lies between the femur and the common tendon of insertion of the quadriceps (base of the patella)
Ligamentum Patella
This is an anterior ligament of the knee joint and represents the original distal common tendon of insertion of the quadriceps
Runs from the apex of the patella to the tibial tubercle
Important role in maintaining the alignment of the patella
Extrinsic
Collateral ligaments
These ligaments (lateral and medial collateral) are taut when the knee joint is fully extended and thus contribute to stability when standing
Lateral (fibular) collateral ligament
Located on the lateral side of the knee joint
Attaches from the lateral epicondyle of the femur (proximally) to the head of the fibula (distally)
Function:
- wall
- extrinsic
- prevent lateral movement
Medial (tibial) collateral ligament
Located on the medial side of the knee joint
Attaches to the medial epicondyle of the femur (proximally) and to the medial side of the tibia just below the medial condyle (distally)
Function:
- wall
- extrinsic
- prevents medial movement
Oblique and accurate popliteal ligaments
Found on the posterior aspect of the knee joint
Function:
- wall
- extrinsic
- prevent hyperextension
- stabilize the posterior aspect of the joint
Cruciate ligaments (ACL, PCL)
2 Very strong ligaments which cross each other like and “X” in the center of the joint
They are named according to their tibial attachments
They are the main bonds between the femur and tibia*****
-intrinsic
Anterior cruciate ligament (ACL)
The weaker of the 2 and runs from the lateral condyle of the femur (proximally) to the anterior intercondylar area of the tibia (distally)
Function:
- prevents antihero displacement of the tibia under the femur
- rope
- intrinsic
Posterior Cruciate ligaments (PCL)
Stronger of the 2 and runs from the medial condyle of the femur (proximally) to the posterior intercondylar area of the tibia (distally)
Function:
- prevents posterior displacement of the tibia under the femur
- rope
- intrinsic
Menisci or semilunar cartilages
the ______ have a well developed blood supply from the time of birth until about 18 months of age. ONCE infant begins to walk they loose 75% of their vascular supply.
Nutrition of the _____ is from the synovial fluid for the central portion of the _____.
Functions:
- deepen the articulating surface
- shock absorber
- mechanoreceptor to increase positional sense of the knee joint
Medial meniscus
Is “C” shaped and firmly adheres to the tibial collateral ligament
It’s less mobile on the surface of the tibia
Lateral Meniscus
Nearly circular in shape and smaller than the medial meniscus
More freely moveable on the surface of the tibia
Coronary ligaments
Associated with the menisci
Are a portion of the joint capsular ligament which attaches to the edge of the menisci and helps to hold them in place
Transverse ligament
Joins the anterior edges fo the medial and lateral menisci and allows them to work together
Flexion and extension
What are the main movements of the knee joint?
Popliteus muscle
To unlock the knee the ______ ______ must contract to rotate the tibia medially and thus cause flexion at the knee joint
Prepatellar (housemaid’s) bursitis
Caused by friction between the skin and the patella
May also occur from a direct blow or falling on a flexed knee
If chronic, the bursae will become distended with fluid and form a swelling anterior to the knee
Subcutaneous infrapatellar bursitis
Caused by excessive friction between the skin and tibial tubercle
Also known as “clergyman’s knee”
Suprapatellar Bursitis
Caused by bacteria from an abrasion or penetrating wound
Infection may spread to the knee joint cavity
Ligament sprains
Very common especially when the foot is fixed on the ground
Unhappy triad
Refers to a blow to the lateral aspect of the joint while it is in weight bearing that can cause damage to the medial collateral (MCL), anterior cruciate (ACL), and medial meniscus
Damage to the medial collateral ligament (MCL)
Most commonly injured ligament of the knee joint
Occurs from a lateral blow and rotational forces during trauma
Damage to medial meniscus
More vulnerable to injury than the lateral meniscus
Patients will complain of their knee “clicking”, locking up, pain when going up stairs
Larger tears need surgery
Can lead to damage of the articular cartilage and osteoarthritis
Damage to anterior cruciate ligament (ACL)
Can be damaged in sports that require twisting and jumping
Patients will hear a “pop” and a sensation that their knee has “given out”
This type of injury will produce a condition in which the tibia can be pulled excessively forward under the femur (Positive anterior drawer test)
Damage to the posterior cruciate ligament (PCL)
Is injured much less commonly than the ACL
This type of injury, the tibia can be pulled or moved excessively backward under the femur (positive posterior drawer test)
Tibia
- weight bearing bone
- articulates with the condyles of the femur and head of the fibula (proximally
- articulates with the talus and distal end of the fibula (distally)
Fibula not part of the articulation with the knee joint
Ossification of the Tibia
4 ossification centers
Primary
-shaft
Secondary
- centers for the proximal end
- distal end
- tibial tuberosity/tubercle
Osgood-Schlatter’s Disease
A condition in which there is disruption of the epiphyseal plate of the tibial tuberosity that occurs around puberty in active adolescents
An example of what is known as apophyseal injury or a traction apophysitis
Bilateral
Avulsion fractures of the tubercle are common
Fibula
- not weight wearing bone
- articulation with the ankle joint and the proximal and distal tibiofibular joints
Ossification of the fibula
3 ossification centers
Primary
-shaft
Secondary
-distal and proximal ends of the bone
Fractures of the tibia and fibula
These fractures are common
These bones can act as a splint
Fractures of the medial and/or lateral malleoli can occur in contact sports
BOTH bones are good for bone grafting
Fracture of the tibia
Is the commonly fractured bone of the lower extremity because of its unprotected medial aspect of the bone
Bumper fracture = direct trauma
Poor blood supply
Fracture of the fibula
Usually fracture just proximal to the lateral malleolus or just distal to the head of the bone
Damage to the neck affects the common fibular nerve = paralysis of anterior and lateral leg musculature
- 7 tarsal bones
- 5 metatarsals
- 14 phalanges
What are the bones of the foot?
Calcaneus (heel)
Largest and strongest of the tarsals
Articulates with the talus and the cuboid
Calcaneus tuberosity
A large prominence on the calcaneus and allows among others for the insertion of the tendon calcaneus (Achilles tendon)
Fibular trochlear
Found on the lateral side of the calcaneus and separates the tendons of the fibularis longus and brevis from each other
Sustentaculum Tali
A prominent ledge of the medial aspect of the calcaneus that has articular facets associated with it
Calcaneal sulcus
A deep groove on the calcaneus which separates the articular facets of the bone
Talus (ankle)
The only tarsal bones that articulates with the tibia and fibula to form the ankle joint
Articulates inferiorly with the calcaneus to form the subtalar joint
Articulates anteriorly with the navicular
Os Trigonum
During ossification of the talus, under certain circumstances a secondary ossification center may develop for the lateral tubercle of the bone.
This occurs when the lateral tubercle WILL NOT fuse with the bone
Common in soccer players and ballet dancers
Asymptomatic
Navicular (Boat)
Found on the medial side of the foot
Projection on its medial side is the _______ tuberosity
Articulates posteriorly with the talus, anteriorly with the 3 cuneiform bones, and laterally with the cuboid
Cuboid
Is situated on the lateral border of the foot
Articulates posteriorly with the calcaneus; anteriorly with the 5th metatarsal;medially with the lateral cuneiform and navicular
Cuneiforms (wedge shaped)
3 small bones
Medial =largest
Second/intermediate =smallest
Third/lateral
Fracture of the talus
This fracture usually occurs through the neck during sever dorsal flexion at the ankle (car accident)
Avascular necrosis happens of the head of the bone
Fracture of the calcaneus
This fracture of the bone occurs from a hard fall on the tuberosity (heel)
Typically comminuted
disable or may disrupt the subtalar joint (talus and calcaneus)
1st metatarsal
What is the largest and strongest metatarsal?
2nd metatarsals
What is the longest metatarsal?
5th metatarsals
What metatarsal has a prominent tuberosity on its base which is the attachment of the fibularis brevis and Tertius muscles?
Crural fascia
The term used to designate the deep and superficial fascia of the leg
Superior and inferior extensor retinacula
This binds the tendons of the anterior leg muscles and prevent the tendons from bowstringing when the foot is dorsal flexed
Fibular Retinacula
Binds down the tendons of the lateral leg muscle
Flexor retinaculum
Binds down the tendons of the deep posterior leg muscles
Interosseous membrane
A strong ligament which connects the interosseous borders of the tibia and fibula
Anterior tibial artery to enter the anterior compartment of the leg
The large opening in the upper portion of the interosseous membrane permits what?
- ) serves as an attachment for muscles
2. ) Stabilizes the tibia and fibula
What are the 2 functions of the interosseous membrane?
Plantar flexion
Is carried out when the heel is raised off the ground and the dorsum of the foot is moved away from the anterior aspect of the leg
Dorsal flexion
Is carried out when the toes are raised off the ground and the dorsum of the foot and the anterior aspect of the leg are brought closer together
Version (pronation)
Carried out when the lateral aspect of the foot is elevated (plantar surfaces of the foot face laterally)
Inversion (supination)
Carrie donut when the medial aspect of the foot is elevated (plantar surfaces of both feet face each other)
Arches of the foot
- Medial longitudinal arch
- lateral longitudinal arch
- transverse arch (through metatarsals)
Deep fibular nerve
What is the nerve supply of the anterior leg compartment?
Extensor Hallucis Longus
What muscle is found eep to and in between the tibialis anterior and extensor digitorum longus
Common fibular nerve
This is the smallest of the 2 terminal branches of the sciatic nerve
L4, L5, S1, S2
What is the segmental innervation of the common fibular nerve?
- ) Sural communicating- joins the sural branch of the tibial nerve and helps supply skin on the posterior aspect of the leg
- ) Lateral Sural cutaneous- supplies skin on the proximal lateral posterior aspect of the leg
- ) articular to the knee joint
What are the branches of the common fibular nerve?
Common fibular nerve
What is the most commonly injured nerve of the lower extremity?
- all anterior and lateral leg muscles 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
What are the clinical problems that might occur with the common fibular nerve?
Deep fibular nerve
This is the nerve that is found in the anterior compartment of the leg and is the medial terminal branch of the common fibular nerve
L4, L5, S1
What is the segmental innervation of the Deep fibular nerve?
Anterior tibial artery
What does the deep fibular nerve descend with?
The nerve terminates at the front of the ankle into a medial and lateral branch found on the dorsum of the foot
Where does the dee fibular nerve terminate?
The web space between the 1st and 2nd digits
What is the cutaneous supply of the deep fibular nerve?
Ski boot syndrome
A condition that indicates compression of the deep fibular nerve as it leaves the anterior compartment and becomes superficial at the anterior aspect of the ankle
Motor
- loss of dorsal flexion of the foot and extension of toes
- diminished inversion of the foot
Sensory
-loss of sensation to skin in the web space between digits 1 and 2
Anterior tibial artery
Supplies structure of the antihero compartment of the leg. The vessel is the smaller branch of the popliteal artery
- begins at the lower portion of the popliteal fossa and passing thro an opening in the proximal portion of the interosseous membrane
- the artery descends along the anterior aspect of the interosseous membrane
- the vessel leaves the anterior compartment of the leg and as it become superficial and continues on the dorsum of the foot to become the dorsal pedis artery
What is the pathway of the anterior tibial pathway?
Dorsal pedis artery
This artery is a continuation of the anterior tibial artery in the dorsum of the foot?
Superficial fibular nerve
What is the nerve that supplies the lateral leg compartments?
Fibularis longus and fibularis brevis
What 2 muscles are well developed and can noted why we walk slightly more everted?
Superficial fibular nerve
This is the lateral terminal branch of the common fibular nerve
L4, L5, S1
What is the segmental innervation of the superficial fibular nerve?
The nerve descends along the lateral aspect of the leg between the fibularis longus and fibularis brevis and the extensor digitorum longus to the distal end of the leg
What is the pathway of the superficial fibular nerve?
The skin of the distal part of the anterior leg and the dorsum of the foot (except those areas supplied by the deep fibular and sural nerves)
What is the cutaneous supply of the superficial fibular nerve?
Anterior tibial artery and fibular branch of the posterior tibial artery
The lateral leg muscles receive their vascular supply from _____ _____ _____ and the _____ _____. The reason why it is because the lateral leg doesn’t have any blood vessels directly in the compartment.
The calf or triceps surae
The gastrocnemius + soleus = ___ _____
Gastrocnemius and soleus
What muscle tendons fuse together to form the prominent Achilles’ tendon or tendon calcaneus?
Tibial nerve
What are the posterior legs muscles (superficial and deep) supplied by?
Fabella
Is a seasmoid bone which is found imbedded in the lateral head of the origin of the gastrocnemius and articulates with the lateral condlye of the femur
Achilles Tendonitis
Due to microscopic tears in the collagen fibers of the tendons, usually just proximally to the attachment on the calcaneus. This is due to repetitive activities.
Flat feet are more prone to this condition due to the fact that their foot is more hypereverted
Rupture of the tendon calcaneus
Typically occurs in poorly conditioned individuals with a history of Achilles Tendonitis. Usually happens with forceful plantar flexion when the knee is extended.
Calcaneal tendon reflex
S1 and S2 is the segmental innervation for this test
Wearing high heeled shoes
An individual who wear high heeled shoes a lot may develop a shortening of the calf muscles
Plantaris
This muscle is missing in about 5% of the population and is part of the posterior leg muscles
Tibial nerve
Is the large and more medial of the 2 terminal branches of the sciatic nerve.
It crosses the popliteal fossa, superficial to the popliteal artery and vein
In the leg the nerve descends deep to the soleus and passes behind the medial malleolus between the tendons of the flexor digitorum and flexor hallucis longus
As the nerve enters the plantar surface of the foot it divides into the medial and lateral plantar nerves
What is the pathway of the tibial nerve?
L4, L5, S1, S2, S3
What is the segmental innervation of the tibial nerve?
No, because of its protected position int he popliteal fossa and posterior leg
Is the tibial nerve commonly injured?
Posterior dislocation
What type of dislocation of the knee joint causes damage to the tibial nerve?
- unable to flex toes
- weakened plantar flexion
- weakened inversion of the foot
There may be loss of sensation of the posterior aspect of the leg and plantar surface of the foot
If the tibial nerve is damaged what can occur?
Posterior tibial artery
The larger of the 2 terminal branches fo the popliteal artery. It provides the blood supply to the posterior leg compartments and the plantar surface of the foot
- the vessel descends deep to the soleus with tibial nerve and passes behind the medial malleolus
- as the vessel enters the plantar surface of the foot it divides into the medial and lateral plantar arteries
What is the pathway of the posterior tibial artery?
Fibular artery
Is the larges and most important branch of the posterior tibial artery, it descends along the fibula and supplies the muscles of the deep posterior and lateral leg compartment, as well as giving off a nutrient branch to the fibula.
Peripheral Arterial Disease (intermittent Claudication)
A condition in which there’s a narrowing or occlusion of the posterior tibial artery and/or its branches
