final revision Flashcards
bones of the knee
femur
tibia
fibula
patella/kneecap
longest bone that transmits weight to the legs
femur
largest sesamoid bone
patella
knee joints
tibiofemoral
patellofemoral
superior tibiofibular
meniscus
lateral meniscus
medial meniscus
why dislocation on knee joint is very rare.
because of support given by the meniscus
medial meniscus
crescent shaped and open faces laterally
lateral meniscus
oval and its opening faces medially
what type of structures are meniscus?
they are avascular structures.
about meniscus
innervated by nerves from capsular plexus but lack vein except for 1/3 of its outer part. so there is pain in meniscus but no intraarticular bleeding and no spontaneous healing observed.
tasks of meniscus
=smoothness and increases width
=stability of joints by increasing contact surface of tibia
=shock absorption
= prevent flexion that may occur during movement and provides lubrication
bursae
synovial sacs aimed at reducing friction between bones and tendons.
main ligaments of the knee
anterior cruciate ligaments
posterior cruciate ligaments
medial collateral ligaments
lateral collateral ligaments
patella ligament
the strongest ligament on the knee
patella ligament
about MCL and LCL
They are tense while knee is in extension as to ensure lateral stability and they are loose when in flexion
about PCL and ACL
prevent excessive rotation of the knee.
when they are loosen in flexion, forward displacement is prevented by ACL and rear displacement by PCL.
what percentage of stability does PCL provide towards the back?
90
which ligament prevent tibia from displacing forward under femur?
ACL
Knee biomechanics
flexion-extension
internal - external rotation as important movements
least important movements include compression-distraction and medial - lateral translation.
screw home mechanism
also known as auger shaped movement
is the rotation between tibia and femur, the mechanism serves as critical function of the knee and is key element to knee stability for standing upright.
valgite angle
171 btn anatomical axis of femur and tibia
muscles of knee and functions
rectus femoris = extends the knee/ pulls patella outwards + flex thigh
vastus medialis= prevent patella from sliding to the outer side
hamstrings/gracilis/sartorius +popliteus= flexors
which muscle or group of muscles participate in knee flexion and internal rotation as well as support knee against valgus stress
sartorius, gracillis and semitendinosus [goose’s foot/pes anserinus]
rotation at the knee
performed after 30-degree flexion around vertical axis passing middle of concave surface of medial condyle of tibia.
at 90-degree flexion
40 ext
30 internal
what is Q angle?
angle between line drawn from anterior superior iliac spine to the midpoint of patella and from patella to tibial tubercle.
genu varum and valgum
varum q angle below and valgum above
anteversion
internal rotation gait, to keep the head in acetabulum.
if excess Q angle increases, subtalar goes to excess pronation and increases lumbar lordosis.
retroversion
external rotation gait, Q angle decreases and supination increases. transverse axis of knee is parallel to hip.
gravity center of the body
2nd sacral vertebra
genu valgum
=narrow valgite angle
=congenital, metabolic diseases
=has effect on static conditions.
=if child put weight on medial tibial plateau hypertrophy occurs on medial tibial and atrophy on lateral part
=muscle shortness [TFL and v.lateralis
=as result of prolonged tension MCL will loosen and no adduction
=if one side shortness the person bends knee or bring it to valgus to compensate
=if not sever lateral force can correct it
genu varum
it leads to more serious biomechanical problems and severe pain in the knee.
evaluated at loading because stress is eliminated while resting and deformity will appear lighter.
genu recurvatum
=due to imbalance between muscles
=hyperextension up to 10-degrees is normal.
=increase angle of the pineal plaque of tibia
tibial torsion
inability to complete external torsion of tibia
knee bursitis
inflammation of bursae
examples
popliteal cyst
prepatellar bursitis
patella femoral pain
=characterized by erosions of articular cartilage to underlying bone.
=anterior knee pain that increases with activity
=often bilateral
=going down the stairs or hills pain occurs
=pain located in peripatellar and spreads to the medial and lateral retinaculums.
false locks
patella induced locks.
they disappear quickly.
osteochondritis dissecans
=process that begins with deterioration of the blood supply of the bone under the articular cartilage in certain part of any joint
which turns into dead bone [necrosis].
=it can end into degenerative arthritis.
=can occur in any joint but common in the knee joint.
=common in men
position pelvis is always at
oblique position
bones of pelvis
ilium
pubis
ischium
ligaments of pelvis
Sacro spinal ligament
Sacro tuberous ligament
pelvis movements [foot on the air]
=anterior n posterior tilt
=right left lateral tilt
=right to left tilt
pelvis movements [foot on the ground]
closed kinematics motion.
muscles for anterior tilt
hip flexors=iliopsoas rectus femoris
waist extensors=erector spinae
posterior tilt muscles
abdominal muscles=rectus abdominis
hip extensors=hamstrings and gluteus maximus
lateral tilt muscles
left and right quadratus lumborum
hip abductors
inclination angle
angle between femoral neck and femoral body in frontal plane
anteversion angle
angle between longitudinal axis of femoral neck and line connecting posterior femoral condyles in transverses plane.
kinematics relations between knee and hip
for max flex-ext = hip 5 abd
hamstring tension at 90 knee flex =hip flex limited at 90
lumbopelvic rhythm [LPR]
kinematics relationship between lumbar spine and hip joints in sagittal plane
opposite direction=grabbing with your hands something from up
same direction= pelvic tilt example when picking up a box from the ground
inclusion angle disorders
coxa Valga angle is greater than 125.
coxa Vara angle less than 125
coxa vara
congenital
acquired causes.
metabolic bone diseases
slippage of pineal plaque
normal anteversion angle decreases or takes -ve value
coxa valga
congenital causes
femoral inclination angle increases
anteversion angle increases
stress of shredding reduced
transverse plane deformities
anteversion=introverted walking
retroversion=extroverted walking
congenital hip dislocation
presence of femoral head outside acetabulum as a result of anomalies of the soft tissues around the joints
intrinsic balance of the spine
the tension stress of the ligaments ensures the tight connection of the vertebrae to each other and create continuity in the spine.
=intervertebral disc help maintaining intrinsic balance
=it is caused by combination of elastic tension resistance of the ligaments and elastic pressure resistance of the disc
ligaments of spine
anterior longitudinal ligaments= prevents hyperextension of the vertebral column
posterior longitudinal= prevents hyperflexion of the vertebral column
ligamentum flavum= maintain upright posture
supraspinous = flexion
spinal stability
=instability increases with degeneration
= vertebral column is capable of reacting to forces coming from different direction at same time.
=restructuring is tried to be achieved with fibrous tissue and/or osteophyte changes
segmental loads
axial compression
bending
torsion
shear
axial compression
=occurs as a result of reactions of ligaments to gravity, ground reaction forces, muscle contraction tensile forces.
=anterior segment can lift more loads. overflows are frequent posteriorly.
=compression in the disc causes tension in the annulus, angular changes in fibers and stability increases
bending
=combination of shear. compression and tension force
=during bending posterior annulus resist while anterior compressive force on the posterior longitudinal ligament, capsule and anterior segments cause displacement [protrusion] of the disc
torsion
formed by axial rotation and combination of several movements.
=stiffness may occur in some movements due to joint compression; flexion increases torsional hardness in L3-4
shear
force exerted by opposing force on the same point
=if there is wear on the disc, an injury occurs
flexion
tension force is on the posterior longitudinal ligament.
extension
nucleus pulposus moves anterior direction
lateral flexion
tension force on convex side, compression force on concave side
cervical spine
has foramen transversarium.
=C1-2 * rotation function+ flexion extension
=more spinal cord injuries on upper cervical because of narrow canal
=C1atlas-no real spinous process
=C2axis-has dens
=C7*has longest spinous process
=ligaments include internal and external craniocervical [connects atlas and axis] + vertebral ligament
ligamentum nuchae
provides an adhesion site for the muscles.
tectorial membrane
=located in the vertebral canal
=continuation of posterior longitudinal ligament
=covers ligaments and dens. acting as additional protector at junction site of medulla spinalis and medulla oblongata
joint where flexion- extension of the head take place.
atlanto-occipital joint
rotation of the head takes place at
atlanto-axial joint
muscles of anterolateral region
1]platysma=draws the skin around the lower part of mouth down or out
2]sternocleidomastoid= flexes the neck and extends head
3] hyoid muscle =swallowing and speech
4]scalene= elevates 1st rib
most mobile part of spine
cervical vertebrae
most basic element in cervical stability
transverse ligament
most common site of cancer metastases but least common for musculoskeletal system
thoracic region
most load bearing part of skeletal sytem
lumbar
sitting and standing
the loose and unsupported sitting position that puts the most strain on the waist.
in the loose standing position. lumbar lordosis should be normal
Whiplash injury
type of neck injury usually a hypertension but can also occur with sudden hyperflexion
cervical spondylosis
degeneration. Osteophyte formation and intervertebral disc disorder occurring in cervical
thoracic lumbar pathomechanics
inflammation
disc herniation
articular pathologies
thoracic outlet syndrome
structural pathologies
Scheuermann’s juvenile kyphosis
a growth age disease characterized by increase in dorsal kyphosis and an increase lumbar lordosis occurring in juvenile period.
ratio of carpal. Metacarpal and fingers
2;3;5 thus the hand is the forefront of mobile
bones of the hand
ulna
radius
carpals
metacarpal
phalanxes
movements that occurs more on he hands
=flexion-extension than radial-ulnar deviation
=extension is more limited than flexion
=radial deviation associated with flexion of the hand
=ulnar deviation associated with extension of the hand
flexor zones of the hand Zon V
=Zon V * containing musculotendinous compound on distal part of the arm
medial and ulnar artery injuries and nerve injuries can be seen
flexor zone 4
level of Carpal tunnel
the tendons have synovial sheaths
flexor zone 3
located at distal side of the carpal tunnel
contains synovial sheaths of FPL, flexor digitorum profundus and superficialis
flexor Zon 2
between beginning of digital synovial sheaths proximally and adhesion site of the FDS distally
fibroosseous tunnels called PULLEYS are found
flexor zon 1
extends from adhesion site of FDS to the proximal phalanx of FDP
extensor zones of hand
five zones for the thumb and eight for other fingers
extensor zon 8
level of forearm and at line of supinator muscles
extensor zon 7
at wrist level
do not have synovial sheaths thus easy to repair than flexor tendons
extensor zon 6
the extensor digitorum komunis tendon spread to the fingers on the back of the hand
zone 5 extensor
extensor tendons cross the sagittal bands between MCP joint heads.
if rupture tendon falls into intermetacarpal area during flexion
extensor plus phenomenon occurs here
extensor zon 4
it is the alignment of the proximal phalanxes
extensor zon 3
the central band. extensor of PIP joint passes PIP joint and adheres to the middle phalanx’s proximal part
extensor zone 2
middle phalanx and lateral bands are here
zone 1 extensors
the tendon attaches to the base of distal phalanx.
swan neck can be seen here.
functional position of the hand
wrist 15-30 extension, 10-12 ulnar deviation. thumb opposition and other fingers semiflexion.
neural position
not 180
12 extension and 3 ulnar deviation
ROM with angles
extension=50-80
flexion=60-85
add=30-45
abd=15-30
pronation=80-90
supination=80-90
muscles of the hand
extrinsic=take their origo from outside of the hand
intrinsic
functional ROM for DLA
flex=10
ext=25-30
radial=10
ulnar=15
capitulum humeri
has spherical surface as it goes from top to bottom it’s curvature increases and so it does not have fixed radius
medial collateral ligament of elbow
when elbow forced into valgus it is stretched and prevents the movement of ulna to the radial side
lateral collateral ligament of elbow
it is stretched when elbow forced into varus
annular ligament of elbow
hold the radial head in the sigmoid cavity
arthrokinematics movement
compression/distraction of ulna to humerus
osteokinematic movements
=radius head rotates in the annular ligament and in the capitulum of the humerus
=actual movement occurs when the elbow is in 90-degrees flexion
closed kinematics movements of elbow
open door handle
open a can
location of medial and lateral epicondyle
medial =posteriorly
lateral=anteriorly
brachialis and brachioradialis
elbow flexion activities
biceps brachii
=elbow flexion when forearm supinated
=flexes shoulder
elbow extensors
triceps brachii
anconeus
dynamic stability of elbow
=anconeus opposes varus stress
=antagonists co-contraction increases compression force and brings the joint closer
common injuries of elbow by direct stress
longitudinal compression stress fracture
distraction elbow
elbow backward dislocation
repetitive stress
lateral epicondylitis when forearm pronated
medial epicondylitis wehn supination is repeated
anatomical orientation of shoulder gridle
clavicula 20 behind frontal plane
scapula 35 ahead frontal plane
humerus 30 behind frontal /medial lateral axis
GH joint stability structures
[static structures]
bone
glenoid labrum
joint
ligaments
negative intraarticular pressure
dynamic=muscles
GH joint stability
=provided by rotator cuff muscles and fibrous capsule
*Static stability= provided by the position of the head of the humerus in the glenoid pit and there is -ve pressure
*Dynamic stability= by normal resting tone and functional strength of 4 muscles
subscapularis
medial rotation of the arm
adduction of the arm
supraspinatus
abduct the arm
infraspinatus
lateral/external rotation of the arm
teres minor
lateral rotation and adduction of humerus
deltoid
anterior = flexion
posterior=extension
lateral=abduction of the humerus
latissimus dorsi
extends. adducts and medially rotates humerus.
climbing muscle
pectoralis major
clavicular head=flexion
sternal head = adduction and medial rotation
scapulothoracic Joint
=physiological joint
*elevation=sternoclavicular elevation +acromioclavicular downward rotation
*Upward rotation= SC elevation + AC upward rotation
trapezius
superior=elevation of scapula
middle=retraction
inferior=depression
sternoclavicular joint and acromioclavicular joint
synovial
planar type
scapular rhythm 0-90 degrees abduction
60 from GH
30 from ST= 20-25 clavicular elevation
= 5 AC upward rotation
90-180 abduction scapular rhythm
60 GH
30 ST=5 clavicular elevation
= 25 AC upward rotation
scapulohumeral rhythm
abduction is created by synergistic coordination of ST combined with GH, AC and SC
2;1
front side shoulder pain
*Rotator cuff tendinopathy= simple strain
=tearless
=chronic calcific
=with tear
*Adhesive capsulitis=pain and limitation of movements
*Labral tear=deep pain cannot be localized. instability
*AC problems=can be localized. trauma. OA and AC separation
what causes pain that are not well localized?
usually caused by extrinsic problems
AC pain
pain can be well localized on the anterior face of the shoulder
shoulder instability
subluxation
loose shoulder
partial dislocation
may be as a result of rotator cuff tear
common in young women
