GA2 Exam 1 - USAHS Flashcards
- What Bones make up the Pelivs?
- What are the 3 articular surfaces?
- Ilium
Ischium
Pubis - Acetabulum
Auricular Surace
Symphyseal Surface
- What Bones Make up the Pelvic Girdle?
- What are the Functions of the Pelvic Girdle?
- Os Coxa (ilium , ishium, pubis) + Saccrum with coccyx
- Functions include:
-bearing weight of the upper body
-distribute forces from the lower body
-attatchment site for muscles of lower extremity needed for locomotion
-Protection of the pelvic viscera
-attatchment site for pelvic floor muscles
- What are the articulations associated with the pelvic girdle?
- Lumbosacral : a joint of axial skeleton
- Sacroiliac: Link between the appendicular and axial skeleton and is a synovial joint anteriorly, auricular surface of the ilium and auricular surface of the sacrum, has minimal movement
- Sacro-Coccygeal: where sacrum and coccyx meet
- Pubis Symphysis: Cartilagenous joint, medial surface of the pubic bones, seperated by inter-pubic disc
How many articulations create the lumbosacral joint?
- Intervertebral Joint between L5 and Sacrum
- 2 Zygopophyseal joints
What motions occur at the lumbosacral joints?
- Flexion
- Extension
- Lateral Flexion
- Rotation
What Ligaments Stabilize the sacroiliac joint and what are their functions?
- Anterior Sacral-iliac: Permits little sliding , tiliting and rotation , attach sacrum to ilium , helpssuspension of sacrum on ilium
- Posterior Sacral-Iliac :Permits little sliding , tiliting and rotation , attach sacrum to ilium , helpssuspension of sacrum on ilium
- Interosseous Sacral-Iliac:Permits little sliding , tiliting and rotation , attach sacrum to ilium , helpssuspension of sacrum on ilium
- Sacrotuberous ligament: Prevent excessive rotation of sacrum on the ilium
- Sacrospinous Ligament:Prevent excessive rotation of sacrum on the ilium
What are ligaments of the lumbosacral joints and what are their functions?
- Iliolumbar Ligament: mainly for stabilization , transverse process of L5(4) to the ilium
- Anterior Longitudinal Ligament : Limits excessive extension
What are the ligaments of the pubic symphysis and their function?
- Superior Pubic Ligament
- Inferior Pubic Ligament
These both join the right and left pelvis and acts like a strut to dissipate forces through the pelvic rim
What articulations make up the hip joint?
What is its classfication?
What motions occur at this joint?
- Acetabularfemoral Joint (coxafemoral joint) (acetabulum and femoral head)
- Synovial joint , ball + socket
- Flexion, extension, abduction, adduction, medail rotation, lateral rotation, circumduction
What are the ligaments of the hip and what are their functions?
- Iliofemoral: hyperextension and lateral rotation (both bands) abduction (inferior band) , adduction (superior band)
- Ischiofemoral: Hyperextension, flexion (posterior inferior capsule) , medial rotation
- Pubofemoral: Hyperextension , abduction , lateral rotation
A tear to the iliofemoral ligament will affect which part of the joint capsule?
- Anteriorly + Superior and Anterior + Lateral
What are the boarders of the gluteal region?
- Superior: iliac crest
- Medially: midline of the body, intergluteal cleft
- Laterally: posterior margin of the greater trochanter
- Inferiorlly : Gluteal Fold
- Anteriorly: innominate (body pelvis)
- Posteriorly: skin
Gluteal muscle functions during ambulation:
- Glute med/min stabilize the pelvis in a unilateral stance , important in advancement of the limb
- Fibers from the glue med/min may fall lateral or medial to axis of rotation / anterior fibers produce medial rotation of stance limb
- posterior fibers produce lateral rotation of the advancing limb
What are the abductors and medial rotators of the hip joint?
Gluteus Medius
Gluteus Minimis
TFL
What are the extensors of the hip joint?
Gluteus Maximus
Semitendinosus
Semimembranosus
Long head of Biceps femoris
Adductor magnus , hamstring part
What are the lateral rotators of the hip?
Obturator Externus
Piriformis
Obturator Internus
Gemelli (superior and inferior)
Quadratus Femoris
Gluteus Maximus
What are the adductors of the hip?
Pectineus
Adductor Longus
Adductor Brevis
Adductor Magnus
Obturator Externus
Gracillis
What are the flexors of the hip?
Iliopsoas (major, minor, iliacus)
Sartorius
TFL
Rectus Femoris
Pectineus
Adductor Longus
Adductor Brevis
Adductor magnus, adductor part
Gracillis
What are the bursae of the hip andwhat structures are they associated with?
- Trochanteric: between gluteus maximus and greater trochanter
- Gluteofemoral: gluteus maximus and the vastus lateralis
- Ischial: gluteus maximus and the ischial tuberosity
What nerve roots make up the sacral plexus?
What are the terminal Nerves?
- Lumbosacral trunk: L4 and L5 anterior rami
- Lumbosacral trunk unite with the anterior rami of S1-S4
- Sciatic
- superior and inferior gluteal
- nerve to piriformis
- nerve to quadratus femoris
- nerve to obturator internus
- pudendal
- nerve to levator ani and coccygeus
Superior Gluteal Nerve
Motor? Sensory?
- Superior Gluteal Nerve: L4-S1
- Motor : Glute medius, minimus , TFL
- Sensory: SI JT and Hip Joint
Inferior Gluteal Nerve?
Motor ? Sensory?
- Inferior Gluteal Nerve L5-S2
- Motor: Gluteus Maximus
- Sensory: None
Nerve to Quadratus Femoris?
Motor? Sensory?
- Nerve to Quadratus Femoris L4-S1
- Motor: Quadratus femoris , inferior gemellus
- Sensory: Hip Joint
Nerve to Obturator Internus?
Motor? Sensory?
Obturator Internus L5-S2
Motor: Obturator internus, superior gemellus
Sensory: None
Nerve to Piriformis?
Motor? Sensory?
Nerve to Pirformis S2-S3
Motor: Piriformis
Sensory: None
What are the clunial nerves and what do they supply?
- Superior Clunial Nerve = Posterior Rami L1-L3 , skin over the superior and central buttock
- Middle Clunial Nerve= Posterior Rami S1-S3, skin to the medial buttock and gluteal cleft
- Inferior Clunial = Anterior Rami S2-S3, supplies skin to inferior gluteal region, is a branch off of the posterior cutaneous nerve of the thigh
What is the pathway to get to the following from abdominal aorta?:
Superior Gluteal
Inferior Gluteal
Internal Pudendal
Obturator
- Superior Gluteal: abdominal aorta, common iliac, internal iliac, superior gluteal
- Inferior Gluteal : abdominal aorta, common iliac, internal iliac, inferior gluteal
- Internal Pudendal: abdominal aorta, common iliac, internal iliac , internal pudendal
- Obturator: abdominal aorta, common iliac, internal iliac, obturator
- What is angle of inclination and noramtive values
- What is torison angle and normative values for male / female?
- Angle of inclination is the cross section between head and neck of the femur and the shaft of the femur
the average angle is 126 degrees
angle ranges is 116-140 - Torsion angle is the intersection between the head and neck of the femur viewed superiorly and the transverse axis of femoral condyles
Men= 7 degrees
Women= 12 degrees
What are the noramtive values for :
* Coxa Vara
* Coxa Valga
- Coxa Vara: < 126
- Coxa Valga: >140
What are the boarders of the femoral triange?
What are the contents?
Boarders
* Superiorly: Inginual Ligament
* Medially: Adductor Longus
* Laterally: Sartorius
* Floor: Pectineus and Iliopsoas
* Inferiorly: Junction where sartorius and adductor longus intersect
Contents
* Femoral vein
* Femoral artery
* femoral nerve
- What nerve roots make up the lumbar plexus?
- What areas are innervated by the lumbar plexus?
- How are these nerves organized?
- Where are the divisons found?
- Ventral rami L1-L4
- structures of the abdominal walls, pelvic regions, and LE’s
- rami, divisons, and terminal nerves
- divisions are only found from L2-L4
Lateral Femoral Cutaneous Nerve:
What is its segement and what does it have sensory too?
(L2-L3) skin over the lateral thigh
Femoral Nerve (L2-L4)
* Motor?
* Sensory?
- Motor: Quadriceps , iliacus , pectineus , sartorius
- Sensory:
Anterior Cutaneous: skin over the anterior thigh
Saphenous: skin over the medial knee, leg, ankle
Obturator Nerve
What are the segments? Motor ? Sensory?
L2-L4
Motor: Adductor(s) , gracillis
Sensory: medial thigh
Adductor Canal
* What are the contents?
* Where is it found?
Contents:
* Femoral Nerve
* Femoral Artey
* Femoral Vein
* Saphenous Nerve
Found:
* Between the sartorius, adductor longus , and vastus medialis
Adductor Hiatus
* What are the contents?
* Where is it found?
Contents:
* Femoral Artery
* Femoral Vein
Found:
* opening in the adductor magnus
* permits structures to pass from anterior to posterior
Sciatic Nerve
Segements? Branches? Motor? Sensory ?
- Segements: L4-S3
- Branches: Tibial Nerve (L4-S3) and Common Fibualr (L4-S2)
- Motor through the tibial and common fibular:
Tibial: long head of biceps femoris, semitendinosus, semimembranosus, hamstring part of adductor magnus
Common Fibular: Short head of biceps femoris - Sensory: none
Which arteries supply the head and neck of the femur?
- Medial Circumflex femoral (posterior head and neck of femur)
- Acetabular branch of Obtruator Nerve (femoral head)
- Lateral Circumflex femoral the ascending and transverse branches (trochanters)
what are the three articulating surfaces of the knee?
- Medial Femorotibial Articulation
- Lateral Femorotibial Articulation
- Femoropatellar Acticulation
Describe the movement of the patella
Beyond 90 degrees patella tilts and the contact with the odd facet is made to the medial condyle of the femur
What are the available movements of the knee joint complex?
Flexion, Extension, Medial and lateral rotation
Which extensor of the knee also acts at the hip joint and what is its proximal attachment?
- Rectus Femoris
- AIIS
Which nerve(s) are involved in producing lateral rotation of the knee joint?
What is the distal attachment of the muscles that produce lateral rotation of the knee joint?
- Tibial Nerve: Biceps Femoris long head to the lateral condyle of the head of the fibula
- Common Fibular: Biceps Femoris short head to spliting at the site of the fibular collateral ligament of the knee
What Extra-articualr structures of the knee provide stability anteriorly?
- Quadriceps Tendon = tendon of the 4 quadricep muscles
- Patellar ligament = from the patella to the tibial tuberosity
What extra-articular structures provide stability to the anterolateral aspect of the knee?
- Lateral Patellofemoral Ligament: transverse band from patella to IT
- Lateral Patellotibial Ligament: Longitudinal band from patella to lateral tibia
- These are from the lateral patellar retinaculum : the expansion from the tendon of the vastus lateralis and iliotibial band to the patella
What extra-articular structure provides stability to the medial aspect of the knee?
- Medial (tibial) collateral Ligament : from the medial epicondyle of the femur to the medial tibial condyle and the upper medial tibial shaft
- Has an attachment at the medial meniscus
What extra-articular surfaces provide stability to the knee posteriorly?
- Oblique popliteal ligament: fibrous extension of semimembranosus tendon that runs along the posterior capsule from medial tibial condyle to lateral femoral condyle
- Arcuate Popliteal Ligament: Y shaped ligament with a medial and lateral band
-Medial band: from fibular head medially to join with oblique popliteal ligament
Lateral Band: from fibular head to posterior
What extra-articular structures provide stability to the anteromedial aspect of the knee?
- Medial Patellofemoral Ligament: transverse band from VMO tendon to patella
- Medial Patellotibial ligament: longitudinal band from patella to medial tibia
- These are from the medial patellar retinaculum : expansion from tendon of vastus medialis to patella
What extra-articular structure provides stability to the lateral side of the knee?
- Lateral (fibular) Collateral Ligament: from the lateral femoral epicondyle to the head of the fibula
- no attachment to the lateral meniscus
What intra-articular surfaces provide stability during flexion and extension of the knee
- Medial Meniscus: C shaped fibrocartilage plate runs along the medial condyle of the tibia AND attaches the MCL and the anterior and posterior tibial intercondylar areas
- Lateral Meniscus : Semi-circular fibrocartilage plate , runs along the lateral condyle of the tibia AND attaches anterior and posterior horns
The Menisci attatch to the tibia via what intra-articular ligaments?
- Coronary Ligaments: attach the menisci to the periphery of the tibial condyles
- Transverse genicular ligament: tethers the menisci together
- Posterior meniscofemoral ligament: attached the lateral meniscus to the PCL and medial femoral condyle
What intra-articular structure limits anterior translation of the tibia?
- Anterior Cruciate Ligament:
-Distally:posterior to the anterior horn of the medial meniscus in the anterior intercondylar fossa of the tibia
-Proximally: intercondylar fossa side of the lateral femoral condlye
What intra-articular structure limits Posterior translation of the tibia?
- Posterior Cruciate Ligament
-Distally: posterior to the posterior horn of the medial meniscus in the posterior intercondylar fossa of the tibia
-Proximally: intercondylar fossa side of the medial femoral condyle
Cutaneous Innervation of the knee from :
Antero-Lateral : anterior cutaneous branches of femoral nerve
Medial: cutaneous branches of Spahenous n.
Posterior: Posterior cutaneous N. of thigh
Which type of nerve fiber innervates the knee joint capsule?
Afferent-Sensory
What are the boundaries of the popliteal fossa? (Diamond Shaped)
- Superior Lateral: Biceps Femoral
- Superior Medial: Semitendinosus + Semimembranosus
- Inferior Lateral: Lateral head of the gastrocnemius , Plantaris
- Inferior Medial: Medial head of gastrocnemius
What are the contents of the popliteal fossa?
2 Nerves
1 Artery
1 Vein
5 Muscles
- 2 Nerves: Common Fibular and Tibial
- 1 Artery: Popliteal A.
- 1 Vein: Popliteal Vein.
- 5 Muscles: Popliteus, Biceps femoris tendon, semitendinosus tendon, semimembranosus tendon, med/lat head of the gastrocnemius
What contributes to the unlocking of the knee joint?
Unlocking of the knee joint happens in the early stages of flexion.
* Leg is medially rotated and thigh is laterally rotated
* Action of the popliteus muscle at 5 degrees (help from semimembranosus, semitendinosus, gracilis muscles)
What are the effects of Valgus and Varus on the Patellofemoral Joint ?
- Patella tracking with Genu Valgus = laterally
- Patella tracking with Genu Varum = medially
What is the Unhappy Triade?
- Anterior Cruciate Ligament
- Medial Meniscus
- Medial Collateral Ligament
What Knee structures attach at the head of the fibula?
- Biceps Femoris tendon
- Lateral ( Fibular )collateral ligament
What is a syndesmosis injury?
It is a high ankle sprain
Superior and Inferior Extensor Retinaculum
- What muscles pass deep to the retinacula?
-Tibialis Anterior , extensor digitorum longus , extensor hallucis longus , fibularis tertius - What vessels/nerves will pass deep to the retinaculum
-anterior tibial artery, anterior tibial vein, deep fibular nerve
What does an injury to the dep fibular nerve present as?
- Foot Drop , can be caused by an injury to the common fibular nerve since it is extremly vulnerable to injury since it goes around the neck of the fibula.
Your pateint has a lesion to the superficial fibular nerve , what areas would you expect to find sensosry deficits?
- Skin of the anterolateral leg and the dorsum of the foot
- Besides webspaces between the great and 2nd toe
What motion would you resist to test innervation of the superficial fibular nerve?
- Resist the motion for foot eversion and weak platarflexion
- Superficial Fibular nerve is comprised of muscles fibularis longus and fibularis brevis , responsibe for foot eversion and weak plantarfelexion
Tom , Dick , and , nervous , harry
- Tibialis Posterior tendon
- Flexor Digitorum Longus tendon
- posterior tibial artery and vein + tibial nerve
- Flexor Hallucis Longus Tendon
this is from the angle posterior medial malleolus to posterior medial calcaneous
What makes up the Arches of the foot?
- Medial Longitudinal : calcaneous , talus, navicular, cuneiforms, and 3 metatarsals
- Lateral Longitudinal : calcaneous , cuboid , and 2 lateral metatarsals
- Transverse : cuboid, cuneiforms, and bases of metatarsals
What are the structues that support the arch?
Passive?
Dynamic?
- PASSIVE
- Plantar Aponeurosis
- Long Plantar Ligament
- Short Plantar Ligament
- Spring Ligament
- DYNAMIC
- medial longitudinal arch is the main weight bearing arch
- TA, TP, support the medial longitudinal arch
- FHL , FDL, support the longitudinal arch
- Fibularis longus and tibialis posterior –> Transverse arch
What is an aquired flat foot deformity?
What Static and dynamic structures have the greatest impact on the arch of the foot?
- Pes planus , fallen arch 2 degrees tendon dysfunction or ligamentous laxity
- Posterior and anterior tibialis tendon, plantar calcaneonavicular (spring) ligament
What arteries supply the ankle joint?
- Fibular A.: Posterior lateral malleolar
- Anterior Tibial A. : Anterior Lateral malleolar and Anterior medial malleolar
- Posterior Tibial : Posterior medial malleolar
- Which cutaneous nerves supply the dorsum of the foot?
- Which cutaneous nerves supply the sole of the foot?
- Dorsum =
1) Sural Nerve (skin of postereolateral leg and lateral margin of foot)
2) Superficial Fibular nerve ( skin of the antereolateral leg and dorsum of the foot , excluding webspaces between great and 2nd toe)
3) Deep fibular nerve ( skin of webspaces between great and 2nd toe) - Sole =
1) Calcaneal branch of Tibial nerve ( skin of the heel)
2) Lateral Plantar nerve (skin of the lateral sole , and plantar aspect sides and nail beds of lateral 1 1/2 toes)
3) Medial Plantar Nerve (skin of medial side of sole and plantar aspect, sides of nail beds of medial 3 1/2 toes)
Which spinal segments supply the ankle and the foot?
L3: medial knee and posterior midline of upper leg
L4 : medial leg and ankle
L5 : lateral upper leg and central dorsum of foot and middle of plantar foot , 1-4
S1 : lateral ankle and lateral plantar foot 5th toe , lateral posterior leg
S2: medial bottom of the plantar foot on calcaneous and middle posterior leg
What function does the superficial fibular nerve have on the foot?
Sensory to the dorsum of the foot
What is the sensory innervation of :
1. Medial Dorsal Cutaneous Branch of Superficial Fibular N. ?
2. Lateral Dorsal Cutaneous Branch of Superficial Fibular N. ?
- Medial Dorsal Cutaneous Branch of Superficial Fibular N : medial dorsum of the foot , toes 1-3
- Intermediate Dorsal Cutaneous Branch of Superficial Fibular N: Toes 3-5 and medial side of 5th
What area does the deep fibular nerve supply sensation to the foot?
Webspaces 1-2
Which nerve provides motor innervation to muscles of the dorum of the foot ?
Deep Fibular Nerve
Which nerve innervates the extensor digitorum longus?
Deep Fibular
What nerve innervates the extensor digitorum brevis?
Deep Fibular
An inability to flex the distal IP joints of the lateral 4 toes may be casued to a lesion where?
Tibial nerve : Flexor digitorum longus
Which nerve innervates the flexor digitorum brevis?
Medial Plantar Nerve.
An inability to abduct the small toe may be caused by a lesion to where?
Lateral Plantar Nerve
What are the functions and requirments of the foot?
must be both ridgid and mobile
-rigid for propulsion during walking, jogging, and jumping
-mobile for accomodate uneven terrain , absorb shock, and control proximal forces
What articulation makes up the ankle joint?
How is it classified?
- Articulation is made up of distal tibia and fibula and talus (dome)
- (tibiotalar joint)
- synovial hinge joint , mortise
- What motions occur at the talocrual joint?
- Which muscle is a primary DF of the ankle?
- Which muscles Assist in DF?
- Dorsiflexion and Plantarflexion
- Tibialis Anterior
- Extensor hallucis longus, extensor digitorum longus , fibularis tertius
- Which muscles are primary PF of the ankle?
- Which muscles assist in PF?
- Gastrocnemius and Soleus
- Plantaris, tibialis posterior, flexor digitorum longus , flexor hallucis longus
What articulations make up the Subtalar joint?
- Calcaneous (sustentaculum tali of calcaneous) and talus , inferiorly
- Also called talar-calcaneal joint
- plane synovial joint
- motions that occur here are eversion and inversion
Which muscles invert the subtalar joint ?
- Tibialis Anterior
- Tibialis Posterior
Which muscles evert the subtalar joint?
- Fibularis Longus
- Fibularis Brevis
- Fibularis Tertius
Transverse Tarsal Joint
comprised of 2 joints
-called talonavicular joint (head of the talus and the nevicular and cuboid)
-this is a ball and socket joint
-calcaneocuboid joint (cuboid articulates of the calcaneous and the cuboid) a plane synovial joint
What motions occur at the tarsometatarsal joints?
limited gliding and sliding
What motions occur at the MTP joints?
flexion, extension and some abduction , adduction and circumduction
What are the attachments of the
1. Anterior Talofibular Ligament?
2. Calcaneofibular Ligament?
3. Posterior Talofibular Ligament?
4. Tibionavicular?
- Anterior Talofibular Ligament: inferior medial fibula to neck of talus
- Calcaneofibular Ligament: lateral malleolus to lateral calcaneus
- Posterior Talofibular Ligament: post/medial malleolus to lateral tubercle of the talus
- Tibionavicular: from tibia to navicular bone
- Tibiocalcaneal : to sustentaculum tali
Which ligaments support the arches of the foot?
Foot
Long Plantar Ligament
Short Plantar Ligament
Spring Ligament
Ankle
lateral ligaments of the ankle and the deltoid ligament
A high grade ankle sprain of the interosseous (crual) fibular ligament would resist excessive motion at which joint?
Distal Tibiofibular Joint
Which muscle flexes the IP of the 1st digit ?
Flexor hallucis longus
Which muscle of the leg extends the IP’s 2-5
Extensor Digitorum Longus
What are the layers of the foot and what is in each layer?
- Layer 1: Abductor Hallucis , flexor digitorum brevis, abductor digitminimi
- Layer 2: Quadrate Plantae and lumbricals
- Layer 3: Flexor Hallucis Brevis , adductor hallucis , flexor digitiminimi brevis
- Layer 4: Plantar Interossei , Dorsal Interossei
Which muscles are on the Dorsum of the foot?
Extensor Digitorum Brevis
Extensor Hallucis Brevis
Which muscles produce MTP or IP Flexion?
- Flexor Digitorum Brevis
- Flexor Hallucis Brevis
- Interossei
Which muscles abduct the MTP’s?
- Abductor Hallucis
- Abductor Digitiminimi
- Dorsal Interossei
Which muscles exend the MTP’s or IP’s
- Extensor Hallucis Longus
- Extensor Digitorum Longus
- Extensor Digitorum Brevis
Which muscles adduct the MTP’s
- Adductor Hallucis
- Plantar interossei