GL 22 and GL 23: The Hip and Knee Joints Flashcards
What type of joint is the hip joint?
A synovial joint—designed for stability and weight bearing
What are the articulations of the hip joint?
head of the femur and acetabulum of the pelvic bone
What are the ligamentous support of the hip joint?
Iliofemoral—strongest ligament in the body
Ischiofemoral
Pubofemoral
How are the ligaments arranged in the hip joint?
In a spiral fashion— to stabilize the joint, reduce muscular energy needed, limits flexion and adduction
What is the ligament of the head of the femur?
Ligament of teres
What does the ligament of teres caries?
A small branch of the obturator artery—which continues blood supply to head of the femur
What is the vascular supply of the hip joint?
small branch of the obturator, medial and lateral circumflex femoral arteries
What is the innervation of the the hip joint?
Articular branches of: femoral, obturator, superior gluteal and the nerve to the quadratus femoris
What is the safe and unsafe areas for the gluteal intramuscular injection?
Safe: Outer Upper Quadrant
Unsafe: Lower medial quadrant—sciatic nerve runs through here
Upper medial—-superior gluteal nerve runs through here.
What are the normal characteristics of gait and anatomical structures structures influencing normal?
60 % stance
40 % swing
Smooth gait:pelvic tilt, pelvic rotation, moving knees toward the midline, flexion of knees, interaction b/w hip and knee acts to minimize fluctuations in the change of center of gravity to maintain locomotion and produce smooth efficient gait
What are the characteristics of an abnormal gait, specifically antalgic gait?
A gait developed when you’re trying to avoid pain in the area
i. stride length is shortened
ii. cane in opposite hand
iii. opposite side of pelvis rises
What are the characteristics of an abnormal gait, specifically trendelenburg gait?
associated with a positive Trendelenburg sign
i. gluteus medius and gluteus minimus are impacted (weak/paralyzed abductor muscles)
ii. superior gluteal nerve is affected
iii. dropped hip over the swing limb (unaffected limb will droop)
iv. patient will exhibit trunk lean to the affected side (opposite of droop side)
What can cause abnormal gait?
fracture of the greater trochanter
lumbar spinal pathology (bulging disk impinging on nerves)
What are the clinical implications of the hip with the change in age?
Early in the development, the epiphyseas and the metaphyseas have different blood supplies.
Infants and Children (until 8 y/o): head of femur gets arterial supply by a direct branch of the obturator artery
As you get older, fractures become more damage b/c /you have less collateral blood supply so you’re more likely to have avascular necrosis
What are the structures at risk from a fracture of the femoral neck or dislocation of the hip and explain the functional consequences of these injuries.
Damage to Femoral Neck:
will affect the femoral head b/c the neck supplies the arterial supply for the head. This could lead to avascular necrosis
Medial femoral circumflex artery is the one that is most likely to get damaged
Hip Dislocation
Posterior: hip is flexed, internally rotated, and adducted
Hip dislocation can affect ligaments supporting the hip
Differentiate between a Trendelenburg sign and a Trendelenburg test.
Trendelenburg Sign: Pelvis drops when lifting the leg opposite to the weak gluteus muscles (Test would be asking the patient to demonstrate that)
Explain the functional significance of anastomosis between branches of the major arteries of the knee.
- ) Deep femoral artery—> lateral and deep circumflex femoral arteries
- ) Femoral artery–>descending genicular artery and perforating branches of perforating arteries
- ) Popliteal artery–> Superior and inferior medial and lateral arteries
All anastomose at the knee
What factors are responsible for maintaining stability of the knee?
static —immovable (patella and tibia)
dynamic—movable (ligaments)
Popliteal Muscle (stabilizes knee in flexion and extension; unlocking mechanism–lateral rotation of femur on tibia)
Horns of the Meniscus ---- Posterior Horn (keeps knee from dislocating; most common place for meniscus tear)
What are the ligaments of the knee?
Collateral Ligaments (medial, lateral)— reinforce synovial joint
Cruciate Ligaments (anterior, posterior) –connects femur to tibia
Patellar Ligament: (continuation of the quadriceps femoral tendon) —-Stabilizes the patella
Attaches to the tibial tuberosity
What is Oschgod Slotter’s disease ?
Inflammation of the patellar ligament that leads to pain in adolescents
Which side of the menisci helps w/ congruency (freely movable, not attached to a ligament) ? Lateral or medial?
Lateral menisci
Which side of menisci is attached to the MCL, more constrained so it’s easily damaged? Lateral or medial?
Medial
What are the two zones of the meniscus?
Red zone: has vasculature
White Zone: has no vasculature stimulation
What is the clinical correlations of the zones in the meniscus?
If there is a tear in the white zone, it is more difficult to heal because the is no vascular stimulation
What is the unhappy triad and what test confirms that this occurs?
A tear in the ACL, MCL and meniscus
Anterior Drawer Test
What is the fibrous membrane of the knee?
It is formed and reinforced by extensions from tendons of the surrounding muscle
What is the anatomy and function of the anterior and posterior cruciate ligaments?
ACL: anteriorly, prevents anterior tibia dislocation; Also has proprioceptors for spatial relations——Issues w/ this would make it hard to orient yourself during walking
PCL: posteriorly, prevents posterior dislocation of fixed femur
What are the tests performed to confirm that the ACL is torn?
Lachman Test
Pivot Test
Cross Over Test
Anterior Drawer Test
What are the tests performed to confirm that the PCL is torn?
Posterior Drawer Test
What are the articular surfaces of the knee joint?
Femur and Tibia
Patella and Femur
What is the cause of housemaid’s knee?
Excessively compressing the pre-patellar bursa, which leads to pain and swelling
Caused by constant friction irritating the lubricating sac anterior to the patella
Explain the consequence of a lesion of the superficial and deep fibular nerves just distal to their origin.
Deep Fibular: leads to foot drop
Common Fibular: leads to foot drop
Superficial Fibular: weakened eversion (you would still have some b/c of the fibularis tertius)
Explain the consequence of a lesion of the tibial nerve in the popliteal fossa.
Loss of plantarflexion
Describe hallux valgus.
Lateral displacement of the great toe; presents as pain over the prominent metatarsal head
Describe hallux varus.
Medial displacement of the great toe
