Joints and ligaments Flashcards
What is the iiofemoral Ligament
Y shaped ligament that is one of body’s strongest ligaments.
Prevents hyperextending of hip
On the anterior side of the body
what is the pubofemoral ligament
Tightens when we extend
Prevents hyperabduction
Ischiofemoral L
located on the posterior portion of femoral neck
3 extracapsular ligaments of hip
- Iliofemoral L
- Pubofemoral L
- Ischiofemoral L
What are the 4 Intracapsular Ligaments of the Hip
1 .Zona Orbicularis
- Acetabular Labrum
- Ligamentum Teres
- Transverse Acetabular L
ZALT
Zona Orbicularis
Intracapsular Ligaments of the Hip
Runs deep and perpendicular to the previously mentioned Extracapsular Ligaments. Supports the weak Femoral Neck
Acetabular Labrum
An Extension of the Acetabular Ridge , creating a deeper socket for the Femoral Head to sit inside.
Transverse Acetabular Ligament
Connects the inferior aspect of the Acetabulum.
Acts as a gateway for vessels going to the head of the femur, since the rest of the Acetabulum is a bony structure.
Ligamentum Teres
Ligament of the Head of the Femur.
During childhood, a branch of the Obturator Artery runs into / around it. Usually this closes, but in some populations it does not.
When runs around the Ligamentum Teres in childhood
obturator a
Anterior hip dislocations
very uncommon due to the strength of the Iliofemoral Ligament.
Posterior Dislocations
Occur in car crashes when knee car crashes slams into the dash, and the head of the femur is pushed post out of the socket.
what happens during Posterior Dislocation of the Femur
shortening of limb
internally rotated
flexed
adducted
Log Roll
Pt supine. Externally and internally rotate the hip and check for pain.
Labral Loading
Pt supine.
Flex the patient’s knee to 90 degrees while the patient is supine and apply weight to the acetabulum by pressing down on the femur. Check for pain.
Labral Distraction
Pt supine.
Flex the patient’s knee to 90 degrees as above, but then lift on the leg to take weight off of the acetabulum. Check for relief of pain
Scour Maneuver
Pt supine. Rotate the patient’s thigh in circles at the hip joint. Check for pain.
Lateral (fibular) collateral L
does not directly connect to lateral meniscus. underneath is the popliteus m.
does medial (tibiaa) collateral L attach to medial meniscus
yes
blow to side of knee. what happens
- tear of medial collateral m
- tear of medial meniscus
- acl tear
Anterolateral Ligament
prevents [excessive internal tibial rotation] when the leg is near full extension.
why is there high rates of re-tearing in post ACL patients
[anterolateral ligament] of knee is also torn but rarely repaired
what is weaker; lateral collateral or medical collateral
medial. tears commonly w the medial meniscus
Oblique Popliteal Ligament
comes off of the Semimembranosus Tendon–> Lateral Femoral Condyle
Where is the posterior cruciate L
Behind ACL.
but medial to the anterior cruciate L if looking at it from anterior
ACL: wwd
- during flexion, limits rolling of femoral conydles on tibia
- Prevents hyperextension of the knee
what is stronger: PCL and ACL
PCL; more vascularized
PCL job
Prevents hyperflextion
What does the lateral meniscus connect to
Posterior Cruciate Ligament.
Thicker than medial and more full circle
Transverse Ligament of the Knee
Connects the anterior portions of the Menisci together to add strength to the knee joint.
Meniscal Tear
inner portion of the Menisci are not connected to anything, and can fold and “catch,” which the patient can feel.
unhappy triad of knee injury
lateral impact will tear
- acl
- mcl
- medial meniscus
what is the valgus stress test
Start with the pt’s knee straight, and apply force on the lateral part of the knee (pushing the leg into a valgus shape) and check for pain.
Do the same with a slightly flexed knee. This checks the Medial Collateral Ligament , as that is the ligament that would be stretched by that maneuver.
Valgus stress test looks at the
medial collateral L
what is the varus stress test
Start with the pt’s knee straight, and apply force on the medial part of the knee (pushing the leg into a varus shape) and check for pain. Do the same with a slightly flexed knee.
This checks the Lateral Collateral Ligament , as that is the ligament that would be stretched by that maneuver.
Varus stress test looks at the
lateral collateral l
Lachmans test
Checks ACL.
Flex the pt’s knee to about 30 degrees. Pull anteriorly on the Tibia to check for laxity of the Anterior Cruciate Ligament.
Push posteriorly on the Tibia to check for laxity of the anterior Cruciate Ligament.
lachmans test
pull- check laxity of ACL
push- check laxity of ACL
What does McMurray tests test?
Meniscus
how to run McMurray tests
- supine
- flex knee to 90
- load meniscus and extend. check for pain
how do we test medial meniscus on mcmurray
Externally rotate by loading pressure onto medial menisucs, trying to “catch it” into the tibia
Valgus stress.
how do we test lateral meniscus on mcmurray
Interally rotate by loading pressure onto lateral menisucs, trying to “catch it” into the tibia
Varus stress.
Alternate name for superior extensor retinaculum
trans-crural ligament
Alternate name for inferior extensor retinaculum
cruciate ligament
When we invert our ankle, what ligament is first and most likely to tear?
ATF
(Anterior Talofibular ligament)
ATF is located on the antero-lateral aspect of our foot.
What ligament mirrors the ATF?
ATF= anterior talofibular ligament
Posterior talofibular ligament
What ligament prevents hyperinversion of the foot?
Calcaneofibular ligament
What is the “Always Tear First” Ligament?
Anterior Talofibular Ligament
When we invert our ankle, it is the first to tear.
What does the [deltoid ligament] do?
Located on the medial mallelous and make ankle resistant to tearing
Parts of the deltoid ligament
Start on medial malleolus and named for the foot bone they go to.
- Anterior tibiotalar part
- Tibionavicular part
- Tibiocalcaneal part
- Posterior tibiotalar part
Anterior Talofibular Ligament (ATFL) sprain is due to what movement of the foot?
inversion
What is Pott’s fracture dislocation?
Occurs in the ankle due to an [EVERSION SPRAIN].
Your deltoid ligament will not break because its so strong.
Instead, internal rotation will fracture [medial malleolus + fibula].
Potts, bone breaks before ligament
In Pott’s fracture, where does the force come from?
What way does our ankle roatate?
-Force comes laterally, causing eversion of foot and internal rotation will cause talus to strike the fibula.
What is the purpose of foot arches?
- Absorb shock
2. Adapt to surfaces
what is in the transverse arch of the foot?
- Three cuneiforms
- Cuboid
- Proximal heads of the metatarsals
What is in the lateral longitudinal arch of the foot
- 2 distal digits (metatarsals and phalanges)
- Cuboid
- Calcaneus
What are the dynamic supports of the foot?
Muscles
Tendons of legs that affect the foot
What are the passive supports of the foot?
- shapes of the bones
- AponeuroSIS
- Spring ligament, short plantar ligament and long plantar ligament
What is the spring ligament called?
plantar calcaneonavicular L
What is the short plantar L called?
Plantar calcaneocuboid L
What is another name for the spring ligament and why is it so important?
Plantar calcaneonavicular L
Passive support to the arch by passing weight from talus–> rest of the foot.
What tendons are important in dynamic support of the arch?
- Tendon of fibularis longus m
2. Tendon of tibialis posterior m.
What is pes planus?
Flat feet
Types of pes planus?
- Loose
- Dense
- Acquired
Loose pes planus
most common in infants due to laxity of dynamic supports of arch (intrinsic ligaments
Dense pes planus
Due to deformity of bones, often caused by fracture
Acquired pes planus
Due to:
laxity of tibialis posterior tendon due to age,
denervation of the muscle,
What is the most common pes planus?
Acquired planus
How can we tell what innervates a joint
if a muscle crosses a joint, whatever nerve innervates that muscle supplies the joint
What is the least effective small rotator?
Quadratus femoris m.
What is Hilton’s law?
A joint is innervated by the same nerve of the muscle that crosses over it.
Main artery of the thigh?
Deep femoral A.
What are the thickened parts of the articular capsule called?
intrinsic ligaments
Iliofemoral joint resists hyperextension. this extension is permitted by what?
lumbar spine.
Why is a medial meniscal tear often found with a MCL tear?
They’re bound to one another.
Where are internal ligaments located?
in the capsule, but seperate from the joint cavity
How does ACL prevent hyperextension of the knee?
Prevents femur from dislocating POSTERIORLY
Prevents tibia from dislocating ANTERIORLY.
When is the PCL taut?
when leg is flexed
How does the PCL prevent hyperflexion of the knee
Prevents femur from displacing ANTERIOR
Prevents tibia from displacing POSTERIOR
THINK: What happens when you flex your leg: femur goes anterior and tibia goes posterior
When would we tear our ACL?
Hyperextension
Tibia goes anterior
Femur goes posterior
Anterior drawn sign
What is this indicative of?
Leg is flexed; doc attempts to displace the tibia by pulling anteriorly bc ACL should resist.
If pain, ACL Damage
How do we test anterior drawer sign clinically?
Lachman’s test
what is the difference between anterior drawer test and lachmans?
In anterior drawer, leg is more flexed
Pivot-shift test
What does it test?
Mechanism?
Tests–> ACL laxity
How? IT band can be a flexor or extensor. When it becomes a flexor, it pulls the tibia posterioly.
In this test, we begin with the tibia shifted anterior. We then look for when IT becomes a flexor and check if the tibia gets pulled back.
If so, the ACL is lax.
If not, tibia will shift anterior.
Posterior drawer sign:
Leg is flexed; doc attemtps to displace tibia by pushing posteriorly bc PCL should resist.
If pain, PCL damage
How can we test the posterior drawer sign?
Quads active test.
How is a quads active test ran?
Doc pushes posterior on tibia,
Pt will then activate quads and it will pull the tibia anterior due to patellar ligament.
what does the transverse ligament of the knee allow?
both menisci to move together when femur and tibia move.
are peripheral meniscal tears often easily healed or repaired?
yes bc of blood supply.
how do we test for meniscal tears
locate pain and crepitus along joint line while adducting or abducting leg`
What causes passive fallen arch
laxity in spring ligament
what usually happens in pes planus?
Medial part of longitudinal arch falls.
Plantar ligaments and plantar aponeurosis become stretched out.
Plantar calcaneonavicular ligament can not longer support head of the talus so it displaces inferomedially.
What is hallux valgus
Lateral deviation of big toe.
Tissue will swell and pressure and friction against shoe causes bursa (bunion) to form
Bunion
a tender and inflamed bursa
Corns
Inflamed areas of thick skin over proximal interphalangeal joints.
What is mallet toe?
Flexion in distal IP joint
What is hammer toe?
Usually occurs in 2nd digit.
Extension at MP joint
Flexion at proximal IP joint
What is claw toe?
Extension at MP
Flexion at proximal IP and distal IP
Apply Grind test will test the
meniscus
On interior inversion, what is the first ligament to tear or be damaged?
Anterior
Talofibular Ligament
If we evert our foot, is the Deltoid ligament likely to tear?
No. It is v strong.
when a person slips and their foot is forced into an excessively inverted position, what happens?
the ankle ligament tears, tilting the talus against the lateral malleolus and tearing it off. This can fuck up the fibula.
During hip replacement, what is replaced
acetabulum and the femoral head and neck
Osteoarthritis of the hip is caused by what?
erosion of articular cartliage
Dislocation of hip joint in kids can do what
disrupt the artery to the head of the femur, causing necrosis
joint becomes incongruint and growth stops
What is a characteristic of hip dislocation
- We cannot abduct the thigh
- Limb appears shorter because the dislocated femoral head is more superior
- +Trendelinbergs sign
Trendelenburgs sign
hip appears to drop on one side when we walk
Is aquired hip dislocation common
no because the articulation is strong.
During a car accident, what iis the position of the thigh that may cause the hip to be dislocated
Hip is
- flexed
- adducted
- medially rotated
What nerve may be injured during posterior hip dislocations or fracture-dislocations of the hip?
sciatic nerve.
What can result when a specific nerve (name it) is damaged during posterior hip dislocations or [fractures/dislocations] of hip joints
sciatic nerve
paralysis of hamstrings and muscles below the knee, which are supplied by the sciatic n
Anterior hip dislocations are caused by what movements of the hip
extension
adduction
laterally rotation
How is the femur placed in our thigh?
Diagnally
How is the tibia placed in our thigh?
Vertical
Angle between tibia and femur is called what
Q-angle
Genu varum
bow legged
Q-angle decreases
Excess weight is placed on medial aspect of the knee and [lateral collateral ligament] is overstressed
Genu valgum
Knock-knee (knees touch)
Q-angle increases
Excess weight is placed on lateral part of knee and the [medial collateral ligament] is overstretched
most common knee injury in contact sports
and how
ligament sprain, which occurs when the foot is fixed in the ground.
When a force is applied against the knee when the foot cannot move, ligament injuries are common. ACL and PCL are tightly stretched when the leg is extended, normally preventing disruption of the sides of the knee.
Most common knee injury during skiing accidents
ACL rupture
Free tibia slides anterior under a fixed femur (anterior drawer sign)
Instance where the PCL can tear
when you land on your tibial tuberosity when the knee is flexed.
Knocked on the floor in backetball
Tibia will slide posterior under fixed femur (posterior drawer sign)
Posterior drawer sign
Tibia slides posterior under fixed femur
What does pain during lateral rotation of the tibia indicate?
injury to lateral meniscus
What does pain during medial rotation of the tibia indicate?
injury to medial meniscus
What happens to a knee joint when the meniscus is removed
will suffer no loss of mobility but it may be less stable and tibial plateus may undergo inflammation
Fractures of the DISTAL FEMUR or lacterations to the anterior thigh may involve what?
Suprapatellar bursa, causing the knee joint to become infected.
Increases amount of synovial fluid
What is a prepatellar bursitis
Prepatellar bursitis occurs at the knee joint when the skin rubs against the patella from kneeling
OR
direct blow to falling on a flexed knee.
Friction between the [skin and tibial tuberosity] results in what
Subcutaneous infrapatellar bursitis (used to be called clergymans knee)
Edema will occur
Deep infrapatellar bursitis
Edema will occur in between the [patellar tendon and tibia].
What is a popliteal cysts
abnormal fluid filled sac of synovial fluid in the popliteal fossa due to herniation of gastrocnemius bursa or semimembranous bursa
knee replacements are made of waht
plastic and metal components are used to mimic smoothness of cartlage on cartilage
A sprained ankle injury is almost always a inversion/eversion injury
INVERSION
