Joints of LE Flashcards
1
Q
What is the hip joint called?
A
Acetabulo-femoral joint
2
Q
What is the Acetabulo-femoral joint aka?
A
coxa-femoral joint
3
Q
What type of joint is the Acetabulo-femoral joint?
A
ball and socket synovial joint
4
Q
How many DOF does Acetabulo-femoral joint have and what are they?
A
3 DOF:
Flexion/extension
abduction/adduction
IR/ER (circumduction)
5
Q
What is the size ratio between acetabulum and femoral head?
A
similar in size, about 1:1 ratio there making it very stable
6
Q
What is the Acetabulo-femoral joint’s angle of inclination?
A
tend to have a normal angle that is medial angle
7
Q
If the normal medial angle of the Acetabulo-femoral joint straightens out what is that called?
A
coxa valga, valgus
8
Q
If the normal medial angel of the Acetabulo-femoral joint decreses what is that called?
A
coxa vara, varus
9
Q
As you begin to weight bear and also in geriatric years of prolonged weight bearing results in what?
A
decreased angle
10
Q
When looking at the femur from top down, you see a proximal difference to distal what is that curve called?
A
angel of torsion
11
Q
What angle is the head and neck of the femur angled at?
A
30 degrees
12
Q
What is angle of torsion increase called?
A
antiversion
13
Q
What does antiversion of the femur mean?
A
when the distal portion of femur points medially
14
Q
What does antiversion of the femur result in?
A
knock knee
15
Q
What is angle of torsion decrease called?
A
retroversion
16
Q
What does retroversion of the femur mean?
A
when the distal portion of the femur points more laterally
17
Q
What retroversion of the femur result in?
A
bowlegged
18
Q
What closes off the acetabular notch of the acetabulum?
A
transverse acetabular ligament
19
Q
What vessel travels through transverse acetabular ligament of the acetabulum?
A
artery to ligamentum teres
20
Q
What is the continuation of the joint capsule of the acetabulum?
A
acetabular labrum
21
Q
What is the function of the acetabular labrum?
A
contributes to congruency and stability of the joint
22
Q
What causes there to be a higher amount of stability in the acetabulum?
A
vacuum in the joint
23
Q
What are the 3 major ligaments of the hip?
A
iliofemoral
Pubofemoral
Ischiofemoral
24
Q
Which two ligaments attach from intertrochanteric line of femur anteriorly?
A
iliofemoral
pubofemoral
25
Which ligament attaches from the intertrochanteric crest of femur posteriorly?
Ischiofemoral ligament
26
What do all three major ligaments of the hip attach from and to?
femur to ilium, pubis, and ischium
27
The hip ligaments and capsule are most taught and provide most restriction/stability in what motions?
Hip extension
abduction
IR
28
Hip Joint surfaces have maximum articulation in what motions?
Hip flexion
abduction
ER
29
What position is hip dislocation most common?
flexed, adducted, and IR causing posterior dislocation
30
How are the three ligaments of the hip described?
as intra-capsular, blending in with the joint capsule
31
What is the position of the joint where ligaments and joint capsule are most taught and joint surfaces are most congruent called?
closed pact position
32
What does joint congruency mean?
most area matches up
33
Unlike other joints what is the hip joints relationship of congruency and taughtness?
they are inverse
34
When is the hip at high congruency?
Hip flexion
abduction
ER
FABER
35
When is the hip at high taughtness?
Extension
Abduction
IR
36
What is the the hip at closed pact position?
just when it's taught and low congruency
37
What part of the hip joints are cut when doing a total hip replacement?
posterior-lateral joint capsule
| iliofemoral ligament
38
What motion is restricted post total hip replacement?
flexion,
adduction,
IR
39
When an infant is born with a mal-formed femoral head, what motion is done to reshape it into a sphere?
FABER
flexion
abduction
ER
40
What is the knee joint called?
Tibio-femoral joint
41
What type of joint is the tibio-femoral joint?
Bi-condyloid joint
42
How many DOF does the tibio-femoral joint have and what are they?
1 DOF primary but there is technically 2
primary- flexion/extension
secondary- when weight bearing abd/add
43
What do the two condyles of the femur articulate with in the tibio-femoral joint?
two condyles of the tibia
44
What is the screw home mechanism?
when the knee is at full extension the tibia ER on the femur for about the last 30 degrees
45
Why does screw home mechanism occur?
This is due to the medial condyle of the femur continuing to move on the medial condyle of the femur, causing the tibia to ER
46
What is the benefit of screw home mechanism?
allows for energy efficiency when you lock the tibia into femur while standing. This is substituting the use of huge muscles of the leg to maintain standing posture
47
How do you unlock the knee after standing with screw home mechanism?
IR the tibia
48
What surrounds the tibio-femoral joint?
joint capsule
49
Where does the joint capsule's synovial membrane joint into in the tibio-femoral joint?
folds in at the intercondylar fossa
50
How does the synovium engulf the knee joint?
the Synovium doesn't completely surround the tibio-femoral joint
51
Since the synovium doesn't completely surround the knee capsule what occurs?
the ACL and PCL are not supplied by synovial fluid
52
How are ACL and PCL oriented in relations to the synovium and joint capsule?
ACP and PCL are extra-synovial
| ACP and PCL are intro-capsular
53
Since ACP and PCL are extra-synovial what can occur?
if they are torn they can't repair themselve and surgery is needed
54
What does the synovial membrane of the knee have that allows for more freedom?
redundancies which are folds
55
What is it called when the knee's synovial membrane redundancies become irritated called?
Synovial Plica
56
What causes synovial plica?
reduced friction or overuse
57
What are the two fibrocartilagenous support structures of the knee called?
medial and lateral menisci
58
What are four functions of menisci?
- form concavities for femur to articulate with
- increase congruency
- disperse force
- increases articulation
59
What does a meniscal tear result in?
smaller area to disperse force and increased likelihood of osteoarthritis
60
Which meniscus is larger and what is it's shape?
medial menisicus is larger with a C shape
61
Which meniscus is less mobile? and why?
medial meniscus is less mobile due to having mulitple attachments
62
Which meniscus is more likely to tear?
medial meniscus
63
Which meniscus is smaller and what is it's shape?
lateral meniscus is smaller with an almost complete ring shape
64
What attaches to the posterior aspect of the medial meniscus?
semimembranosus
65
What attaches to the posterior aspect of the lateral meniscus?
popliteous
66
What prevents impingement of the menisci when the two bones come in flexion and pulls them taught?
muscular attachement to menisci
67
Can menisci get stuck?
no
68
What is another function of muscular attachment on menisci besides preventing impingement?
ensures menisci are drawn posteriorly and there is always meniscus in contract with tiba and femur throughout the entire ROM
69
How is menisci bound to the tibial plateau?
by coronary ligaments (mensco-tibial)
70
How is menisci loosely bound to the femur?
by menisco-femoral ligament
71
What are the ligaments of the knee?
```
Anterior cruciate ligament
Posterior cruciate ligament
Medial collateral ligament
Lateral collateral ligament
Arcuate ligament
Oblique popliteal ligament
Posterior oblique ligament
```
72
Where is the ACL and PCL found?
in the intercondylar fossa
73
What do both ACL and PCL resist?
as they cross one another they prevent excessive IR of the Tibia
74
Which femoral condyle does ACL and PCL attach to?
LAMP
lateral ACL
medial PCL
75
What does ACL resist?
anterior translation of the tibia or femur posteriorly
76
What does PCL resist?
posterior translation of the tibia or femur anteirorly
77
When the femur moves anteriorly/posteriorly what resists excessive movement?
excessive femoral anterior: PCL
| excessive femoral posterior: ACL
78
What other structures does the ACL attach to?
medial meniscus and MCL
79
How are the ACL/PCL attached on their respective condyles?
ACL is posteriorly on the lateral condyle
| PCL is anteriorly on the medial condyle
80
What does the MCL attach to and from?
medial epicondyle of the femur and blends with the medial meniscus
81
What muscle does the MCL attach with?
pes anserenus
82
What force does the MCL resist on the knee?
excessive valgus force
83
What is happening to the MCL during geno-valgum? and what results?
MCL is elongated and knock knee results
84
Is MCL intra/extra-capsular?
intra-capsular blending with the joint capsule
85
What does the LCL attach to and from?
lateral epicondyle of femur
| fibular head
86
is LCL intra/extra-capsular?
completely extra-capsular
87
What happening to the LCL during geno-varo? and what results?
LCL is elongated and bow legged results
88
What does LCL and MCL both resist together?
ER of tibia
89
What is the unhappy triad?
ACL
Medial meniscus
MCL
all being torn
90
What three ligaments are located along the posterior of the knee capsule?
Posterior oblique ligament
Oblique popliteal ligament
Arcuate ligament
91
What does Posterior oblique ligament, Oblique popliteal ligament, and Arcuate ligament do together?
They reinforce joint capsule
and
resist excessive hyperextension of the knee
92
What is hyperextension on the knee called?
genu-recurvatul
93
How is the arcuate ligament oriented?
more lateral near fibular head
94
How is oblique popliteal and posterior oblique ligaments oriented?
more postero-medially
95
Posterior oblique ligament, oblique popliteal ligament, and arcuate ligament resist valgus or varus forces of the knee?
both valgus and varus
96
What joint is located in between patella and patella surface of the femur?
patello-femoral joint
97
What type of joint is patello-femoral joint?
plane synovial joint
98
What are the three posterior facets of the patella?
lateral, medial, odd
99
Which patella facet is the most medial in the aspect to the body?
odd facet
100
Which patellar facet is the largest?
lateral facet
101
Which patellar facet is the smallest?
odd facet
102
What does the patellar facets articulate with?
femur
103
What type of bone is the patella?
sesamoid
104
What tendon is the patella inbedded in?
quadriceps femoris
105
What is the function of the patella in aspect to the quadriceps?
Patella acts to change the angle of pull of the quadriceps acts as a pulley and angulation of force of quad
106
What is superiorly/inferiorly attached to the patella?
```
superior= quadriceps tendon
inferior= patellar tendon/ligament
```
107
What does the patellar tendon connect?
patella to tibial tuberosity
108
What is the patellar tendon a continuation of?
tendon of quadriceps
109
Why is the patellar tendon also a ligament?
bc it connects bone to bone
110
What does the patella help protect?
ACL and PCL located just posterior to it
111
What are the four ligaments binding the patella?
lateral and medial patello-femoral ligaments
| lateral and medial patello-tibial ligaments
112
Two lateral ligaments of patello-femoral and patello-tibial ligament, collectively is called what?
lateral patellar retinacula
113
Two medial ligaments of patello-femoral and patello-tibial ligament, collectively is called what?
medial patellar retinacula
114
What are the attachment sites of the iliotibial band?
Iliac tubercle on iliac crest
runs along the lateral aspect of thigh
lateral aspect of patella (lateral retinacula)
Gurdey's tubercle on tibia
115
The ilitotibial band crosses at the knee to blend in with what?
lateral retinaculum
116
What is the ligament that blend the patella with the lateral retinaculum?
ilio-patello ligament
117
What occurs when there is tension on the iliotibial band?
pulls the patella laterally
118
What is the Q-angle?
estimation of line of pull of quadatus femoris muscle. This is not a definitive measurement
119
What are the locations to measure for the Q-angle?
Measure from ASIS to Mid patella to tibial tuberosity
120
WIth the Q-angle you can make an assumption that a wider pelvis will what?
cause the Quadatus femoris to pull more laterally
121
WIth the Q-angle you can make an assumption that a narrower pelvis will what?
cause the quadatus femoris to pull more superiorly
122
Are Q-angle related quad/knee tracking assumptions alwasy true?
no
123
What movements should the patella be able to perform?
Tilt medially and laterally
Rotate medially and laterally
Glide superiorly/inferiorly/medially/laterally
124
What is the union between the head of fibula and tibia?
proximal tibio-fibular joint
125
What type of joint is the proximal tibio-fibular joint?
plane synovial joint
126
What two structures make up the proximal tibio-fibular joint?
anterior tibio-fibular ligament
| posterior tibio-fibular ligament
127
What little movement proximal tibio-fibular joint has, is to do what?
accommodate for very distal ankle motion
128
A fusion at the proximal tibio-fibular joint will result in what?
limited ROM at the ankle
129
What motions does the proximal tibio-fibular joint have?
superior/inferior translation
| rotation
130
What type of joint is the distal tibio-fibular joint?
syndesmosis
131
What membrane is found in the distal tibio-fibular joint?
interosseous membrane
132
What two structures make up the distal tibio-fibular joint?
anterior tibio-fibular ligament
| posterior tibio-fibular ligament
133
Why is the distal tibio-fibular joint very stable and strong?
bc its supported by ligaments and interosseous membrane
134
The distal tibio-fibular joint doesn't articulate any structure. What separates the distal tibia and fibula?
fibro-adipose tissue
135
What is a high ankle sprain?
separation of distal tibia and fibula by a tear of interosseous membrane
136
What is the joint found amongst the talus, distal tibia, distal fibula?
talocrural joint
137
What does Crural mean?
leg
138
The distal tibia and fibula create a mortise, what is it and what is mortise's function?
a bowl shape
| that grips the talus
139
What type of joint is the talocrural joint?
synovial hinge joint
140
What aspect of the talus is larger in the talocrural joint?
the dome of talus bone is larger anterior than posterior
141
How is the lateral and medial malleolus extended in relations to each other?
lateral malleolus extend inferior and posteriorly relative to the medial malleolus
142
What is talocrural joint motion?
dorsiflexion
| plantarflexion
143
Which talocrural joint motion is more limited and why? *also how does this relate to proximal tibio-fibial joint
dorsiflexion is more limited since the wider portion of talus is inside the distal tibio-fibial joint, not a lot of movement. therefore the proximal tibio-fibila joint needs to move to compensate motion
144
What are the 3 lateral collateral ligaments of the ankle?
ATFL anterior talo-fibular ligament
CFL calcaneo-fibular ligament
PTFL posterior talo-fibular ligament
145
Where is the ATFL located?
sits on top of sinus tarsi
146
What motion does the ATFL, CFL, PTFL resist?
ankle inversion
147
Which lateral collateral ankle ligament is most commonly injured?
ATFL
148
When is the ATFL stressed?
during plantar flexion
149
What two structures is the ATFL found connecting?
Lateral malleolus
| anterior aspect of the talus
150
Where is the CFL found?
posterior to the ATFL
151
When is the CFL stressed?
neurtral inversion
152
What two structures is the CFL found connecting?
lateral malleolus
| calcaneous
153
Where is the PTFL found?
most posterior to all other ligaments
154
When is the PTFL stressed?
during dorsiflexion and pushing into inversion
155
What two structures is the PTFL found connecting?
lateral malleolus
| posterior talus
156
Which lateral collateral ankle ligament is least injured?
PTFL
157
What is the function of the medial collateral ankle ligaments?
resist evertsion of the ankle
158
What is the medial collateral ankel ligaments commonly called?
deltoid ligaments
159
How often do you see medial collateral ankle injures and why?
The deltoid ligaments are super strong, rarely seen a injure here. More likely to see the ligament be pulled off the bone before it is torn
160
What are the 4 medial collateral ankle ligaments?
Anterior tibio-talar ligament
Tibio-navicular ligament
tibio-calcaneal ligament
Posterior tibio-talar ligament
161
What two structures is the anterior tibio-talar ligament found connecting?
medial malleolus
| anteiror aspect of talus
162
When is the anterior tibio-talar ligament found stressed?
in platar flexion and pushed into eversion
163
What two structrues is the tibio-navicular ligament found connecting?
meidal malleolus
| navicular tubercle
164
When is the tibio-navicular ligament stressed?
plantar flexion and pushed into eversion
165
What two structures is the tibio-calcaneal ligament found connecting?
medial malleolus
| medial aspect of the calcaneous
166
When is the tibio-calcaneal ligament stressed?
when neutral and then eversion
167
What two structures is the posterior tibio-talar ligament found connecting?
medial malleolus
| posterior aspect of talus
168
When is the posterior tibio-talar ligament stressed?
in dorsiflexion and pushed into eversion
169
What is the union of talus and calcaneus?
subtalar joint
170
What is subtalar joint's primary motions?
supination
| pronation
171
During supination/pronation of subtalar joint, what is the navicular and medial longitudinal arch doing?
```
supination= elevation of navicular and medial long arch
pronation= depression of navicular and medial long arch
```
172
Why is the subtalar motion so complex?
due to the concavity of posterior facet and
| convexity of the anterior and middle facets
173
How is the subtalar joint supported?
by MCL and LCL of the ankle
174
What two ligaments support Sinus tarsi?
Cervical ligament
| interosseous talo-calcaneal ligament
175
Where do the cervical ligament and interosseous talo-calcaneal ligament attach to?
talus and calcaneous
176
What shaped opening does the sinus tarsi ? and where?
a cone shaped opening/space in between the talus and calcaneus
177
How is the cone shaped sinus tarsi oriented?
wider laterally
| narrow medially
178
What sits on the sinus tarsi?
ATFL
179
Where is it a common site for edema in the LE? and why?
Sinus tari. bc fluid takes path of least resistance.
180
What does the depression of the subtalar joint/sinus tarsi look like?
depression on the lateral side, and runs horizontally across the ankle
181
Where does the transverse tarsal joint articulate (4)?
proximal of talus
posterior of calcaneus
distal of navicular
anterior of cuboid
182
Transverse tarsal joint effects what motions of the foot?
supination
| pronation
183
Which joint is more limited in motion, Transverse tarsal joint or subtalar joint?
Transverse tarsal joint is less mobile
184
What does the ray consist of?
phalanges, metatarsal, and cuneiforms or cuboid
185
Which ray is least mobile?
2nd
186
What is the midline of the feet aka axis of movement?
2nd ray
187
What type of joint is MTP?
condyloid
188
How many DOF and what are MTP?
2 DOF
abd/add
flexion/extension
189
What type of joint is Interphalanges?
hinge joints
190
How many DOF and what are IP?
1 DOF
| flexion/extension
191
What prevents excessive abduction of metatarsals?
Deep transverse metatarsal ligament
192
What make up the 1st ray?
medial cuneiform
1st metatarsal
2 phalanges (one functional unit)
193
What make up the 2nd ray?
middle cuneiform
2nd metatarsal
3 phalanges
194
What make up the 3rd ray?
lateral cuneiform
3rd metatarsal
3 phalanges
195
What make up the 4th ray?
Cuboid
4th metatarsal
3 phalanges
196
What make up the 5th ray?
Cuboid
5th metatarsal
3 phalanges
197
Where is the medial longitudinal arch located?
apex of navicular bone on medial aspect of the foot
198
Where is the lateral longitudinal arch located?
smaller than medial long arch, on the lateral aspect of the foot
199
What the arch that runs horizontally across the metatarsal heads?
transverse arch
200
what ligament supports the medial longitudinal arch?
Calcaneo-navicular ligament (spring)
201
What ligament goes from lateral aspect of the calaneous to the metatarsals?
long plantar ligament
202
What ligament goes from calcaneous to the cuboid?
short plantar ligament
203
What is the short plantar ligament aka?
Plantar calcaneo-cuboid ligament
204
What ligaments support the lateral longitudinal arch?
short and long plantar ligament
205
What is the thick connective tissue in the bottom of the feet?
plantar aponeurosis
206
Where does the plantar aponeurosis attach to?
medial calcaneal tubercle of calcaneous
lateral calcaneal tubercle of calcaneous
metatarsal heads
proximal phalanges
207
Which calcaneal tubercle on calcaneous has the most fibers of the plantar apeneurosis bound to it?
medial calcaneal tubercle of calcaneous
208
Extending the feet digits will cause the plantar aponeurosis to do what??
stretch
209
What ligament holds the plantar apeneurosis to the metatarsal heads?
superficial transverse metatarsal ligament
210
What are the 3 groups of retinacula around the ankle?
extensor retinaculum
flexor retinaculum
fibular retinaculum
211
What do each group of retinaculum around the ankle have?
a superior and inferior band for each retinaculum
212
What is the attachment for extensor retinaculum and it's function?
attached on the anterior aspect of the ankle
| to bind the extensor tendons down to prevent bowstringing
213
What is the attachment for flexor retinaculum and its function?
bands on the medial aspect of the ankle
| to close off the tarsal tunnel
214
What is the attachment for fibular retinaculum and its function?
bands on lateral aspect of the ankle
| to close off fibular tunnel
