Joints of the Lower Extremity (Darren's) Flashcards
What happens in Pott’s Dislocation Fracture?
An eversion sprain causes the deltoid ligament to avulse the medial malleolus, and the resulting snap causes the talus to strike the fibula, breaking it through the shaft.
What ligament starts on the head of the fibula, crosses over the popliteus, and attaches to another ligament in the middle of the popliteal space?
Arcuate popliteal ligament
Which tendon does the lateral collateral ligament run through?
The tendon of the biceps femoris
What does McMurray’s Test check for, and how is it performed?
Test for the Meniscus. Pt lies supine, Knee is flexed at 90 degrees. Apply internal rotation (to load pressure on the Lateral Meniscus) or external rotation (to load pressure on the Medial Meniscus) and extend the Lower Extremity out straight. Check for pain.
How can you know which nerves innervate joints, generally speaking?
If a muscle crosses a joint, the nerve that innervates that muscle also innervates that joint.
What is the function of the transverse acetabular ligament?
Serves as a gateway for vessels
Connects the inferior aspect of the acetabulum
What is the function of the anterior cruciate ligament?
Limits rolling of the Femoral Condyles on the Tibial Plateau during flexion (forces sliding rather than rolling posteriorly), and prevents hyperextension of the knee.
What is the weakest intrinsic ligament of the hip?
What is that ligament’s function?
The ischifemoral ligament
Preventing posterior dislocation
What is the general cause for dense pes planus?
Deformity or fracture of the bones of the foot
What important ligament passes weight from the talus to the rest of the foot?
The calcaneonavicular (spring) ligament
Which collateral ligament of the knee connects to its meniscus?
The medial collateral ligament of the knee
Give the correct setup and execution for:
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
What can cause all the members of the Unhappy Triad of O’Donoghue to tear together?
Lateral impact
What is the function of the posterior cruciate ligament?
Prevents the Tibia from going anterior when the knee is flexed
What is the function of the zona orbicularis?
Support for the relatively weak femoral neck
What gives rise to the oblique popliteal ligament?
The tendon of the semimembranosus muscle
Which of the two collateral ligaments of the knee is most likely to tear?
The medial collateral ligament
Give the correct setup and execution for:
Quads active test
Pt supine, knee bent. Physician pushes on the Tibia (as in Posterior Drawer), and instructs the patient to flex their quadriceps femoris. If the Tibia pushes outwards, it shows that the quads were initially relaxed, are able to be activated, and that there is a laxity in the posterior cruciate ligament.
What are the four structures involved in the Deltoid ligament of the medial ankle?
Anterior tibiotalar ligament
Tibionavicular ligament
Tibiocalcaneal ligment
Posterior tibiotalar ligament
What are the structures of the transverse arch of the foot?
Heads of the metatarsals
Cuneiforms
Cuboid
Which intrinsic ligament of the hip prevents hyperabduction?
Pubofemoral ligament
The lateral meniscus is connected to the posterior cruciate ligament by what structure?
The posterior meniscofemoral ligament
Give the correct setup and execution for:
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.
What structures make up the medial longitudinal arch of the foot?
Phalanges and Metatarsals of the first three digits
Cuneiforms
Navicular
Talus
Calcaneus
Which ligament is tested for laxity by a varus stress test?
Lateral collateral ligament
(the ligament that would be stretched by the movement)
What is the technique for the Apley Grind Test?
Pt prone with the knee bent at 90 degrees, press down on the foot, and internally and externally rotate - checking for pain. You can also lift up on the foot (distraction), and if that alleviates pain, it is indicative of some sort of pathology.
What is the general cause for loose pes planus?
Laxity in the intrinsic ligaments of the arch
What is the strongest intrinsic ligament of the hip?
What it that ligament’s function?
The iliofemoral ligament
Preventing anterior dislocation and hyperextension
What is the most likely ligament to tear on an inversion ankle sprain?
Anterior TaloFibular ligament (ATF)
Always tears first
What separates the lateral collateral ligament from the meniscus?
The popliteus muscle
Generally speaking, what all make up the passive supports for the foot?
Ligaments of the foot
Plantar Aponeurosis
Shapes of the bones of the foot
Which of the cruciate ligaments of the knee is stronger and more vascularized?
Posterior cruciate ligament
What are the attachments for the anterolateral ligament?
Lateral condyle of the femur
Lateral to Gurdy’s tubercle
What structure does the posterior meniscofemoral ligament connect to the lateral meniscus?
The posterior cruciate ligament
(not the femur)
What ligament houses a branch of the obturator artery in childhood and in some adults?
The ligamentum teres / ligament of the head of the femur
What structures make up the lateral longitudinal arch of the foot?
Phalanges and metatarsals of the lateral two digits
Cuboid
Calcaneus
What is the function of the transverse ligament of the knee?
Connects the anterior portions of the medial and lateral menisci together to add strength to the knee joint.
How will a patient’s lower extremity present if they have a posterior dislocation of the femur?
Shortened and internally rotated
What part of the inner surfaces of a joint are not covered in the synovial membrane?
The parts that are covered in articular cartilage
What contributes to the feeling of “catching” in some people’s knees?
The interior aspect of the menisci are not attached, and they can roll and fold, feeling like catching. Happens in a meniscal tear.
What are the three intrinsic ligaments of the hip?
Iliofemoral l.
Ischiofemoral l.
Pubofemoral l.
What is the possible clinical significance of the anterolateral ligament?
May tear along with the anterior cruciate ligament in injuries, and if reattached, may decrease the incidence of ACL re-tears.
(Zak’s research)
Give the correct setup and execution for:
Scour Maneuver
Pt supine. Rotate the patient’s thigh in circles at the hip joint. Check for pain.
What is another name for the plantar calcaneocuboid ligament?
The short plantar ligament
What makes up the (classical) “Unhappy Triad of O’Donoghue?”
Anterior cruciate ligament
Medial collateral ligament
Medial meniscus
What is the general cause for acquired pes planus?
Laxity of tibialis posterior due to age
Denervation of the muscle
Many other reasons
(Most common type)
What is Lachman’s test?
Same as Anterior / Posterior Drawer, except the patient’s knee is only slightly bent, instead of at 90 degrees.
Give the correct setup and execution for:
Log roll test
Pt supine. Externally and internally rotate the hip and check for pain.
Give the correct setup and execution for:
Faber (Apprehension) test
Pt supine. Flex the knee to 90 degrees and abduct, checking for apprehension.
