Joints of the Lower Limb Flashcards
The hip joint is a ball and socket type synovial joint formed by the articulation between the ____ of the pelvis and the ___ of the femur
acetabulum; head
The hyaline cartilage-lined ___ surface of the acetabulum is incomplete inferiorly forming the acetabular notch, which is bridged by the ____ ____ ligament
lunate; transverse acetabular
The acetabulum is deepened by the presence of the acetabular _____, a triangularly-shaped fibrocartilaginous rim around the periphery of the acetabulum
labrum
The head of the femur is covered by articular cartilage except at the ___ for the ligament of the head
fovea
The inverted Y-shaped _____ ligament (of Bigelow) has superior attachments to the acetabular rim and the ASIS and inferior attachments to the intertrochanteric line and lesser trochanter
iliofemoral
The iliofemoral ligament prevents ____ at the hip joint
hyperextension
The inferiorly placed _____ ligament has attachments to the pubic bone medially, while blending laterally with the iliofemoral ligament
pubofemoral
The pubofemoral ligament prevents excessive _____ at the hip joint
abduction
The posteriorly placed ____ ligament has attachments to the ischial part of the acetabular rim, then spiraling superolaterlally attaches to the neck of the femur by the greater trochanter
ischiofemoral
Of the three hip ligaments, which one is the weakest?
ischiofemoral
The three hip ligaments as a whole work to restrict ____ of the thigh
extension
____ fibers encircle the fibrous joint capsule and constrict the joint capsule around the neck of the femur
orbicular
The fibrous capsule of the hip joint is weakest ____ and _____
posteriorly and inferiorly
Inside the joint space, what ligament arises form the margins of the acetabular notch and transverse acetabular ligament and attaches to the femoral head at the fovea
ligament of the head of the femur
The ligament of the head of the femur is a weak ligament that provides no support to the joint, but serves to convey an artery to what?
the epiphysis of the developing femoral head
The rectus femoris covers the hip joint capsule ____, the iliopsoas tendon reinforces the joint capsule ____ and ____, and the gluteus medius and minimum provide support _____
anteriorly; medially, inferiorly; superiorly
Contraction of muscles that cross the hip joint provide considerable ___ force to keep the head of the femur seated in the acetabulum
shunt
The most important blood supply to the hip joint, including the head and neck of the femur is by retinacular branches of what artery?
medial circumflex femoral artery
The nerve supply to the hip joint follows ____ law, which states that nerves that supply muscles that cross a joint will also give sensory fiber innervation to the joint
Hilton’s
Fracture of the femoral neck, commonly called a hip fracture, is a fairly common occurrence, especially in elderly women due to osteoporosis. In this case, the limb will appear to be ____ and ____ rotated
shortened; externally
Intracapsular fractures are especially problematic since they interrupt the blood supply with can lead to ____ ____
avascular necrosis
This joint is a modified hinge-joint and is the largest synovial joint in the
knee joint
Due to the size difference between the articular surfaces of the femur and of the tibia, the knee joint is a mechanically weak joint that depends on muscles and ligaments for stability. True or false?
true
Between the medial and lateral condyles of the femur, which one is larger?
medial condyle is larger both medial-laterally and antero-posteriorly
The two femoral condyles are continuous onto the anterior surface of the distal femur where their union forms the articular surface for the patella (often termed the ____ ____)
patellar groove
The superior surface of the tibia presents the ___ _____ formed of irregularly concave medial and lateral tibial condyles separated by an intercondylar eminence
tibial plateau
This ligament of the knee arises from the anterior intercondylar area and passes posteriorly, laterally and superiorly to attach to the medial side of the lateral femoral condyle
ACL
the ACL resists ____ displacement of the femur on the tibia during flexion, and functions to resist _____
posterior; hyperextension
This ligament attaches to the posterior intercondylar area and extends anteriorly, medially, and superiorly to attach to the lateral side of the medial femoral condyle
PCL
The PCL resists ____ displacement of the femur during extension and functions to resist ____
anterior; hyperflexion
The ____ are crescent-shaped fibrocartilaginous plates applied to the margins of the tibial condyles
menisci
The ends of each meniscus are firmly attached to the intercondylar area of the tibia and their anterior ends are joined by what ligament?
transverse ligament of the knee
This meniscus is the larger and more C-shaped. It is attached to the MCL and is often injured when the MCL is torn
medial meniscus
This ____ meniscus is smaller and more circular. The tendon of ____ intervenes between the lateral meniscus and LCL
lateral; popliteus
A small but strong _____ ligament attaches the posterior margin of the lateral lemniscus to the medial condyle of the femur, coursing on both sides of the PCL
meniscofemoral
Medially, the capsule of the knee joint is reinforced by this broad, thick ligament that is attached to the medial femoral epicondyle and the supermodel surface of the tibia. It is fused to the fibrous capsule
MCL
This ligament is found laterally on the knee. It is a strong cord-like structure that interconnects the lateral epicondyle of the femur and the head of the fibula.
LCL
The tendon of the popliteus separates the fibular collateral ligament from what?
the lateral meniscus
A reflection from the semimembranosus tendon forms the ____ ____ ligament that reinforces the capsule
oblique popliteal
At the site where the tendon of the popliteus penetrates the capsule, the overlying thickening of the capsule forms what ligament
arcuate popliteal ligament
The tibiofemoral and patellofemoral articular surfaces are inside the synovial cavity, but the space between the condyles including the cruciate ligaments is not. True or false?
true
Superior to the patella, the synovial cavity extends deep to the vastus intermedium to some distance forming the _____ bursa
suprapatellar
A small slip of muscle, the ____ ___ attaches to the superior tip of the suprapatellar bursa pulling it away from the joint space when the knee is extended
articularis genu
A number of small, localized bursae protect muscles and/or tendons as they lie adjacent to bone, the knee joint capsule, or each other. Some are continuous with the joint cavity. Subcutaneous bursa superficial (____ bursa) and inferior to the patella help the skin glide smoothly over the bones as the knee is moved
prepatellar
The most important muscle that stabilizes the knee joint is the ____ ____
rectus femoris
The lower fibers of the vestus medialis and vestus lateralis extend over the anterior surface of the knee joint as ____ reinaculum and ____ ____ retinacula
medial; lateral patellar
Posteriorly, the knee capsule is supported by the tendons of the ____ muscles as well as the heads of the ____
hamstring; gastrocnemius
Primary vascular supply to the lower limb is from which arteries?
descending, superior lateral, inferior lateral, superior medial, and inferior medial genicular arteries which have connections with the femoral, popliteal, lateral circumflex femoral, circumflex fibular, and the anterior tibial arteries
The genicular arteries form an anastomotic complex around the knee joint that is termed the ____ ____ ___
perimeniscal vascular ring
The anastomotic complex formed by the genicular arteries is more prominent anteriorly where it forms what plexus?
infrapatellar vascular plexus
This artery is a small branch off the popliteal artery which pierces the oblique popliteal ligament and supplies the ligaments and synovial membrane around the intercondylar eminence
middle genicular artery (intercondylar radiate artery)
The nerve supply to the lower limb is by articular branches of what nerves
femoral, tibial, common fibular, and obturator
A blow to the ____ side of the knee usually results in tearing of the ACL, MCL and medial meniscus (unhappy triad)
lateral
The tibia and fibula are interconnected through most of their length by an interosseous membrane that has an opening superiorly for the ____ ____ vessels and inferiorly for the perforating branch of the ____ artery
anterior tibial; fibular
The proximal tibiofibular joint is a synovial joint but allows for very little movement. The LCL spans this joint which is reinforced by what two ligaments?
anterior and posterior tibiofibular ligaments
The distal tibiofibular joint is _____
syndesmotic
The ligamentous attachments of the distal tibiofibular joint allow for limited ____ displacement of the lateral malleolus
lateral
Disruption of the anterior tibiofibular ligament will result in what?
high ankle sprain
The ankle joint allows what two movements of the foot?
dorsiflexion, plantarflexion
Because the anterior part of the talar articular surface is wider than the posterior part, the joint is more stable during _____ than during ____
dorsiflexion; plantarflexion
The ____ ligament is triangular-shaped and strong on the medial side of the ankle. This ligament has 4 separate components that interconnect the tibia and medially located bones of the foot.
deltoid (medial)
What are the 4 components of the deltoid ligament? What do they limit?
anterior tibiotalar, tibionavicular, tibiocalcaneal, and posterior tibiotalar; limit eversion of the foot
The lateral ligament located on the lateral side of the ankle has 3 components. What are they? What do they limit?
anterior talofibular, posterior talofibular, and calcaneofibular; limit inversion of foot
Vascular perfusion of the ankle joint is supplied by Malleolar branches of what two arteries?
anterior tibial and preoneal arteries
Innervation of the ankle joint is by branches of what nerve?
deep peroneal nerve
Ankle sprains (low ankle sprains) are common injuries and most frequently involve what ligament?
anterior talofibular ligament
nemonic: always tears first
The inferior surface of the talus supports a large concave ____ facet on its posterior aspect
calcaneal
The superior surface of the calcareous supports a convex ____ ___ facet near the middle of the bone
posterior talar
This ligament attaches to the lateral surface of the talus just anterior to the fibula; the distal attachment on the calcareous is shared with the more superficial calcaneofibular ligament
lateral talocalcaneal ligament
The medial talocalcaneal ligament spans from the ____ ____ of the talus to the posterior surface of the ____ ____
medial tubercle; sustenaculum tali
The strongest link between the talus and calcaneum is what ligament?
interosseus talocalaneal ligament
Inflammation of the interosseus talocalcaneal ligament can impinge on the venous plexus, small artery, and branch of deep peroneal nerve located in sinus between two bones. What is this condition called?
tarsal sinusitis
This joint separates the hindfoot and midfoot and is actually a complex of two joints, the calcaneocuboid and the talocalcaneonavicular joints. It is the main site of rotational displacement of the foot
transverse tarsal joint
Directly covering the inferior surface of the calceocuboid joint is the plantar calcaneocuboidal ligament also known as?
short plantar ligament
Immediately superficial to the short plantar ligament is the ____ ____ ligament which attaches further posteriorly on the calcaneum and spans the cuboid to attach to the base of metatarsals 2-5
long plantar
This ligament attaches to the anterior surface of the posterior tarsal facet of the calcaneum then courses anteriorly the superolateral surface of the calcaneum and forms a soft-tissue floor to the tarsal sinus
bifurcate ligament
The bifurcate ligament spans both the calcaneocuboid and talocalcaneonavicular joints. True or false?
true
The interosseous talocalcaneal ligament supports the talocalcanonavicular joint but the primary support is by way of which ligament
plantar calcaneonavicular ligament (spring ligament)
note: attaches to the sustentaculum talk of the calcaneum, courses anteromedial over the inferior surface of the navicular
Tearing or stretching of the weight bearing ligaments that span the inferior surface of the transverse tarsal joints can cause disruption of what?
spring ligament, short and long plantar ligaments (longitudinal arches of foot)
