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MSK 1 > Knee Anatomy & Palpation > Flashcards

Knee Anatomy & Palpation Flashcards

1
Q

The medial meniscus is palpated /c the knee flexed and /c tibial _________ rotation

A

The medial meniscus is palpated /c the knee flexed and /c tibial EXTERNAL rotation

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2
Q

The lateral meniscus is palpated /c the knee flexed and tibial _________ rotation

A

The lateral meniscus is palpated /c the knee flexed and tibial INTERNAL rotation

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3
Q

What 3 muscles make up the pes anserine?

A
  1. Sartorius
  2. Gracilis
  3. Semitendonous
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4
Q

Biceps Femoris

  • ___________ and _________ rotator of the knee
  • visible when muscle ________ contracts
  • Fibers hug the ______
  • inserts on the _______________
A
  • FLEXOR and LATERAL rotator of the knee
  • visible when muscle ISOMETRICALLY contracts
  • Fibers hug the LCL
  • inserts on the HEAD OF FIBULA
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5
Q

Femur

  • Convex in nature; most distal end is nearly _______ allowing for increased WB
  • Epicondyles provide elevated attachment sites for __________ ligaments
A
  • Convex in nature; most distal end is nearly FLAT allowing for increased WB
  • Epicondyles provide elevated attachment sites for COLLATERAL ligaments
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6
Q

Tibial Plateau!!!!!

  • Transfers weight across the _____ to the _______
  • Medial tibial plateau is _________
  • Lateral tibial plateau is _______ (allowing for more movement in the transverse plane)
A
  • Transfers weight across the KNEE to the ANKLE
  • Medial tibial plateau is CONCAVE
  • Lateral tibial plateau is FLAT (allowing for more movement in the transverse plane)
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7
Q

Normal Alignment of the knee

  • ________ deg. of genu valgum
  • Excessive genu valgum (knock-kneed): Lateral angle < _________ deg.
  • Genu Varum (bow-legged): lateral angle > ______ deg.
A
  • 170 - 175 deg. of genu valgum
  • Excessive genu valgum (knock-kneed): Lateral angle < 170 deg.
  • Genu Varum (bow-legged): lateral angle > 180 deg.
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8
Q

Capsule and Related Structures
- Fibrous capsule encloses medial and lateral _________ joints and __________ joint
Capsule is reinforced by multiple structures such as _________ and ________
- Knee has the most complex and extensive _________ membrane in the body
- The infrapatellar fat pad is ____-capsular, but _____-articular

A
  • Fibrous capsule encloses medial and lateral TIBIOFEMORAL joints and PATELLOFEMORAL joint
    Capsule is reinforced by multiple structures such as LIGAMENTS and MUSCLE
  • Knee has the most complex and extensive SYNOVIAL membrane in the body
  • The infrapatellar fat pad is INTRA-capsular, but EXTRA-articular
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9
Q

What is the muscular stability (3 structures) provided to the lateral capsule of the knee?

A
  1. Biceps femoris
  2. Tendon of popliteus
  3. Lateral head of gastrocnemius
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10
Q

Posterior capsule

  • reinforced by __________ ligament, which is an extension of the semimembranosus
  • taut in _________ /c tibial _________ rotation
A
  • reinforced by OBLIQUE POPLITEAL ligament, which is an extension of the semimembranosus
  • taut in EXTENSION /c tibial EXTERNAL rotation
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11
Q

Arcuate Popliteal Ligament

  • part of the ________ capsule
  • Branches into _______ divisions: (1) arch across top of popliteal tendon, (2) lateral femoral condyle & small seasmoid in lateral head of gastrocnemius
A
  • part of the POSTERIOR capsule
  • Branches into TWO divisions: (1) arch across top of popliteal tendon, (2) lateral femoral condyle & small seasmoid in lateral head of gastrocnemius
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12
Q

What 3 muscles is the posterior capsule reinforced by?

A
  1. Popliteus
  2. Gastrocnemius
  3. Hamstrings
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13
Q

The medial capsule is reinforced by what 3 structures?

A
  1. Sartorius
  2. Gracilis
  3. Semitendinosus
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14
Q

The medial capsule consists of what 3 structures?

A
  1. MCL
  2. Medial patellar retinacular fibers
  3. tendonous expansions of semimembranosus
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15
Q

Arthrology
- knee has as many as ____ bursae, ________ activities lead to frequent bursitis
- ______ & _________ reduce friction between moving parts
Most extensive fat pads are in areas of _____________ and deep ______ bursae
- _________ are embryologic remnant of synovial folds
- Plica are present in ______% of knees

A
  • knee has as many as 14 bursae, REPETITIVE activities lead to frequent bursitis
  • FAT & SYNOVIAL reduce friction between moving parts
    Most extensive fat pads are in areas of SUPRAPATELLAR and deep INFRAPATELLAR bursae
  • SYNOVIAL PLICA are embryologic remnant of synovial folds
  • Plica are present in 25 - 50% of knees
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16
Q

What bursa is located….

- between femur and quadriceps tendon; communicated /c synovial membrane of knee joint

A

Deep supra patellar bursa

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17
Q

What bursa is located…

- between the patella and the skin

A

Subcutaneous pre patellar bursa

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18
Q

What bursa is located…

- between the tibia and patellar ligament

A

Deep infra patellar bursa

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19
Q

What bursa is located…

  • between tendon of popliteus and capsule of knee joint
  • communicates /c synovial membrane of knee joint
A

Popliteal bursa

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20
Q

What bursa is located…

- beneath the semimebranosus tendon

A

Semimembranosous bursa

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21
Q

What bursa is located…

- beneath the sartorius, gracilis, and semitendinosus tendons

A

Pes anserinus / subsartorial bursa

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22
Q

Tibiofemoral Joint

  • ________ joint of the body
  • Resting position = ______ deg. of flexion
  • Close pack position = ___________, & _______ rotation
  • Capsular pattern = ________ more limited than _______
  • ________ condyle of femur is larger than _________ and encounters greater weight bearing force than _______ aspect
A
  • LARGEST joint of the body
  • Resting position = 25 deg. of flexion
  • Close pack position = FULL EXTENSION, & EXTERNAL rotation
  • Capsular pattern = FLEXION more limited than EXTENSION
  • MEDIAL condyle of femur is larger than LATERAL and encounters greater weight bearing force than LATERAL aspect
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23
Q

Tibiofemoral Joint

  • Lateral condyle of femur projects _______ and acts as a stabilizer of the ________
  • Anterior part of lateral condyle is ________ and provides a contact surface /c _______ horn and anterior part of tibial articular surface during knee extension
  • The lateral compartment of the tibiofemoral joint allows for greater _______, less _______, and is more prone to _______ than medial compartment
A
  • Lateral condyle of femur projects ANTERIORLY and acts as a stabilizer of the PATELLA
  • Anterior part of lateral condyle is FLATTENED and provides a contact surface /c ANTERIOR horn and anterior part of tibial articular surface during knee extension
  • The lateral compartment of the tibiofemoral joint allows for greater MOBILITY, less STABILITY, and is more prone to LAXITY than medial compartment
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24
Q

Patellofemoral Joint

  • Articulation of the patella within the __________
  • Has _______ articular cartilage of any joint - up to 7 mm thick
  • Resting positon = __________ to ____ deg. of flexion
  • Closed pack position = _________ deg. of knee flexion
  • Capsular pattern = _________
  • During flexion/extension, patella moves upto 7-8cm in relation to femoral _________
A
  • Articulation of the patella within the FEMORAL GROOVE
  • Has THICKEST articular cartilage of any joint - up to 7 mm thick
  • Resting positon = HYPEREXTENSION to 5 deg. of flexion
  • Closed pack position = 30 - 60 deg. of knee flexion
  • Capsular pattern = UNKNOWN
  • During flexion/extension, patella moves upto 7-8cm in relation to femoral CONDYLES
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25
Q

Patellofemoral Joint

  • Patella moves in a ____ - shaped pattern from extension to flexion and back
  • Patella tilts _______ from knee flexion to _______ during knee extension
A
  • Patella moves in a C - shaped pattern from extension to flexion and back
  • Patella tilts MEDIALLY from knee flexion to LATERALLY during knee extension
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26
Q

At 135 deg. knee flexion

  • Patella contacts femur near the ________ pole
  • patella rests _______ the intercondylar groove bridging the intercondylar notch
  • _______ and ______ facet contact the femur
A
  • Patella contacts femur near the SUPERIOR pole
  • patella rests BELOW the intercondylar groove bridging the intercondylar notch
  • LATERAL and ODD facet contact the femur
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27
Q

At 90 deg. knee flexion

  • Contact area of the patella migrates ______
  • btw __ and _____ deg flexion the patella occupies its greatest area of contact /c the femur
  • Significant ________ force
A
  • Contact area of the patella migrates INFERIORLY
  • btw 90 and 60 deg flexion the patella occupies its greatest area of contact /c the femur
  • Significant COMPRESSIVE force
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28
Q

At 20 - 0 deg. extension

  • Contact area is the _________ pole
  • in full extension, the patella is completely ______ the intercondylar groove
A
  • Contact area is the INFERIOR pole

- in full extension, the patella is completely ABOVE the intercondylar groove

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29
Q

PFJ Reactive forces increase /c flexion of the knee from

  • _____x body weight during level walking
  • ______x body weight during stair climbing
  • _____x body weight /c squatting
A
  • 0.5x body weight during level walking
  • 3-4x body weight during stair climbing
  • 7-8x body weight /c squatting
30
Q

PFJR & contact stress is greatest in OKC at _______ deg.

A

PFJR & contact stress is greatest in OKC at 0 - 45 deg.

31
Q

PFJR & contact stress is greatest in CKC at ________ degrees

A

PFJR & contact stress is greatest in CKC at 45 - 90 degrees

32
Q

Intra-articular Structures

- Most prominent nonligamentous structures are medial/lateral ________

A
  • Most prominent nonligamentous structures are medial/lateral MENISCI
33
Q

What are the 4 primary roles of the menisci?

A
  1. Stabilization
  2. Shock absorption
  3. Proprioception
  4. Improvement in lubrication
34
Q

True or False: the menisci absorbs the majority of compressive forces at the knee

A

True

35
Q

Medial Meniscus

  • Attaches ________ to articulating surface of tibia, to _________ aspect of capsule of knee, and at __________ tubercle
  • Posterior attachement /c ____________
  • _____ shaped
A
  • Attaches ANTERIOR to articulating surface of tibia, to MEDIAL aspect of capsule of knee, and at INTRACONDYLAR tubercle
  • Posterior attachement /c SEMIMEMBRANOSUS
  • C shaped
36
Q

Lateral Meniscus

  • Connects both the anterior/posterior _______ near a common attachment to the intracondylar tubercle of the tibia and near attachment of _______ horn of medial meniscus
  • Primarily ______ shaped
  • Attached to two ___________ ligaments: thought to be significantly altered biomechanically by the cooperative action of the popliteus and meniscofemoral ligaments
A
  • Connects both the anterior/posterior HORN near a common attachment to the intracondylar tubercle of the tibia and near attachment of POSTERIOR horn of medial meniscus
  • Primarily CIRCLE shaped
  • Attached to two MENISCOFEMORAL ligaments: thought to be significantly altered biomechanically by the cooperative action of the popliteus and meniscofemoral ligaments
37
Q

Medial menisci encounters more forces during weight bearing:

  • Damaged during WBing & /c normal processes of ____________
  • Damage leads to cartilage __________ and subsequent loss of joint _________
  • ______ aspect of menisci is innervated/capable of producing pain
A

Medial menisci encounters more forces during weight bearing:

  • Damaged during WBing & /c normal processes of DEGENERATION
  • Damage leads to cartilage THINNING and subsequent loss of joint SPACE
  • OUTER aspect of menisci is innervated/capable of producing pain
38
Q

Both menisci distort significantly during motion:

  • Move _________ during flexion
  • Move _________ during extension
A
  • Move POSTERIORLY during flexion

- Move ANTERIORLY during extension

39
Q

Medial Meniscus

  • has ______ or __ shape
  • attaches to _____ and ______________
A
  • has OVAL or C shape

- attaches to MCL and ADJACENT CAPSULE

40
Q

Lateral Meniscus

  • has ________ or ____ shape
  • externally attaches only to _______ not _____
A
  • has CIRCULAR or 0 shape

- externally attaches only to CAPSULE not LCL

41
Q

The primary function of menisci is to reduce ________ stress at tibiofemoral joint

A

The primary function of menisci is to reduce COMPRESSIVE stress at tibiofemoral joint

42
Q

4 Secondary functions of the menisci are?

A
  1. stabilizing joint during motion
  2. Lubricating articular cartilage
  3. Reducing friction
  4. Guiding knee arthrokinematics
43
Q

What type of joint is the tibiofemoral joint?

A

Bicondylar synovial joint

44
Q

What type of joint is the superior tibiofibular joint?

A

arthrodial joint

45
Q

What type of joint is the patellofemoral joint?

A

pseudosaddle joint

46
Q

Patellar Facets

  • Lateral = ________
  • Medial = ________, carries in shape
  • Odd = on the extreme ________ border
A
  • Lateral = LARGER
  • Medial = SMALLER, carries in shape
  • Odd = on the extreme MEDIAL border
47
Q

The quadriceps and semimembranosus attach to both ________. Popliteus attaches to the _______ menisci. Muscles act to ______ the respective menisci anterior or posterior

A

The quadriceps and semimembranosus attach to both MENISCI. Popliteus attaches to the LATERAL menisci. Muscles act to PULL the respective menisci anterior or posterior

48
Q

True or False: The lateral menisci is more mobile than the medial menisci d/t its O shape

A

True

49
Q

Quadriceps Group

  • Efficiency depends on _______ and ________ of patella during muscular contraction
  • Maximal quad contraction occurs at ____ deg. of knee flexion
A
  • Efficiency depends on TIMING and POSITION of patella during muscular contraction
  • Maximal quad contraction occurs at 60 deg. of knee flexion
50
Q

Popliteus

- contributes to knee ______ concurrently while initiating _______ rotation

A
  • contributes to knee FLEXION concurrently while initiating INTERNAL rotation
51
Q

Quadriceps Femoris

  • Large and powerful
  • Name the 4 muscles: ________, _______, _________, ________
  • Vastus group produces ____% of knee extension torque
  • Rectus femoris produces ____% of knee extension torque
  • Knee extensor mechanisms consists of what?
  • _________ is the largest of quad muscles
A
  • Large and powerful
  • Name the 4 muscles: RECTUS FEMORIS, VASTUS LATERALIS, VASTUS MEDIALIS, VASTUS INTERMEDIUS
  • Vastus group produces 80% of knee extension torque
  • Rectus femoris produces 20% of knee extension torque
  • Knee extensor mechanisms consists of what? QUAD MUSCLE & TENDON, PATELLA & PATELLAR LIGAMENT
  • VASTUS LATERALIS is the largest of quad muscles
52
Q

Vastus Medialis

  • 2 distinct fiber directions
  • 1 muscle
  • VMO fibers approach patella at _______ degree angle
  • Vastus medialis longus approaches patella at ________ deg
  • VMO pull on patella has important implications for ____________ and _______ of patella in intercondylar groove
A
  • 2 distinct fiber directions
  • 1 muscle
  • VMO fibers approach patella at 50 - 55 degree angle
  • Vastus medialis longus approaches patella at 15 - 18 deg
  • VMO pull on patella has important implications for STABILIZATION and TRACKING of patella in intercondylar groove
53
Q

MCL — 2 Layers

(1) Deep = has attachment to ________ meniscus
(2) Superficial

A

(1) Deep = has attachment to MEDIAL meniscus

(2) Superficial

54
Q

What is the primary function of the MCL?

A

protect the knee against valgus forces

  • contributes most at knee flexion angles
  • aided by contribution of muscles of the pes anserine
55
Q

What is the secondary function of the MCL?

A
  • restraint against ER of the tibia on femur

- prevents anterior translation of tibia on femur

56
Q

LCL

  • has no attachment to the joint ________ or _______
  • primary function = restraint against ________ forces when knee is between full ________ and _____ deg. flexion
  • secondary function = restraint against _____ of tibia on the femur
A
  • has no attachment to the joint CAPSULE or MENISCUS
  • primary function = restraint against VARUS forces when knee is between full EXTENSION and 30 deg. flexion
  • secondary function = restraint against ER of tibia on the femur (then IR)
57
Q

ACL acts as a stabilizer against:

(1) ________ translation of the tibia on the femur
(2) _________ rotation of the tibia on the femur
(3) _________ rotation of the tibia on the femur
(4) _____________ of the knee (CKC post femur)

A

(1) ANTERIOR translation of the tibia on the femur
(2) INTERNAL rotation of the tibia on the femur
(3) EXTERNAL rotation of the tibia on the femur
(4) HYPEREXTENSION of the knee (CKC post femur)

58
Q

ACL

  • 2 discrete segments: ________ & _________
  • When knee is extended anteriomedial bundle is _________ to posterolateral bundle (When knee is flexed the opposite is true)
  • This causes the ACL to “_______” itself
A
  • 2 discrete segments: ANTEROMEDIAL & POSTEROLATERAL
  • When knee is extended anteriomedial bundle is ANTERIOR to posterolateral bundle (When knee is flexed the opposite is true)
  • This causes the ACL to “WIND UP” itself
59
Q

ACL

  • ___________ bundle is taut in both flexion and extension
  • __________ bundle is only taut in extension
  • AM and PL bundle at increased risk of injury at ~ _______ deg. of flexion d/t peak ACL shear forces
  • At terminal extension, _____ tibia greatly increases strain on ACL; _____ will relieve the stress
  • ________ & _________ stresses increase the strain on the ACL t/o the entire ROM
  • Commonly injured when tibia is driven _______ on the femur
  • Large portion of ACL injuries are ___________ (ex. cutting, pivoting)
A
  • ANTERIOMEDIAL bundle is taut in both flexion and extension
  • POSTEROLATERAL bundle is only taut in extension
  • AM and PL bundle at increased risk of injury at ~ 15 - 30 deg. of flexion d/t peak ACL shear forces
  • At terminal extension, IR tibia greatly increases strain on ACL; ER will relieve the stress
  • VARUS & VALGUS stresses increase the strain on the ACL t/o the entire ROM
  • Commonly injured when tibia is driven ANTERIORLY on the femur
  • Large portion of ACL injuries are NONTRAUMATIC (ex. cutting, pivoting)
60
Q

PCL

  • _________ than ACL
  • Origin = posterior aspect of tibia then runs ________, ________, and ________ to ACL
  • Primary restraint of tibia posterior glide on femur /c knee flexion at _______ deg.
  • Insertion = Lateral portion of the femur’s _______ condyle
A
  • STRONGER than ACL
  • Origin = posterior aspect of tibia then runs SUPERIORLY, ANTERIORLY, and MEDIALLY to ACL
  • Primary restraint of tibia posterior glide on femur /c knee flexion at 30 -90 deg.
  • Insertion = Lateral portion of the femur’s MEDIAL condyle
61
Q

Iliotibial Band

  • Inserts on ______________ (deep fibers attached to __________ joint capsule)
  • Functions as an anterolateral knee __________
A
  • Inserts on GERDY’S TUBERCLE (deep fibers attached to LATERAL joint capsule)
  • Functions as an anterolateral knee LIGAMENT
62
Q

ITB Line of Pull

  • At full extension, the angle of pull makes the ITB a knee ________
  • When the knee is flexed beyond 30 deg., the angle of pull makes the ITB a knee ________
A
  • At full extension, the angle of pull makes the ITB a knee EXTENSOR
  • When the knee is flexed beyond 30 deg., the angle of pull makes the ITB a knee FLEXOR
63
Q

Degrees of Knee Flexion During Deep Squat
0 - 60 deg. = maximum _______ shear forces
15 - 30 deg. = peak _______ shear forces
10 - 70 deg. = Max ________ EMG
80 + deg. = Max _________ EMG
50 - 90 deg. = Max __________ shear forces
~90 deg. = Max ________ shear forces
90 - 130 deg. = Max ____________ forces
90+ deg. = Max ________ EMG

A 
0 - 60 deg. = maximum ANTERIOR shear forces
15 - 30 deg. = peak ACL shear forces
10 - 70 deg. = Max HAMSTRING EMG
80 + deg. = Max QUADRICEPS EMG
50 - 90 deg. = Max POSTERIOR shear forces
~90 deg. = Max PCL shear forces
90 - 130 deg. = Max COMPRESSIVE forces
90+ deg. = Max GLUTE EMG
64
Q

Osteokinematics of Tibiofemoral Jt

  • ______ degree of freedom
  • __________ & ________ in sagittal plane
  • slight ________, _____/________ in the horizontal plane
A
  • 2 degree of freedom
  • FLEXION & EXTENSION in sagittal plane
  • slight FLEXION, IR/ER in the horizontal plane
65
Q

Flexion/Extension Tibiofemoral Jt

  • _______/_________ axis of rotation, which migrates in a _______ path known as the evolute or instant center of rotation
  • Flexion = ________ deg.
  • Hyperextension = _______ deg.
A
  • MEDIAL/LATERAL axis of rotation, which migrates in a CURVED path known as the evolute or instant center of rotation
  • Flexion = 130 - 140 deg.
  • Hyperextension = 5 - 10 deg.
66
Q

Internal/External Rotation of Tibiofemoral Jt

  • ________ or _________ axis of rotation
  • Increases /c greater knee ________
  • Knee at 90 deg. flexion allows _______ deg of total rotation
  • _____ > _____ by 2:1 ratio
  • Absent in full ________ d/t passive tension in stretched ligaments and increased bony congruity
A
  • VERTICAL or LONGITUDINAL axis of rotation
  • Increases /c greater knee FLEXION
  • Knee at 90 deg. flexion allows 40 - 50 deg of total rotation
  • ER > IR by 2:1 ratio
  • Absent in full EXTENSION d/t passive tension in stretched ligaments and increased bony congruity
67
Q

OKC - Tibiofemoral

  • During knee extension, tibia glides ________ on femur. More precisely, from 20 deg. knee flexion to full extension, tibia rotates _________
  • During knee flexion, tibia glides _________ on femur and from full knee extension to 20 deg. flexion, tibia rotates __________
A
  • During knee extension, tibia glides ANTERIORLY on femur. More precisely, from 20 deg. knee flexion to full extension, tibia rotates EXTERNALLY
  • During knee flexion, tibia glides POSTERIORLY on femur and from full knee extension to 20 deg. flexion, tibia rotates INTERNALLY
68
Q

CKC - Tibiofemoral

  • During knee extension, femur glides ________ on tibia. To be more specific, from 20 deg knee flexion to full extension, femur rotates ________ on stable tibia
  • During knee flexion, femur glides __________ on tibia and from full knee extension to 20 deg flexion, femur rotates ________ on stable tibia
A
  • During knee extension, femur glides POSTERIORLY on tibia. To be more specific, from 20 deg knee flexion to full extension, femur rotates INTERNALLY on stable tibia
  • During knee flexion, femur glides ANTERIORLY on tibia and from full knee extension to 20 deg flexion, femur rotates EXTERNALLY on stable tibia
69
Q

Tibiofemoral Osteokinematics

  • _________ directs the roll
  • Quadriceps stabilize the ________ against a posterior shear caused by the sliding femur
A
  • QUADRICEPS directs the roll

- Quadriceps stabilize the MENISCI against a posterior shear caused by the sliding femur

70
Q

Screw-Home Mechanism

  • considered a key element to knee ________ (rotation btw the tibia and femur)
  • It occurs at the end of knee extension, btw full extension and _____ deg. of knee flexion
  • ________ rotation occurs during the terminal degrees of knee extension and results in tightening of both ________ ligaments, which locks the knee. The tibia is then in the position of maximal stability /c respect to the femur
  • the tibia rotates ________ during OCK mvmt into flexion (swing phase) and _______ during CKC mvmt into extension (stance phase)
A
  • considered a key element to knee STABILITY (rotation btw the tibia and femur)
  • It occurs at the end of knee extension, btw full extension and 20 deg. of knee flexion
  • EXTERNAL rotation occurs during the terminal degrees of knee extension and results in tightening of both CRUCIATE ligaments, which locks the knee. The tibia is then in the position of maximal stability /c respect to the femur
  • the tibia rotates INTERNALLY during OCK mvmt into flexion (swing phase) and EXTERNALLY during CKC mvmt into extension (stance phase)
71
Q

Screw-Home Mechanism: Unlocking

  • NWB = _________ contraction
  • WB = unlocked via ___________, ___________, & ____________ muscles
A
  • NWB = POPLITEAL contraction

- WB = unlocked via POPLITEAL, SEMIMEMBRANOSIS, & SEMITENDINOSIS muscles

MSK 1 (4 decks)

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