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Human Anatomy 2 > Knee and posterior leg > Flashcards

Knee and posterior leg Flashcards

1
Q

what are the articulations of the knee joint

A
  • femoral condyles to the tibial plateuas
  • patellar surface of femur with patella
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2
Q

Joint capsule of the knee

A
  • surrounds the knee
  • fibrous layer (dense CT) with a synovial membrane (loose CT to secrete synovial fluid)
  • function: seals joint space, stability aids in function of the joint
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3
Q

Ligaments of the knee

A
  • patellar ligament
  • medical collateral ligament
  • lateral collarteral ligament
  • anterior cruciate ligament
  • posterior cruciate ligament
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4
Q

Patellar ligament

A
  • runs form patella to the tibial tubercle
  • continuation of the quadricepts tendon inferiorly to the patella
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5
Q
A
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6
Q

LCL

A
  • runs from the lateral epicondyle of the femur to the fibular head
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7
Q

MCL

A
  • runs from the medial femoral condyle to the medial surface of the tibia
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8
Q

ACL

A
  • runs from anterior intercondylar area of the tibia to the posterior lateraly condyle of the femur
  • extended knee = taut
  • prevents anterior translation of tibia on femur (open chain)
  • prevents posterior translation of the femur on the tibia

APEX

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9
Q

PCL

A
  • runs from the posterior intercondylar tibia to the anterior medial condyle of femur
  • flexed = taut
  • prevents posterior translation of the tibia on the femur
  • prevents anterior translation of the femur on the tibia
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10
Q

Menisci

A
  • fibrocartilaginous ring that cushions the femoral condyles to dissipate forces
  • function: shock absorption, congruence, increase contact area, reduce frition, lubricate nutrition, joint proprioception
  • during extension = move anterior
  • during flexion = moves posterior
  • during rotation = moves opposite tibial plateau
  • blood supply :red zone = outter zone and white zone = less blood supply
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11
Q

Lateral meniscus

A
  • circular
  • more motion than medial
  • attaches to the popliteus, coronary ligaments
  • not the LCL
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12
Q

Medial meniscus

A
  • thinner than lateral
  • attaches to the MCL
  • C-shaped
  • less motion
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13
Q

Bursae of the knee

A

extensions of the capsule:

  • suprapatellar: above patella
  • subpopliteal: under popliteus
  • gastrocnemius: b/w the medial head of the gastroc and semimembranosus tendon

Independent bursa:

  • prepatellar in front of patella
  • infrapatella: nder the patellar tendon
  • deep infrapatellar: posterior to the distal portion of the patellar tendon
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14
Q

Gastrocnemius

A

Origin:
1. medial and lateral condyles

Insertion:
1. calcaneus

Action:
1. knee flexion
2. planterflexion

Innervation:
1. tibial nerve S1-S2

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15
Q

Soleus

A

Origin:
1. poximal posterior tibia
2. proximal posterior fibula

Insertion:
1. calcaneus

Action:
1. Plantarflexion

Innervation:
1. tibial S1-S2

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16
Q

Plantaris

A

Origin:
1. posterior distal shaft of femur

Insertion:
1. calcaneus

Action:
1. knee flexion
2. ankle plantarflexion

Innervation:
1. tibial S1-S2

17
Q

popliteus

A

Origin:
1. posterior tibia

Insertion:
1. Lateral femoral condyle

Action:
1. medially rotates tibia to unlock knee

Innervation:
1.Tibial L4-S1

18
Q

Flexor hallucis longus

A

Origin:
1. posterior fibula
2. interosseous membrane

Insertion:
1. distal phalanx of toe #1

Action:
1. flexes great toe
2. plantarflexion of the foot
3. inverts the foot

Innervation:
1. tibial nerve L5-S2

19
Q

Flexor digitorum longus (foot

A

Origin:
1. posterior middle tibia

Insertion:
1. distal phalanges of toes 2-5

Action:
1. action flexion of toes 2-5
2. plantarflexion of foot
3. inversion of foot

Innervation
1. tibial L5-S2

20
Q

Tibialis posterior

A

Origin:
1. posterior tibia
2. posterior fibula
3. interosseous membrane

Insertion:
1. calcaneus
2. navicular
3. cuboid
4. metatarsals 2-4
5. cuneiforms

Action:
1. plantarflexion of foot
2. inversion of foot

Innervation:
1. tibial nerve L5-S1

21
Q

Arteries of the posterior leg

A
  • femoral artery runs through the adductor hiatus and becomes popliteal
  • runs through head of gastroc
  • dives deep to soleus
  • divides into posterior tibial and anterior tibial artery
  • posterior tibial: through deep region of posterior compartment and behind medial malleolus
  • anterior tibial artery runs anteriorly through the interosseous membrane
22
Q

nerves of the posterior leg

A
  • sciatic nerve runs down the posterior thigh
  • branches into the tibial and common peroneal nerve at popliteal fossa
  • tibial nerve runs through the heads of the gastroc and under tendinous arch
  • tibial nerve supplies innervation to the posterior leg musculature
  • continutes to run down the posterior compartment and behind the medial malleolus to the foot
  • sural nerve is a branch off the tibial nerve that supplies cutaneous innervation to the posterolateral portion of the leg and foot
23
Q

Posterior compartment syndrome

A

types:

  • acute: requires medical attention due to bleeding into a compartment
  • chronic: exertional due to muscle swelling that results in them being too large for the sheath that surrounds them

chronic stop and rest once symptoms come n and then eventually they should be able to go longer without symptoms
- can also provide with STM and myofascial release

24
Q

tibial nerve entrapment

A
  • uncommon type of entrapment due to the nerve’s deep path of travel and strong protective tissue
  • causes include: posterior compartment syndrome and soleal sling
  • tibial branches into medial and lateral plnatar nerve, medial calcaneal nerve and sural nerve
25
Q

Clinical presentation of tibial nerve entrapment

A
  • sensation: tingling/numbness over posterolateral leg, lateral foot and sole of foot
  • motor: weak plantar flexion and toe flexion
  • leg discomfort at rest distrubing sleep
  • symptoms worsen with exercise
26
Q

ACL tears

MOI

A
  • contact MOI: ER + flexion + external valgus force
  • non-contant: hyperexention
27
Q

ACL tears

clinical presentation

A
  • typically hear a loud pop
  • severe pain
  • immediate swelling
  • feelings of instability in WB
  • can accompany injury to MCL and medial meniscus

Differential DX: other ligaments or bakers cyst on the posterior aspect

28
Q

ACL tears

why is it more common in

A
  • women than men?
  • when they jump women land in more extension
  • quad: hamstring strength is decreased
  • hamstrings are weaker
29
Q

Diagnostic tools for ACL: imaging

A
  • MRI: primary
  • X-ray: rule out other issues
  • US: difficult to use
  • CT: can only detect an intact ACL no accurat
30
Q

Diagnostic tests for PTs

ACL

A
  • lachman test: most sensitive and specific
  • anterior drawer: better from chronic injuries
  • pivot shift test: very specific
31
Q

ACL reconstruction

general considerations post-op

A
  • restoring joint stability and function
  • restore strength and endurance
  • ability to return to preinjury activites
32
Q

ACL reconstruction

early inerventions

A
  • brace: 6 weeks in extension
  • PRICE
  • decrease swelling will reduce inhibition of wuads
  • gait training
  • PROM/AARM
  • turning on muscles
  • asssted SLR in supine
33
Q

Achilles injury

A
  • acute rupture of the tendon that typicall occurs in the fourth to sixth decade of life
  • men>women
  • can be assoicated with Degenerative changes - typically tears 3-4 cm from insertion
  • MOI: forceful contraction of gastrocnemius during suddent acceleration or deceleration; forceful Dorisflexion
34
Q

achilles injury

clinical presentation

A
  • pain
  • swelling
  • palpation of defect
  • significant planatarflexion weakness

could be DVT = differential diagnosisi

35
Q

achilles rupture

imaging for dx

A
  • US: can determine type and level of tear
  • MRI
  • X-ray to rule out fracture
36
Q

achilles rupture

PT tests

A
  • thompson test:
  • tendon gap palpation
  • matles test: positive if decreased resting ankle plantar flexion (shoudl be about 20-30 degrees of plantarflexion at rest)
37
Q

achilles inerventions

conservative

A
  • focus on protection of tissue
  • walking boot
  • gradual weight bearing with crutches
  • ROM exercises of the ankle in neutral
  • avoiding DF past neutral
  • PRICE
  • NWB cardio
38
Q

achilles interventions

post-op

A
  • 6 weeks immobilization

protection phase:

  • encourgae proper gait
  • maintain ROM of unaffected limbs
  • preventing joint stiffness and adhesions
  • maintaining cardiovascular fitness

Intermediate phase:

  • 4-6 weeks after surgery
  • dorsiflexion ROM exercise
  • begin light resistance exercise of operated LE

Human Anatomy 2 (14 decks)

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