Knee, leg, ankle and foot Flashcards
describe the bones of the leg *
the tibia and fibia are 2 parallel bones that articulate with each other
they have an interosseous membrane between them
tibia has medial and lateral condyles involved in articulation
the articular surfaces are called the medial and lateral tibial plateau - this is where the femer sits
the intercondylar tubercles of the intercondylar eminence are between the plateaus
tibial tuberosity is for the attachment of teh atella tendon
the distal end of the fibula and tibula have a malleolus - a pointy bit involved in the proximal ankle joint
between the distal nds of the tibia and fibia is a trough for the ankle bones to fit into
prox end of fibula is more rounded
what is the anatomical name for big toe *
hallux
describe the bones pof the feet *
have tarsal, metatarals and phalanges
tarsals - talus, navicular, cuboid and 3 cuneiforms
together the tarsals form transverse joints - allow flexibility
the tarsal called talus is involved in articulation with the leg bone
underneath the talus have the calcaneus bone - this is the heal bone and where the calcaneus tendon attaches posteriorly
have sesamoid bones at big toe in flexor hallucis brevis - when on tip toes put a lot of weight here = the seamoid bones prevent you crushing on the tendons
what are the muscular compartments involved in the knee, leg ankle and foot *
anterior compartment of leg
lateral compartment of leg
posterior compartment of the leg
intrinsic muscles of the foot - sole 4 layers, drosum 2 muscles
what muscles of teh anterior compartment of the thigh are involved in the knee *
tensor fascia latae
sartorius
quadriceps femoris
how is the fascia of the buttock and thigh relatd to the knee *
the iliotibial tract mergs with fascia distal to the knee - provides knee joint stability
what muscles of the medial compartment of the thigh are involved in the knee *
gracialis - acts across the knee joint
from inferior ramus of pubis
provides knee joint stability
what muscles from the posterior thigh are involved in the knee *
the hamstrings - semimembranous, semitendinous, biceps femoris
prox attachement is ischial tuberosity, EXCEPT shot head of the biceps comes off the shaft of femer
distal attachment - semimembranous and semitendinous: attach to tibia (tendinous anterior, membranous posterior), biceps femoris: fiula
what is dorsiflexion *
raise foot to body
movement of the dorsal side of the foot towards the leg
what is plantar flexion *
move feet away from body
when feet are planted it is goint onto tip toes (dorsi-flexion is th opposite of this)
describe the anterior compartment of the leg *
func: ankle dorsiflxors (extensors) and extend the digits
nerve: deep peroneal; nerve
blood: anterior tibial artery
muscles:
- tibialis anteior,
- extensor digitorum longus
- extensor hallucis longus (ie acts on thumb)
describe the tibialis anterior muscle *
most superficial of the anterior compartment
acts across the ankle on medial side of teh tarsals
attaches to the prox 1/2 of anterolateral tibial surface nad the interosseous membrane, lateral tibial condyle, anterior intermuscular septum and crucal fascia
tendon runs inferomedially to cross the ankle joint
attach to medial cuneiform and base of teh 1st metatarsal
INVERSION OF THE FOOT, dorsiflexor, adducts foot
deep peroneal nerve - l4 5 s1
describe extensor digitorum longus *
act on the 4 digits
attach to lateral head of the fibula, upper 2/3 of medial fibular shaft surface and upper part of the interosseous membrane, and the related surface of the lateral tibial condyle, crucal fascia
its tendon crosses the ankle medially and splits into 4 tendon slips
each of which insert on dorsm of middle and distal phalanges as part of extensor expansion
extends lateral 4 digits, weak dorsiflexor, extends foot
deep peroneal nerve l4 5 s1
describe etensor hallucis longus *
only act on hallux
attach to mid and distal anterior surface of the fibula and adjacent interosseous membrane
tendon crosses ankle centrally
insert into dorsal surface of distal phalanx of hallux
extend distal phalanx, weak dorsiflexor, weak inversion and adduction
anterior tibial a
deep peroneal nerve l4 5 s1
describe the muscles on the dorsum of tyhe foot *
have extensor hallucis brevis
extensor digitorum longus tendon and brevis (brevis si a small muscle that is covered by tendons)
describe the lateral compartment of the leg *
func: ankle evertors (pull foot so soles face laterally), can contribute to dorsiflexion
nerve: superficial peroneal nerve
blood: peroneal artery
muscles:
- peroneus longus
- peroneus brevis
- peroneus tertius - small but is present
describe peroneus longus and brevsi *
prox attachment: fibular and tibea
go behind the lateral malleoulus adn run laterally in the foot
brevis attaches to base opf 5th metacarple
longis turns and goes to the opposite side of th foot - strong evertor
describe the posterior compartment of the leg *
func: ankle plantarflexors
nerve: tibial nerve
blood: posterior tibial artery
muscles - superficial
- gastrocnemius
- soleus
- plantaris
muscles - deep
- popliteus
- flexor digitorum longus
- flexor hallucis longus
- tibialis posterior
describe the popliteus *
deep posterior muscle
associated with the knee
attachgment on lateral side of femeral condyle- fans out to attach to the upper shaft of the posterior tibia
func: unlock the knee by initiating lateral rotation of the femer on the tibia (when knee is locked it twists slightly)
describe the gastrocnemius *
has 2 heads - medial and lateral
the proximal attachment is at the posterior non-articualr surface of the femoral condyles
they coinverge to form calcaneal tendon and attach to the posterior surface of the calcaneous
plantar flex ankle, knee flexion when not weight bearing, stabalises ankle and knee when standing
poplital artery and peroneal artery, posterior tinial a
tibial nerve s1 2
describe soleus *
look like flat fish - deep to the gastrocnemius
attachs to the posterior aspect of the fibular head, the upper 1/4 of posterior surface of fbula and middle 1/3 of medial border of the tibial shaft, tendinous arch between tibial and fibular attachments, soleal line of tibia
converges with tendon of gastrocnemius to form th calcaneus tendon - inserting on the middle 1/3 of the poosterior calcaneal surface
plantarflex foot and flex knee
popliteal, peroneal and tibial a
tibial nerve s1 2
describe the triceps surae *
teh 2 heads of gastrocnemius and the 1 head of soleus form the triceps surae
the distal tendon is tendocalcaneus
describe plantaris *
small belly muscle
origin - inferior area of lateral supracondylar area of femer, medial to prox lateral head of gastrocnemius and oblique popliteal ligament of the knee
has long tendon
inserts into calcaneus bone, medial to the calcaneal tendon
has little function but is used in surgey - plantarflexes foot and flexes knee
damage to it is pauinful
describe the gastrocnemius and plantaris contribution to knee joint *
they act across the knee so prvide stability
attachment of flexor digitorum longus and tibialis posterior *
longus - attaches to distal 1/2 of postrior tibial surface
tibialis posterior - attach to posterior aspect of interoosseous membrane, superior 2/3 of medial posterior surface of the fibula and superior aspect of the posterior surface of the tibia
path of the flexor digiorum longus *
attaches to medial side of posterior surface of the tibia, crural fascia
tendon passes posterior to the medial malleolus and under the plantar aponeurosis
here the tendon divides to insert into plantar surface of distal phalanges of 2-4
flexes 2nd-5th toes, weak plantar flexor
peroneal and post tibial a
tibial n l5 s1
attachment of fibularis brevis and flexor hallucis longus *
shaft of fibular
describe the tibalis posterior, flxor digitorum longus and flexor hallucis longus *
FHL is deeper than the others
all tendons go behind the medial malleoulus and had into foot
tibialis posterior tendon attaches in tarsal region
FHL and FDL act on digits - go to distal phalanges
describe the function of the sesamoid bones in toe *
the big toe important in push off so the sesamoid protect the FHL tendon when you put weight on it
describe the sole of the foot *
4 layers
intrinsic muscles
tibial nerve
describe the dorsum of the foot *
EDB - supplid by the common peroneal nerve
EHB
function of the foot *
for most people intrinsci muscles of the foot act as shock absorbers, adjusting the foot to uneven surfaces
feet can be trained for carrying out fine movmnts eg writing dn drawing when people lack upper limbs
describe layer 1 of the foot *
muscles
- abductior digiti minimi
- flexor digitorum brevis
- abductor hallucis longus
describe layer 2 of the siole of the foot *
have th 4 lumbricles
quadratus plantae
FDL and FHL tendons from the posterior of the leg are present in this layer
describe quadratus plantae
plantar muscle in layer 2 of sole of foot
pulls on tendon of FDL and modifies its action so that FDL dioesnt pull the toes at an angle
describe layer 3 of the sole of the foot *
flexor digiti minimi brevis
flexor hallucis brevis
adductor hallucis - transverse and oblique head
muscles present in layer 4 of the sole of the foot *
dorsal and plantar interossei
peroneal longus (frol lateral compartment of leg) and tibialis posterior (from posterior compartment of leg) are seen here
what is the poopliteal fossa *
teh diamond shapd space posterior to the knee joint
boundaries of teh popliteal fossa *
biceps femoris - superiorly
semimembranosus - superiorly
lateral head of gastrocnemius - inferiorly
madial head of gastrocnemius - inferiorly
possible a contribution from plantaris muscle
skin and fsacia
femer - posteriorly
what are the contents of the popliteal fossa *
popliteal artery and vein
tibial nerve and common peroneal nerve
short saphenous vein
popliteal lymph nodes
(order serve and volly new ball -semimemranous muscle, artery, vein, nerve, biceps femoris)
describe the location of the contents of the popliteal fossa *
small saphenous vein is superficial and pierces the fascia and drains into the politeal vein
popliteal artery adn vein is deeper
the sciatic nerve divides just above popliteal fossa forming tibial and common peroneal nerve
genicular branches iof the arteries
describe the knee joint *
hinge joint - primarily allows flexion and extension - there is some gliding, rolling and rotation movement
the shapes of the distal femer and prox tibia do not allow stability
what gives the knee joint stability *
ligaments
- anterior cruciate ligament
- posterior cruciate ligament
- medial collateral ligament
- lateral collateral ligament
meniscsi
- medial meniscus
- lateral meniscus
extensor mechanism
- quandriceps
- quadriceps tendon
- patella ligament
- tibial tuberosity
bursae
- pre-patellar bursa
- popliteal bursa
what are meniscsi ie the ones that stabalise the knee joints
cartilagionous C shapes on surface of condyles of tibia
one is medial and 1 lateral
both are attached to the facets in the intercondylar region of the tibial plateau
the medial meniscus is attached around its margin to the capsule of the joint and to the tibial collateral ligament
the lateral mensiscus is attached to the capsule
therefore the lateral meniscus is more mobile
they are interconnected by the transverse ligament of the knee
lateral is also connected to the tendon of the popliteus muscle which passes supereolaterally between the meniscus and the capsule to insert on the femur
the menisci improves congruency between femoral and tibial condyles during movement
describe how the extensor mechanisms provide stabilty to the knee joint *
quadriceps act through the patella to the tibial tuberosity
patella has articulation with supracondylar region of the femer - not involved in the knee joint
describe the bursae that provide stability to the knee joint *
they are a sac found between muscle tendons and ones
reduce friction
some our out-pockets of synovial membrans of joints
if get inflammed they are dehabilitating in long term/short term ie in prepatellar bursitis
describe the bones of the knee joints *
femer comes in at an angle
the condyles form lateral femorotibial articulations and medial femorotibial articultaions
the femoral condyle is a long curved surface to allow flexion adn extension
the distal femer articultes to the proximal tibia
describe the cruciate ligaments of the femer
*
in the intercondylar region of the knee
the anterior cruciate ligament attaches to the anteriro of the intercondylar eminence of the tbia and crosses back to attach to the intercondylar fossa of femer,
posterior cruciate ligament attachs posteriorly to tuibia then goes anteriorly to to attach to the intercondylar fossa of femer
describe the collateral ligaments of the femer *
there is a lateral and medial
they prevent any abduction./adduction
lateral so string if you apply enough pressure the head of the fibula will break before the ligament will
lateral is attached to lateral femoral epicondyle and depresson in upper surface of the fibula head - separated from teh fibrous membrane by a bursa
the medial is attached to fibrous membrane, anchored superiorly to the medial and femoral epicondyle inferior to the adductor tubercle then attach to medial margin of the tibia
describe the cartilage of the tibial plateau *
the hyalin cartilage is on top of the bone, on top of this are the menisci
meniscus is attached to collateral lig - so if ligament stretches it will pull on the meniscus and possible damage it
illustrate the tendol of politus muscle on the superior view of the tibia
describe the proximal tibioibular joint *
is plane type synovial
has capsular ligaments that limit the movement
describe the distal tibiofibular joint *
fibrous joint
fibres on outside, adn ligaments hold the joint together
not at very tip of tibula
when is there movement of the tibiofibular oint *
during dorsi/plantarflexion of the foot
describe the collateral ligaments of the ankl joint *
medially - tibiotalar ligament - broad - also called delytpid ligament
lateral - all related to the fibular malleoulus: posterior talofibular and anterior talofibular (attach to the talus bone) and calcaneofibular ligament attaching to calcaneos bone
describe a sprained ankle *
one of the collateral ligaments breaks in the foot - usually lateral by over inversion
describe the location of the talus joint *
the weight baring ankle boe is the talus
it is in a square socket called a mortise sitting ion top of calcaneus
the socket is formed by distal ends of tibular and fibular
the fact that fib is held tightly to tibia maintains the stability of this
describe the joints of teh foot *
subtalar joint is the joint consists of the talo-calcaneal joint, talo-navicular joint, calcaneo-buboid joint
the talo-calcaneonavicular joint is between the navicular bone, cboid, calcaneus and talus
also have tarsometatarsal joint
the talo-calcaneonavicular jpoint is the transverse tarsal joint or the mid-tarsal joint
movement here contributs to inversion adn eversion with movment of the subtalar joint
plantarflexion and dorsiflexion occur at the ankle joinyt
the joints btween the tarsels are synovial joints
what are the arches of the foot *
medial longitudinal
laterak longitudinal
transverse metataral arch
describe teh arches of the foot *
longitudinal is formed between the posterior end of the calcaneus and the heads of the metatarsals
the medial longitudinal is higher than the lateral
transverse arch is formed from the tarsal bones - highest in coronal plane at the head of the talus
if have flat feet it reduces the efficiency of locomotion
what stabalise the arches *
the plantar aponeurosis that comes from the calconeus and fans out
ligaments ]including the spring ligament - calcaneonavicular ligament that holds the arches together, the plantar calcaneocuboid (short plantar ligament) adn long plantar ligaments
long tendons and intrinsic muscles also help eg FHL, calcaneal tendon, tibialis posterior, tibialuis anterior, peroneal longus, intrinsic plantar muscles, fibularis longus
what is the path of teh arteries *
external iliac - femoral artery at midinguinal point - profunda femoris artery and circumflex vessles
femoral arteyr continues as the superficial femoral artery and then popliteal artery which gives off genicular branches
the popliteal artyery divides to give tibial artery adn common perineal artery
anterior tibial pierces the interosseous membrane and posterior continues down the back of the leg
anterior tibial artery supplies anterior compartment, posterior tibial artery supplis the posterior compartment and peroneal artery supplis lateral compartment
at ankle the posterior tibial artery passes behind the medial malleolus supplies the sole of the feet via medial and lateral plantar arteries
anterior tibial continues across ankle adn bcomes dorsalis pedis artery supplying dorsum of foot and digits
describe the venous drainage of the region *
dorsal venous arch gives off long saphenous and short saphenous and perforating veins to the deep system
long saphenous travels 2cm above adn 2cm medial to the medial maleous up leg, behind the knee in the medial of thigh, then travels anterior and pierces through the saphenous opening and enters the femoral vein
in the leg the long saphenous anastomoses with the short, both also have perforating veins with the deepo veins of the calf
the short travels posterior to the lateral malleolus at ankle - pierce the popliteal fascia and enter the popliteal vein
describe the deep veins of the region *
they follow the arteries and have venae comittates
dorsal digital veins
posterior tibial veins
venae comitantes of arteries in deep calf
popliteal vein
femoral
external iliac
sapheno-femoral junction
venae comitants of the profunda femoris artery
perferatng veisn where blood passes from superficial to deep system
what is the motor segmental supply *
hip flexors - l2 3
hip extensors ;4 5
knee extensors l3 4
knee flexors l5 s1
ankle dorsiflexors l4 5
ankle plantar flexors s1 2
what is the segmental sensory supply *
dermatomal distribution
l5 to great toe s
s1 to lateral side of foot and sole
what is teh motor peripheral supply *
femoral nerve - knee xtensors
sciating nerve - hamstring - knee flexors
tibial nerve - posterior compartment and foot intrinsics
common perineal - anterior and lateral compartmnets
describ ethe path of the sciatic nerve *
pass from pelvis to buttock via greater sciatic notch
n buttock lis in inferior and medial quadrant
pass along anterior aspect of the thigh
divides into tibial nerve and common perineal nerve
supplies hamstring adn all muscles below knee
describe the tibial nerve 8
posterior compartment of the leg
pass behind medial malleolus - divides into medial plantar nerve and lateral plantar nerve
supply intrinsics of foot except EDB
describe the common perineal nerve &
winds around neck of fibula
deep peroneal supplies anterior compartment
superficial supplies lateral
describe the sural nerve *
formed from a branch of tibial nd common peroneal nerves
cutaneous branch
used in nerve regeneration surgery
runs distally close to the short saphenous vein towards the lateral foot
describe the sensory peripheral supply *
sensory nbranches of the femoral l2 3 4 supply the front of the thigh
saphenous nerve a branch of femoral nerve supplis a strap of skin along the inner border of the leg and ankle - this accompanies the long saphenous veinn
sural nerve a bracnch of tibial nerve in popliteal fossa, supply lateral aspect of leg and foot = accompanies the short saphenous vein
superficial peroneal - most of the dorsum of the foot
deep peroneal - a patch of skin on the dorsum of the foot at the base of the great and second toes
tibial nerve
medial and lateral plantar nerve
summarise the ankle joint *
hinge synovial joint
between the tibia (medial malleolus) fibula (lateral malleolus) and talus (talar dome)
mainly allows dorsiflexion and plantarflexion
the tibia and fibia form a bracket shaoped socket for the talus
- roof is the inferior surface of distal end of tibia
- medial is medial malleosus
- lateral end is lateral malleosus
articular surfaces are covered by hyaline cartilage
the joint is more stable when it is dorsiflexed because the wider part of the hyaline cartilage is in the joint, compared to when plantar flexed and the narrower part of the talus is in the joint
the articular cavity is surrounded by a synovial membrane - attaches around membranes of the articular surfaces and by a fibrous membrane that attaches around the synovial membranes and is attached to the adjacent bones
escribe the lymph drainage *
lymph flows with the deep and superficial veins
describe the path of the flexor hallucis longus *
attach to distal 1/2 of posterior surface of fibula and lower part of the interosseous membrane, crural fascia and posterior intermuscular septum
tendon passes posterior to medial malleolus
runs medially in foot to attach to plantar surface of the distal phalanx of hallux
flex hallux, weak plantar flexion of foot, weak inversion adn adduction of foot
peroneal a, posterior tibial a
tibial nerve l5 s1 2
describe the path and function of the tibialis posterior *
attach to the posterior surface of the interosseous membrane and adjacent regions of tibia and fibia
tendon passes posterior to the medial malleolus
under the plantar calcaneal lig
splits to attach to the navicular tuberosity and adjacent region of the medial cuneiform and bases of the 2-4th etatarsals, cuboid and sustentaculum tali of calcineus
INVERSION OF FOOT, stabalises ankle, adduction of foot, prevents hyperpronation in gait, weak plantarflexion of ankle
blood - peroneal and posterior tibial a
tibial n - l5 s1
describe the path of peroneus longus *
attach to head of fobula adn the upper 1/2 -2/3 of lateral fibular shaft surface
pass behind the lateral malleolus nad run laterally in foot
the tendon turns medially to attach at the plantar-posterolateral aspect of the medial cuneiform nad lateral side of the 1st metatarsal base
describe the path of peroneus brevis *
attaches to the inferior 2/3 of the lateral fibula surface
pass behind the lateral malleolus and runs laterally in the foot
it attaches to the lateral styloid procewss 5th metatarsal base
what is the flexor retinaculae at the ankle *
strap like layer of conective tissue that spans the bony depression formed by the medial malleolus, medial and posterior surfaces of tallus and medial surface of calcaneous and the inferior surface of the sustentaculum tali
it attaches above the medial malleolus and below and behind to the inferio-medial margin of the calcaneus
what is the extensor retinaculae of the ankle *
2 extensor retinaculae strap the extensor tendens of the extensor muscles to the ankle region and prevent tendon bowling during expression of the foot and toes
- superior extensor retinaculum - is a thickening of deep fascia in the distal leg, just superior to the ankle joint and attached to the anterior borders of the fibula and tibia
- inferiro retinaculum - y shaped, attached by its base to the lateral sideof the upper surface of the calcaneus and crosses medially over the foot to attach by one of its arms to the medial malleolus; the otehr arm wraps medially around the foot and attaches to the medial side of the polantar aponeurosis
describe the flexor hallucis brevis tendon *
distal attachment os to the latreal and medial sides of the proximal phalanx of hullux via 2 tendons - each of which contain a sesamoid bone
this allows the the long tendon of the flexor hallucis longus to run in the groove between the sesamoid bones - protecting iot during walking and running
observe on the femer the shaft, linea aspera, medial and lateral femoral condyles, mdial and latreal supracondylar lins, intecondylar fossa, femora; trochlea, medial and lateral epicondyles , adductor tubercle *
femoral trochlea is on patlla surface
intercondylar fosa is posterior
adductor tubercle is above the medial epicondyle
identofy on th tibia
medial and lateral condyle
medial and lateal tibial plateaus
intercondylar eminence
medial and lateral intercondylar tibercles
anterior and posterior intercondylar areas (where the cruciate ligamnts and menisci are attached)
tibial tuberosity,
shaft
mdial mallolus
distal articular surface for the tallus
*
identify on a fibula
head
neck
body
kateral malleolus
articular facet on lateral mallelus
malleolar fossa
head - superior end, oval/round articular facet dn styloid process
facet on malleolus - triangular facet for talus on medial side of malleolus
fossa - located behind the triangular articular fact for talus - found on its L for the L fibula and on R for the R fibula
find on the patella *
anterior surface
posterior surface
pointd apex - inferior
broad base - superior
anterior surface - convex
posterior - inclined medial and lateral articular surfaces - lateral surface longer so if put patella down it will sit on lateral side so that indicates what side of the body it is from
how many tarsus bones are there
7 `
identify the bones and tehir features in the proximal row of the tarsus
talus - trochlear (dome of talus on superior surface), body (sits on calcaneum), nck of talus, head
calcaneus (heel bone) - calaneal tuberosity, sustentaculum tali (medial side)
identify the bones and their features of the intermediate row of the tarsal bones *
navicular (little ship) - navicular tuberosity inferiorly
identify the bones of the distal row of the tarsus *
medial, intermediate and lateral cuneiform, cuboid (mnost lateral)
describe the metatarsals *
there is a single row of 5 metatarsals
1 is the big toe etc
have a body/shaft, base (at proximal end), head at distal end
describe the phalanges *
there are 3 - prox, middle and distal, in each digit xcept the great toe which has 2
have body base and head
examine the bony landmarks above the knee
medial and lateral femoral condyls - palpate anteriorly in a flexed knee
medial and lateral femoral epiconyles - palpate on the sides of the condyles superiorly
patella
adductor tubercle - above medial femoral epicondyl
medial and lateral tibial condyls
medial and lateral joint lines - palpate in a flexed knee between the condyles of the femer and tibia
head of the fibula - palpate on the lateral border of the leg at the level of the tibial tuberosity
neck of the fibula - palpate just below head
examine the bony landmarks in th kleg adn ankle
body of tubia
body of fibia = only felt distally
medial malleolus
lateral malleolus
talar done - palpate anteriorly when the ankle is fully plantar flexed
examine the feartures of the foot
calcaneus
navicular
base of the 5th metataral
head of the 1st metatarsal
the metatarso-phalangeal joint of the great toe
medial arch of the foot
lateral and transverse arches of foot
examine the sopft tissue parts in the thigh *
quad muscle
quad tendon
patella tendon
popliteal fossa
hamstring muscle
bicep femoris muscle - lateral boundary of the popliteal fossa
semitendinous - medial boundary of the popliteal fossa is innermost
smeimembranous - medial boundary of the popliteal fossa tndon is outermost
examine the tibialis anterior *
nerve - deep fibular l4 5
subject asked to turn foot in and upward - inversion
examiner grasps forefoot to opose movement
tendon becomes prominant and is palpated below and anterior to the medial malleolus
examine the extensor hallucis longus admn extensor digitorum longus *
nerve - depp fibular l4 5
subject asked to dorsiflex
examiner place palm of hand across toes - inc great toe to oppose the movement
the tendons of EHL EDL and tibialis anterior can be seen and palpated
examine ibularis longus and brevis *
nerve - superficial fibular l5 s1 s2
subject asked to evert foot - turn out and platar flex
while examiner grasps forefoot to oppose movement
the tendons become prominent and palpated below the lateral malleolus
examine the gastrocnemous, soleus muscles and teh calcaneal tendon *
nerve - tibial
subjct is asked to stand on tos
muscle bellies and calcaneal tendon can be seen and palpatd on the calf and on the posterior side of the ankle
take the popiteal artery pulse *
subject lies prone with knee flexed
palpate in inferior part of the fossa in relation to the tibia
palapate the dorsalis pedis artery pulse *
just lateral to the extensor hallucis longus tendon
palpate the posterior tibial artery pulse *
palpate just behind the middle malleolus
surface mark the long saphenous vein *
runs upars 2cm in front of medial malleolus along the mdial side of the leg, a hands width along the medial sie of the patella ad along the medial side of the thigh to the saphenous opening in the inguinal region
what are the phases of the gait cycle
- heel strike - initial contract - glut max, tibialis anterior and posterior capsule
- loading response - foot flat = quad
- midstance - triceps surae
- terminal stance - heel off triceps surae
- pressing - toe off - ectus femois, deep plantar-flexors, flexors of the toes, intrinsic foot muscles
- initial swing - contralateral abductors of the hip ileopsas and rectus femoris
- mid swing - contralateral abductors of the hip ileopsas and rectus femoris
- terminal swing - hamstrings, quadriceps femoris, tibialis anterior
stance phase is 1-4
swing phase is 5-8
which joints are flexed at each of the subphases of the joint cycle *
- hip knee
- hip ankle
- ankle
- kne ankle
- knee ankle
- knee ankle
- knee ankle
- hip
which joints are extended at each of the subphases of the gait cycle *
- ankle hip
- ankle hip
- -
- knee
- knee
- kjnee hip
- hip
during which phae of the gait cycle do the ight gluteus medius and mnimus muscles remain contracted *
2 3 4
that is when the L leg is in the air - they contract so that you dont fall over
during which part of the gait cycle are both fet on the ground *
1 4
during which part of teh gait cycle do the calf muscles contract
1
2
3
4
5
8
during which part of the gait cycle does the r ilum move in front of the l ileum
6
function iof the acl
stops the femer foving posterior relative to the tibia
function of the pcl
stops the femer moving anterior in relation to tibia
what type of joint is the interosseous membrane
fibrous
describe the intertarsal joints *
they are the subtalar, talocalcaneonavicular, calcaneocuboid joints
the talocalcaneonavicular and calcaneocuboid joints together form the transverse tarsal joint
intertarsal joints between the cuneiforms and cuneiforms and the navicular allow limited movement
joint between cuboid and navicular is normally fibrous
describe the subtalar joint *
it is between the large posterior calcaneal facet on the inferior surface of the talus and the corresponding posterior talar facet on the superior surface of the calcaneus
the articular cavity is enclosed by synovial membrane which is covered by fibrous membrane
it allows gliding and rotation - these are involved in inversion and eversion of the foot
lateral, medial and interosseous talocalcaneal ligaments stabalise the joint
the interosseous talocalcaneal ligament is in the tarsal sinus
describe the talocalcaneonavicular joint *
the head of the talus articulates with the clacaneous and the calacaneonavicular ligamnet below and the navicular in front
allows gliding and rotation movement - when combined with similar movements from the subtalar joint it allows inversion and eversion
also involved in pronation adn supination
describe the calcanecuboid joint *
synovial
between the facet on the anterior surface of the clacaneous and the corresponding facet on the posterior surface of teh cuboid
allows sliding and rotating movements involved with inversion and eversion
also contributes to pronation adn supination
describe the tarsometatarsal joints *
plane joints and allow limited sliding movement
WHEN COMBINED WITH THE TARSOMETATARSAL JOINT ARE INVOLVED IN PRONATION AND SUPINATION OF THE FOOT
describe the metatarsophalangeal joints
ellipsoid synovial
allow extension., flexion, limited adduction and abduction rotation and circumduction
describe the medial ligament of the ankle joint *
deltoid ligament
large, stroong, triangular,
apex attached above the medial malleolus
base is attacehd from tuberosity of navicular bone to infront of the medial tubercle of teh talus
the tibionavicular part attaches in front of the navicualr tuberosity nd the margin of the spring ligament - connects the navicular bone to the sustentaculum tali of the calcaneus behind
tibiocalcaneal part - attaches to sustentaculum tali of calcaneus bone
posterior tibiotalr part attaches to medial side and medial tubercle of the talus
the nateriortibiotalar part is deep to the tibionavicualr and tibiocalcaneal parts of the medial ligament and attaches to the medial surface of the talus
describe teh 3 parts of the lateral ligament of the ankle *
anterior talofibular lig - short, attaches the anterior margin of lateral malleolus to the adacent region of the talus
posterior - runs horizontally backward and medially from the malleolar fossa on the medial side of the lateral malleolus to the posterior process of teh talus
calcaneofibular - is attached above to the malleolar fossa on the posteriomedial side of the lateral malleolus and passes posteroingferiorly to attach below to a tubercle on the lateral surface of the calcaneus
attachment of peroneus tertius *
distal part of medial surface of fibula
dorsomedial surface of base of metatarsal
explain the locking mechanism of the knee that occurs at full extension*
the knee joint is locked into position - reducing the amount of muscle work needed to maintain the position
the femoral surfaces that articulate with the tibia change shape - they move to the broad flat areas on the inferior aspect of the femoral condyles, as opposed to the curved and rounded surface on the posterior condyles
the joint surfaces become larger and more stable in extension
there is also medial rotation of the femer on the tibia during extension - this tightens all of the ligaments
also the body’s centre of gravity is positioned along a vertical line that passes anterior to the knee joint
describe the anatomy of the knee joint *
synovial
articulation between the femer and tibia is weight bearing
aticulation between patella and femer which allows pull of quadriceps femoris muscle to be directed anteriorly over the knee
the fibrocartilaginous menisci accomodate changes in shape of the articular surfaces
articular surcaes are covered by hyaline cartilage - the surfaces are the superior aspect of the tibial condyle and the femoral condyles
the artiuclar surfaces and the menisci are enclosed in a single articular cavity
the synovial membrane attaches ot the margins of the articular surface and to the superior and inferior margins of the mensici
the cruciate ligaments are outside the articular cavity but enclosed in the fibrous membrane
the synovial membrane is separated from the patella by the infrapatella fat pad - on each side of the margin the membrane forms an alar fold
the synovial mebrane covering the lower part of the infrapatella fat pad is raised into the infrapatella synovial fold which attaches to the intercondylar fossa from the femur
describe the pouches formed by the synovial membrane *
teh smallest is the subpopliteal recess - extends posterolaterally from articular cavity and lies betweel lateral meniscus and popliteal tendon
teh suprapatella bursa is a continuation of the articular cavity superiorly between distal end of shaft of femer and the quadriceps femoris muscle and tendon, the apex of the bursa is attached to the small articulus genus muscle which pulls the bursa away from the joint during extension of the knee
other bursa include the subcutaneous prepatella bursa, deep and subcut infrapatella bursae
describe the fibrous membrane of the knee joint *
partly formed and reinforcesd by extensions of the tendons of surrounding muscle
on medial side it blends with tibial collateral lig, ans is attached to internal surface of meniscus
laterally - separated by a space from the fibular collateral ligament
anteriorly - attached to the margins of the patella where it is reinforced by tendinous expansions from vastus lateralis and vastus medialis muscles
it encloses the articular cavity and the intercondylar region
is reinforced anterolaterally by the liotibial tract and posteriorly by the oblique popliteal ligament
test for the stability of the posterior cruciate ligament *
posterior drawer test - a positive posterior drawer test is when the prox head of tibia can be pushed posteriorly on the femer
the pts knee is placed in a supine position and knee is flexed to 90degrees with the foot in the neutral position
teh examiner sits gently on the pts foot placing both thumbs on the tbial tuberosity and pushing the tibia back
if tibial plateau moves the posterior cruciate ligament is torn
test for the anterior cruciate liagment *
lachman’s - pt lies on bed, examiner places 1 hand around distal femur and other around prox tibia, elevates knee producing 20 degrees of flexion, pts heel rest on the couch - the examiner’s thumb must be on the tibial tuberosity, the hand on the tibia applies a brisk anteriorly directed force - if movement of tibia doesnt come to sudden stop - tear in ACL
ant4erior drawer test - same as posterior, index fingers are used to check taht the hamstrings are relaxed, while other fingers encircle the upper end of the tibia and pull it - if moves frowrd ACL is torn- other structues ie medial mesniscus must be damaged for this sign
pivot shift test - pts foot wedged between examiner’s body nda elbow, examiner places 1 hand flat under tibia, pushing it forward into knee extension, other hand is placed against pts thigh pushing it the other way. lwoer limb is taken into slight abduction by examiner’s elbow. examiner maintains anterior tibial translation and the valgus and initiates flexion of knee - at 20degrees the pivot shift will occur as the lateral tibial plateau reduces
which structures of the knee joint can be damaged in trauma *
soft tissue injuries are common
tear of ACL and PCL, meniscal tears and trauma to collateral ligaments
may ingvolve the neuromuscular bundle
