Knee, Leg, Ankle and Foot Flashcards
1
Q
what muscles originate from the distal femur?
A
the medial and lateral heads of the gastrocnemius
2
Q
which lines on the femur widen to form the floor of the popliteal fossa?
A
linea aspera
3
Q
what type of bone is the patella?
A
sesamoid bone (the largest in the body of its kind)
4
Q
what ligament does the patella lie within?
A
the tendon of the quadriceps femoris
5
Q
what is the natural position of the patella?
A
supero-medially , posterior surface against the femur
6
Q
position of tibia and fibula
A
tibia- medial
fibula- lateral
7
Q
where does the tibia articulate?
A
with the medial distal femur at knee joint
8
Q
what can be found at the tibia plateau?
A
medial and lateral condyles divided by the intercondylar region:
contain the ACL/PCL inferior attachments
anterior and posterior horns of the medial and lateral menisci
9
Q
where does the patellar ligament attach?
A
anterior proximal tibia at the tibial tuberosity
10
Q
where do the satoris, gracilis and semitendinous attach on the proximal tibia?
A
per anserinus
11
Q
what line is found at the posterior proximal tibia?
A
soleal line
12
Q
Is the fibula involved in the knee joint?
A
no, nor is it involved in weight bearing
13
Q
what type of joint is the tibia-fibular joint?
A
synovial
14
Q
what muscle attached to the lateral surface of the proximal fibula?
A
biceps femoris
15
Q
what type of joint is the knee joint and what are its motions?
A
Largest synovial joint in the body; Hinge-type
Gliding, Rolling and Rotation
16
Q
what are the ligaments of the knee joint?
A
ACL
PCL
Medial (Tibial) Collateral Ligaments
Lateral (Fibular) Collateral Ligaments
17
Q
what are the fibrocartilginous menisci?
what do they do?
A
Medial Meniscus
Lateral Meniscus
Cartilaginous discs which accommodate changes in the shape of the articular surfaces during joint movements
18
Q
what muscles are the extensors of the knee joint?
A
quadriceps
19
Q
what are the flexors of the knee?
A
Hamstrings Sartorius Gracilis Popliteus Gastrocnemius Plantaris
20
Q
what are the bursae around the knee?
A
Pre-patellar
Suprapatellar
Infrapatellar
Popliteus
21
Q
what does the patella enable?
A
allows the pull of the quadriceps femoris muscle to be directed anteriorly over the knee to the tibia without tendon wear
22
Q
what is the function of the intra-articular menisci?
A
Enable greater stability of the knee joint + Shock Absorber
23
Q
where do the medial and lateral menisci attach?
A
Each with respective Anterior and Posterior Horns attaching to the Intercondylar Region of the Tibia
24
Q
Which ligament is the medial meniscus attached to?
A
Tibial Collateral Ligament
Joint Capsule
25
why is the medial capsule more susceptible to injury compared to the lateral meniscus?
it is joint to the joint capsule
26
how do the menisci receive their nutrition?
Devoid of vasculature towards centre – Synovial fluid nutrient derived by hydrostatic pressure
27
how are the names of the cruciate ligaments derived?
from attachment position on Tibial Plateau
"cruciate” (Latin for “shaped like a cross”) because they cross each other in the sagittal plane between their femoral and tibial attachments
28
what is the superior and inferior attachment of the ACL?
Superior: Lateral Wall of Femoral Intercondylar Fossa
Inferior: Anterior Tibial Intercondylar region
29
what is the superior and inferior attachment of the PCL?
Superior: Medial Wall of Femoral Intercondylar Fossa
Inferior: Posterior Tibial Intercondylar region
30
ACL and PCL attachments
LAMP
31
how do you asses the ACL/PCL integrity?
ACL/PCL integrity
32
what are the bursae of the knee for?
Minimise friction generated
33
what type of tissue are the bursae?
| where do they occur?
Sacs of fibrous tissue lined with synovial membrane and filled with fluid (synovia)
Occur where parts move over one another
E.g. Around joints, where ligaments/tendons pass over bone
34
what is the inflammation of the bursae and what are the causes?
Bursitis
- Repetitive injury/pressure/friction
- Infection
- Inflammatory conditions
show typical signs of inflammation and restrict joint movment
35
how is the fibrous membrane of the knee joint formed?
Formed by extensions from tendons of the surrounding muscles
36
what does the fibrous membrane of the knee joint enclose?
Encloses the articular cavity and intercondylar region
37
what is the function of the collateral ligaments?
stabilise the hinge-like motion of the knee
there is a lateral/fibular and a medial/tibial
38
what does the full extension of the knee (locked out) enable us to do?
reduces the amount of muscle work need to maintain the standing position
39
what are the changes that take place when the knee is locked?
1) Shape of the femoral condyles – flatter/broader anteriorly stabilises the joint
2) Medial rotation of the femur on the tibia – tightens ligaments (‘Locking’ mechanism)
3) Body’s line of centre of gravity is anterior to the knee joint
40
what muscle unlocks the knee?
?popliteus
41
what is the popliteal fossa?
Diamond-shaped space posterior to the knee join
42
what is contained in the popliteal fossa?
- Popliteal artery/vein
- Short saphenous vein (becomes Popliteal vein)
- tibial nerve
- common perineal nerve
- popliteal lymph nodes
43
what are the boundaries of the popliteal fossa?
- Floor: Knee Capsule; Femur/Tibia
- Roof: deep fascia
- semitendinous
- biceps femoris long head
- gastrocnemius medial head and lateral head
44
where is the small saphenous vein contained?
in the superficial fascia
45
what are the bones of the foot?
- tarsals (7)
- metatarsals (5)
- phalanges
46
where are the sesamoid bones of the foot located?
within Flexor Hallucis Brevis; on the head of the 1st metatarsal (ball of the foot)
the FH longus transverses throught these
47
what type of joint is the ankle joint?
what movement does it enable?
synovial, hinge-like joint
Dorsi-/Plantarflexion
48
what is the meeting point of the tibia/fibula with the talus of the foot called?
mortice
49
what are the faces of the mortice?
- Roof – Inferior Surface of Distal Tibia
- Medial Side – Medial Malleolus of Tibia
- Lateral Side – Lateral Malleolus of Fibula
50
what ligaments stabilise the ankle?
medial (deltoid) and lateral ligaments
51
medial ligament attachments
to medial malleolus and
Anterior/Posterior Tibiotalar
Tibionavicular
Tibiocalcaneal
52
lateral ligament of ankle attachments
lateral malleolus and
Anterior/Posterior Talofibular
Calcaneofibular
53
which ligament is most commonly sprained
lateral ligaments
- occur during over-inversion injuries
tearing of the ligament
54
what is the subtler joint?
joint between the large posterior calcaneal facet and the inferior surface of the talus
55
action at subtler joint
gliding and rotation
| Thus, enables foot Inversion/Eversion
56
what stabilises the subtalar joint
Lateral, Medial, Posterior & Interosseous talocalcaneal ligaments
57
what type of joint is the Proximal Tibiofibular Joint?
synovial
58
what type of joint it the Distal Tibiofibular Joint?
Fibrous Joint
59
what are the motions of the posterior compartment of the leg?
Flexion of the knee
Plantarflexion
Foot inversion
Toes flexion
60
what is the innervation to the posterior compartment of the leg?
tibial
61
what are the superifical posterior muscles of the leg?
Gastrocnemius
Soleus
Plantaris
62
where do the superficial posterior muscles of the leg insert? via which tendon?
Insert into calcaneus via ‘Achilles tendon’
63
what muscles make up the triceps surae?
Gastrocnemius + Soleus = Triceps Surae
64
what are the deep posterior muscles of the leg?
Popliteus
Tibialis Posterior
Flexor Digitorum Longus
Flexor Hallucis Longus
65
action of gastrocnemius
Plantarflexion, Knee Flexion
66
proximal attachment of gastrocnemius
Medial Head – Superior to medial femoral condyle
Lateral Head - Superior to lateral femoral condyle
67
distal attachment of gastrocnemius
Calcaneal tendon
68
action of plantaris
Plantarflexion, Knee Flexion
69
proximal attachment of plantaris
Inferior part of lateral supracondylar line of femur
70
distal attachment of plantaris
Calcaneal tendon
71
action of soleus
Plantarflexion
72
proximal attachment of soleus
Soleal line and medial border of tibia
| Posterior fibular head
73
distal attachment of soleus
Calcaneal tendon
74
function of popliteus
Stabilises knee joint and limits lateral rotation of tibio-femoral joint
75
proximal attachment of popliteus
Lateral femoral condyle
76
distal attachment of popliteus
Posterior surface of tibia
77
action of tibialis posterior
Plantarflexion, Foot Inversion, Support of Medial Arch
78
Proximal attachment of tibialis posterior
Posterior interosseous membrane
| Tibia/Fibula
79
Distal attachment of tibialis posterior
Navicular Tuberosity
| Medial Cuneiform
80
action of flexor hallucis longus
Flexion of Great Toe
81
Proximal attachment of flexor hallucis longus
Posterior interosseous membrane
| Fibula
82
Distal attachment of flexor hallucis longus
Plantar surface of Base of Distal Phalanx of Great Toe
83
action of flexor digitorium longus
Flexion of Lateral 4 Toes
84
proximal attachment of flexor digitorium longus
Medial Tibia
85
distal attachment of flexor digitorium longus
Plantar surfaces of Base of Distal Phalanx of Lateral 4 Toes
86
motions of lateral compartment of the leg
Foot eversion
| Plantarflexion
87
innervation to lateral compartment of the leg
Superficial Peroneal Nerve
| Branch of Common Peroneal Nerve
88
muscles of the lateral compartment of the leg
Fibularis longus
| Fibularis brevis
89
actions of fibularis longus
Foot Eversion, Plantarflexion, Support arches of foot
90
Proximal attachment of fibularis longus
Upper lateral surface/Head of fibula
91
Distal attachment of fibularis longus
Base of 1st Metatarsal
Medial cuneiform
(The tendon of Peroneus Longus grooves the lateral malleolus, hooks around the calcaneal trochlea, grooves cuboid and then inserts at the undersurface of MEDIAL CUNEIFORM and BASE of METATARSAL I)
92
actions of fibularis brevis
Foot Eversion
93
Proximal attachment of fibularis brevis
Lower 2/3 of lateral surface of fibula
94
Distal attachment of fibularis brevis
Base of 5th Metatarsal
95
motions of anterior compartment of the leg
Dorsiflexion
Toes extension
Foot inversion
96
innervation to anterior compartment of the leg
Deep Peroneal Nerve
| Branch of Common Peroneal Nerve
97
muscles of the anterior compartment of the leg
Tibialis Anterior
Extensor Hallucis Longus
Extensor Digitorum Longus
Peroneus Tertius
98
actions of tibialis anterior
Dorsiflexion, Foot Inversion, Support of medial arch of foot
99
Proximal attachment of tibialis anterior
Lateral Tibia
| Anterior interosseous membrane
100
Distal attachment of tibialis anterior
Medial Cuneiform
| Base of 1st Metatarsal
101
actions of extensor hallucis longus
Extension of Great Toe, Dorsiflexion
102
Proximal attachment of extensor hallicus longus
Medial Fibula
| Anterior Interosseous Membrane
103
Distal attachment of extensor hallicus longus
Dorsal surface of Base of Distal Phalanx of Great Toe
104
actions of extensor digitorum longus
Extension of Lateral 4 Toes, Dorsiflexion
105
Proximal attachment of extensor digitorum longus
Medial Fibula
| Lateral Tibial Condyle
106
Distal attachment of extensor digitorum longus
Dorsal surface of Bases of Distal & Middle Phalanges of Lateral 4 Toes
via Dorsal Digital Expansions
107
actions of fibularis/peroneal tertius
Dorsiflexion, Eversion of Foot
108
Proximal attachment of fibularis teritus
Distal, Medial Fibula
109
Distal attachment of fibularis tertius
Dorsal surface of Base of 5th Metatarsal
110
what muscle tendons are found in the dorsal of foot?
Extensor Digitorum Brevis/Longus
Extensor Hallucis Brevis/Longus
111
what are the 4 layers of the sole of the foot?
from superificial to deep:
- 1st Layer: Abductor hallucis, Abductor digiti minimi, FDB
- 2nd Layer: Quadratus plantae, Lumbrical
- 3rd Layer: Adductor halluces, FHB, FDMB
- 4th Layer: 4 Dorsal / 3 Plantar interossei
112
what is the quadratus plantae?
It acts to aid in flexing the 2nd to 5th toes (offsetting the oblique pull of the flexor digitorum longus) and is one of the few muscles in the foot with no homolog in the hand.
113
what are the arches of the foot?
Medial/Lateral Longitudinal Arches & Transverse Arch
114
what is the function of the foot arches?
Absorb and distribute downward forces when standing/different surface types
115
what help support the arches of the foot?
Long tendons and Intrinsic muscles support arches
116
main arterial branches of the knee
```
Femoral
Popliteal
Lateral circumflex femoral artery
Circumflex peroneal artery
Anterior tibial artery (recurrent branch)
```
117
how does the popliteal artery enter the posterior compartment of the leg?
The popliteal artery passes into the posterior compartment of the leg between the gastrocnemius and popliteus muscles
118
what does the popliteal artery pass under as it goes down inferiorly?
inferiorly it passes under the tendinous arch formed between the fibular and tibial heads of the soleus muscle
119
what happens when the popliteal artery enters the deep region of the posterior compartment?
immediately divides into an anterior tibial artery and a posterior tibial artery
120
where does the femoral artery come through to form the popliteal artery?
Adductor Hiatus
121
what is the arterial supply to the superficial posterior compartment?
Sural arteries (2 come off the popliteal)
122
what is the arterial supply to the deep posterior compartment?
Posterior Tibial Artery
123
where does the posterior tibial artery enter the foot?
Enters Sole of Foot via Tarsal Tunnel posterior to Medial Malleolus
124
what is the arterial supply to the lateral compartment?
posterior tubular artery produces the peroneal artery which descends down the lateral part of the posterior compartment
branches of the peroneal artery penetrate intermuscular septum into lateral compartment
125
what is the arterial supply to the anterior compartment?
Anterior Tibial Artery
126
what arteries anatomise with the posterior tibial and peroneal arteries around the ankles?
Anterior Medial/Lateral Malleolar Arteries
127
what does the anterior tibial artery become in the dorsum?
Dorsalis Pedis Artery
128
what are the deep veins of the leg?
- Venae comitantes of arteries (Calf; Profunda femoris)
- Popliteal
- Femoral
129
what are the superificial veins of the leg?
Great/Small Saphenous Veins
130
what connects the superficial venous system to the deep?
perforating veins
131
origin of great saphenous vein
Medial Side of Dorsal Venous Arch
132
where does the great saphenous vein ascend?
Anterior to Medial Malleolus
| Medial side of leg, knee and thigh
133
where does the great saphenous vein drain into?
Femoral vein inferior to inguinal ligament
| Sapheno-femoral junction
134
origin of the small saphenous vein
Lateral Side of Dorsal Venous Arch
135
where does the small saphenous vein ascend?
Posterior surface of leg
136
where does the small saphenous vein drain into?
Penetrates deep fascia -->Popliteal Vein
| Popliteal vein proximal to knee become femoral vein
137
what innervates the knee extensors i.e. quadriceps?
femoral nerve
138
what innervates the knee flexors i.e. hamstrings
sciatic nerve
139
what innervates the Posterior Compartment + Foot Intrinsic Muscles?
Tibial Nerve
140
what innervates the anterior compartment?
Common Peroneal Nerve (Deep Branch)
141
what innervates the lateral compartment?
Common Peroneal (Superficial Branch)
142
pathway of sciatic nerve
Traverses from the Pelvic Cavity into Gluteal Region via
| Greater Sciatic Foramen
143
where does the sciatic nerve lie in the buttock?
inferior and medial quadrant of the buttock
144
what is the region of the sciatic nerve in the buttock used for?
Safe Area’ for IM Ventrogluteal Gluteal Injections
145
what does the sciatic nerve supply?
Supplies all muscles below the knee
146
which intrinsic foot muscle is NOT innervated by the tibial nerve?
extensor digitorium brevis
| innervated by deep peroneal nerve
147
what does the tibial nerve divide into behind the medial malleolus?
Medial plantar nerve
| Lateral plantar nerve
148
where does the sural nerve originate from?
Originates high in the leg between two heads of gastrocnemius
149
where is the sural nerve formed from?
Formed from branch of Tibial Nerve + Common Peroneal
150
what is the cutaneous innervation of the sural nerve?
Lower Posterolateral Leg
| Lateral Foot/Little Toe
151
what is a use of the sural nerve?
Harvested for Nerve Repair
152
where does the common peroneal nerve descend from?
Descends around the neck of the fibula
153
what types of injury is the common peroneal susceptible to?
Fibular Fracture
| Knee Joint Dislocation
154
what is the presentation of common Peroneal nerve palsy?
foot drop
155
what does the common peroneal nerve divide into?
Deep Peroneal Nerve
| Superficial Nerve
156
what transverse the tarsal tunnel?
```
Tibialis Posterior
Flexor Digitorum Longus
Posterior Tibial Artery, Posterior Tibial Vein
Tibial Nerve
Flexor Hallucis Longus
```
[Tom, Dick And Very Naught Harry]
157
what forms the tarsal tunnel?
Formed by Flexor Retinaculum on posteromedial side of ankle (behind Medial Malleolus
158
motor segmental supply to hip flexion
L2, L3
159
motor segmental supply to hip extension
L4, L5
160
motor segmental supply to knee extension
L3, L4
161
motor segmental supply to knee flexion
L5, S1
162
motor segmental supply to ankle dorsiflexion
L4, L5
163
motor segmental supply to ankle plantar flexion
S1, S2
164
motor segmental supply and the action of the muscle
- Most muscle groups are supplied by two adjacent spinal cord segments.
- Muscles with the same primary action on a joint have similar segmental innervation.
- The muscles causing the opposing movements are supplied by the two spinal cord segments below.
165
dermatomes of the leg
L3 to the Knee
L4 to the Floor
L5 – Great Toe
S1 – Lateral Dorsum of Foot/Sole
S2 – Most of the Posterior Leg/Thigh
166
L3 dermatome
knee
167
L4 dermatome
floor (foot)
168
L5 dermatom
great toe
169
S1 dermatome
Lateral Dorsum of Foot/Sole
170
S2 dermatome
Most of the Posterior Leg/Thigh
