Knee, leg, ankle and foot Flashcards
1
Q
What are the bones of the region?
A
Femur. Tibia. Fibula. Patella. The bones of the foot.
2
Q
What is the anatomy of the tibia and fibula?
A
- PROXIMAL TIBIA: expanded for weight-bearing with flattened medial and lateral condyles for articulation with the femur. Condyles are separated by INTERCONDYLAR EMINENCE which contains site of attachment of cruciate ligaments and menisci of the knee joint. The area of articulation is often referred to as the TIBIAL PLATEAU (or can be split into the medial and lateral tibial plateaus. Medial and lateral INTERCONDYLAR TUBERCLES are small protrusions that point inwards in the intercondylar eminence.
- SHAFT OF TIBIA: sharp anterior border, descending from TIBIAL TUBEROSITY. Interosseous border descends along LATERAL ASPECT (lateral aspect is a smooth surface). Posterior surface is widest superiorly and crossed by a roughened, oblique SOLEAL LINE.
- DISTAL TIBIA: rectangular shape with medial bony protuberance (MALLEOULUS). Lateral surface has FIBULAR NOTCH to articulate with fibula.
- FIBULA is the lateral bone of the leg and does not articulate with the knee or bear weight.
- PROXIMAL FIBULA: head is globe-shaped with a circular facet, that articulates with the lateral condyle of the tibia. Styloid process just posterolateral on the head and is a rough prominence.
- SHAFT OF FIBULA: sharp anterior border in the midshaft and rounded posterior border.
- DISTAL FIBULA: expands to form the LATERAL MALLEOLUS. MALLEOLAR FOSSA (lateral) allows attachment of posterior talofibular ligament.
- INTEROSSEUS MEMBRANE is a sheet between the tibia and fibula with a distal aperture for perforating branch of the fibular artery.
3
Q
What are the bones of the foot?
A
- TARSALS: made up of the TALUS bone (articulates with tibia and fibula), CALCANEUS (heel bone and allows attachment to the Achilles tendon posteriorly), cuboid (articulates with 4th and 5th metatarsals), navicular and cuneiform bones.
- CUNEIFORM BONES: there are THREE – medial, intermediate and lateral. These can be numbered and articulate with the 1st-3rd metatarsals.
- METATARSALS: numbered from 1 medially, to 5 laterally.
- PHALANGES: the HALLUX (big toe; 1) has just a proximal and distal phalange. All other toes have proximal, distal and middle phalanges.
- SESAMOID BONES are formed within tendons and found on the plantar (inferior) aspect of the foot. Lots of weight is placed in the hallux, and these bones prevent crushing of the tendon that runs through them.
- NOTE THE TARSOMETATARSAL and TRANSVERSE TARSAL JOINTS.
4
Q
What is the bony anatomy of the patella?
A
Anterior surface is slightly convex, posterior surface has LATERAL articular surfaces and an inclined medial surface. Patella has a pointed apex inferiorly and a broad base superiorly.
5
Q
What are the compartments of the region? (x4)
A
• Anterior compartment of the leg. • Lateral compartment of the leg. • Posterior compartment of the leg. • Intrinsic muscles of the foot – sole has 4 layers; dorsum has 2 muscles.
6
Q
What are the actions of the muscles in each compartment of the region? !!!
A
• ANTERIOR COMPARTMENT OF THE LEG: ankle dorsiflexors (extensors). • LATERAL COMPARTMENT OF THE LEG: eversion of foot. • POSTERIOR COMPARTMENT OF THE LEG: ankle plantarflexors. • INTRINSIC MUSCLES OF THE FOOT: foot absorbers, adjusting the foot to uneven surfaces. These muscles can also be ‘trained’ for carrying out fine movements, such as writing and drawing. Individuals lacking upper limbs are able to use their feet to carry out a variety of fine activities.
7
Q
Note about muscles of the thigh.
A
Many/most of the muscles of the compartments of the thigh have actions over the knee joint: all muscles of the anterior compartment of the thigh are KNEE EXTENSORS (apart from ilio-psoas and pectineus); all muscles of the posterior compartment of the thigh are KNEE FLEXORS; the gracilis of the medial compartment of the thigh acts across the knee joint. [Revise ‘Hip, buttock and thigh’ before revising these flashcards.]
8
Q
What are the muscles of the anterior compartment of the thigh? (x4)
A
• Tibialis anterior. • Extensor digitorum longus. • Extensor hallucis longus. • Fibularis tertius.
9
Q
What are the attachments of the tibialis anterior? Functions? (x2)
A
- PROXIMAL: lateral surface of the tibia and adjacent interosseus membrane.
- DISTAL: medial cuneiform and adjacent surfaces on base of metatarsal I.
- FUNCTIONS: dorsiflexion of foot at ankle joint; inversion of foot.
10
Q
What are the attachments of the Extensor digitorum longus? Functions? (x2)
A
- PROXIMAL: proximal one-half of medial surface of fibula.
- DISTAL: via dorsal digital expansions, into bases of distal and middle phalanges of lateral four toes.
- FUNCTIONS: extension of lateral four phalanges and dorsiflexion of foot.
11
Q
What are the attachments of the Extensor hallucis longus? Functions? (x2)
A
- PROXIMAL: middle one-half of medial surface of fibula and adjacent surface of interosseous membrane.
- DISTAL: dorsal surface of base of distal phalanx of hallux.
- FUNCTIONS: extension of great toe and dorsiflexion of foot.
12
Q
What are the attachments of the Fibularis tertius? Functions? (x2)
A
- PROXIMAL: distal part of medial surface of fibula.
- DISTAL: dorsomedial surface of base of metatarsal V.
- FUNCTIONS: dorsiflexion and eversion of foot.
13
Q
What is the surface anatomy of the tendons of the anterior and compartment of the leg, on the dorsum of the foot?
A
- (Extensor hallucis brevis – intrinsic muscle of the foot.)
- Fibularis tertius.
- Extensor digitorum longus.
- Extensor hallucis longus.
- Not a tendon – don’t need to know.
- Tibialis anterior.
14
Q
What are the muscles of the lateral compartment of the leg? (x2)
A
Peroneus Longus and Peroneus brevis (also known as fibularis longus/brevis).
15
Q
What are the attachments of the Peroneus Longus? Functions? (x2)
A
- PROXIMAL: upper lateral surface of the head of the fibula.
- DISTAL: distal end of medial cuneiform and base of metatarsal I.
- FUNCTIONS: Eversion and plantarflexion of foot.
16
Q
What are the attachments of the Peroneus brevis? Function?
A
- PROXIMAL: lower two-thirds of lateral surface of shaft of fibula.
- DISTAL: lateral tubercle at base of metatarsal V.
- FUNCTIONS: eversion of foot.
17
Q
What are the muscles of the posterior compartment of the leg? (x7)
A
• SUPERFICIAL: • Gastrocnemius. • Soleus. • Plantaris. • DEEP: • Popliteus. • Flexor Digitorum Longus. • Flexor Hallucis Longus. • Tibialis Posterior.
18
Q
What are the attachments of the gastrocnemius? Functions? (x2)
A
- PROXIMAL: MEDIAL HEAD – superior to medial condyle of distal femur; LATERAL HEAD – lateral femoral condyle.
- DISTAL: via the calcaneal (Achilles) tendon to the posterior surface of the calcaneus.
- FUNCTIONS: plantarflexion and flexion of the knee.
19
Q
What are the attachments of the Soleus? Function?
A
- PROXIMAL: soleal line and medial border of tibia; posterior aspect of fibular head/neck/shaft; tendinous arch between tibial and fibular attachments.
- DISTAL: via the calcaneal (Achilles) tendon to the posterior surface of the calcaneus.
- FUNCTIONS: plantarflexion.
20
Q
What do the gastrocnemius form?
A
Gastrocnemius (2 heads) and Soleus (1 head) together form TRICEPS SURAE.
21
Q
What are the attachments of the Plantaris? Functions? (x2)
A
- PROXIMAL: lateral supracondylar line of the femur/oblique popliteal ligament of the knee.
- DISTAL: via the calcaneal (Achilles) tendon to the posterior surface of the calcaneus.
- FUNCTIONS: plantarflexion and flexion of the knee.
22
Q
What are the attachments of the Popliteus? Functions? (x3)
A
- PROXIMAL: lateral femoral condyle.
- DISTAL: posterior surface of proximal tibia.
- FUNCTIONS: stabilizes and unlocks the knee joint to allow flexion (from standing, locked extension position). It also medially rotates tibia on the femur if the femur is fixed (sitting down) or laterally rotates femur on the tibia if tibia is fixed (standing up).
23
Q
What are the attachments of the Flexor Digitorum Longus? Function?
A
- PROXIMAL: posterior surface of tibia.
- DISTAL: plantar surfaces of bases of distal phalanges of the lateral four toes.
- FUNCTIONS: flexes lateral four toes.
24
Q
What are the attachments of the Flexor Hallucis Longus? Function?
A
- PROXIMAL: posterior surface of fibula and the adjacent interosseous membrane.
- DISTAL: plantar surface of distal phalanx of hallux.
- FUNCTIONS: flexes great toe.
25
What are the attachments of the Tibialis Posterior? Functions? (x2)
* PROXIMAL: posterior surfaces of interosseous membrane and adjacent regions of tibia and fibula.
* DISTAL: tuberosity of navicular and adjacent region of medial cuneiform.
* FUNCTIONS: inversion and plantarflexion of foot.
26
What are the intrinsic muscles of the SOLE of the foot? (x10)
* SOLE OF THE FOOT – LAYER 1:
* Abductor hallucis.
* Flexor digitorum brevis.
* Abductor digiti minimi.
* SOLE OF THE FOOT – LAYER 2:
* Quadratus plantae.
* Lumbricals.
* SOLE OF THE FOOT – LAYER 3:
* Flexor hallucis brevis.
* Adductor hallucis.
* Flexor digiti minimi brevis.
* SOLE OF THE FOOT – LAYER 4:
* Dorsal interossei.
* Plantar interossei.
27
What is the anatomy and function of the muscles of Layer 1 of the sole of the foot?
* Abductor hallucis, Flexor digitorum brevis, and Abductor digiti minimi.
* PROXIMAL ATTACHMENT of the three muscles: calcaneal tuberosity (postero-inferior surface).
* DISTAL ATTACHMENTS: adductor hallucis – medial side of base of proximal phalanx of hallux; flexor digitorum brevis – sides of plantar surface of middle phalanges of lateral four toes; abductor digiti minimi – lateral side of base of proximal phalanx of little toe.
* FUNCTIONS: AH – abducts and flexes the great toe at the MTPJ; FDB – flexes lateral four toes at the IPJ; ADM – abducts little toe at the MTPJ.
28
What is the anatomy and function of the muscles of Layer 2 of the sole of the foot?
* Quadratus plantae and lumbricals.
* PROXIMAL: QP – medial surface of calcaneus and lateral process of calcaneal tuberosity; Lumbricals – lumbricals attach on the medial side of the tendon of flexor digitorum longus associated with each toe. 1st lumbrical attaches to tendon of toe II --\> 4th lumbrical attaches to tendon of 5th toe.
* DISTAL: QP – lateral side of tendon of flexor digitorum longus in proximal sole of the foot. Lumbricals – extensor hoods of toes II-V.
* FUNCTIONS: QP – assists flexor digitorum longus tendon in flexing toes II-V. Lumbricals – flexion of MTP joints and extension of IP joints.
29
What is the anatomy and function of the muscles of Layer 3 of the sole of the foot?
* Flexor hallucis brevis, flexor digiti minimi brevis, and adductor hallucis.
* PROXIMAL: FHB – plantar surface of cuboid and lateral cuneiform; AH – TRANSVERSE HEAD (ligaments associated with MTPJs of lateral three toes) and OBLIQUE HEAD (bases of metatarsals II to IV and from sheath covering fibularis longus; FDMB – base of metatarsal V and related sheath of fibularis longus tendon.
* DISTAL: FHB – lateral and medial sides of base of proximal phalanx of hallux; AH – lateral side of base of proximal phalanx of hallux; FDMB – lateral side of base of proximal phalanx of little toe.
* FUNCTIONS: FHB and FGMB flex their respective toes at the MTP joint; AH adducts the great toe at the MTP joint.
30
What is the anatomy and functions of the muscles of Layer 4 of the sole of the foot?
* Dorsal and plantar interossei.
* PROXIMAL: DI – side of adjacent metatarsals; PI – medial sides of metatarsals of toes III-V.
* DISTAL: extensor hoods and bases of proximal phalanges of toes II-VI (III-V for PI).
* FUNCTION: DI – ABDUCTION of toes II-IV at MTP joints; PI – ADDUCTION of toes III-V at MTP joints.
31
What are the muscles of the dorsum of the foot? (x2)
Extensor hallucis brevis and extensor digitorum brevis.
32
What are the attachments of the extensor hallucis brevis? Function?
* PROXIMAL: calcaneus.
* DISTAL: proximal phalanx of the hallux.
* FUNCTION: extends hallux.
33
What are the attachments of the extensor digitorum brevis? Function?
* PROXIMAL: dorsal surface of calcaneus.
* DISTAL: proximal dorsal region of middle phalanges II-IV.
* FUNCTION: extends digits II-IV.
34
What are the movements of the foot? (x8)
* Adduction and abduction.
* Plantarflexion (tiptoes) and dorsiflexion (stand on heel).
* Inversion (on later arch of foot) and eversion (on medial arch of foot).
* Supination (plantarflexion and adduction) and pronation (dorsiflexion and abduction).
35
What is the popliteal fossa?
The diamond shaped space posterior to the knee joint – an area of transition between the thigh and leg.
36
What are the boundaries of the popliteal fossa?
* UPPER: medially by the distal semitendinosus/membranosus and laterally by biceps femoris muscle.
* LOWER: medially by medial head of gastrocnemius and laterally by the lateral head of the gastrocnemius and plantaris.
37
What are the contents of the popliteal fossa?
Popliteal artery, vein, tibial nerve, and common fibular (aka peroneal) nerve (MEDIAL--\>LATERAL). Branches from the common peroneal and tibial nerves also unite to form the sural nerve in this region, which descends between the two nerves. The short saphenous vein (superficial) pierces the fascia covering the fossa from the popliteal vein (deep) and runs close to the sural nerve distally.
38
What are the articulations at the knee joint? Type of joint?
* Hinge-type synovial joint that consists a weight-bearing articulation between the femur and tibia and non-weight bearing articulation between the femur and patella – femoropatellar articulation.
* The femoropatella articulation increases the leverage that the quadriceps femoris (which is attached to the patella) can exert on the femur by increasing the angle at which it acts.
* The femur articulates with the tibia at an angle: the axis of the tibia is not parallel with the axis of the femur.
* In the femorotibial articulation, there is a medial and lateral articulation (with the lateral and medial condyles of each bone). The femur has extended condyles, which permits the hinge-like flexion and extension at the joint.
39
Stability of the knee joint? Anatomy of ligaments?
* The shapes of the bones involved (distal femur and proximal tibia) do not produce a stable arrangement.
* They therefore heavily rely on ligaments for STABILITY.
* ANTERIOR and POSTERIOR CRUCIATE LIGAMENTS: these are ligaments of the intercondylar region that connect the tibia and femur. Anterior connects anterior intercondylar area of tibia to lateral wall of intercondylar fossa of femur; posterior connects intercondylar area of tibia to medial wall of intercondylar fossa of femur.
* MEDIAL and LATERAL COLLATERAL LIGAMENTS: lateral (or FIBULAR) attaches superiorly to lateral epicondyle of femur and inferiorly to lateral fibular head; medial (or TIBIAL) is broader and attaches superiorly to medial epicondyle and inferiorly to the medial margin of the tibia behind the tendon attachment.
* PATELLAR LIGAMENT: continuation of the quadriceps femoris tendon encapsulating the sesamoid patella bone – attached to tibial tuberosity.
40
What are the menisci of the knee joint? Attachments? Purpose?
There are MEDIAL and LATERAL menisci in the knee joint. These are fibrocartilaginous C-shaped cartilages which are attached to facets in the intercondylar region of the tibial plateau which improve congruency (fluidity of movement) of condyles during joint movements. MEDIAL is attached to capsule of joint and MEDIAL COLLATERAL LIGAMENT; LATERAL is NOT attached to capsule joint but is attached to the popliteus tendon. The medial and lateral menisci are joined anteriorly by the TRANSVERSE LIGAMENT of the KNEE.
41
What are the bursae of the knee joint? Function?
Small fluid-like sacs lined by synovial membrane with an inner capillary layer of viscous synovial fluid. It provides a cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement.
42
What happens in bursae inflammation?
Bursitis – very painful.
43
What are the major bursae of the knee joint? (x3)
Pre-patellar bursa (red), pre-patellar tendon bursa (red) and popliteal bursa (Baker’s cyst).
44
What are the movements at the knee joint? (x4)
Extension, flexion, lateral rotation, medial rotation.
45
What is the anatomy of the proximal tibiofibular joint?
Is a plane-type SYNOVIAL JOINT between lateral condyle of tibia and superomedial head of fibular. The articulation is reinforced by capsular ligaments which limit movement.
46
What is the anatomy of the distal tibiofibular joint?
It is a FIBROUS JOIINT (ligaments) and allows only SLIGHT hinge movement during dorsiflexion/plantarflexion of the foot.
47
What happens in a sprained ankle?
Occurs from strain to the collateral ligaments of the ankle joint.
48
What are the two collateral ligaments of the ankle joint?
Medial ligament of the ankle joint, and lateral ligament of the ankle.
49
What is the anatomy of the medial ligament of the ankle joint?
MEDIAL LIGAMENT OF THE ANKLE JOINT: split into the TIBIONAVICULAR part (attaches to the tuberosity of the navicular bone), TIBIOCALCANEAL part (attached to calcaneus – also called DELTOID LIGAMENT), POSTERIOR RIBIOTALAR part (attaches to medial side, talus), and ANTERIOR TIBIOTALAR part (attaches to medial talus).
50
What is the anatomy of the lateral ligament of the ankle joint?
LATERAL LIGAMENT OF THE ANKLE JOINT: composed of three separate ligaments: ANTERIOR TALOFIBULAR LIGAMENT (short ligament attaching the anterior margin of the lateral malleolus to the talus), POSTERIOR TALOFIBULAR LIGAMENET (attaches malleolar fossa to posterior process of talus, and CALCANEOFIBULAR LIGAMENT (attaches malleolar fossa of lateral malleolus, to a tubercle on the lateral calcaneus posteroinferiorly).
51
What is the susceptibility to damage of the each of the ligaments of the ankle joint? (x2 points)
The lateral ligaments are commonly damaged by over-inversion. The broader and tougher tibiocalcaneal (deltoid) ligament is less often damaged.
52
What is the anatomy of the ankle joint?
The TALUS is the weight-bearing part of the ankle joint via its superior articulation with the tibia. The fibula is not weight-bearing, but it’s distal lateral malleolus – with the tibia’s medial malleolus – forms the square socket of the ankle joint.
53
What are the joints of the foot? (x8) !!!
* Subtalar joint – between the talus and calcaneus.
* Midtarsal joint – includes the CALCANEOCUBOID JOINT between the calcaneus and cuboid, and the TALOCALCANEONAVICULAR JOINT between the talus, calcaneus and navicular.
* Tarsometatarsal joints: between the cuneiform and cuboid bones, and the metatarsals.
* Intermetatarsal joints.
* Metatarsophalangeal (MTP) joints.
* Interphalangeal (IP) joints.
* Together, the TALONAVICULAR part of the talocalcaneonavicular joint and the calcaneocuboid joint forms the TRANSVERSE TARSAL JOINT (indicated by red dotted line) aka the MID-TARSAL joint.
* Together, the TALOCALCANEAL part of the talocalcaneonavicular joint and the subtalar joint forms the SURGICAL SUBTALAR JOINT.
54
What are the arches of the foot? (x3)
* Medial longitudinal, marked from the medial three phalanges of the foot.
* Lateral longitudinal, LOWER than the medial arch, marked from the lateral two phalanges.
* Transverse metatarsal arches – formed from tarsal bones (cuneiform and cuboid bones).
55
What are the structures that maintain the arches of the foot?
LIGAMENTS and MUSCLES. Ligaments include the plantar calcaneonavicular ligament (SPRING ligament), plantar calcaneocuboid (short plantar ligament), long plantar ligaments and the plantar aponeurosis. Muscles provide DYNAMIC SUPPORT for the arches during walking, including the tibialis anterior and posterior, and the fibularis longus.
56
What is the arterial supply of the region?
* Femoral artery passes through the adductor hiatus to become the POPLITEAL ARTERY in the distal thigh.
* Popliteal splits at knee to form Posterior and Anterior Tibial Arteries.
* Anterior tibial artery passes through the aperture in the interosseous membrane enter anterior compartment of the leg and travels with the deep fibular (peroneal) nerve.
* Posterior tibial artery remains in the posterior compartment but forms the FIBULAR (PERONEAL) ARTERY for the lateral compartment. This branching happens so close to the original branching of the popliteal artery, it is collectively known as POPLITEAL TRIFURCATION.
* Anterior tibial artery becomes the DORSALIS PEDIS ARTERY in the foot and supplies the dorsum of the foot and the digits.
* Posterior tibial artery supplies the sole of the foot via the MEDIAL and LATERAL PLANTAR ARTERIES.
57
What is the venous drainage of the region?
• SUPERFICIAL VEINS: DORSAL VENOUS ARCH drains into the GREAT SAPHENOUS VEIN and the SMALL SAPHENOUS VEIN. Great saphenous vein passes anteriorly to the medial malleolus at the ankle and drains into the FEMORAL VEIN at the groin. Small saphenous vein ascends posteriorly to the lateral malleolus at the ankle and drains into the POPLITEAL VEIN at the popliteal fossa. • DEEP VEINS: mirrors the arterial supply, with venae comitantes. Includes dorsal digital veins, posterior tibial veins, popliteal vein and perforating veins whereby blood normally passes from the superficial to the deep systems.
58
How are the compartments of the region innervated? !!!
• ANTERIOR COMPARTMENT OF THE LEG: deep fibular (peroneal) nerve. • LATERAL COMPARTMENT OF THE LEG: superficial fibular (peroneal) nerve. • POSTERIOR COMPARTMENT OF THE LEG: tibial nerve. • SOLE OF THE FOOT: medial and lateral plantar nerve from the tibial nerve. • DORSUM OF THE FOOT: common peroneal nerve (both deep and superficial fibular nerves).
59
What are the lumbar divisions of the motor peripheral supply of the region? (x3)
• DEEP PERONEAL (FIBULAR) NERVE – L45S1. • SUPERIFICAL PERONAL (FIBULAR) NERVE – L5S12. • The above collectively form the common peroneal nerve. • TIBIAL NERVE – L45S123. NB: medial and lateral plantar nerves are innervated by later lumbar segments, S123.
60
What is the motor segmental supply of the region?
• Knee Extensors – L34. • Knee Flexors – L5S1. • Ankle Dorsiflexors – L45. • Ankle Plantarflexors – S12.
61
What is the sensory segmental supply of the region?
Remember, L3 to the knee an L4 to the floor. L5 to the great toe, S1 to the lateral side and sole of the foot. Remember, the photo shows two different interpretations of the dermatome.
62
What is the course of the sciatic nerve in relation to the region?
Passes from the pelvis to the buttock via the greater sciatic notch/foramen. In the buttock, it lies in the inferior and medial quadrant. The sciatic nerve then passes along the posterior aspect of the thigh and divides into the TIBIAL and COMMON PERONEAL NERVE. This supplies the hamstring muscles and all the muscles below the level of the knee.
63
What is the course of the tibial nerve?
Passes behind the medial malleolus to divide into medial plantar and lateral plantar nerve.
64
What is the course of the peroneal nerve?
Winds around the neck of the fibula.
65
What is the sural nerve? Clinical significance?
The Sural nerve is formed from a branch of the tibial nerve and a smaller branch from the common peroneal nerve. CLINICAL SIGNIFICANCE: can be used in nerve repair.
66
How is the semitendinosus and semimembranosus differentially palpated?
Semitendinosus is the medial boundary of the popliteal fossa, and the tendon is innermost. Semimembranosus is also the medial boundary of the popliteal fossa, but tendon is outermost.
67
How do you palpate the tibialis anterior?
Subject is asked to turn the foot inward and upward (inversion) while the examiner grasps the forefoot to oppose the movement. The tendon becomes prominent and is palpated just below and anterior to the medial malleolus.
68
How do you palpate the extensor hallucis longus?
Subject is asked to dorsiflex the toes while the examiner places the palm of his hand across the toes (including the great toe) to oppose the movement. The tendons of EHL, EDL and tibialis anterior can be seen and palpated.
69
How do you palpate the extensor digitorum longus?
Same test as extensor hallucis longus.
70
How do you palpate the fibularis longus and fibularis brevis?
Subject is asked to turn the foot outward and plantar flex (eversion) while the examiner grasps the forefoot to oppose the movement. The tendons become prominent and palpated just below the lateral malleolus.
71
How do you palpate the gastrocnemius, soleus muscle and calcaneal (Achilles) tendon?
Subject is asked to stand on the toes. The muscle bellies and the calcaneal tendon can be seen and palpated in the calf area and on the posterior side of ankle.
72
How is the popliteal artery pulse palpated?
Knee flexed – palpated in the inferior part of the fossa in relation to the tibia.
73
How is the dorsalis pedis artery pulse palpated?
Palpate just lateral to the extensor hallucis longus tendon.
74
How is the posterior tibial artery pulse palpated?
Palpate just behind the medial malleolus.
75
What is the tarsal tunnel?
Formed by depression formed by medial malleolus of tibia, medial surfaces of talus/calcaneus, and overlying flexor retinaculum. It is formed MEDIALLY.
76
What are the contents of the tarsal tunnel?
Tendon of tibialis posterior, flexor digitorum longus and flexor hallucis longus, posterior tibial artery and tibial nerve.
77
What are the extensor retinacula at the ankle?
Extensor retinaculum is a thickening of deep fascia of the foot. The SUPERIOR extensor retinaculum extends from the distal end of the fibula and medially to the tibia and binds down the tendons that run anteriorly. The INFERIOR extensor retinaculum is Y-shaped attached to the calcaneus and wraps medially around the medial malleolus and to the plantar aponeurosis; it also holds down tendons and vessels.
78
Explain the locking and unlocking mechanisms of the femur? [This is in the spec but was not mentioned whatsoever in lectures or living anatomy.]
* LOCKING – FEMUR ARTICULATION: During flexion, areas of femur articulating with tibia are the curved/rounded areas on the posterior aspects of the condyles. During extension the surfaces move to the broad and flat areas on the inferior aspects of the femoral condyles. Increases surface area and stability of extension.
* LOCKING - FEMUR ROTATION: Medial rotation of the femur on the tibia occurs, tightening the associated ligaments.
* UNLOCKING: popliteus muscle unlocks by initiating lateral rotation of femur on the tibia.
