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MSK 2 > LE Joints > Flashcards

LE Joints Flashcards

1
Q

Articulating parts of hip

A

Femur (femoral l.) and acetabulum

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2
Q

4 parts of the acetabulum

A
  1. acetabular notch
  2. acetabular fossa
  3. lunate surface of the acetabulum: articular area
  4. acetabular rim (acetabular labrum attached)
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3
Q

What type of joint in the hip?

A

ball and socket- largest ROM secondary to shoulder

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4
Q

Acetabulum joint

A
  • irradiate (“shiny”) cartilage with 15 degree anteverted and 45 degree caudal tilt
  • fully fuses between 15-25 yo
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5
Q

7 Ligaments involved in acetabulofemoral joint

A
  1. transverse acetabular l.
  2. acetabular labrum: fibrocartilaginous rim to margin of acetabulum
  3. Articular capsule of the acetabulofemoral joint: fibrous capsule and internal synovial membrane
    - - 4. Iliofemoral l
    - - 5. pubofemoral l
    - - 6. Ischiofemoral l
  4. L. of the Head of the Femur
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6
Q

Ligaments of joint capsule of hip bone and function

A
  1. Iliofemoral (anterior and posterior): prevent hyperextension
  2. Pubofemoral l. (anterior and inferior)
    - anterior are strongest
  3. Ischiofemoral l. (posterior, weakest)
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7
Q

Iliofemoral l. attachments and function

A
  • Attachments: AIIS and acetabular rim (proximally) and intertrochanteric line (distally)
  • strongest ligament of body
  • prevent hyperextension of hip while standing by screwing femoral head into acetabulum
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8
Q

What is the strongest ligament of the body?

A

iliofemoral l.

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9
Q

Pubofemoral ligament attachments

A

obturator crest to IT line (merges with fibrous layer of joint capsule)

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10
Q

Pubofemoral ligament function

A

prevents overabduction and hyperextension

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11
Q

Iliofemoral ligament function

A
  • prevent hyperextension of hip while standing by screwing femoral head into acetabulum
  • reinforced by rectus femoris and iliopsoas
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12
Q

Ischiofemoral l origin and insertion

A

ischial part of acetabular ring to femoral neck, medial to base of greater trochanter

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13
Q

Vasculature of the hip joint (3)

A
  1. Main: retinacular arteries from circumflex femoral a.
  2. medial and lateral circumflex femoral arteries:
    - medial: underneath capsule posterior
    - lateral: pierces Ischiofemoral L.
  3. Artery to head of femur: (only 0-4 yo) (branch of Obturator A)
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14
Q

What are the 5 ligaments/cartilage of the bony pelvis?

A
  1. Obturator membrane
  2. Inguinal L.
  3. Pubic symphysis: 4) superior and 5) inferior pubic l.
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15
Q

What are the 2 ligaments of the sacroiliac joint?

A
  1. Sacrospinous L

2. Sacrotuberous L

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16
Q

What are the 11 ligaments of the knee?

A
  1. Articular capsule of the knee
    * Extracaosular l
  2. Patellar L.
  3. Fibular (Lateral) Collateral L.
  4. Tibial (Medial) Collateral L.
  5. Oblique Popliteal L.
  6. Arcuate Popliteal L.
    * Intraarticular l.
  7. Anterior Cruciate L
  8. Posterior Cruciate L.
  9. Coronary L. of the Knee
  10. Transverse L. of the Knee
  11. Posterior Meniscofemoral L
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17
Q

What are the 5 extracapsular ligaments of the knee?

A
  1. Patellar L.
  2. Fibular (Lateral) Collateral L.
  3. Tibial (Medial) Collateral L.
  4. Oblique Popliteal L.
  5. Arcuate Popliteal L.
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18
Q

What are the 5 intracapsular ligaments of the knee?

A
  1. Anterior Cruciate L
  2. Posterior Cruciate L.
  3. Coronary L. of the Knee
  4. Transverse L. of the Knee
  5. Posterior Meniscofemoral L
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19
Q

What are the 4 ligaments of the tibiofibular joint?

A
  1. Superior tibiofibular L.
  2. Posterior inferior tibiofibular L.
    * Tibiofibular syndesmosis
  3. Interosseous membrane
  4. Anterior inferior Tibiofibular L.
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20
Q

What are the 3 joints involving the talus bone?

A
  1. Talocrural joint
  2. Talocalcaneal (subtalar) joint
  3. Transverse tarsal joint: talocalcaneonavicular joint
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21
Q

What are the 2 ligaments of the talocrural joint and each of their subligaments?

A
  1. Lateral L of the Ankle
    - Anterior Talofibular L
    - Posterior Talofibular L
    - Calcaneofibular L
  2. Medial L. of the Ankle
    - Anterior Tibiotalar L.
    - Posterior Tibiotalar L.
    - Tibionavicular L.
    - Tibiocalcaneal L.
    - Plantar calcaneonavicular l.
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22
Q

What are the 5 ligaments within the Medial L. of the Ankle “deltoid L”

A
  • Anterior Tibiotalar L.
  • Posterior Tibiotalar L.
  • Tibionavicular L.
  • Tibiocalcaneal L.
  • Plantar calcaneonavicular l.
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23
Q

What are the 3 ligaments within the Lateral L. of the Ankle

A
  • Anterior Talofibular L
  • Posterior Talofibular L
  • Calcaneofibular L
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24
Q

What are the two joints within the transverse tarsal joint?

A
  1. Talocalcaneonavicular joint

2. Calcaneocuboid joint

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25
Q

What is the ligament of the Talocalcaneonavicular joint

A

Plantar calcaneonavicular L.

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26
Q

What are the ligaments of the Calcaneocuboid joint

A
  1. Plantar calcaneocuboid (spring) L.

2. Long plantar L

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27
Q

What are the movements permitted at the acetabulofemoral joint?

A
  1. Flex/Extend
  2. Abd/ADd
  3. Medial/Lat Rotation
  4. Circumduction
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28
Q

What are the 4 nerves supplying the hip?

A

Articular rami from intramuscular rami

  1. Femoral N: Anterior (hip flexors)
  2. Obturator N: Inf/Post (lateral rotators)
  3. N. to Quadratus Femoris: inferior (lateral rotators)
  4. Superior gluteal N.: superior (abductors)
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29
Q

What do the sacrospinous and sacrotuberous ligaments produce?

A

ligamentous borders produce greater and lesser sciatic foramen

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30
Q

Calcar Femorale

A
  • dense, vertically oriented bone in posteromedial aspect of proximal femur
  • fractures unstable vs stable
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31
Q

Ligament of Head of the Femur: O/I, function

A
  • Acetabular notch/transverse acetabular L to fovea
  • Synovial fold: conducts artery to head of femur (from Obturator A)
  • Minimal contribution to stability
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32
Q

Labrum O/I and Function

A
  • Fibrocartilaginous rim to margin of acetabulum

- increase acetabular articular area by 10%

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33
Q

Transverse acetabular L

A

Cont of labrum inferiorly over acetabular notch

-increase acetabular articular area by 10%

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34
Q

Hilton’s Law in regard to innervation of hip

A

nerve supplying muscles extending directly across and acting at hip, also contribute to innervation of that hip

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35
Q

What muscles flex the hip?

A
  1. Iliopsoas
  2. Sartorius
  3. Tensor fascia lata
  4. Rectus femoris
  5. Pectineus
  6. Adductor longus
  7. Adductor brevis
  8. Adductor Magnus - anterior
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36
Q

What is the strongest hip flexor?

A

Iliopsoas m.

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37
Q

What muscle flexes and extends hip?

A

Adductor magnus

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38
Q

What is the primary extensor from sitting to standing?

A

Gluteus maximus

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39
Q

What 6 muscles adduct the hip?

A
  1. pectineus
  2. adductor longus
  3. adductor brevis
  4. adductor Magnus
  5. obturator exturnus
  6. gracilis
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40
Q

What 6 muscles laterally rotate hip?

A
  1. obturator externes
  2. obturator internus
  3. Piriformis
  4. Gemelli, superior and inferior
  5. Quadratus femoris
  6. Gluteus maximus
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41
Q

What 5 muscles extend the hip?

A
  1. gluteus maximus
  2. semitendinosus
  3. semimembranosis
  4. biceps femoris, long head
  5. adductor Magnus, posterior
42
Q

What 3 muscles abduct hip?

A
  1. gluteus medius
  2. gluteus minimus
  3. tensor fascia lata
43
Q

What 3 muscles medially rotate hip?

A
  1. gluteus medius
  2. gluteus minimus
  3. tensor fascia lata
44
Q

Fadir Special test for hip

A

-Pt starts: hip flexed to 90, adducted and IR
+ if groin pain
-indication: labral pathology

45
Q

Faber (Patricks) Hip Specialty Test

A
  • Pt starts: flex, ABd, ER
    • pain with limited ROM
  • Indication: intraairticular or iliopsoas (hip pain) or SI pain (if posterior pain)
46
Q

Hip Dislocation

A
  • Simple vs complex (with acetabular/femur fx)
  • Posterior dislocation 90% of time
  • Hip position at time of injury affects dislocation direction (if flexed like when driving a car then more susceptible to dislocation b/c capsular laxity)
47
Q

What is the resting leg position in a posterior hip dislocation?

A

slightly flexed, adducted, IR

48
Q

What are the 3 compartments of the knee joint?.

A
  1. medial femorotibial
  2. lateral femorotibial
  3. patellofemoral
49
Q

In what position is the knee most stable?

50
Q

What is the function of the lateral collateral l.?

A

resist varus strain

51
Q

What is the O/I of the lateral collateral l.?

A

lateral epicondyle to fibular head

-inserts along with biceps femoris m.

52
Q

What is the function and O/I of anterolateral l?

A
  • lateral femoral epicondyle to tibia posteriorly

- stability with knee rotation

53
Q

What is the function and O/I of anterolateral l?

A
  • lateral femoral epicondyle to tibia posteriorly

- stability with knee rotation

54
Q

What does a segond fracture indicate?

A

-ACL rupture

55
Q

What is the function of MCL l.?

A

resist valgus stress

56
Q

What is the function of the meniscus’?

A
  • shock absorption

- 2ndary knee stabilizer (lateral x2>medial)

57
Q

what are the ligaments attaching to the meniscus?

A
  1. Inter meniscal l. - connect each other
  2. Coronary L. - connect to capsule
  3. Meniscofemoral l
58
Q

What is the O/I for the ACL?

A

lateral intercondylar ridge to anterior tibia (b/t intercondylar eminence)

59
Q

What are the 2 parts of the ACL?

A
  1. anteromedial (tightest in flexion)

2. posterolateral (tightest in extension)

60
Q

O/I for PCL

A

post tibial sulcus to medial femoral condyle

61
Q

What are the 2 parts of PCL?

A
  1. anterolateral: tight in flexion

2. posteromedial: tight in extension

62
Q

What does the middle genicular a supply?

A

cruciate, synovium, posterior horn of meniscus

63
Q

What 4 nerves innervate the knee?

A
  1. Femoral N., anterior
  2. Common fibular N.
  3. Tibial N.
  4. Obturator/Saphenous N.
64
Q

What are the motions of the knee? What muscles supply these?

A

Extension: 1. quadriceps femoris & 2. tensor fascia lata (weak)
Flexion: 1. Hamstrings & 2. Gracilis, sartorius, gastrocnemius, popliteus

65
Q

What are the 3 sprain classifications?

A

Grade 1: stretching & small tears
Grade 2: larger tear
Grade 3: complete rupture

66
Q

How would one test/diagnose LCL pathology?

A

Varus stress test: brace medial knee, push distal leg midline
-tenderness laterally

67
Q

How would one test/diagnose MCL pathology?

A

Valgus stress: 30 knee flexion and push ankle away from midline
+: medial tenderness, instability at 0 degrees

68
Q

What are common causes of an MCL injury?

A

Valgus stress in slight flexion (blow to lateral knee)

  • commonly associated with ACL injury
  • intimately associated with medial meniscus
69
Q

What is O’Donoghue unhappy triad

A

ACL, MCL, and medial meniscus are inter-related so injury to one commonly affects all

70
Q

What is the most accurate test for a PCL injury diagnosis?

A

posterior drawer test

71
Q

What are the mechanisms of PCL injury?

A
  1. direct blow to anterior tibia
  2. dashboard injury
  3. hyperextension injury
  4. fall onto flexed knee with foot plantarflexed
72
Q

What are 3 ACL exams?

A
  1. lachmans test
  2. anterior drawer test
  3. pivot shift
73
Q

Foot arch function

A
  1. absorbs shock during weightbearing

2. makes foot adaptable to surface and weight change

74
Q

What bones form the medial longitudinal arch?

A 
calcaneus
talus- talar head is keystone*
navicular
3 cuneiforms
medial 3 metatarsals
75
Q

What tendons support and bones form the lateral longitudinal arch?

A
  • flatter than medial and rests on ground during standing
  • calcaneus, cuboid, 2 lateral metatarsals
  • fibularis longus t. and flexor digitorum longus
76
Q

What is the transverse arch and what bones make it up?

A
  • area b/t medial and lateral longitudinal arch

- cuboid, 3 cuneiforms, metatarsal base

77
Q

What tendons maintain curvature of transverse arch?

A

fibularis longus and tibialis posterior

78
Q

What tendons help support the medial longitudinal arch?

A

tibialis anterior

tibialis posterior

79
Q

What is passive support of the foot and what 4 ligaments make it up?

A
  • forming and maintaining foot arches
    1. plantar aponeurosis
    2. long plantar ligament
    3. plantar calcaneocuboid (short plantar) L.
    4. plantar calcaneonavicular (spring) L.
80
Q

What is dynamic support of the foot and what 5 muscle groups/ligaments compose it?

A
  • maintaining arches
    1. tibialis anterior m.
    2. tibialis posterior m.
    3. flexor hallucis longus m.
    4. fibularis longus m.
    5. intrinsic plantar muscles
81
Q

Pes transversoplanus

A

loss of transverse arch

82
Q

pes planus

A

loss of longitudinal arch, “fallen arches”

  • usually medial
  • plantar ligaments and aponeurosis become abnormally stretched
  • Plantar spina L. no longer support talus head so it displaces inferomedially and becomes prominent
83
Q

What type of joint is the ankle (talocrural) joint?

A

Hinge synovial

84
Q

What is the movement of the talocrural joint?

A

dorsiflexion and plantar flexion

85
Q

function of the medial L of the ankle?

A

stabilize during eversion

86
Q

Pott’s fracture

A
  • occurs when ankle is forcibly everted which pulls on extremely long medial L, which tears off medial malleolus
  • talus then moves laterally, sheering off lateral malleolus or breaking fibula
  • Can cause trimalleolar fx if distal end of tibia is also sheered off of talus
87
Q

High ankle sprain involves which ligaments?

A

2 of the lateral L., Tibiofibular syndesmosis

  1. posterior tibiofibular l.
  2. Anterior tibiofibular l.
88
Q

Movement of transverse tarsal joint and what 2 joints make up this?

A

Work together to permit slight rotation and thus add to inversion/eversion of talocalcaneal joint
-talonavicular and calcaneocuboid joints

89
Q

What do you transect when amputating the foot?

A

across transverse tarsal joint

90
Q

Subtalar (talocalcanean) joint: location, motion, components

A
  • Where talus rests on calcaneus
  • inversion and eversion
  • fibrous capsule supported by interosseous talocalcaneal ligament
91
Q

Ankle sprain

A

ligament fiber tears, almost always inversion

-most frequently injured joint in body

92
Q

How would the affect leg present with a posterior hip dislocation?

A

IR, adducted, and flexed knee

93
Q

6 Specialty tests of the hip

A
  1. Fadir
  2. Patricks Faber
  3. Log roll
  4. Thomas test
  5. Ober’s test
  6. Stinchfield
94
Q

Patricks Faber test

A
  • flex, abduct, ER

- Positive = pain

95
Q

What is a clinical suspicion for positive Patricks faber test with hip pain?

A

intraarticular or iliospoas

96
Q

What is a clinical suspicion for positive Patricks faber test with posterior pain?

A

sacroiliac pain

97
Q

FADIR specialty test

A
  • hip flex to 90, adduct, IR
  • positive = groin pain
  • DD: labral pathology/FAI
98
Q

Log Roll Specialty hip test

A
  • supine, IR/ER rotate leg
  • Positive = pain
  • DD: possible hip fx
99
Q

Ober’s Specialty Hip Test

A
  • lat recumbent with affected side up
  • extend hip/flex knee and allow to drop
    • if affected leg not passing neutral adduction
100
Q

Stinchfield specialty hip test

A
  • supine and resist hip flexion
    • = pain
  • DD: intraarticular pathology, particularly osteoarthritis
101
Q

Affected leg presentation in a hip fracture

A

shortened and ER

MSK 2 (6 decks)

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