Lec 16 - Knee, Thigh Gluteal Flashcards
Rectus femoris
MA: extend knee, STEADIES hip joint and helps iliopsoas flex hip joint
PA: AIIS (anterior inferior iliac spine) and ilium
DA: Quadriceps tendon to tibial tuberosity via patellar tendon
N: femoral nerve L2 L3 L4
Vastus Lateralis
MA: Extends the knee
PA: Greater trochanter and lateral lip of linea aspera of femur (back of femur)
DA: quad tendon to tibial tubercle via patellar tendon and to tibia and patella via aponeurosis
N: femoral L2 L3 L4
Vastus Medialis
MA: Extends the knee
PA: intertrochanteric line and medial lip pf linea aspera of femur
DA: “via common tendinous (quadriceps tendon) and independent attachments to base of patella; indirectly via patellar ligament to tibial tuberosity” MEDIAL AND LATERAL VASTI also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)
N: femoral N L2 L3 L4
Vastus Intermedius
MA: Extends the knee
PA: anterior and lateral surfaces fo shaft of femur
DA: DA: “via common tendinous (quadriceps tendon) and independent attachments to base of patella; indirectly via patellar ligament to tibial tuberosity”
N: femoral L2 L3 L4
Where do all 3 of the pubic bones meet?
Acetabulum
What articulate forms the hip joint?
Head of femur and acetabulum
What covers the head of the femur?
Articular cartilage
What and where is the fovea?
medially placed depression on the head of femur
fovea for ligament of the head
Describe the screw home mechanisms of the knee joint
- what motions and muscles lock the knee?
- what unlocks the knee?
LOCK
- open chain: lateral rotation of tibia on fixed femur to allow quads to extend the knee
- closed chain: medial rotation of the femur on fixed tibia to allow quads to extend the knee
UNLOCK
- open chain: popliteus contracts to medially rotate tibia on fixed femur so hamstrings can flex knee
- closed chain: popliteus contracts, laterally rotating femur on fixed tibia to allow hamstrings to flex knee
NUMONIC
Only Cats Understand My Talking (Open Chain, Unlock = Medial roatation of Tibia)
Over-Cooked Lasagna Looks Terrible (Open Chain Locked = Lateral Tibia rotation)
What is meant by neurovascular bundle?
Superior and Inferior gluteal artery, vein and nerve travel together
How many hamstring muscles are biarticulate? How many Quad?
Hamstrings - 3/4 (short head of biceps femoris only crosses knee)
Quads - 1/4 (rectus femoris starts at ASIS)
Semitendinosus
MA: extend the hip, flex the knee and medially rotate when flexed
when hip and knee are flexed (sitting) can hep muscles extend the trunk at hip
PA: ischial tuberosity
DA: superior part of medial surface of tibia (as part of pes anserinus)
N: Tibial N L5 S1 S2
austin 512 area code
What is the order of muscles attaching to the pes anserine
Medial to lateral is
Semitendinosis
Gracialis
Sartoripus
Semimembranosus
MA: MA: extend the hip, flex the knee and medially rotate when flexed
when hip and knee are flexed (sitting) can hep muscles extend the trunk at hip
PA: ichial tuberosity
DA: posterior part of medial condyle of tibia, reflected attachment forms oblique popliteal ligament (to lateral femoral condyle)
N: tibial N L5 S1 S2
Bicpes Femoris
MA: flexes knee and laterally rotates it when flexed
long head extends hip joint
PA: Long head: ischial tuberosity
Short head: linea aspera and lateral supracondylar line of femur
DA: lateral side of head of FIBULA. Tendon is split at this site by fibular collateral ligament of knee
N: Long head: tibial division of sciatic N L5S1S2
short head: common fibular divison of sciatic nerve L5 S1 S2
What arteries branches off the external iliac artery at the femoral head region (hip)?
what does the external iliac artery split into?
lateral circumflex femoral artery
becomes femoral artery with profunda femoris artery coming off
What does the femoral artery change names to? Where does this occur?
Femoral artery to popliteal artery at adductor hiatus
What does Geni mean? What arterial structures exist at the Geni region?
knee
superior lateral genicular artery
inferior lateral genicular artery
superior medial genicular artery
middle genicular artery
inferior medial genicular artery
Where does femoral hernia often occur and what is it?
occurs at the femoral ring - a very small weak area in the anterior abdominal wall above the saphenous opening
at the saphenous opening, the abdominal viscera (small intestine) can protrude through the femoral ring to create a femoral hernia
often appears as a mass in the femoral triangle, inferolateral to the pubic tubercle
What are the borders of the popliteal fossa?
Semitendinosus and Biceps long head
bottom borders are the lateral and medial gastrocnemius
What are the contents of the popliteal fossa?
AVN from medial to lateral
popliteal artery, vein, and TIBIAL nerve
Describe the nerves of the popliteal fossa
Begins above the knee with the bifurcation of the sciatic nerve into the common fibular nerve and tibial nerve
The sural nerve branches off from the tibial
Superficial and deep fibular nerves
What area of the leg does the sural nerve supply?
lateral lower leg
What area does the saphenous nerve go to?
medial lower leg and foot
comes off femoral nerve
What happens to the knee when someone has a decreased Q angle?
genu varum
“bowed legs” knee out
What happens to the knee when someone has a increased Q angle?
genu valgum
knock knee, knee in
What do genu varum and valgum lead to? Who might be more at risk?
both lead early degeneration
females have a bigger Q angle
Where is the patellar ligament? What movement does it resists? Intra or Extracapsular?
distal part of the quadriceps femoris tendon, extends from the apex of the patella to the tibial tuberosity
Maintains alignment of patella over femur
extracapsular
List the extracapsular ligaments of the knee
MCL (tibial collateral)
LCL (fibular collateral)
oblique popliteal ligament
arcuate popliteal ligament
patella ligament
Where is the fibular collateral ligament (LCL) ligament? What movement does it resists? Intra or Extracapsular?
extends from lateral epicondyle of the femur to the lateral surface of the fibular head
resists MEDIAL motion
extracapsular
Where is the oblique popliteal ligament? What movement does it resist? Intra or Extracapsular?
it is an expansion of the semimembranosus tendon
arises from posterior medial tibial condyle and passes superolateral toward the lateral femoral condyle
Reinforces joint capsule and prevents hyperextension of knee
extracapsular
Where is the tibial collateral ligament (MCL)? What movement does it resist? Intra or Extracapsular?
from medial epicondly of femur to medial condyle and superior medial surface of tibia
deep fibers are firmly attached to medial meniscus
resists lateral movement
extracapsular
Where is the arcuate popliteal ligament? What movement does it resists? Intra or Extracapsular?
from the posterior aspect of the fibular head, passes superomedially over tendon of the popliteus and spreads over the posterior surface of knee joint
strengthens joint capsule posterolaterally
extracapsular
Where is the Anterior Cruiciate ligament? What movement does it resists? Intra or Extracapsular?
attaches to the posterior part of the medial side of the LATERAL CONDYLE of the FEMUR extending to the ANTERIOR intercondylar area of the TIBIA
prevent anterior displacement of the tibia on the femur and hyperextension of the knee joint
intracapsular
which side of the PCL does the ACL pass?
lateral side
Where is the posterior cruciate ligament? What movement does it resists? Intra or Extracapsular?
attaches to posterior part of the lateral side of the MEDIAL CONDYLE of the FEMUR extending to the POSTERIOR intercondylar area of tibia
prevents anterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur and helps prevent hyperflexion of the knee joint
Intracapsular
The cruciate ligaments form and X. What does this orientation allow?
rotatory movements at the knee
Which knee ligament has two divisions?
The ACL
anteromedial (AM)
posterolateral (PL)
What is special about the menisci of the knee? What is their role?
fibrocartilage, blood supply only reaches the out third
lateral and medial of the tibia, deepen the surface and play a role in shock absorption
Medial Meniscus - location/attachment, which side is wider?
C shaped, wider POSTERIORLY and LESS MOBILE
attached to the anterior intercondylar area of the tibia, anterior to ACL attachment, posterior intercondylar area and PCL
medial meniscus firmly attaches to the deep surface of the TCL
Lateral Meniscus
circular, smaller and more freely moveable than the medial meniscus
medial part of popliteal tendon attaches to the posterior limb of the lateral meniscus
Which menisci is more injured?
medial
What ligaments are involved in the unhappy triad?
MCL, ACL and medial meniscus
What movements commonly lead to ACL injuries?
hyperextension along with severe anterior force directed against the femur with the femur semi flexed
can be contact or no contact
What is a total knee arthroplasty?
an artificial knee joint in replacement of a degenerative knee from a disease such as OA
consists of plastic and metal components cemented to the ends of the femur and tibia
replacement mimics the smoothness of cartilage on cartilage
(low demand people have good results compared to high-demand people active in sports)
angle of inclination and torsion angle of femur
Inclination : 126
Torsion of femur: 12
If your torsion angle of the femur is larger, you will walk with ____
If it’s smaller you will walk with _____
Larger torsion angle= femur is more internally rotates, toe-in walking
Smaller torsion angle=decreased fe,oral torsion or Sam,Lee angle = less internally rotated or externally rotates = toe out walk
What is required for full knee extension?
Patella provides mechanical advantage for quads to fully extend
Know the following bony landmarks: intercondylar eminence, lateral and media, tibial plateau, Gerdys tubercle (what attaches at gerdys?
IT BAND
What is the parents structures to the artery to the head of the femur? What is that ones parent structure?
Obturator artery
Internal iliac artery
What ligament at the hip joint limits hip extension? Is in anterior or posterior?
What does pubofemoral limit?
Iliofemoral (anterior)
Abduction
What ligament exists on the back of the hip?
Ischiofemoral
Limits internal rotation and adduction
What other arteries exist at the hip joint?
Lateral circumflex humeral from deep femoral artery
Why is the knee joint unstable? What is important for stabilizing it?
Unstable bc incongruent (fibula)
Quads is most important for stabilizing, extended position is most stable
How many bursae are in the knee? What might happen to them?
12
Get inflammed
