Lec 16 - Knee, Thigh Gluteal Flashcards by Caroline Sparks

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

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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

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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

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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

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Where do all 3 of the pubic bones meet?

Acetabulum

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What articulate forms the hip joint?

Head of femur and acetabulum

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What covers the head of the femur?

Articular cartilage

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What and where is the fovea?

medially placed depression on the head of femur

fovea for ligament of the head

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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)

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What is meant by neurovascular bundle?

Superior and Inferior gluteal artery, vein and nerve travel together

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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)

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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

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What is the order of muscles attaching to the pes anserine

Medial to lateral is

Semitendinosis
Gracialis
Sartoripus

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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

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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

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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

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What does the femoral artery change names to? Where does this occur?

Femoral artery to popliteal artery at adductor hiatus

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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

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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

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What are the borders of the popliteal fossa?

Semitendinosus and Biceps long head

bottom borders are the lateral and medial gastrocnemius

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What are the contents of the popliteal fossa?

AVN from medial to lateral

popliteal artery, vein, and TIBIAL nerve

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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

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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