Lecture 3 Flashcards
What attaches the two hipbones together?
Pubic symphysis
Relaxes in birth to allow babies head out
What group of muslces attach to the lesser trochanter of the femur?
Medial: abductors
What is the insertion for the quads?
Tibial tuberosity
The linea aspera goes into what?
popliteal surface
What is the dimple region?
posterior superior illiac spine
What does the red line indicate?
indicate supracristal plane (high points of iliac crests) crossing L4 spinous process and L4/5 IV disc
What are the three parts of the hip bone?
Ilium: superior
Pubis: anterior
Ischium: posterior
What does the head of the femur fit into?
Acetabulum
What are the important ligaments that we care about?
What is a common site for intramuscular injections of drugs and why?
The gluteal region is a common site for
intramuscular injection of drugs because the gluteal muscles are thick and large, providing a large area for venous absorption of drugs.
Injections into the buttocks are safe only where? What can happen if not placed here?
- the superolateral quadrant of the buttocks
- Complications of improper technique include nerve injury, hematoma, and abscess formation.
What does trochanteric bursitis cause? What is it characterized by?
- Diffuse deep pain in the lateral thigh region, especially during stair climbing or rising from a seated position
- It is characterized by point tenderness over the greater trochanter; however, the pain often radiates along the iliotibial tract.
A commonly overlooked diagnosis that clinically mimics trochanteric bursitis is what?
a tear of the insertion of gluteus medius tendon on the trochanter.
What does the ischial bursitis result from?
Ischial bursitis results from excessive friction between the ischial
bursae and the ischial tuberosities (e.g., as from cycling).
Because the tuberosities bear the body weight during sitting, these pressure points may lead to what?
pressure sores in debilitated people, particularly paraplegic persons.
What are the ligaments of hip joint?
What are the flexors of the hip joints?
What are the adductors of the hip joints?
What are the lateral rotators of the hip joints?
What are the extensors of the hip joints?
What are the abductors of the hip joints?
- gluteus medius
- gluteus minimus
- tensor fasciae latae
What are the medial rotators of the hip joints?
gluteus medius, minimus and tensor fasciae latae
- The hip joint is subject to what?
The hip joint is subject to severe traumatic injury and degenerative disease.
Osteoarthritis of the hip joint, characterized by what?
Osteoarthritis of the hip joint, characterized by pain, edema, limitation of motion, and erosion of articular cartilage, is a common cause of disability.
During hip replacement, what happens?
During hip replacement, a metal prosthesis anchored to the person’s femur replaces the femoral head and neck and the acetabulum is often lined with a metal/plastic socket
Congenital dislocation of the hip affects who?
1.5 per 1,000 live births; affects more girls; bilateral in half the cases
What does the dislocation of hip joint look like (congenital)?
The affected limb appears (and functions as if) shorter because the dislocated femoral head is more superior than on the normal side, resulting in a positive Trendelenburg sign (hip appears to drop to one side during walking).
What is the action of the sartorius?
At the hip it flexes, weakly abducts, and rotates the thigh laterally.
* Sit crossed legged
What is the action of the tensor fasciae latae?
- Hip joint: Thigh internal rotation, (Weak abduction)
- Knee joint: Leg external rotation, (Weak leg flexion/ extension); Stabilizes hip & knee joints by Tightening the IT band
What is the attachment points and actions of rectus femoris?
knee extension; hip flexion
* Attach to ant. infer iliac spine
* All the quad muslces attach at the quadriceps tendon which then goes into the patella-> patellar ligament that attaches to the tibular trob.
What are the quad muscles?
Vatus lateralis, medalis and intermedius
* All attach to the greater trochanter
* Only work on knee
Retus femoris
quad muscles: hip flexion and knee extension
- What is the suprapatellar bursa?
- What does the articularis genu?
- Between articulatis genu and vastus intermedius
- Help joint cap tighten (synivol sac during contraction) and so there is no pitching of synivol membrane
What is most frequently fractured in the femur and why?
The neck of the femur is most frequently fractured, especially in females secondary to osteoporosis.
Fractures of the proximal femur can occur where?
at several locations— for example, transcervical and intertrochanteric
When can a femoral shaft be fractured?
Femoral shaft strong; however, a violent direct injury e.g. (automobile accident), may fracture it (e.g. spiral fracture)
Fractures of the distal femur may be complicated by what?
Fractures of the distal femur may be complicated by separation of the condyles, resulting in misalignment of the knee joint.
+ ligament damage
Fracture of the neck of the femur often what? Explain?
- often disrupts the blood supply to the head of the femur.
- The medial circumflex femoral artery supplies most of the blood to the head and neck of the femur. Its retinacular arteries often are torn when the femoral neck is fractured or the hip joint is dislocated.
What may result with a fracture of femoral neck?
Avascular necrosis may result
Neck femoral fractures are common in who?
These fractures are especially common in individuals older than 60 years of age, especially in women because their femoral necks are often weak and brittle as a result of osteoporosis
Ischiopubic ramus goes down to what?
Adductor tubercle
What are the adductors of the medial groin?
Pectineus, adductor longus (+ adductor mangus and bravis), gracilis
What are the boarders of the femoral triangle?
Adductor longus, inguinal ligament, sartorius
What are the muscles of the hamstring?
Semitendinosis (on top of ->), semimembranous and biceps femoris
What is a groin pull?
- These terms refer to a strain, stretching, and probably some tearing of the proximal attachments of the flexor and adductor thigh muscles.
- The proximal attachments of these muscles are in the inguinal region (groin)
Where is the attachment points of semimembranosus and semitendinosus?
between the ischial tuberosity of pelvis and bones of the leg
Biceps femoris attachment
Origin:
* Long head: ischial tuberosity, sacrotuberous ligament
* Short head: linea aspera of femur (lateral lip), lateral supracondylar line of femur
Insertion: (Lateral aspect of) head of fibula
What is the pes anserinus?
a region where tendinous structures of the semitendinosus, gracilis, and sartorius muscles join to insert at the medial knee (tibia)
- Hamstring strains are common in who?
- The muscular exertion required to excel in these sports may cause what?
- Hamstrings strains (pulled and/or torn hamstrings) are common in people who run and/or kick hard (e.g., quick-start sports such as sprinting, baseball, and soccer).
- The muscular exertion required to excel in these sports may tear part of the proximal attachment of the hamstrings to the ischial tuberosity.
- What covers the thigh and the leg?
- Where does the IT tract attach?
What are the different fascial compartments?
What is genu varum (bowleg)?
- Medial angulation of the leg in relation to the thigh
- Femus is abnormally vertical and the Q angle is small
- Causes unequal weight distribution and excess pressure is placed on the medial aspect of the knee joint
- Results in arthrosis (destruction of the knee cartilage)
What is Genu valgum (knock-knee).
- Lateral angulation of the leg in relation to the thigh (exaggeration of knee angle)
- Excess stress is placed on the lateral structures of the knee
- Patella, normally pulled laterally by the tendon of the vastus lateralis, is pulled even farther laterally when the leg is extended in the presence of genu varum so that its articulation with the femur is abnormal.
Patellofemoral Syndrome:
* Where is the pain? How does it happen?
* The pain results from what?
- Pain deep to the patella often results from excessive running, especially downhill; hence, this type of pain is often called “runner’s knee.”
- The pain results from repetitive microtrauma caused by abnormal tracking of the patella relative to the patellar surface of the femur, a condition known as the patellofemoral syndrome.
Patellofemoral syndrome:
* Can also result from what?
* What can help?
- Could also result from a direct blow to the patella and from osteoarthritis of the patellofemoral compartment (degenerative wear and tear of articular cartilages).
- In some cases, strengthening of the vastus medialis corrects patellofemoral dysfunction.
What bursae knee joint and proximal leg?
What are prepatellar bursitis (“housemaid’s knee”)
is usually a friction bursitis caused by friction between the skin and the patella. If inflammation is chronic, the bursa becomes distended with fluid and forms a swelling anterior to the knee
What is Subcutaneous infrapatellar bursitis
results from excessive friction between the skin and the tibial tuberosity; the edema occurs over the proximal end of the tibia
Deep infrapatellar bursitis results in what?
results in edema between the patellar ligament and the tibia, superior to the tibial tuberosity.
Suprapatellar bursitis caused by what?
caused by bacteria entering the bursa from the torn skin. The infection may spread to the knee joint because the suprapatellar bursa communicates with the articular cavity of the knee joint
What is pes anserine bursitis?
An inflammation of the bursa located between the shinbone (tibia) and three tendons of the hamstring muscle at the inside of the knee
- What are popliteal cysts (Baker cysts)?
- Almost always a complication of what?
- Abnormal fluid-filled sacs of synovial membrane in the region of the popliteal fossa.
- Almost always a complication of chronic knee joint effusion.
Popliteal cysts (Baker cysts):
* Synovial fluid may also do what?
* What does ut form?
- Synovial fluid may also escape from the knee joint (synovial effusion) or a bursa around the knee and collect in the popliteal fossa
- Here, it forms a new synovial-lined sac, or popliteal cyst. In adults, popliteal cysts can be large, extending as far as the midcalf, and may interfere with knee movements.
Cyst may be what? What does it cause?
Cyst may be a herniation of the gastrocnemius or semimembranosus bursa through the fibrous layer of the joint capsule into the popliteal fossa, communicating with the synovial cavity of the knee joint by a narrow stalk.
Where does the IT band attach to?
Anterolateral tibial (gerdy) tubercle
Fractures Involving Epiphyseal Plates:
* Where?
* May cause what?
- Disruption of the epiphyseal plate at the tibial tuberosity
- May cause inflammation of the tuberosity and chronic recurring pain during adolescence (Osgood-Schlatter disease), especially in young athletes).
Tibialis Anterior Strain (Shin Splints):
* What is it?
* What is the result of?
* Shin splints are a mild form of what?
- Edema and pain in the area of the distal two thirds of the tibia
- Result of repetitive microtrauma of the tibialis anterior, which causes small tears in the periosteum covering the shaft of the tibia and/or of fleshy attachments to the overlying deep fascia of the leg.
- Shin splints are a mild form of the anterior compartment syndrome.
Interosseous (IO) infusion:
What is it?
- Intraosseous infusion technique is used to provide fluids and medication when intravenous access is not available or not feasible.
- Allows for the administered medications and fluids to go directly into the vascular system.
What are th compartments of the leg?
Compartment Syndromes in Leg and Fasciotomy:
* Caused by what?
Trauma to muscles and/or vessels in the compartments from burns, sustained intense use of muscles, or blunt trauma may produce hemorrhage, edema, and inflammation of the muscles in the compartment.
Compartment Syndromes in Leg and Fasciotomy:
* Increased pressure causes what?
* Structures distal to the compressed area may become what?
- Increased pressure in a confined anatomical space adversely affects the circulation and threatens the function and viability of tissue within or distal to the space (compartment syndrome).
- Structures distal to the compressed area may become ischemic and permanently injured (e.g., muscles with compromised blood supply and/or innervation will not function).
Compartment Syndromes in Leg and Fasciotomy:
* What is an obvious sign of arterial compression?
* What is the txt?
- Loss of distal leg pulses is an obvious sign of arterial compression, as is lowering of the temperature of tissues distal to the compression.
- A fasciotomy (incision of overlying fascia or a septum) may be performed to relieve the pressure in the compartment(s) concerned.
Rupture of Calcaneal Tendon:
* Often sustained by who?
* What is it?
* After complete rupture of tendon, what happens?
- Calcaneal tendon rupture is often sustained by people with a history of calcaneal tendinitis.
- Microscopic tears of collagen fibers in the tendon, particularly just superior to its attachment to the calcaneus, result in tendinitis, which causes pain during walking.
- After complete rupture of the tendon, passive dorsiflexion is excessive, and the person cannot plantarflex against resistance.
What is the test for achilles tendon rupture?
Thompson squeeze test
* lack of plantar flexion with calf squeezed
What is the medial procces of tubercle a site of?
Complication for plantar fasica because that is where it attaches
What tarsal for medially for arch and lateral?
Med: Navicular
Lateral: Cuboid
What is the difference btw hammertoe and claw toe?
Hammertoe
* Affects the second or middle joint in the toe causing it to bend downward.
* Typically affects a single toe, most commonly the second toe.
Claw toe
* affects one or more of the little toes and can happen to all four toes.
* It can affect the middle and end toe joints and cause the toes to bend and curl under.
What are the medial and lateral ankle ligaments?
- Medial: posterior tibiotalar, tibiocalcaneal, anterior tibiotalar ligament
- Lateral: Posterior talogibular ligament, Calcaneofibular ligament, anterior talofibular ligament
What is the broad tendon on the medial tub?
plantar aponeurosis
Plantar fascilitis:
* What is it ?
* What does it result from?
* Pain where?
- Straining and inflammation of the plantar aponeurosis
- result from running and high-impact aerobics, especially when inappropriate footwear is worn.
- pain on the plantar surface of the heel and on the medial aspect of the foot.
Plantar fasciitis:
* Point tenderness?
* The pain increases with what?
- Point tenderness is located at the proximal attachment of the plantar aponeurosis to the medial tubercle of the calcaneus and on the medial surface of this bone.
- The pain increases with passive extension of the great toe and may be further exacerbated by dorsiflexion of the ankle and/or weight bearing.
What are the dynamic support and passice support of the foot?
Plantar calcaneonavicular ligament:
Attaches where?
Attach to naviular and tallus
- What consequently happens with pes planus (flatfeet)?
- What is the result?
- Consequently, the talar head displaces inferomedially and becomes prominent.
- As a result, some flattening of the medial longitudinal arch occurs, along with lateral deviation of the forefoot.
Pes planus (flatfeet):
* What are acquired flatfeet where?
* In the absence of normal passive or dynamic support, what happens?
- Acquired flatfeet (“fallen arches”) are likely to be secondary to dysfunction of the tibialis posterior owing to trauma, degeneration with age, or denervation.
- In the absence of normal passive or dynamic support, the plantar calcaneonavicular ligament fails to support the head of the talus.
