Lower Extremity Flashcards

1
Q

What are the functions of the lower extremity?

A

Weight bearing, locomotion, maintenance of equilibrium

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2
Q

what is the appendicular skeleton of the lower extremity?

A

Lower extremity attaches to the axia skelton via the pevlic girdle

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3
Q

What makes up the pevlis?

A

Innomiate

Sacrum

coccyx

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4
Q

What are the sex differences with pevlic girdle?

A

subpubic angle (angle formed by pubic symphysis) in men is much smaller 70° than women, 90-100°

this makes the females have greater sacral width and great flare of iliac bones

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5
Q

What are implications of a female plevis?

A

brings proximal aspect of femur more laterally on body, knees more likely to be knock-kneed

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6
Q

What makes up the innominate?

A

ilium

ischium (inferior posterior)

pubic (inferior anterior)

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7
Q

What is number 9?

A

Iliac Crest

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8
Q

What is the iliac crest?

Att:

A

located superiorly, on the lateral side of the ilium.

Att: ilacus, latissiumus dorsi, tensor fasciae latae

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9
Q

Where is the anterior interior iliac spine?

Att:

A

just inferior to iliac crest on anterior side of ilium.

rectus femoris m and iliofemoral ligament

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10
Q

what is 1?

Att:

A

Posterior superior iliac spine

gluteus maximus

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11
Q

what is 3?

Function?

A

Greater sciatic notch

transmits piriformis m, superior and inferior gluteal A and V, internal pudendal a and v, sciatic, pudendal, and Sup and inf. gluteal n.

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12
Q

Where is the gluteal surface?

att:

A

body and lateral side of the ilium

att: gluteus maximum, medium, minimum

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13
Q

What is number 1?

attachments:

A

iliac fossa or wing of ilium

iliacus m.

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14
Q

What is number 6 and 7?

What does this include?

A

Sacropelvic surface

1) iliac tuberosity (7)
2) Articular surface (6)

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15
Q

What are the attachments of the illiac tuberosity?

A

dorsal sacroiliac, interossesous sacroiliac, iliolumbar lig, quadratus lumborum

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16
Q

What is 5 and anteriorly to 5?

A

Public crest and pubic tubercle

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17
Q

What attaches to public crest?

A

rectus abdominis

adductor longus m.

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18
Q

what attaches to pubic tubercle?

A

inguinal ligament

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19
Q

What is number 2?

What does it consist of?

A

Superior pubic ramus

1) pecten public (pectineal line)
2) obturator groove
3) iliopubic eminence

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20
Q

Superior pubic ramus attachments

A

pectineus, obturator internus, obturator externus, pubofemoral ligament

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21
Q

Pectineal line attachments

A

conjoined tendon, lacunar and pectineal ligaments

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22
Q

obturator groove location

A

Groove on superioer part of pubic bone in obturator foramen

Transmist obturator n, a, v

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23
Q

Iliopubic eminence location

att

A

loc: border between ilium and pubic
att: obturator internus m.

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24
Q

What is 4?

Function?

A

Lesser sciatic notch

transmists obturator internus tendon, pudendal n., interal pudendal a and v

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25
Q

What is number 5?

Att

A

Ischial Spine

at: supraspinous ligament, superior gemellus m.

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26
Q

Where is the ischial ramus?

A

located just posteriorly to the pubis on border of obturator foramen. Anerior connects with pubis

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27
Q

attachemnts of anterior ischial ramus surface

A

obturator externus

adductor magnus m.

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28
Q

attachments to posterior surface of ischial ramus

A

obturator internus m.

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29
Q

What is 6?

Attachments

A

Ischial tuberosity

sacrotuberous ligament, gamellus inferior, adductor magnus, semimembranosus, semitendinosus, biceps femoris, quadratus femoris m.

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30
Q

What is the hole in the inominate?

Func:

att:

A

Obturator foramen

function; transmists obturator n, a, v

att: obturator internus and externus m.

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31
Q

Development of inominate bone

A

Ischiopubic ramus fuses at 7-8 years

full fushion at 15-25 years

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32
Q

What is the bottom line represent?

A

sacrotuberous ligament

conncets posterior of superior iliac spine and lateral margin of sacrum to ischial tuberosity.

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33
Q

what does top line represent?

A

sacrospinous ligament

ischial spine to lateral margin of sacrum

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34
Q

What are the ligament stabalizers of the SI joint?

A

sacrospinous lig.

sacrotuberous lig.

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35
Q

What do the sacrospinous and sacrotuberous ligaments have in common?

A

both are stabalizers of SI joint of pelvis.

Both attach to lateral aspect of the sacrum

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36
Q

What boundaries make up the sciatic foramina?

A

Anterior sacroiliac lig.

sacrotuberous lig.

sacrospinous lig

greater sciatic notch

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37
Q

what boundaries make up lesser sciatic foramen?

A

spine of ischium

sacrotuberous lig.

tuberosity of ischium

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38
Q

What are the contents of the greater sciatic foramen?

A

piriformis, sciatic n., posterior femoral cutaneous nerve., superior gluteal vessels, inferior gluteal vessels, internal pudendal vessels, pudendal n.

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39
Q

What are the contents of the lesser sciatic foramina?

A

obturatory internus

internal pudendeal vessels

pudendal n.

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40
Q

Where does the head of the femur reside?

A

in the acetabulum

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41
Q

What is the acetabulum?

A

holds the head of the femur to make the hip joint.

projects lateral, anterior and inferior

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42
Q

Which direction does the head of the femur project?

A

medially, anteriorly, superiorly.

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43
Q

What does the acetabulum surface consist of?

A

lunate surface (incomplete) that is closed off by transver acetablar ligament

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44
Q

What is the sacroiliac joint?

class

movement

A

joint between articular surface of ilium and the articular surface of sacrum.

synovial place (gliding)

mv: slight contribution towards pelvid movement

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45
Q

What is pubic symphysis joint?

Class

A

joint connecting the two pubis together

symphysis joint

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46
Q

What is the joint at the hip?

A

Synovial ball and socket.

Mvmt: FE, Abduction, adduction, medial and lateral rotation, and circumduction

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47
Q
A

Flexion

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48
Q

What is this?

A

Extension

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49
Q

what is this?

A

Lateral ritation

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50
Q

What is this?

A

Medial rotation

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51
Q

What is this?

A

Abduction

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52
Q

What is this?

A

Adduction

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53
Q

What is circumduction?

A

combination of all movements FE, Rotation, AA

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54
Q

Genu Valgum

A

Medical tern for knock-knee

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55
Q

Genu varum

A

medical term for bow-legged

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56
Q

Normal angle of inclication for hip joint

What is angle of inclination?

A

125

formed between lines of by head and neck of femur with shaft of femur

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57
Q

Coxa Valga

A

Angle of inclination greater than 125°

leads to genu varum (blowed legs)

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58
Q

What are the consequences of coxa valga?

A

lengthens lower extremity

increases load on femoral head, decreases load on femoral neck.

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59
Q

Coxa vera

A

angle of inclination below 125°

leads to genu valgum knocked knees

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60
Q

Consequences of coxa vara

A

shortens lower extremity

reduces load on femoral head, increases load on femoral neck

risk of osteoarthritis on head, and risk of frature in neck

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61
Q

Q Angle men vs women

A

Quadriceps angle

angle between shaft of femur and tibia

men 12°

women 17°

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62
Q

Angle of torsion

A

angle of axis of femoral head in relation to the axis of femoral condyle at the knee. Normal is 8-15°

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63
Q

Anteversion

A

proximal aspect of femur is rotated more anteriorly in angle of torsion

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64
Q

retroversion

A

decreased angle of torsion of femur

Twisted posteriorly, all the way down to 0°

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65
Q

Anteversion

A

increased angle of torsion

pigeon toed

increased angle on femur, foot is not longer able to keep this rotation and keep good contact in acetabulum, therefore lower extremity must rotate.

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66
Q

Retroversion

A

decreased angle of torsion

duck feet

to increase maximal contact, lower extremity must rotate outward

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67
Q

HIp Joint

classification

movement

A

synovial ball and socket, wrapped in firbour joint capsule.

F/E, AA, medial and lateral rotation, circumduction

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68
Q

what is the fibrous joint capsule?

A

attaches from margin of acetabulum to the neck, intertrocahntic line and interochanteric crest of the femur

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69
Q

What is this?

attachments:

function:

A

iliofemoral ligament

anterior inferior iliac spine to interochanteric line of femur

limits extension of femur

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70
Q

What are the capsular ligaments?

A

pubofemoral

ischiofemoral

iliofemoral

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71
Q

What is the lower line pointing towards?

A

ischiofemoral ligament

from ischitium posterior to the greater trochanter and iliofemoral ligament

assist iliofemoral in limiting extension of femur

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72
Q

What is the lower line pointing towards?

A

Pubofemoral ligament

from iliopublic eminence and superior pubic ramus to the fibrous capsule

limits abduction of femur

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73
Q

what do the capsular ligaments do?

A

limit the extension of the hip

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74
Q

What is the ligament of the femoral head?

A

goes from fovea from femoral head to acetbular notch

not supporting role of joint capsule

aid in weight bearing

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75
Q

Hip Dislocation

A

posterior dislocation 9:1 anterior

interferes with ischiofemoral ligamen and ligamentum teres.

could impinge or break sciatic nerve

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76
Q

Fascia Lata

A

Deep fascia fo the thigh, wraps around entire circumference.

extension of the inguinal ligament outside the fascia lata

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77
Q

What are the subtypes of fascia lata?

A

Iliotubial tract

lateral intermuscular septum

medial intermuscular septum

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78
Q

What is the iliotibial tract?

A

fascia lata that extens from tesnor fascia lata and gluteus maximum to the proximal lateral tibia

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79
Q

what is the lateral intermuscular septum?

A

attaches to the linea aspera and separates the anterior and posterior compartmetns of the thigh

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80
Q

What is the left red line?

right red line?

A

lateral intermusclar seputm in the thigh

medial intermuscular septum

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81
Q

Femoral Sheath

A

distal continuation of ilacus fascia and trasversalis fascia inferior to inguinal ligament

contains femoral a,v, canal

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82
Q

gluteus maximum

attach

A

for erector spinae, sacrum, acrotuberous ligament and gluteal surface of ilium to gluteal tuberosity of the femur and iliotibial tract.

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83
Q

What are the actions of the gluteus maximum?

A

extends and laterally rotates thigh

tenses fascia lata

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84
Q

What is the innervation of gluteus maximus?

A

inferior gluteal nerve

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85
Q

Gluteus medius

A

lies anteriorly and superiorly to gluteus maximus

from external iliac surface to the lateral aspect of great trochanter

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86
Q

gluteus medius actions

A

abducts and medially rotates thigh

keeps pevlis upright when lifting one leg

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87
Q

innervation of gluteus medius

A

superior gluteal nerve

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88
Q

Gluteus minimus

A

deepest of the gluteus muscles

from the external iliac surface to the anterolateral aspect of the greater trochanter

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89
Q

gluteus minimus actions

A

abducts and medially rotates thigh

keeps pelvis upright with lifiing one leg

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90
Q

innervation of gluteus minimus

A

superior gluteal nerve

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91
Q

What are the major differences between gluteal maximus, minimus, and medius?

A

Max: most superficial, extends and laterally rorates thigh, inferior gluteal nerve

Med: intermediate; abducts and medially rotates thigh, super GN

Min: deep, abducts and medially rotates thigh, superior GN

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92
Q

Trendelenburg gait

A

weakened of ineffective gluteus medius or minimus

with small weakness, pelvis on other side (ipsilateral) sags.

in Duchenne’s limp, overcompesation by other pevlis and it tilts upwards

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93
Q

What are the lateral rotators muscles of the hip?

A

piriformis

super gemellus

obturator internus

inferior gemellus

quadratus femoris

quadratus femoris

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94
Q

Piriformis

attach

A

for the anterolateral sacrum to the greater trochanter of femur

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95
Q

Piriformis

action:

A

abducts and laterally rotates hip

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96
Q

innervation of piriformis

A

lumosacral plexus

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97
Q

superior gemellus

A

ischial spine to obturator internus tendon

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98
Q

Gemellus action

A

laterally rotates thigh

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99
Q

gemellus innervation

A

sacral plexus

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100
Q

Gemellus inferior

A

ischital tuberosity to obturator internus tendon

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101
Q

Obturator internus

A

inbetween gemellus superior and inferior

anterolateral wall of pelvis, obturator foramen and obturator membrane –> medial surface of great trochanter

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102
Q

which three muscles merge on obturator internus tendon?

A

gemellus superior, gemellus inferior, and obturator internus

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103
Q

Quadratus femoris

A

from ischial tuberosity to quadrate tubercle of the femur.

most inferior of the lateral rotators

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104
Q

quatratus femoris action

A

laterally rotates thigh

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105
Q

innervation of quadratus femoris?

A

sacral plexus

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106
Q

Obturator externus

A

most anterior lateral rotating muscle

from exteral aspect of rim of obturator foramen to trochanteric fossa.

inferior to gemallus

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107
Q

what is obturator externus innervated with?

A

obturator nerve

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108
Q

Where are the external rotator muscles located?

A

posteriorly

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109
Q

Where are the internal muscles located?

A

anteriorly

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110
Q

Anterior compartment of the thigh

A

innevated by femoral nerve

flexors of hip, extensors of knee

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111
Q

Posterior compartments of thigh

A

innervated by sciatic nerve

extensors of hip, flexors of knee

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112
Q

medial compartment of thigh

A

obturator nerve territory

adductors of thigh

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113
Q

Anterior compartment of thigh muscles

A

rectus femoris

vastus medialis

vastus lateralis

vastus intermedius

sartorius

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114
Q

action of anterior muscles of thigh

A

flex hip, extend knee

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115
Q

anterior of thigh innervation and blood supply

A

femoral nerve and artery

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116
Q

Medial compartment of thigh muscles

A

adductor longus

adductor brevis

adductor magnus

gracilis

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117
Q

action of medial compartment of thigh

A

adduct and medially rotate thigh

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118
Q

medial compartment innervation and blood supply

A

obturator n and a

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119
Q

Adductor Magnus

A

dual innervation

Adductor part innervated by obturator n

hamstring part innervated by sciatic (tibial) n

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120
Q

Posterior compartment of thigh

A

hamstring

biceps femoris, long and short heads

semimembranosus

semitendinosus

121
Q

function of posterior compartment of thigh

A

extend hip and flex knee

122
Q

innervation and blood supply of posterior compartment of thigh

A

tibial dividsion of sciatic n.

profunda femoris a.

123
Q

Lateral aspect of thigh

A

Iliotibial tract (or band)

no lateral compartment

124
Q

What is the iliotibial band?

A

thickening of fascia lata

gluteus maximum and tensor fasciae latae attach

125
Q

Femoral Nerve Course

A

saphenous branch descends through femoral triangle, enter adductor canal

Deep to inguinal ligament

126
Q

What vertebraes does the femoral nerve correspond to?

A

L2-4

127
Q

Obturator nerve course

A

emergens inferior to pubic ramus

anterior branch is superior to adductor brevis, inferior to adductor longus

Posterior inferior to adductor brevis

128
Q

where does obturator nerve originate?

A

L2-4

129
Q

Sciatic nerve course

A

on posterior aspect of thigh, Between great trochanter and ischial tuberosity. Then it splits and common fibular innervates biceps short head, and tibial innervates long head

130
Q

Femoral triangle border

A

inguinal ligament

adductor longus

sartorius

131
Q

Contents of femoral triangle

A

Femoral n, a, v

132
Q

Artery supply of femur for children for adults

A

Children: obturator a

adults: primarily becomes circumflex femoral a.

133
Q

Avascular necrosis

A

reduced femoral blood supply due to disloaction or fracture

134
Q

Joints of the knee

A

tibiofemoral

patellofemoral

superior (proximal) tibiofibular

135
Q

Femoral condyle morphology

A

tiba externally and laterally rotates as knee reachs full extension due to larger medial femoryl condyle

incrase stability to knee

136
Q

Knee joint

class

movement

A

synovial bi-condylar hinge (complex

E/F, medial lateral rotation

137
Q

Superior tibiofibular joint

A

synovial plane (gliding)

138
Q

Popliteus muscle

A

posteior to knee

from lateral femoral condyle to sleal line of the tibia

139
Q

popliteus function/action

A

unlocks knee during flexion

140
Q

Which is bigger lateral or medial facet on patella?

A

Lateral

141
Q

Bursae

A

extension of the joint capsule at the knee

142
Q

Fibrous capsule of knee

A

margins of femoral condyles to margins of tibial condyles

143
Q

Cruciate ligamments in the knee

A

Anterior cruciate

posterior cruciate

144
Q

Anterior cruciate ligament

A

in knee joint

medial part of anterior intercondylar tibia to posterior part of the intercondylar fossa of femur.

More lateral than PCL

Anterior to PCL

145
Q

Posterior cruciate ligament

A

from posterior intercondylar area of tibia to lateral surface of the intercondylar fossa

posterior and medial to ACL

146
Q

What are the functions of ACL and PCL?

A

ACL: prevents anterior displacement of tibia and posterior dispalcement of femur. prevents hyperextension

PCL: prevents posterior displacement of tibia; prevent anterior dispacement of femur

147
Q

Tibial (medial) collateral

A

Knee ligament on medial side

connects medial epicondyle of femur to medial condyle and shaft of tibia.

Function: prevents abduction of tibia

injured by glow to outside of knee

148
Q

Fibular (lateral) collateral

A

resists bow legged stress genu varus

ligament on lateral side connecting lateral epicondyle of femur to head of fibula

Injured by inside blow to the knee

149
Q

in genu valgum, which is stressed MCL or LCL?

A

MCL

150
Q

what is stressed in genu varum, MCL or LCL?

A

LCL

151
Q

Menisci

A

fibrocarilaginous shock absorbers in the knee, decrease friction, increase contact area

medial and lateral

152
Q

medial meniscus

A

attaches to anterior and posterior regions of intercondylar area of tibia and fibrous capsule at TCL

larger menisc

forms C

153
Q

Lateral menisci

A

attaches anterior and posterior regions of intercondylar area of tibia

smaller, forms O

154
Q

Meniscectomy

A

removal of mensicus, old procedure.

increased wear of articular cartilage

increased risk of degenerative joint disease

total knee replacemnt necessary

155
Q

Mensici blood supply

A

greatest in peripheral 1/3 and least in central

156
Q

crural interosseous membrane

A

spans margins of tibia and fibula

157
Q

Ankle joint

A

talocrurcal

synovial hinge

allows for dorsiflexion/plantar flexion movement

158
Q

joints of foot

A

talocalcaneal joint

tarsometatarsal joints

mentatarsophalangeal joint

interphalangeal joints

159
Q

Characterisics of inter phalangeal joints

A

head of one phalanx to base of distal one

syovial hing

flexion and extension

160
Q

Crural Fascia

A

continuous with fascia lata, but covers crural leg

also forms comparments

thickening forms retinacula

161
Q

Talocrural fascia

A

superior extensor

inferior extensor

superior peroneal

inferior peroneal

162
Q

what muscles provide knee support

A

sartorius, gracilis, semitendinosus

163
Q

interphalangeal joint

A

head of on phalanx to base of distal one

hinge

flexion and extension

164
Q

superior extensor retinacula

A

distal tibia to distal fibula

165
Q

inferior extensor retinaculum

A

extens from calcaneus to the navicular and medial malleolus

166
Q

superior peroneal retinaculum

A

lateral malleolus to calcaneus

167
Q

inferior peroneal retinaculum

A

inferior extensor retinaculum to calcaneus

168
Q

anterior crural intermuscular septum

A

anterior fibular border

separates anterior and lateral leg comparments

169
Q

posterior crural inter muscular septum

A

attaches to posterior tibia border

separates lateral and posterior comparments

170
Q

deep transverse fascia

A

separates superficial and deep posterior compartment of muscles

171
Q

compartment syndrome

A

trauma, overuse, hemorrhage, infection produce edema or hemmorage within the comparments

can be anterior or posteior

increased pressure compresses nerves and vessles and compromises leg function

perform a fasciotomy

172
Q

fasciotomy

A

incision in the skin, fascia removed, skin grafted

173
Q

anterior vs. posterior compartment syndrome

A

ant: most common, weakness if dorsiflex or toe extension and parasthesia over the dorsum of the foot.

Deep posterior: weakness in two flexion and inversion, parastehsias in plantar aspects

superficial posterior: weakness in plantarflexion, dorsolateral hypoesthesia

174
Q

common fibular nerve

A

deep to proximal fibularis longus

curves lateral to neck of fibula

splits deep to fibularis longus

175
Q

superficial fibular nerve course

A

begins at bifrication of common fibular n.

supplies fibularis longus and brevis

emerges as cuteansous branch around ankle

176
Q

Deep fibular n. course

A

approaches interosseus membrane

between tibials ant and extensor hallucis longus

descends with anterior tibial a.

177
Q

tibial n. course

A

joins with popliteal a. and v.

continues on with the posterior tibial a.

gives off sural n.

splits into lateral and medial plantar nn in foot.

178
Q

tarsal tunnel

A

posterior tibia a and v

tibial n.

tibialis posterior

flexor digitorum longus

flexor hallucis longus

179
Q

tarsal tunnel syndrome

A

entrapment and compression of tibial nerve.

edema and tightness in ankle involveing synovial sheaths

pain, tingling, numbness in plantar aspect, weaknessof intrinsic foot muscles

180
Q

Ankel inversion sprain

A

90% of these are sprains.

rolling plam of foot inward

181
Q

ankle sprain grade 1

A

ligament stretch, macroscopic tearing

little swelling and tendernes

no ligamentous laxity

little to no loss of function

182
Q

ankle sprain grade 2

A

partial tear of ligament

mod. pain and welling

mild to moderate ligamentous laxity

moderate loss of function

183
Q

grade III ankle sprain

A

complete ligament rupture and/or failure of load carrying capacity

severe swelling, pain, and hemorrhage

considerable ligamentous laxity

total loss of function

184
Q

supporting strucutres of medial longitudinal arch

A

plantar aponeurosis, plantar calcaneovicular lig.

185
Q

support for transverse arch

A

fibularis longus

186
Q

plantar ligaments

A

short plantar (plantar calcaneocuboid) deep to long plantar

plantar calcaneonavicular (spring)

187
Q

where is the thickest skin on the body?

A

overlying the heep

188
Q

plantar aponeurosis

A

the fibrous structure on bottomo fthe foot. from proximal calcaneous to each of the five toes

189
Q

plantar fasciitis

A

2 million americans

10% experience it

inflammation caused by overstrech or overuse

pain with palpation of attachment

most affects men 40-70yo

no heel spurrs needed

190
Q

superficial inguinal lymph nodes

A

cenetereda round pelvic area on surface fo skin

drain from superficial structures inferior to the umbilicus except for the anus and glans of the clitoris or penis

191
Q

deep inguinal lymph nodes

A

deep in pelvis

drain deep tissue of the thigh, the popliteal notes, and the superficial inguinal nodes

192
Q

popliteal lymph nodes

A

dreain the knee and deep deep tissues of the leg and foot.

condisdered deep nodes

193
Q

lymph nodes of lower extremities

A

superifical inguinal

deep inguinal

popliteal

194
Q

what do deep inguinal lyph nodes give rise to

A

lympthatic trunks

195
Q

what doe lympathit trunks give rise to…

A

cisterna chyli

196
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