Lower Extremity Flashcards by Theresa Casinillo

How many jts in pelvic girdle?

And what consist it?

7 joints

1 lumbosacral
1 sacrococcygeal
2 sacroiliac
2 acetabulofemoral jt
1 symphysis jt

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How many bones in pelvic girdle?

And what consist it?

4 bones

1 sacrum
1 coccyx
2 innominate bones/os coxae

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Largest part of innominate bone

Ilium

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Smallest part of innominate bone

Pubis

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Serve as proximal attachment of inguinal ligament

ASIS

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Serve as proximal attachment of iliofemoral ligament

AIIS

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Inguinal ligament aka?

Poupart’s ligament

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Iliofemoral ligament aka?

Y ligament of Bigelow

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Contusion to ASIS

HIP POINTER INJURY

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PUBIS - Where does the origin of specific adductors?

Mnemonics?

President Arroyo Loves MGB

Superior ramus of pubis
- pectineus

Body of pubis
-Adductor longus

Inferior ramus of pubis

Magnus
Gracilis
Brevis

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Inguinal ligament is from what aponeurosis?

External oblique aponeurosis

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GREATER SCIATIC FORAMEN
What passes:

Above the piriformis?
Below the piriformis?

SGN, SGA

IGN, Sciatic nerve, pudendal nerve

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ANGLE OF PELVIC INCLINATION
Landmark?
APT (Increase/decrease)?
PPT (Increase/decrease)?
Normal value?

Who does have high pelvic inclination (male or female)?

PSIS, Symphysis pubis

Increase
Decrease

50-60 degrees

Female

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Acetabulum aka?

Vinegar’s cup

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ORIENTATION OF:
Acetabulum?
Femur?

ALI
Anterior, lateral, inferior

SAM
Superior, anterior, medial

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Acetabular labrum aka?

Cotyloid ligament

Triradiate ligament

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How many percent is the femur in person’s height?

25% (1/4)

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Main blood supply in children

Obturator artery

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Main blood supply in adult

Medial & lateral circumflex artery

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ANGLE OF INCLINATION/NECK SHAFT ANGLE Normal Values in:

Adult?
Children?

125 degrees

150 degrees

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COXA VALGA

Value?
Shorter/longer leg?
Stable/Unstable?
More prone to?
Position?
Limited to what action?

More than 125
Longer leg
Unstable 
More prone to hip d/L
Abduction
Limited adduction

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COXA VARA

Value?
Shorter/longer leg?
Stable/Unstable?
More prone to?
Position?
Limited to what action?

<125
Shorter leg
Stable
More prone to femoral neck fx
Adduction
Limited abduction

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R COXA VARA COMPENSATIONS

R PF
L knee flexion
R s/t supination
L s/t pronation

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R COXA VALGA COMPENSATIONS

R knee flexion
L PF
R s/t pronation
L s/t supination

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CENTER EDGE ANGLE aka?

Angle of Wiberg

CENTER EDGE ANGLE Normal value? Landmark? Increase angle (more stable/less stable)? Decrease angle (more stable/less stable)? DDH (increase or decrease angle)?

More than 25 degrees Make an axis on edge of acetabulum & center in femoral head More stable Less stable Decrease angle

ACETABULAR ANTEVERSION ANGLE Normal value? ``` Increase angle (Increase or decrease coverage of femoral head)? Decrease angle (Increase or decrease coverage of femoral head)? ```

15-20 degrees Decrease Increase

TRUE/APPARENT LLD? Coxa valga/coxa vara? Poliomyelitis? Hip fx? Scoliosis?

True LLD True LLD True LLD Apparent LLD

Normal value for ANGLE OF FEMORAL TORSION

15 degrees

What compensation are there in ANTEVERSION: ``` IR/ER? Limited IR/ER? Intoeing/outtoeing? Toes? Knees? SPITT/SSETT? ```

``` IR Limited ER Intoeing Pigeon toes Knock knees/Squinting patella SPITT ```

What compensation are there in RETROVERSION: ``` IR/ER? Limited IR/ER? Intoeing/outtoeing? Knees? SPITT/SSETT? ```

``` ER Limited IR Outtoeing Grasshopper's eyes/Frog eyes patella SSETT ```

Special test to measure anteversion?

Craig's test aka Ryder's test

W SITTING POSITION Hip? Tibia? Foot?

Increase anteversion ETT Outtoeing

JAPANESE SITTING/HEEL SITTING POSITION Tibia? Foot?

ITT | In toeing

What limited motions that the ligament of the hips limit: Iliofemoral? Pubofemoral? Ischiofemoral?

EXT, ADD, ER EXT, ABD, ER EXT, ABD, IR

Strongest ligament in the hip? | Weakest ligament in the hip?

Iliofemoral ligament | Ischiofemoral ligament

Strongest/primary hip flexor

Iliopsoas

Only hip flexor capable of flexion more than 90 degrees

Iliopsoas

Tailor's muscle

Sartorius

Longest muscle in the body

Sartorius

Pes Anserine Muscles Aka? What ms consist this group?

Goose foot ms Inverted tripod SGT Sartorius Gracilis Semitendinous

Action of Sartorius Hip? Knee?

FABER | FIR

RECTUS FEMORIS Straight head? Reflected head?

AIIS | Ilium above acetabulum

SLR Muscle

RECTUS FEMORIS

Action of TFL?

FABIR

Where does the TFL & ITB inserts?

Gerdy;s tubercule - anterolateral tibia

Pocket muscle

TFL

Stretching of ITB in PNF

D2 Extension (EXADER)

Largest muscle in the body

G. Max

GLUTEUS MAXIMUS Upper fibers? Lower fibers?

Abd | Add

PNF diagonal used for g.max strengthening?

D2 EXTENSION

MC strained ms in the LE

Hamstrings

Peak activity during gait of Hamstrings

Decelerator - terminal swing (eccentric cxn)

HAMSTRINGS Lateral hams? Medial hams?

Biceps femoris Semitendinosus, semimembranosus

SH of biceps femoris Origin? Insertion? Nerve supply? Action?

Linea aspera Fibular head CPN Knee flex + ER

GLUTEUS MEDIUS ACTIONS Upper fiber? Middle fiber? Posterior fiber?

Hip flex/IR Abduction Hip ext/ER

COMPENSATION PT WITH G.MED WEAKNESS Cane? Briefcase? Trunk listing?

C/L I/L I/L

The only ms in the adductor group that can flex the hip

Pectineus

The only ms in the adductor group that can flex the knee

Gracilis

Weakest adductor

Gracilis

Strongest adductor

Adductor longus

Thickest adductor

Adductor brevis

Largest adductor

Adductor magnus

Most superficial adductor

Adductor longus

MC myotomize adductor (pt c scissoring gait)

Adductor longus

The only ms in the adductor group that has dual nerve supply

Adductor magnus

The only ms in the adductor group that is 2 jointed

Gracilis

Special test for Gracilis tightness

Phelp's tightness

TENDON GRAFT MUSCLES

Gracilis Pecs Major Plantaris Palmaris longus

EXTERNAL ROTATORS OF THE HIP Aka? Consist of (mnemonic)?

Red carpet muscle ``` POOSIQ Piriformis Obturator internus Obturator externus Superior gemellus Inferior gemellus Quadratus femoris ```

PIRIFORMIS ACTIONS | Mnemonic?

PXER Extension - ER Flexion - IR

FEMORAL TRIANGLE Borders: Superior? Medial? Lateral? Floor? Content? ((mnemonics))

Inguinal ligament Adductor longus Sartorius LIPAM Lateral to medial Iliopsoas - Pectineus - Adductor longus ``` NAVEL (Lateral to medial) Femoral nerve Femoral artery Femoral vein Empty space Femoral lymphatics ```

LUMBAR PLEXUS (nerve roots?) ``` Iliohypogastric nerve Ilioinguinal nerve Genitofemoral nerve LFCN Obturator nerve Femoral nerve ```

``` T12 L1 L1 L1 L2 L2 L3 L2 L3 L4 (anterior division) L2 L3 L4 (posterior) - pemoral nerve ```

Femoral nerve aka?

Anterior crural nerve

Largest nerve in lumbar plexus

Femoral nerve

SACRAL NERVE (nerve root?) ``` Nerve to quadratus femoris SGN Nerve to obturator internus IGN PFCN Pudendal nerve Sciatic ```

``` 4 5 1 (ant) 4 5 1 (post) 5 1 2 (ant) 5 1 2 (post) 1 2 3 2 3 4 4 5 1 2 3 ```

What consist in the nerve roots L4 L5 S1?

Anterior division: Nerve to quadratus femoris Post division: SGN Inferior gemellus

What consist in the nerve roots L5 S1 S2?

Ant division: Nerve to obturator internus Post division: IGN Superior gemellus

What nerve supply to perineum & pelvic floor muscle

Pudendal nerve

What are the branches of sciatic nerve & their nerve roots?

``` Tibial nerve (L4 L5 S1 S2 S3) CPN (L4 L5 S1 S2) ```

What are the branches of tibial nerve?

LPN, MPN

What are the branches of CPN?

DPN, SPN

What artery is above the inguinal ligament

EIA

What artery that comes from femoral artery and supplies the posterior compartment of the thigh?

Profunda femoris artery

What artery that passes the inguinal ligament and supplies the anterior compartment of the thigh?

Femoral artery

2 branches of popliteal artery

Ant tibial artery & post tibial artery

Ant tibial artery becomes the?

Dorsal pedis artery

Post tibial artery becomes the?

Medial plantar artery | Lateral plantar artery

3 articulations in the knee joint

Medial tibiofemoral jt Lateral tibiofemoral jt Patellofemoral jt

Characteristics of MEDIAL FEMORAL CONDYLE? LATERAL FEMORAL CONDYLE?

Mahaba (longer) Malaki (larger) Shorter More anterior in location (to prevent lateral disloc)

How many degrees is the axial rotation in the knee?

40 degrees

Menisci Aka? Vascular in what area?

Semilunar cartilages | Outer 1/3

MEDIAL MENISCUS ``` Shape? (mnemonic) More/less mobile? How many mm? More/less fixed? What structures that is assoc? ```

``` (MCLO) C-shaped Less mobile 6 mm (C shape = 6mm) More fixed ACL MCL, Semimembranosus ```

LATERAL MENISCUS ``` Shape? (mnemonic) More/less mobile? How many mm? More/less fixed? What structures that is assoc? ```

``` (MCLO) O-shaped More mobile 12mm Less fixed PCL, Popliteus ```

Taut position in MENISCUS

Lat rot + extension

SWIMMER'S KNEE What kind of stroke in swimming? What structure is affected?

Breast stroke | MCL

Ossification of MCL

Pellegrini Steida Disease

Tautest position of COLLATERALS | Mnemonic?

LaRo sa ExColTa | Lateral rotation + extension, the collaterals are taut

ORIENTATION OF: ACL? PCL?

PLS | SAM

LOCATION OF CRUCIATES | Mnemonic?

ICES Intracapsular Extrasynovial

Stoutest/strongest ligament

PCL

Tautest position of CRUCIATES | Mnemonic?

InExCruTa | Internal rot + extension

What muscle that will hep in function perform by PCL?

QUADS

What muscle that will hep in function perform by ACL?

HAMS

Tendinous expansion of semimembranosus

OPL

From popliteus, reinforces the posterolateral capsule

Arcuate ligament

Meniscotibial ligament aka?

Coronary ligament

MENISCOFEMORAL LIGAMENT Only for what meniscus? Anterior lig aka? Posterior lig aka? ((mnemonics))

Lateral meniscus Ligament of Humphrey (Harap) Ligament of Wrisberg (Wikod)

SCREW HOME MECHANISM During knee extension? During knee flexion?

CKC: FIR OKC: TER CKC: FER OKC: TIR

Key to unlocking the knee

Popliteus

MC knee bursitis

Prepatellar bursitis

MC contused mm

Quadriceps

MC site of MO (in the whole body)

Quadriceps

Workhorse for knee extension

Vastus Medialis

1st muscle to atrophy

VMO

Last ms to recover after a knee surgery

VMO

Dynamic stabilizer of the patella

VMO

Most efficient knee extensor

VASTUS INTERMEDIUS

(+) accessory head in vastus medialis

Articularis genu/Subcrureus

Retracts the capsule to prevent compression during knee extension

Articularis genu/Subcrureus

Articularis genu aka?

Subcrureus

How many facets are there in the patella?

5 facets ``` Medial facet Lateral facet Odd facet Superior pole Inferior pole ```

FACETS IN THE PATELLA After 90 degrees of knee flexion, what facet is in contact c the medial femoral condyle? After 135 degrees of knee flexion, what facet is in contact c the medial femoral condyle?

Odd facet Odd facet & lateral facet

PATELLAR MOBILIZATION (What glide?) Increase knee flexion? Increase knee extension?

Caudal glide | Rostral glide

``` PATELLAR MALPOSITION (+) camel sign? More prone to dislocation? Abnormally high? Abnormally low? ```

Alta Alta Alta Baja

PATELLOFEMORAL LOADING/JOINT REACTION FORCE | Mnemonics?

``` WADS Walking = 0.3 x BW Ascending = 2.5 x BW Descending = 3.5 x BW Squatting = 7 x BW ```

Q-ANGLE Normal value? Genu varum? Genu valgum?

13-18 degrees <10 >20

Sing the MISERABLE ALIGNMENT SYNDROME

TIBIOFEMORAL SHAFT ANGLE <170 degrees in medial aspect? <170 degrees in lateral aspect?

Genu varum | Genu valgum

Normal value for the valgus of the knee?

5 degrees

OA of the knee

Genu varum

MC deformity in polio

Genu recurvatum

What is the compensation of the pelvis if there is Genu Recurvatum?

PPT - to flex the hips

``` NEWBORN MILESTONES (GENU VARUM & GENU VALGUM) Genu varum up to what? Genu valgum up to what? ```

Normal up to 18-19months > Straight > Normal up to 3-4 y.o > Straight

``` POPLITEAL FOSSA Sup. lat? Sup. med? Inf. lat? Inf. med? ``` Contents (mnemonic)?

Biceps femoris Semimem, Semiten Lat head of gastrocs Med head of gastrocs AVN (deepest to most superficial) Popliteal artery Popliteal vein Popliteal nerves

What does Tibial & CPN nerves become in popliteal fossa?

Popliteal nerves

TIBIA OR FIBULA ``` Lateral leg bone? Medial leg bone? Splint bone? Shin bone? 10% weight bearing? 90% weight bearing? MC site of stress fx in runners? MC sire of non union fx? ```

``` Fibula Tibia F T F T T T ```

MEDIAL OR LATERAL MALLEOLI Longer? Shorter? Posterior? ANterior?

LATERAL MALLEOLI: Longer Likod (Posterior) MEDIAL MALLEOLI: Shorter Anterior

Normal values of inversion-eversion

Inversion: 0-35 Eversion: 0-15

Whis inversion greater than eversion?

Bc it has a longer lateral malleoli

``` OUT TOEING ANGLE OF THE FOOT Aka? Why is there an angle? Normal? Average? ```

Fick's angle Bc medial malleolus is situated ant 5-10 degrees 7 degrees

SUPERIOR TIBIOFEMORAL JOINT Aka? Type of joint? Action?

Forgotten Synovial plane jt It moves up during DF (Fibula glides upward)

INFERIOR TIBIOFEMORAL JOINT Type? Affected c?

Syndesmosis | HIgh ankle sprain

``` ANTERIOR COMPARTMENT OF THE LEG Aka? Muscles (mnemonic)? Action? Nerve supply? ```

Pretibial muscles ``` TOM, DICK, HARRY POTTER Tibialis anterior Extensor digitorum longus Extensor hallucis longus Peroneus tertius ``` Deep peroneal nerve

Deep peroneal nerve aka?

Anterior tibial nerve

In paralysis of TA, what ms subtitutes for ankle DF

EDL

LATERAL COMPARTMENT OF THE LEG

Peroneus longus | Peroneus brevis

``` POSTERIOR COMPARTMENT OF THE LEG Superficial group? Deep group? (mnemonic) Action? Nerve supply? ```

Gastrocnemus Soleus Plantaris ``` TOM DICK, HARRY POTTER Tibialis Posterior Flexor digitorum longus Flexor hallucis longus Popliteus ``` PF Tibial nerve

Tibial nerve aka?

Posterior tibial nerve

Deepest muscle of the calf

Deepest muscle of the knee

Popliteus

Primary DF? Primary PF? Primary invertors? Primary evertors?

TA TRICEPS SURAE TP PL/PB

Combined actions of foot muscles | draw in mind...

Superficial peroneal nerve aka?

Musculocutaneous nerve of the leg

POLAND'S DISEASE | Ms involved?

5 P's ``` Plantaris Palmaris longus Psoas minor Pyramidalis Pectoralis major (sternal part) ```

NORMAL VALUES OF ANKLE DF? PF?

0-20 | 0-50

Most osteologically stable position of ankle

DORSIFLEXION

MEDIAL COLLATERAL LIGAMENT Aka? Consists of?

Deltoid ligament ANTATI POTATI CATI TINA

LATERAL COLLATERAL LIGAMENT | Consists of?

ANTAFI POTAFI CAFI

Reasons why LCL is MC sprained?

Fewer ligaments on the lat side Ligaments are separated Inv more than eversion

MOI OF: ATFL? Calcanofibular lig?

PF + INV | DF + INV

MC sprained ligament in the ankle sprain? 2nd MC sprained lig? LC sprained lig on LCL? Strongest lig of the ankle?

Antafi Cafi Potafi Deltoid lig

How many total bones in the foot region? Tarsals? Metatarsals? Phalanges?

26 7 5 14

What line is there when you form between medial calcaneus and 1st MTP? What is the significance?

FEISS LINE | - navicular should fall on the line

What inserts in the navicular?

TP & Spring ligament

Talus aka?

Astragalus

Tarsal bone that has no muscular attachment

Talus

Tarsal bone that is involve in the TB of the foot

Talus

AVN of Talus

Diaz Disease

Calcaneus aka?

Os calcis

Largest tarsal bone

Calcaneus

1st to ossify tarsal bone

Calcaneus

MC fx tarsal bone

Calcaneus

What's in the medial calcaneus? | It supports the what?

(+) Sustentaculum Tali | Talus

Proximal attachment of spring ligament

Calcaneus

Spring ligament aka?

Plantar calcaneonavicular lig

METATARSALS | Shortest & stoutest?

1st MTT

AFFECTED IN: 2nd MTT shaft? 2nd MTT head (AVN)?

March fracture | Freiberg disease

AFFECTED IN: 5th MTT base? Apophysitis of 5th MTT?

Jone's fx | Iselin disease

Weight bearing ratio of MTT?

2:1:1:1:1

Forward projection of MT bones?

2>3>1>4>5

FOOT CONFIGURATION Morton's foot/Greek foot Egyptian foot? Squared foot?

2>1>3>4>5 1>2>3>4>5 1=2>3>4>5

MC foot configuration (69%)?

Egyptian foot

NORMAL WEIGHT BEARING OF THE FOOT How many percent in: Hindfoot? Forefoot?

50% | 50%

``` MEDIAL LONGITUDINAL ARCH Components? Keystone? Main supporting ligaments? Main supporting tendon? ```

Talus, calcaneus, navicular, 1st, 2nd, 3rd cuneiform 1,2,3 MTT Talus Spring ligament Tibialis posterior

Injury to the spring ligament/T.P tendon

(Collapse of MLA) Pes planus/flat foot deformity

Synonyms of pes planus

Pronated foot Everted foot Pes valgus

What disease is assoc c Pes Cavus?

CMTD

CMTD aka?

Peroneal Muscular Atrophy

``` LATERAL LONGITUDINAL ARCH Components? Keystone? Main supporting ligaments? Main supporting tendon? ```

Calcaneus, cuboid, 4 & 5 MTT Cuboid Long plantar ligament Peroneus longus tendon

TRANSVERSE ARCH Components? Keystone? Main supporting structure?

Base of MTT, all cuneiforms, cuboid 2nd cuneiform Intrinsic ms of the foot

Collapse of the transverse arch

TRANSVERSE ARCH

Paralysis of the intrinsic ms of the foot

TRANSVERSE ARCH

SUBTALAR JT Aka? How many axis? Actions?

Talocalcaneal jt Triaxial PF/DF INV/EV ABD/ADD ***Pronation/supination

``` MIDTARSAL JT Aka? How many axis? Actions? Components? (mnemonic) ```

Transverse tarsal jt Surgeon's jt Chopart's jt ``` Triaxial PF/DF INV/EV ABD/ADD ***Pronation/supination ``` TALO NA CC PA Talonavicular Calcaneocuboid

MC joint site for amputation

Midtarsal jt

SUPINATION OKC? CKC?

SINADPA SINABDA (SSETT)

PRONATION OKC? CKC?

PEVABDA PEVADPA

The only muscle on the dorsum of the foot that has no counterpart in the hand

EDB

TMT jt aka?

Lisfranc jt

PLANTAR MUSCLES OF THE FOOT - LAYER 1 | Mnemonics?

AFA Abductor hallucis Flexor digitorum brevis Abductor digiti minimi

PLANTAR MUSCLES OF THE FOOT - LAYER 2 Mnemonics? Plus??

(LQ) Lumbricals Quadratus Planta Plus: FHL & FDL Tendons

PLANTAR MUSCLES OF THE FOOT - LAYER 3 | Mnemonics?

FAF Flexor hallucis Adductor hallucis Flexor digiti minimi BREVIS

Opening found in the AH that serves as a passage of nerves

PORTA PEDIS

Site of entrapment of BAXTER'S NERVE

PORTA PEDIS

1st branch of LPN

BAXTER'S NERVE

PLANTAR MUSCLES OF THE FOOT - LAYER 4 | Plus??

INTEROSSEI Tibialis posterior & peroneus longus tendon

Muscles supplied by the MPN | Mnemonics??

``` FAF1 Flexor hallucis brevis Abductor hallucis Flexor digitorum brevis 1st lumbricals ```

TARSAL TUNNEL Medial/lateral side? Contents (mnemonic)?

Medial side ``` TOM DICK AND VERY NERVOUS HARRY Tibialis posterior Flexor digitorum longus Posterior tibial artery Posterior tibial vein Posterior tibial nerve Flexor hallucis longus tendon ```

Where can be the posterior tibial artery be palpated?

Behind the medial malleolus

Flexor retinaculum of ankle aka?

Lanciniate Ligament

EXTENSOR RETINACULUM | Content (mnemonic)?

From medial to lateral side TOM HANKS AND VERY NERVOUS DICK TRACY ``` Tibialis anterior tendon Extensor hallucis longus tendon Anterior tibial artery Anterior tibial vein Anterior tibial nerves Extensor digitorum longus tendon Peroneus tertius tendon ```

Anterior tibial artery becomes WHAT after the WHAT structure?

Dorsalis pedis artery Extensor retinaculum