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ANAT2029 > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

What Comprises the pelvis?

A

The two hip bones of the pelvic girdle and the sacrum

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2
Q

Which of these bones contribute to the formation of the –

  • obturator foramen?
  • greater sciatic notch?
A

obturator foramen? ischium and pubis

greater sciatic notch? ilium and ischium

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3
Q

Define nutation & when it occurs:

A

Body weight forces the base of the sacrum anteriorly & inferiorly, which forces the apex posteriorly and superiorly. This causes an anterior tilt of the sacrum relative to the ilium. Eg. Trunk or hip flexion

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4
Q

Define counternutation & when it occurs:

A

Opposite of nutation. Body weight forces the base of the sacrum posteriorly & superiorly, which forces the apex anteriorly and inferiorly. This causes an anterior tilt of the ilium relative to the sacrum
Eg. Hip or trunk extension

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5
Q

Which capsular hip ligaments increase tension during flexion of the hip?

A

None

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6
Q

Which capsular hip ligaments increase tension during extension of the hip?

A

Iliofemoral, Ischiofemoral and Pubofemoral

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7
Q

Which capsular hip ligaments increase tension during Abduction of the hip?

A

Pubofemoral

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8
Q

Which capsular hip ligaments increase tension during adduction of the hip?

A

Iliofemoral (superior part) and Ischiofemoral (in hip flexion)

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9
Q

Which capsular hip ligaments increase tension during medial rotation of the hip?

A

Iliofemoral (superior part) and Ischiofemoral (primary restraint)

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10
Q

Which capsular hip ligaments increase tension during lateral rotation of the hip?

A

Iliofemoral

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11
Q

In what position are all the ligaments of the hip taut?

A

Extension

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12
Q

Which of the 3 ligaments provide greatest restraint to anterior translation of the femoral head in hip extension?

A

Iliofemoral ligament

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13
Q

If you had an intra-articular hip pathology (i.e. increase synovial fluid inside the capsule), what hip position would you adopt?

A

Hip Flexion as the ligaments are most lax

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14
Q

Which 2 movements move the head of the femur deeper into the acetabulum?

A

Hip flexion and abduction

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15
Q

Which end of range movement could impinge the anterior femur on the anterior acetabulum?

A

Internal rotation in end range flexion

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16
Q

What is the function of the muscles in the lateral pelvis group during gait?

A

The gluteus medius provides stability to the non-weight bearing leg to prevent contralateral hip drop.

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17
Q

Describe and identify the fascia lata and the iliotibial tract (band).

A

ITB is the thickening of the tensor fascia latae muscle. The TFL runs from the ASIS and iliac crest to the ITB which attaches to the lateral tibia at gerdy’s tubercle.

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18
Q

Which muscles attach closely to the pubic symphysis?

from superiorly: from inferiorly:

A

from superiorly: rectus abdominis from inferiorly: adductor group and gracilis

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19
Q

Which muscles are hip flexors?

A

psoas major
iliacus
rectus femoris

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20
Q

Which muscles are hip extensors?

A

gluteus maximus
hamstrings
adductor magnus

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21
Q

Which muscles are hip abductors?

A

gluteus maximus (superior fibres)
gluteus minimus
tensor fascia latae

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22
Q

Which muscles are hip adductors?

A

pectineus
adductor brevis adductor longus
adductor magnus
gracilis

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23
Q

Which muscles are hip external rotators?

A 
piriformis
obturator internus*
superior gemellus
inferior gemellus
quadratus femoris
obturator externus*
gluteus maximus*
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24
Q

THERE ARE NO MUSCLES AT THE HIP WITH A PRIMARY ACTION OF HIP MEDIAL ROTATION. List some that may contribute.

A 
gluteus medius (F/E) (anterior fibres)
gluteus minimus (F/E) (anterior fibres)
semitendinosus (E)
semimembranosus (E)
piriformis* (F)
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25
Q

List the ligaments of the Sacro-Iliac joint (SIJ)

A 
dorsal sacroiliac ligament
interosseous sacroiliac ligaments 
ventral sacroiliac ligaments
sacrospinous ligament
sacrotuberous ligament
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26
Q

List the ligaments of the Pubic Symphysis

A

superior pubic ligament

arcuate (inferior) pubic ligament

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27
Q

Observe the difference in anterior-posterior length of the articular surfaces of the lateral and medial femoral condyles. What affect does this have on tibiofemoral joint movement?

A

The medial condyle is longer, which means that they move together until end range extension where the femur internally rotates and locks. This is known as the screw home mechanism

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28
Q

Observe the shape (anterior versus posterior portions) of the femoral condyles. How does the shape affect stability in knee extension (standing) versus knee flexion?

A

In extension (standing) the knee is in close packed position which allows greater stability but less mobility (limited rotation). Whilst in flexion the knee is in open packed position which allows more mobility (rotation) but less stability (reduced articular surface contact area).

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29
Q

Compare the relative sizes of the tibial condyles with those of the femoral
condyles. What does the difference in size mean for the relative movement of articular surfaces during flexion – extension?

A

The femoral condyles are larger than the tibial condyles, this means that for flexion at the knee to occur the femur must glide anteriorly on the tibia to avoid rolling off of the tibia.

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30
Q

What are the functions of the menisci?

A

To increase surface area, reduce articular friction, absorb joint forces, improve tibiofemoral joint congruency and protect the hyaline cartilage.

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31
Q

Which meniscus is less mobile and what is the possible consequence of this?

A

Medial, predisposed to shearing force injury tears

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32
Q

Which meniscus provides relatively less coverage of its tibial plateau and what is a possible consequence of this?

A

Medial, more likely to develop osteoarthritis

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33
Q

Which is the most common direction of deviation / subluxation / dislocation of the patella? Why?

A

Lateral. The bony features create a barrier to medial movement of the patellar. Ligamentous stability is stronger on the lateral side. The line of action of the quadriceps all include a lateral pull, except for the vastus medialis and obliquus which have a much smaller PSCA and pull than the laterally pulling muscles.

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34
Q

What are the passive restraints to lateral dislocation?

Passive =

A
  • Lateral femoral condyle
  • Medial patellofemoral ligament
  • Natural alignment of the knee (lateral pull) Q angle
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35
Q

How would removal of the patella affect knee extensor strength?

A

The patella increases the moment arm of the quadriceps at the knee. By reducing the moment arm, torque is also reduced, thus the strength of the knee extensors would be reduced.

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36
Q

What action does sartorius produce?

A

Hip F + ER + Abd + Kn F

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37
Q

What action does rectus femoris produce?

A

Hip F + Kn E

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38
Q

What action does vastus lateralis produce?

A

Kn E

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39
Q

What action does vastus medialis longus produce?

A

Kn E

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40
Q

What action does vastus medialis obliquus produce?

A

Kn E

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41
Q

What action does vastus intermedius produce?

A

Kn E

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42
Q

What action does gracilis produce?

A

Add Hip + Knee F

43
Q

What action does biceps femoris produce?

A

Both heads Knee F + LR and the long head also Hip E

44
Q

What action does semitendinosus produce?

A

Hip E + Knee F & MR

45
Q

What action does semimembranosus produce?

A

Hip E + Knee F & MR

46
Q

What action does semimembranosus produce?

A

Hip E + Knee F & MR

47
Q

What action does gluteus maximus produce?

A

Hip E, LR & ABD

Resists knee varus

48
Q

What action does tensor fasciae latae produce?

A

Hip F, IR & ABD

resists knee varus

49
Q

What action does gastrocnemius produce?

A

PF and Knee F

50
Q

What action does plantaris produce?

A

Weak PF and weak knee F

51
Q

What action does popliteus produce?

A

Performs LR of femur on tibia; resists LR of tibia on femur

52
Q

Which structures resist anterior translation of the tibia on the femur?

A

ACL, menisci, hamstrings

53
Q

Which structures resist posterior translation of the tibia on femur?

A

PCL, quadriceps, menisci

54
Q

Which structures resist tibiofemoral hyperextension?

A

oblique popliteal ligament, ACL, PCL

55
Q

Which structures resist tibiofemoral valgus?

A

tibial collateral ligament, ACL, PCL, semitendinosus, gracilis, sartorius, semimembranosis

56
Q

Which structures resist tibiofemoral varus?

A

fibular collateral ligament, ACL, PCL, popliteus, menisci, ITB

57
Q

Which structures resist internal rotation of tibia on femur?

A

ACL, ALL

58
Q

Which structures resist external rotation of tibia on femur?

A

PCL

59
Q

Identify the boundaries and contents of the popliteal fossa:

A

Superomedial: semimembranosus and semitendinosus
Superolateral: biceps femoris Inferomedial: medial head of gastrocnemius
Inferolateral: lateral head of gastrocnemius (+plantaris)

Contents: popliteal artery, popliteal vein, tibial nerve, common fibular nerve

60
Q

Define -
Genu varus:
Genu valgus:

A

Genu varus: distal segment is medial from the knee (knock-kneed)
Genu valgus: distal segment is lateral from the knee (bow-legged)

61
Q

How do we measure the mechanical alignment of the lower limb?

A

Hip knee angle (HKA). Intersection of mechanical axis of femur and mechanical axis of tibia. On average is slightly less than 180 degrees = 1-2 degrees varus

62
Q

How does HKA affect loading of the tibiofemoral joint?

A

Load bearing more medial compartment than lateral

63
Q

What is the normal alignment of the femur and tibia in the coronal plane using the anatomical axes? What is the consequence of this alignment?

A

Natural anatomical valgus. More prone to valgus injuries

64
Q

What is the “pes anserinus”?

A

Goose’s foot - insertion of the conjoined medial knee tendons into the anteromedial proximal tibia

65
Q

Define the components of the functional units within the foot:
• hindfoot:
• midfoot:
• forefoot:

A

hindfoot: calcaneus and talus
• midfoot: medial cuneiform, intermediate cuneiform, lateral cuneiform, navicular and cuboid
• forefoot: metatarsals, proximal, middle & distal phalanges and seismoid

66
Q

Which metatarsal is shortest?
Which metatarsal is longest?
Which metatarsal has the thickest diaphysis?
What does this suggest?

A

Which metatarsal is shortest? 1st
Which metatarsal is longest? 2nd
Which metatarsal has the thickest diaphysis? 1st
What does this suggest? More load bearing

67
Q

Compare the relative length of the metatarsals & phalanges of the foot with the metacarpals & phalanges of the hand.

A

Phalanges in the hand are longer to assist with dexterous function. Metatarsals are longer to assist with an increase in surface area of feet for bipedal gait.

68
Q

Compare the mobility and function of the 1st ray & hallux with that of the thumb.

A

1st ray and hallux is designed for weight bearing function. Thumb is designed for function tasks such as gripping and dexterity rather than weight bearing

69
Q

Identify the plantar fascia / aponeurosis.
Proximal attachment:
Distal attachment:

A

Proximal attachment: medial tuberosity of the calcaneus

Distal attachment: capsules of all MTP joints

70
Q

What action(s) does the tibialis anterior perform?

A

DF + Inversion

71
Q

What action(s) does the extensor digitorum longus perform?

A

2nd - 5th toe E

72
Q

What action(s) does the extensor hallucis perform?

A

Hallux E

73
Q

What action(s) does the fibularis tertius perform?

A

DF + eversion

74
Q

What action(s) does the soleus perform?

A

Ankle PF

75
Q

What action(s) does the tibialis posterior perform?

A

Inversion + PF

76
Q

What action(s) does the flexor digitorum longus perform?

A

2nd - 5th toe F

77
Q

What action(s) does the flexor hallucis perform?

A

Hallux F

78
Q

What action(s) does the fibularis longus perform?

A

Eversion

79
Q

What action(s) does the fibularis brevis perform?

A

Eversion

80
Q

What action(s) does the extensor digitorum brevis perform?

A

2nd - 4th toe E

81
Q

What action(s) does the extensor hallucis brevis perform?

A

Hallux E

82
Q

What action(s) does the abductor hallucis perform?

A

Hallux abduction + F

83
Q

What action(s) does the flexor digitorum brevis perform?

A

2nd - 5th PIP F

84
Q

What action(s) does the abductor digiti minimi perform?

A

5th digit abduction

85
Q

What action(s) does the quadratus plantae perform?

A

Assists FDL

86
Q

What action(s) does the lumbricles perform?

A

MTP F + IP E

87
Q

What action(s) does the flexor hallucis brevis perform?

A

Hallux F

88
Q

What action(s) does the flexor digiti minimi perform?

A

5th MTP F

89
Q

What action(s) does the dorsal interossei perform?

A

abduct toes 2-4

90
Q

What action(s) does the plantar interossei perform?

A

adduct toes 3-5

91
Q

What does the anterior talofibular ligament (ATFL) resist?

A

Inv in PF

92
Q

What does the posterior talofibular ligament (PTFL) resist?

A

DF

93
Q

What does the anterior tibiotalar ligament resist?

A

PF

94
Q

What does the posterior tibiotalar ligament resist?

A

DF

95
Q

What does the calcaneofibular ligament (CFL) resist?

A

adduction

96
Q

What does the tibionavicular ligament resist?

A

abduction

97
Q

What does the tibiocalcaneal ligament resist?

A

abduction

98
Q

Which ligament is most commonly injured in an ankle sprain? Explain how & why

A

ATFL, a forced supination in plantarflexion movement.
It usually occur during a rapid shift of body center of mass over the landing or weight-bearing foot. The ankle rolls outward, whilst the foot turns inward causing the lateral ligament to stretch and tear.

99
Q

What does the interosseous ligament within the sinus tarsi do?

A

controls the talus during inversion and eversion

100
Q

What does the plantar calcaneonavicular (spring) ligament resist?

A

stabilises medial longitudinal arch + head of the talus

101
Q

What does the deltoid ligament resist?

A

PF, ER + Pronation

102
Q

What does the anterior inferior tibiofibular ligament (AITFL) resist?

A

anterior displacement + medial shifting of the talus

posterior displacement + lateral rotation of the tibia + fibula

103
Q

What does the posterior inferior tibiofibular ligament (PITFL) resist?

A

posterior displacement of the talus

ANAT2029 (4 decks)

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