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SF1 Unit 1 Post Exam 1 > Lower Limb Joints- Wilson > Flashcards

Lower Limb Joints- Wilson Flashcards

1
Q

What are the major features you would find in the synovial joints around in the body?

A
  • synovial joints surrounded by thick connective tissue capsule which surrounds the articular surfaces of the joints isolating the joint from the rest of the body
  • capsule made up of collagen fibers
  • thickening in capsule that serve as intrinsic ligaments that help support and maintain stability of the joint
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2
Q

What cartilage is lining the bony articular surfaces and is the toughest cartilage in the body?

A

hyaline cartilage

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3
Q

What is a synovial membrane?

A

single layer of squamous epithelium that secrete synovial fluid that acts as a lubricant so that movement of cartilage on top of cartilage moves without any friction

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4
Q

What is the angle of the mechanical axis of the hip joint?

A

degree of incline is 87 degrees compared to 90 degree to earth

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5
Q

Describe the medial slant of the axis of the long bone.

A

vara or varus condition

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6
Q

Describe the lateral slant of the axis of the long bone.

A

valga or valgus condition

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7
Q

Why is there a slant of femur normally?

A

allows for the ability to stand in an erect posture using little energy with our bone locked together; tibia is more or less perpendicular to the earth so our feet is underneath our body weight; don’t have to utilize a lot of muscle contraction

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8
Q

What is the angle of inclination?

A

anlge between the neck and shaft of femur

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9
Q

What is the normal range for the angle of inclination?

A
  • 125 (btw 120 and 135) is normal

- excessive amount of slant: > 135 degrees–> coxa valga

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10
Q

What is the condition called when the angle of inclination is excessive or not enough?

A

coxa valga: >135 degrees

coxa vara : <120 degrees

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11
Q

Describe the hip joint.

A
  • is a synovial joint
  • has a ball and socket variety of movement
  • can move in the saggital coronal and axial planes
  • very similar to the range of motion of the shoulder joint (glenohumeral joint)
  • this joint is deeper and provides more stability as it is more weight bearing compared to the glenohumeral joint

-consists of the ilium, pubis, ischium

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12
Q

Know boundaries of ilium, ischium, and pubis of the coxal bone

A
  • The posterior margin of the ilium has the large greater sciatic notch.
  • The posterolateral portion of the hip bone is the ischium. It has the expanded ischial tuberosity, which supports body weight when sitting. The ischial ramus projects anteriorly and superiorly.
  • The pubis forms the anterior portion of the hip bone. The pubis curves medially, where it joins to the pubis of the opposite hip bone at a specialized joint called the pubic symphysis.
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13
Q

What are the 3 distinct ligaments for stability of the pelvic girdle?

A
  • iliofemoral ligament (thickest, most strongest and important): head of the femur rests here; helps to support the hip joint in an erect position
  • pubofemoral ligament
  • ischiofemoral ligament seen posteriorly
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14
Q

What is the intra ligament of the femur?

A

ligament of the head of the femur

  • very thick
  • acetabular artery runs within it which supplies the head of the femur
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15
Q

The presence of this acetabular artery is variable and may not be present at times. What is the clinical significance of this?

A
  • the femur has a reliable source of blood to the head of the femur
  • because of hardening of the acetabular artery with aging, the blood flow of the artery could be reduced or absent
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16
Q

Elderly are prone to fracture of the hip joint specifically the neck of the femur which has what characteristic?

A

shortening and lateral rotation of the affected limb

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17
Q

What is the anatomical reason for the shortening and lateral rotation of the affected limb during a fracture of the neck of the femur?

A

because attached to the proximal part crossing the hip joint are a number of muscles

external rotators :

  • gluteus maximus
  • quadratus femoris
  • obturator internus
  • obturator externus
  • piriformis

internal rotators:

  • gluteus medius
  • gluteus minimus
  • tensor fascia lata

when you damage or fracture bone these muscles undergo protective SPASMS and the limb will move depending on which muscles are stronger (lateral rotators are stronger)

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18
Q

Lateral rotators are stronger than the medial rotators when they contract at the same time. Why is this significant in a fracture of the neck of the femur?

A

fracture of the neck of the femur has a characteristic of shortening and lateral rotation as the lateral rotators not only laterally rotate the femur but they pull the femur up as the cross the the neck of the femur allowing for PROTECTIVE SPLINTING OF THE HIP

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19
Q

As you get older the prognosis for healing is lower. What are the 3 arteries that supply the neck and head of femur?

A
  • medial femoral circumflex artery
  • lateral femoral circumflex artery
  • acetabular artery which is not a reliable source of blood
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20
Q

radicular arteries of the medial and lateral femoral circumflex

A

radicular arteries of the medial and lateral femoral circumflex

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21
Q

When you fracture the head of femur, how does that change blood supply if at all?

A

Proximal fracture of femoral neck (poor prognosis):
severing all the branches of the medial and lateral femoral circumflex resulting in avascular necrosis

Distal fracture of femoral neck (good prognosis): all segments of the head, neck, and shaft blood supply is intact

22
Q

Why does the hip joint not dislocate anteriorly?

A

iliofemoral ligament

23
Q

What happens when the hip joint dislocates

posteriorly?

A
  • shortening of the limb

- medial rotation of the hip

24
Q

Entrapment of what nerve is common complication of a dislocated hip?

A

sciatic nerve

25
Q

What are the bones that make up the knee joint?

A
  • condyles of femur and tibia, patella
  • 99% hinge joint: locking the knee in position as you’re standing; when you stand erect there is a slight degree of rotation
26
Q

What bone does not participate in the knee joint?

A

fibula: primarily fxn for muscle attachment

27
Q

The knee joint is supported by what 3 types of ligaments?

A

extrinsic (do not participate in the capsule): fibular (lateral) collateral ligament; patellar ligament

Intrinsic: medial meniscus, lateral meniscus, tibial (medial) collateral ligament;

intra-articular ligament: posterior and anterior cruciate ligaments; support and maintain stability of knee joint; if they are ruptured there will be loss of function

28
Q

When the tibia slides excessively anterior when testing cruciate ligament what is injured?

A

positive drawer sign if anterior cruciate ligament is ruptures

when tibia slides excessively posterior the posterior cruciate ligament is ruptured

29
Q

What ligament may be injured when the knee is hyperextended?

A

rupture of the ACL: anterior cruciate ligament

30
Q

What ligament may be injured when the knee is hyperflexed?

A

posterior cruciate ligament

31
Q

What is the purpose of the two menisci that are interposed between the condyles made up of hyaline cartilage?

A

makes the joint a little deeper than what it would be otherwise to allow for better contact between the femur and tibia

32
Q

The medial meniscus is directly attached to the tibial collateral ligament. Why is this clinically significant?

A

Clinical significance: if you end up tearing or stretching the tibial collateral you end up pulling out the medial meniscus from its normal position

33
Q

What are the 3 structures normally damaged with fracture to the knee (the unhappy triad)?

A
  • tibial (medial) collateral ligament
  • medial meniscus
  • ACL: anterior cruciate ligament which prevents anterior displacement
34
Q

What is another term for knocked knee?

A

genu valgum

valgus force pushes knee closer together

35
Q

What is another term for bow leg?

A

genu varum

varus pressure pushes knee laterally

36
Q

Tibia compensates by going the opposite direction. Explain.

A

knocked knee:

  • genu valgum
  • coxa vara

bow leg:

  • genu varum
  • coxa valga
37
Q

What is a positive valgus stress test?

A
  • push ankle laterally

- medial collateral ligament is torn

38
Q

What is a positive varus stress test?

A
  • push ankle medially

- lateral collateral ligament is torn

39
Q

The patella can be dislocated laterally, usually laterally. How is the probability of its dislocation determined?

A

probability of dislocation is determined by the Q angle ( angle between femur and line of gravity)

  • women have large Q angle (wider hips)
  • men have smaller Q angles
40
Q

What is the affect of broad or narrow hips on the patella dislocation?

A

rectus femoris pulls on patella

small hips: rectus femoris is pulling the patella straight up (less prone to patellar fracture)

braod hips: patella is being pulled up at an angle by rectus femoris (more prone to patellar fracture)

41
Q

What bones form the ankle joint?

A

tibia (medial malleolus), fibula (lateral malleolus), talus

42
Q

What ligaments are damaged when you twist your ankle?

A

lateral ligaments

  • calcaneofibular ligament
  • anterior talofibular ligament

-posterior talofibular ligament

43
Q

What is the medial ligament supporting the ankle joint?

A

deltoid ligament: very strong and difficult to tear but can occur with FORCE eversion of the ankle

44
Q

What does a tear to the deltoid ligament cause?

A

Pott’s fracture dislocation

pulls off the medial malleolus off the tibia

45
Q

As you dislocate the foot what happens to the fibula?

A

you bend the fibula producing a lot of torque until it fractures

46
Q

What are the 3 things that happen with a Pott’s fracture dislocation?

A
  • medial malleolus is avulsed (fractured) by the strong deltoid ligament
  • the ankle becomes unstable and dislocates
  • torque on the fibula results in fracture
47
Q

Does the synovial membrane line the entire joint?

A

No, because if you put the synovial membrane around the hyaline cartilage the membrane itself would be ground to pieces as it is very thin and hyaline cartilage is very resilient

so it is inside the joint outside of the articular surfaces

48
Q

The articular capsule is composed of parallel fibers. Why is this significant?

A

extension causes the fibers to spiral (become oblique) which draws the acetabulum and femur closer together (like a screw). This increases hip stability. The fibers unwind during flexion.

The collagen fibers of the articular capsule run parallel; allows for maximum amount of contact between the head of the femur and and iliofemoral ligament that during standing the hip joint is in the most stable condition.

49
Q

Hip injuries cause its myotatic unit to spasm which provides protecting splinting. These spasms can cause what?

A
  • limb shortening

- lateral rotation

50
Q

Sprained ankle is the most common joint injury. What causes it?

A

forced inversion of the foot tears the lateral ligaments of the ankle:

  • anterior talofibular ligament
  • calcaneofibular ligament
51
Q

Why is there medial rotation of the hip with a posterior dislocation of the hip?

A

the normal relationship between the femur and the coxal bone has changed

  • now the point of action of muscles on the femur is not located anteriorly in the acetabular fossa but the head of femur is now located posteriorly
  • the angle when these muscles contract, the fulcrum of action and movement is changed
  • lateral rotators become medial rotators

SF1 Unit 1 Post Exam 1 (14 decks)

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