Midterm Exam Flashcards
Patella
-Triangle Shaped Sesamoid
-Bone in tendon of the quad (Specifically Rec Fem)
Sesamoid
A bone embedded in a tendon (usually shaped like a sesame seed)
Patella (Anterior View)
-Base (the flat superior edge)
-Apex (the more pointed inferior edge)
Patella (Posterior View)
-Vertical Ridge
-Medial Articular Facet
-Lateral Articular Facet
*Facets articulate with the patellar surface of the femur and the medial and lateral condyles of the femur
What are the three articulations of the knee?
- Lateral condyle of the tibia articulates with the lateral femoral condyle
- Medial condyle of the tibia articulates with the medial femoral condyle
- Patella articulates with the femur
Available Movements of the Knee
-Flexion
-Extension
-Internal Rotation (Limited)
-External Rotation (Limited)
*Rotation occurs ONLY when Knee is flexed
Patellofemoral Joint
-Medial and Lateral facets of the patella articulate with the patellar surface of the femur
-Synovial
-Plane
-Patella moves down (inferiorly) during flexion and up (superiorly and laterally) during extension
*The lateral femoral condyle projects farther (anteriorly) than the medial femoral condyle
*This more anterior prominence of the lateral femoral condyle prevents the patella from tracking too far laterally
Tibiofemoral Joint
-Medial and Lateral Condyles of the tibia articulate with the medial and lateral femoral condyles
-Synovial
-Modified Hinge (because it allows for some rotation)
-Biaxial
The __________ femoral condyle projects farther (anteriorly) than the __________ femoral condyle
Lateral, Medial
This more anterior prominence of the lateral femoral condyle prevents the _____________ from tracking too far ___________.
Patella, Laterally
Valgus
Lateral deviation of the distal bone(s) of a joint
-When knee is fixed and the tibia (specifically the distal end) has deviated laterally (relative to knee)
-a.k.a. Knock-Knee
Varus
(return) Medial deviation of the distal bone of a joint
-When the knee is fixed and the tibia (specifically the distal end) has deviated medially (relative to the knee)
-a.k.a. bow-leg
Lateral Collateral Ligament (LCL) (fibular collateral ligament)
-Attached: lateral epicondyle of the femur - fibular
head
-checks/restricts VARUS deviation
-“pencil-like” (easier to palpate)
Medial Collateral Ligament (MCL) (tibial collateral ligament)
-Attaches: medial epicondyle of femur - medial condyle of the tibia
-checks/restricts VALGUS deviation
-it is a flat thickening of the joint capsule
-the deep fibres of the ligament are attached to the medial meniscus
Anterior Cruciate Ligament (ACL)
-Attaches: medial epicondyle of the femur - medial condyle of the tibia
-checks/restricts valgus deviation
-it is a flat thickening of the joint capsule
-the deep fibres of the ligament are attached to the medial meniscus
Posterior Cruciate Ligament
-Attaches: posterior intercondylar area of the tibia - anterior and lateral side of the medial femoral condyle
-slack when the knee is extended and taut when the knee is in full flexion
-checks posterior translation of the tibia on the femur (or anterior translation of the femur on the tibia) and knee flexion
Cruciate ligaments are named for __________________.
Where they attach on the tibia. (i.e. the anterior cruciate ligament attaches anteriorly on the tibia)
Medial and Lateral Coronary Ligaments (Attachments)
-Attach the medial and lateral menisci to their respective tibial plateaus
Menisci of the knee
-C-shaped plated of fibrocartilage attached to the articular surfaces of the tibia
-Centre is thinner than the outer edges
-Slightly mobile and and aid in the spreading of synovial fluid during knee movement
-Function: shock absorbers
-Function: deepen the articulation (provide more stable articulation between the tibia and the femur
-ends of the C-shape are called horns
-medial meniscus is attached to the medial collateral ligament
What is the terrible triad?
Anterior Cruciate Ligament (ACL)
Medial Collateral Ligament (MCL)
Medial Meniscus
2 menisci are connected anteriorly by the _____________.
Transverse Ligament of the Knee
Menisci of the knee (Function)
-Function: shock absorbers
-Function: deepen the articulation (provide more stable articulation between the tibia and the femur
Menisci of the knee (Attachments)
-C-shaped plated of fibrocartilage attached to the articular surfaces of the tibia
-Medial meniscus is attached to the medial collateral ligament
Posterior Cruciate Ligament (Checks/Restricts)
-Checks posterior translation of the tibia on the femur (or anterior translation of the femur on the tibia) and knee flexion
Posterior Cruciate Ligament (Attachments)
-Attaches: posterior intercondylar area of the tibia - anterior and lateral side of the medial femoral condyle
Anterior Cruciate Ligament (ACL) (Attachments)
-Attaches: medial epicondyle of the femur - medial condyle of the tibia
-The deep fibres of the ligament are attached to the medial meniscus
Anterior Cruciate Ligament (ACL) (Checks/Restricts)
-Checks/restricts valgus deviation
Medial Collateral Ligament (MCL) (Attachments)
-Attaches: medial epicondyle of femur - medial condyle of the tibia
-the deep fibres of the ligament are attached to the medial meniscus
Medial Collateral Ligament (MCL) (Checks/Restricts)
-Checks/restricts VALGUS deviation
Lateral Collateral Ligament (LCL) (Attachments)
-Attached: lateral epicondyle of the femur - fibular
head
Lateral Collateral Ligament (LCL) (Checks/Restricts)
-Checks/restricts VARUS deviation
Patellofemoral Joint (joint type)
-Synovial
-Plane
Patellofemoral Joint (Articulation)
-Medial and Lateral facets of the patella articulate with the patellar surface of the femur
Patellofemoral Joint (Movements)
-Patella moves down (inferiorly) during flexion and up (superiorly and laterally) during extension
*The lateral femoral condyle projects farther (anteriorly) than the medial femoral condyle
*This more anterior prominence of the lateral femoral condyle prevents the patella from tracking too far laterally
Tibiofemoral Joint (joint type)
-Synovial
-Modified Hinge (because it allows for some rotation)
-Biaxial
Tibiofemoral Joint (Articulation)
-Medial and Lateral Condyles of the tibia articulate with the medial and lateral femoral condyles
Pelvis Functions
-Protect the internal organs
-Transmit forces from upper body onto the lower limb
-Absorb forces from lower limb
Female Pelvis is _______________ and ________________ than the male pelvis.
Shorter, Wider
Coccyx
Tailbone (remnant of tail human embryos have until the beginning of 8th week)
Sacrum
-Wedge-shaped bone between 2 hip bones
Hip
-2 hip bones
-Each hip bone has 3 regions (separated in newborn (connected with cartilage) fused in early adulthood (15-20yrs))
1. Ilium
2. Ishium
3. Pubis
What are the 3 regions of hip bone?
- Ilium
- Ishium
- Pubis
Ilium
(pl. Ilia) (yellow)
-Large, superior part (2/3rds of the bone)
Ischium
(pl. Ischia) (blue)
-Posterior, Inferior
Pubis
-Piriformis
-Sciatic Nerve
-Posterior Femoral Cutaneous Nerve
Lateral View of Pelvis Structures
-Posterior superior iliac spine (PSIS)
-Posterior inferior iliac spine (PIIS)
-Greater sciatic notch (converted into greater sciatic foramen by sacrospinous ligament)
-Body of ilium
-Ischial spine
-Lesser Sciatic notch
-Body of ischium
-Ischial tuberosity “sitting bone”
-Ramus of ischium
-Obturator foramen
-Inferior pubic ramus
-Pubic tubercles
-Superior pubic ramus (ischopubic ramus)
-Acetabulum
-Anterior inferior iliac spine (AIIS)
-Anterior superior iliac spine (ASIS)
-Iliac crest (runs from the ASIS to PSIS)
Iliac tubercle (tuberculum) (~5cm posterior to ASIS)
Obturator Foramen
-Junction of ischium-pubis forms the obturator foramen
-Partly covered by connective tissue membrane
-Opening allows nerves and blood vessels to pass through (obturator vessels and nerve)
Greater sciatic notch (converted into __________________ by __________________ ligament).
Greater Sciatic Foramen, Sacrospinous
Medial View Pelvis Structures
-Iliac crest
-Anterior superior iliac spine (ASIS)
-Iliac fossa
-Anterior inferior iliac spine (AIIS)
-Iliopubic eminence
-Superior pubic ramus
-Pectineal Line (Pectin Pubis)
-Pubic tubercle
-Inferior pubic ramus
-Obturator foramen
-Ramus of Ischium
-Ischial Spine
-Greater sciatic notch
-Posterior inferior iliac spine (PIIS)
-Auricular (ear) surface of the ilium (for articulation with sacrum)
-Posterior superior iliac spine (PSIS)
Acetabulum
-The junction of the Ilium-ischium-pubis forms the acetabulum
-Place where thigh bone (head of femur) articulates with pelvis
Anterior View Pelvis Structures
-Iliac crest
-Anterior superior iliac spine (ASIS)
-Anterior inferior iliac spine (AIIS)
-Iliopubic eminence
-Superior pubic ramus
-Obturator foramen
-Pubic tubercle
-Inferior pubic ramus
-Ischial tuberosity
-Pubic symphysis (a.k.a. symphysis pubis)
-Lesser sciatic notch
-Pectineal Line
-Ischial Spine
-Greater sciatic notch
Sacrum
Each ilium articulates with the ____________.
Sacrum
Ischiopubic rami
Combined form of ramus of the ischium and the inferior pubic ramus
Inguinal Ligament
The boundary between the lower limb and the abdomen
-ASIS and pubic tubercle are attachments of inguinal ligament
-Inguinal region is the depression between the abdomen and thigh (referred to as groin)
Hip (Coxafemoral Joint)
-Head of femur articulates with the acetabulum
-Synovial
-Multiaxial
-Ball and Socket
-Head of femur projects medially, superiorly, & anteriorly
-Acetabulum projects laterally inferiorly, & anteriorly
Available Motions at Hip Joint
-Flexion
-Extension
-Medial Rotation
-Lateral Rotation
-Abduction
-Adduction
Articular Surface of the Acetabulum
-Horseshoe Shaped
Articular Cartilage
-Covers head of the femur and the horseshoe shaped part of the acetabulum
*Articular cartilage is part of a synovial joint
Ligament of the Head of Femur
-a.k.a ligamentum teres, round ligament, foveal ligament
-Connects head of femur to the acetabulum
Acetabular Labrum
-Fibrocartilagenous lip that attached to the bony rim of acetabulum
-Functions to deepen acetabulum (make ‘socket’ a deeper socket)
Acetabular Fossa
-Centre of acetabulum
-Fossa is occupied by fat pad covered with synovium
Acetabular Notch
-Notch between the 2 ends of the horseshoe
-Passage for blood vessels
Transverse Ligament of Acetabulum
-Connects (closes) the acetabular notch
Ligaments of the Hip
-All the capsular ligaments of the hip are coiled or twisted as they pass from the pelvis to the femur (in a neutral position)
-Extension/hyperextension tightens them further making extension part of the close-packed position and a position of stability in an upright posture
-Conversely, full hip flexion with abduction is an unstable position
Iliofemoral Ligament (Y ligament)
Attaches: AIIS, acetabular rim - intertrochanteric line of femur
Checks: extension, abduction, lateral rotation
Pubofemoral Ligament
Attaches: superior pubic ramus - iliofemoral ligament
Checks: abduction
Ischiofemoral Ligament
Attaches: ischial part of acetabular rim - femoral neck and medial greater trochanter
Checks: hyperextension
Trochanteric Bursa
-Between the gluteus maximus muscle and the (postero-lateral) greater trochanter
Ischiogluteal Bursa
-Overlying the ischial tuberosity
-Weavers bottom (layman’s term for ischiogluteal bursitis) - people weaving would have to extend one leg forward then the other - the repetitive position changes put excessive pressures on the ischial tuberosity and therefore the bursa
Weavers bottom
(layman’s term for ischiogluteal bursitis)
-People weaving would have to extend one leg forward then the other - the repetitive position changes put excessive pressures on the ischial tuberosity and therefore the bursa
Iliopectineal Bursa
Between the iliopsoas muscle and the iliopubic eminence
Pubic Symphysis (a.k.a. Symphyis Pubis)
-Joint between the 2 pubic bones
-Cartilaginous Joint (there is cartilage between 2 ends)
-Fibrocartilagenous disc between 2 bones which acts as a shock absorber
-Limited movement
-Ligaments: superior pubic ligament, inferior pubic ligament
Sacroiliac Joint
-Joints between ilia and sacrum (sacrum is suspended between the ilia)
-Synovial Joints (very strong joint - capsule is strong, ligaments are strong, etc.)
*Does not fit under specific joint category
-Surfaces are irregular in shape and contour (elevations and depressions) which result in. a partial interlocking of the bones
-Limited movement (trade mobility for stability)
-Ligaments: anterior and posterior sacroiliac ligaments
Pelvis is held together by _________________.
Ligaments
Ligaments (and the pubic symphysis) progressively _____________ during pregnancy to allow passage of the fetus through the birth canal.
Relax
Iliolumbar Ligament
-TVP’s L4 & L5 to the posterior iliac crest
-Key stabilizer of L5
-Limits/checks/restricts lateral flexion
Sacrotuberous Ligament
-Posterior surface of the sacrum/coccyx to the ischial tuberosity
-Stabilizes the SI joint and provides a surface attachment for gluteus maximus
Sacrospinous Ligament
-Lateral sacrum/coccyx to the ischial spine
-Converts the greater sciatic notch into the greater sciatic foramen
What is the only intrinsic muscle on dorsum foot?
Extensor Digitorum Brevis
Potential cause of tarsal tunnel syndrome
Rheumatoid Arthritis
What is the most anterior tendon behind medial malleolus?
Tibialis Posterior
To stretch soleus you need to ___________ ankle and _________ knee.
Dorsiflex, Flex
What is the 2nd tendon you will palpate across anterior ankle medial to lateral?
Extensor Hallusis Longus
Tendon sheath surround tendon to prevent friction between tendon and ________________.
Retinacula
What 2 muscles form a stirrup for the foot by sharing a common distal attachment at base of 1st MT?
Peroneus Longus, Tibialis Anterior
Boundary between lower limb and abdomen?
Inguinal Ligament
Subcutaneous Prepatellar Bursa
-a.k.a. housemaid’s knee
-Between the skin and the anterior part of the patella
Suprapatellar Bursa
-Between tendon of the quadriceps muscle and the femur
-Connected to the joint capsule
-Bursa is held in place (and retracted during knee extension) by the articularis genus muscle
Subcutaneous Infrapatellar bursa
-a.k.a. clergyman’s knee or carpet layer’s knee
-Between the skin and the proximal tibia (in the area of the tibial tuberosity)
Deep Infrapatellar Bursa
-Between the patellar ligament and the anterior tibia (superior to the tibial tuberosity)
Pes Anserine Bursa
-Between the tendons of the pes anserinus muscles and the medial tibia
-Pes anserinus muscles: sartorius, gracilis, semitendinosus
-Looks like goose foot
Pes Anserine Muscles
sartorius, gracilis, semitendinosus
Medial Semimembranosus Bursa
-a.k.a. Bakers Cyst
-Between the tendons of the medial semimembranosus muscles and the medial gastrocnemius
Bursa Deep to the Iliotibial Band
-a.k.a. runners knee (layman’s term), IT band friction syndrome (medical term)
-Between the iliotibial band and the lateral femoral epicondyle
Quadriceps
-4 quadriceps
-Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius
-Prime mover for extension of the knee
-All share a common distal attachment at the tibial tuberosity, via the patellar ligament
How many Quadriceps are there?
4
What are the 4 Quadriceps?
-Rectus Femoris
-Vastus Lateralis
-Vastus Medialis
-Vastus Intermedius
What is a prime mover for extension of the knee?
Quadriceps
Rectus Femoris (Attachment)
-Superior/Proximal Attachment: AIIS and superior to acetabular rim (straight head and reflected head)
-Inferior/Distal Attachment: Tibial Tuberosity (via patellar ligament)
Rectus Femoris (Actions)
-Hip flexion
-Knee Extension