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year 2 > MS- tib/fib joint (prox and distal), ankle and foot > Flashcards

MS- tib/fib joint (prox and distal), ankle and foot Flashcards

1
Q 
superior tib/ fib joint
 type of joint
 movements
 degrees of freedom => direction of movements
 articular surfaces (arthrokinematics)
 nerve supply
A
  1. arthrodial/ plane synovial joint
  2. movements: gliding (sliding)
  3. 2 degrees of freedom => caudal/cephalad and dorsal/ventral
  4. concave fib moving on convex tib => same motion
  5. nerve supply: common peroneal nerve
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2
Q

superior tib/fib joint
resting position
closed pack position
capsular pattern

A

resting position: 25 knee flex & 10 PF
closed pack position: none known
capsular pattern: none known

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3
Q

superior tib/fib joint
function/purpose
does this help increase ROM?

A
  1. serve the ankle, considered closed chain unit

2. joints don’t increase ROM but if limited they will decrease ROM

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4
Q

ligaments of superior tib/fib joints (3)
+ 1 muscle
+ primary stabilizer

A
  1. anterior and (2) posterior superior tibiofibular ligaments
    both reinforce the capsule
    both ligamentsrun oblique superiormedial from fib head -> lateral femoal condyle
    (anterior is made up of 2-3 bands)
  2. interossous membrane
  3. popliteus muscle reinforces posterior capsule
  4. primary stabilizer are ligaments of inferior tib/fib jt
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5
Q 
LAB: sup tib/fib jt
 anterior glide
pt position
stabilize
mobilize (w/ what)
indication
A
  1. pt prone, knee flexed 25, ankle on pillow at 10PF
  2. stabilize- tib
  3. mobilize- head of fib with heel of hand
  4. increase splaying in DF
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6
Q 
LAB: sup tib/fib jt
 posterior glide
pt position
stabilize
mobilize (w/ what)
indication
A
  1. pt. supine, knee flexed, foot on bed
  2. stabilize foot by sitting on it
  3. mobilize- head of fib with heel of hand
  4. increase PF
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7
Q 
inferior tib/fib jt
 type of joint
 movements
 degrees of freedom => direction of movements
 articular surfaces (arthrokinematics)
 nerve supply
A
  1. syndesmosis = fibrocartilaginous, about 1mm hyaline cartilage covers inf joint
  2. 2 degrees of freedom => 4 possible movements
    dorsal/ ventral glide
    caudal/ cephalad glide
    medial/ lateral splay (during DF)
    lat rotation around fibula
  3. articular surfaces- convex fibb moving on concave tib => opposite motions
  4. nerve supply- deep peroneal and tibial nerve
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8
Q

inferior tib/fib joint
resting position
closed pack position
capsular pattern

A

resting position- 10PF midway btwn eversion/inversion
closed pack position - none b/c syndesmosis joint
capsular pattern- none b/c syndesmosis joint

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9
Q

inferior tib/fib joint what happens to fib during PF? (3)

A

adducts
IR
glides anteriorly

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10
Q

inferior tib/fib joint what happens to fib during DF? (3)

A

abduct
ER
glide posterior

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11
Q

ligaments of inf tf joint (5)

and their purposes

A
  1. crural tibiofibular interosseous ligament
    strong/thick oblique fibers which serve as axis of motion for fib
    gives stability at inf jt, movement at sup jt.
  2. ant (3) posterior tibiofibular ligaments (so strong bone will break before these tear)
    ant- limits post glide
    post- limits ant glide
    b/c these are a little oblique
  3. inferior transverse ligament
  4. interosseous membrane
    holds shafts of bones together
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12
Q

clinical relevance of tib/fib joints
falling
joint health

A
  1. falling on mortice (side of foot) will fracture fib or tear ankle collateral lig before injure tf ligs
  2. prox tf is dependent on distal tf for motion so they both must have adequate mobility because hyaline cartilage nourishment is dependent on movements
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13
Q 
LAB: inf tib/fib jt
 ant glide
pt position
stabilize
mobilize (w/ what)
indication
A

pt: prone (or side-ly) with leg on wedge and foot in 10PF
stabilize: med tibia
mobilize: heel of hand mobilize posterior lateral malleolus
indication: PF

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14
Q 
LAB: inf tib/fib jt
 posterior glide
pt position
stabilize
mobilize (w/ what)
indication
A

pt: supine (or side-ly) with leg over edge of table
stabilize: med tibia
mobilize: heel of hand mobilize anterior lateral malleolus
indication: DF

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15
Q 
LAB: inf tib/fib jt
 cranial glide
pt position
stabilize
mobilize (w/ what)
indication
    how to turn this into treament
A

pt: side-ly (or supine) with medial leg on plinth
stabilize: foot or distal leg against table
mobilize: heel of hand mobilize inferior lateral malleolus
indication: DF
with exersion => treatment

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16
Q 
LAB: inf tib/fib jt
 caudal glide
pt position
stabilize
mobilize (w/ what)
indication
    how to turn this into treament
A

pt: side-ly (or supine) with medial leg on plinth
stabilize: foot or distal leg against table
mobilize: heel of hand mobilize inferior lateral malleolus
indication: PF
with inversion => treatment

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17
Q

subtalar joint fibular movement
pronation
supination

A
  1. pronation => slides proximal and ant

2. supination => distal and posterior

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18
Q 
transmalleolar axis 
 stresses
 type of axis
 bones that comprise the axis 
 angle of inclination, what it is and why
A

transmalleolar axis

  1. subject to varus stress and compressive loading
  2. oblique axis
  3. joint axis goes btwn med/lateral mall thru talus
  4. angle of inclination is 15 deg ER (toe out) because fibular head extends further distally (and is smaller)
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19
Q

ankle and foot injury
%
things it can affect (2)

A
  1. 80% of pop has problem

2. can affect: gait and stresses on other joints => further pathology

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20
Q

stability demands on ankle/foot complex (4)

A
  1. provide stable base for the body
  2. adapt to variety of postures and positions
  3. avoid excess muscular activity/ energy expenditure
  4. act as rigid lever for effective push off during gait
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21
Q

mobility demands on ankle/foot complex (3)

A
  1. dampen rotations imposed by prox joints (tib/fib)
  2. be flexible to absorb shock of bw as foot hits floor
  3. allow foot to conform to changing terrains
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22
Q

4 types of force acting on ankle/foot

A
  1. compression: during heel plant-> mid stance
  2. shearing: during transitions in gait
  3. rotation: of tib/fib
  4. tension: from ligaments/ tendons and muscles
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23
Q

planes of ankle movement
x
y
z (two names for movements)

A
  1. x = DF/PF around saggital plane
  2. y= ad/aB around transverse plane
  3. z= inversion/eversion (or talar tilt) around frontal plane
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24
Q

pronation of ankle in non-WB

3 cardinal plane movements

A

pronation and supination are considered movement around axis that lies in an angle to the cardinal planes

movements that comprise pronation:
DF
eversion
abduction

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25
Q

supination of ankle in non-WB

3 cardinal plane movements

A

pronation and supination are considered movement around axis that lies in an angle to the cardinal planes

movements that comprise supination:
PF
inversion
adduction

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26
Q

pronation of ankle in closed chain (WB)

4 movements

A

calcaneal eversion
talus aDduction
PF
IR of tibia

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27
Q

supination of ankle in close chain (WB)

4 movements

A

calcaneal inversion
talus aBducted
DF
ER of tibia

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28
Q

ankle varus and valgus

A

calcaneal valgus - increase in medial angle

calcaneal varus - decrease in medial angle

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29
Q

3 sections of the foot and joints involved
hindfoot
midfoot
forefoot

A 
hindfoot:
  talocrural joint (talus & calcaneus)
  subtalar joint
midfoot: 
 navic, cuboid, & 3 cuneiform bones
3. forefoot- MT & phalanges
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30
Q 
ankle joint
 a.k.a. (2)
 3 bones that make it up
 articular surfaces of talus (3)
 arthrokinematics
A

ankle = talocrural joint

made of up medial and lateral malleoli + trochlea of talus

talus has 3 convex surfaces that move on the concave med/lateral malleoli (mortise)

31
Q

cartilage of talar trochlear is…

A

continuous with medial and lateral facets of the malleoli

32
Q

articular surfaces of talus (relative sizes) (2)

A
  1. anterior > posterior
    2-4mm
  2. lateral facet > medial facet (despite that lateral malleoli < medial)
33
Q 
talocrural joint
 type of joint
 movements
 degrees of freedom => direction of movements
 articular surfaces (arthrokinematics)
A
  1. synovial hinge joint
  2. 1 DOF => DF/PF
  3. convex talus (3 surfaces) moving on concave mortise
34
Q

talocrural joint
resting position
closed pack
capsular pattern

A

resting position: 10 PF/ midway btwn sup/pro
closed pack: max DF
capsular pattern: limited PF (>DF)

35
Q

talocrural joint capsule

A 
very thin and weak ant & post so...
    lig of (1) distal tf jt,  (2) talocrural and (3) subtalar jts support capsule
36
Q

medial ligaments of talocrural joint (4)

purpose of ligaments

A 
1. superficial deltoid (= medial collateral lig)
  made of up:
  posterior tibiotalar
     med mall => med talar & talar tuberosity
  anterior tibionavicular
     med mall => navicular tuberosity
  tibialcalcaneal ligament 
     med mall => sustentaculum tali
  1. deep deltoid = anterior tibiotalar

resist valgus force and help limit motions when at end range of DF/PF

37
Q

lateral ligaments (lateral collaterals) 3 segments
what they each check individually
what they check as a whole (2)

A 
1. anterior talofibular** most often sprained
 checks PF and inversion
2. posterior talofibuar 
 checks DF
3. calcaneofibular ligament
  checks inversion

together these check varus forces and end range PF/DF

38
Q

DF… what happens at the tibfib joints as a result of talocrural joint
mortise
fib (3)
talus

A 
b/c talus is wider anterior:
mortise spreads
fib glides cranially
     aBducts
     glides posterior/ ER
talus glides posterior
39
Q

PF… what happens at the tibfib joints as a result of talocrural joint
talus
fib (2)

A

talus glides anterior
fib glides caudally
anterior/ IR

40
Q 
LAB: talocrural joint distraction
  *assessment or treatment*
pt position
stabilize
mobilize (w/ what)
indication
A

pt supine with ankle 10PF
stabilize- lower leg to table with belt or assistance
mobilize: cup hand over dorsum of foot at talus and shift weight backwards to distract
indication: DF

41
Q

LAB: talocrural joint anterior/ post glide assessment
pt position
stabilize
mobilize (w/ what)

A

pt supine with knee flexed, heel on table
stabilize foot around calcaneus
mobilize tibia

42
Q 
LAB: talocrural joint anterior/ post glide treatment and assesment
pt position
stabilize
mobilize (w/ what)
indication
A

pt supine with ankle 10 PF over edge of table (or flex knee and fixate foot on table)

stabilize: cup and distract calaneus
mobilize: anterior talus –> posterior with web of hand
indication: increase DF

43
Q 
LAB: talocrural joint anterior/ glide treatment and assesment
pt position
stabilize
mobilize (w/ what)
indication
A

pt prone with ankle 10 PF over edge of table

stabilize: cup and distract calaneus
mobilize: posterior talus –> anterior with web of hand
indication: increase PF

44
Q 
subtalar joint (talocalcaneal)
  type of joint
  degrees of freedom => movements
        secondary movements around oblique axis

articular surfaces (arthrokinematics) and capsules

A
  1. synovial joint/ plane
  2. only 1 DOF because of all the opposite articulations
    => pronation/ supination

secondary motions that occur around oblique axis inversion/eversion, aB/ad and maybe some DF/PF (all these movements should have equal ROM)

3 separate articulations:
anterior and middle surfaces are the convex inferior body and neck of talus moving on concave calcaneus
these share joint capsule with talonavicular joint

posterior surface of talus is concave with own joint capsule

45
Q

subtalar joint
resting position
close packed position
capsular pattern

A 
resting position: midway btwn pro/sup and 1- PF
closed pack: supination
capsular pattern: 
 inversion (varus) limited > eversion
 supination > pronation
46
Q

angle of inversion of subtalar joint
from above
from side

A 
above = 23 degrees
side = 41 degrees
47
Q

ligaments of subtalar joint (4) and what motions they check

A
  1. interosseous talocalcaneal ligament - runs the length of tarsal canal; checks pronation and maintains stability
all others check supination
2. lateral talocalcaneal ligament
3. posterior talocalcaneal ligament
4. ligamentum cervicis*- strongest 
  lat sinus tarsi -> neck of talus
   **only on the talus**
48
Q

passive normal movements of hindfoot (review)
talocrural joint
subtalar joint

and end feels of both

A

talocrural - PF/DF
subtalar- pronation/ supination (** even though capsular pattern in inversion)
and some inversion/eversion and aB/adduction

normal end feel is tissue stretch

49
Q

accessory movements of hindfoot (joint play- what we do in lab)

 talocrural joint (2)
 subtalar joint (2)
      what bone are we moving?
A

talocrural joint-
long axis extension (traction)
A/P glide

subtalar joint-
talar rock: A/P and M/L with distraction
moving talus
talar tilt: valgus and varus tilt - also called inversion/eversion
moving calcalenus

50
Q 
subtalar joint in gait
 heel strike
 foot flat
 mid stance
 push off
A

heel strike - supination (2-3deg)
foot flat- pronation (3-4 deg)
mid stance-neutral
push off- supination

51
Q

midfoot joints

6

A
  1. talocalcaneo-navicular
  2. cuneonavicular
  3. cuboidonavicular
  4. intercuneiform
  5. cuneicuboid
  6. calcaneocuboid
52
Q

talocalcaneal-navicular
type of joint
movements
degrees of freedom => direction of movements

A

talo-navicular+ subtalar- functionally and anatomically work together

ball and socket synovial
joint => multi-axial, 3 DOF

concave navicular on convex talus

53
Q

talocalcaneal-navicular joint
resting position
close pack position
capsular pattern

A 
resting position- midway btwn extremes
close pack position- supination
capsular pattern:
  DF
  PF
  Add
  MR
54
Q

TCN jt ligaments (3)

A
  1. dorsal talonavicular
  2. bifurcated - reinforces capsule laterally
  3. plantar calcaneonavicular (spring* ligament)
55
Q

calcaneocuboid joint
type of joint
degrees of freedom => movements
secondary movements around oblique axis

articular surfaces (2 on each bone) & (arthrokinematics)

closed pack position

A

saddle synovial joint w/ its own capsule
2DOF => gliding and conjoint rotation
1: supination/ pronation
2: because of horizontal/ oblique axis of the transverse tarsal:
longitudinal axis is so horizontal => inversion/eversion
oblique axis => PF w/ aD (DF w/ aB)

articular surfaces:
calcaneus
concave dorsal-> plantar on oblique axis*** => concave movement on convex cuboid
convex M ->L on longitudinal axis

cuboid
*convex dorsal -> plantar
concave M -> L

closed pack = supination

56
Q

calcaneocuboid joint interaction with hindfoot/ subtaler joint
capsules and WB
arthrokinematics

A

even though calcaneocubiod jt has it has its own capsule, it is linked in WB to subtalar joint.

calcaneus and talus move on a fixed cuboid => concave calcaneus moving on convex cuboid

57
Q

midfoot plantar ligaments (3)

and purpose

A

purpose is to support tarsal joints and bony arches

  1. plantar calcaneonavicular = spring ligament
    sustentaculum tali => inf navic (short oblique ligament lat -> med)
  2. short plantar ligament = plantar calcaneocuboid
    supports lateral longitudinal arch
  3. long plantar ligament
    supports lateral longitudinal arch (and transverse tarsal joints calcan => 3rd/4th MT))
58
Q

review of medial and dorsal ligaments that support the hindfoot (4)

A
  1. deltoid ligament (medial)
  2. bifurcate (calcaneus -> cuboid and calcaneus -> navicular) dorsal
  3. dorsal talonavicular
  4. dorsal calcaneocuboid
59
Q

articular motions of transverse tarsal joints
what motion locks and unlocks jts?
what happens in early gait
what happens in late stance

A
  1. transverse tarsal jts are unlocked when foot is everted
  2. early gait the IR of tibia moves foot into eversion => unlocked => able to supinate and allow forefoot to maintain contact with ground
  3. end of stance ER of tibia moves foot into inversion => locked ** so its rigid for push off*
60
Q

cuboidnavicular jt
portion of foot
type of joint
movement

A

midfoot
fibrous joint
movement = slight gliding and rotation

61
Q

accessory movements of midfoot (2)

A

a/p glide

rotation

62
Q 
all midfoot joints, except cuboidnavicular are...
 what type of joint
 movements allowed
 resting position
 closed pack position
 capsular pattern

midfoot joints

A 
plane synovial
slight gliding and rotation
resting postion= 10PF, midway btwn sup and pro (slight sup)
closed pack = supination
capsular pattern = limit sup > pronation
midfoot joints:
 cuneonavicular
 cuboidonavicular
 cuneocuboid
 intercuneiform 
 TMTs
63
Q 
TMT joints (a.k.a.)
 type of joint & DOF
 primary movement
 resting position
 closed pack
 capsular pattern
 articular surfaces
A

a.k.a. Lisfranc’s joint- common place for amputation

all: plane synovial joints with 1 DOF
primary movement is PF/DF

resting position: midway btwn pro/sup
closed pack: full supination
capsular pattern: none

tarsals are convex/ MTs concave

64
Q

joint capsules of TMT (3)

A
  1. 1st TMT has own capsule
  2. 2nd and 3rd TMT share capsule
  3. 4th and 5th TMT share a capsule
65
Q

types of movement at

1st & 2nd TMT vs. at 4th & 5th

A

1st TMT most amount of motion

1/2 - DF + inversion/aDduction
4/5- DF + eversion/aBduction

66
Q

TMT ligaments (3)

A

each joint is reinforced by:

  1. interosseous
  2. dorsal and (3) plantar tarsometatarsal ligaments
67
Q

accessory movements of TMT joints (2)

A

A/P glide

rotation

68
Q

forefoot: interMT joints
classification of joints
DOF / movements

A

synarthrosis

1DOF => dorsal and plantar glide

69
Q

MTphalangeal joints
classification of joints
DOF/ movements
articular surfaces

resting position
closed pack
capsular pattern

A

condyloid synovial joint
2 DOF => flex/extend
ab/aDduction

MT convex, phalanges concave

resting postion- midway btwn flex/ext
closed pack - full extension
capsular pattern:
 1st toe- limited ext > flex
 2-5th toes- limites flex > ext
70
Q

accessory movements of MTP joint (4)

A
  1. long axis extension (traction)
  2. A/P glide
  3. lateral glide
  4. rotation

same at interphalangeal

71
Q

ligaments of forefoot (2)

A
  1. plantar ligaments

2. collateral ligaments

72
Q

interphalangeal joints
classification of joints
DOF/ movements
articular surfaces

resting position
closed pack
capsular pattern

A

synovial joint - 1 DOF flex/extend

proximal phalanx is convex, distal is concave

resting position- slight flexion
closed pack position- full extension
capsular pattern- limited flex > ext

73
Q

ligaments of interphalangeal joints (2)

A

medial and lateral collateral ligaments

74
Q

accessory movements of interphalangeal jts (4)

A
  1. long axis extension (traction)
  2. A/P glide
  3. lateral glide
  4. rotation

same as MTP

year 2 (24 decks)

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