MSK lower limb 2 Flashcards
What type of joint is the proximal and distil tibiofibular joint
Proximal = Plane
Distil= syndesmososis (fibrous joint)
what inserts into this groove
Tibialis posterior tendon
What are the two division of
- the scitatic nerve
- the popliteal artery
- common fibular nerve
sciatic nerve -> tibial & common fibular nerve
Popliteal artery = Anterior tibial & Posterior tibial artery
Common fibular nerve = superficial fibular nerve and deep fibular nerve
Label the diagram
Label the diagram
what is the motor function of the tibial nerve
The tibial nerve innervates the muscles of the posterior leg and the majority of the intrinsic foot muscles.
including the popliteus of the knee
What is the sensory function of the tibial nerve
Cutaneous branches of the tibial nerve combine with branches from the common fibular nerve to form the sural nerve. This sensory nerve innervates the skin of the posterolateral side of the leg and the lateral side of the foot.
The tibial nerve also supplies all the sole of the foot via three branches:
Medial calcaneal branches: These arise within the tarsal tunnel, and innervate the skin over the heel.
Medial plantar nerve: Innervates the plantar surface of the medial three and a half digits, and the associated sole area.
Lateral plantar nerve: Innervates the plantar surface of the lateral one and a half digits, and the associated sole area.
The muscles listed below are all innervated by the tibial nerve. Which of the following produces flexion of the knee joint?
- gastrocnemius
- tibialis posterior
- soleus
- flexor digitorum longus
Which of these cutaneous nerves does not arise from the tibial nerve?
- Medial plantar
- Lateral plantar
- Medial calcineal
- Saphenous
Saphenous- this is a terminal branch of the femoral nerve
What is the motor and sensory function of the common fibular nerve
Motor: Innervates the short head of the biceps femoris directly. Also supplies (via branches) the muscles in the lateral and anterior compartments of the leg.
Sensory: Innervates the skin of the lateral leg and the dorsum of the foot.
Explain the clinical relevance of damage to the common fibular nerve
common fibular nerve wraps around the neck of the femur and so fractures of the fibular neck can cause nerve palsy
this can result in foot drop- loose the ability to dorsiflex the foot at the ankle
loss of sensation over the dorsum of the foot, and lateral sideof the leg. Innervation is preserved on the medial side of the leg (supplied by the saphenous nerve, a branch of the femoral), and the heel and sole (supplied by the tibial nerve, a branch of the sciatic)
What is the route of the common fibular nerve distal to the knee?
- Around the head of fibula
- Around the neck of fibula
- Along the tibial shaft
- None of the above
Around the neck of the fibula
Which fibular nerve supplies the muscles of the lateral compartment of the leg
Superficial fibular nerve
What can damage to the superficial fibular nerve result in
Loss of eversion of the foot
Fill in the diagram of the arterial suooky of the leg
what artery does the posterior tibial and the dorsalis pedis arise from
Posterior tibial= popliteal artery
Dorsalis pedis= Anterior tibial artery
Complete the sentence: The adductor canal ends at the adductor hiatus, a space within the _____________ muscle
Adductor magnus muscle
What nerve supplies the lateral compartment of the leg?
Superficial fibular nerve
Where can damage to the fibular nerve occur & what can it result in
The fibular neck
It can result in footdrop
label: dorsum of foot
where is the posterior tibial pusle felt
posterior to the medial maleolus
What type of joint is the ankle joint
Mortise joint
Synovial hinge
When is the malleolar grip the strongest
During dorsiflexion of the ankle, the ankle joint is most unstable during plantarflexion
Fill in the blanks
Deltoid ligament = medial ligament
What is the deltoid ligament and the lateral ligament?
Medial ligament: consists of four ligaments, which fan out from the malleolus, attaching to the talus, calcaneus and navicular bones.
Primary action = resist over-eversion of the foot.
Lateral ligament
Resists over-inversion of the foot, and is comprised of three distinct and separate ligaments:
Anterior talofibular – spans between the lateral malleolus and lateral aspect of the talus.
Posterior talofibular – spans between the lateral malleolus and the posterior aspect of the talus.
Calcaneofibular – spans between the lateral malleolus and the calcaneus.
Label the diagram
- Tibial navicular ligament
- Tibiocalcanel ligament
(2 of the 4 ligaments making up the deltoid ligament- along with anterior & posterior tibiotalar)
Label this diagram- lateral ligaments
- Posterior talofibular ligament 4. Anterior tibiofibular ligament
- Calcaneofibular ligament 6. Anterior talofibular ligament
What ligament of the ankle joint is the weakest
The anterior talofibular ligament
Where can the dorsalis pedis be palpated
Between the first and second metatarsal bones
label the bones of the foot & ankle joint
- Fibula
- Tibia
- Talus
- Calcaneus
- Cuboid
- Navicular
- Lateral cuniform
- Intermediate cuniform
- Medial cuniform
- 5th metatarsal
Which movements of the ankle are ankle sprains most common
Inversion most commonly causes ankle sprains
Label this diagram- lateral knee
a. Popliteus
b. Semimembranosus
c. Gastrocnemius (medial head)
d. Gastrocnemius (lateral head)
e. Soleus
f. flexor digitorum longus
g. tibialis posterior
h. fibula (soleus removed)
i. Fibularis longus
j. medial condyle of femur
k. Tibial collateral ligament
l. fibular collateral ligament
Label the popliteal fossa contents & borders
- Biceps femoris
- Semimembranosus
- Semitendinosus
- Tibial nerve
- Popliteal artery
- Common fibular nerve
What is the deep fascia of the foot known as
Plantar/investing fascia
it forms the plantar appaneurosis
What is Plantar fasciitis
Plantar fasciitis is a condition in which the plantar aponeurosis is strained and inflamed. This may result from running and high impact aerobics, especially when an inappropriate foot-wear is worn. It causes severe pain in the plantar surface of the heel and on the medial aspect of the foot.
Sole of the foot diagram- label
Movements of the different joints of the ankle
Mortise jiont: plantar and dorsiflexion
Subtalar joint: inversion & eversion
Describe the type and the function of the talonavicular and the talocalcanel joint
The talonavicular joint (1), is a ball and socket joint which allows the foot to pivot from side to side.
The talocalcaneal joint (2), (plane synovial joint) helps this process allowing for some lateral sliding movement
complete this showing the ligaments of the foot
Describe pes cavus
Unusually high medial longitudinal arch. It can appear in early life and become symptomatic with increasing age.
Due to the higher arch, the ability to shock absorb during walking is diminished and an increased degree of stress is placed on the ball and heel of the foot.
Pain in the foot, which can radiate to the ankle, leg, thigh and hip. This pain is transmitted up the lower limb from the foot due to the unusually high stress placed on the hindfoot during the heel strike of the gait cycle.
Causes of pes cavus can be idiopathic, hereditary, due to an underlying congenital foot problem such as club foot, or secondary to neuromuscular damage such as in poliomyelitis.
Describe Pes planus
Flat feet
can be acquired due to dysfunction of tibialis posterior
plantar calcaneonavixular ligament fails to support the head of the talus. consequently, talar head displaces inferiomedially, resulting in flattening of medial longitudnal arch
What are the two terminal branches of the tibial nerve which innervates the intrinsic muscles of the foot?
Which are the two terminal branches of the posterior tibial artery which supply the foot region?
The medial and lateral plantar nerve
The medial and lateral plantar aretery
complete diagram of sole of the foot
function of the first vs second layer of the foot
First layer flexes the toes, initiating the first part of the gait cycle
Layer two, we find the terminal branches of the tibial artery and nerve, with the muscles which flex the toes
3- deep intrinsic muscles
4- interossei muscles
Where does the tendon of the popliteus muscle pass deep to
The lateral collateral ligament, separating it from the lateral meniscus
Function of the anterior vs posterior crusciate ligament
The anterior cruciate ligament (ACL) prevents the femur from sliding posterior on the tibia.
The posterior cruciate ligament (PCL) prevents the femur from sliding anterior on the tibia.
What does lateral impact to the knee joint risk damaging
Risks both damaging the medial meniscus and disrupting both the ACL and medial collateral ligaments.
If the cartilage becomes loose within joint space, there is a risk that the knee can become ‘locked in fixed flexion or extension
Unhappy triad= anterior cruciate ligament tear, medial collateral ligament injury and the medial meniscus
What knee bursea communicates with the joint cavity and what is the clinical significance of this?
Supra-patellar bursae- suprapattelar bursitis can spread to the knee joint
What normally causes meniscal tears
Any lateral impact to the knee joint risks both damaging the medial meniscus and disrupting both the ACL and medial collateral ligaments.
If the cartilage becomes loose within joint space, there is a risk that the knee can become ‘locked in fixed flexion or extension
The dysfunction of what muscle can cause pes panus?
Tibialis posterior
