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Semester 2 > MSK Session 12 > Flashcards

MSK Session 12 Flashcards

1
Q

What is the function of the ankle joint in upright posture?

A

Bear all body weight as it transfers to foot

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2
Q

What is the clinical importance of the ankle joint?

A

Arterial pulses of limb can be examined here

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3
Q

Where do venous and lymph drainages undergo particular changes so that their low pressure systems can return fluid to the body?

A

Ankles

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4
Q

How do arteries, motor nerves and tendons enter the foot?

A

Turning forwards

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5
Q

How do veins, sensory nerves and lymphatics exit the foot?

A

Turning upwards

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6
Q

What prevents bow-stringing of the long tendons of leg muscles at the ankle?

A

Crural fascia

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7
Q

How does the foot support body weight?

A

Establishes broad base for bearing body weight
Robust
Absorbs shock

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8
Q

What two opposing functions does the foot have?

A

Supporting body weight and organ of locomotion

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9
Q

What features of the foot allow it to be an organ of locomotion?

A

Loose to permit movement but stable when moving
Permits movement on flat, sloping and uneven surfaces
Lightweight
Able to lift body weight during initiation of movement

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10
Q

What forms the ankle joint proper?

A

Articulation of tibia and fibula w/talus

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11
Q

How many articular surfaces are there in the ankle joint proper?

A

6

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12
Q

What are the articular surfaces of the ankle joint proper lined with?

A

Hyaline cartilage

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13
Q

What are key landmarks in distal superficial venous drainage of the lower limb?

A

Malleoli

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14
Q

Where do the tibia and fibula articulate with each other?

A

Most of their lengths

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15
Q

What is the proximal articulation of the tibia and fibula?

A

Tibio-fibular articulation

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16
Q

What type of joint is the proximal articulation of the tibia and fibula?

A

Plane type synovial

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17
Q

What is the intermediate articulation of the tibia and fibula?

A

Interosseous membrane

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18
Q

What is the distal articulation of the tibia and fibula?

A

Tibio-fibular syndesmosis

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19
Q

What type of joint is the distal articualtion of the tibia and fibula?

A

Fibrous

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20
Q

Which two ligaments tie the ends of the tibia and fibula together in the tibio-fibular syndesmosis?

A

Anterior and posterior tibio-fibular ligaments

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21
Q

Which ligament deepens the articulatory surfaces of the tibio-fibular syndesmosis?

A

Posterior tibio/fibular

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22
Q

What type of joint is the ankle joint proper?

A

Mortise and tenon
Ginglymus
Rolling hinge synovial

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23
Q

Why is the ankle joint described as a mortise and tenon joint?

A

Leg bones form recess (mortise)

Superiorly rounded talus fills recess (tenon)

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24
Q

What allows changes between extremes of plantarflexion and dorsiflexion at the ankle joint?

A

Superiorly rounded talus allows rolling in a plane

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25
Which are the joint stabilising surfaces of the ankle joint?
Malleolus Posterior distal tibio-fibular ligament Transverse tibio-fibular ligament
26
Which are the weight bearing surfaces of the ankle joint?
Tibia Talus (Fibula takes ~17% so contributes to stability)
27
Which bones of the foot form the medial longitudinal arch?
``` Calcaneus Talus Navicular 3 cuneiforms 1-3 metatarsals ```
28
Which bones of the foot form the lateral longitudinal arch?
Calcaneus Cuboid 4th + 5th metatarsals
29
Which bones of the foot form the transverse arch?
Tarsals and metatarsals
30
What strengthens the transverse arch of the foot?
Long tendon of leg muscles
31
Why must the segmented structure of the foot be arranged in an arch?
Can only weight bare if in an arch
32
How many arches are present in the foot at birth?
3
33
Why may the foot appear flat in children
Subcutaneous fat pad masks arches present
34
In which two direction are the arches of the foot arranged?
2 antero-posteriorly | 1 transverse medio-lateral
35
What type of attachments does the talus have?
Purely ligamentous
36
Where is the long axis of the talus directed?
Forwards and medially
37
What is the significance of the direction of the long axis of the talus?
Tibia and fibular can roll over and direct weight in its deviated path
38
How is the dorsal aspect of the talus identified?
Superiorly convex medial and lateral edges | Central portion concave
39
How does the posterior articular surface (body) of the talus compare to the anterior articular surface (head)?
Narrower
40
What are the three parts of the talus bone?
Head, neck and body
41
What does the plantar surface of the talus form?
Talo-calcaneal (sub-talar) joints
42
What is visible on the inferior view of the talus?
Sulcus tali
43
What type of joint is the subtalar joint?
Uniaxial hinge
44
What allows side to side motion of the foot?
3 parts of subtalar joint
45
How is the talus orientated in relation to the calcaneus?
Slightly obliquely on anterior surface
46
What separates the two articulations of the talus and calcaneus?
Tarsal canal (sinus tarsi)
47
What is the anterior talocalcaneal articulation?
Convex talus on concave calcaneus
48
What is the posterior talocalcaneal articulation?
Concave talus accommodates convex calcaneus
49
What allows us to walk on sloping/uneven ground by allowing the use of the sides of the feet?
Subtalar joint facilitating version and inversion
50
How far can the foot usually be everted?
15 degrees
51
How far can the foot usually be inverted?
30 degrees
52
Which surfaces articulate in dorsiflexion?
Anterior option of talar trochlea occupies and completely fills mortise
53
What is joint stability like in dorsiflexion?
Maximum
54
Adjustments at what contribute to stability of ankle joint in extreme dorsiflexion when the malleoli spread?
Tibio-fibular syndesmosis
55
What innervates dorsiflexion?
Fibular division of sciatic nerve (L4-5 same as for great toe)
56
Which muscles cause dorsiflexion?
Tibialis anterior | Assistance from extensor digitorum longus and extensor hallucis longus
57
What articulates in plantar flexion?
Posterior portion of talar trochlea occupies mortise
58
What allows some rotation for AB/AD-duction?
Posterior talar trochlea not filling mortise
59
Why is dorsiflexion less stable than plantar flexion?
Smaller articulation
60
What is the innervation of plantar flexion?
Tibial division of sciatic (S1-2)
61
Which muscles cause plantar flexion?
Gastrocnemius Soleus Assistance from tibialis posterior, FHL and FDL
62
Which ligament is the strongest of the ankle joint?
Medial
63
Where is the deltoid ligament positioned?
Originates from apex of medial malleolus and fans downwards in triangular shape to tarsal bones
64
Where do the anterior fibres of the medial ligament stretch down to?
Tibio-navicular
65
Where do the middle fibres of the medial ligament of the ankle joint stretch down to?
Calcaneo-tibial
66
Describe the posterior fibres of the deltoid ligament.
Talo-tibial which pass backwards and laterally
67
What is the deep ligament of the ankle joint?
Fibres attached to medial malleolus and medial talus
68
Which fibres of the deltoid ligament is the deep ligament of the ankle joint related to?
Tibio-navicular
69
What do the anterior and posterior fibres of the lateral ligament of the ankle join?
Lateral malleolus and talus
70
What do the intermediate fibres of the lateral ligament of the ankle join?
Lateral malleolus and calcaneus
71
Why does trauma to the ankle usually result in injury to both medial and lateral aspects of the joint?
Joint forms arming of bones and ligaments
72
What causes a Pott's fracture?
Excessive eversion of the foot w/abduction and external rotation
73
What is a Pott's fracture?
Bimalleolar ankle fractures
74
Describe the mechanism of injury in Pott's fracture.
Pull on medial ligament often causes avulsion of medial malleolus Talus moves laterally Lateral malleolus sheared off
75
What injury to the fibula is commonly caused in Pott's fracture?
superior to tibio-fibular syndesmosis
76
What happens if the tibia is carried anteriorly in Pott's fracture?
Posterior margin of distal tibia is sheared off by talus
77
What type of bones are the tarsals?
Short
78
What are the characteristics of the tarsals that classify them as short bones?
Irregular Cuboidal 6 articular surfaces
79
What is the anterior talofibular ligament?
Flat, weak band that extends anteromedially from lateral malleolus to neck of talus
80
What is the posterior talofibular ligament?
Thick, strong band horizontal medially and posteriorly that passes from malleolar fossa to lateral tubercle of talus
81
Which ligament is a round cord that joins the lateral malleolus to lateral calcaneus?
Calcaneofibular
82
What is the nerve supply to the ankle joint?
Derived from tibial nerve and deep fibular
83
What is the blood supply of the ankle joint?
Arteries derived from malleolar branches of the fibular, anterior and posterior tibial arteries
84
What limits dorsiflexion by the muscles in the anterior leg compartment?
Passive resistance of triceps surae to stretching | Tension in medial and lateral ligaments
85
How is the gait cycle split into two phases?
40% swing | 60% stance
86
What are the three stages of the stance phase in the gait cycle?
Heel strike Support Toe-off
87
What are the functions of gluteus maximus, quadriceps femoris and the muscles in the anterior compartment of the leg during heel-strike?
Gluteus maximus: decelerates lower limb Quadriceps femoris: keeps leg extended at knee and hip Anterior compartment: maintain ankle dorsiflexion
88
What is the function of quadriceps femoris in the support stage of the stance phase?
Keeps leg extended to accept body weight
89
What do the foot inverters and everters do in the support stage in the stance phase of the gait cycle?
Stabilise foot?
90
What is the function of gluteus medius and tensor fascia lata in the support stage of the stance phase in the gait cycle?
Steady pelvis
91
Which muscles are involved in the toe-off stage of the stance phase?
Hamstrings extend hip Quadriceps femoris maintain extended knee Posterior leg plantarflexes ankle
92
Which muscles are involved in the swing phase of the gait cycle?
Iliopsoas Rectus femoris Quadriceps femoris Anterior compartment of leg
93
What is the function of iliopsoas and refute femoris in the swing phase of the gait cycle?
Keep hip flexed and resist gravity
94
What is the function of quadriceps femoris in the swing phase of the gait cycle?
Extend knee to position foot for landing
95
What role do the muscles in the anterior compartment of the leg play in the swing phase of the gait cycle?
Maintain ankle dorsiflexion
96
What are the 5 stages of the gait cycle?
``` Heel strike Support Toe-off Leg lift Swing ```
97
What causes Trendelenberg gait?
Lesion of superior gluteal nerve
98
Why does the pelvis drop on the side of the raised leg in a Trendelenberg gait?
Abductor muscles on opposite side of pelvis are paralysed
99
Describe the movements of the trunk in Trendelenberg gait.
Lurches to opposite side of pelvic drop then whips back but overcompensates
100
What is an antalgic gait?
When the patient spends less time on painful limb
101
How is an antalgic gait identified?
Examine cadence
102
What causes foot drop?
Lesion of common/deep fibular nerve
103
What is observed in foot drop?
Foot dragged on floor
104
How do patients with foot drop compensate for their lost plantarflexion?
High stepparent gait Eversion flick Waddling gait Swing-out gait
105
Why do guardsmen fall forwards when they faint?
Centre of gravity passes just anterior to ankle joint
106
What are the components of the deltoid ligament?
Tibionavicular Tibiocalcaneal Anterior and posterior tibiotalar
107
Which three tarsals are attached to the medial ligament of the ankle?
Talus Calcaneus Deltoid

Semester 2 (45 decks)

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