Muscles, joints, tendons and ligaments Flashcards

1
Q

Filaments in each myofibril are arranged into what? Thick filaments made of? Contains what act as molecular spring too? Dark bands called what?Proteins that link central region of A band?

A
Sarcomeres
Myosin 
Titin
A bands 
M line
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2
Q

Length and diameter of thick filament? How many per filament? How many heavy and light chains? Thin filament made of? Light band just actin called what?

A

1.6 micrometers long and 15nm diameter
300
2 heavy and 4 light chains
I band

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3
Q

I bands anchored to what? Length and diameter of thin filament? How many per filament? Filaments (F-actin) made of monomers of what? F-actin makes a chain of 2 what?

A
Z line 
1 micrometer long and 8nm diameter 
380 per filament
Globular protein G-actin 
2 alpha helices
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4
Q

What is tropomyosin and what does it do? 3 troponin types? What does each do?

A

Double alpha helix around actin- partially covers myosin binding sites on actin filament
Tn I- inhibitory
Tn T- binds tropomyosin
Tn C- binds calcium

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5
Q

Membrane AP propagates through what? Ca2+ in sarcoplasm combines with what causing what? Energised by what? What breaks link between actin and myosin? When does contraction end?

A

T- tubules
Troponin- allows tropomyosin to move away from myosin binding site on actin
ATP hydrolysis
Binding of new ATP molecule
When Ca2+ returns to ECF by Ca2+/ATPase pumps and Na+/Ca2+ counter transporters

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6
Q

What is needed for energy for muscle contraction? When is creatinine kinase released?

A

High energy from ATP and creatinine phosphate- short term energy store, replenished by creatinine kinase- released on muscle fibre damage

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7
Q

Functions of joints? 3 structural joint types? Examples of each?

A

Allows movement, weight bearing and transfers load evenly to MSK system
Fibrous, cartilaginous and synovial
Fibrous= teeth sockets, cartilaginous= intervertebral discs, synovial= metacarpophalangeal

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8
Q

3 functional joint types and examples?

A

Syntharthroses- immovable joints e.g. skull sutures
Ampiathroses- slightly moveable e.g. intervertebral discs
Diarthroses- freely moveable joints e.g. hip

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9
Q

What are sutures?

A

Between bones of skull- allow growth in development, adjacent ones interdigitate and filled with short connective tissue

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10
Q

What are syndesmoses?

A

Bones connected by a ligament/ sheet of fibrous tissue e.g. interosseous membrane between trivia fibula

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11
Q

What are gomphoses?

A

Peg in socket fibrous joint found inly in tooth articulation

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12
Q

What are 3 fibrous joint types? 2 types of cartilaginous types?

A

Sutures, syndesmoses, gomphoses

Synchondroses and symphyses

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13
Q

What are synchondroses?

A

Bones directly connected by hyaline cartilage e.g. costal cartilage of ribs

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14
Q

What are symphyses?

A

Connecting cartilage is a pad/ plate of fibrocartilage e.g. intervertebral discs

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15
Q

What are synovial joints known as? The 5 components of synovial joints?

A

Freely moveable joints

1) Articular cartilage 2) Joint capsule 3) Joint (synovial) cavity 4) Synovial fluid 5) Reinforcing ligaments

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16
Q

Features of articular cartilage?

A

Almost frictionless surface, resists compressive loads, high water content, low cell content, no blood supply

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17
Q

What is the inner layer of the joint capsule? What is the external layer? Features of the synovial membrane?

A

The synovial membrane
It’s continuous with periosteum (tough, fibrous)
Only few cells thick, can have villi and projections to increase SA, secretes synovial fluid components

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18
Q

What is the synovial cavity filled with? What does the synovial fluid cover, what is it modified from and what is in it?

A

Synovial fluid
Covers articulating surfaces with thin film- reducing friction during articulation
By plasma from synovial membrane
Fluid, proteins, charged sugars that bind water e.g. hyaluronate

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19
Q

3 types of reinforcing ligaments in synovial joints? What do ligaments do?

A

Intrinsic- thickened part of fibrous capsule
Extrinsic- outside capsule
Intracapsular- deep to capsule covered with synovial membrane
They connect bone to bone, stabilise joints and have less regularly arranged fibres than a tendon

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20
Q

What do tendons do and what do they have?

A

Connect bone to muscle, stabilise joints, allow muscles to be accommodated at a distance from their insertion, provides solid base on which muscles can pull
Dense, regular connective tissue

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21
Q

3 types of cartilage? Composition? What are proteoglycans made of and what do they do?

A

Elastic, fibrocartilage, hyaline cartilage
Water, proteoglycan, collagen and ions
PPC to which are covalently attached chains of sulphated disaccharide repeating units
High density of -ve charges allows binding of water, conferring properties of compressive stiffness and friction-free surfaces e.g. aggrecan

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22
Q

3 synovial joint lever types? Where is fulcrum, weight and resistance in 1st class levers?

A
1st, 2nd and 3rd class levers. 
Fulcrum in middle, force is at one end and resistance is at other e.g. elbow joint and triceps muscle
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23
Q

Fulcrum, weight and resistance in 2nd class lever?

A

Fulcrum at one end, force at other end and resistance in centre e.g. mandible joint

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24
Q

Fulcrum, resistance and force in 3rd class lever?

A

Fulcrum at one end, resistance at other end and force in middle e.g. below joint and biceps muscle

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25
Movements of synovial joints and examples?
Ball and socket e.g. hip, shoulder Condyloid e.g. metacarpal Gliding joint e.g. intercarpals, femur/patella, humerus/ radius Hinge joint e.g. humerus/ ulna Pivot joint e.g. Atlanta-axis joint Saddle joint e.g. between trapezius and 1st metacarpals
26
What is the major component of the tendon and ligament fibres? What makes up 1-5% of the dry weight? What does this act to do?
Collagen- mainly type 1 (90-95% dry weight) Proteoglycan Regulates fibre diameter, keeps fibrils together, acts as a lubricant to aid collagen fibres gliding over each other
27
Where are collagen molecules synthesised and as what? Consists of what? 3 alpha chains combine in a what? What between alpha chains enhances strength of molecules?What occurs after secreting outside the cell?
In fibroblasts as procollagen 3 individual PPCs each coiled in left hand helix A right handed triple helix Bonding(cross-linking) Processed to remove terminal peptides- for tropocollagen and self assembles into collagen fibrils
28
Hierarchal structure of collagen--> tendons? (fibrillogenesis) What are fascicles separated by? What is the tendon surrounded by?
Collagen molecules--> microfibrils--> sub fibrils--> fibrils--> fibres--> fascicles--> tendon Endotenon Epitenon
29
What other molecule do tendons and ligaments contain? How does collagen I content, elastin content and fibre organisation differ between ligaments and tendons?
Elastin- more elasticity, proportion varies by function | Ligaments= lower collagen I, higher elastin, fibre organisation more random
30
What are the major ligaments of the knee? Function of each?
ACL- provides rotational stability and resists anterior translation of the tibia. PCL- resists posterior translation of the femur. MCL- resists valgus force on the knee LCL- resists varus force
31
6 degrees of freedom of the knee?
Internal/ external rotation Varus/ valgus Flexion/ extension
32
What is locking of the knee? What isn't true locking?
An inability to fully straighten the knee due to a mechanical block, usually a piece of cartilage/ loose body. If cannot flex/extend/ if fully flexed or fully extended.
33
Are MCL and LCL injuries common or rare? Are PCL or ACL injuries more common?
MCL= common, LCL= rare | PCL less common than ACL
34
What is valgus knee also known as? What is varous knee also known as?
'Knee-knock' | 'Bowed knee'
35
What is not part of the wrist joint? Articulates as what instead? Prevented from articulating with carpal bones by what?
Ulna Distal radioulnar joint Articular disk
36
Four ligaments of the wrist?
Palmar radiocarpal Dorsal radiocarpal Ulnar collateral Radial collateral
37
What type of joint is the wrist joint? What movements can it perform? Why is the scaphoid at wrist of avascular necrosis?
Ellipsoidal Flexion, extension, adduction, abduction Its retrograde blood supply entering at its distal end- fracture to the middle may interrupt blood supply to the proximal part
38
Most common fracture of the wrist? This clinical condition produces what?
Colles' fracture- radius fractures with the distal fragment being displaced posteriorly 'Dinner fork deformity'
39
How can the lunate be dislocated anteriorly? Causing what symptoms? What can also happen?
By falling on a dorsiflexed wrist Carpal tunnel symptoms Avascular necrosis
40
Types of distal radius fracture? What is less common than distal radius fractures and how does it present?
Colles'= extra-articular with dorsal displacement Smith's= extra-articular with volar displacement Barton's= intra-articular with dislocation of the radiocarpal joint Fracture of the radial shaft- ROM= typically pain-free
41
What forms the glenohumeral joint? Humerus articulates with what distally?
Proximal humerus--> glenoid fossa of the scapula | Head of the radius and trochlear notch of the ulna
42
Attachment site for supraspinatus, infraspinatus and teres minor? Attachment for subscapularis? Separating the 2x tuberosities? What attaches to the lips of this?
Greater tuberosity Lesser tuberosity Inter-tubercular sulcus= pec major, teres major and latissimus dorsi
43
Neurovascular structures lying against surgical neck of humerus? Axillary nerve damage would paralyse which muscles? Difficulty doing what movement? Also innervates what area?
Axillary nerve and posterior circumflex artery--> deltoid and teres minor paralysis Abduction of the affected limb Regimental badge area
44
Lateral side on humeral shaft where deltoid attaches? Shallow depression on posterior surface? What lies in this groove?
Deltoid tuberosity | Radial groove= radial nerve and profunda brachii artery
45
Muscles attaching anteriorly to the humeral shaft? Posteriorly?
Coracobrachialis, deltoid, brachialis, brachioradialis | Medial + lateral heads of triceps
46
What would happen to the wrist if there was a mid-shaft fracture?
'Wrist drop'- wrist extensors affected, can be some sensory loss over dorsum of the hand and proximal ends of lateral 3 1/2 fingers dorsally
47
What do the lateral and medial borders of the distal humerus form? What are immediately distal to the ridges? What runs in a groove on posterior of medial epicondyle?
Medial and lateral supraepicondylar ridges Lateral and medal epicondyles Ulnar nerve
48
Where is trochlea located distally on humerus? Articulates where? Lateral to this is what? Articulates with what? 3 depressions on distal humerus?
Medially- trochlear notch of the ulna Capitulum Radius Coronoid, radial and olecranon fossae
49
Head of radius forms what joint? Radial tuberosity attaches what? Middle of lateral shaft surface, roughening for attaching what?
Proximal radioulnar joint Biceps brachii Pronator teres muscle
50
Lateral distal radius projects as what? What in medial surface concavity called what articulating to form what?
Styloid process | Ulnar notch--> distal radioulnar joint
51
What attaches the radius and ulna? What bone is fractured and dislocated in Monteggia fracture? Galleazi? Way of remembering?
Interosseous membrane Ulna/ radius Radius/ ulna MU/GR--> MUGGER
52
Landmarks of proximal ulna? Muscle attaching to superior olecranon surface? What attaches to tuberosity of ulna?
``` Olecranon Coronoid process Trochlear notch Radial notch Tuberosity of ulna ``` Triceps brachii muscle Brachialis muscle
53
Anterior of ulnar shaft attaches what? Rounded head with distal projection of distal ulna?
Pronator quadratus muscle | Styloid process
54
Articulating surfaces of the elbow joint?
Trochlear notch of ulna and trochlea of humerus | Head of radius and capitulum of humerus
55
Ligament found on lateral side of elbow joint? Blends with what? What ligament originates from medial epicondyle?
Radial collateral ligament Annular ligament Ulnar collateral ligament
56
Muscles needed to extend elbow? Flex?
Triceps brachii and anconeus | Brachialis, biceps brachii, brachioradialis
57
Intratendinosus bursa formed where in elbow joint? Subtendinosus? Subcutaneous?
Within the tendon of the triceps brachii Between the olecranon and tendon of triceps brachii- reduces friction Between olecranon and overlying tissue
58
Clavicle extends between what?
Sternum and acromium of scapula?
59
3 main functions of the clavicle?
1) Attaches upper limb to trunk 2) Protects underlying NV structures supplying upper limb 3) Transmit force from upper limb--> axial skeleton
60
Where does conoid ligament of clavicle attach? Trapezoid ligament? At what end of the clavicle?
Conoid tubercle Trapezoid line Acromial end
61
Sternal end of clavicle has facet called what? Inferior surface has what depression? Clavicular shaft acts as a point of origin for what muscles?
Sternoclavicular joint For costoclavicular ligament Deltoid, trapezius, subclavius, pec major, sternocleidomastoid and sternohyoid
62
Concave depression on anterior surface of scapula? Muscle originating from this? Hook like process attachment for biceps brachii and pec minor?
Subscap fossa Subscapularis Coracoid process
63
Attaches to supraglenoid tubercle? Attaches to infraglenoid tubercle?
Long head of bicep | Long head of triceps
64
Site of supraspinatus origin? Projection on posterior surface of clavicle that arches over glenohumeral joint and articulates with clavicle?
Supraspinous fossa | Acromion
65
Articular surfaces of AC joint lined with what? Partially divided by what?
Fibrocartilage | Articular disc-wedge of fibrocartilage
66
3 ligaments of AC joint?
``` Intrinsic= AC ligament- runs horizontally, covering joint capsule reinforcing superior aspect Extrinsic= conoid and trapezoid ligaments Conoid= from coracoid process to conoid tubercle of clavicle Trapezoid= from coracoid process to trapezoid line of clavicle ```
67
Movements of AC joint? NV supply?
Axial rotation and anteroposterior movement Suprascapular artery and thoraco-acromial artery Suprascapular and lateral pectoral from brachial plexus
68
Type of joint is the shoulder joint? Articulating surfaces? Fossa deepened by what fibrocartilage rim? Why is the joint instable and has a wide range of movement?
Ball and socket between scapula and the humerus Head of the humerus--> glenoid fossa of the scapula Both surfaces covered in hyaline cartilage Glenoid labarum Humeral head= much larger than glenoid fossa
69
2 important bursae in the shoulder joint?
1) Subacromial= deep to deltoid and acromion, superficial to supraspinatus tendon 2) Subscapular= between subscap tendon and scapula
70
5 ligaments of the shoulder joint?
1) Glenohumeral ligament= glenoid fossa--> humerus- stabilises anterior aspect 2) Coracohumeral ligament= base of coracoid process--> greater tubercle of humerus- supports superior joint capsule 3) Transverse humeral ligament= between 2 tubercles of humerus- holds tendon of long head of biceps 4) Coraco-clavicular ligament= clavicle--> coracoid process- can be injured in ACJ injuries 5) Coracoacromial ligament= between acromion and process of scapula--> coraco-acromial arch= prevents superior displacement
71
Muscles needed for extension(behind) of shoulder joint? Flexion(in front)?
Posterior deltoid, lat dorsi and teres major | Biceps brachii, pec major, anterior deltoid and coracobrachialis
72
Muscles needed for abduction of the shoulder? Adduction?
1st 15 degrees= supraspinatus, 15-90= middle fibres of deltoid, >90 degrees= trapezius + serratus anterior to rotate scapula Pec major, lat dorsi and teres major
73
Muscles needed for internal rotation of the shoulder? External rotation? Circumduction?
Subscapularis, pec major, lat dorsi, teres major and anterior deltoid Intraspinatus and teres minor Combination of movements
74
Arteries supplying shoulder joint? Nerves?
Anterior and posterior circumflex humeral arteries | Axillary, suprascapular and lateral pectoral nerves
75
Where do extrinsic muscles of the shoulder originate and attach to? Intrinsic muscles?
From torso--> shoulder bones | From scapula and/ or clavicle--> humerus
76
6 intrinsic muscles of shoulder?
Deltoid, teres major and four rotator cuff muscles(supraspinatus, infraspinatus, subscapularis and teres minor)
77
Origin of supraspinatus? Insertion? Nerve supply? Action?
Medial 2/3 supraspinous fossa Capsule of joint + greater tubercle of humerus Suprascapular nerve ABDuction
78
Origin of infraspinatus? Insertion? Nerve supply? Action?
Medial 2/3 infraspinous fossa Greater tubercle of humerus Suprascapular nerve Lateral rotation
79
Origin of teres minor? Insertion? Nerve supply? Action?
Lateral border of scapula Capsule of joint + greater tubercle of the humerus Axillary nerve Lateral rotation
80
Origin of subscapularis? Insertion? Nerve supply? Action?
Subscapular fossa Lesser tubercle of humerus Upper and lower subscapular nerves Medial rotation
81
Origin of deltoid? Insertion? Nerve supply? Action?
``` Clavicle, acromion, spine of scapula Deltoid tuberosity of the humerus Axillary nerve Anterior fibres= flex arm Middle= major ABDuctor beyond 15 degrees Posterior= extends arm ```
82
Origin of teres major? Insertion? Nerve supply? Action?
Posterior surface of inferior surface of scapula Intertubecular/ bicipital groove of humerus Lower subscapular nerve ADDucts at shoulder + medially rotates arm
83
Origin of trapezius? Insertion? Nerve supply? Action?
Skull, nuchal ligament and spinous processes of C7-T12 Clavicle, acromion + scapula Accessory nerve + CNXI(spinal part) Elevates scapula and rotates scapula during abduction of humerus above horizontal Middle fibres= retract scapula, lower= depress scapula
84
Origin of latissimus dorsi? Insertion? Nerve supply? Action?
T6-T12, iliac crest, thoracolumbar fascia, inferior 3 ribs Bicipital groove Thoracodorsal nerve C6-8 Extends, adducts and medially rotates upper limb
85
Origin of levator scapuli superioris? Insertion? Nerve supply? Action?
C1-C4 transverse processes Medial border of scapula Dorsal scapular nerve Elevates the scapula
86
Origin of rhomboid major? Insertion? Nerve supply? Action?
T2-T5 vertebrae Posterior surface of medial scapula Dorsal scapular nerve Elevates and retracts the scapula
87
Origin of rhomboid minor? Insertion? Nerve supply? Action?
C7-T1 Posterior surface of medial scapula Dorsal scapular nerve Elevates and retracts the scapula
88
Type of joint knee joint? Articulations? Articulation surfaces?
Bicondylar Patella, femur + tibia Tibiofemoral: between medial + lateral condyles of femur + tibia (weightbearing) Patellofemoral: anterior + distal part of femur--> patella- allows quad femoris tendon to insert over knee
89
Neurovascular supply to knee joint? Proximal end of tibia is covered by 2 what? What are they? Function of them?
The genicular anastomoses- from genicular branches of the femoral and popliteal arteries Femoral, tibial + common fibular nerves Menisci C-shaped fibrocartilage structures Deepen articular surface of tibia--> increased stability + shock absorbers
90
Menisci attached to what? Medial meniscus also attached where? Which is smaller? 4 bursae of the knee?
The intercondylar area of the tibia Tibial collateral ligament + joint capsule Lateral meniscus Suprapatellar, prepatellar,, infrapatellar, semimembranosus
91
Where is the suprapatellar bursa found? Prepatellar? Infrapatellar? Semimembranosus?
Between quadriceps femoris + femur Between apex of patella and skin Deep= between tibia + patella ligament, superficial= between patellar ligament + skin Posteriorly between semimembranosus muscle + medial head of gastrocnemius
92
5 ligaments of the knee? Attachments?
Patellar: quad femoris tendon--> tibial tuberosity Medial collateral: medial epicondyle of femur + medial tibia Lateral collateral: lateral epicondyle of femur, lateral surface of fibular head Anterior cruciate: at anterior intercondylar region of the tibia--> in intercondylar fossa of femur Posterior cruciate: at posterior intercondylar region of tibia--> intercondylar fossa of femur
93
Muscles producing extension of knee? Flexion? Lateral rotation? Medial rotation?
Quadriceps femoris--> tibial tuberosity Hamstrings, gracilis, sartorius and popliteus Biceps femoris 5 muscles: semimembranosus, semitendinosus, gracilis, sartorius + popliteus
94
Ankle joint between what bones? Articulating surfaces? What bone fits into the mortise?
Hinge joint between tibia, fibula + talus Tibia + fibula by tibiofibular ligaments--> socket= mortise Talus bone
95
Ligaments of the ankle? Resists what motions?
1) Medial ligament- x4 ligaments from malleolus--> talus, calcaneus + navicular bones Over-eversion 2) Lateral ligament- from lateral malleolus a) Anterior talofibular--> lateral talus b) Posterior talofibular--> posterior talus c) Calcaneofibular--> calcaneus Over-inversion
96
Plantarflexion of the knee caused by what muscles? Dorsiflexion?
Posterior leg: gastrocnemius, soleus, plantaris + posterior tibialis Anterior leg: tibialis anterior, extensor hallucis longus + extensor digitorum longus
97
NV supply of ankle joint?
Malleolar branches of anterior tibial, posterior tibial and fibular arteries
98
Type of joint hip joint articulates with? What is the cavity of the acetabulum deepened by? Both covered by what?
``` Ball + socket= acetabulum--> head of femur Acetabular labrum( fibrocartilaginous collar) Articular cartilage ```
99
Acetabulum made of what 3 bones?
Ilium, ischium + pubis bones
100
Greater trochanter attaches what muscles? Lesser trochanter? What connects these anteriorly? Posteriorly?
Abductor and lateral rotator muscles Psoas major and iliacus Intertrochanteric line= ilio-femoral ligament Intertrochanteric crest- attaches quadratis femoris
101
Roughened ridges on posterior shaft of femur? Splits distally and also proximally into what? Medial supracondylar line ends in what where what attaches?
Linea aspera Medial + lateral supracondylar lines + floor of the popliteal fossa Medial border--> pectineal line, lateral border--> gluteal tuberosity where gluteus maximus attaches Adductor tubercle= adductor magnus
102
Rounded ends of femur? What is depression between these? What is on the medial wall of the intercondylar fossa? Lateral wall?
Medial + lateral epicondyles Intercondylar fossa Facet for attaching PCL Facet for ACL
103
Where is patella located? Attached superiorly and inferiorly to what? What type bone?
Within patellofemoral groove Quad tendon and patellar ligament Sesamoid type due to position within quad tendon
104
What is apex inferiorly connected to by? What attaches the quad tendon superiorly? 2 facets on posterior surface?
Tibial tuberosity by patellar ligament The base Medial--> medial condyle of femur Lateral--> lateral condyle of femur
105
2 functions of patella?
Leg extension | Protection of anterior knee from trauma
106
Proximal tibia widened by what? Form what flat surface? Region located between condyles? Projects upwards on either side as what? Attach what?
Medial + lateral condyles--> tibial plateau Intercondylar eminence Medial + lateral intercondylar tubercles Knee ligaments + menisci
107
How many borders/ surfaces to tibial shaft? What shape? Proximal anterior border called what? Attaches what? Posterior surface marked by what? Site of origin for part of what? Lateral border attaches what?
``` Prism-shaped 3: anterior, posterior + lateral Tibial tuberosity= patellar ligament Soleal line- soleus muscle Interosseous membrane ```
108
On posterior tibia, groove where what passes through? Laterally is what where what is bound?
Tendon of tibialis posterior | Fibular notch= fibula--> tibia
109
Main function of fibula? 3 main articulations?
Muscle attachment- not a weight-bearer 1) Proximal tibiofibular joint--> lateral condyle of tibia 2) Distal tibiofibular--> fibular notch of tibia 3) Ankle joint= talus bone
110
Proximal fibula contains facet for articulation with what? What nerve runs on posterior and lateral surface of fibular neck? 3 surfaces of shaft?
Lateral condyle of tibia Common fibular nerve Anterior, lateral and posterior
111
Intracapsular ligaments of the hip? Extracapsular? Prevents what movements?
Ligament of head of femur= acetabular fossa--> fovea of femur 1) Iliofemoral: anteriorly ilium--> intertrochanteric line- hyperextension 2) Pubofemoral: anteriorly + inferiorly= pelvis--> iliopubic eminence + obturator membrane- abduction + extension 3) Ischiofemoral: posteriorly= ischium--> greater trochanter- excessive extension
112
NV supply of the hip? Major supplier? Damage can lead to what?
Medial + lateral circumflex femoral arteries= anastomose at base of femoral neck--> a ring Medial artery--> avascular necrosis of the HOF Sciatic, femoral and obturator nerves
113
Muscles needed to flex the hip? Extend? Abduct? Adduct? Laterally rotate? Medially rotate?
Iliopsoas, rectus femoris, sartorius and pectineus GMax, semimem, semitend, biceps femoris(hammies) GMed, GMini, piriformis and tensor fascia latae Adductors longus, brevis and magnus, pectineus and gracilis BF, Gmax, piriformis, obturators, gemilli + QF Anterior GMed and mini fibres, tensor fascia latae