Quiz 3 Review Flashcards
Tibialis Posterior Attachment’s
Inferior/Distal attachment: navicular tuberosity and surrounding bones (cuneiforms, cuboid, bases of the 2nd-4th MTs
Tibialis Posterior Actions
Action: Plantar Flexon
Action: Inversion
Flexor Hallucis Longus (FHL) Attachment’s
Inferior/Distal attachment: plantar surface of 1st distal phalanx
Flexor Hallucis Longus (FHL) Actions
Action: 1st MTP, 1st IP Flexion
Action: Plantar Flexion
Flexor Digitorum Longus (FDL) Attachment’s
Inferior/Distal Attachment: plantar surface of distal phalanges of lateral 4 toes
Flexor Digitorum Longus (FDL) Actions
Action: PIP/DIP, MTP flexion of 2nd-5th digits
Action: Plantar flexion
Tibialis Posterior, FHL, FDL tendons pass behind the ________________.
Medial Malleolus
What forms a tunnel called the tarsal tunnel?
Flexor Retinaculum
(Possible causes tarsal tunnel syndrome: Prolonged eversion/pronation, chronic tendonitis, direct trauma, RA)
What tendons can be referred to as Tom, Dick, Harry.
Tibialis Posterior, FHL, FDL
What is the only intrinsic foot muscle in the dorsum foot?
Extensor digitorum brevis
Extensor Digitorum Brevis Attachment
Inferior/Distal attachment: Medial distal 4 phalanges
Extensor Digitorum Brevis Action
Extension of the medial 4 toes
_____________ and ______________ are essentially the same muscle.
Extensor Digitorum Brevis, Extensor Hallucis Brevis
How many muscular layers are in the sole of the foot?
4
First layer in sole of the foot (most superficial)
-3 Muscles
-All attach proximately to the medial process of the calcaneus and plantar aponeurosis
-Deep to plantar fascia
What muscles are in the first layer in the sole of the foot?
Abductor Hallucis, Flexor Digitorum Brevis, Abductor Digiti Minimi
Abductor Hallucis Attachment
Inferior/Distal Attachment: medial side of the base of the proximal phalanx of the 1st toe
Abductor Hallucis Action
Action: abduction of the 1st toe
Flexor Digitorum Brevis Attachment
Inferior/Distal attachment: both sides of middle phalanges of 2nd-5th toes
-Note: the tendons split to attach to the sides of the phalanx
Flexor Digitorum Brevis Action
Flexion of 2nd-5th toes
Abductor Digiti Minimi Attachment
Inferior/Distal Attachment: Lateral side of the base of the proximal phalanx of the 5th toe
Abductor Digiti Minimi Action
Abduction of the 5th toe
How many muscles are in the second layer of the foot?
2
What tendons are in the second layer of the foot?
FHL and FDL
What are the muscles in the second layer of the foot?
Quadratus Plantae and Lumbricals,
Quadratus Plantae Attachment
Inferior/Distal Attachment: posterolateral margin of the FDL tendons
Quadratus Plantae Actions
Action: assists FDL in flexion of the lateral 4 digits
Action: adjusts the pull of the FDL tendons along the ling axis of the digits
-Note: the line of pull of FDL and how it would track medially so quadratus plantae helps to keep the vector more linear
Lumbricals Attachment
Inferior/Distal attachment: extensor expansion, and medial sides of proximal phalanges of the lateral toes
Lumbricals Action
Action: Flexion of the MTP joints and extension the PIPs/DIPs
How many muscles are in the 3rd layer of the sole of the foot?
3
3rd layer of the sole of the foot
-There are 3 muscles in the anterior 1/2 of the foot
-2 act on the 1st toe, the other on the 5th
What are the three muscles in the 3rd layer of the foot?
Flexor Hallucis Brevis, Adductor Hallucis, Flexor Digiti Minimi Brevis
Flexor Hallucis Brevis Attachment
Inferior/Distal attachment: both sides of the base of the proximal phalanx of the 1st toe
-There are 2 sesamoid bones - one adhered to each of the 2 tendons - they protect tendons from pressure during standing and walking
Adductor Hallucis Attachment
Inferior/Distal attachment (both heads): lateral side of the base of the proximal phalanx of the 1st toe
Adductor Hallucis Action
Action: adducts 1st toe
-Also helps maintain transverse arch
Flexor Digiti Minimi Brevis Attachment
Inferior/Distal attachment: base of the proximal phalanx of the 5th toe
Flexor Digiti Minimi Brevis Action
Flexion of the 5th MTP joint
4th layer of the sole of foot
-Deepest Layer
-Interossei muscles (DAB, PAD)
-Note: when discussing abduction and adduction of the toes, the ‘midline’ (reference point) is through the 2nd toe
How many muscles are in the fourth layer of the foot?
2
What are the 2 muscles in the fourth layer of the foot?
Dorsal Interossei, Plantar Interossei
Dorsal Interossei Attachments
Inferior/Distal attachment (1st): medial side of the proximal phalanx of the 2nd toe
Inferior/Distal attachments (2nd-5th): lateral sides of proximal phalanges 2nd-4th toes
Dorsal Interossei Action
Abduction of 2nd-4th MTP joints (DAB)
-moving the digits away from the 2nd toe
DAB
Dorsal Abduction
PAD
Plantar Adduction
Plantar Interossei Attachment
Inferior/Distal attachment: Medial sides of the bases of proximal phalanges 3-5
Plantar Interossei Action
Action: Adduction of the 3rd-5th MTP joints (PAD)
-moving the digits towards the 2nd toe
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 (Attachments)
-Attaches: posterior intercondylar area of the tibia ⬄ anterior and lateral side
of the medial femoral condyle
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
Anterior Cruciate Ligament (ACL) (Attachments)
-Attaches: anterior intercondylar area of the tibia ⬄ posterior and medial
side of the lateral femoral condyle
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
