session 1: lower limb Flashcards
1
Q
what bones is the pelvis formed from?
A
2 hip bones and sacrum
2
Q
describe the joints in the pelvis
A
2 sacro-iliac joints: behind
pubic symphysis: in front
permit almost no movement
3
Q
which 3 bones is the hip bone formed from?
A
fusion of ilium (upper), ischium, pubis (front)
4
Q
where is the wing/ala of ilium?
A
broad bony plate
5
Q
what is the iliac crest?
A
broad roughened edge of wing, where many muscles attach
6
Q
where does the iliac crest end?
A
front=anterior superior iliac spine
behind=posterior superior iliac spine
7
Q
where is the ischial spine?
A
extends from posterior border of superior aspect of the ischium at the level of the lower border of the acetabulum
8
Q
where are the greater and lesser sciatic notches?
A
above and below ischial spine
9
Q
where is the ischial tuberosity?
A
rounded bone that extends from the ischium, many muscles attach, part of the hip we sit on
10
Q
what is the acetabulum?
A
hip joint socket, broad smooth area is the articular surface
11
Q
where is the obturator foramen?
A
hole in the lower part of the hip bone
12
Q
describe the structure of the pubis.
A
body, superior ramon, ischio-pubic ramus. prominence=pubic tubercle (inguinal ligament attaches
13
Q
do the upper and lower parts of the pelvis face in the same direction?
A
no
14
Q
in which orientation is the pelvic surface of the sacrum?
A
nearly horizontal
15
Q
how does the sacrum attach to th epelvis by ligaments?
A
2: 1 goes to ischial spine and 1 to ischial tuberosity
16
Q
what is the longest bone in the body?
A
femur
17
Q
where are the greater and lesser trochanters of the femur?
A
on the proximal end, bony lumps
18
Q
what does the intertrochanteric line mark?
A
insertion of major ligament
19
Q
where is the inter-trochanteric crest?
A
ridge on the back of the femur, runs from greater to lesser trochanter
20
Q
where is the gluteal tuberosity on the femur?
A
broad rough area
21
Q
where is the linea aspera?
A
rough line running down shaft of femur
22
Q
which ligaments bridge the gap between ischium and sacrum and what does this create?
A
sacro-spinous ligament: goes to ischial spine
sacrotuberous ligament: goes to ischial tuberosity
crates 2 openings: lesser sciatic foramen (lowe-between 2 ligaments), and greater sciatic foramen (upper-between ligament and bone)
23
Q
where does the greater sciatic nerve pass through in the hip?
A
greater sciatic foramen
24
Q
where is the lunat esurface of the acetabulum?
A
C shaped articular surface
25
what is the non-articular part of the acetabulum called?
acetabular fossa
26
what is the acetabular labrum?
rim of fibrocartilage on edge of acetabulum, adds depth
27
describe the capsule of the hip joint.
sleeve of ligaments, thin on underside. ischiofemoral ligament (part of behind).anterior part is thickest-ilio-femoral ligament. is attached to the hip bone all the way around the acetabular labrum. on the back of the femur the capsule is attached part-way along the femoral neck, on the fron tis attaced on the intertrochanteric line
28
what axis of movement does the hip joint have?
3: flexion/extension, abduction/adduction, lateral/medial rotation
29
what are the short hip rotator muscles?
6, all deep to sciatic nerve except piriformis
30
where to the short hip rotator muscles insert?
back of femur, medial to greater trochanter
31
what is the origin of piriformis? and where does it leave the pelvis
sacrum
| through greater sciatic foramen
32
where are the obturator internus and externus?
either side of obturator membrane
33
where does the obturator internus originate?
ilium, ischium and obturator membrane
34
what is the origin of obturator externus?
obturator membrane and adjoining edge of ischiopubic ramus
35
does the obturator externus insert above or below piriformis?
below
36
which muscles does obturator internus insert with?
gemellus muscles (superior and inferior)
37
where is the origin of the gemellus muscles?
ischium
38
where does quadratus femoris originate?
ischial tuberosity
39
what is the action of the short rotator hip muscles?
pull back of femur laterally to produce lateral rotation of hip. when foot is on the floor this manifests as rotation of runk to opposite side
40
what are the hip adductor muscles? and what layers are they in
5 in 3 layers:
pectineus and adductor longus
adductor brevis
adductor magnus
also gracillis
41
where do hip the adductor muscles originate?
ischium and pubis
42
where is the origin and insertion of adductor magnus?
outer border of ischiopubic ramus
| insertion in 2 parts: linea aspera and adductor tubercle of femur
43
where is the adductor hiatus?
gao between 2 insertions of adductor magnus
44
where does adductor brevis orginate and insert?
body of pubis
| above magnus
45
where does adductor longus originate and insert?
body of lubus
| below magnus-stops just before hiatus
46
where does pectineus originate and insert?
superior pubic ramus
| in front of brevis
47
which is the most medial thigh muscle?
gracillis
48
where does gracillis orginate and insert?
pubis
| tibia (crosses knee and hip_
49
what are the hip abductor muscles?
gluteus minimus, gluteus medius, tensor fascia lata
50
where does gluteus minimus originate and insert?
wing of ileum
| anterior aspect of grater trochanter
51
where does gluteus medius orginate and insert?
ileum (between posterior and anterior gluteal lines just below iliac crest)
lateral aspect greater trochanter
52
what do the different fibres in gluteus medius produce?
anterior fibres: flexion and medial rotation of hip
| posterior: extend and laterlaly rotate hip
53
where does the tensor fascia lata originat eand insert?
iliac crest
| iliotibial tract
54
what is the fascia lata?
continuous sheet of dense tissue around thigh muscles
55
what is the iliotibial tract and where does it insert?
thickening of fascia lata, acts as a tendon of insertion, inserts onto the lateral tibial plateau (gerdys tubercle)
56
what are the hip flexor muscles?
4: 2 act only at hip (iliacus, psoas major) and 2 at hip and knee (rectus femoris, sartorious)
57
where is the origin, pathway and insertion of iliacus?
iliac crest
pass over superior pubic ramus and under inguinal ligament downward and backward
lesser trochanter
58
where is the origin, pathway and insertio psoas major.
lumbar spine transverse processes and intervertebral discs
over superior pubic ramus and under inguinal ligament downward and backward
lesser trochanter
59
what is the origin and insertion of rectus femoris?
2 heads just above acetabulum
| tibia
60
what is the origin, insertion and action of sartorius?
asis
tibia
knee flexion, hip flexion, lateral rotation of hip
61
what are the hip extensor muscles?
4: 3=hamstring muscles (semi-membranosis, semi-tendanosus, biceps femoris) and gluteus maximus
62
where do the hamstring muscles originate and in what direction do they run?
ischial tuberosity
to medial aspect: semi membranosus and semi-tendinosus
to lateral asoect of leg: biceps femoris
63
where does semi-membranosis insert?
back of tibia
64
where does semi-tendinosus insert?
medial aspect of tibia close to sartorious and gracilis, long tendon of insertion
65
where does the biceps femoris originate and insert?
2 heads of origin: long=same place as semi-tendinosus, short=linea aspera. join to form a tendonr that inserts on head of fibula
66
where does gluteus maximus originate and insert?
coccyx, edge of sacrum, posterior iliac crest
| upper 3/4 inserts onto ilio-tibial tract, lower 1/4 more deeply onto back of femur on gluteal tuberosity
67
what are the 2 big anti-gravity muscles in the lower limb?
gluteus maximus and quadriceps
68
where does the inguinal ligament run and what does it form?
asis to pubic tubercle
| forms lowest part of anterior abdo wall, lower edge of external oblique aponeurosis
69
what is the femoral triangle and its borders?
```
gap in muscles
lateral wall=sartorious
medial=adductor longus
above=inguinal ligament
passing backward towards insertions=pectineus, psoas major, iliacus
```
70
what is the name of the external iliac vein/artery below the inguinal ligament?
femoral
71
describe the pathway of the long saphenous vein to the IVC
ankle, medial side of knee, top of thigh, through saphenous hiatus (opening in fascia lata), ends by joining femoral vein which passes beneath the inguinal igament and becomes the external iliac vein which is joined by the internal iliac to form common iliac, right and left join to form IVC
72
describe the pathway of the femoral arteries from the Abdominal aorta.
abdominal aorta, L and R common iliac, internal and external iliac, external passes under inguinal ligament emrgeing as femoral artery, small bracnhes (superficial circumflex runs laterally, external pudendal runs medially), and 1 large branch the deep femoral, once it has give off deep femoral may be referred to as superficial femoral
internal iliac goves off superior and inferior gluteal arteries, pass backward through greater sciatic foramen 1 above and 1 below piriformis
73
where does the femoral nerve originate?
anterior primary rami of L2-4
74
where does the obturator nerve originate?
lumbar plexus
75
describe the pathway of the femoral nerve and the muscles in the thigh it supplies.
emerges lateral to psoas major, runs across iliacs and over inguinal ligament to femoral artery-branches to supply iliacus, quadriceps head, pectineus and sartorious
76
dscribe the pathway of the obturator nerve and the muscles it supplies.
crosses wing of sacrum and crosses back of ischiopubic ramus, leaves pelvis through obturator canal above obturator internus. emerges over obturator externus and branches run down between abductor muscles. supplies obturator externus, adductor brevis and longus, anterior part of adductor magnus
77
where does the sciatic nerve originate from?
L4-S3
78
what does the sciatic nerve supply?
posterior thigh (semitendinosus, semi-membranosus, biceps femoris, posterior part adductor magnus), mostly everything below knee
79
what does the superior gluteal nerve supply?
gluteus medius, minimus and tensor fascia lata
80
what does the inferior gluteal nerve supply?
gluteus maximus
81
which muscles have their own nerve supply from branches of sacra plexus?
piriformis, obturator internus, quadratus femoris
82
where are the lateral and medial condyles on the femur?
on distal femur, separated by intercondylar notch
| smoothly curved surfaces,
83
where are the epicondyles on the femur?
above the condyles
84
what is the adductor tubercle?
on the femur, sharp corner on medial epicondyle
85
where are the medial and lateral supracondylar lines?
prominent risges on distal femur
86
how are the tibia and fibular fixed to each other?
proximal and distal tibiofibular joints, almost no movement
87
what is the interartcular area?
on condyles of proximal tibia, rugged expanse between articular surfaces
88
what is the tibial tubercle?
prominent lump on front of proximal tibia, final insertion of quadriceps tendon
89
what is the articular surface on the condyles of the proximal tibia?
flattened
90
what is the space between the femoral and tibial condyle occupied by?
meniscus
91
what is the intercondylar notch?
space in the middle, occupied by cruciate ligaments, divides the knee into 2 halves
92
describe the patella and what it articulates with.
embedded within quadriceps tendon articular surface divided into facets, articulate with femoral condyles when flexed or central articular area when extended
93
what are menisci made of?
flexible fibrocartilage
94
what are the differences between the lateral and medial menisci?
lateral: circular, more mobile
medial: C shaped
95
which edge of th e menisci is thicker?
outer
96
where do the menisci attach?
2 ends of each attach to intra-articular area of tibia
| attached all around its edge to th ejoint capsule
97
which ligaments are on the inside and outside of knee?
cruciate on inside (anterior and posterior)
| collateral on outside
98
describe the arrangement of the cruciate ligaments.
form a cross
anterior cruciate ligament on inner aspect of lateral condyle prevents femur moving backwards
posterior stops femur moving forwards
99
where is the tibial/medial collateral ligament?
from medial epicondyle of femur to anteromedial aspect of proximal tibia, blends with capsule of the knee joint in front and behind, attached to edge of medial meniscus on inner aspect
100
where is the fibular/lateral collateral ligament?
from lateral epicondyle of femur to head of fibular. doesnt blend with capsule and not attached to meniscus
101
what movement do the collateral ligaments prevent?
sideways
102
what is the part of the quadriceps tendon below the patella called?
patella ligament
103
what is the quadriceps bursa?
between quadriceps tendon and femur. is lined with synovial membrane allowing the quadriceps tendon to slide on the femur
104
describe the fibrous capsule of the knee.
thin on medial side, thick at back to prevent hyper extension. lined with synovial membrane except at back
105
what are the knee extensor muscles?
quadriceps
106
what are the 4 heads of the quadriceps and their origins?
vastus intermedius: origin=lateral aspect and front of femur
vastus medialis: origin=medial edge of linea aspera and below lesser trochanter
vastus lateralis: origin=lateral edge of linea aspera and side and front of greater trochanter and gluteal tuberosity
rectus femoris: origin posterior tendon=abive acetabulum and anterior=aiis
107
where do the quadriceps insert?
all converge on quadriceps tendon, inserts on side of patella
108
what is the adductor canal?
between vastus medialis and adductor longus. covered by sartorious. femoral vessels run through
109
what are the knee flexor muscles?
hamstring (main), minor-sartorius and gracillis
110
what are the different actions of the hamstring muscles?
extend hip when knee flexion opposed by quadriceps
knee flexion when extension of hip resisted by hip flexors
when act separatelt they produce medial (2 semi muscles ) and lateral (biceps femoris) rotation at knee joint
111
where is gastrocnemius, its origin, insertion and action?
on top of popliteus and plantaris
2 heads from back of medial and lateral epicondyles of femur
joins with soleus to form cancaneal tendon
slight flexing of knee, mainly ankle joint
112
where does plantarus originate?
lateral epicondyle of femur, long tendon to ankle
| is on top of popliteus
113
where does popliteus originate, insert and action?
back of tibia
lateral epicondyle of femur, tendon passes through capsule of knee
minor flexor and medial rotation onf tibia
114
what are the arteries and veins called below the adductor hiatus?
femoral->popliteal
115
describe the pathway of the femoral artery and vein from the adductor canal?
pass beneath roof of adductor canal and through hiatus, emerge behind adductor magnus-now called popliteal artery and vein. artery is deepest at the back of the knee. joined by sciatic nerve above knee. popliteal artery gives off 2 superior genicular arteries (lateral an dmedial) above the knee, 2 branches to the heads of gastrocnemius, below the knee gives off 2 inferior genicular branches (medial and lateral, then goes deep to the 2 heads of gastrocnemius
116
what does the sciatic nerve divide into above the knee and describe their pathways.
tibial nerve: runs downward in midline and passes between 2heads of gastrocnemius along with popliteal vessels. supplies gastrocnemius and plantaris
common peroneal: diverges laterall running behind tendon of biceps femoris, passes arounf neck of fibula and into peroneus longus
117
what is the upper and lower surface of the foot called?
dorsal
| plantar
118
what are the upwards and downwards movements at the ankle called?
dorsiflexion
| plantarflexion
119
what is the ankle turning outwards and inwards called?
eversion
| inversion
120
what holds the tibia and fibula together?
interosseous membrane
121
what type of joint is the distal tibiofibular joint?
synovial-held togeter by anterior tibio-fibular ligament and posterior tibio-fibular ligament
122
where are the medial and lateral malleolus?
projecting ends of tibia and fibula
123
where is the articular surface on the tibia and fibula?
curved surface of tibia and inner surfaces of medial and lateral malleoli
124
what articulates with the tibia and fibula to form the ankle joint?
talus
125
describe the structure of the talus.
head, neck, 3 articular surfaces: 1 on the head, one on the underside for inversion and eversion, 1 on top for ankle joint
126
what is the ankle joint held together by?
lateral side: posterior and anterio talofibular ligaments
| medial side: deltoid ligament
127
why is the capsule on the ankle loose on the front and back?
allows for full range of dorsiflexion and plantarflexion
128
what axis is inversion and eversion on?
oblique
129
what are the joints of inversion and eversion?
subtalar joint, talocalcaneonavcular joint
130
what is the sustentaculum tali?
on calcaneus, on medial side projecting shelf which talus sits on
131
where is the calcaneo-navicular ligament?
aka spring ligament
| calcaneus, to navicular, helps hold up hwad of talus
132
where does the deltoid ligament fo?
medial malleolus to talus, parts fan out below sustenaculum tali of calcaneus and in front onto the navicular bone. holds all 4 of these bones together
133
name 2 important ligaments on the lateral side of the foot and where they go?
```
calcaneofibular ligament (lateral malleolus to side of calcaneus)
interosseous talo-calcaneal ligament (calcaneus to talus)
```
134
what are the retinacula of the ankle?
one on front (extensor retinaculum) and each side below malleolus, lateral=peroneal retinaculum (accomodeates tendons of the 2 peroneal muscles), medial=flexor retinaculum (fans out from back of medial malleolus, space beneath divided int o4 separate tunnels). is a thickening of fascia, keeps in place tendons
135
what is the action, origin and insertion of tibialis anterior?
dorsiflexion and inversion
lateral condyle of tiba, proximal and lateral surface of tibia ad interosseus membrane
tendon passes under flexor retinaculum to the 1st cuneiform bone and metatarsal
136
what muscles provide plantar felxion?
gastrocnemeus and soleus and plantaris
| join together to form calcaneal tendon
137
what is the origin and insertion of soleus/
medial edge of tibia, oblique line on tibia and posterior aspect of head of fibula
calcaneal tendon
138
where does the calcaneal tendon insert?
back of calcaneus
139
what is the investing deep fascia?
outer layer of fascia in the leg, surrounds all muscles
attached to tibia and indirectly to fibular by fibrous septa
continuous with flexor retinaculum, peroneal retinaculum and externsor retinaculum
140
what are the fibrous septa?
3 (transverseintermuscular septum, anterior and posterior crural intermuscular septa)
divide the muscles of the leg into 4 compartments
141
which compartment is tibialis anterior in?
anterior
142
which muscles in the foot provide inversion?
tibialis anterior and posterior
143
where does tibialis posterior originate and insert?
posterior shafts of tibia and fibular and interosseous membrane
tendon passes behind medial malleolus, fans out to a wide insertion on navicular tuberosity, 1st cuneiform bone and bases of 2nd-4th metatarsals
144
which muscles provide eversion?
peroneus longus, brevis and tertius
145
where does peroneus/fibularis brevis originate and insert?
distal 2/3 lateral fibula
| tuberosity 5th metatarsal
146
where does fibularis longus originate and insert?
proximal fibula and head
| base of 1st metatrsal and medial cuneiform
147
where does peroneus tertius originate and insert and it's action?
fibula
5th metatarsal next to brevis
eversion and dorsiflexion
148
what are the major superficial veins of leg an dankle?
short saphenous: on back, runs uo between calcaneal tendon and lateral malleolus to join popliteal vein
long saphenous: on front
149
what is the deep vein of the leg?
popliteus, sa,e course as arterirs
150
what are the main arteries of the leg and ankle?
branches of popliteal: anterior tibial, posterior tibial, peroneal
151
describe the pathway of the popliteal artert from the soleus?
passes through fibrous arch in origin of soleus, fives off anterior tibial at loewr border of popliteus. ends by dividing into peroneal and posterior tibial
152
describe the pathway of the posterior tibial artery.
down back of leg covered by transverse muscular septum, passes towards medial side of ankle, divided in tunnel beneath flexor retinaculum into medial and lateral plantar arteries
153
describe the pathway of the peroneal artery.
passs laterally and beneath flexor hallucis longus, between deep posterior muscles close to fibula, gives off branches to surrounding muscles, ends behind lateral malleolus
154
describe the pathway of the anterior tibial artery.
passes forward through gap in interosseus membrane, runs down interosseus membrance lateral to tibialis anterior, passes beneath extensor retinaculum onto dorsum of foot, now called dorsalis pedis artery
155
where does the tibial nerve supply in leg and ankle?
gastrocnemius, soleus, plantaris, deep flexor muscles. divides in flexor retinaculum into medial and lateral plantar nerves
156
what does the commone peroneal nerve supply in leg and ankle and its pathway.
under peroneus longus and divides into superficial and deep peroneal
superficial runs beneath peroneus longus and continues as a sesnsory nerve, supplies longus and brevis
deep peroneal runs under longus and extensor digitorum longus and suplies tibialis anterior and peroneus tertius
157
how many phalanges do the toes have?
big toe=2 (proximal and distal)
| toes 2-5=3 (proximal, middle, distal)
158
what are the main ligaments supporting the arches?
dorsum: continuou slayer of ligaments connecting tarsal bones and metatarsals
underside=stronger: short plantar (calcaneuous to cubeoid), long plantar (calcaneus to 3rd-5th metatarsals) and plantar aponeurosis (whole length, fans out into 5 divisions)
159
where does the deep transverse metatarsal ligament run?
1st to 5th MP joint
160
describe the ligaments and capsule at the MP joint?
broad ligament on each side
| capsule thickeneed on plantar side=plantar ligament (attaches to tendon sheath and deep transverse metatarsal ligament)
161
what does the 1st MP joint have in it's plantar ligament?
2 sesamoid bones
162
how does the plantar aponeurosis insert onto the MP joint?
5 divisions that each has 2 slips-insert on each side of plantar ligament
163
what is the plantar aponeurosis?
strongest part of plantar fascia, acts as a continuation of achilles tendon
164
what are the toes extensor muscles?
long: extensor hallucis longus, extensor digitorum longus
short: extensor hallucis brevis, extensor digitorum brevis
165
where does the extensor hallucis longus originate and insert?
interosseus membrane and medial and anterior surface of fibula
extensor expansion of 1st MP joint and base of distal phalynx big toe
166
where does the extensor digitorum longus originate and insert
(is on top of hallucis)
proximal portion of fibular and tibia
2nd-5th toes on middle and distal phalanges
167
where does extensor digitorum brevis originate and insert?
dorsal surface calcaneous
| 2nd-4th toes via extensor digitorum longus tendon
168
what are the long toe flexor muscles?
flexor hallucis and digitorum longus
169
what is the origin and insertion of flexor hallucis longus?
middle half of posterior fibula
| tendon passes forwards and enters fibrous sheath of big toe to insert on base of distal phalanx
170
where does the flexor digitorum longus originate and insert?
(medial to hallucis)
middle and posterior surface of tibia
divides into 4 tendonds and inserts on distal phalanges of 2nd-5th toes
171
what are the short toe flexor muscle groups?
```
on plantar aspect, many
interosseuous muscles (7, 2 for each of 3 middle toes and 1 for 5th), 4 lumbricals, flexor accessorius, flexor digitorum brevis, flexor hallucis brevis, adductor hallucis, abductor hallucis, flexor digiti minimi brevis, abductor adductor digiti minimi
```
172
where to the interosseuous muscles originate and insert?
shafts of metatarsals
| bases of proximal phalanges
173
where does flexor accessorius originate and insert?
2 heads, orignate at calcaneus
| deep aspect of flexor digitorum longus
174
where does flexor digiitorum brevis originate and insert?
calcaneus
| divides to 4 tendons an inserts on bases of middle phalanges
175
where does flexor hallucis brevis originate and insert?
cuboid and 3rd cuneoform
| 2 tendonds of insertion: medial and lateral sesamoid bones and then to base of phalanx of big toe
176
where does adductor hallucis originate and insert?
oblique head from bases of 1st 3 metatarsals, transverse from deep transverse metatarsal ligament
converge with medial head of flexor hallucis brevis and shares insertion
177
where does abductor hallucis originate and insert?
medial side calcaneus
| tendon merges with medial part flexor hallucis brevis and inserts on medial sesamoid bone and base of proximal phalan
178
where do the superficial veins of the foot join?
lateral aspect join to form short saphenous
| on medial form long saphenous
179
describe the pathway of the dorsalis pedis
beneath extensor hallucis brevis to join lateral plantar artery
180
describe the pathway of the medial plantar artery.
usually smaller, runs along medial side of foot, supplies underside of big toe
181
describe the pathway of th elateral plantar artery.
gives off calcaneal branch, passes down lateral and to 5th metatarsal and curvs to join dorsalis pedis
182
where does the superficial peroneal nerve go to in the foot?
fans out to dorsum
183
where does the deep peroneal nerve go in the foot?
motor branch to short toe extensors, continues dustally as sensorry to supply between big and 2nd toes
184
what does the medial plantar nerve supply?
flexor digitorum brevis, abductor hallucis, flexor hallucis brevis
breaks into plantar digital nerves to supply underside of big to half of 4th toes and medial sole of foot
185
what does the lateral plantar nerve supply?
flexor accessorius, abductor digiti minimi.
divides into a deep banch: supplies inerossi and adductor hallucis
superficial branch: flexor digiti minimi brevis and sensation to lateral sole and 5th toe and half of 4th toe
186
what is the sural nerve and what does it supply?
formed by a branch of tibial and peroneal
runs down back of leg
supplies sensation to lateral foot
187
what is the saphenous nerve and what does it supply?
branch of femoral
runs down medial leg
supplies sensation to medial foot and ankle
188
what is the nerve supply to the heel?
calcaneal branches of tibial nerve
189
what is the difference between the skin on the dorsum and plantar surfaces?
dorsum=thin and mobile
| plantar=thickened
190
how can you tell apart the medial and lateral condyles of the femur?l
lateral more verticle and higher ridge
191
what is guerneys tubercle?
smooth facet o lateral aspect of upper tibia, 2-3cmlateral from tibial tubercle, insertion of iliotibial band
192
what is an open chain movement?
distal aspect is free e.g. arm movements
193
what are closed chain movements?
distal aspect is fixed orstationary e.f. walking
194
what is the pes anserinus?
conjoined tendnds of sartorius, gracilis and semitendinosus. inserts onto anteromedial aspect of proximal tibia
195
what borders the femoral triangle and what does it contain?
superior=inguinal ligament, medial=superior border adductor longus, lateral=medial border sartorius, floor=pectineus and adductor longus medially and iliopsoas laterally
lateral cutaneuos, nerve, femoral nerve, nerve to pectineus, femoral sheath encoses vessels (femoral branch genitofemoral, femoral artery, femoral vein)
196
what are the roles of the menisci?
disributre and absorb force, lubrication and decrease friction, proprioception
197
what muscle in the lower limb doesn't everyone have?
plantaris
198
what are the deep posterior muscles of the leg?
posterior tibial, flexor digitorum logus, flexor hallucis longus (tom, dick, harry)
199
what binds the popliteal fossa and what does it contain?
biceps feomris, plantaris, lateral and medial heads gastrocnemius, semimembranosis
contain spopliteal artery tibial nerve, popliteal vein and common fibular nerve
200
how can you find the head of 1st metatarsal?
go to ball of foot, move proximally-bones flare at base of bone were it meets medial cuneiform bone, can wiggle to feel where joint lies
201
where is the navicular tubercle?
proximal to head of 1st metatarsal
202
where is the talar head?
proximal to navicular tubercle, inversion and eversion can help feel
203
where is the talus?
head halfway between medial malleolus and navicular
204
where is the cubeoid?
approximates with 4th and 5th metatarsals
205
where does the middle cuneiform approximate with?
base of 2nd metatarsal
206
where is the lateral cuneiform in line with?
3rd metatarsal
207
where is the sustentaculum tali?
palpate down from medial malleolus about 2cm until you feel a ridge
208
where is the navicular bone?
distal to and in lin ewith sustentaculum tali
209
describe hip palpation.
compare both side
anterior: asis, sartorius, rectus femoris, tensor fascia lata, inguinal ligament, adductor tendonds
posterior: psis, ischial tuberosity, sacrum, sacrotuberous ligament, greater trochanter, piriformis, sciatic nerve
lateral: greater trochanter, gluteus medius and minimus
210
where would you palpate asis?
find iliac crest and move forward to where it drops. can use for leg length
211
where can the inguinal ligament be palpated?
find asis, ligament in groin line from here
212
where is the psis?
trae ileum around back until feel a bump. if standing will be dimples
213
where is the ischial tuberosit palpated?
under gluteal fold
214
where is the greater trochnater palpated?
on lateral aspect of femur, prominent bump
215
where is the sciatic nerve palpated?
in between greater trochanter ans ischial tuberosity. when put pressure on will feel unpleasant for patient
216
how do you assess the lateral hip rotators? (piriformis and quadratus femoris)
piriformis: use PSIS, coccyx and greater trochanter to create a T shape, muscle is on the base of the T
quadratus femoris: find ischial tuberosity and osterior shaft of femur, muscle is in between
to shorten laterally rotate
217
how do you assess the adductor group?
flex and laterally rotate and ask to adduct thigh to see contract
find pubic crest, move laterally to superior ramus, follow to ischial tuberosity. adductors attach on this line
have in adduction: find the prominent tendon which will be either gracilis or adductor longus. if goes medial is gracillis, laterally adductor longus
for adductor magnus ask to lie on side, is posterior to prominent tendon
218
how to you assess gluteus maximus?
extend hip to engage.
bony landmarks: PSIS an dmove down along edge of sacrum to coccyx 91 side of maximus), muscle descendsat angle to gluteal tuberosity (move distal from greater trochanter to posterior surface of femur)
laterally rotate to shorten
219
how do you assess gluteus medius and minimus?
turn on to side and abduct hip to see medius
find psis and move along to asis (medius goes 3/4 way along), fibres insert at greater trochanter
cant assess mimimus directly as beneath medius
220
how do you assess sartorius?
follow from asis, passes medial around to vastus medialis
| to see enage flex and laterally rotate hip and adduct thigh
221
how do you assess iliopsoas?
psoas major: halfway between asis and umbilicus, ask to flex hip to feel contraction
iliacus: scoop fingers around into iliac crest into iliac fossa and flex hip
on side: use same landmarks
222
how do you assess the hamstrings?
between vastus lateralis and adductor magnus
biceps femoris is lateral, semis are media
lie on front and flex knee to see hamstrings contract, palpate down from ischial tuberosity
223
how to you assess tensor fascia lata?
accessible between rectus femoris and gluteus medius
find asis and move along iliac crest, 2 inch region annd move down side to level of greater trochanter
to engage: medially rotate hip against resistance
224
how can you assess the iliotibial tract?
superficial on lateral thigh, feels toughest closest to knee
225
where does the cause of the pain on the ankle joint usually correspond to?
the place the pain is felt
226
where is the dorsalis pedis pulse?
between 1st and 2nd toes in the mid foot
227
what do you palpate in the ankle joint?
anterior: flexor and extensor compartments in leg, anterior subtala joint, dorsalis pedis pulse,
lateral: lateral malleolus, anterotalofibular ligaments, calcaneofibular ligaments, posteriortalofibular ligaments
medial: leg muscles, medial malleolus, navicular, navicular tuberisty, deltoid ligament, tibial artery
posterior: gastrocnemius, soleus, achills tendon (posterior, lateral anterior, anterior medial, insertion), fat pad on heel, palpate down to plantar fascia
228
where is the tibial artery palpated?
between medial malleolus and calcaneus
229
what pain is commonly felt in a microfracture in the leg?
specific shin pain when tap bone
230
where is the medial ligament in the ankle, it's alternative name and it's function?
medial mallelous, fans out into 4 ligaments, attaching to talus, calcaneus and navicular bones
deltoid ligament
resist over eversion
231
what are the lateral ligaments of the ankle joint and their function?
anterior talofibular: lateral malleolus to lateral talus
posterior talofibular: lateral malleolus to posterior talus
calcaneofibular: lateral malleolus to calcaneus
resists over-inversion
232
where is the coccygeus muscle?
ischial spine to edge of lower sacrum and coccyx
233
where does the levator ani originate and insert?
body of pubis, ischial spine, tendinous arch
| meet in midline with opposite side at anococcygeal ligament
234
what are the 2 parts of levator ani?
iliococcygeus=thin
| pubococcygeus
235
what are the actions of levator ani/
keep pelvic organs in one place, pulls rectum up and forward
236
where is the ischiorectal fossa?
between levator ani and sacrotuberous ligament, filled with fat
237
what is at the urogenital hiatus/
rectum, urethra, vagina
238
where is the perineum
between coccyx, ischial tuberosities, and pubic sympthysis
239
where is the urogenital triangle/
area between ischiopubic rami
