TBL 15 Flashcards
What forms the hip bone?
fusion of the ilum, pubis, and ischium
What forms the hip joint?
acetabulum articulates with the head of the femur
Body and superior ramus of the pubis
know it
Body, ischial spine, ischial tuberosity, and ischiopubic ramus of the ischium
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Iliac fossa, iliac crest, anterior superior and anterior inferior iliac spines of the ilium
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Obturator foramen
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The capsule of the hip joint is reinforced by what ligmanents?
iliofemoral, pubofemoral, and ischiofemoral ligaments that pass in a spiral fashion from the hip bone to the femur
What results in hip dislocations and in what anatomical direction?
weakness of the ischiofemoral ligmament, most commonly in a posterior direction
What does extension of the femur do to the hip ligaments and what is the result?
which increases joint stability but restricts extension to 10-20 degrees beyond the vertical position
What does flexion of the femur do to the hip ligaments and what is the result?
unwinds the ligaments, which increases joint mobility and allows flexion to greater than 90 degrees beyond the vertical
What are avulsion fractures of the hip bone?
a small bone with a piece of a tendon or ligmanet attached is avulsed; occurs at apophyses (bony projections that lack secondary ossifcation centers) where muscle attach -> anterior superior and inferior iliac spines, ischial tuberosities, and ischiopubic rami
Cartliagenous replicas at future elbows and knee joints bend in what direction? What happens next?
anteriorly with the elbow and knee directed laterally; upper and lower limbs undergo 90 degree torsions around their long axes (i.e., the thumb and big toe assume their lateral and medial positions)
Head, neck, greater and less trochanters, lateral and medial epicondyles and condyles, linea aspera of the femur
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Tuberosity, medial and lateral condyles, medial malleolus of the tibia
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Head, neck, and lateral malleolus of the fibula
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Lateral and medial menisci
incomplete rings of dense connective tissue that partially cover the articular surface of the tibial condyles at the knee joint
Lateral/fibular collateral ligament (LCL)
attaches the lateral epicondyle of the femur to the head of the fibula
The LCL and lateral meniscus are separated by what?
tendon of the popliteus muscle
Medial/tibial collateral ligament (MCL)
strong, flat; attaches the medial epicondyle of the femur to the superomedial tibia
Difference between LCL and MCL
MCL is stronger and is attached to its meniscus
Anterior and posterior cruciate ligaments (ACL and PCL) positioning
cross obliquely in the center of the knee joint
PCL attachments
attaches the posterior intercondylar area of the tibia to the anterior aspect of the femoral medial condyle
PCL function
prevents anterior displacement of the femur on the tibia and hyperflexion of the leg
ACL attachments
anterior intercondylar area of the tibia to the posterior aspect of the femoral lateral condyle
ACL function
ACL prevents posterior displacement of the femur on the tibia and hyperextension of the leg
Which is stronger, ACL or PCL
PCL
Articular cartilage
(i.e., hyaline cartilage lacking a perichondrium) forms the sliding area of all joints
Menisci function
provide shock absorption and load distribution at the knee joint
What forms the synovial membrane that lines all joint capsules and produces synovial fluid to lubricate the articular surfaces
simple cuboidal epithelium
How can twisting of the flexed knee create the unhappy triad injury?
caused by blow to the lateral side of the extended knee or excessive lateral twisting of the flexed knee that disrupts the TCL and concomitantly tears and/or detaches the medial meniscus; ACL is taut during flexion and can also tear -> “unhappy triad”
What are the anterior and posterior drawer signs?
anterior = free tibia slides anteriorly under the fixed femur; posterior = free tibia to slide posteriorly under the fixed femur
How is the upper body weight transmitted?
centrally through the vertebral column, bilaterally to the sacrum, and via the sacroiliac joints to the thick portions of the ilia
Pubic symphysis
union of the pubic rami; stabilizes the weight-bearing sacrum and ilia
Ilia transfer the weight to?
the femurs at the hip joints (i.e., when standing, the weight of the upper body is transmitted to the heads and necks of the femurs)
Femoral obliquity
places the knee joint inferior to the sacrum and the verticality of the tibia returns the center of gravity to the vertical axes of the supporting legs and feet
Angle of inclination (of the femur) becomes more acute with?
aging and increased strain on the femoral neck makes its fracture more common in the elderly
Deep fascia of the thigh (aka fascia lata)
thickened laterally as the iliotibial tract and continues as the deep fascia of the leg
Dorsal vein of the big toe joins the dorsal venous arch of the foot to form?
great saphenous vein
Great saphenous vein, superior path?
courses anterior to medial malleolus of the tibia and posterior to the medial condyle of the femur before terminating in the femoral vein
Dorsal vein of the little toes join the dorsal venous arch to form?
small saphenous vein
Small saphenous vein, superior path?
courses posterior to the lateral malleolus of the fibula and along the lateral edge of the calcaneal tendon before terminating in the popliteal vein.
Superficial lymphatic vessels that accompany what and drain into what?
the great and small saphenous veins drain into the superficial inguinal and popliteal lymph nodes
Iliopsoas attachements
formed by the psoas major in the abdomen and the iliacus in the pelvis -> attaches to the lesser trochanter of the femur distally
Iliopsoas function
strongest flexor of the thigh and lifts the lower extremity when walking
Quadriceps femoris (4 muscles)
powerfully extends the knee when rising from squatting or accelerating for running or jumping (i.e. actions that lift or move the entire body weight)
Quadriceps tendon continues as?
the patellar ligament that attaches to the tibial tuberosity distally
Vastus lateralis, vastus intermedius, and vastus medialis with their respective positions
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Rectus femoris attachments
attaches to the anterior inferior iliac spine proximally
Rectus femoris function
assists flexion of the thigh; extension of the leg when the thigh is extended and the leg is flexed (e.g., kicking a soccer ball)
Patella
sesamoid bone within the patellar ligament, can withstand compression placed on the quadriceps tendon during movements at the knee joint
Suprapatellar bursa
continuous with the synovial cavity of the joint and extends between the femur and quadriceps tendon, cushions the tendon when it pulls lengthwise across the knee joint to extend the leg
What causes Osgood-Schlatter disease and what are its symptoms?
disruption of the epiphysial plate at the tibial tuberosity -> cause inflammation of the tuberosity and chronic recurring pain during adolescence
Sartorius attachments
attaches to the ASIS proximally and medial to the tibial tuberoslty distally
Sartorius function
synergizes with the psoas during flexion of the thigh and with stronger muscles (to be studied later) during flexion of the leg
Abduction and adduction of the lower extremity at the hip joint
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Adductor longus
attach to the body of the pubis proximally and the linea aspera distally
Adductor brevis
attach to the body of the pubis and the linea aspera distally
Adductor magnus
attach to the body of the pubis and ischiopubic ramus proximally and the linea aspera distally
Gracilis attachments
attaches to the ischiopubic ramus proximally and medial to the tibial tuberosity distally
Gracilis function
synergizes with the adductor muscles, and with stronger muscles (to be studied later) during flexion of the leg
Where is the gracilis muscle used for transplantation and why is lower limb function not noticeably compromised?
it is a relatively weak member of the adductor group of muscles so it can be removed without noticeable loss of its actions on the leg
What forms the superior boundary of the femoral triangle?
inguinal ligament -> extends between the ASIS and body of the pubis
What forms the lateral boundary of the femoral triangle?
sartorius
What forms the medial boundary of the femoral triangle?
adductor longus
Femoral nerve originates from what spinal cord segments
L2-L4
Femoral artery path
enters the lateral aspect of the femoral triangle to innervate the muscles of the anterior thigh before terminating as the cutaneous saphenous nerve
What lesions might cause diminution or loss of the patellar tendon reflex?
results from any lesion that interrupts the innervation of the quadriceps
Obturator nerve originates from what spinal segments
L2-L4
Obturator nerve path
originates from spinal segments L2-L4, exits the abdominopelvic cavity via the obturator foramen to innervate the muscles of the medial thigh
Femoral sheath extends from where?
extends from the deep fascia covering the iliopsoas under the inguinal ligament to surround the femoral artery and vein
Femoral sheath function
allows the femoral artery and vein to glide under the inguinal ligament
Femoral artery
supplies the anterior thigh
Obturator artery
follows the course of the obturator nerve to supply the medial thigh
Deep artery of the thigh (profunda femoris)
branches from the femoral artery to supply the posterior and lateral thigh
Medial circumflex femoral artery
branch of the deep artery of the thigh, supplies the head and neck of the femur
Why can aseptic vascular necrosis of the displaced femoral head occur after femoral neck fractures?
femoral neck fractures often disrupt the blood supply of the head of the femur -> artery to the ligament of the femoral head is only source of blood but it is inadequate
Femoral canal
formed from the femoral sheath; contains efferent lymphatic vessels from the inguinal lymph nodes that pass through the oval femoral ring at the base of the canal to enter the abdomen
Anterior compartments of the leg enclosed by deep fascia and positioned?
anteriorly; tibialis anterior, extensor digitorum longus, extensor hallucis longus
Lateral compartments of the leg enclosed by deep fascia and positioned?
laterally; fibularis longus, fibularis brevis
What are compartment syndromes and how are prolonged symptoms relieved?
fascial compartments of the lower limbs are generally closed spaces; trauma can produce hemorrhage, edema, and inflammation of the muscles -> increased intracompartmental pressure that compresses structures like small vessels, leading to ischemia and viability of tissue within; prolonged symptoms are relieved by a fasciotomy (incision) to relieve the pressure in the compartment
Inversion vs eversion of the foot
inversion - medial goes up; eversion - lateral side goes up
Dorsiflexion and plantarflexion of the foot
dorsiflexion - up; plantarflexion - down
Tibialis anterior attachment
attaches to the tibia proximally and to the medial surface of the medial cuneiform bone and the 1st metatarsal bone
Tibialis anterior function
dorsiflexes and inverts the foot
Extensor digitorum attachment
attach to the tibia and fibula proximally and to the dorsum of the toes distally
Extensor digitorum function
dorsiflex the foot and extend the toes
Extensor hallucis longus attachment
attach to the tibia and fibula proximally and to the dorsum of the toes distally
Extensor hallucis longus function
dorsiflex the foot and extend the toes
Fibularis longus attachment
attaches to the fibula proximally and to the plantar surface of the foot distally
Fibularis brevis attachment
attaches to the fibula proximally and to the lateral side of the foot distally
Fibularis longus and fibularis brevis function
synergistically evert the foot
Common peroneal nerve path
originates in the posterior thigh and passes around the neck of the fibula into the anterolateral leg where it terminally bifurcates into the superficial and deep peroneal nerves
Deep peroneal nerve
innervates the muscles of the anterior compartment
Superficial peroneal nerve
innervates the muscles of the lateral compartment
The femoral artery continues into the popliteal fossa as?
popliteal artery
Popliteal artery
bifurcates into the anterior and posterior tibial arteries
Anterior tibial arteries
supplies the anterior and lateral compartments of the leg and continues onto the dorsum of the foot as the dorsal pedis artery
Saphenous nerve
provides sensory fibers to the anteromedial leg and medial side of the ankle
Common peroneal nerve
convey sensations from the inferolateral leg
Superficial peroneal nerve
convey sensations to the lateral side of the ankle
Why is the common peroneal nerve frequently injured and what are the symptoms after its injury?
because of its superficial position as it winds subcutaneously around the fibular neck, leaving it vulnerable to direct trauma; severance results in flaccid paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexors of ankle and evertors of the foot) -> makes the limb “too long” so the toe do not clear the ground during the swing phase of walking
Where is the dorsal pedis pulse palpated and what is the most common cause of its diminution or absence?
palpated with the feet slightly dorsiflexed, just lateral of the EHL tendons; most common cause of its diminution or absence is vascular insufficiency resulting from arterial disease
When is a saphenous cutdown required and where can sensory loss occur after the procedure?
in trauma or hypovolemic shock patients when peripheral cannulation is impossible; saphenous nerve can be cut -> pain or numbness along the medial border of the foot
