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Anatomy > Test 3 Info > Flashcards

Test 3 Info Flashcards

1
Q

what type of nerves are pelvic splanchnic nerves?

A

parasympathetic

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2
Q

what types of nerves are lumbar splanchnic nerves?

A

sympathetics

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3
Q

what type of and name of the muscle that makes up the wall of the bladder?

A

smooth muscle; detrusor muscle

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4
Q

peritoneum

A

fascial covering in the gut

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5
Q

is the urinary bladder mostly superior or inferior to the peritoneum?

A

inferior to (along with the kidneys)

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6
Q

apex of bladder

A

anterior aspect near pubic symphysis

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7
Q

fundus of bladder

A

base of bladder, formed by its posterior wall; opposite the apex

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8
Q

body of bladder

A

major portion of bladder between apex and fundus

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9
Q

neck of bladder

A

where fundus and inferolateral surfaces of bladder meet (close to exit point, near prostate in males)

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10
Q

trigone of bladder

A

area of bladder defined by smooth internal surface, formed by 2 ureters and internal urethral orifice
* sensitive to expansion/ stretch (highly innervated with sensory fibers– lets you know bladder is filling)

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11
Q

what prevents urine from retrograding when it is leaving the bladder?

A

flap valves at the point where ureters enter bladder, shut when bladder muscle contracts

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12
Q

referred visceral pain: heart

A

C8-T4 on left

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13
Q

referred visceral pain: lungs

A

T2-T5

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14
Q

referred visceral pain: esophagus

A

T4-T5

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15
Q

referred visceral pain: liver

A

T6-T9 on right

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16
Q

referred visceral pain: ovaries and Fallopian tubes

A

T11-L1

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17
Q

referred visceral pain: kidneys

A

T10-T11

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18
Q

referred visceral pain: ureters

A

T11-L2

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19
Q

referred visceral pain: colon

A

T8-L2

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20
Q

referred visceral pain: bladder

A

T11-L3

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21
Q

referred visceral pain: rectum, ovaries, prostate

A

S2-S5

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22
Q

4 parts of urethra in male

A

preprostatic
prostatic
membranous
spongy

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23
Q

preprostatic urethra characteristics

A

contains internal urethral sphincter

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24
Q

membranous urethra characteristics

A

passes through external urethral sphincter

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25
Q

spongy urethra characteristics

A

goes through the penis

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26
Q

internal urethral sphincter characteristics and function

A

involuntary sphincter of smooth muscle

prevents retrograde movement of SEMEN into bladder during ejaculation

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27
Q

what kind of neural control is the internal urethral sphincter under?

A

ANS control

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28
Q

what is the internal urethral orifice?

A

leads to urethra

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29
Q

what is the purpose of the ejaculatory duct and where is it found?

A

where sperm enters the semen, found in the prostatic urethra

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30
Q

what is the purpose of the prostate?

A

secretes fluid that provides nutrition for sperm

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31
Q

external urethral sphincter characteristics and function

A

consists of skeletal muscle – under VOLUNTARY control
makes up part of the UG diaphragm
provides a means of stopping the escape of urine from the body

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32
Q

function of urogenital diaphragm

A

supports contents of deep pelvis along with pelvic diaphragm

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33
Q

what is one reason why females are more prone to UTIs?

A

length of female urethra is shorter (bacteria has a shorter distance to go)

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34
Q

what is the micturition reflex?

A

visceral afferent fibers stimulated by bladder stretch (~350-400mls) causes the bladder to contract reflexively while the internal sphincter relaxes and urine flows into urethra

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35
Q

what is required in order to suppress the micturition reflex?

A

training and intact neural pathway from supra spinal centers (e.g., external urethral sphincter would remain contracted – voluntary control via pudendal n)

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36
Q

testes

A

male sex organs that lie within scrotum

produce sperm and testosterone

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37
Q

epididymis

A

portion of male genital tract where sperm maturation is partially accomplished (sperm stored here)
receives sperm from testes and continues as ductus deferens

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38
Q

ductus deferens

A

thick walled tubular structure running from each testis into ejaculatory duct
carry sperm from epididymis towards penis

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39
Q

seminal vesicles

A

produce semen (fluid that activates and protects sperm after it has left penis)

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40
Q

prostate

A

gland in male that surrounds portion of urethra

secretes alkaline liquid that neutralizes acid in urethra and stimulates motility of sperm

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41
Q

bulbourethral glands

A

two small, rounded, pea sized bodies posterolateral to membranous urethra
discharge component of seminal fluid into urethra

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42
Q

ejaculatory duct

A

begins at seminal vesicles, passes through prostate, and empties into urethra
during ejaculation, semen passes through EJ ducts

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43
Q

function of internal urethral sphincter in female

A

literature suggests no function or it does not exist, bc function is specific to male

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44
Q

what does parasympathetic innervation do in terms of B B SF?

A

generally vasodilatory (–> erection)
stimulate (motor) bladder contraction
inhibit internal urethral sphincter (so it relaxes and you can urinate)
modulates activity of lower colon (peristalsis)

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45
Q

what does sympathetic innervation do in terms of B B SF?

A

contraction of smooth muscle in internal urethral sphincter and internal anal sphincters (preventing urination and defecation)
cause smooth muscle contraction associated with reproductive tract and accessory glands
help move secretions from epididymis and associated glands into urethra to form semen during ejaculation

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46
Q

spastic bladder occurs with what type of injury?

A

SCI above S2-4 segments

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47
Q

what aspects of bladder control are intact with a spastic bladder?

A

micturition reflex is intact

bladder contracts and reflexively empties in response to certain level of filling pressure

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48
Q

what aspects of bladder control are lost with a spastic bladder?

A

lose sensation of bladder dissension and urge to urinate (supraspinal contral)

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49
Q

how does an SCI pt with a spastic bladder relieve themselves?

A

bladder training can be used – trigger stimulus to establish planned voiding (makes bladder reflexively contract)

  • tapping
  • pulling pubic hair
    also. ..
  • pay attention to how much you drink
  • try to plan ahead of time
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50
Q

flaccid bladder occurs with what type of injury?

A

SCI involving S2-4 levels or the sacral ventral/dorsal roots of S2-4

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51
Q

what aspects of bladder control are intact with a flaccid bladder?

A

not really anything

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52
Q

what aspects of bladder control are lost with a flaccid bladder?

A

no reflex action of detrusor muscle – micturition reflex destroyed
no supraspinal control (pathway between brain and SC interrupted)
- unable to establish reflex voiding

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53
Q

how does an SCI pt with a flaccid bladder relieve themselves?

A

usually intermittent catheterization is used
may use Val Salva maneuver along with manual compression (Crede Maneuver) of lower abdomen
*more apt to leakage

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54
Q

external anal sphincter

A

under voluntary control
skeletal muscle
supplied by S4 ventral ramus

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55
Q

internal anal sphincter

A

involuntary smooth muscle
supplied by sympathetic fibers (maintain tone)
supplied by parasympathetic fibers (inhibit tone)

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56
Q

spastic bowel occurs with what type of injury?

A

SCI above S2-4 region

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57
Q

what aspects of bowel control are intact with spastic bowel?

A

anal sphincters are intact

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58
Q

what aspects of bowel control are lost with spastic bowel?

A

no supraspinal control (pathway between brain and SC interrupted)

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59
Q

how does an SCI pt with a spastic bowel relieve themselves?

A

responds well to rectal/ anal stimulation and timed voiding

prognosis excellent for good bowel control – hydration, fluid monitoring with high fiber diet are essential

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60
Q

flaccid bowel occurs with what type of injury?

A

SCI at S2-4 region

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61
Q

what aspects of bowel control are intact with flaccid bowel?

A

not much of anything

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62
Q

what aspects of bowel control are lost with flaccid bowel?

A

anal sphincters are not intact
no supraspinal control (pathway between brain and SC interrupted)
arrival of stool in rectum results in incontinence

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63
Q

how does an SCI pt with a flaccid bowel relieve themselves?

A

bowel control possible with routine daily bowel evacuation (removes stool before it enters rectum– manual evacuation with straining via increased abdominal pressure)
hydration and fluid monitoring along with high fiber diet is key to success

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64
Q

what could happen if stool is impacted?

A

ANS is activated –> autonomic dysreflexia

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65
Q

what is an upper motor neuron (UMN)?

A

UMN is a neuron whose cell body originates in the cerebral cortex or brainstem and terminates within the brainstem or spinal cord

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66
Q

what is a lower motor neuron (LMN)?

A

cell body of a LMN lies within the ventral horn of the spinal cord or the brainstem motor nuclei of the cranial nerves which have motor modalities (in CNS). axon of a LMN exits the CNS and forms the somatic motor part of the peripheral nervous system (PNS).

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67
Q

example of LMN lesion

A

ventral rami lesion

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68
Q

example of LMN lesion

A

ventral rami lesion

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69
Q

is erectile function greater for male with a UMN or LMN lesion?

A

UMN lesion

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70
Q

reflexogenic erection

A

sensory stimulation of genitals or perineum
also can occur due to (day)dreams
requires intact reflex arc (S2-S4)

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71
Q

what is still intact in a female in terms of sexual function if there is an UMN lesion?

A

reflex arc still intact — vaginal lubrication, engorgement of labia and clitoral erection are still intact

aka motor process works but can’t feel the sensation through the genital region

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72
Q

another name for deep fascia of lower limb

A

fascia lata

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73
Q

fascia lata characteristics

A

non-elastic
especially strong – encircles limb like a stocking
prevents bulging of muscles during contraction, making it more efficient

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74
Q

fasciotomy

A

since fascia is not elastic, nerves start dying off if fascia is too tight
often done when person has compartment syndrome

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75
Q

what is a Trendelenburg sign and what does it indicate?

A

pelvic drop during gait – pelvis drops on uninvolved side when uninvolved side is lifted
indicates gluteus medius weakness

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76
Q

weakness in R gluteus medius - what would Trendelenburg sign show?

A

when walking and left foot is in the air, left hip would drop

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77
Q

piriformis muscle is a landmark for what?

A

superior gluteal n.a.v. exit above it
inferior gluteal n.a.v. exit below it
sciatic n TYPICALLY exits below it

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78
Q

what positioning can compress sciatic nerve and why?

A

passive hip IR
because piriformis is hip ER so it is stretched via IR – when muscle is elongated, it can compress on the sciatic n which typically exits below it

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79
Q

what is piriformis syndrome?

A

irritation of sciatic n caused by “compression” or irritation of n within buttock area by piriformis m

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80
Q

etiology of piriformis syndrome (5)

A

hypertrophy, inflammation or spasm (rare) of piriformis m
direct trauma resulting in hematoma and scarring
more common in females (6:1)
pseudoanuerysm of inferior gluteal a
anatomical abnormalities (like potentially split piriformis)

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81
Q

s/s of piriformis syndrome

A

pain in posterior buttock that may or may not radiate into posterior thigh
increased by contraction of piriformis muscle, prolonged sitting, or direct pressure applied to muscle
pain with active ER of hip
pain with passive IR of hip

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82
Q

differential diagnosis for piriformis syndrome

A 
lumbar radiculopathy (nerve involvement)
lumbar spine referred pain (joint involvement)
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83
Q

where can lumbar spine refer pain?

A

lower back, buttock, posterior thigh

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84
Q

where does nerve to obturator internus and superior gemellus exit?

A

exits below piriformis

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85
Q

where are the gemelli muscles?

A

form a “gemellus sandwich” with the obturator internus

superior gemellus - obturator internus - inferior gemellus

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86
Q

what are the 6 deep lateral rotators of the thigh?

A 
piriformis
obturator internus
superior gemelli
inferior gemelli
quadratus femoris
obturator externus
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87
Q

what is a common fracture site of femur

A

intertrochanteric line

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88
Q

the intertrochanteric line is ___

A

anterior

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89
Q

the intertrochanteric crest is __

A

posterior

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90
Q

what is the angle of inclination and what is the normal measure of the angle?

A

angle between long axis of neck/head and long axis of shaft

normal = ~126

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91
Q

coxa vara

A

angle of inclination is diminished

<126 deg

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92
Q

coxa valga

A

angle of inclination is increased

(>126 deg) – valGa is Greater

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93
Q

angle of anteversion is…

A

aka angle of femoral torsion

plane of femoral neck and head lies ANTERIOR to plane of femoral condyle

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94
Q

normal degree of angle of anteversion

A

~15 deg

~31 in infancy and decreases with WB

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95
Q

what is the most frequent cause of childhood in-toeing?

A

excessive femoral anteversion

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96
Q

excessive femoral anteversion characteristics

A

affected LE is IR
more common in females
most noticeable between ages 4-6
gait looks clumsy
in-toeing will often appear worse with running and when fatigued
will become worse over time with W-sitting

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97
Q

excessive femoral anteversion - braces, twister cables, special shoes, etc.

A

make no difference in outcome

compliance is problem

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98
Q

acetabular labrum

A

fibrocartilaginous ring, which deepens the cup and increases stability

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99
Q

transverse acetabular ligament

A

goes across acetabular notch to help create full “circle” around head of femur

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100
Q

what is the fovea and what is attached here?

A 
pit in head of femur
ligamentum teres (or ligament of the head of the femur) attaches here
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101
Q

what does the ligament of the head of the femur help with?

A

blood supply to region - contains a small artery to head of femur

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102
Q

what are the ligaments that support the hip?

A

iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament

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103
Q

iliofemoral ligament attachments

A

from AIIS to intertrochanteric line

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104
Q

iliofemoral ligament characteristics

A

strongest ligament

located anteriorly

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105
Q

iliofemoral ligament becomes taut with what action of the hip?

A

hyperextension of the hip

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106
Q

pubofemoral ligament attachments

A

from superior ramus of pubis to intertrochanteric line

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107
Q

pubofemoral ligament characteristics

A

runs anterior and inferior

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108
Q

pubofemoral ligament becomes taut with what action of the hip?

A

hyperextension and abduction of hip joint

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109
Q

ischiofemoral ligament attachments

A

ischium to femoral neck

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110
Q

ischiofemoral ligament characteristics

A

arises posteriorly and spirals superolaterally

- only ligament on posterior aspect of hip

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111
Q

ischiofemoral ligament becomes taut with what action of the hip?

A

hyperextension of hip

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112
Q

what ligaments restrict hip extension?

A

iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament

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113
Q

blood supply to femoral head and neck

A
  • ligamentum teres acetabular branch of the obturator aa

- medial circumflex femoral artery

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114
Q

examples of intracapsular fractures of femur

A

subcapital neck fracture

transcervical neck fracture

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115
Q

examples of extracapsular fractures of femur

A

subtrochanteric fracture
fracture of greater trochanter
fracture of lesser trochanter

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116
Q

when would you use a pin vs ORIF?

A

both used for hip fractures

pin only is typically used for clean neck fracture, where ORIFs are used for big fractures that need more support

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117
Q

importance of hip ligamentous structures for our patients

A

paraplegic patients can “stand” or hang on iliofemoral ligaments for stability because they are so strong

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118
Q

what are bursae?

A

membranous sacs lined with synovial membrane, found between tendons and bony protuberances in areas subject to friction (like hip)
role: decrease friction

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119
Q

ischial bursa

A

separates gluteus maximus from ischial tuberosity

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120
Q

iliopsoas bursa

A

separates joint from muscle

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121
Q

trochanteric bursa

A

separates gluteus maximus from greater trochanter

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122
Q

gluteofemoral bursa

A

separates iliotibial band from superior portion of vests laterals

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123
Q

how do bursae become irritated and how is this irritation treated?

A

resting or leaning on something hard for a long time (i.e. falling asleep on concrete)
rest, relaxation, and injections can help

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124
Q

how to differentiate between semitendinosus and semimembranosus

A

semitendinosus tendon feels more tendinous and is more superficial (“Tom on Mary”)
semiMembranosus is more Medial

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125
Q

superior border of popliteal fossa

A

hamstrings

medially: semimembranosus and semitendinosus
laterally: biceps femoris

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126
Q

inferior border of popliteal fossa

A

2 heads of gastroncnemius (medial and lateral heads) and plantaris (laterally)

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127
Q

posterior border of popliteal fossa

A

skin and fascia

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128
Q

anterior border of popliteal fossa

A

popliteal surface of femur, oblique popliteal ligament, popliteal fascia over popliteus

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129
Q

where does the sciatic nerve split and what are the names of its branches?

A

just proximal to or right around popliteal fossa

splits into common fibular (peroneal) branch and tibial branch

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130
Q

what is sural n?

A

superior cutaneous nerve of lower leg that is formed by the medial and lateral sural nn coming together (which are branches off the common fibular/ peroneal branch and tibial branch of sciatic nerve)

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131
Q

what is the commonplace name of the plantaris tendon?

A

“fool’s nerve” or “freshman’s nerve”

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132
Q

contents of popliteal fossa

A

popliteal arteries and veins (deeper)
lesser saphenous vein (superficial)
tibial and common perineal nerves (med/lat sural nn, sural n)
posterior femoral cutaneous n
popliteal lymph nodes and lymphatic vessels

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133
Q

when the femoral artery passes through the ___, it changes its name to the popliteal artery

A

adductor hiatus

134
Q

what does the femoral artery supply?

A

anterior and anteromedial surface of thigh

135
Q

what does the profunda femoral artery supply?

A

posterior, lateral, and anterior aspect of thigh

136
Q

what does the medial femoral circumflex artery supply?

A

primary blood supplier to head and neck of femur via posterior reticular arteries

137
Q

what does the lateral femoral circumflex artery supply?

A

primarily supplies lateral hip muscles
ascends to gluteal region
transverses around femur
descends to knee

138
Q

when does the external iliac artery change its name to the femoral artery?

A

after crossing the inguinal ligament

139
Q

where does the profunda femoral artery arise from and what does it give rise to?

A

from femoral artery near inguinal ligament

gives rise to perforating branches thru adductor magnus muscles (4)

140
Q

what does the medial femoral circumflex artery arise from and what does it give rise to?

A

usually from profunda femoral artery, but can arise from femoral artery
terminates by dividing into ascending/ transverse branches
** enters gluteal region below quadratus femoris and gives rise to posterior reticular aa **
** travels posteriorly between iliopsoas and pectineus**

141
Q

what does the lateral femoral circumflex artery arise from?

A

usually from profundal femoral artery, but can arise from femoral artery

142
Q

what are retinacular arteries?

A

arise from medial (and lateral) femoral circumflex arteries and are main supply to hip joint

143
Q

what arteries does cruciate anastomosis include?

A
  1. transverse and ascending branch of lateral femoral circumflex a
  2. medial femoral circumflex a
  3. inferior gluteal a
  4. first perforating artery from profunda femoral a
144
Q

the cruciate anastomosis of hip - which artery anastomoses with ascending branch of medial circumflex femoral a?

A

ascending branch of lateral femoral circumflex a

145
Q

the cruciate anastomosis of hip - inferior gluteal a anastomoses with which artery?

A

ascending branch of medial femoral circumflex a

146
Q

if the neck of the femur is fractured, what happens with the blood supply to the head of the femur?

A

all of the arteries of the cruciate anastomosis may be compromised, and the acetabular branch of the artery to the head of the femur (in ligamentum teres) is the only branch that is still intact

147
Q

what is often the result of a femur neck fracture?

A

pt needs ORIF or hip replacement, depending on how much blood supply is compromised or if the bone is shattered

148
Q

what is avascular necrosis?

A

condition that results from poor blood supply to an area of bone, causing bone death

149
Q

what can cause avascular necrosis?

A 
trauma and damage to blood vessels that supply oxygen to bone
systemic steroids
sickle cell anemia
alcohol abuse
radiation therapy
150
Q

poor blood supply may lead to _________________________________, causing …

A

may lead to ischemia and necrosis of bone tissue, causing weakening of bone with eventual collapse

151
Q

what is Legg-Calves Perthes disease?

A

child avascular necrosis with unknown origin

152
Q

is Legg-Calves Perthes disease more common in boys or girls, and at what age is it most prevalent?

A

boys

4-7

153
Q

how is Legg-Calves Perthes disease treated?

A

historically, with casting or bracing
now, evidence suggests that those who are casted or braced have no difference in outcomes to those who did not receive treatment
now, it is more important to treat specifically for pt’s condition – research done on joint-preserving surgery which is relatively successful

154
Q

what is slipped capital femoral epiphysis (SCFE)?

A

epiphysis of femoral head make slip away from femoral neck due to weakened epiphyseal plate

155
Q

causes of slipped capital femoral epiphysis (SCFE)

A

acute trauma (large force through hip like a fall)
repetitive micro trauma with shear stress
gradual slippage with associated hip pain that may refer to the knee

156
Q

what s/s is often associated with a slipped capital femoral epiphysis (SCFE)

A

antalgic gait

hip pain that also may refer to the knee

157
Q

slipped capital femoral epiphysis (SCFE) usually occurs in…

A

children between 10 and 16
overweight and short, or thin and tall adolescents
boys > girls
African Americans > caucasian

158
Q

difference between stable and unstable slipped capital femoral epiphysis (SCFE)

A

if unstable, likely unable to weight bear and is often an emergent situation

159
Q

common treatment for slipped capital femoral epiphysis (SCFE)

A

“in situ fixation”
bone held in place with single central screw, which keeps femur from slipping and closes growth plate
sometimes do prophylactic bilateral surgical intervention

160
Q

great saphenous vein blood flow

A

ascends anterior to medial malleolus
passes posterior to medial condyle of femur
passes through saphenous opening/ fossa ovalis
empties into femoral vein

161
Q

what is the popliteal artery a continuation of, and where does it end?

A

continuation of femoral artery

ends at superior border of popliteus muscle

162
Q

what are the branches of the popliteal artery?

A 
superomedial genicular
superolateral genicular
middle genicular
inferomedail genicular
inferolateral genicular
163
Q

what do the genicular arteries supply?

A

articular capsule and ligaments of knee

164
Q

what does the genicular anastomosis include?

A

all genicular arteries (x5)
descending genicular branch of femoral a (anteriorly)
descending branch of lateral femoral circumflex a
recurrent branch of anterior tibial a

165
Q

the popliteal artery divides into….

A

anterior and posterior tibial arteries

166
Q

when doing hip abductions in sidelying, if hip is placed into flexion, what primary muscle(s) is being used?

A

tensor fascia lata (TFL)

167
Q

when doing hip abductions in sidelying, if hip is placed into extension/ neutral, what primary muscle(s) is being used?

A

gluteus medius and gluteus minimus

168
Q

what is the femoral triangle?

A

triangular depress inferior to inguinal ligament

169
Q

borders of femoral triangle

A

superior: inguinal ligament
medial: adductor longus m
lateral: sartorius m
floor: iliopsoas and pectineus mm
roof: (deep to superficial) fascia lata, cribriform fascia, subcutaneous tissue, skin

170
Q

name of the opening of the femoral triangle

A

saphenous opening (or fossa ovalis)

171
Q

what covers/ fills in saphenous opening?

A

cribriform fascia

172
Q

what is the falciform margin?

A

the most lateral portion of the saphenous opening, very clear rounded border, very tough

173
Q

drainage pattern of great saphenous vein

A

dorsal venous arch
anterior to medial malleolus
posterior to medial knee
up along medial thigh to saphenous opening

174
Q

femoral triangle contents (from lateral to medial)

A

NAVEL

femoral nerve, artery, vein, empty space, and lymph

175
Q

contents of femoral sheath (from lateral to medial)

A

femoral artery, vein, and canal

femoral n is NOT INCLUDED

176
Q

purpose of femoral sheath

A

allows for femoral artery and vein to glide deep to inguinal ligament with hip motion (prevents compression during hip flexion)

177
Q

what is femoral canal and what does it contain?

A

most medial compartment of sheath
contains loos CT, fat, and lymph vessels
purpose: allows room for blood vessels to expand

178
Q

femoral ring is the proximal opening to the ____

A

femoral canal

179
Q

clinical correlation of the femoral canal

A

femoral hernia
intestine protrudes through femoral ring
most common postpartum or in people with digestive problems (lots of bearing down)

180
Q

clinical correlation of femoral triangle

A

palpating femoral a

trigger point dry needling – DO NOT want to go near femoral triangle

181
Q

what is the patellar tendon reflex and what does it check?

A

tap patellar ligament, which pulls on quadricep tendon and on the muscles that attach to it
integrity check of L2-L4

182
Q

quadriceps tendon vs patellar ligament

A

quadriceps tendon is PROXIMAL and connects muscle to bone (superior aspect of patella)
patellar ligament is DISTAL and connects bone to bone (apex of patella to tibial tuberosity)

183
Q

medial and lateral patella retinaculi

A

tendinous expansions of vastus medialis and lateralis which attach to margins of the patella – meshes to help become the patellar ligament

184
Q

if the patella dislocates laterally, the __ retinaculum could rupture

A

medial

185
Q

if the patellar retinaculum ruptures, what could happen to the patella?

A

it could be prone to sublux more often

186
Q

deep tendon reflex of patellar region tests integrity of…

A

L2, L3, L4*

187
Q

deep tendon reflex of achilles tests integrity of…

A

S1*

188
Q

deep tendon reflex of hamstrings tests integrity of…

A

L5*

189
Q

what is the adductor canal and where is it found?

A

middle 1/3 of medial thigh

contains femoral a and v, saphenous n (sensory), and usually the n to vastus medialis

190
Q

boundaries of adductor canal

A

lateral: vastus medialis
medially: adductor magnus and adductor longus
superficial: sartorius

191
Q

adductor hiatus location and what goes through it

A

opening in aponeurotic distal attachment of adductor angus
distal end of adduct canal
femoral a and v, and saphenous n go through it to the popliteal fossa
n to vastus medialis exits and innervates VM before entering popliteal fossa

192
Q

where is adductor brevis relative to adductor longus?

A

adductor brevis is deep to adductor longus

193
Q

about what % of body weight does the tibia accept?

A

~90%

194
Q

what does the tibia articulate with?

A

femoral condyles proximally
talus distally
fibula

195
Q

tibia plateau

A

superior surface of tibia, within it you can find medial and lateral tibial condyles and intercondylar groove

196
Q

what attaches to Gerdy’s tubercle and where is it found?

A

insertion of IT band

on anterior aspect of lateral condyle of tibia

197
Q

what attaches to tibial tuberosity and where it is found?

A

distal attachment for patella tendon (ligament)

on anterior surface of tibia

198
Q

distal articulating surface of tibia is…

A

plafond

199
Q

normal tibial torsion at distal end:

A

externally rotated (toe-out when standing), usually 20-40 deg

200
Q

where is soleal line?

A

on posterior aspect of tibia

201
Q

where is the “third malleolus”?

A

posterior margin of articular surface of distal tibia

202
Q

function of fibula

A 
function for attachment of muscle
provides lateral stability of ankle joint (talocrural joint), assists in stabilizing talus
203
Q

head of fibula articulates with…

A

proximal/ lateral portion of tibia

204
Q

apex of fibula

A

pointed end of head

205
Q

body of fibula is __ shape… borders are ….

A

triangular with 3 borders
anterior
interosseous
posterior

206
Q

where does the lateral malleolus end relative to medial malleolus

A

lateral malleolus is directed more posteriorly and ends 1cm more distal than medial malleolus

207
Q

common characteristics of trimalleolar fracture (what occurs with injury, how it is treated)

A

dislocation with ligamentous injury
disruption and separation to tibial-fib syndesmosis
treatment: ORIF
can happen with extreme inversion injuries

208
Q

proximal tibiofibular joint is __ shape and a __ joint

A

plane shaped

synovial joint

209
Q

proximal tibiofibular joint is between the ___ and ___

A

slightly convex facet on head of fibula

slightly concave facet on lateral condyle of tibia

210
Q

proximal tibiofibular joint: surrounded by joint capsule?

A

yes

211
Q

proximal tibiofibular joint is supported by…

A

anterior and posterior ligaments to head of fibula

212
Q

movements of proximal tibiofibular joint

A

small amounts of…
- superior and inferior sliding of fibular and fibular rotation - during DF/PF of ankle joint (respectively)
ER of fibula during DF
- IR of fibula during PF

213
Q

distal tibiofibular joint is made up of __ joint between ….

A

syndesmosis (fibrous joint) between concave facet of tibia and convex facet of fibula

214
Q

distal tibiofibular joint surrounded by joint capsule?

A

no

215
Q

in distal tibiofibular joint, tibia and fibula are separated by…

A

fibroadipose tissue

216
Q

distal tibiofibular joint is supported by…

A

**interosseous ligament (extension of interosseous membrane)
anterior tib-fib ligament
posterior tip-fib ligament
medial collateral (deltoid) ligament

217
Q

ankle joint function is completely dependent on..

A

tib-fib mortise

218
Q

purpose of ligaments at distal tibiofibular joint

A

restrict motion at distal tip-fib joints and assist in maintaining stable ankle mortise

219
Q

mortise joint

A

comprised of distal tib-fib articulation

articulates with talus

220
Q

two most common fractures in body

A
  1. radial head fracture

2. distal tib-fib fracture

221
Q

distal tib-fib fracture usually results from…

A 
sprained ankle
avulsion fracture (fragment of bone tears away from main mass of bone) or from shear force on talus along surface of tibia and fibula
222
Q

talus articulates with…

A

fibula
calcaneus
navicular

223
Q

body of talus has __ articular surfaces:

A

3: large lateral facet, smaller medial facet, trochlear facet superiorly

224
Q

body of talus characteristics

A

** wider anteriorly than posteriorly, wedge shape

225
Q

trochlear surface of talus characteristics

A

large convexity, central groove at angle

226
Q

talus muscular attachments

A

** NONE

227
Q

talus rests medially on…

A

sustentaculum tali ** (part of calcaneus)

228
Q

sustentaculum tali

A

on medial surface of calcaneus, juts out like a shelf for talus to rest on

229
Q

talocrural joint is a __ shape and a __ joint, with __ DOF

A 
hinge shaped synovial joint 
1 DOF (PF/ DF)
230
Q

talocrural joint is articulation between…

A

convex talus and concave distal tibia

convex talus and concave distal fibula

231
Q

closed pack position of talocrural joint

A

full DF

closed pack position –> all tissues are elongated and can’t move as much

232
Q

open pack position of talocrural joint

A

PF – can still move ankle well aka is MORE UNSTABLE

one reason why walking on toes or in heels is unstable

233
Q

why does eversion have the end feel it does? (what is this end feel)

A

hard because of contact between lateral malleolus and calcaneus

234
Q

what happens to the bones of the talocrural joint during DF?

A

**DF moves the wider anterior part of the trochlea (of talus) posteriorly, which spreads the tibia and fibula slightly apart
this is why DF is closed pack position

235
Q

if the distal tib-fib joint is fused (i.e. with trimalleolar fracture), what movements are affected?

A

DF is compromised – tibia and fibula cannot spread

236
Q

axis of rotation of talocrural joint

A

oblique line running med/lateral through fibular (lateral) malleolus, body of talus, and just distal to tibial malleolus
about 15 deg off coronal plane – “toe out” position
about 8 deg off horizontal

237
Q

medial ligamentous support of ankle

A 
medial collateral ligament (deltoid ligament)
runs from medial malleolus to...
- talus
- calcaneus 
- navicular
238
Q

deltoid ligament is comprised of…

A
  1. anterior and posterior tibiotalar ligaments
  2. tibiocalcaneal ligament
  3. tibionavicular ligament
239
Q

lateral ligamentous support of ankle

A

lateral collateral ligaments:

  • anterior talofibular (ATFL)
  • calcaneofibular (CFL)
  • posterior talofibular (PTFL)
240
Q

anterior talofibular ligament (ATFL) goes from…

A

lateral malleolus of distal fibula to neck of talus

241
Q

calcaneofibular ligament (CFL) goes from…

A

from tip of lateral malleolus to lateral calcaneus

242
Q

posterior talofibular ligament (PTFL) goes from…

A

from malleolar fossa to lateral tubercle of talus

runs horizontal

243
Q

calcaneus articulates with…

A

talus superiorly and cuboid anteriorly

244
Q

characteristics of calcaneus

A

largest and strongest bone in foot
transmit most of weight of foot to ground
sustentaculum tali (medially)
peroneal (fibular) trochlea (laterally)

245
Q

what would happen if there was a fracture of sustentaculum tali?

A

articulation between talus and calcaneus would be compromised

246
Q

what ligament(s) are tested in anterior drawer test for ankle?

A

ATFL (anterior talofibular ligament) and CFL (calcaneofibular ligament)

247
Q

performance of anterior drawer test for ankle

A

posterior to anterior translatory force
ankle remains in neutral position (no DF/ PF)
if positive, see puckering/ gapping in skin

248
Q

if there was a fracture at the base of the 5th metatarsal, what motions would be limited?

A

DF and eversion (because peroneus tertius attaches there)

249
Q

superior extensor retinaculum function

A

binds down muscles in anterior compartment, prevents them from bowstringing during DF

250
Q

superior extensor retinaculum attachments

A

connects fibula to tibia, proximal to malleoli

251
Q

inferior extensor retinaculum function

A

forms strong loop around tendons of peroneus tertius and EDL

252
Q

inferior extensor retinaculum attachments

A

Y-shaped, attaches laterally to anterosuperior surface of calcaneus

253
Q

compartment syndrome

A
  • crural fascia around leg compresses structures in compartment (usually after trauma to leg that results in inflammation or hemorrhage)
  • fasciotomy to reduce pressure
254
Q

deep peroneal nerve entrapment: how it occurs and what is the result

A

occurs due to excessive use of muscles supplied by deep peroneal n
muscles swell in anterior compartment, and there is dorsal pain in 1st web space

255
Q

shin splints, aka

A

anterior tibialis tendinopathy

256
Q

anterior tibialis tenidonpathy

A

overuse injury that could lead to stress fracture
swelling and pain in distal 2/3 of tibia, resulting from repetitive micro trauma of tibia anterior and small tears of periosteum of tibia

257
Q

peroneus longus position relative to brevis

A

share fascial compartment, longus is more superficial

258
Q

common peroneal n location

A

near neck of fibula

259
Q

common peroneal n injuries

A
  • when fibular head fractures
  • prolonged bedrest with LE externally rotated (puts pressure on nerve)
  • “bar stool palsy” legs crossed for prolonged period of time
260
Q

common peroneal n injury results in…

A

paralysis of muscle of anterior and lateral compartments

foot drop

261
Q

region of common peroneal n where lesion would affect lateral sural n

A

closer to popliteal fossa = lost

near fibular head = intact

262
Q

lateral sural n innervates…

A

lateral aspect of proximal 1/2 of shank

263
Q

superficial peroneal n innervates…

A

lateral aspect of distal 1/2 of shank and dorsal aspect of foot (not 1st web space)

264
Q

sural n innervates….

A

lateral aspect of dorsum of foot

265
Q

deep peroneal n innervates…

A

1st web space on dorsal aspect of foot

266
Q

saphenous n innervates…

A

anterior and medial aspect of shank

267
Q

which is the largest compartment of the leg?

A

posterior compartment

268
Q

what divides superficial and deep groups of calf muscles?

A

transverse intermuscular septum

269
Q

what provides blood supply to posterior compartment of leg?

A

posterior tibial artery and vein

270
Q

muscles in superficial group of posterior compartment of leg

A
  1. gastrocnemius
  2. soleus
  3. plantaris
271
Q

muscles in deep group of posterior compartment of leg

A
  1. popliteus
  2. flexor digitorum longus
  3. flexor hallicis longus
  4. tibialis posterior
272
Q

where is the small saphenous vein found? What region does it drain, and what does it drain into?

A

goes down center of bifurcation of gastrocnemius muscle
drains superficial foot
drains into popliteal vein

273
Q

gastrocnemius and soleus combined is called…

A

triceps surae

274
Q

which posterior leg compartment muscle is absent is 10-15% of the population? What is it commonly used for?

A

plantaris – commonly used for grafting during reconstructive surgery

275
Q

plantaris and popliteus relative locations to each other

A

popliteus is more medial

276
Q

clinical importance of popliteus

A

attaches to lateral meniscus — if lateral meniscus is torn and is surgically repaired, active or resisted knee flexion is deferred for a few weeks

277
Q

where does the flexor hallucis longus tendon run and why is its location important?

A

tendon runs between 2 sesamoid bones in tendons of flexor hallucis brevis
sesamoid bones protect FHL tendon from pressure at first metatarsal

278
Q

anterior tibial artery terminates as….

A

dorsalis pedis a

279
Q

where to find pedal pulse

A

just distal to medial/ lateral malleoli, between 1st and 2nd metatarsals

280
Q

deep fascia of plantar foot is called ___ and thick central part is ___

A

plantar fascia, central part is plantar aponeurosis

281
Q

roles of plantar fascia

A

holds foot together
protects plantar surface from injury
supports longitudinal arches of foot

282
Q

plantar aponeurosis attachments

A

from calcaneus

to 5 divided bands that become continuous with tendon sheath of each toe

283
Q

function of intrinsic muscles of foot

A

instead of producing motion, primarily focus on isometrically working to maintain foot arches

284
Q

layer 1 of intrinsic foot muscles

A
  1. abductor hallucis
  2. flexor digitorum brevis
  3. abductor digiti minimi
285
Q

layer 2 of intrinsic foot muscles

A
  1. quadratus plantae

5. lumbricals (x4)

286
Q

layer 3 of intrinsic foot muscles

A
  1. flexor hallucis brevis (2 heads – medial and lateral)
  2. adductor hallucis (2 heads – oblique and transverse)
  3. flexor digiti minimi brevis
287
Q

layer 4 of intrinsic foot muscles

A
  1. plantar interossei (x3)

10. dorsal interossei (x4)

288
Q

how many plantar interossei are there?

A

3

289
Q

how many dorsal interossei are there?

A

4

290
Q

characteristics of medial plantar n compared to lateral plantar n

A

medial plantar n larger and more anterior

291
Q

border between medial and lateral plantar nn is…

A

along 4th metatarsal

292
Q

which cutaneous n travels through the adductor canal?

A

saphenous n

293
Q

bones in hindfoot

A

talus and calcaneus

294
Q

bones in mid foot

A

navicular, cuboid, cuneiforms (medial, lateral and intermediate)

295
Q

bones in forefoot

A

metatarsals, phalanges

296
Q

subtalar joint is articulation between…

A

three separate inferior articulating surfaces on talus with 3 separate articulating surfaces on superior aspect of calcaneus

297
Q

functions of subtalar joint

A
  • translates motion of tibia to foot and vice versa
  • dampens rotational forces while maintaining contact with ground
  • allows for smooth walking over uneven surfaces, pivoting
298
Q

ligaments supporting subtalar joint

A
  • talocalcaneal ligaments
  • medial collateral ligaments
  • lateral collateral ligaments
299
Q

the subtalar joint has __planar movement around a __ axis

A

triplanar movement

single oblique joint axis

300
Q

subtalar axis is __ degrees up from horizontal plane and __ degrees in from sagittal plane

A

42 degrees up from horizontal

25 degrees in from sagittal plane

301
Q

composite motions of subtalar joint

A

supination and pronation

302
Q

supination is a combination of…

A

inversion
adduction
PF

303
Q

pronation is a combination of…

A

eversion
abduction
DF

304
Q

lateral subtalar joints

A
  • lateral talocalcaneal ligament
  • dorsal talonavicular ligament
  • interosseous talocalcaneal ligament (at sinus tarsi canal)
305
Q

cuboid bone articulates with….

A

calcaneus posteriorly
lateral two metatarsals anteriorly
navicular and lateral cuneiform medially

306
Q

cuboid bone key characteristics

A

cuboid tuberosity on plantar surface

groove for peroneus longus tendon

307
Q

navicular articulates with…

A

talus
cuboid
3 cuneiform bones

308
Q

navicular key characteristics

A 
flattened, boat shape
navicular tuberosity (attachment of tibialis posterior m)
309
Q

in ankle pronation, medial malleolus is ____ relative to lateral malleolus

A

higher

310
Q

medial cuneiform articulates with….

A

1st MT bone

311
Q

intermediate cuneiform articulates with…

A

2nd MT bone

312
Q

lateral cuneiform articulates with…

A

3rd MT bone and cuboid bone

313
Q

cuneiform ___ motion lends to….

A 
planar motion (small amount)
lends some flexibility to foot
314
Q

high ankle sprain

A

separation between distal tibia-fibula joint

315
Q

transverse tarsal joint is between….

A

calcaneus and talus proximally, and cuboid and navicular distally (divides hind foot and Midfoot)

316
Q

what type of joint is transverse tarsal joint?

A

compound synovial joint

317
Q

transverse tarsal joint major ligamentous support

A

plantar calcaneonavicular ligament (spring ligament)
long plantar ligament
short plantar ligament (plantar calcaneocuboid ligament)

318
Q

long plantar ligament extends from…

A

calcaneus to 2-4 MT

319
Q

function of plantar calcaneonavicular ligament (spring ligament)

A

helps maintain middle arch

320
Q

purpose of arches of foot

A

adds to weight bearing capabilities and resiliency of foot
provides for shock absorption
arches become slightly flattened during WB, resume curve during NWB

321
Q

integrity of arches maintained by…

A

shape of interlocking bones
strength of plantar ligaments
strength of plantar aponeurosis

322
Q

lateral longitudinal arch is comprised of…

A

calcaneus, cuboid, and lateral 2 metatarsals

323
Q

medial longitudinal arch

A

calcaneus, talus, navicular, 3 cuneiforms, and medial 3 metatarsals

324
Q

if you fracture your talus, which arch(es) would be affected?

A

medial longitudinal arch

325
Q

if you fracture your calcaneus, which arch(es) would be affected?

A

lateral and medial longitudinal arches

326
Q

transverse arch is comprised of…

A

cuboid, cuneiforms, and bases of metatarsals (runs lateral to medial)

327
Q

tarsometatarsal joint is a ___ joint

A

plane joint (gliding only), synovial

328
Q

inter metatarsal joint is a ___ joint

A

plane joint (gliding motion only), synovial

329
Q

metatarsophalangeal joints (MTP) are ___ joints with __ DOF

A

ovoid synovial joints with 2 DOF (flex/ext, abd/add)

330
Q

interphalangeal joints are ___ joints

A

synovial hinge joints

Anatomy (3 decks)

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