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UW Madison Anatomy > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

What is fascia lata?

A

Fascia of the thigh

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2
Q

What is crural fascia?

A

Fascia of the leg

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3
Q

Compartments of the lower limb and their innervations and their divisions

A 
In the thigh:
- Anterior compartment:
 Femoral n, posterior division
- Posterior compartment:
 Tibial n, anterior division 
- Medial compartment: Obturator n, anterior division

In the leg:

  • Anterior compartment: Deep fibular n, posterior division
  • Posterior compartment: Tibial n, anterior division
  • Lateral compartment: Superficial fibular n, posterior division
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4
Q

Tarsal tunnel syndrome and problems associated with it

A

Compression of the tibial nerve as it passes beneath the flexor retinaculum on the medial aspect of the ankle joint.

This can lead to parasthesia or even anesthesia of the plantar surface of the foot, and problems w/ movements of the toes.

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5
Q

Compartment syndrome and problems associated with it

A

Increased tissue pressure in one of the compartments (like anterior compartment thigh or anterior compartment of leg). May be caused by inflammation resulting from trauma to muscles in the compartment. This inflammation can put pressure on nerves and vessels traveling within or through the compartment. Can lead to ischemia and dysfunction of muscles included in the specific compartment due to decreased blood flow from vessel compression.

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6
Q

Which compartment of the lower limb is one of the more common compartment syndromes?

A

Anterior compartment syndrome (increased pressure in anterior compartment of the leg)

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7
Q

Lumbosacral plexus innervation; its spinal cord levels; and fiber types

A

Innervates skeletal muscles and skin of lower limb and pelvis from ventral rami T12-S4.

Carries sensory, motor, and postganglionic sympathetic fibers

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8
Q

Lumbosacral trunk

A

Serves as a connecting link btwn lumbar and sacral portions of lumbosacral plexus (it’s formed by L4 and L5)

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9
Q

Name the “non-limb” nerve closely related to sacral component of lumbosacral plexus and its spinal cord segments.

What does it innervate?

A

Pudendal nerve comes from ventral rami S2-S4.

Provides sensory innervation for perineal region and external genitalia, and motor fibers to striated skeletal muscle of external genitalia and external anal sphincter.

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10
Q

Name the major arteries to the lower limb

A
  1. Femoral artery
  2. Superior gluteal artery
  3. Inferior gluteal artery
  4. Obturator artery
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11
Q

What is the largest artery in the lower limb?

A

Femoral artery

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12
Q

What are the branches of the femoral artery?

A
  1. Medial femoral circumflex
  2. Lateral femoral circumflex
  3. Profunda femoris (deep femoral)
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13
Q

Where are lower limb arteries positioned?

A

On the flexor side of the joints

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14
Q

How does the femoral artery get to the flexor side of the knee joint?

A

The femoral artery passes to posterior aspect of the femur near its distal end through the adductor hiatus (hole) in the adductor magnus muscle

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15
Q

When does the femoral artery become popliteal artery?

A

Femoral artery goes through adductor hiatus and enters popliteal fossa to become popliteal artery.

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16
Q

Branches of the popliteal artery and where it distributes to

A
  1. Anterior tibial artery
  2. Posterior tibial artery
  3. Fibular artery

Distributes to leg and foot

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17
Q

Branches of anterior tibial artery

A
  1. Dorsalis pedis artery

2. Dorsal arch of the foot

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18
Q

Branch and subbranch of posterior tibial artery

A
  1. Fibular artery (which branches into lateral and medial plantar arteries to form plantar arch)
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19
Q

Plantar arch gives rise to what arteries?

A

Common digital arteries

Proper digital arteries

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20
Q

Collateral circulation around the hip is provided through what structure?

A

Cruciate anastomosis, which forms from 3 branches of the femoral artery (medial femoral circumflex, lateral femoral circumflex, first perforating branch of profunda femoris) and a branch of the internal iliac artery (inferior gluteal artery).

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21
Q

When does lower limb development begin?

A

~4 weeks gestation; lags behind upper limb

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22
Q

Name the cutaneous nerves of the lumbosacral plexus and their spinal cord segments

A
  1. Subcostal (T12)
  2. Iliohypogastric (L1)
  3. Ilioinguinal (L1)
  4. Genitofemoral (L1-L2)
  5. Lateral femoral cutaneous (L2-L3)
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23
Q

Name the anterior division nerves of the lumbosacral plexus and their spinal cord segments

A
  1. Obturator (L2-4)

2. Tibial (L4-S3) (from sciatic nerve)

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24
Q

Name the posterior division nerves of the lumbosacral plexus and their spinal cord segments

A
  1. Femoral (L2-4)
  2. Superior gluteal (L4-S1)
  3. Inferior gluteal (L5-S2)
  4. Common fibular (L4-S2) (from sciatic nerve)
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25
Q

What movement is being tested for function of peripheral nerves or spinal cord segment L2-L3?

A

Hip flexion

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26
Q

What movement is being tested for function of peripheral nerves or spinal cord segment L4-L5?

A

Hip extension and ankle flexion

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27
Q

What movement is being tested for function of peripheral nerves or spinal cord segment L3-L4?

A

Knee extension

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28
Q

What movement is being tested for function of peripheral nerves or spinal cord segment L5-S1?

A

Knee flexion

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29
Q

What movement is being tested for function of peripheral nerves or spinal cord segment S1-S2?

A

Ankle extension

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30
Q

Varicose veins and its risk factors

A

Weakening of venous walls; cusp of valves pulled apart and cannot prevent backflow of blood

Risk factors: standing for long period of time, pregnancy, obesity, heredity weakness of veins

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31
Q

Collateral circulation around the knee is provided through what structure?

A

Geniculate branches off popliteal artery (medial superior geniculate, medial inferior geniculate, lateral superior geniculate, lateral inferior geniculate)

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32
Q

Greater saphenous vein drains into what vein?

A

Femoral vein in the groin region

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33
Q

Lesser saphenous vein drains into what vein?

A

Popliteal vein in the popliteal fossa

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34
Q

Skeletal muscle pump

A

Transports blood against the pull of gravity. Since compartments do not expand when muscles contract, each time muscles contract it also squeezes the veins within the compartment to move the blood upwards. The venous valves prevent the blood from flowing backwards.

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35
Q

Testes exocrine and endocrine functions

A

Exocrine function: produce sperm in seminiferous tubules

Endocrine function: produce testosterone made by cells called interstitial cells of Leydig

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36
Q

Describe how testes descend during development and how that creates the inguinal canal and rings

A

Testes (and part of peritoneum) descend from an abdominal position to scrotum by following gubernaculum and pushing through layers of anterior abdominal wall (along with blood vessels and vas deferens) which creates inguinal canal and rings at either end of the canal.

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37
Q

Describe the route of sperm

A
  1. In testes, sperm made in seminiferous tubules
  2. Held in epididymis for maturation/storage
  3. Travels through ejaculatory ducts to pick up secretions from seminal vesicles
  4. Travels in vas deferens (ductus deferens) in spermatic cord through inguinal ring/canal
  5. Goes into urethra
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38
Q

What structures form the spermatic cord?

A

Vas deferens
Testicular artery and veins
Lymphatic vessels
Autonomic nerve fibers

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39
Q

Male urethra can be subdivided into 3 segments

A
  1. Prostatic urethra
  2. Membranous urethra
  3. Penile or spongy urethra
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40
Q

Accessory glands associated w/ the male reproductive tract and what they make

A
  1. Prostate gland: makes componetns of seminal fluid necessary for sperm maintenance in female genital tract
  2. Seminal vesicles: make components of seminal fluid for sperm maintenance too
  3. Bulbourethral glands: release fluid that cleans out urethra of urine and bacteria prior to ejaculation
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41
Q

Ovary exocrine and endocrine functions

A

Exocrine function: make ova (eggs)

Endocrine function: make estrogen and progesterone

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42
Q

Describe the continuity of male v. female reproductive systems

A

Male reproductive system is continuous; female is discontinuous

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43
Q

Describe the different types of uterus positions

A

Anteversion: uterus flipped anteriorly relative to vagina
Retroversion: uterus flipped posteriorly relative to vagina

Retroflexion: uterus flexed posteriorly relative to cervix
Anteflexion: uterus flexed anteriorly relative to cervix

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44
Q

Arteries in the pelvis

A
  1. Aorta
  2. Common iliac a. (external and internal)
  3. External iliac a. and internal iliac a.
  4. Internal iliac branches (vesicular, uterine, and rectal a.)
  5. Superior gluteal a. and inferior gluteal a.
  6. Internal pudendal a.
  7. Obturator a.
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45
Q

Describe sympathetic and parasympathetic innervation in pelvic organs

A

Sympathetic (lumbar and sacral) splanchnics send sympathetic innervation from sympathetic trunk.

Pelvic splanchnics send parasympathetic innervation from S2-4 nerves

Sympathetic and pelvic splanchnics send fibers to inferior hypogastric plexuses and pelvic plexuses.

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46
Q

Sympathetic splanchnics send out sympathetic innervation to pelvic organs to perform what functions?

A

Inhibit defecation

Emission (phase before ejaculation where sperm moves from testes to urethra)

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47
Q

Pelvic splanchnics send out parasympathetic innervation to pelvic organs to perform what functions?

A

Allow defecation

Erection

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48
Q

Where can preganglionic and postganglionic cell bodies in sympathetic (lumbar and sacral) splanchnics be found?

A

Preganglionic: ventral rami of T1-L2

Postganglionic: sympathetic chain

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49
Q

Where can preganglionic and postganglionic cell bodies in pelvic splanchnics be found?

A

Preganglionic: lateral horn to ventral rami S2-S4

Postganglionic: terminal ganglia

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50
Q

Pelvic diaphragm, what it consists of, and its functions

A

Floor of pelvis and roof of perineum consists of muscles (levator ani + coccygeus muscle)

Functions:

  1. Helps w/ fecal continence (via puborectalis)
  2. Supports pelvic viscera against gravity so they don’t fall out of bottom of pelvis
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51
Q

Describe the pelvic plexuses route innervation to perineal structures

A
  1. Posterior to anterior route along pelvic organs

2. Exit inferior to pubic symphysis

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52
Q

Describe the pudendal nerve route innervation to perineal structures

A
  1. Exit pelvis through greater sciatic foramen
  2. Enter perineum through lesser sciatic foramen
  3. Travel anteriorly through pudendal canal and runs along ischiopubic ramus to get to skin and skeletal muscles
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53
Q

Describe the structures that help fecal continence

A
  • Rectal folds: internal assistance (like KerPlunk) exists to slow down feces from getting to anus
  • Internal anal sphincter: smooth muscle in wall of rectum controlled by ANS
  • External anal sphincter: combo of 3 voluntary, skeletal muscles that form ring around internal anal sphincter
  • Puborectalis: makes a “sling” around external anal sphincter to hold your poop (voluntary muscle)
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54
Q

Describe the somatomotor aspect of fecal continence

A

Levator ani innervated by direct branches from sacral plexus S2-S4

External anal sphincter innervated by Pudendal n.

Tonic contraction closes external anal sphincter; relaxation allows defecation

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55
Q

Describe the visceromotor aspect of fecal continence

A

Internal anal sphincter innervated by sympathetic splanchnics and pelvic splanchnics whose fibers go to pelvic plexuses

Smypathetic contracts to close internal anal sphincter; parasympathetic relaxes to allow defecation.

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56
Q

Episiotomy and its alternatives

A

Surgical cut to perineal body (an anchoring point btwn pelvic diaphragm and urogenital diaphragm which supports pelvic contents) to prevent traumatic tear and allow baby to get through.

Perineal massage and warm compression can help to minimize damage to perineum.

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57
Q

Pelvic organ prolapse; how it can happen and what structures try to prevent it

A

Organ prolapse through urogenital hiatus due to weakness of pelvic diaphragm.

Can happen after childbirth when retroverted uterus creates pressure where uterus can prolapse out of vagina.

Fat-filled space (ischioanal fossae) superficial to posterior part of pelvic diaphragm helps to keep pelvic organs in. Also have urogenital diaphragm to cover pelvic outlet.

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58
Q

Urogenital hiatus

A

Opening of pelvic diaphragm which allows urethra and vagina to pass through. It is covered inferiorly by urogenital diaphragm.

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59
Q

Anal hiatus

A

Opening of pelvic diaphragm which allows anus and rectum to pass through.

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60
Q

Urogenital diaphragm

A

Covers anterior pelvic outlet. Consists of muscle in the deep space (external urethral sphincter and compressor urethrae) AND CT layers in the superficial space (perineal membrane) (where as pelvic diaphragm is ONLY muscle). It is attached to perineal body.

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61
Q

Describe the structures that help urinary continence

A
  • Internal urethral sphincter: smooth muscle (involuntary), closes during ejaculation to block semen from entering bladder
  • External urethral sphincter: skeletal muscle (voluntary)
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62
Q

Describe the somatomotor aspect of urinary continence

A

External urethral sphincter innervated by pudendal n.

Tonic contraction closes sphincter; relaxation allows urination.

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63
Q

Describe the visceromotor aspect of urinary continence

A

Internal urethral sphincter innervated by sympathetic splanchnics, pelvic splanchnics, pelvic plexuses.

Sympathetic contracts to close sphincter; parasympathetic relaxes to allow urination.

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64
Q

Types of urinary incontinence and causes

A

Types:

  1. Stress (sneeze and pee lol)
  2. Urge (always feeling like you need to pee)
  3. Overflow (bladder so full it just opens up flood gates)

Causes:

  1. Weakness of sphincters (after childbirth)
  2. Blockage of urethra (BPH, prostate cancer, constipation)
  3. Neurological problems (MS, Parkinson’s, SCI)
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65
Q

Describe erectile tissues of the penis and the clitoris and their location in relation to the UG diaphragm

A

Penis:

  • Corpora cavernosa (2 dorsal masses)
  • Corpus spongiosum (midline mass that contains urethra)
  • Tunica albuginea (tough CT that puts a limit on how much erectile tissue can expand)

Clitoris:

  • Corpora cavernosa
  • Vestibular bulbs (homologous w/ corpus spongiosum in males)
  • Tunica albuginea

Erectile tissue are anchored to superficial surface of perineal membrane of urogenital diaphragm

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66
Q

Visceromotor and somatomotor roles in sexual response and their innervation

A
  • Erection: pelvic splanchnics, parasympathetic (male and female)
  • Emission: sympathetic splanchnics (male only)
  • Ejaculation/orgasm: Pudendal n., somatomotor reflex (male and female)
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67
Q

The perineum can be divided what 2 regions? What do these regions consist of starting with deep to superficial structures?

A

Urogenital triangle (anterior):

  1. Peritoneum
  2. Pelvic organs
  3. Pelvic diaphragm
  4. Urogenital diaphragm
  5. Erectile tissue
  6. Superficial perineal muscles
  7. Skin

Anal triangle (posterior):

  1. Peritoneum
  2. Pelvic organs
  3. Pelvic diaphragm
  4. Ischioanal fossa
  5. Skin
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68
Q

Sacrioiliac joint description; joint type; auricular surfaces

A

Synovial joint that connects lower limb to axial skeleton via sacrum and hip bones. Very stable and very little movement.

Sacral auricular surface is hyaline; iliac auricular surface is fibrocartilage

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69
Q

Os coxa/innominate is composed of these 3 bones

A

Ilium (wing part)
Ischium (what you sit on)
Pubis

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70
Q

Symphyseal surfaces of each pubic bone articulates to each other to form

A

Pubic symphysis

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71
Q

How many ossification centers does the os coxa have?

A

8 ossification centers

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72
Q

Triradiate cartilage

A

Centered in acetabulum of os coxa to hold the 3 bones together (ilium, ischium, pubis) until they fuse (which fuses around ~16 years)

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73
Q

Sacroiliac joint actions

A

Transverse axis:

  • Nutation/anterior rotation
  • Counternutation/posterior rotation
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74
Q

Sacroiliac joint ligaments and what movements they resist

A
  • SI joint ligaments
  • Sacrospinous ligaments
  • Sacrotuberous ligaments

Resist anterior rotation of sacrum during standing (so it doesn’t tip forward too far)

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75
Q

Pubic symphysis

A

Cartilagenous joint w/ fibrocartilaginous disc in-btwn the symphyseal surface. Has very little movement.

Can have a joint cavity, in which case, it’d be a synovial ojint.

76
Q

Relaxin

A

Hormone that “relaxes” ligaments and increases joint laxity for labor and delivery. Allows SI joint and pubic symphysis to widen during childbirth.

77
Q

Describe the bone structure of the femur and its strength in relation to compression and being bent.

A

Trabecular bone pattern of femur head/neck follows lines of principle loads which allow for multiaxial load.

It has a thick cortical shell on interior surface of neck to help resist bending forces.

Muscles help turn bending force into compressive force (bc the bone is strongest in compression, not bent)

78
Q

Femoral neck angles

A

Neck to shaft angle in coronal plane (affects height):

  • Coxa vara (angle less than 120 degrees)
  • Coxa valga (angle greater than 135 degrees)

Neck to shaft angle in transverse plane:

  • Anteversion (angle pointing anterior, pigeon toed)
  • Retroversion (angle pointing posterior, out toed)
79
Q

When does the external iliac artery change its name? What name does it become?

A

External iliac artery becomes femoral artery once it cross inguinal ligament.

80
Q

What happens if the circumflex femoral arteries to the femoral head and neck get blocked or damaged?

A

Because there are few, if any, collateral channels collecting these vessels w/ vessels associated w/ the shaft of the femur, damage to the circumflex vessels may leave the femorarl head w/ no blood supply at all, resulting in avasular necrosis (death) of the bone.

81
Q

What are some causes of avascular necrosis (lack of blood supply) of the femoral head? What treatment would need to be done?

A

Causes:

  • Fracture
  • Chronic corticosteroid use
  • Excessive alcohol use
  • Slipped capital femoral epiphysis

Treatment:
- Hip replacement

82
Q

Describe the iliofemoral (hip) joint

A
  • Ball-and-socket joint
  • Large articular surface (big femoral head and huge lunate surface)
  • Deeper joint cavity (acetabular fossa) w/ a round ligament that joins the articulating surfaces
  • Acetabular labrum makes cavity even deeper
83
Q

Hip joint ligaments

A
  • Iliofemoral ligament
  • Pubofemoral ligament
  • Ischiofemoral ligament

Resists hyperextension beyond anatomical standing position.

84
Q

Spinal arrangement of collagen fibers/ligaments of hip joint

A

Loosen during flexion; resists and tighten during extension (limited extension to 15 degrees)

85
Q

Hip joint actions

A

Transverse axis:
- Flexion/extension

AP axis:
- Abduction/adduction

Vertical axis:
- Medial/lateral rotation

86
Q

What two points should be kept in mind with respect to analyzing muscle function and the reversal between fixed muscle and movable muscle?

A
  1. The relationships of that muscle to a given axis at a joint remain the same
  2. Pulls of the muscle are simple reversed
87
Q

Gait cycle

A

Consists of movement of one limb through a stance phase and a swing phase

Very efficient process (the change of fixed and mobile attachments) that uses gravity and momentum and minimizes energy expenditure

88
Q

Ways gait cycle can maintain center of gravity

A
  • Pelvic rotation in transverse plane minimizes drop in center of gravity by effectively lengthening limbs
  • Knee flexion on full stance. Limb minimizes rise in center of gravity by effectively shortening the limb
  • Movement of knees towards midline (adduction of hip) minimizes lateral shift in center of gravity
  • Pelvic tilt (drop) on swing side minimizes rise in center of gravity
89
Q

Saphenous nerve

A

Branches from femoral nerve and does cutaneous innervation to antero-medial leg

90
Q

Muscles attached to ilium are innervated by (posterior / anterior) division fibers?

A

Posterior division

91
Q

Muscles attached to ischium are innervated by (posterior / anterior) division fibers?

A

Anterior division

92
Q

Muscles attached to pubis are innervated by (posterior / anterior) division fibers?

A

Anterior division

93
Q

Adductor hiatus

A

A “hole” in the adductor magnus that allows the passage of the femoral artery and vein into the popliteal fossa

94
Q

Femoral triangle borders; floor; vessels/nerves

A

Borders:

  • Inguinal ligament (superior)
  • Sartorius (lateral)
  • Adductor longus (medial)

Floor:

  • Iliopsoas
  • Pectineus

Vessels/nerves:

  • NAVL (Femoral nerve, artery, vein; and lymphatics)
  • Great saphenous vein
95
Q

Route of femoral triangle vessels

A

Femoral triangle vessels travel down adductor canal to reach thigh.

They reach adductor hiatus where they can go to the posterior side of the lower limb.

96
Q

Describe the types of contractions hip muscles use during walking

A

Concetric (propel limb forward)

Eccentric (decelerate limb down)

Isometric (keeps us stabilized)

97
Q

Which muscle(s) are considered to be primary hip extensors?

A

Hamstring muscles (semitendinosus, semimembranosus, biceps femoral)

98
Q

Which muscle(s) are considered to be strongest hip extensors?

A

Gluteus maximus

Ex: going upstairs, standing up from sitting, running, etc.

99
Q

Trendelenburg sign

A
  • Weakness of hip abductors causes contralateral (opposite, functioning) side to descend
  • Weakness/paralysis on both sides will cause more dramatic gait
  • Tendon transfer of hip flexor (iliacus)
100
Q

Hip extensors function during walking

A

Help in deceleration of swing of lower limb (eccentric contraction) and then propel body forward (concentric contraction)

101
Q

Hip flexors function during walking

A

Help accelerate thigh in swing phase (concentric contraction and decelerate thigh at end of stance phase (eccentric contraction)

102
Q

Hip rotation function during walking

A

Helps to lengthen stride

103
Q

Hip adduction function during walking

A

Control the position of lower limb during swing phase and keeps center of gravity from shifting laterally.

104
Q

Hip abduction function during walking

A

Work primarily when femur is fixed to elevate opposite side of pelvis

105
Q

“Knee” joints and their articulations

A

2 synovial joints:

  • Tibiofemoral joint: btwn tibial and femoral condyles
  • Patellofemoral joint: btwn patella and patellar articular surfaces of femur
106
Q

Patella is considered to be what kind of bone?

A

Sesamoid (bone that develops inside a tendon)

107
Q

Patella functions in patellofemoral joint

A
  1. Protects quadriceps tendon

2. Increases mechanical advantage of quads

108
Q

Patellofemoral joint

A

Plane joint; could possibly move in any direction

Gliding joint?

109
Q

Tibiofemoral joint

A

Biaxial (can flex/tendon and rotate)

Flexibility during locomotion v. stability during standing.

110
Q

Q-angle (aka bicondylar angle) and its functional importance

A

Angle btwn the femur and tibia (shaft of femur is at an angle to shaft of tibia; not perfectly lined up)s

This allows for feet to be planted directly underneath us. This increases stability.

111
Q

Lower leg angles

A

Genu valgum: Increase in q-angle of knee causes knee to project medially (knock knee)
Genu varus: Decrease in q-angle of knee causes knee to project laterally (bow leggedness)

112
Q

Describe the knee joint capsule and its structures

A

Keeps the 2 knee joints together.

Fibrous capsule makes up posterior, lateral, and medial wall (quadriceps make up anterior wall).

Infrapatellar fat pad sits inside anterior joint capsule

113
Q

Knee ligaments and the movements they resist

A

Intracapsular ligaments:

  • Lateral (fibular) collateral ligament: adduction, rotation
  • Medial (tibial) collateral ligament: abduction, rotation
  • Anterior cruciate ligament: anterior translation (anterior displacement of tibia on femur), hyperflexion/extension
  • Posterior cruciate ligament: posterior translation (anterior displacement of femur on fixed tibia), hyperflexion/extension
114
Q

True/false: LCL is attached to lateral meniscus

A

False, tendon of popliteus muscle runs inside fibrous capsule of knee joint. This separates LCL from attaching to lateral meniscus.

115
Q

Describe the knee menisci and their functions

A

Fibrocartilage; has good blood supply on its outer 1/3 (where ligaments attach)

Functions:

  1. Increased surface contact btwn tibia and femur (spread load)
  2. Help w/ synovial fluid distribution for lubrication
  3. Help w/ rotation of knee
116
Q

Describe the movements of knee menisci

A
  • Menisci move posteriorly during knee flexion and move anteriorly during knee extension
  • Menisci move during rotation
117
Q

Knee joint movements

A

Transverse axis: Flexion/extension

Vertical axis: Medial/lateral rotation

118
Q

Pick one: (Extension / flexion) has a larger amount of freedom within the knee joint.

A

Flexion has a larger amount of freedom for flexion than extension

119
Q

Describe flexion of knee joints

A

A small amount of gliding causes axis position to change throughout flexion (knee is not a perfect hinge, so transverse axis does not stay in place)

120
Q

Describe active rotation of knee joints

A

Occurs when knee joint is flexed. Muscles (hamstrings, mostly) actively medially/laterally rotate tibia on a fixed femur.

Has the most range of motion when knee is flexed 90⁰

121
Q

Describe passive rotation of knee joints

A

Involves slight, inevitable rotatory movements of femur on a fixed tibia during final stages of full extension at knee joint. All ligaments of knee are tight and knee is very stable.

Medial rotation occurs when locking knee joint into full extension. Lateral rotation occurs when unlocking knee joint from full extension to flexion.

122
Q

Coronary ligaments

A

Attaches each meniscus to the tibia with its strong fibrous bands

123
Q

Why does passive rotation occur at the knee joint?

A

Medial condyles are longer than lateral condyles. As the femoral condyles slide posteriorly on the tibia during extension of the knee, lateral condyle stops gliding first bc it is shorter and medial condyle continues to slide posteriorly and femur rotates medially.

124
Q

Meniscus tears

A

MCL/LCL tears due to excess rotation of knee may result in menisci tear.

Menisci tears can interfere w/ joint mobility. Alteration of load can lead to osteoarthritis.

125
Q

Collateral ligament tears

A

Blows to the sides of the knee or extreme torsion of a flexed knee.

Valgus knee causes more strain on MCL; Varus knee causes more strain on LCL

MCL tears can cause concomitant tear of medial meniscus.

126
Q

Cruciate ligament tears

A

ACL tear: hyperextension of knee

PCL tear: posterior displacement of tibia (happens in flexed knee); “Dashboard” incident

127
Q

How to test for cruciate ligament tears

A

Anterior and posterior drawer test (pull/push on tibia and see if it comes out anteriorly or posteriorly)

128
Q

Terrible triad

A

Traumatic knee injuries can involve multiple ligaments and menisci. Typically ACL, MCL, and LM. Sometimes ACL, MCL, MM.

Occurs more in women than men bc women have wider hips and larger g-angle.

129
Q

Meniscus repair

A

“Red zone” usually heals well; may not need surgery.

“White zone” does not heal well and is commonly removed. Treatment may include debridement or adding sutures to tack meniscus down so it doesn’t move too much.

130
Q

ACL and PCL repair

A

Partial tears do not usually call for surgery and heals well.

Complete rupture repair depends on needs of patient. Tendon graft repair may be an option.

131
Q

Knee joint replacement

A

Damage to knee from arthritis or trauma can require partial or total replacement.

Total knee replacement requires removal of ACL; you can keep PCL depending on what type of implant is required.

132
Q

During the first year of development, lower limb rotates 180 deg (laterally / medially) until original posteriorly positioned muscles come to lie anteriorly and laterally.

A

Medially

133
Q

Structures that pass piriformis inferiorly

A
  1. Inferior gluteal artery
  2. Inferior gluteal nerve
  3. Inferior gluteal vessel
  4. Internal pudendal artery
  5. Pudendal nerve
  6. Sciatic nerve
134
Q

Which vein is often utilized for coronary bypass surgeries?

A

Greater saphenous vein

135
Q

2 ways you can differentiate btwn male and female pelvises

A
  1. Subpubic angle wider in females

2. Sciatic notch wider in females

136
Q

Why are pelvic inlet and outlet named the way they are?

A

Baby goes in pelvic inlet to get into pelvis; baby goes out of pelvic outlet to get out of pelvis.

137
Q

Perineal body

A

CT structure that connects pelvic diaphragm and urogenital diaphragm just anterior to anus. Muscles of these diaphragms attach here.

138
Q

Bulbospongiosus covers what erectile tissue?

A

Vestibular bulbs (females) or corpus spongiosum (males)

139
Q

Ischiocavernosus covers what erectile tissue?

A

Crura along ischiopubic rami

140
Q

Superficial transverse perineal does what?

A

Supports viscera; runs along edge of UG diaphragm and attaches to perineal body

141
Q

Superficial perineal muscles include what and do what?

A

Bulbospongiosus and ischiocavernosus

Functions:

  1. Restrict blood during erection
  2. Propulse sperm during ejaculation
142
Q

The quadriceps femoris muscle is made of what muscles

A
  1. Rectus femoris
  2. Vasus medialis
  3. Vastus intermedius
  4. Vastus lateralis
143
Q

Quadriceps tendon and what it turns into

A

A single tendon formed by the quad muscles joining together distally. It becomes patellar ligament btwn the patella and tibial tuberosity.

144
Q

Quadriceps tendon/patellar ligament function

A
  1. Decreases wear on quadriceps tendon/patellar ligament

2. Increases mechanical advantage of quadriceps femoris for good extension of knee

145
Q

Which direction is most common for patellar dislocation; why; and what prevents this?

A

Lateral dislocation bc of superior, lateral pull of quadriceps on patella

Genu valgum increases chance of dislocation bc increased q-angle.

Bony “block” (everytime you extend knee, you run patella into bondy block) and pulls of muscles (vastus medialis lower fibers are horizontal, so when they contract in full extension, they will pull patella medially) resists dislocation.

146
Q

Pes anserinus

A

Insertion point on tibia where gracilis, sartorius, and semitendinosus come together.

It runs posteriorly to knee, wraps around, and comes to side of tibial tuberosity of medial side of tibia.

147
Q

Describe range of motion for muscles crossing both hip and knee

A

Range of motion on knee depends on position of hip, and vice versa.

Hamstrings cannot extend hip AND flex knee maximally at same time. Flexion of hip is greater when knee is flexed bc of reduced tension on hamstrings.

A muscle can only get so contracted (active insufficiency); a muscle can only stretch so far (passive insufficiency). Going past insufficiency can cause muscle tears or avulsion from its attachment.

148
Q

Which muscles are exceptions to the rule that muscles work from anatomical position?

A

Hamstrings and gastrocnemius are knee flexors, but if you start in flex position, they can extend knee back into anatomical position. Hams will pull superiorly and posteriorly; gastrocnemius will pull inferiorly and posteriorly.

149
Q

Which muscle allows you to “unlock” your knee from a locked position?

A

Popliteus can unlock knee by laterally rotating femur to flex. (You cannot flex from a locked knee position)

150
Q

Describe knee flexion during gait cycle

A

Stance phase: passive flexion while walking on level ground is mostly due to momentum of body driving knee flexion

Swing phase: active flexion helps keep limb from hitting ground

151
Q

Describe knee extension during gait cycle

A

Knee extensors (quads) act as shock absorbers during first part of stance phase (heel strike)

Knee extensors help stabilize knee in stance phase so that knee doesn’t “buckle”

Eccentric contraction of knee extensors during stance phase more pronounced when walking downstairs. Helps slowly lower you down steps to control descent downstairs.

152
Q

Describe knee rotation during gait cycle

A

When knee is flexed, it’s medially rotated. When knee is extended, it’s laterally rotated.

Passive rotation of knee could occur during middle part of stance phase as knee is extended (in a locked position)

153
Q

Boundaries of popliteal fossa and its structures

A

Superior, medial side: semitendinosus and semimembranosus

Inferior, medial side: gastrocnemius (medial head) and lesser saphenous vein

Superior, lateral side: biceps femoris

Inferior, lateral side: gastrocnemius (lateral head)

Structures: popliteal artery, popliteal vein (its lesser saphenous vein), and tibial nerve and common fibular nerve (sciatic nerve divides in fossa).

154
Q

A pinprick test btwn the first two toes tests which dermatome and nerve?

A

L5 dermatome

Deep fibular nerve

155
Q

Where does femoral nerve enter thigh?

A

Enters thigh deep to inguinal ligament and lateral to femoral artery

156
Q

Which branch of the lumbar plexus has a large cutaneous branch extending below the knee?

A

Femoral nerve

157
Q

A pinprick test of the skin on the superior side of the big toe tests which dermatome and nerve?

A

L5 dermatome

Superficial fibular nerve

158
Q

Sural nerve and its fiber types

A

Sensory nerve in the calf region (sura) of the leg made up of cutaneous collateral branches of tibial nerve and common fibular nerve.

Contains sensory and postganglionic sympathetic

159
Q

A pinprick test of the plantar surface of the heel tests which dermatome and nerve?

A

S1 dermatome

Tibial nerve

160
Q

Lateral and medial plantar nerves are branches of what nerve?

A

Tibial nerve

161
Q

Common fibular nerve branches into what nerves? What fibers do they carry?

A

Goes around head of tibia and splits into superficial and deep fibular nerve.

162
Q

Describe the shape of the trochlea of talus

A

Trochlea of talus is narrow posteriorly and broad anteriorly.

163
Q

Deltoid ligament and what movement it resists

A

Extends medial side of ankle btwn tibia and tarsal bones.

Limit outward movements (eversion) of the entire foot.

164
Q

Which ligament(s) extend on the lateral side of the ankle and named on basis of their attachments? What do they do?

A
  1. Anterior talofibular
  2. Posterior talofibular
  3. Calcaneofibular

Limit inward movements (inversion) of the foot.

165
Q

What is the most common ankle sprain?

A

Forced inversion (with plantarflexion) damaging anterior talofibular ligament.

166
Q

What kind of joint is ankle joint (aka talocrural)? What are their movements and axis?

A

Uniaxial joint btwn medial and lateral malleoli of tibia and fibula, and trochlea of talus.

Dorsiflexion (extension) and plantarflexion (flexion) around transverse axis.

167
Q

Subtalar joint

A

Btwn talus and calcaneus.

Inversion and eversion around oblique axis.

168
Q

Transverse tarsal joint

A

Actually 2 joints:

  • Talonavicular joint
  • Calcaneocuboid joint

Pronation and supination around longitudinal axis (it is most reasonable to consider only inversion and eversion)

169
Q

Extensor retinacula

A

Thickenings of crural fascia that all anterior leg compartment muscle tendons must pass deep to. Prevents bowstringing of tendons.

170
Q

What type of contraction do plantarflexors use? What movement are they doing?

A

Concentric contraction to lift heel off of ground and accelerate mass of body.

171
Q

What is the most powerful plantarflexor?

A

Gastrocnemius

172
Q

What is the more “postural” plantarflexor muscle?

A

Soleus

173
Q

What is a result of weakness/loss of superficial plantarflexors?

A

No heel push off and can’t run or jump. Deep posterior leg muscles are not strong enough to push calcaneus off the ground.

174
Q

Which dorsiflexor muscle is active throughout gait cycle? What kind of contractions does it do throughout the gait cycle?

A

Tibialis anterior

Eccentric contraction: heel strike and beginning of stance phase

Concentric contraction: end of stance phase

Isometric contraction: keep toes up off ground in swing phase

175
Q

Shin splints

A

Muscle fibers become dedtached from tibia. Tears in periosteum and slight compartment syndrome.

Extended overexertion can lead to tibial microfractures (build up of microfractures can lead to traumatic fracture).

176
Q

Foot drop/steppage gait

A

Damage to deep fibular nerve affects tibialis anterior which results in inability to dorsiflex foot. Foot drags during swing phase (can’t isometrically contract) and slaps down during heel strike (can’t eccentrically contract).

177
Q

What is a result of weakness/loss of invertors?

A

Foot will be more everted; loss of tibialis anterior will lead to some foot drop.

178
Q

What is a result of weakness/loss of evertors? What is a way to treat this?

A

Ankle instability and problems w/ arches.
Potential for ankle sprains.

Split tibialis anterior tendon transfer (transfer portion of tibialis anterior tendon from medial attachment to lateral attachment to help provide some ability to evert)

179
Q

Clunial nerves

A

Provides cutaneous innervation to posterior gluteal region.

Not part of gluteal nerves.

180
Q

Where’s the midline and axis for abduction/adduction of the tarsals?

A

Midline to the 2nd digit.

Vertical axis.

181
Q

What bones do we stand on? What are the arches of the feet?

A

Stand on:
Head of 1st metatarsal
Head of 5th metatarsal
Calcaneal tuberosity

Arches:
Transverse arch
Medial longitudinal arch
Lateral longitudinal arch

182
Q

Describe passive and active support of arches of the foot

A

Passive: bone (“keystone”) and ligaments (tie bone together)
Active: muscles contracting to pull end of arches together

183
Q

Ligaments of the foot that support the arch

A 
Calcaneonavicular (spring) ligament
Long and short plantar ligaments
Plantar aponeurosis (not a ligament technically, but helps arch)
184
Q

Muscles of the foot that support the arch

A

Fibularis longus
Tibialis posterior
Flexor digtiorum longus
Flexor hallucis longus

185
Q

Arch problems

A

High arches
Splayfoot (fallen transverse arch)
Flat foot (fallen longitudinal arch)

186
Q

Synovial cavity of the knee joint capsule excludes what structures?

A

Synovial cavity is continuous btwn the 2 joints inside fibrous joint capsule and excludes intracapsular ligaments and infrapatellar fat pad.

UW Madison Anatomy (3 decks)

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