Week 4 Flashcards
1
Q
What is the pelvic girdle composed of?
A
Inominate bones: ilium, iscium, pubis
2
Q
Gluteal vs femoral vs leg vs foot region?
A
Gluteal = buttocks and hip
Femoral = femor
Leg = knee to ankle
Foot = ankle onwards
3
Q
Lateral vs medial rotation in leg? Abduction vs adduction?
A
4
Q
Inversion vs eversion in foot? Dorsi vs plantar flexion?
A
5
Q
Pelvic girdle function? Structure and joints?
A
Connects vertebral column to femurs
Stronger and less flexible than shoulder girdle
3 bones: L/R hip bones and sacrum
Sacroiliac, lumbrosacral, sacrococcygeal and pubic symphysis joints
6
Q
Joint type of lumbrosacral joint>
A
Synovial
7
Q
Joint type of sacroiliac joint?
A
Synovial plane joint
8
Q
Joint type of sacrococcygeal joint?
A
Secondary cartilaginous joint
9
Q
Joint type of pubic symphysis?
A
Secondary cartilaginous
10
Q
Label this
A
11
Q
What is the acetabulum formed by fusion of?
A
Ilium, iscium and pubis bones
12
Q
Label this
A
13
Q
What is the acetabulum?
A
Socket in hip bone articulating with femur to form hip joint
14
Q
Where is ischium in relation to hip?
A
Posterior
You sit on it
15
Q
What is the hip joint? Characteristics?
A
Ball and socket synovial joint between femoral head and acetabulum of inominate bone
Very stable. Good congruency between articular surfaces
Scarifices mobility for stability
16
Q
Function of acetabular labrum?
A
Deepends socket of acetabulum for better congruency
17
Q
Function of fovea of femur?
A
Shallow depression on femoral head not covered by articular cartilage
Where round ligament/ligamentum teres passes through. Also had artery to femoral head
18
Q
What is the lunate surface of the acetabulum?
A
Articular area of acetabulum
19
Q
What is the lunate surface of the acetabulum?
A
Articular area of acetabulum
19
Q
What is the lunate surface of the acetabulum?
A
Articular area of acetabulum
20
Q
Transevrse acetabular ligament function?
A
Portion of acetabular labrum with no cartilage
Strong flattened fibres converting labrum into formamen where arteries can pass through
Prevents displacement of femoral head
21
Q
Which artery supplies the acetabulum?
A
Obturator artery through acetabular notch
22
Q
Acetabular notch function?
A
Deep notch in acetabulum
Nutrient vessels travel through
23
Q
Label this
A
24
Structure of hip joint ligaments?
Capsular thickenings forming a spiral around the hip
25
3 hip joint ligaments?
Iliofemoral
Pubofemoral
Ischiofemoral
26
Iliofemoral ligament structure and function?
Covers hip joint superiorly and anteriorly
Strongest ligament in body
Prevents hyperextension of hip when standing
27
Pubofemoral ligament s and f?
Covers hip joint anteriorly and inferiorly
Prevents excessive abduction
28
Ischiofemoral ligament s and f?
Covers hip joint posteriorly
Weakest ligament
Limits internal rotation of hip
28
Importance of artery to head of femur in kids vs adults?
Kids - main blood supply so dangerous if damaged
Adults - not as important as has other blood supplies
29
Movements of hip joint?
Extension/flexion
Abduction, adduction
Internal (shy) / external rotation
30
Where is the lumbosacral plexus?
L1-S4
31
3 major nerves for motor sensory innervation of lower limb?
Femoral: L234
Obturator: L234
Sciatic: L4-S3
32
Which nerves are these?
33
Gluteus maximus:
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Posterior surface of ileum, sacrum, coccyx. Thoracolumbar aponeurosis. Sacrotuberal ligament.
2. Iliotibial tract (cranial portion). Gluteal tuberosity of femur (caudal portion).
3. Main extensor of thigh. Only used when force is required aka running/climbing. Cranial portion does abduction.
4. Inferior AND SUPERIOR gluteal nerve.
34
Gluteus medius:
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Fan shaped and lies between gluteus maximus and gluteus minimus. Posterior surface of ileum.
2. Lateral surface of greater trochanter.
3. Abduction and medial rotation of lower limb.
4. Superior gluteal nerve.
35
Gluteus minimus:
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Ileum, converges to form tendon.
2. Anterior greater trochanter.
3. Abudction and medial rotation of lower limb.
4. Superior gluteal nerve.
36
Piriformis:
- Origin?
- Insertion?
- Actions?
- Innervation?
Most superior of deep muscles.
1. Anterior sacrum. Fibres travel through great sciatic foramen.
2. Medial Greater trochanter of femur.
3. Lateral rotation and abduction.
4. Nerve to piriformis.
37
Obturator internus:
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Obturatory membrane.
2. Tronchanteric fossa.
3. Lateral rotation and abduction.
4. Nerve to obturatory internus.
38
3 deep gluteal muscles?
Gluteus medius
Gluteus minimus
Piriformis
Obturator internus
Quadratus femoris
Gemelli
39
Name the nerves and muscles? What are these nerves named in accordance to?
Named in accordance to where they are in reference to piriformus
40
Quadratus femoris
- Origin?
- Insertion?
- Actions?
- Innervation?
Most inferior of deep muscles below gemelli and obturatory internus. Square and flat.
1. Lateral iscial tuberosity.
2. Quadrate tuberosity on intertrochanteric crest.
3. Lateral rotation.
4. Nerve to quadratus femoris.
41
Gemelli
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Superior gemellus: ischial spine. Inferior gemellus: ischial tuberosity.
2. Greater trochanter of femur.
3. Lateral rotation, abduction.
4. Suoperior: nerve to obturator internus
Inferior: nerve to quadratus femoris
42
Which tendon seperates the gemelli?
Obturator internus tendon
43
Where is a safe area for intramuscular injections in the glutes?
Draw a cross on glutes
Inject on upper right quadrant
Avoids sciatic nerve
44
What is the sacrotuberal ligament?
Connects sacrum to iliac tuberosities
45
What is the trendelenburg test? other reasons for this?
Detects weakness of gluteus medius and minimus
1. ask patient to stand on each leg in turn
2. observe pelvis for any tilt. Normal individuals the pelvis will be level.
3. when weight bearing on affected hip, pelvis on opposite side drops and body leans away from affected side.
4. May be due to hip dislocations/arthritis
46
Tensor fascia latae
- Descritption?
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Small superficial muscle on anterior iliac crest, Tightens fascia lata.
2. Anterior iliac crest.
3. Iliotibial tract.
4. Assists gluteus medius and minimus in abduction and medial rotation of lower limb. Also helps with venous return.
4. Superior gluteal nerve.
47
What is the iliotibial tract?
Fibrous reinforcement of fascia lata
48
What is the great sciatic foramen?
Opening in pelvis where piriformis passes through
49
Medial rotators of lower limb?
Gluteus medius and tensor fascia latae
50
Lateral rotators of lower limb?
Gluteus minimus, piriformis, obturator internus
51
What is the obturatory membrane?
Thin fibrous sheet connecting obturator muscles
52
What is the trochanteric fossa?
Deep depression in greater trochanter where muscles inseert
53
Label this
54
What is in the anteiror compartment of the thigh? Nerve innervation?
Hip flexors, knee extensors
Femoral nerve
55
Hip flexors?
Pectineus
Sartorius
Iliopsoas
Quadriceps
Rectus femoris
56
Knee extensors?
Quadriceps
57
What is in the medial compartment of the thigh? Innervation?
Adductors
Obturator nerve
58
Adductors of the lower limb?
Pectineus
Gracilis
Adductor magnus (anterior)
59
What is special about pectineus and adductor magnus?
Have involvement in 2 thigh compartments, 2 functions and dual nerve supply
60
What is in the posterior thigh? Innervation?
Hip extensors, knee flexors
Sciatic nerve
61
Hip extensors?
Hamstrings
Posterior adductor magnus
62
Knee flexors?
Hamstrings
63
Rectus femoris
- Origin?
- Insertion?
- Actions?
- Innervation?
Anterior thigh, crosses hip and knee joint.
1. Anteror inferior iliac spine.
2. Patella. Tibial tuberosity. Patellar ligament attaches patella to tibial tuberosity.
3. Knee extension, hip flexion.
4. Femoral nerve.
64
Iliopsoas
- Origin?
- Insertion?
- Actions?
- Innervation?
2 seperate muscles, psoas major/minor, iliacus.
1. Iliacus: iliac fossa, anterior inferior iliac spine, anterior hip joint capsule.
Psoas major: T12-L4
Psoas minor: T12-L1
2. Iliacus and psoas major: femur (trochanter minor, medial labrum of linea aspera)
Psoas minor: iliopectineal arch, fascial layers of psoas major
3. Flexion of hip
4. Femoral nerve
65
Sartorius
- Origin?
- Insertion?
- Actions?
- Innervation?
Long and thin anterior muscle
1. Anterior superior iliac spine
2. Pes anserinus
3. flexion at hip and knee
4. Femoral nerve
66
Pectineus
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Pubis bone
2. Pectineal line
3. Flexion at hip joint and adduction
4. Femoral nerve
67
Gracilius
- Origin?
- Insertion?
- Actions?
- Innervation?
1. pubic bone, inferior ramus of pubis
2. pes anserinus
3. adduction
4. Obturator nerved
68
Adductor longus
- Origin?
- Insertion?
- Actions?
- Innervation?
1. Pubic bone. Superior ramus of pubis and symphysis.
2. linea aspera
3. adduction
4. obturator nerve
69
Adductor magnus
- Origin?
- Insertion?
- Actions?
- Innervation?
1. pubic bone inferior ramus
2. linea aspera
3. adduction
4. obturator nerve
70
Biceps femoris long head
- Origin?
- Insertion?
- Actions?
- Innervation?
1. ischial tuberosity
2. head of fibula
3. extensor of hip
4. sciatic nerve
71
semitendinosis
- Origin?
- Insertion?
- Actions?
- Innervation?
1. iscial tuberosity
2. pes anserinus
3. hip extension
4. sciatic nerve
72
semimembranosus
- Origin?
- Insertion?
- Actions?
- Innervation?
1. ischial tuberosity
2. medial condyle of tibia
3. hip extension
4. sciatic nerve
73
Adductor magnus hamstring portion
- Origin?
- Insertion?
- Actions?
- Innervation?
1. ischial tuberosity
2. adductor tubercle
3. hip extension
4. sciatic nerve
74
4 hamstring extensor?
Biceps femoris long head
Semitendinosis
Semimembranosus
Adductor magnus hamstring portion
75
What does abdominal aorta artery split into?
Common iliac R
R internal iliac
R external iliac
76
Internal iliac bracnhes?
Superior and inferior gluteal arteries
77
What does the R external iliac artery become when it passes under the R inigual ligament?
Femoral artery
Becomes anterior tibial
Becomes dorsalis pedis
78
What does femoral artery become when passing through adductor hiatus?
Popliteal artery
Dvides into posterior tibial and fibular artery
Then becomes medial and lateral plantar
79
Where is the inigual ligament?
Between ASIS and pubic tubercle
Gateway from abdromen to lower limb
When external iliac passes under becomes femoral artery
80
Name these structures
81
Name these structures
82
Name contents of femoral triangle laterally to medially
Nerve
Artery
Vein
Lymphatics
83
What can happen at the femur and inigual ligament?
Hernias
84
Knee joint type and structure?
Synovial hinge joint
Femoral condyles
Tibial plateaus
Patella
85
3 knee articulations?
2x tibiofemoral , medially and laterally
1x patellofemoral
86
Function and not functions of fibula?
Not involved in knee joint
Little role in weightbearing
Muscle attachment role
Contributes to ankle joint
Biceps femoris attaches here
86
Why is the knee joint unstable? When is it most stable and why?
Articulating surfaces are incongruent
Most stable when extended as flattest surfaces are in contact
87
What are the menisci? Function?
C shaped wedges of fibrocartilage medially and laterally
Improve the congruency between articular surfaces
88
Where do the medial and lateral meniscus attach?
M - attached around its border to joint capsule and to tibial collaterla ligament
L - unnattached to capsule making it more mobile
89
Functions of menisci?
Accomodate shape changes during movement
Shock absorbers
Joint nutrition and lubrication
Assist locking mechanism
90
How are menisci connected?
Anteriorly by a tranverse ligament of the knee
91
What is the lateral meniscus connected to?
Tendon of popliteus muscle
Passes superolaterally between this meniscus and the capsule to insert on the femur
92
How are menisci thought to work?
Menisci may compress synovial fluid into articular cartilage to reduce friction
93
What are microcanals in menusci?
Located closley to blood vessels
Provide fluid transport for nutrition and joint lubrication
Communication with synovial cavity
94
Which menisci is torn most often and how? What is the unhappy triad?
Medial injured more by direct blow to the side of the knee
When medial is injured usually Anterior Cruiciate Ligament ACL and Medial Collateral Ligament MCL will also be injured
95
Vascularisation of mensici? Probelms?
Outer 1/3 vascularised
Inner 2/3 recieves nourishment from synovial fluid meaning it has a limited healing ability
96
What is meniscus removal a risk factor for?
Osteoarthritis
97
What can allow you to be a menisci donor>
No family history of osteoarthritis
98
Positioning of cruciate ligaments?
Cross each other in the centre of the knee
Cruiciate = cross
99
Where is the ACL attached and insert? Function?
O - anterior intercondylar region of tibia
I - travels superoposteriorly to insert on lateral femoral condyle
Prevents hyper extension
100
Which of the ACL and PCL is weaker?
ACL
101
PCL origin and insertion? Functions?
O - posterior intercondylar region of tibia
I - travels superoanteriorly to insert only medial femoral condyle
Prevents hyperflexion of knee
Prevents posterior displacement of tibia on femur
Stabilises flexed knee when weight bearing e.g. walking downhill
102
What are the intra vs extra articular ligaments?
Intra - ACL, MCL
Extra - fibular/tibial collateral ligament
103
Fibular collateral ligament origin and insertion? Structure?
O - lateral epicondyle of femur
I - lateral fibula
Thin and cordlike
Seperate from joint capsule
104
Tibial collateral ligament origin and insertion? Structure
O - medial femoral epicondyle
I - medial tibia
Broad and flat
Attached to joint capsule and medial meniscus
105
Extra articular ligaments function?
Prevent rotation during extension of the knee
Stability while standing
106
What is most important in stabilising the knee?
Muscles
107
Muscles stabilising the knee?
Quadriceps
Hamstrings
Gracilis
Sartorius
Iliotibial tract
Popliteus
108
How are many sport injuries preventable? Why?
Approportiate conditioning and training escpeically of the quadriceps
Knee koint can function well after ligament sprain if quadriceps are well conditioned
Building up quadriceps through physio can compensate for damage to ligaments menaing you dont need surgery
109
What are some components of the locking mechanism?
Muscles e.g. quads
Medial rotation of femur on tibia during extension (this tightens all assoctaed ligaments)
Bodys centre of gravity is positioned along vertical line passing anterior to knee joint
110
How does the knee unlock?
]Politeus muscle initiates lateral rotation of the femur on the tibia
111
Difference in alignment between femur and tibia?
Femur diagonal
Tibia vertical
112
What is the obliquity of the femur dependent on?
Angle of inclination (126 degrees) between neck and shaft of femur
113
What is the Q angle?
Angle between femur and tibia 15 degrees
114
How can the angle of inclincation be measured?
Draw line from ASIS to middle of patella
Draw another vertical line through patella and tibial tuberosity
115
Q angle function?
Allows knee to be positioned underneath hip and distrubutes weight evenly across the knee
116
Why are the joints and muscles of the lower limb arranged in such a way?
To minimise muscular activity
Person normally stands with feet slightly apart and rotated laterally = only a few back and lower limb muscles are active
117
Positions of bones in stand easy position?
Knee and hip joints extended to be most stable (max contact of articulating surfaces, ligaments taut)
Knee is locked when extended because of medial rotations of femoral condyles of tibial plateau
Allows lower limb weight bearing
Knee locking makes thigh and leg muscles relaxed
118
How is weight transferred through the body?
Vertebral column to sacroiliac joints to pelvic girdle to hip joints to femurs
119
Why are femurs oblique?
So the knee is inferior to the trunk
120
What is genu varum?
Bow leg
Angle between longitudinal axes of bones <17 degrees, decreased Q angle
Tibia adducted with respect to femur
121
What is genu valgum?
Knock knee
Angle between longitudinal axes of bones >17 degrees
Tibia abducted with respect to femur
122
2 directions of embryonic folding? Driven?
Lateral: driven by somites
Cephalocaudal: driven by CNS
123
How does embryo folding occur?
Simeltaneously
Close body wall of embryo
Create tube like structure
124
How does the embryo change in week 4?
Mesoderm growth and CNS development helps change embryo shape by folding
Close body wall of embryo to become tube
Head and tail of embryo bend towards each other to create C shape
Allows next stage of develipment
125
What colours are each layer of trilaminar embryo usually?
Blue = ectoderm
Red= mesoderm
Yellow = endoderm
126
Identify:
1. neural tube
2. surface ectoderm
3. extra embryonic ectoderm
4. amniotic cavity
5. notochord
127
What actually happens when a womans water breaks?
Amniotic membrane ruptures and fluid comes out
128
Marginal vs mantle zone of neural tube?
Marginal: white edges of neural tube, future white matter, grow from neuroblasts
Mantle: proliferating neuroblasts doing mitosis, future grey matter
129
Identify these
Blue = block of somites, other pair on opposit side
Red = dermomyotome
130
Identify this
Intermediate mesoderm
131
Identify this
Aorta with blood cells
132
What are the arrows pointing to
Somatic lateral plate mesoderm
133
Identify the structures ? what is happening here
Somatic LPM most superior
Next down is coelom
Next down is splanchnic LPM
Endo derm inside
somatic LPM is fusing to close the body wall of the embryo
134
What is the coelom?
Body cavity for organs
135
What is the splanchnic LPM continuous with?
Endoderm
136
Identify the structures? what are holes
splanchnic LPM
endoderm
yolk sac
ducts/vessels
137
What hapens to a structure in week 17-18 when embryo closes?
Yolk sac pinched off
138
What is appositional growth?
Surface growth
Increase in girth/width of bone
Development/fractures
Chondrocytes deposit collagen matrix beneath periosteam and add bone widthwise
139
What is interstitial growth?
Length increase
Growth plate cartilage model from growth until puberty
140
What is endochondral ossification?
Cartilage model laid down as precursor to bone
141
WHat is intramembranous ossification? what does it allow? how does it begin?
Condensation of mesenchyme straight to bone (mesenchymal stem cells)
bones of skull/face
appositional growth of long bones
142
What is mesenchyme?
Connective tissue formed from mesoderm
Migratory and stem cell population for musculoskeletal system
143
WHat are osteoprogenitor cells?
stem cells in bone
precursors to more specialised osteocytes/blasts
differentiate from mesenchymal stem cells
144
What is the myotome?
part of somite forming muscles
145
Steps of intramembranous ossification?
1. condensation of mesenchymal stem cells
2. they proliferate and undergo morpholical change
3. differentiate into osteoprogenitor cells then osteoblasts
4. osteogenic cells deposit bone matrix arranged in bony spicules
5. differentiating osteoblasts arrange themselves along spicules and secrete more bone matrix
6. as more matrix is laid down the spicules increase in size and fuse
7. spicules form trabeculae
146
What is the metaphysis?
Unites epiphyses and diaphyses in long bone
Find growth plate here
147
How long is fetal crown rump length at 24 weeks?
200mm
148
Steps of endochondral bone growth?
1. mesenchyme developed first
2. chondrocytes lay down cartilage matrix
3. chondrocytes start to calcify = less nutrients are able to pass in and out of bone
4. chondrocytes degenerate
5. blood vessels invade spaces left behind where chondrocytes have degenerated and become primary ossification centres
6. blood vessels bring in osteogenic cells which differentiate into osteoblasts which lay down bone on top of calcified cartilage matrix
7. bone marrow forms laying down more osteogenic cells
8. blood vessels invade epiphyses forming secondary ossification centres
9. cartilage remains at joint edges for bone articulation
149
Why does metaphysis remain cartilagionous?
Growth plate is here allowing growth through childhood
150
What colours do bone and cartilage stain?
Bone = red/pink with H and E
Cartilage = blue with alcian blue
151
Name each section and describe what occurs? direction?
1. resting cartilage
2. proliferation of chondrocytes, chondrocytes become ordered and stacked
3. maturation, no more mitosis
4. zone of hypertrophy, cells get bigger, vacuoles form, calcified matrix laid down
5. cartilage degeneration
6. osteogenic activity, resorption of unncessesary cells
from epiphyses to diaphyses
152
Osteoclast structure? Where are they derived from?
multinucleated and large, ruffled border
blood monocytes/macrophages which are derived from hamatopoetic stem cells in bone marrow
153
How are precursors often released? WHere do tey collect?
Released as monocytes into bloodstream
Collect at sites of bone resorption where they fuse to form multinucleated osteoclaasts and stick to bone surface
154
Priminent aspects of osteoclasts? What do they secrte? Why?
Golgi apparatus and vesicles as theyre secereotry
Secrete enzymes e.g. carbonic anhydrase, This acidifies matrix and makes it decalcify and hydrolyses to break down matrix
155
wHERE ARE OSTEOCLASTS DERIVED?
osteoprogenitor cells from mesenchymal stem cells
small cells
156
Shown?
osteoblasts
osteoid
157
Shown?
lacunae
osteocytes
158
Shown?
Osteoclasts
Howships lacuna
159
What is howships lacuna
groove/cavity containing osteoclasts
160
What is the amnion a continuation of?
Ectoderm
161
How does the circultory system contribute to homeostasis?
Delivery of nutrients and oxygen via blood from one part of body to another
162
Artery function?
Carry oxygenated blood away from heart
Pressure reservoir
163
Capillary bed function?
area of exchange of water, oxygen, nutrients, between blood
164
Venules/vein function?
Hihgly distensible
return oxygen depleted blood back to heart and lungs
