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MD2002 Arvin > Elbow and Knee Joints > Flashcards

Elbow and Knee Joints Flashcards

1
Q

Which kind of joint are elbow and knee joints ?

A

Hinge Joints

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2
Q

What are some characteristics of all hinge joints ?

A
  • articular surfaces are reciprocally shaped
  • strong collateral ligaments
  • muscles are grouped at the sides of the joint where they do not interfere with movement
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3
Q

What are the 2 joints making up the elbow joint ?

A

Humero-radial and humero-ulnar joints

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4
Q

What movements does the proximal radio-ulnar joint allow for?

A

Supination and pronation

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5
Q

The knee joint allows for free movement in how many planes ?

A

One plane

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6
Q

Describe the main features of the elbow joint capsule.

A
  • Single fibrous capsule for 3 joints
  • lined by synovial membrane
  • attaches to the articular margins
  • strengthened by radial and ulnar collateral ligaments
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7
Q

What are the weak areas of the elbow joint capsule ?

A

Capsule is weaker anteriorly and posteriorly

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8
Q

Does the radial collateral ligament attach to the radius ?

A

No

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9
Q

What are ligaments surrounding the elbow joint ? What is the role of each ?

A

Anular ligament: holds the radial head in place, but allows its rotatory movement for supination and pronation

Interosseal membrane: holds the radius and ulna together and transmits forces from the radius to the ulna; muscle attachment

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10
Q

What is the possible result of an excessively forceful pull on the hand ?

A

Dislocation of the radial head from the anular ligament

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11
Q

Which joints are in use during pronation and supination ?

A

Proximal and distal radio-ulnar joints

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12
Q

Describe the main features of the knee joint capsule.

A
  • fibrous
  • lined by synovial membrane
  • attaches to the articular margins
  • has collateral ligaments supporting the sides of the joint
  • has intra- articular ligaments and cartilages
  • INCOMPLETE (Anteriorly, replaced by the quadriceps tendon (patellar ligament), the patella and fat pads on either side of patellar ligament)
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13
Q

What are the augmentations of the knee joint capsule ?

A
  • ANTERIORLY, by the iliotibial tract and patellar retinacula from quadriceps
  • POSTERIORLY, by the oblique popliteal ligament (expansion of the semimembranous) and the arcuate popliteal ligament
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14
Q

What bursaes communicate with the articular cavity of the knee joint ?

A
  • Suprapatellar bursa
  • popliteus bursa
  • anserine bursa
  • gastrocnemius bursa
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15
Q

What are the collateral ligaments of the knee joint ? What is their respective role ? Where do they extent from, and where do they extend to ? Are they fused to the joint capsule (if yes, anything else they are fused to ?) ?

A

Lateral (Fibular) ligament:

  • prevents adduction of leg
  • from Lateral femoral epicondyle to Head of fibula
  • Not fused to joint capsule

Medial (Tibial) ligament:

  • prevents abduction of leg
  • from Medial femoral epicondyle to Tibial condyle
  • fused to joint capsule and medial meniscus
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16
Q

Where is the tendon of popliteus found ?

A

Between the lateral fibular ligament and the knee capsule

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17
Q

Allocate each of the following characteristics to either medial, or lateral collateral ligament of the knee: broad, strong, flat

A

Medial collateral ligament: broad, flat

Lateral collateral ligament: strong

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18
Q

How many menisci are there around the knee joint ? What is their names ?

A

2

Medial meniscus and Lateral meniscus

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19
Q

Which connective tissue are menisci usually made of ?

A

Fibrocartillage

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20
Q

What are the functions of the medial and lateral menisci of the knee ?

A
  • Increase the congruence of articular surfaces
  • Dissipate the forces/stress on articular cartilage
  • Absorb shock
  • Decrease friction
  • Participate in locking of knees
  • Proprioception
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21
Q

Where, and how are the medial and lateral menisci of the knee connected ?

A

Anteriorly, by the transverse ligament of the knee

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22
Q

Where do the medial and lateral menisci of the knee move during flexion and extension of the knee?

A

They move antero-posteriorly

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23
Q

Describe the vascularity of the menisci of the knee.

A

Inner 2/3 is avascular, outer 1/3 partially vascular

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24
Q

Where are the horns of the menisci of the knee attached to ?

A

To the intercondylar region of the tibial plateau

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25
Q

What are surrounding structures attached to the medial and lateral menisci of the knee respectively ?

A

Medial meniscus: to the joint capsule AND to the medial collateral ligament

Lateral meniscus: to the joint capsule and to the tendon of the popliteus muscle but NOT to the lateral collateral ligament

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26
Q

Where does the Meniscofemoral ligaments extend from and to ?

A

From the posterior horn of lateral meniscus, to medial condyle of femur

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27
Q

What are the two cruciate ligaments of the knee called ?

A

Anterior and posterior cruciate ligaments

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28
Q

What are the functions of the anterior and posterior cruciate ligaments respectively ?

A

Anterior cruciate ligament:

  • Prevents anterior movement of tibia and hyperextension
  • Act as a pivot for rotatory movements between the bones

Posterior cruciate ligament:

  • Prevents posterior movement of tibia (walking downhill)
  • Act as a pivot for rotatory movements between the bones
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29
Q

True or false: Parts of the cruciate ligaments of the knee are taut in all positions of the joint.

A

True

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30
Q

What do the Q-angle and the Carrying angle refer to respectively ?

A

Q-angle: angle between the anatomical axis of the femur and that of the tibia

Carrying angle: angle between the long axes of arm and forearm.

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31
Q

Is the carrying angle more pronounced in males or females ? Why ?

A

More pronounced in the female to account for the wider pelvis

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32
Q

What is the carrying angle approximately equal to, in males, and in females ?

A

10-15 degrees in males

>15 degrees in females

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33
Q

Where do flexors of the elbow and knee pass, relative to the elbow and knee joint respectively ?

A

Anterior to the elbow joint

Posterior to the knee koint

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34
Q

What are the flexors of the elbow ?

A

Main: Brachialis (and control the extension produced by gravity)

Also: Brachioradialis (when the forearm is midway between pronation and supination), Biceps brachii (esp. when supinated), Pronator teres and the wrist/digit flexors (Palmaris longus, flexor carpi radialis, flexor digitorum superficialis)

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35
Q

What is the major flexor origin ?

A

Medial epicondyle

36
Q

What is another movement enabled by biceps brachii, besides flexion of the elbow ?

A

Supination

37
Q

Name the origin and insertion of the main flexors of the elbow.

A

BRACHIALIS
Origin: Distal half of anterior surface of humerus
Insertion: Coronoid process and tuberosity of ulna

BICEPS BRACHII:
Origin: Short head: Coracoid process of scapula Long head: supraglenoid tubercle of scapula
Insertion: Tuberosity of radius and fascia of forearm via bicipital aponeurosis (lacertus fibrosus)

BRACHIORADIALIS:
Origin: Proximal part of lateral supraepicondylar ridge of humerus
Insertion: Distal end of the radius just proximal to the radial styloid process

PRONATOR TERES

38
Q

How are the flexors of the elbow innervated ?

A

Supplied by the musculocutaneous nerve except Brachioradialis (radial nerve) and pronator teres

39
Q

True or False: Brachioradialis is the only muscle supplied by the radial nerve that brings about flexion.

A

True

40
Q

What are the extensors of the elbow ?

A

Main: Triceps Brachii (but gravity takes over most of the time)
Also: Anconeus, Superficial forearm extensors (Extensors carpi radialis longus and brevis, Extensor carpi ulnaris, Extensors digitorum and digiti minimi)

41
Q

What is another function of the long head of the triceps (besides extension of the elbow) ?

A

Preventing dislocation of the abducted shoulder

42
Q

What is the name of the indentation between lateral and medial heads of triceps ?

A

Radial (spiral) groove of humerus

Radial nerve and Profunda brachii artery

43
Q

What is the origin and insertion of the extensors of the elbow ?

A

TRICEPS
Origin: Long head: infraglenoid tubercle of scapula Lateral head: posterior surface of humerus, superior and lateral to the radial groove Medial head: posterior surface of humerus, medial and inferior to the radial groove
Insertion: Olecranon

ANCONEUS
Origin: Lateral epicondyle of humerus
Insertion: Lateral surface of olecranon and superior part of posterior surface of ulna

44
Q

How are extensors of the elbow innervated ?

A

Supplied by the radial nerve (including the superficial forearm extensors)

45
Q

Which structures keep the radius in place ?

A

Anular ligament, the interosseous membrane and the inferior radio-ulnar joint

46
Q

What are the pronators of the elbow ? Which one initiates pronation ?

A

Pronator Teres and Pronator Quadratus (initiates it)

47
Q

What are the supinators of the elbow ?

A

Main: Biceps Brachii
Also: Supinator

48
Q

What is the origin and insertion of the pronators of the elbow ?

A

PRONATOR TERES
-Origin:
Ulnar head- coronoid process of ulna
Humeral head- Medial epicondyle of humerus

-Insertion: Middle of convexity of lateral surface of radius

PRONATOR QUADRATUS
-Origin: Distal quarter of anterior surface of ulna

-Insertion: Distal quarter of anterior surface of radius

49
Q

What is the origin and insertion of the supinators of the elbow ?

A

SUPINATOR:

  • Origin: Lateral epicondyle of humerus, radial collateral and anular ligaments, supinator fossa, crest of ulna
  • Insertion: Lateral, posterior, and anterior surfaces of proximal third of radius

BICEPS BRACHII:
Origin: Short head: Coracoid process of scapula Long head: supraglenoid tubercle of scapula
Insertion: Tuberosity of radius and fascia of forearm via bicipital aponeurosis (lacertus fibrosus)

50
Q

How are the pronators of the elbow innervated ?

A

Median Nerve

51
Q

How are the supinators of the elbow innervated ?

A

Supinator muscle is supplied by radial nerve

Biceps brachii is innervated by musculocutaneous nerve

52
Q

What is the most powerful supinator when the elbow is flexed ?

A

Biceps Brachii

53
Q

Which structure passes through supinator muscle ?

A

Deep branch of the radial nerve

54
Q

List the structures present in the antecubital fossa, lateral to medial.

A
  • biceps brachii tendon
  • brachial artery and vein
  • median nerve
  • superficial veins (median cubital vein)
55
Q

What are the main movements at the knee ?

A

Flexion and Extension

56
Q

What other movements may take place at the knee when the knee is in a semiflexed position and the foot is off the ground ?

A

Medial and lateral rotation of the tibia with respect to the femur

57
Q

True or false: Long muscles acting across two joints (e.g. the hamstrings, rectus femoris) can only work efficiently across one joint at a time.

A

True

58
Q

What are the flexors of the knee ?

A 
Biceps femoris
Semitendinosus
Semimembranosus
Gastrocnemius
Gracilis
Sartorius
Plantaris
59
Q

What is the origin and insertion of the flexors of the knee ?

A

BICEPS FEMORIS
Long Head-
Origin: Ischial tuberosity
Insertion: Lateral side of the head of the fibula

Short Head-
Origin: linea aspera and lateral supracondylar line of femur
Insertion: lateral side of the head of the fibula

SEMITENDINOUS
Origin: ischial tuberosity
Insertion: medial surface of tibia

SEMIMEMBRANEOUS
Origin: ischial tuberosity
Insertion: medial tibial condyle

GASTROCNEMIUS
Origin:
Lateral head- lateral aspect of lateral condyle of femur
Medial head- popliteal surface of femur, superior to medial condyle
Insertion: Posterior surface of calcaneus via calcaneal tendon

GRACILIS and SARTORIUS
Origin: pelvis
Insertion: upper, medial tibia

PLANTARIS
Origin: Inferior end of lateral supracondylar line of femur and oblique popliteal ligament
Insertion: Posterior surface of calcaneus via calcaneal tendon

60
Q

What is the main movement enabled my gastrocnemius, besides knee flexion ? How come it also flexes the knee ?

A

Plantar flexor of the ankle

Because it is attached to the femur (its origin)

61
Q

What are the hamstring muscles ?

A

Semimembranous, semitendinous, biceps femoris

62
Q

What movements do the hamstring muscles allow for ?

A

Flexion of the knee

Extension of hip

63
Q

Which type of flexion exactly does the GASTROCNEMIUS muscle function in ?

A

When the foot is fixed and the person kneels down

64
Q

What muscles is the Pes Anserinus muscle group made of ?

A

Semiteninosus, Gracilis, Sartorius

65
Q

What is the function of Pes Anserinus as a muscle group ?

A

Adds significant dynamic stability to the medial

side of the knee

66
Q

Where do the muscles of Pes Anserinus attach, relative to the medial-lateral axis of rotation of the knee ?

A

Posterior to it

67
Q

What is the structure that Gluteus Maximus and Tensor Fasciae Latae insert into ?

A

The iliotibaial tract

68
Q

What movements of the knee do the gluteus maximus and tensor fasciae latae facilitate ?

A

They support the knee in extension, until the hamstrings flex the knee
May also augment flexion

69
Q

What are the extensors of the knee ?

A

Main: Quadriceps femoris
Also: Gluteus Maximus, Tensor Fascia Latae

70
Q

What is the origin and insertion of the extensors of the knee ?

A

QUADRICEPS FEMORIS
Origin:
Rectus femoris- Anterior inferior iliac spine and ilium superior to acetabulum
Vastus lateralis- Greater trochanter and lateral lip of linea aspera
Vastus medialis- Intertrochanteric line and medial lip of linea aspera
Vastus intermedius- Anterior and lateral surfaces of shaft of femur

Insertion:
Base of patella
Tibial tuberosity via patellar ligament Patella and tibia via Medial and lateral
patellar retinacula

GLUTEUS MAXIMUS
Origin: via iliotibial tract
Insertion: via iliotibial tract

TENSOR FASCIA LATAE
Origin: via iliotibial tract
Insertion: via iliotibial tract

71
Q

How is quadriceps femoris innervated ?

A

Supplied by femoral nerve

72
Q

What does the femur do in the final stage of extension ?

A

Rotates medially to “screw” the knee into its stable, “close-packed” position

73
Q

What are the roles of the lateral facets of the patella ?

A
  • articulates with prominent lateral femoral condyle
  • prevent dislocation during knee extension
  • increase the insertion angle of quadriceps tendon
74
Q

What are the anatomical features of a locked knee ?

A
  • tightened ligaments
  • flat surface of the femoral condyles are in contact with the tibia plateaus so joint surfaces become larger
  • amount of muscle work needed to maintain the standing position is reduced
  • vastus medialis locks the knee, aided by Gluteus maximus, tensor fascia latae
75
Q

During flexion of the knee, what position must popliteus be in ?

A

Laterally rotated

76
Q

What is the origin and insertion of the popliteus muscle ?

A

Origin: Posterior surface of tibia, superior to soleal line
Insertion: Lateral surface of lateral condyle of femur and lateral meniscus

77
Q

What movements does popliteus participate in ?

A

Lateral rotation of the femur

Un-locking of the knee

78
Q

Where is the Popliteal Fossa found ? What is its shape ?

A

Behind the knee joint

Diamond shape

79
Q

What is the Popliteal Fossa bounded by ?

A

Biceps femoris, semimembranosus and tendon of semitendinosus and Lateral and medial heads of the gastrocnemius

80
Q

Finish the sentence: The adductor canal opens to the popliteal fossa through ?

A

Adductor hiatus

81
Q

What does the popliteal fossa contain ?

A
  • Popliteal artery and vein, with their branches and tributaries (artery slightly medial to Vein)
  • Tibial nerve
  • Common fibular nerve
  • Posterior cutaneous nerve of the thigh
  • Terminal part of small saphenous vein
  • Lymph nodes
  • Fat
82
Q

Which structure is at risk in knee dislocation and supracondylar fracture of the femur ?

A

Popliteal artery

83
Q

How is the biceps reflex elicited ?

A

By tapping the biceps tendon in the antecubital fossa

84
Q

How is the knee reflex elicited ?

A

By tapping the patellar ligament

85
Q

Which nerve does the biceps reflex test ? Which spinal segments ?

A

Musculocutaneous nerve

C5 and C6

86
Q

Which nerve does the knee reflex test ?

Which spinal segments ?

A

Femoral nerve

L3 and L4

87
Q

What are the different levels of a reflex ?

A
  • Absent
  • Trace (Diminished)
  • Normal
  • Brisk
  • Hyperactive
  • Clonus

MD2002 Arvin (110 decks)

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