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Basic Science Test 2 > 2.4 > Flashcards

2.4 Flashcards

1
Q

What are the 3 joints of the knee?

A

femoropatellar joint
lateral femorotibial joint
medial femorotibial joint

The proximal tibiofibular joint is not a knee joint because of its movement.

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2
Q

Knee capsule

A

Synovial joint surrounded by a fibrous capsule
Some ligaments are continuous with fibrous capsule
Synovial membrane separates from the fibrous capsule in the center

2 layers:
1. fibrous: intrinsic ligaments
2. Synovial: lines fibrous layer laterally and separate medially

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3
Q

What type of joint is the knee?

A

It’s primarily a hinge joint allowing flexion and extension.

It also allows some sliding, rolling, and slight rotation.

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4
Q

Support for the knee joint

A

Surrounding muscles and tendons
Ligaments of femur and tibia

Anteriorly: quadriceps tendon/ patellar ligament
Laterally: IT band
Medially: pes anserinus

NO CONTRIBUTION FROM THE FIBULA

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5
Q

What is the “screw-home” mechanism?

A

The “screw-home” mechanism is a medial rotation of the femur on a fixed tibia that occurs at the end of knee extension to “lock” the knees. In order to initiate knee flexion from a fully extended state, the popliteus muscle laterally rotates the femur on the tibia to “unlock” the knee. Once unlocked, primary knee flexor can mediate knee flexion.

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6
Q

Knee extensors

A

quadriceps femoris

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7
Q

Knee flexors

A

hamstrings and sartorius

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8
Q

Knee rotators

A

hamstrings and sartorius

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9
Q

Collateral ligaments of the knee

A

Lateral (fibular)collateral ligament (LCL)
- cord-like, extracapsular ligament
- lateral femoral condyle –> fibular head
- not attached to lateral meniscus

Medial (tibial) collateral ligament (MCL)
- broad, capsular (intrinsic) ligament
- medial femoral epicondyle –> medial tibial condyle
- attached to medial meniscus at midpoint
- more commonly injured than LCL

Both ligaments prevent rotation and lateral flexion in the coronal plane.

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10
Q

Cruciate ligaments of the knee

A

Anterior cruciate ligament (ACL)
- limits anterior translocation (movement in abnormal direction)
- anterior, intercondylar tibial plateau –> posterior part of lateral femoral condyle

Posterior cruciate ligament (PCL)
- limits posterior translocation
- posterior, intercondylar tibial plateau –> anterior part of lateral femoral condyle

Intracapsular: within joint capsule
Extrasynovial: synovial membrane is folded around the ligament

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11
Q

MMT for cruciate ligaments

A

Anterior drawer test:
- pull tibia anteriorly with flexed knee
- tests ACL integrity

Posterior drawer test:
- push tibia posteriorly with flexed knee
- tests PCL integrity

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12
Q

Menisci

A

Medial and lateral

2 crescent shaped fibrocartilage pads within the knee joint
wedge shaped in axial section
Function: shock absorption and deepens articular surface

Medial meniscus is more prone to injury because of where it’s attached. It’s less mobile and fixed to ACL.

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13
Q

Unhappy triad

A

The simultaneous tearing of the ACL, MCL, and medial meniscus caused by a lateral blow to the knee when the foot is fixed to the ground.

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14
Q

Knee bursae

A

Acute (sudden) or chronic trauma can lead to bursitis and swelling of the knee.

Prepatellar bursa is common in people who work on their knees, like carpet and tile installers.

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15
Q

Label

A
  1. lateral meniscus
  2. LCL
  3. head of fibula
  4. medial meniscus
  5. MCL
  6. ACL
  7. PCL
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16
Q

Which ligament is torn?
A. patellar
B. MCL
C. LCL
D. ACL
E. PCL

A

D. ACL

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17
Q

Varus and valgus stress

A
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18
Q

Q angle

A

The measure of angle between 2 lines
1. ASIS to patella
2. tibial tuberosity through midpoint of patella

Clinically used to evaluate varus or valgus stress

Oblique arrangement of femur in the thigh places the tibial axis directly under femoral head and weight centered in the middle of the tibial plateau. With varus and valgus stress on the knee, weight is shifted over one side of the tibia, which can cause wearing of the joint cartilages and ligament articular cartilage (osteoarthritis), meniscus, MCL/LCL.

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19
Q

Popliteal fossa

A

Diamond-shaped region behind the knee
Marks the transition region between the thigh and the leg
Vascular components of the thigh pass to the flexor side of the knee
Covered by popliteal fascia

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20
Q

Arteries of popliteal fossa

A

Femoral artery becomes popliteal artery when it passes through the adductor hiatus

Genicular arteries branch to give blood supply to the knee joint.

21
Q

Neurovasculature of knee and popliteal fossa

A

Transition and division
1. popliteal artery divides anterior and posterior tibial arteries
2. sciatic nerve divides tibial nerve and common fibular nerve
3. small saphenous vein empties into popliteal vein

The genicular arteries help to form an anastomosis of the knee joint to maintain blood flow to the distal leg if the popliteal artery becomes “kinked” which can happen during full knee flexion.

22
Q

Baker’s cyst

A

Swelling of the synovium of the knee
Produces an enlarged synovial cyst in the popliteal fossa
Causes knee injury and arthritis
Usually minimally painful, but can impinge neurovasculature
Important to differentiate from a popliteal aneurism or DVT

23
Q

Compartments of the leg

A

Anterior
- dorsiflex (extend) and invert/evert
- toe extension
- innervated by deep fibular n.
- supplied by anterior tibial a.

Lateral
- evert foot and ankle
- weak plantarflexion
- innervated by superficial fibular n.
- supplied by branches of fibular a.

Posterior
- primarily plantarflexion and inversion
- toe flexion
- innervated by tibial n.
- supplied by posterior tibial a.

24
Q

Compartment syndromes

A

Pressure within a closed compartment exceeds the perfusion pressure resulting in muscle and nerve ischemia

Signs:
1. Pain
2. Palor - pale, loss of color
3. Paresis - weakness
4. Paresthesia - abnormal feeling (tingling, pins and needs)
5. Pulselessness

Treatment: fasciotomy

25
List muscles of posterior leg
2 muscle groups: Deep - tibialis posterior - flexor digitorum longus - flexor hallicus longus - popliteus Superficial - gastrocnemius - soleus - plantaris
26
Triceps surae
muscles of the calf
27
Achilles Tendon
Most powerful (strongest and thickest) tendon - Avulsion from calcaneus or tendon rupture results in loss of plantarflexion. This interferes with the push off phase of gait, jumping, etc. - Subcutaneous bursa - allows the skin to move over the tendon - Retrocalcaneal bursa - allows the tendon to glide over the calcaneus
28
Achilles Tendon Reflex (ankle jerk reflex)
Tests S1-S2 nerve roots and tibial nerve Tap Achilles tendon with reflex hammer just proximal to calcaneus Plantarflexion of ankle should result
29
Gastrocnemius
O: condyles of the femur I: calcaneus via Achilles tendon A: plantarflexion, raises heel when walking N: tibial n. Blood supply: posterior tibial a.
30
Soleus
O: proximal tibia/fibula I: calcaneus via Achilles tendon A: plantarflexion, raises heel when walking N: tibial n. Blood supply: posterior tibial a.
31
Plantaris
O: inferior end of supracondylar line I: calcaneus via Achilles tendon A: plantarflexion, raises heel when walking N: tibial n. Blood supply: posterior tibial a. (YELLOW)
32
Popliteus
Short muscle that crosses knee and is important for unlocking the knee O: lateral condyle of femur I: posterior tibia A: lateral rotation for flexion N: tibial n. Blood supply: posterior tibial a.
33
Tibialis posterior
O: interosseus membrane I: plantar surface of foot A: plantarflexion, inversion N: tibial n. Blood supply: posterior tibial a.
34
Flexor digitorum longus
O: medial part of posterior tibia I: distal phalanges 2-5 A: plantarflexion, flexion of digits 2-5 N: tibial n. Blood supply: posterior tibial a.
35
Flexor hallicus longus
O: inferior, posterior fibula I: distal phalanx of great toe A: plantarflexion, flexion of great toe N: tibial n. Blood supply: posterior tibial a.
36
List muscles of anterior compartment of leg
Tibialis anterior Extensor hallicus longus Extensor digitorum longus Fibularis tertius
37
Tibialis anterior
O: lateral condyle, superolateral tibia, and interosseous membrane I: base of 1st metatarsal and medial cuneiform A: dorsiflexion and inversion N: deep fibular n. Blood supply: anterior tibial a.
38
Extensor hallicus longus
O: anterior fibula and interosseous membrane I: distal phalanx of 1st digit A: dorsiflexion, hallus extension N: deep fibular n. Blood supply: anterior tibial a.
39
Extensor digitorum longus
O: lateral tibial condyle, superoanterior fibula, interosseous membrane I: distal phalanx 2-5 A: dorsiflexion and extension of digits 2-5 N: deep fibular n. Blood supply: anterior tibial a.
40
Fibularis tertius
O: inferior third of anterior fibula and interosseous membrane I: base of 5th metatarsal A: dorsiflexion and eversion N: deep fibular n. Blood supply: anterior tibial a.
41
Shin splints
Anterior shin splints - tibialis anterior - pain is usually diffuse Medial tibial stress syndrome (MTSS) - posterior compartment muscles - usually localized to area of stress fracture Cause: repetitive use of muscles leading to small tears in the tibial periosteum - usually affects runners and running sports Symptoms: - pain - edema in distal 2/3 of tibia Differential for anterior shin pain shin splints stress fractures exertional compartment syndrome
42
Muscles of lateral leg
Fibularis longus Fibularis brevis
43
Fibularis longus
O: head and superior 2/3 of lateral fibula I: base of 1st metatarsal, medial cuneiform A: plantarflexion, eversion N: superficial fibular n. Blood supply: perforating branches of fibular a.
44
Fibularis brevis
O: lateral fibula I: base of 5th metatarsal A: plantarflexion, eversion N: superficial fibular n. Blood supply: perforating branches of fibular a.
45
A patient presents with pain on the lateral side of the foot. The pain is most severe with palpation of the tuberosity of the 5th metatarsal and with eversion. A diagnosis of ___ tendinitis is made. A. Tibialis anterior B. Fibularis longus C. Fibularis brevis D. Extensor hallicus longus E. Extensor digitorum longus
46
Tibial nerve
Injury is uncommon because of its deep and protected position in popliteal fossa. The nerve may be injured by deep lacerations or posterior dislocation of the knee joint. Damage to the nerve causes: - paralysis of the flexor leg muscles and intrinsic muscles in the sole of the foot - inability to plantar flex their ankle or toes - loss of sensation also occurs on the soles of the foot - weakened inversion - shuffling gait It innervates the posterior leg and plantar foot. The Achilles tendon reflex tests this nerve.
47
Common fibular nerve
Also called peroneal Branches from sciatic nerve in posterior thigh Wraps around lateral aspect of fibular neck Branches into deep and superficial nerves Deep fibular nerve: - motor innervation to anterior compartment of leg and 2 small muscles on dorsum of foot - sensory innervation to space between 1st and 2nd digits - runs with anterior tibial a. Superficial fibular nerve: - motor innervation: lateral compartment - sensory: dorsum of foot doesn't run with any artery
48
Pathology of common fibular nerve
The common fibular nerve is easily injured as it passes on lateral aspect of the knee. Injury affects muscles of lateral and anterior compartment. Foot drop: condition in which patient is unable to dorsiflex foot --> toes drag on the ground during walking - paralysis of anterior compartment muscles (dorsiflexors)
49
Sural nerves
Branches of tibial and common fibular nerves. Cutaneous innervation to leg

Basic Science Test 2 (6 decks)

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