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Anatomy (Karen) > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

Weight-bearing epiphyses are formed as a result of

A

weight bearing pressure

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2
Q

Traction epiphyses are formed as a result of

A

attachments of ligaments and muscles that exert force

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3
Q

The head of the femur is a ______ epiphysis

A

weight-bearing (fuses early 20s)

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4
Q

The greater trochanter is a ______ epiphysis

A

traction

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5
Q

The head of the femur is oriented

A

upwards, medially, and slightly anteriorly (ante-verted)

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6
Q

T/F The anterior part of the head of the femur is within the socket

A

False, it lies anteriorly outside the socket, protected by the psoas bursa

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7
Q

T/F The psoas bursa communicates with the acetabular joint

A

False, but it may

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8
Q

The head of the femur articulates with

A

the roof of the acetabulum (thickest cartilage here)

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9
Q

What are the intra-articular structures of the hip joint?

A

fat pad, labrum, ligamentum teres

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10
Q

What is ligamentum teres?

A

Directs branch of obturator artery to femoral head in development until puberty

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11
Q

What is the role of the vertical bundle of trabeculae?

A

Weight-bearing in stance

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12
Q

What is the role of the arcuate bundle of trabeculae?

A

Resisting bending forces on the neck of the femur

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13
Q

What is the significance of the 2 trabeculae system in the neck of the femur?

A

At the inferior aspect of the arcuate bundle where the 2 intersect becomes a site of weakness in ageing and osteoporosis due to loss of trabeculae

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14
Q

At the hip joint, the line of gravity passes _________ the centre of the joint

A

behind

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15
Q

At the knee joint, the line of gravity passes _________ the centre of the joint

A

in front of

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16
Q

At the ankle joint, the line of gravity passes _________ the centre of the joint

A

in front of

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17
Q

What is the ‘close packed position’?

A

Position of greatest stability; articular surfaces meet as best they can with the capsules and ligaments taught - hip extension, abduction, and medial rotation (open packed is sitting cross-legged, least stability)

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18
Q

Which ligaments of the hip joint blend with the capsule?

A

Pubofemoral and ischiofemoral

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19
Q

Iliofemoral ligament attaches

A

ASIS to intertrochanteric line

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20
Q

What is the function of the iliofemoral ligament?

A

Tightens in extension to resist further extension; causes medial rotation in extension

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21
Q

Retinacular fibres

A

extension of capsule around neck of femur; transmits retinacular blood vessels to epiphysis (growth) and head of femur (following closure)

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22
Q

Disruption of retinacular blood vessels in development causes

A

Perthe’s disease - avascular necrosis of the femoral head

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23
Q

What is a screw-home mechanism?

A

The joint gets tighter as it goes into extension - eg in hip, medial rotation occurs with extension to lock the joint

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24
Q

_______ rotation occurs in stance, _______ rotation occurs in swing

A

medial; lateral

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25
Q

Main movements of the hip are in the ________ plane

A

sagittal

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26
Q

What is the function of gluteus maximus?

A

hip extension in extreme force/acceleration; stabilizes pelvis when rising from seated position

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27
Q

The principal role of the cuff muscles in the hip joint is to

A

pull the head of the femur into the socket; they can laterally rotate the hip as well

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28
Q

Range of flexion at the hip

A

120 deg

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29
Q

Range of extension at the hip

A

10-20 deg

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30
Q

Medial rotation of the hip is associated with

A

stance

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31
Q

Lateral rotation of the hip is associated with

A

swing

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32
Q

Gluteus medius and minimus _______ the thigh

A

abduct

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33
Q

Illiopsoas ________ the thigh

A

flexes

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34
Q

What is the critical role of gluteus medius and minimus?

A

Keeping the pelvis level in walking by pulling it down to prevent fall to the unsupported side

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35
Q

Injury to the gluteus medius and minimus results in

A

Trendellenberg gait where the pelvis is unstable and drops to the unsupported side

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36
Q

The hip joint is innervated by

A

articular branches of the femoral and obturator nerves

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37
Q

Referred pain from the hip via the obturator nerve presents

A

medial thigh above the knee

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38
Q

Referred pain from the lumbar spine and sacro-iliac joints presents

A

Hip joint

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39
Q

Hip flexion myotome

A

L2 L3

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40
Q

Hip extension myotome

A

L4 L5

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41
Q

Knee extension myotome

A

L3 L4

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42
Q

Knee flexion myotome

A

L5 S1

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43
Q

Dorsiflexion myotome

A

L4 L5

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44
Q

Plantar flexion myotome

A

S1 S2

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45
Q

Inversion myotome

A

L4

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46
Q

Eversion myotome

A

L5 S1

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47
Q

Hallicus flexion myotome

A

S1 S2

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48
Q

Hallicus extension myotome

A

L5 S1

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49
Q

Blood supply to the hip joint comes from

A

retinacular fibres from the medial and lateral femoral circumflex arteries (profunda femoris; femoral a.)

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50
Q

Which vessels are susceptible in a #NOF?

A

retinacular and circumflex vessels

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51
Q

Posterior dislocation of the femur endangers

A

Sciatic nerve

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52
Q

What is the normal neck-shaft angle of the femur?

A

135 deg (smaller in women)

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53
Q

Coxa valga

A

neck-to-shaft angle less than 125

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54
Q

Coxa vara

A

neck-to-shaft angle greater than 125

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55
Q

Why does a #NOF present with external rotation and shortening of the limb?

A

Spasm of gluteal muscles, especially external rotators

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56
Q

Pain of osteoarthritis in the hip joint commonly refers via

A

articular branches of the obturator nerve tf presenting on medial knee

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57
Q

How is congenital hip dislocation tested?

A

Abdudction of the flexed hip joint

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58
Q

How is congenital hip dislocation treated?

A

Hips braced in abducted position so that adductor magnus will pull along the line of the femur and the head of the femur back into the socket

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59
Q

What are the two types of hip dislocation?

A

Traumatic and congenital

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60
Q

Rotation of the knee only occurs during

A

flexion

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61
Q

The knee is in closed-pacjed position when in __________

A

extension

62
Q

Bursae in the knee joint sit

A

between the patella and the overlying ligament; between the femur and the quadriceps tendon; deep to popliteus and semimembranosus; between ligaments and bone

63
Q

The knee gets its support primarily from

A

cruciates, collaterals, menisci, and muscles

64
Q

The knee joint is most vulnerable in

A

flexion and rotation

65
Q

Medial condyles of tibia and femur are

A

longer and thinner than the lateral

66
Q

The femur rotates ______ on the tibia in moving from flexion to extension

A

medially

67
Q

What is the screw-home mechanism at the knee?

A

passive, occurs around the tightening ACL in the last 15-20deg of extension - the femur rotates medially on the tibia

68
Q

________ is responsible for initiating flexion at the knee

A

Popliteus

69
Q

Locking of the knee in extension is ________ whereas flexion of the knee is ________

A

passive; active

70
Q

Menisci are made of

A

fibrocartilage

71
Q

T/F Menisci are covered in synovial membrane

A

False; this would wear out and cause swelling

72
Q

Menisci are lubricated by

A

synovial fluid

73
Q

The synovial membrane covers

A

interior of the joint capsule and cruciates (anterior of PCL and ACL)

74
Q

The cruciate ligaments are _____capsular but ______synovial

A

intracapsular but extra-synovial (outside the membrane)

75
Q

Why is an ACL tear likely to be accompanied by bleeding?

A

because the cruciates are covered in synovial membrane which is very vascular

76
Q

What is Osgood-Schlatter disease?

A

apophysitis of tibial tubercle - inflammation of the patellar ligament at the tibial tuberosity

77
Q

The knee joint capsule is reinforced anteriorly by

A

patellar tendon and retinacular fibres (lateral and medial)

78
Q

The knee joint capsule is reinforced laterally by

A

popliteus, biceps femoris, IT band

79
Q

The knee joint capsule is reinforced medially by

A

pes anserinus tendons

80
Q

The knee joint capsule is reinforced posteriorly by

A

oblique popliteal ligament from semimembranosus

81
Q

What are the components of pes anserinus?

A

Say Grace Before Tea: Sartorius, Gracilis, Bursa, semiTendinosus

82
Q

Which bursa communicate with the knee joint?

A

suprapatellar and those deep to popliteus and semimembranosus

83
Q

What is a Baker’s cyst?

A

Thickening of the lining of the bursa at the back of the knee, becomes irritated in flexion

84
Q

The anterior cruciate ligament travels __________ from the ___________ to the __________

A

Posterolaterally, anterior tibia to lateral condyle

85
Q

The posterior cruciate ligament travels __________ from the _________ to the __________

A

anteromedially, posterior tibia to medial condyle

86
Q

What is the function of the ACL?

A

Stops anterior displacement of the tibia on the femur/posterior displacement of the femur on the tibia

87
Q

What is the function of the PCL?

A

Stops anterior displacement of the femur on the tibia/posterior displacement of the tibia on the femur in flexion eg going down stairs

88
Q

The ACL is ________ in flexion and ________ in extension

A

twisted; untwisted & tight (pulls femur medially to lock it)

89
Q

ACL is commonly injured when

A

rotation occurs in the opposite direction (laterally) on the weight bearing leg - ie moving laterally in extension instead of medially

90
Q

ACL repair grafts are commonly taken from

A

mid-portion of patellar tendon or a hamstring tendon from the pes anserinus (sartorius)

91
Q

PCL is prone to injury in

A

falls on flexed knee; bumper bar impact on femur

92
Q

The MCL attaches to

A

medial femoral epidondyle to medial tibia close to pes; deep part blends w/capsule and inserts into medial meniscus

93
Q

What is the function of the MCL?

A

Resists valgus (abduction) forces and lateral rotation of the tibia; limit anterior displacement of tibia 2nd to ACL

94
Q

The LCL attaches to

A

Lateral epidcondyle to head of fibula; separated from meniscus but popliteus tendon

95
Q

What is the function of the LCL?

A

Resists varus (adduction) forces, medial movement of tibia

96
Q

What is the ‘unhappy triad’?

A

Tearing of the ACL, MCL, and medial meniscus usually due to lateral rotation of the femur on the planted tibia

97
Q

What is the function of the menisci?

A

Absorb and distribute weight; increase area of contact by 1/3

98
Q

Menisci move with the femur during ________ but the tibia during ________ and _______

A

rotation; flexion and extension

99
Q

Menisci are endangered in

A

changing direction with the knee flexed

100
Q

Locked knee occurs when

A

a flap of torn cartilage gets in the way of the articular surfaces and prevents unlocking

101
Q

The meniscus receives blood supply to the

A

(because it is fibrocartilage it can have a blood supply) periphery but not the medial zone which is avascular (white)

102
Q

What structures are responsible for stability at the patellofemoral joint?

A

raised lateral lip of femoral condyle (passive); medial patellar retinaculum/capsule (passive); strong vastus medialis (active)

103
Q

What is the role of vastus medialis in stabilizing the patella?

A

Pulls patella in position during the last 15-20 degrees of extension

104
Q

The Q angle is between

A

quadriceps tendon and patellar tendon

105
Q

What is chondromalacia patellae?

A

inflammation of the underside of the patella and softening of the cartilage

106
Q

Why is fibular fracture common with tibial fracture?

A

the 2 bones form a ring (ring hypothesis)

107
Q

The tibial tuberosity is a _________ epiphysis

A

Traction

108
Q

The ___________ eminence sits between the tibial plateaus and serves as attachment for

A

intercondylar eminence; cruciate and meniscal hook ligaments

109
Q

Fractures in the distal 3rd of the tibia heal more slowly due to

A

less blood supply than proximal

110
Q

The soleal line runs

A

obliquely along the posterior tibia (lateral to medial)

111
Q

The superior tibiofibular joint is a ______________ joint and allows _________ movement

A

plane synovial; some gliding movement

112
Q

The superior tibiofibular joint is supported by

A

LCL, ant and post tibiofibular ligaments, biceps femoris tendon

113
Q

The inferior tibiofibular joint is a ___________ joint and

A

fibrous (syndesmosis)

114
Q

The inferior tibiofibular joint functions to

A

prevent separation of tib and fib in weight bearing

115
Q

The inferior tibiofibular joint is reinforced by

A

ant and post tibiofibular ligaments, continuous fibres of IOM

116
Q

What is the malleolar mortise?

A

formed by lateral malleolus, hinge of ankle joint that connects tib and fib to the talus

117
Q

What is a March Fracture?

A

Stress fracture of the 2nd metatarsal due to it’s wedged position between the 1st and 3rd metatarsal bones

118
Q

What are accessory bones?

A

Secondary centres of ossification that don’t fuse with the parent bone

119
Q

Talocrural joint

A

Between talus and mortice between tib and fib malleoli

120
Q

The taolcrural joint is reinforced by which ligament?

A

Inferior transverse ligament

121
Q

The talocrural joint is a ____________ joint and permits ____________ and __________ only

A

synovial hinge; flexion and extension

122
Q

What is the significance of the longer lateral malleolus?

A

Creates an oblique axis of rotation such that dorsiflexion is associated with eversion and plantar flexion is associated with some inversion - it’s not a straight hinge

123
Q

Subtalar joint

A

talocalcaneal joint

124
Q

Midtarsal joints

A

talocalcaneonavicular and calcaneocuboid

125
Q

The ankle is more stable in ___________ due to

A

dorsiflexion; the talus is wider anteriorly and fits better into the mortice in dorsiflexion; hence the ankle is less stable in plantar flexion where the narrower posterior talus sits in the mortice

126
Q

Deltoid ligament

A

MCL of ankle joint

127
Q

Spring ligament

A

plantar calcaneonavicular ligament

128
Q

Deltoid ligament/MCL has ___ parts

A

4

129
Q

LCL at the ankle has ___ parts

A

3

130
Q

_____% of ankle sprains are ________ injuries

A

85-90%; inversion

131
Q

The ankle is most vulnerable to injury in

A

inversion and plantarflexion

132
Q

Inversion injuries to the ankle stress

A

LCLs and fibularis muscles

133
Q

Pott’s fractures are

A

associated with ankle inversion sprains - fracture of the medial malleolus and fibular shaft

134
Q

Inversion injuries of the ankle commonly fracture

A

lateral malleolus of fibula

135
Q

Inversion and eversion occur about the ________ joints

A

subtalar/talocalcaneal and taleocalcaneonavicular (TCN)

136
Q

What is the function of the spring ligament?

A

Supports the head of the talus inferiorly into the TCN joint

137
Q

What is the significance of the sinus tarsi?

A

carries the interosseus talocalcaneal ligament which binds the talus and calcaneus together, and the vascular sling which supplies the otherwise avascular talus

138
Q

Where is the sinus tarsi?

A

between the talus and calcaneus, between the talocalcaneal articular surfaces

139
Q

Fracture of the talus occurs at the _______ and endangers __________

A

neck; vascular sling - can get avascular necrosis of talus

140
Q

Heel strike in running is in which plane?

A

eversion

141
Q

Weight transfer to the forefoot in running puts the foot into

A

inversion (greater ROM)

142
Q

The calcaneocuboid joint is a ___________ joint and allows ____________

A

plane synovial joint; rotary gliding movement for pronation and supination

143
Q

What occurs in pronation of the foot?

A

eversion at subtalar and TCN, lateral rotation at calcaneocuboid

144
Q

What occurs in supination of the foot?

A

inversion at subtalar and TCN, medial rotation at calcaneocuboid

145
Q

What joints form the midtarsal joint?

A

TCN and calcaneocuboid

146
Q

T/F The calcaneocuboid joint is involved in inversion and eversion with the TCN

A

False; it provides some rotation but is functionally independent of the TCN

147
Q

Pronation and supination of the foot occur about the ___________ joint

A

calcaneocuboid (with subtalar and TCN involvement)

148
Q

Pronation and supination of the foot refers to relative movement between

A

hindfoot (stable) and forefoot around it - up and down movement of the arch

149
Q

What are the arches of the foot?

A

2 longitudinal: medial (higher) and lateral, 1 transverse hemi-arch

150
Q

Arches of the foot are supported by which ligaments?

A

Long and short plantar ligaments, plantar aponeurosis

Anatomy (Karen) (16 decks)

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