Exam 3 Flashcards Preview

DPT 720 Gross Anatomy I > Exam 3 > Flashcards

Flashcards in Exam 3 Deck (65):
1

Knee Complex

-femoral tibial joint
-patella femoral joint
-within one joint capsule

2

Distal Femur

-medial and lateral condyles
-intercondylar fossa
-medial and lateral epicondyles
-medial and lateral supracondylar lines
-adductor tubercle
-popliteal surface
-patella articulating surface

3

Femoral Condyles

-two weight bearing condyles covered with articular cartilage
-separated posteriorly by the intercondylar (femoral) notch: provides area for cruciate ligaments to pass
-separated anteriorly by trochlear groove: the articulating surface with the patella

4

Femoral Epicondyles

-lateral: proximal attachment for LCL and origin for gastrocnemius
-medial: insertion adductor magnus, proximal attachment for MCL, extends further than lateral

5

Trochlear Groove

-lies superior to medial and lateral condyles
-articulation site for patella
-lateral trochlear surface has increased height to prevent patella from excessively gliding lateral during knee extension-less likely to dislocate patella due to slight valgus force at our knees

6

How do ACL and PCL run?

-ACL: superior, posterior and lateral
-PCL: superior, anterior, and medial
-cross each other in an angled way

7

Proximal Tibia: Landmarks

-medial and lateral condyles are flat on top
-intercondylar eminence (point of bone that sticks up in middle) attachment for ACL, PCL, and horns of medial and lateral menisci
-tibial plateaus
-gerdy's tubercle: between tibial tuberosity and head of fibula
-pes anserine
-tibial tuberosity: attachment for patellar tendon
-soleal line: soleus, popliteus, tibialis posterior, flexor digitorum longus

8

Proximal Tibia: Functions

-transfers weight across knee to ankle
-the flat plateaus articulate with femoral condyles
-separated by intracondylar eminences (tibial spines)
-attachment of cruciate ligaments and menisci
-plateaus densely covered with articular cartilage

9

Menisci of Knee

-medial is more C shaped (attaches to deep portion of MCL-semimembranosus sends attachments to posterior horn) and lateral is more O shaped (no attachment to LCL)
-medial tibial condyle is larger and articulates with more of femur
-wedge shaped fibrocartilage-improves joint congruency and stability and helps maintain joint space (load bearing and shock absorbing)
-attached along periphery of tibial plateaus to medial and lateral superior facets by coronary ligaments
-anchored at horns (on eminences)
-blood supply only to periphery of outer 1/3-none on inner so nutrition comes from synovial fluid
-do not attach to femur

10

Anterior Knee

-most distal fibers of VM extend further than VL
-VMO pulls patella up and out because it tends to drift laterally
-retinaculum that stabilizes your patella is more stable/thicker/stronger laterally than medially

11

Patella

-sesamoid bone of quadriceps
-apex inferiorly
-posterior surface is covered with articular cartilage in your body
-does not articulate with tibia-only femur
-posterior surface articulates with trochlear groove through facets
-articular cartilage here is thickest in the body
-odd facet is only in contact with femur when you're in a deep squat

12

Articular Capsule

-largest synovial capsule in body
-superiorly attaches to femur above femoral condyles and intercondylar fossa
-inferiorly attaches to proximal tibia and periphery of patella
-cruciate ligaments are extra-synovial but intra-articular (inside capsule, outside synovial lining-so they don't get bathed in synovial fluid)
-capsule allows passage of popliteus muscle posteriorly
-infrapatellar fat pad
-suprapatellar bursa

13

Knee Retinaculum

-fibrous tissue that has been described as extension of vastus medialis and vastus lateralis into patella and from patella into medial and lateral sides of tibial condyles
-hold patella in place
-medial and lateral portions
-IT band and lateral retinaculum interconnect so patella is very stable laterally

14

What's in the intercondylar region?

-6 structures
-ACL
-PCL
-horns of meniscus

15

Cruciate Ligaments

-within joint capsule but outside synovial cavity
-anterior cruciate: anterior intercondylar area of tibia; runs superior, posterior, and lateral to posterior medial side of lateral femoral condyle
-posterior cruciate: posterior intercondylar area of tibia; runs superior, anterior, and medial to anterior lateral side of medial femoral condyle
-ACL becomes taut in extension
-PCL becomes taut in flexion

16

Medial Collateral Ligament

-broad and flat (makes it harder to tear completely) from medial epicondyle of femur to medial condyle of tibia
-deep fibers attach to medial meniscus

17

Lateral Collateral Ligament

-cord like from lateral epicondyle to fibular head
-popliteus runs under and biceps femoris tendon splits around LCL-supports knee in varus force
-IT Band also supports knee in varus force also on lateral side

18

Oblique Popliteal Ligament

-expansion of semimembranosus: comes up and run laterally; strengthens capsule posteriorly (runs same way as popliteal muscle)
-taut in hyperextension

19

Arcuate Ligament

-runs along posterior aspect of fibular head
-runs superior and medial over popliteus from lateral side and blends with posterior part of joint capsule
-taut in hyperextension

20

What muscles cross knee joint?

-quadriceps
-popliteus
-gastrocnemius
-gracilis
-hamstrings
-plantaris
-sartorius
-semimembranosus
-IT band

21

Nerves of Popliteal Region

-sciatic splits into tibial and common fibular above knee
-tibial goes straight behind knee
-common fibular wraps behind neck of fibula and splits into superficial and deep fibular nerves

22

Popliteal Artery

-continuation of femoral at adductor hiatus
-passes through popliteal fossa
-branches to knee joint and ends by dividing into anterior and posterior tibial arteries
-ends as it goes under popliteus muscle
-branches: superior, medial, and inferior geniculate arteries, medial and lateral to knee supplying cruciate ligaments and synovial membrane
-splits into medial plantar and lateral plantar arteries behind medial malleolus

23

Interosseous Membrane

-runs from fibula inferior and medially to tibia
-tensile force through IO membrane to transfer force to tibia because fibula doesn't articulate with femur
-ties fibula and tibia together

24

Lower Leg Compartments

-anterior
-lateral
-posterior superficial
-posterior deep
-each surrounded by strong layers of fascia
-know which compartment the muscles are in

25

Posterior Lower Leg Muscles

-superficial: gastroc, soleus, plantaris
-deep: flexor hallucis longus, flexor digitorum longus, tibialis posterior

26

Lower Legs, Medial/Lateral Beginning and Ending Points

-one that finishes most medial (flexor hallucis longus) starts most lateral in deep leg compartment
-one that ends most lateral (extensor digitorum) ends most medial
-tibialis posterior is in middle

27

Arteries of Posterior Lower Leg

-posterior tibial artery: from popliteal artery (after popliteal muscle and popliteal artery becomes posterior tibial artery)
-travels to foot under flexor retinaculum
-supplies posterior compartment
-fibular artery: branches from posterior tibial and descends in posterior compartment along intermuscular septum, perforating branches to lateral compartment but artery never goes into compartment

28

Lateral Compartment Muscles

-fibularis longus
-fibularis brevis

29

Tibial Nerve in Lower Leg

-innervation to: popliteus, gastroc, soleus, plantaris, FHL, FDL, and tibialis posterior
-becomes medial and lateral plantar nerves in foot
-sensory branches: sural (all sensory) from tibial and common fibular nerves-supply posterior and lateral leg

30

Superficial Fibular Nerve

-travels around neck of fibula then cuts into lateral compartment to supply it
-between fibularis longus and brevis
-innervates fibularis longus and brevis
-sensory to distal anterior surface of leg and dorsum of foot

31

PICTURES

-especially in Posterior leg power point
-look at one you drew as well

32

Fibula

-upper end=head
-apex=styloid process
-articular facet for tibia
-neck
-body
-lower end=lateral malleolus

33

Proximal (Superior) Tibiofibular Joint

-arthrodial joint between lateral condyle and head of fibula
-single facet on fibular head articulates with tibia
-covered with articular cartilage and connected by joint capsule and anterior and posterior ligaments
-synovial

34

Tibiofibular Syndesmosis

-distal tibia and fibular form osseous part of syndesmosis linked by: distal anterior and posterior tibiofibular ligament, transverse ligament (extension of IOM-internal to joint), interosseous ligament (extension of IOM-internal to joint)
-nerves go around side, but artery and vein go through membrane
-distal tib-fib joint is syndesmosis: fibrous joint fibers attach directly from tibia to fibula (should be no motion down low and only a tiny bit of gliding at top

35

Syndesmotic or High Ankle Sprain

-estimated 1-11% of all ankle sprains
-due to widening of ankle mortise as a result of increased length of syndesmotic ligaments after acute ankle sprain
-40% of patients still have complaints of ankle instability 6 months after ankle sprain
-tibia and fibula spread and now joint is unstable

36

Deep Fibular Nerve

-begins as branch of common fibular nerve
-passes deep to EHL and anterior to IOM
-travels around neck of fibula then cuts into anterior compartment to supply it
-travels with anterior tibial artery down the middle of leg
-divides into lateral and medial branches at ankle
-supplies all 4 muslces in anterior compartment: tibialis anterior, EDL, EHL, fibularis tertius
-does sensory of web space between toes 1 and 2

37

Injury to Deep Fibular Nerve

-most common LE neuropathy
-damage can result from: lateral knee injury, inflammation, ischemia, diabetes
-foot drop is often consequence: people drag toes because they can't dorsiflex ankle

38

Saphenous Nerve

-cutaneous nerve of anterior compartment
-largest cutaneous branch of femoral nerve
-passes along tibial side of leg with great saphenous vein
-descend behind medial border of tibia

39

Blood Supply of Lower Leg

-popliteal artery ends with two terminal branches
-anterior tibial artery supplies anterior compartment
-posterior tibial artery supplies posterior compartment

40

Anterior Tibial Artery

-supplies anterior compartment
-smaller terminal branch
-passes anteriorly through IOM and along anterior tibia
-travels between tibialis anterior and EHL (deep fibular nerve can travel with anterior tibial artery)
-ends between malleoli where it becomes dorsalis pedis artery

41

Compartment Syndrome

-compression of nerves, blood vessels, and muscle due to bleeding or swelling
-leads to tissue death from lack of oxygenation due to blood vessels being compressed by raised pressure within compartment
-can be divided into acute, subacute, and chronic compartment syndrome

42

Compartment Syndrome Causes-Acute

-can be medical emergency
-blunt force trauma
-fracture
-vascular puncture
-crush injuries
-cast compression

43

Compartment Syndrome Causes-Chronic

-not usually medical emergency
-AKA chronic exertional compartment syndrome
-repetitive muscle use (cycling, soccer)
-arterial inflow out paces venous outflow and pressure builds
-eventually leads to ischemia
-subsides with rest

44

Flexor Retinaculum

-structures that go underneath are Tom Dick and A Very Nervous Harry
-tibialis posterior
-flexor digitorum
-posterior tibial artery
-posterior tibial vein
-tibial nerve
-flexor hallucis longus

45

Retinaculums

-2 extensors
-2 laterals
-1 flexor
-synovial sheaths need to be able to slide underneath these smoothly

46

Bones of Foot and Ankle

-tarsals: talus, calcaneous, navicular, cuboid, cuneiforms (medial, lateral, middle)
-metatarsals: 5 bases are proximal, heads are distal, shafts are in middle
-phalanges: 1st toe has proximal and distal and 2-5 have proximal, middle, and distal

47

Lisfranc Fracture

-one or more MT displace from tarsus

48

Talus

-convex dome
-articulates with distal tibia and fibula (ankle mortis or ankle joint)
-neck
-head: articulates with navicular (part of trans tarsal joint)
-subtalar joint: articulates with calcaneus (inversion and eversion)

49

Calcaneus

-heel bone (part of trans tarsal joint)
-articulates with talus above and cuboid anteriorly
-tuberosity
-sustentaculum tali: medial (FHL tendon fits in groove) Identify this on a bone

50

Tarsal Articulations

-navicular: articulates with talus, cuboid and all 3 cuneiforms
-cuboid: articulates with calcaneous, navicular, lateral cuneiform and base of MT 4 and 5
-cuneiforms: articulate with bases of MT 1-3 and navicular
-metatarsals 1-5: 1-3 articulate with medial middle and lateral cuneiforms; 4 and 5 with cuboid

51

Talocrural Joint

-distal tibia/fibula with talus
-dorsiflexon/plantar flexon

52

Subtalar Joint

-talus with calcaneus
-inversion/eversion

53

Mid Tarsal (Transverse Tarsal) Joint

-navicular and cuboid with talus and calcaneous

54

Tarsometatarsal Joint

-3 cuneiforms and cuboid with bases of MTs

55

Plantar Surface Ligaments

-support the arches
-plantar aponeurosis
-long plantar ligament
-short plantar ligament
-spring ligament

56

Plantar Aponeurosis

-from calcaneal tuberosity and across bottom of foot
-crosses MTP joints to toes
-taut with extension of MTP joints

57

Long and Short Plantar Ligaments

-long: calcaneus to cuboid and base of MTs (deep, lateral)
-short: calcaneus to cuboid (deep, lateral)

58

Spring Ligament

-aka plantar calcaneonavicular ligament
-medial

59

Medial Collateral Ligament

-deltoid
-4 parts that come together to act as one big fan shaped ligament
-anterior and posterior tibiotalar, tibiocalcaneal, tibionavicular

60

Lateral Collateral Ligament

-anterior talofibular
-calcaneofibular
-posterior talofibular
-usually sprain these from front to back

61

Even More Ligaments of Ankle and Foot

-collateral ligaments of MPT, PIP, DIP joints
-transverse metatarsal ligament
-plantar plates at MTP, PIP, DIP (same thing as volar plates-long flexor tendons can slide on them more easily)
-also have cruciate and annular ligaments and an extensor mechanism

62

4 Layers of Plantar Muscles

-flexor digitorum brevis, abductor hallucis, abductor digiti minimi
-quadratus plantae, lumbricals
-flexor hallucis brevis (2 heads), flexor digiti minimi brevis, adductor hallucis (2 heads)
-palmar interossei (3), dorsal interossei (4)

63

Dorsalis Pedis Artery

-branches off anterior tibail
-under extensor retinaculum between EHL and EDL
-divides into deep plantar artery: divides between 1st and 2nd MT and posterior to sole of foot
-and lateral tarsal artery: runs across dorsum of foot on lateral side and under extensor digitorum longus: swings out laterally as arcuate then medially and comes back to dorsalis pedis-forms archway

64

Nerves of Foot

-saphenous: sensory to skin on medial ankle and foot
-superficial fibular: dorsum of foot sensory
-deep fibular: motion to EDB and EHB and sensory to skin between 1 and 2 web space
-medial plantar: sensory to medial side of foot and medial 3 digits and motor to LAFF (lumbrical 1, abductor hallucis, flexor digitorum brevis, flexor hallucis brevis)
-lateral plantar: everything else on bottom of foot and sensory to lateral side of foot 4th toe split with medial plantar
-sural: sensory to skin on lateral foot and heel
-heel is done by tibial nerve before it splits

65

Archways of Foot

-plantar: lateral plantar and medial plantar
-dorsal: dorsalis pedis, lateral tarsal, arcuate
-off of dorsalis pedis is lateral tarsal, to arcuate, then back to dorsalis pedis
-on plantar side is posterior tibial which splits into lateral and medial which link up with each other
-deep branches link the two arches together