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Anatomy > Exam 4: thigh and knee, leg ankle foot > Flashcards

Exam 4: thigh and knee, leg ankle foot Flashcards

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0
Q

Q angle

A

ASIS and tibial tubercle to center of patella

normal = 12-15 deg

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1
Q

patella contact area

A

20 deg flex : inferior portion
45 deg flex: mid patella
90 deg flex: sup. patella
135 deg flex: med, lat patella

  • as flexion increases, more of the patellar contact area increases –> distributes the forces over a greater area –>decreases pressure
  • leg extension (closed chain): very small patellar contact area under max force during full extension –> very high pressure –>more susceptible to wear and tear and cartilage damage
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2
Q

Q angle:

  • genu valgus (knock knee) and femoral anteversion
  • genu varus
  • normal
A

genu valgus: Q angle >20 deg
genu varus: Q angle <10 deg

*normal q angle = 12-15 deg

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3
Q

patellofemoral dysfunction

A

-tightness of ITB: pulls patella laterally–>lateral tilt
-weakness of VMO
Result: increased compressive forces on lat. condylopatellar facet during knee flex

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4
Q

clinically necessary knee ROM values

A

knee ROM: 0-130 deg
walking: need ~70 deg knee flex
stairs: need ~105 deg
getting in and out of chair: ~100 deg

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5
Q

ligaments: extra-articular structures

A
  1. quad tendon and patellar lig
  2. lateral patellar retinaculum
    - fibrous expansion of vastus lateralis & ITB: reinforces anterolat jt cap.
  3. medial patella retinacul.
    - fibrous exp of vast. med.
  4. MCL
    - med femoral epicond –>med tib. condyle
    - attaches to med. meniscus
  5. LCL
  6. Oblique Popliteal Lig: fibrous exp. of semimemb T. (reinforce post. capsule)
  7. arcuate popliteal lig.
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6
Q

arcuate popliteal lig

A

straight part: fibular head to lat femoral condyle

arching part: fibers blend w/ oblique popliteal lig

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7
Q

intra-articular structures of knee (8)

A
  1. ACL:runs post-lat (ant horn of med meniscus–>intercondylar fossa side of lat fem condyle)
  2. PCL: runs ant-med from post to post horn of med menisc to intercondylar fossa side of med femoral condyle)
  3. med meniscus (C-shaped): attaches to MCL
  4. lat meniscus: ring shaped
  5. coronary lig: extend from jt cap, attach outer edge of med, lat menisci to tibial condyles
  6. transverse lig: connects ant horns of med-lat meniscus
    * may be absent
  7. post meniscofemoral lig:lat menisc to med fem condyle
    * may be absent
    * runs behind of and attaches to PCL
  8. ant meniscofemoral lig: lat menisc to med fem condyle
    * may be absent
    * runs in front of and attaches to PCL
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8
Q

ACL & PCL bands

A

anteromedial band: tight w/ knee flex,lax w/ ext
posterolateral: tight w/ knee ext, lax w/ flex

*ACL always taut through whole range of motion

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9
Q

meniscal tears

A

outer peripheral tears repair well
inner 1/3 = avascular (do not repair well)
seldom removed

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10
Q

ACL tears

A

partial: debridement of fibers due to inflamm
complete: effusion due to blood vessel rupture
* instability: ant drawer test, lachmans

  • ER of tibia: ACL and PCL not crossed–>less stability
  • IR of tibia: ACL, PCL crossed –>more stability
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11
Q

menisci: common attachments of both

A
  • capsule
  • coronary lig
  • horns
  • transverse lig
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12
Q

medial meniscus: attachments

A
  • MCL

- semimembranosus

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13
Q

lateral meniscus attachments

A
  • popliteus

- meniscofemoral lig

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14
Q

functions of menisci

A
  • adapt bones to each other
  • shock absorption
  • rotation and flex
    • adapting changing curvatures to each other
  • spreading synovial fluid
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15
Q

unhappy triad

A

MCL
Medial Meniscus
ACL

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16
Q

4 anterior bursae of knee

A
  1. suprapatellar (quad): articularis genu slides it away from moving patella
  2. prepatellar: between skin & patella
  3. superficial infrapatellar: between tibial tub & patellar tendon
  4. deep infrapatellar: near inferior pole of patella, inferior margin of fat pad
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17
Q

4 posterior bursae of knee

A
  1. gastroc
  2. popliteus
  3. semimemb
  4. pes anserine bursa
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18
Q

blood supply of knee

A

popliteal A

  • superior med/lat genicular
  • inferior med/lat genicular
  • middle genicular
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19
Q

sensory innervation of knee

A
  • obturator
  • femoral
  • common fibular (peroneal)
  • tibial
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20
Q

anterior compartment of thigh

A
  • inguinal lig to ant knee
  • femoral triangle
  • adduct canal
  • quads
  • cutaneous innervation:
  • femoral branch of genitofemoral
  • ilioinguinal
  • lat fem cutaneous
  • intermed femoral cut
  • med femoral cut
  • obturator
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21
Q

muscles of ant compartment

A
  1. IP: flex hip, trunk
  2. sartorius: flex, abd, ER of femur @ hip; flex knee
  3. pectineus: flex, add, assists in med rot
  4. quadriceps femoris (femoral N: L2,3,4)
    - rectus femoris: ext knee, flex hip
    - vast lat: ext knee, lat patella
    - vast med: ext knee, med patella
    - vast interm: ext knee
  5. articular genu: moves suprapatellar bursa
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22
Q

patellofemoral syndrome (PFS)

A

anterior compartment of thigh

Abnormal lat patellar movement
-associated w/: tight ITB, weak VMO
Chondromalacia of patella: wear of articular cartilage facets (esp lateral)

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23
Q

plica syndrome

A

inferomedial quadrant of knee usually the most painful region.
A painful taut band of tissue that emanates from the central portion of the medial patella may often be palpated (3 o’clock position)

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24
femoral nerve
L2-4 (post division) of lumbar plexus Motor to ant thigh sensation to skin of ant/med thigh *intermed femoral cutaneous N: ant thigh *med femoral cutaneous N: med thigh Saphenous N: terminal branch innervates skin of med lower leg and medial heel *infrapatellar branch to skin of ant & med knee
25
arterial branches off external iliac A to ant thigh
External iliac A 1. infer epigastric, deep circumflex iliac 2. femoral A a. superficial epigastric (ant abdominal wall) b. superficial circumflex iliac (sup/lat inguinal area) c. external pudendal: medial inguinal area, ext genitalia d. profunda femoris i. med circumflex (fem head, neck) ii. lat circumflex (fem head, TFL, lat VL, VI) iii. perforating A (hamstrings, add magnus, add brevis)
26
adductor (hunter's) canal
ant: middle 1/3 sartorius and fascia from VM to add magnus, longus lat: VM med: Add long & magnus Contains: femoral A, V, saphenous N *vessels leave canal through add hiatus (in add magnus), then run post in popliteal fossa and become popliteal A, V
27
medial compartment of thigh
obturator N, A, V: pass through obturator canal Adductors: obturator N L2-4 (ALL adduct femur) 1.gracilis: assist knee flex, IR tibia 2.adduct long: assist hip flex,IR 3.brevis:assist hip flex, IR 4.magnus: assist EXTand IR @ hip 5.obturator externus: obturator N (add, ER femur)
28
medial compartment thigh innervation
obturator N: all adductors, gracilis femoral N: pectineus tibial N: adduct magnus (L4 component)
29
medial compartment thigh vasculature
- Obturator a - Medial Femoral Circumflex a - Profunda Femoris a
30
iliopsoas and obturator N
obturator N exits through iliopsoas
31
Posterior Compartment of Thigh
- Tibial N - Common Peroneal(fibula) N - ProfundaFemoral A - ProfundaFemoral V - Hamstring Muscles - Ischialpart of add Magnus
32
sural N
- cutaneous innervation for posterolateral leg, lat calcaneous - arises from tibial N & per. communic. branch of common peroneal N. - branches * lat. calcaneal * lateral dorsal cutaneous
33
branches of sciatic N
1. tibial N - med. calc. N - med/lat plantar N - sural N (also shares connect. from common peroneal N) a. lat calc. b. lat. dorsal cutan. 2. common peroneal N a. lat. sural cutaneous b. superficial peroneal-->med & intermed. cutan. N's c. deep peroneal --> med & lat branches (muscles) * cutaneous innervat. for skin between 1st/2nd toe
34
Common or Deep Fibula N.damage
weakness in: - Ankle dorsiflexion(drop foot) - Foot eversion - Common or superficial fibula - Toe extension - Common or deep fibula
35
Posterior Compartment Muscles
1. Biceps Femoris: L5,S1,2 - Long head –Tibial N - Short head –Common Peroneal N 2. Semimembranosus: Tibial N L5,S1,2 3. Semitendinosus:Tibial N L5,S1,2 4. Adductor Magnus (ischial part):Obturator L2,3,4 and Sciatic N
36
post compartment thigh innervat
Tibial N: 1. long head biceps femoris 2. semimembranosus 3. semitendinosus Common peroneal N: -short head of biceps femoris
37
post thigh compartment vasculature
1. perforating branches of profunda femoris A 2. inferior gluteal NAV 3. popliteal NAV
38
hamstring tightness
1. post pelvic rotation 2. decreases lumbar lordosis 3. can lead to strains, especially during eccentric activity
39
boundaries of popliteal fossa
1. medial gastroc 2. lateral gastroc & plantaris 2. hamstrings (biceps fem/ semitend, semimemb)
40
popliteal fossa contents
1. post femoral cutan N 2. small saphenous V 3. tibial N: - med sural cutan N - muscular branches - sup med, inf med, middle genicular N to knee jt 4. common fibular N - lat sural cutaneous N - sup lat, infer lat genicular, recurrent genicular N to knee joint 5. popliteal v 6. popliteal A: * ant, post arteries * sup m/l, inf m/l, middle genicular A's to knee jt
41
contents of pop fossa
``` Nerves: a.Tibial(genicular, med suralcut) b.Common peroneal(lat suralcut) c.Post femoral cut Vasculature: a.PoplitealA andV b.Small saphenous vein Muscles: Popliteus, gastroc, biceps fem, Semitend, semimemb ```
42
iliotibial band
- Intermuscular Septum - Superficial * Gluteus Maximus * TFL * Lateral tibia and fasciae
43
groove for flexor hallucis longus (talus)
between med/lat tubercle of posterior talus
44
groove for FHL (calcaneus)
below sustenaculum tali (medial side)
45
calcaneal tuberosity
med, lat tuberal process
46
tarsal canal
sulcus tali + sulcus calcanei
47
groove for peroneus longus
on inferoanterolateral groove of cuboid
48
metatarsals
tuberosity of 5th: peroneus brevis | tuberosity of 1st (inferomedial side): peroneus longus
49
arches of foot
1. Medial Longitudinal Arch: calcaneus through navicular, cuneiform bones, and medial 3 metatarsals 2. Lateral Longitudinal Arch: calcaneus, through cuboid and 4th& 5th metatarsals 3. Transverse Arch: crosses the cuboid, 3 cuneiform bones and bases of 5 metatarsals
50
distal tibiofibular joint
- Syndesmosis - Ligaments: 1. Anterior tibiofibular lig 2. Posterior tibiofibular lig 3. Interosseous tibiofibular lig
51
ankle talocrural joint
* Tibia and fibula with body and trochlea of talus | * DF and PF movements
52
stability of talocrural joint
1. Medial (tibio-talar):Deltoid lig - Anterior: tibionavicular - Anterior tibiotalar - Middle: tibiocalcaneal - Posterior: tibiotalar 2. Lateral (talofibular): Lateral Collateral Lig - Anterior talofibular - Posterior talofibular lig - Calcaneofibular lig
53
talocrural joint motion
Prime motion: dorsiflexion and plantar flexion, slight rotation * Pronation–DF with slight ER (ABD) and eversion * Supination–PF with slight IR (Add) and inversion
54
talocrural sprains
1. Lateral (inversion) most common –fibular collateral ligs: - Calcaneofibular, ATFL 2. Medial (ER or eversioninjury) –deltoid lig
55
lateral collateral lig of ankle
1. Anterior talofibular lig 2. Posterior talofibular lig 3. Calcaneofibular lig
56
bifucrate ligament
calcaneonavicular portion | calcaneocuboid portion
57
medial collateral lig of talocrural joint (deltoid lig)
1. Ant. tibiotalar lig 2. Tibionavicular lig 3. Tibiocalcaneal lig 4. Post. tibiotalar lig
58
spring ligament of ankle
calcaneonavicular lig (from sustentaculum tali to navicular)
59
short plantar lig of ankle
calcaneocuboid lig
60
long plantar lig of ankle
anterior to calcaneal tuberosity -->cuboid, 2nd, 3rd, 4th MT
61
subtalar joint
- Inferior talus with superior calcaneus - Motion: Inversion and eversionof foot - Stability: * Interosseustalocalcaneal * Cervical lig * Anter(or medial) and Post talocalcaneal * Deltoid and lateral ankle ligaments
62
Talocalcaneonavicular Joint Ligaments
-Dorsal Talonavicular -Spring -Bifurcate –Calcaneonavicular part of bifurcate –Calcaneocuboid part bifurcate -Interosseous talocalcaneal -Tibionavicular part of Deltoid
63
calcaneocuboid joint
- Anterior calcaneus with posterior cuboid - Part of transverse tarsal joint - Highest part of lateral longitudinal arch - Stability: * Long plantar lig * Calcaneocuboid lig of bifurcate * Plantar calcaneocuboid (short plantar) * Dorsal calcaneocuboid * Peroneus longus tendon
64
transverse tarsal (midtarsal) joint
- Talonavicular joint and Calcaneocuboid joint - Movement: inversion and eversion of foot - Stability:Ligaments and tendons that reinforce the respective joints Function: adapting anterior & posterior foot aids eversion & inversion
65
tarsometatarsal joints
–Medial TMT jt: med cuneiform and base of 1st MT –Intermediate TMT jt: 2nd and 3rd cuneiform and base of 2nd& 3rd MT –Lateral TMT jt: cuboid with 4th and 5th MT –Only slight movement –Stability by Dorsal, Plantar and Interosseous TMT Lig
66
MTP joints
–flex, ext, some abd and add | –Stability: med and lat collateral lig, plantar lig, deep transverse MT lig
67
IP joints
–flex/ext –Toes 2-5 have PIP and DIP. Big toe only IP –Stability: med and lat collateral lig, plantar lig,
68
compartments of leg (4)
–Anterior *Anterior tibialav, deep peronealn, superior and inferior extensor retinacula, 4 mms (TA, EHL, EDL, PT) –Lateral *Fibular a branch, superficial fibular n, superior and inferior fibular retinacula, fibularis longus and brevis mms –Superficial posterior *3 mms (gastroc, soleus, plantaris) –Deep posterior *Posterior tibial av, peroneal av, tibial n, flexor retinaculum, 3 mms (FDL, FHL, TP)
69
fascia in the leg
- superficial - deep intermuscular compartments: - anterior (separates ant/lat compartments) - posterior (on the fibular side): separates lateral & post superficial compartments - transverse (separates deep/superficial post compartments)
70
muscles of anterior compartment of leg
innervation: deep peroneal N 1. Tibialis anterior: L4 L5 (S1) 2. Extensor digitorum longus: (L4) L5, S1 3. Extensor hallucis longus: (L4) L5, S1 4. Fibularis tertius: (L4) L5, S1
71
anterior compartment leg Arteries
1. ant tibial A 2. ant. tibial recurrent A 3. med malleolar A 4. lat malleolar A
72
anterior tibial syndrome
boundaries: - tibia - inteross memb - fibula - ant intermuscular septum - crural fascia swelling (increased volume): - DF difficult - ant tibial A compressed -->lack of dorsalis pedis pulse - ant tibial V compress - numbness
73
compartment syndrome (5 P's)
1. pallor 2. pulseless 3. paresthesias 4. paralysis 5. pain on passive extension of compartment
74
posterior compartment of leg
1. posterior tibial A,V 2. peroneal A,V 3. tibial N 4. flexor retinaculum 5. deep muscles: post tib, flexor digit long, flex halluc long 6. superficial muscles: gastroc, soleus, plantaris
75
posterior compartment of leg innervations
``` *all innervated by tibial N superficial muscles: -gastroc, soleus: S1,2 -plantaris: L4,L5,S1 deep muscles: -FDL (L5), S1,S2,(S3) -FHL L5,S1,2 -Tib Post L4,5, (S1) ```
76
muscles actions in post leg compartment
``` superficial: 1.gastroc: ankle PF, knee flex, supinate subtalar jt 2.soleus: PF, supinate subtalar jt 3.plantaris: PF deep: 1.post tib: PF, inv, supination 2.FDL: PF, inv, MTP flex, IP flex 3.FHL: 1st MTP/IP flex, PF, inv ```
77
tibial neuropathy in pop fossa
Affects: - post compartment muscles - plantar foot - sensation to post leg & sole of foot
78
post compartment leg arteries
popliteal A: - inf genicular A - sural A post tibial A: - circumflex fibular A - fibular A (along w/ perforating branches of fibular A) - post med malleolar A - med/lat plantar A
79
achilles tendon tears
Causes: - Trauma - Eccentric activity - Overuse - Post steroid injections Partial thickness Full thickness (ruptures) - Tendon pulled proximal - Thompson’s sign
80
tarsal tunnel syndrome
involves post tib, FDL, FHL under flexor retinaculum
81
lateral leg compartment
``` Superficial peroneal(fibular) nerve –Sensory to lateral and anterolateral skin of distal leg and dorsum of foot ``` Superior and inferior peroneal (fibular) retinacula Peroneus (fibularis) longus Peroneus (fibularis) brevis Perforating branch of fibular A.
82
lateral leg compartment muscle innervations
*all innervated by superficial peroneal N | peroneus longus & brevis: L4,5,S1,(S2)
83
lateral sural N
off common peroneal N | sensory to proximal half of lateral leg
84
dorsal foot
- tendons of muscles in ant compartment: ant tib, EDL, EHL - superficial peroneal N: medial & lateral (intermediate) cutaneous branches - deep peroneal N: EDB, EHB, sensory for area between 1st/2nd toe - dorsalis pedis A - arcuate A - dorsal MT A
85
muscles of dorsal foot innervation
deep peroneal N (L5), S1, (S2): EDB EHB
86
sole of foot
Superficial fascia –Surrounds plantar dig n, vessels, flexor tendon sheath Plantar aponeurosis (Deep fascia) –Calcaneal tuberosity to sides of prox phalanges –Covers FDB –Inflammation = PLANTAR FASCITIS & periostitis
87
septa of the foot
1. medial intermuscular septum 2. lateral intermuscular septum 3. transverse intermuscular septum
88
plantar foot arteries
medial plantar A lateral plantar A -->plantar arch plantar arch plantar digital A
89
medial plantar N
1. abductor hallucis 2. flex digitorum brevis 3. flex hallucis brevis 4. 1st lumbrical
90
lateral plantar N
1. adduct hallucis 2. abductor digiti minimi 3. flexor digiti minimi brevis 4. lumbricals 2-4 5. quadratus plantae 6. plantar/dorsal interossei
91
superficial layer of plantar foot
1. abductor hallucis 2. flexor digitorum brevis 3. abd digiti minimi
92
second layer of plantar foot
1. FDL tendon 2. FHL tendon 3. lumbricals 4. quadratus plantae
93
3rd layer of plantar foot
1. flexor hallucis brevis 2. flexor digit minimi brevis 3. adductor hallucis: oblique & transverse head 4. opponens digiti minimi
94
4th layer of plantar foot
plantar interossei: adduct toward 2nd toe (except for 1st toe) dorsal interossei: abduct away from 2nd toe
95
innervation of 1st foot layer
abd hallucis: medial plantar N flex digit brevis: medial plantar N abd digiti minimi brevis: lateral plantar N
96
innervation of 2nd foot layer
tendons of FDL, FHL 1st lumbrical (to 2nd toe): medial plantar N lumbricals 2,3,4 (toes 3-5): lat plant N quadratus plantae: lat plant N
97
innervation of 3rd layer of foot
1. flexor hallucis brevis: med plantar N 2. adductor hallucis: deep branch of lat plantar N 3. flexor digiti minimi brevis: superficial branch of lat plantar N
98
innervation of 4th layer of foot
1. dorsal interossei: deep branch of lateral plantar N | 2. plantar interossei: deep branch of lat plantar N

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