final revision Flashcards
(136 cards)
1
Q
bones of the knee
A
femur
tibia
fibula
patella/kneecap
2
Q
longest bone that transmits weight to the legs
A
femur
3
Q
largest sesamoid bone
A
patella
4
Q
knee joints
A
tibiofemoral
patellofemoral
superior tibiofibular
5
Q
meniscus
A
lateral meniscus
medial meniscus
6
Q
why dislocation on knee joint is very rare.
A
because of support given by the meniscus
7
Q
medial meniscus
A
crescent shaped and open faces laterally
8
Q
lateral meniscus
A
oval and its opening faces medially
9
Q
what type of structures are meniscus?
A
they are avascular structures.
10
Q
about meniscus
A
innervated by nerves from capsular plexus but lack vein except for 1/3 of its outer part. so there is pain in meniscus but no intraarticular bleeding and no spontaneous healing observed.
11
Q
tasks of meniscus
A
=smoothness and increases width
=stability of joints by increasing contact surface of tibia
=shock absorption
= prevent flexion that may occur during movement and provides lubrication
12
Q
bursae
A
synovial sacs aimed at reducing friction between bones and tendons.
13
Q
main ligaments of the knee
A
anterior cruciate ligaments
posterior cruciate ligaments
medial collateral ligaments
lateral collateral ligaments
patella ligament
14
Q
the strongest ligament on the knee
A
patella ligament
15
Q
about MCL and LCL
A
They are tense while knee is in extension as to ensure lateral stability and they are loose when in flexion
16
Q
about PCL and ACL
A
prevent excessive rotation of the knee.
when they are loosen in flexion, forward displacement is prevented by ACL and rear displacement by PCL.
17
Q
what percentage of stability does PCL provide towards the back?
A
90
18
Q
which ligament prevent tibia from displacing forward under femur?
A
ACL
19
Q
Knee biomechanics
A
flexion-extension
internal - external rotation as important movements
least important movements include compression-distraction and medial - lateral translation.
20
Q
screw home mechanism
A
also known as auger shaped movement
is the rotation between tibia and femur, the mechanism serves as critical function of the knee and is key element to knee stability for standing upright.
21
Q
valgite angle
A
171 btn anatomical axis of femur and tibia
22
Q
muscles of knee and functions
A
rectus femoris = extends the knee/ pulls patella outwards + flex thigh
vastus medialis= prevent patella from sliding to the outer side
hamstrings/gracilis/sartorius +popliteus= flexors
23
Q
which muscle or group of muscles participate in knee flexion and internal rotation as well as support knee against valgus stress
A
sartorius, gracillis and semitendinosus [goose’s foot/pes anserinus]
24
Q
rotation at the knee
A
performed after 30-degree flexion around vertical axis passing middle of concave surface of medial condyle of tibia.
at 90-degree flexion
40 ext
30 internal
25
what is Q angle?
angle between line drawn from anterior superior iliac spine to the midpoint of patella and from patella to tibial tubercle.
26
genu varum and valgum
varum q angle below and valgum above
27
anteversion
internal rotation gait, to keep the head in acetabulum.
if excess Q angle increases, subtalar goes to excess pronation and increases lumbar lordosis.
28
retroversion
external rotation gait, Q angle decreases and supination increases. transverse axis of knee is parallel to hip.
29
gravity center of the body
2nd sacral vertebra
30
genu valgum
=narrow valgite angle
=congenital, metabolic diseases
=has effect on static conditions.
=if child put weight on medial tibial plateau hypertrophy occurs on medial tibial and atrophy on lateral part
=muscle shortness [TFL and v.lateralis
=as result of prolonged tension MCL will loosen and no adduction
=if one side shortness the person bends knee or bring it to valgus to compensate
=if not sever lateral force can correct it
31
genu varum
it leads to more serious biomechanical problems and severe pain in the knee.
evaluated at loading because stress is eliminated while resting and deformity will appear lighter.
32
genu recurvatum
=due to imbalance between muscles
=hyperextension up to 10-degrees is normal.
=increase angle of the pineal plaque of tibia
33
tibial torsion
inability to complete external torsion of tibia
34
knee bursitis
inflammation of bursae
examples
popliteal cyst
prepatellar bursitis
35
patella femoral pain
=characterized by erosions of articular cartilage to underlying bone.
=anterior knee pain that increases with activity
=often bilateral
=going down the stairs or hills pain occurs
=pain located in peripatellar and spreads to the medial and lateral retinaculums.
36
false locks
patella induced locks.
they disappear quickly.
37
osteochondritis dissecans
=process that begins with deterioration of the blood supply of the bone under the articular cartilage in certain part of any joint
which turns into dead bone [necrosis].
=it can end into degenerative arthritis.
=can occur in any joint but common in the knee joint.
=common in men
38
position pelvis is always at
oblique position
39
bones of pelvis
ilium
pubis
ischium
40
ligaments of pelvis
Sacro spinal ligament
Sacro tuberous ligament
41
pelvis movements [foot on the air]
=anterior n posterior tilt
=right left lateral tilt
=right to left tilt
42
pelvis movements [foot on the ground]
closed kinematics motion.
43
muscles for anterior tilt
hip flexors=iliopsoas rectus femoris
waist extensors=erector spinae
44
posterior tilt muscles
abdominal muscles=rectus abdominis
hip extensors=hamstrings and gluteus maximus
45
lateral tilt muscles
left and right quadratus lumborum
hip abductors
46
inclination angle
angle between femoral neck and femoral body in frontal plane
47
anteversion angle
angle between longitudinal axis of femoral neck and line connecting posterior femoral condyles in transverses plane.
48
kinematics relations between knee and hip
for max flex-ext = hip 5 abd
hamstring tension at 90 knee flex =hip flex limited at 90
49
lumbopelvic rhythm [LPR]
kinematics relationship between lumbar spine and hip joints in sagittal plane
opposite direction=grabbing with your hands something from up
same direction= pelvic tilt example when picking up a box from the ground
50
inclusion angle disorders
coxa Valga angle is greater than 125.
coxa Vara angle less than 125
51
coxa vara
congenital
acquired causes.
metabolic bone diseases
slippage of pineal plaque
normal anteversion angle decreases or takes -ve value
52
coxa valga
congenital causes
femoral inclination angle increases
anteversion angle increases
stress of shredding reduced
53
transverse plane deformities
anteversion=introverted walking
retroversion=extroverted walking
54
congenital hip dislocation
presence of femoral head outside acetabulum as a result of anomalies of the soft tissues around the joints
55
intrinsic balance of the spine
the tension stress of the ligaments ensures the tight connection of the vertebrae to each other and create continuity in the spine.
=intervertebral disc help maintaining intrinsic balance
=it is caused by combination of elastic tension resistance of the ligaments and elastic pressure resistance of the disc
56
ligaments of spine
anterior longitudinal ligaments= prevents hyperextension of the vertebral column
posterior longitudinal= prevents hyperflexion of the vertebral column
ligamentum flavum= maintain upright posture
supraspinous = flexion
57
spinal stability
=instability increases with degeneration
= vertebral column is capable of reacting to forces coming from different direction at same time.
=restructuring is tried to be achieved with fibrous tissue and/or osteophyte changes
58
segmental loads
axial compression
bending
torsion
shear
59
axial compression
=occurs as a result of reactions of ligaments to gravity, ground reaction forces, muscle contraction tensile forces.
=anterior segment can lift more loads. overflows are frequent posteriorly.
=compression in the disc causes tension in the annulus, angular changes in fibers and stability increases
60
bending
=combination of shear. compression and tension force
=during bending posterior annulus resist while anterior compressive force on the posterior longitudinal ligament, capsule and anterior segments cause displacement [protrusion] of the disc
61
torsion
formed by axial rotation and combination of several movements.
=stiffness may occur in some movements due to joint compression; flexion increases torsional hardness in L3-4
62
shear
force exerted by opposing force on the same point
=if there is wear on the disc, an injury occurs
63
flexion
tension force is on the posterior longitudinal ligament.
64
extension
nucleus pulposus moves anterior direction
65
lateral flexion
tension force on convex side, compression force on concave side
66
cervical spine
has foramen transversarium.
=C1-2 * rotation function+ flexion extension
=more spinal cord injuries on upper cervical because of narrow canal
=C1*atlas-no real spinous process
=C2*axis-has dens
=C7*has longest spinous process
=ligaments include internal and external craniocervical [connects atlas and axis] + vertebral ligament
67
ligamentum nuchae
provides an adhesion site for the muscles.
68
tectorial membrane
=located in the vertebral canal
=continuation of posterior longitudinal ligament
=covers ligaments and dens. acting as additional protector at junction site of medulla spinalis and medulla oblongata
69
joint where flexion- extension of the head take place.
atlanto-occipital joint
70
rotation of the head takes place at
atlanto-axial joint
71
muscles of anterolateral region
1]platysma=draws the skin around the lower part of mouth down or out
2]sternocleidomastoid= flexes the neck and extends head
3] hyoid muscle =swallowing and speech
4]scalene= elevates 1st rib
72
most mobile part of spine
cervical vertebrae
73
most basic element in cervical stability
transverse ligament
74
most common site of cancer metastases but least common for musculoskeletal system
thoracic region
75
most load bearing part of skeletal sytem
lumbar
76
sitting and standing
the loose and unsupported sitting position that puts the most strain on the waist.
in the loose standing position. lumbar lordosis should be normal
77
Whiplash injury
type of neck injury usually a hypertension but can also occur with sudden hyperflexion
78
cervical spondylosis
degeneration. Osteophyte formation and intervertebral disc disorder occurring in cervical
79
thoracic lumbar pathomechanics
inflammation
disc herniation
articular pathologies
thoracic outlet syndrome
structural pathologies
80
Scheuermann's juvenile kyphosis
a growth age disease characterized by increase in dorsal kyphosis and an increase lumbar lordosis occurring in juvenile period.
81
ratio of carpal. Metacarpal and fingers
2;3;5 thus the hand is the forefront of mobile
82
bones of the hand
ulna
radius
carpals
metacarpal
phalanxes
83
movements that occurs more on he hands
=flexion-extension than radial-ulnar deviation
=extension is more limited than flexion
=radial deviation associated with flexion of the hand
=ulnar deviation associated with extension of the hand
84
flexor zones of the hand Zon V
=Zon V * containing musculotendinous compound on distal part of the arm
medial and ulnar artery injuries and nerve injuries can be seen
85
flexor zone 4
level of Carpal tunnel
the tendons have synovial sheaths
86
flexor zone 3
located at distal side of the carpal tunnel
contains synovial sheaths of FPL, flexor digitorum profundus and superficialis
87
flexor Zon 2
between beginning of digital synovial sheaths proximally and adhesion site of the FDS distally
fibroosseous tunnels called PULLEYS are found
88
flexor zon 1
extends from adhesion site of FDS to the proximal phalanx of FDP
89
extensor zones of hand
five zones for the thumb and eight for other fingers
90
extensor zon 8
level of forearm and at line of supinator muscles
91
extensor zon 7
at wrist level
do not have synovial sheaths thus easy to repair than flexor tendons
92
extensor zon 6
the extensor digitorum komunis tendon spread to the fingers on the back of the hand
93
zone 5 extensor
extensor tendons cross the sagittal bands between MCP joint heads.
if rupture tendon falls into intermetacarpal area during flexion
extensor plus phenomenon occurs here
94
extensor zon 4
it is the alignment of the proximal phalanxes
95
extensor zon 3
the central band. extensor of PIP joint passes PIP joint and adheres to the middle phalanx's proximal part
96
extensor zone 2
middle phalanx and lateral bands are here
97
zone 1 extensors
the tendon attaches to the base of distal phalanx.
swan neck can be seen here.
98
functional position of the hand
wrist 15-30 extension, 10-12 ulnar deviation. thumb opposition and other fingers semiflexion.
99
neural position
not 180
12 extension and 3 ulnar deviation
100
ROM with angles
extension=50-80
flexion=60-85
add=30-45
abd=15-30
pronation=80-90
supination=80-90
101
muscles of the hand
extrinsic=take their origo from outside of the hand
intrinsic
102
functional ROM for DLA
flex=10
ext=25-30
radial=10
ulnar=15
103
capitulum humeri
has spherical surface as it goes from top to bottom it's curvature increases and so it does not have fixed radius
104
medial collateral ligament of elbow
when elbow forced into valgus it is stretched and prevents the movement of ulna to the radial side
105
lateral collateral ligament of elbow
it is stretched when elbow forced into varus
106
annular ligament of elbow
hold the radial head in the sigmoid cavity
107
arthrokinematics movement
compression/distraction of ulna to humerus
108
osteokinematic movements
=radius head rotates in the annular ligament and in the capitulum of the humerus
=actual movement occurs when the elbow is in 90-degrees flexion
109
closed kinematics movements of elbow
open door handle
open a can
110
location of medial and lateral epicondyle
medial =posteriorly
lateral=anteriorly
111
brachialis and brachioradialis
elbow flexion activities
112
biceps brachii
=elbow flexion when forearm supinated
=flexes shoulder
113
elbow extensors
triceps brachii
anconeus
113
dynamic stability of elbow
=anconeus opposes varus stress
=antagonists co-contraction increases compression force and brings the joint closer
114
common injuries of elbow by direct stress
longitudinal compression stress fracture
distraction elbow
elbow backward dislocation
115
repetitive stress
lateral epicondylitis when forearm pronated
medial epicondylitis wehn supination is repeated
116
anatomical orientation of shoulder gridle
clavicula 20 behind frontal plane
scapula 35 ahead frontal plane
humerus 30 behind frontal /medial lateral axis
117
GH joint stability structures
[static structures]
bone
glenoid labrum
joint
ligaments
negative intraarticular pressure
dynamic=muscles
118
GH joint stability
=provided by rotator cuff muscles and fibrous capsule
*Static stability= provided by the position of the head of the humerus in the glenoid pit and there is -ve pressure
*Dynamic stability= by normal resting tone and functional strength of 4 muscles
119
subscapularis
medial rotation of the arm
adduction of the arm
120
supraspinatus
abduct the arm
121
infraspinatus
lateral/external rotation of the arm
122
teres minor
lateral rotation and adduction of humerus
123
deltoid
anterior = flexion
posterior=extension
lateral=abduction of the humerus
124
latissimus dorsi
extends. adducts and medially rotates humerus.
climbing muscle
125
pectoralis major
clavicular head=flexion
sternal head = adduction and medial rotation
126
scapulothoracic Joint
=physiological joint
*elevation=sternoclavicular elevation +acromioclavicular downward rotation
*Upward rotation= SC elevation + AC upward rotation
127
trapezius
superior=elevation of scapula
middle=retraction
inferior=depression
128
sternoclavicular joint and acromioclavicular joint
synovial
planar type
129
scapular rhythm 0-90 degrees abduction
60 from GH
30 from ST= 20-25 clavicular elevation
= 5 AC upward rotation
130
90-180 abduction scapular rhythm
60 GH
30 ST=5 clavicular elevation
= 25 AC upward rotation
131
scapulohumeral rhythm
abduction is created by synergistic coordination of ST combined with GH, AC and SC
2;1
132
front side shoulder pain
*Rotator cuff tendinopathy= simple strain
=tearless
=chronic calcific
=with tear
*Adhesive capsulitis=pain and limitation of movements
*Labral tear=deep pain cannot be localized. instability
*AC problems=can be localized. trauma. OA and AC separation
133
what causes pain that are not well localized?
usually caused by extrinsic problems
134
AC pain
pain can be well localized on the anterior face of the shoulder
135
shoulder instability
subluxation
loose shoulder
partial dislocation
may be as a result of rotator cuff tear
common in young women
