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MSK Exam 2 > Joints and ligaments > Flashcards

Joints and ligaments Flashcards

1
Q

What is the iiofemoral Ligament

A

Y shaped ligament that is one of body’s strongest ligaments.

Prevents hyperextending of hip

On the anterior side of the body

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2
Q

what is the pubofemoral ligament

A

Tightens when we extend

Prevents hyperabduction

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3
Q

Ischiofemoral L

A

located on the posterior portion of femoral neck

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4
Q

3 extracapsular ligaments of hip

A
  1. Iliofemoral L
  2. Pubofemoral L
  3. Ischiofemoral L
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5
Q

What are the 4 Intracapsular Ligaments of the Hip

A

1 .Zona Orbicularis

  1. Acetabular Labrum
  2. Ligamentum Teres
  3. Transverse Acetabular L

ZALT

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6
Q

Zona Orbicularis

A

Intracapsular Ligaments of the Hip

Runs deep and perpendicular to the previously mentioned Extracapsular Ligaments. Supports the weak Femoral Neck

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7
Q

Acetabular Labrum

A

An Extension of the Acetabular Ridge , creating a deeper socket for the Femoral Head to sit inside.

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8
Q

Transverse Acetabular Ligament

A

Connects the inferior aspect of the Acetabulum.

Acts as a gateway for vessels going to the head of the femur, since the rest of the Acetabulum is a bony structure.

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9
Q

Ligamentum Teres

A

Ligament of the Head of the Femur.

During childhood, a branch of the Obturator Artery runs into / around it. Usually this closes, but in some populations it does not.

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10
Q

When runs around the Ligamentum Teres in childhood

A

obturator a

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11
Q

Anterior hip dislocations

A

very uncommon due to the strength of the Iliofemoral Ligament.

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12
Q

Posterior Dislocations

A

Occur in car crashes when knee car crashes slams into the dash, and the head of the femur is pushed post out of the socket.

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13
Q

what happens during Posterior Dislocation of the Femur

A

shortening of limb
internally rotated
flexed
adducted

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14
Q

Log Roll

A

Pt supine. Externally and internally rotate the hip and check for pain.

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15
Q

Labral Loading

A

Pt supine.
Flex the patient’s knee to 90 degrees while the patient is supine and apply weight to the acetabulum by pressing down on the femur. Check for pain.

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16
Q

Labral Distraction

A

Pt supine.
Flex the patient’s knee to 90 degrees as above, but then lift on the leg to take weight off of the acetabulum. Check for relief of pain

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17
Q

Scour Maneuver

A

Pt supine. Rotate the patient’s thigh in circles at the hip joint. Check for pain.

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18
Q

Lateral (fibular) collateral L

A

does not directly connect to lateral meniscus. underneath is the popliteus m.

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19
Q

does medial (tibiaa) collateral L attach to medial meniscus

A

yes

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20
Q

blow to side of knee. what happens

A
  1. tear of medial collateral m
  2. tear of medial meniscus
  3. acl tear
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21
Q

Anterolateral Ligament

A

prevents [excessive internal tibial rotation] when the leg is near full extension.

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22
Q

why is there high rates of re-tearing in post ACL patients

A

[anterolateral ligament] of knee is also torn but rarely repaired

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23
Q

what is weaker; lateral collateral or medical collateral

A

medial. tears commonly w the medial meniscus

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24
Q

Oblique Popliteal Ligament

A

comes off of the Semimembranosus Tendon–> Lateral Femoral Condyle

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25
Q

Where is the posterior cruciate L

A

Behind ACL.

but medial to the anterior cruciate L if looking at it from anterior

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26
Q

ACL: wwd

A
  1. during flexion, limits rolling of femoral conydles on tibia
  2. Prevents hyperextension of the knee
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27
Q

what is stronger: PCL and ACL

A

PCL; more vascularized

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28
Q

PCL job

A

Prevents hyperflextion

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29
Q

What does the lateral meniscus connect to

A

Posterior Cruciate Ligament.

Thicker than medial and more full circle

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30
Q

Transverse Ligament of the Knee

A

Connects the anterior portions of the Menisci together to add strength to the knee joint.

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31
Q

Meniscal Tear

A

inner portion of the Menisci are not connected to anything, and can fold and “catch,” which the patient can feel.

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32
Q

unhappy triad of knee injury

A

lateral impact will tear

  • acl
  • mcl
  • medial meniscus
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33
Q

what is the valgus stress test

A

Start with the pt’s knee straight, and apply force on the lateral part of the knee (pushing the leg into a valgus shape) and check for pain.

Do the same with a slightly flexed knee. This checks the Medial Collateral Ligament , as that is the ligament that would be stretched by that maneuver.

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34
Q

Valgus stress test looks at the

A

medial collateral L

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35
Q

what is the varus stress test

A

Start with the pt’s knee straight, and apply force on the medial part of the knee (pushing the leg into a varus shape) and check for pain. Do the same with a slightly flexed knee.

This checks the Lateral Collateral Ligament , as that is the ligament that would be stretched by that maneuver.

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36
Q

Varus stress test looks at the

A

lateral collateral l

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37
Q

Lachmans test

A

Checks ACL.

Flex the pt’s knee to about 30 degrees. Pull anteriorly on the Tibia to check for laxity of the Anterior Cruciate Ligament.

Push posteriorly on the Tibia to check for laxity of the anterior Cruciate Ligament.

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38
Q

lachmans test

A

pull- check laxity of ACL

push- check laxity of ACL

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39
Q

What does McMurray tests test?

A

Meniscus

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40
Q

how to run McMurray tests

A
  • supine
  • flex knee to 90
  • load meniscus and extend. check for pain
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41
Q

how do we test medial meniscus on mcmurray

A

Externally rotate by loading pressure onto medial menisucs, trying to “catch it” into the tibia

Valgus stress.

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42
Q

how do we test lateral meniscus on mcmurray

A

Interally rotate by loading pressure onto lateral menisucs, trying to “catch it” into the tibia

Varus stress.

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43
Q

Alternate name for superior extensor retinaculum

A

trans-crural ligament

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44
Q

Alternate name for inferior extensor retinaculum

A

cruciate ligament

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45
Q

When we invert our ankle, what ligament is first and most likely to tear?

A

ATF
(Anterior Talofibular ligament)

ATF is located on the antero-lateral aspect of our foot.

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46
Q

What ligament mirrors the ATF?

A

ATF= anterior talofibular ligament

Posterior talofibular ligament

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47
Q

What ligament prevents hyperinversion of the foot?

A

Calcaneofibular ligament

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48
Q

What is the “Always Tear First” Ligament?

A

Anterior Talofibular Ligament

When we invert our ankle, it is the first to tear.

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49
Q

What does the [deltoid ligament] do?

A

Located on the medial mallelous and make ankle resistant to tearing

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50
Q

Parts of the deltoid ligament

A

Start on medial malleolus and named for the foot bone they go to.

  1. Anterior tibiotalar part
  2. Tibionavicular part
  3. Tibiocalcaneal part
  4. Posterior tibiotalar part
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51
Q

Anterior Talofibular Ligament (ATFL) sprain is due to what movement of the foot?

A

inversion

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52
Q

What is Pott’s fracture dislocation?

A

Occurs in the ankle due to an [EVERSION SPRAIN].

Your deltoid ligament will not break because its so strong.

Instead, internal rotation will fracture [medial malleolus + fibula].

Potts, bone breaks before ligament

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53
Q

In Pott’s fracture, where does the force come from?

What way does our ankle roatate?

A

-Force comes laterally, causing eversion of foot and internal rotation will cause talus to strike the fibula.

54
Q

What is the purpose of foot arches?

A
  1. Absorb shock

2. Adapt to surfaces

55
Q

what is in the transverse arch of the foot?

A
  1. Three cuneiforms
  2. Cuboid
  3. Proximal heads of the metatarsals
56
Q

What is in the lateral longitudinal arch of the foot

A
  1. 2 distal digits (metatarsals and phalanges)
  2. Cuboid
  3. Calcaneus
57
Q

What are the dynamic supports of the foot?

A

Muscles

Tendons of legs that affect the foot

58
Q

What are the passive supports of the foot?

A
  1. shapes of the bones
  2. AponeuroSIS
  3. Spring ligament, short plantar ligament and long plantar ligament
59
Q

What is the spring ligament called?

A

plantar calcaneonavicular L

60
Q

What is the short plantar L called?

A

Plantar calcaneocuboid L

61
Q

What is another name for the spring ligament and why is it so important?

A

Plantar calcaneonavicular L

Passive support to the arch by passing weight from talus–> rest of the foot.

62
Q

What tendons are important in dynamic support of the arch?

A
  1. Tendon of fibularis longus m

2. Tendon of tibialis posterior m.

63
Q

What is pes planus?

A

Flat feet

64
Q

Types of pes planus?

A
  1. Loose
  2. Dense
  3. Acquired
65
Q

Loose pes planus

A

most common in infants due to laxity of dynamic supports of arch (intrinsic ligaments

66
Q

Dense pes planus

A

Due to deformity of bones, often caused by fracture

67
Q

Acquired pes planus

A

Due to:

laxity of tibialis posterior tendon due to age,

denervation of the muscle,

68
Q

What is the most common pes planus?

A

Acquired planus

69
Q

How can we tell what innervates a joint

A

if a muscle crosses a joint, whatever nerve innervates that muscle supplies the joint

70
Q

What is the least effective small rotator?

A

Quadratus femoris m.

71
Q

What is Hilton’s law?

A

A joint is innervated by the same nerve of the muscle that crosses over it.

72
Q

Main artery of the thigh?

A

Deep femoral A.

73
Q

What are the thickened parts of the articular capsule called?

A

intrinsic ligaments

74
Q

Iliofemoral joint resists hyperextension. this extension is permitted by what?

A

lumbar spine.

75
Q

Why is a medial meniscal tear often found with a MCL tear?

A

They’re bound to one another.

76
Q

Where are internal ligaments located?

A

in the capsule, but seperate from the joint cavity

77
Q

How does ACL prevent hyperextension of the knee?

A

Prevents femur from dislocating POSTERIORLY

Prevents tibia from dislocating ANTERIORLY.

78
Q

When is the PCL taut?

A

when leg is flexed

79
Q

How does the PCL prevent hyperflexion of the knee

A

Prevents femur from displacing ANTERIOR

Prevents tibia from displacing POSTERIOR

THINK: What happens when you flex your leg: femur goes anterior and tibia goes posterior

80
Q

When would we tear our ACL?

A

Hyperextension

Tibia goes anterior
Femur goes posterior

81
Q

Anterior drawn sign

What is this indicative of?

A

Leg is flexed; doc attempts to displace the tibia by pulling anteriorly bc ACL should resist.

If pain, ACL Damage

82
Q

How do we test anterior drawer sign clinically?

A

Lachman’s test

83
Q

what is the difference between anterior drawer test and lachmans?

A

In anterior drawer, leg is more flexed

84
Q

Pivot-shift test

What does it test?
Mechanism?

A

Tests–> ACL laxity

How? IT band can be a flexor or extensor. When it becomes a flexor, it pulls the tibia posterioly.

In this test, we begin with the tibia shifted anterior. We then look for when IT becomes a flexor and check if the tibia gets pulled back.
If so, the ACL is lax.
If not, tibia will shift anterior.

85
Q

Posterior drawer sign:

A

Leg is flexed; doc attemtps to displace tibia by pushing posteriorly bc PCL should resist.

If pain, PCL damage

86
Q

How can we test the posterior drawer sign?

A

Quads active test.

87
Q

How is a quads active test ran?

A

Doc pushes posterior on tibia,

Pt will then activate quads and it will pull the tibia anterior due to patellar ligament.

88
Q

what does the transverse ligament of the knee allow?

A

both menisci to move together when femur and tibia move.

89
Q

are peripheral meniscal tears often easily healed or repaired?

A

yes bc of blood supply.

90
Q

how do we test for meniscal tears

A

locate pain and crepitus along joint line while adducting or abducting leg`

91
Q

What causes passive fallen arch

A

laxity in spring ligament

92
Q

what usually happens in pes planus?

A

Medial part of longitudinal arch falls.

Plantar ligaments and plantar aponeurosis become stretched out.

Plantar calcaneonavicular ligament can not longer support head of the talus so it displaces inferomedially.

93
Q

What is hallux valgus

A

Lateral deviation of big toe.

Tissue will swell and pressure and friction against shoe causes bursa (bunion) to form

94
Q

Bunion

A

a tender and inflamed bursa

95
Q

Corns

A

Inflamed areas of thick skin over proximal interphalangeal joints.

96
Q

What is mallet toe?

A

Flexion in distal IP joint

97
Q

What is hammer toe?

A

Usually occurs in 2nd digit.

Extension at MP joint

Flexion at proximal IP joint

98
Q

What is claw toe?

A

Extension at MP

Flexion at proximal IP and distal IP

99
Q

Apply Grind test will test the

A

meniscus

100
Q

On interior inversion, what is the first ligament to tear or be damaged?

A

Anterior

Talofibular Ligament

101
Q

If we evert our foot, is the Deltoid ligament likely to tear?

A

No. It is v strong.

102
Q

when a person slips and their foot is forced into an excessively inverted position, what happens?

A

the ankle ligament tears, tilting the talus against the lateral malleolus and tearing it off. This can fuck up the fibula.

103
Q

During hip replacement, what is replaced

A

acetabulum and the femoral head and neck

104
Q

Osteoarthritis of the hip is caused by what?

A

erosion of articular cartliage

105
Q

Dislocation of hip joint in kids can do what

A

disrupt the artery to the head of the femur, causing necrosis

joint becomes incongruint and growth stops

106
Q

What is a characteristic of hip dislocation

A
  • We cannot abduct the thigh
  • Limb appears shorter because the dislocated femoral head is more superior
  • +Trendelinbergs sign
107
Q

Trendelenburgs sign

A

hip appears to drop on one side when we walk

108
Q

Is aquired hip dislocation common

A

no because the articulation is strong.

109
Q

During a car accident, what iis the position of the thigh that may cause the hip to be dislocated

A

Hip is

  1. flexed
  2. adducted
  3. medially rotated
110
Q

What nerve may be injured during posterior hip dislocations or fracture-dislocations of the hip?

A

sciatic nerve.

111
Q

What can result when a specific nerve (name it) is damaged during posterior hip dislocations or [fractures/dislocations] of hip joints

A

sciatic nerve

paralysis of hamstrings and muscles below the knee, which are supplied by the sciatic n

112
Q

Anterior hip dislocations are caused by what movements of the hip

A

extension
adduction
laterally rotation

113
Q

How is the femur placed in our thigh?

A

Diagnally

114
Q

How is the tibia placed in our thigh?

A

Vertical

115
Q

Angle between tibia and femur is called what

A

Q-angle

116
Q

Genu varum

A

bow legged
Q-angle decreases

Excess weight is placed on medial aspect of the knee and [lateral collateral ligament] is overstressed

117
Q

Genu valgum

A

Knock-knee (knees touch)
Q-angle increases

Excess weight is placed on lateral part of knee and the [medial collateral ligament] is overstretched

118
Q

most common knee injury in contact sports

and how

A

ligament sprain, which occurs when the foot is fixed in the ground.

When a force is applied against the knee when the foot cannot move, ligament injuries are common. ACL and PCL are tightly stretched when the leg is extended, normally preventing disruption of the sides of the knee.

119
Q

Most common knee injury during skiing accidents

A

ACL rupture

Free tibia slides anterior under a fixed femur (anterior drawer sign)

120
Q

Instance where the PCL can tear

A

when you land on your tibial tuberosity when the knee is flexed.

Knocked on the floor in backetball

Tibia will slide posterior under fixed femur (posterior drawer sign)

121
Q

Posterior drawer sign

A

Tibia slides posterior under fixed femur

122
Q

What does pain during lateral rotation of the tibia indicate?

A

injury to lateral meniscus

123
Q

What does pain during medial rotation of the tibia indicate?

A

injury to medial meniscus

124
Q

What happens to a knee joint when the meniscus is removed

A

will suffer no loss of mobility but it may be less stable and tibial plateus may undergo inflammation

125
Q

Fractures of the DISTAL FEMUR or lacterations to the anterior thigh may involve what?

A

Suprapatellar bursa, causing the knee joint to become infected.

Increases amount of synovial fluid

126
Q

What is a prepatellar bursitis

A

Prepatellar bursitis occurs at the knee joint when the skin rubs against the patella from kneeling
OR
direct blow to falling on a flexed knee.

127
Q

Friction between the [skin and tibial tuberosity] results in what

A

Subcutaneous infrapatellar bursitis (used to be called clergymans knee)

Edema will occur

128
Q

Deep infrapatellar bursitis

A

Edema will occur in between the [patellar tendon and tibia].

129
Q

What is a popliteal cysts

A

abnormal fluid filled sac of synovial fluid in the popliteal fossa due to herniation of gastrocnemius bursa or semimembranous bursa

130
Q

knee replacements are made of waht

A

plastic and metal components are used to mimic smoothness of cartlage on cartilage

131
Q

A sprained ankle injury is almost always a inversion/eversion injury

A

INVERSION

MSK Exam 2 (23 decks)

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