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anatomy of the limbs > Knee, leg, ankle and foot > Flashcards

Knee, leg, ankle and foot Flashcards

1
Q

describe the bones of the leg *

A

the tibia and fibia are 2 parallel bones that articulate with each other

they have an interosseous membrane between them

tibia has medial and lateral condyles involved in articulation

the articular surfaces are called the medial and lateral tibial plateau - this is where the femer sits

the intercondylar tubercles of the intercondylar eminence are between the plateaus

tibial tuberosity is for the attachment of teh atella tendon

the distal end of the fibula and tibula have a malleolus - a pointy bit involved in the proximal ankle joint

between the distal nds of the tibia and fibia is a trough for the ankle bones to fit into

prox end of fibula is more rounded

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2
Q

what is the anatomical name for big toe *

A

hallux

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3
Q

describe the bones pof the feet *

A

have tarsal, metatarals and phalanges

tarsals - talus, navicular, cuboid and 3 cuneiforms

together the tarsals form transverse joints - allow flexibility

the tarsal called talus is involved in articulation with the leg bone

underneath the talus have the calcaneus bone - this is the heal bone and where the calcaneus tendon attaches posteriorly

have sesamoid bones at big toe in flexor hallucis brevis - when on tip toes put a lot of weight here = the seamoid bones prevent you crushing on the tendons

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4
Q

what are the muscular compartments involved in the knee, leg ankle and foot *

A

anterior compartment of leg

lateral compartment of leg

posterior compartment of the leg

intrinsic muscles of the foot - sole 4 layers, drosum 2 muscles

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5
Q

what muscles of teh anterior compartment of the thigh are involved in the knee *

A

tensor fascia latae

sartorius

quadriceps femoris

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6
Q

how is the fascia of the buttock and thigh relatd to the knee *

A

the iliotibial tract mergs with fascia distal to the knee - provides knee joint stability

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7
Q

what muscles of the medial compartment of the thigh are involved in the knee *

A

gracialis - acts across the knee joint

from inferior ramus of pubis

provides knee joint stability

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8
Q

what muscles from the posterior thigh are involved in the knee *

A

the hamstrings - semimembranous, semitendinous, biceps femoris

prox attachement is ischial tuberosity, EXCEPT shot head of the biceps comes off the shaft of femer

distal attachment - semimembranous and semitendinous: attach to tibia (tendinous anterior, membranous posterior), biceps femoris: fiula

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9
Q

what is dorsiflexion *

A

raise foot to body

movement of the dorsal side of the foot towards the leg

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10
Q

what is plantar flexion *

A

move feet away from body

when feet are planted it is goint onto tip toes (dorsi-flexion is th opposite of this)

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11
Q

describe the anterior compartment of the leg *

A

func: ankle dorsiflxors (extensors) and extend the digits
nerve: deep peroneal; nerve
blood: anterior tibial artery

muscles:

  • tibialis anteior,
  • extensor digitorum longus
  • extensor hallucis longus (ie acts on thumb)
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12
Q

describe the tibialis anterior muscle *

A

most superficial of the anterior compartment

acts across the ankle on medial side of teh tarsals

attaches to the prox 1/2 of anterolateral tibial surface nad the interosseous membrane, lateral tibial condyle, anterior intermuscular septum and crucal fascia

tendon runs inferomedially to cross the ankle joint

attach to medial cuneiform and base of teh 1st metatarsal

INVERSION OF THE FOOT, dorsiflexor, adducts foot

deep peroneal nerve - l4 5 s1

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13
Q

describe extensor digitorum longus *

A

act on the 4 digits

attach to lateral head of the fibula, upper 2/3 of medial fibular shaft surface and upper part of the interosseous membrane, and the related surface of the lateral tibial condyle, crucal fascia

its tendon crosses the ankle medially and splits into 4 tendon slips

each of which insert on dorsm of middle and distal phalanges as part of extensor expansion

extends lateral 4 digits, weak dorsiflexor, extends foot

deep peroneal nerve l4 5 s1

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14
Q

describe etensor hallucis longus *

A

only act on hallux

attach to mid and distal anterior surface of the fibula and adjacent interosseous membrane

tendon crosses ankle centrally

insert into dorsal surface of distal phalanx of hallux

extend distal phalanx, weak dorsiflexor, weak inversion and adduction

anterior tibial a

deep peroneal nerve l4 5 s1

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15
Q

describe the muscles on the dorsum of tyhe foot *

A

have extensor hallucis brevis

extensor digitorum longus tendon and brevis (brevis si a small muscle that is covered by tendons)

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16
Q

describe the lateral compartment of the leg *

A

func: ankle evertors (pull foot so soles face laterally), can contribute to dorsiflexion
nerve: superficial peroneal nerve
blood: peroneal artery

muscles:

  • peroneus longus
  • peroneus brevis
  • peroneus tertius - small but is present
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17
Q

describe peroneus longus and brevsi *

A

prox attachment: fibular and tibea

go behind the lateral malleoulus adn run laterally in the foot

brevis attaches to base opf 5th metacarple

longis turns and goes to the opposite side of th foot - strong evertor

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18
Q

describe the posterior compartment of the leg *

A

func: ankle plantarflexors
nerve: tibial nerve
blood: posterior tibial artery

muscles - superficial

  • gastrocnemius
  • soleus
  • plantaris

muscles - deep

  • popliteus
  • flexor digitorum longus
  • flexor hallucis longus
  • tibialis posterior
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19
Q

describe the popliteus *

A

deep posterior muscle

associated with the knee

attachgment on lateral side of femeral condyle- fans out to attach to the upper shaft of the posterior tibia

func: unlock the knee by initiating lateral rotation of the femer on the tibia (when knee is locked it twists slightly)

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20
Q

describe the gastrocnemius *

A

has 2 heads - medial and lateral

the proximal attachment is at the posterior non-articualr surface of the femoral condyles

they coinverge to form calcaneal tendon and attach to the posterior surface of the calcaneous

plantar flex ankle, knee flexion when not weight bearing, stabalises ankle and knee when standing

poplital artery and peroneal artery, posterior tinial a

tibial nerve s1 2

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21
Q

describe soleus *

A

look like flat fish - deep to the gastrocnemius

attachs to the posterior aspect of the fibular head, the upper 1/4 of posterior surface of fbula and middle 1/3 of medial border of the tibial shaft, tendinous arch between tibial and fibular attachments, soleal line of tibia

converges with tendon of gastrocnemius to form th calcaneus tendon - inserting on the middle 1/3 of the poosterior calcaneal surface

plantarflex foot and flex knee

popliteal, peroneal and tibial a

tibial nerve s1 2

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22
Q

describe the triceps surae *

A

teh 2 heads of gastrocnemius and the 1 head of soleus form the triceps surae

the distal tendon is tendocalcaneus

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23
Q

describe plantaris *

A

small belly muscle

origin - inferior area of lateral supracondylar area of femer, medial to prox lateral head of gastrocnemius and oblique popliteal ligament of the knee

has long tendon

inserts into calcaneus bone, medial to the calcaneal tendon

has little function but is used in surgey - plantarflexes foot and flexes knee

damage to it is pauinful

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24
Q

describe the gastrocnemius and plantaris contribution to knee joint *

A

they act across the knee so prvide stability

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25
Q

attachment of flexor digitorum longus and tibialis posterior *

A

longus - attaches to distal 1/2 of postrior tibial surface

tibialis posterior - attach to posterior aspect of interoosseous membrane, superior 2/3 of medial posterior surface of the fibula and superior aspect of the posterior surface of the tibia

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26
Q

path of the flexor digiorum longus *

A

attaches to medial side of posterior surface of the tibia, crural fascia

tendon passes posterior to the medial malleolus and under the plantar aponeurosis

here the tendon divides to insert into plantar surface of distal phalanges of 2-4

flexes 2nd-5th toes, weak plantar flexor

peroneal and post tibial a

tibial n l5 s1

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27
Q

attachment of fibularis brevis and flexor hallucis longus *

A

shaft of fibular

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28
Q

describe the tibalis posterior, flxor digitorum longus and flexor hallucis longus *

A

FHL is deeper than the others

all tendons go behind the medial malleoulus and had into foot

tibialis posterior tendon attaches in tarsal region

FHL and FDL act on digits - go to distal phalanges

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29
Q

describe the function of the sesamoid bones in toe *

A

the big toe important in push off so the sesamoid protect the FHL tendon when you put weight on it

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30
Q

describe the sole of the foot *

A

4 layers

intrinsic muscles

tibial nerve

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31
Q

describe the dorsum of the foot *

A

EDB - supplid by the common peroneal nerve

EHB

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32
Q

function of the foot *

A

for most people intrinsci muscles of the foot act as shock absorbers, adjusting the foot to uneven surfaces

feet can be trained for carrying out fine movmnts eg writing dn drawing when people lack upper limbs

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33
Q

describe layer 1 of the foot *

A

muscles

  • abductior digiti minimi
  • flexor digitorum brevis
  • abductor hallucis longus
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34
Q

describe layer 2 of the siole of the foot *

A

have th 4 lumbricles

quadratus plantae

FDL and FHL tendons from the posterior of the leg are present in this layer

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35
Q

describe quadratus plantae

A

plantar muscle in layer 2 of sole of foot

pulls on tendon of FDL and modifies its action so that FDL dioesnt pull the toes at an angle

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36
Q

describe layer 3 of the sole of the foot *

A

flexor digiti minimi brevis

flexor hallucis brevis

adductor hallucis - transverse and oblique head

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37
Q

muscles present in layer 4 of the sole of the foot *

A

dorsal and plantar interossei

peroneal longus (frol lateral compartment of leg) and tibialis posterior (from posterior compartment of leg) are seen here

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38
Q

what is the poopliteal fossa *

A

teh diamond shapd space posterior to the knee joint

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39
Q

boundaries of teh popliteal fossa *

A

biceps femoris - superiorly

semimembranosus - superiorly

lateral head of gastrocnemius - inferiorly

madial head of gastrocnemius - inferiorly

possible a contribution from plantaris muscle

skin and fsacia

femer - posteriorly

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40
Q

what are the contents of the popliteal fossa *

A

popliteal artery and vein

tibial nerve and common peroneal nerve

short saphenous vein

popliteal lymph nodes

(order serve and volly new ball -semimemranous muscle, artery, vein, nerve, biceps femoris)

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41
Q

describe the location of the contents of the popliteal fossa *

A

small saphenous vein is superficial and pierces the fascia and drains into the politeal vein

popliteal artery adn vein is deeper

the sciatic nerve divides just above popliteal fossa forming tibial and common peroneal nerve

genicular branches iof the arteries

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42
Q

describe the knee joint *

A

hinge joint - primarily allows flexion and extension - there is some gliding, rolling and rotation movement

the shapes of the distal femer and prox tibia do not allow stability

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43
Q

what gives the knee joint stability *

A

ligaments

  • anterior cruciate ligament
  • posterior cruciate ligament
  • medial collateral ligament
  • lateral collateral ligament

meniscsi

  • medial meniscus
  • lateral meniscus

extensor mechanism

  • quandriceps
  • quadriceps tendon
  • patella ligament
  • tibial tuberosity

bursae

  • pre-patellar bursa
  • popliteal bursa
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44
Q

what are meniscsi ie the ones that stabalise the knee joints

A

cartilagionous C shapes on surface of condyles of tibia

one is medial and 1 lateral

both are attached to the facets in the intercondylar region of the tibial plateau

the medial meniscus is attached around its margin to the capsule of the joint and to the tibial collateral ligament

the lateral mensiscus is attached to the capsule

therefore the lateral meniscus is more mobile

they are interconnected by the transverse ligament of the knee

lateral is also connected to the tendon of the popliteus muscle which passes supereolaterally between the meniscus and the capsule to insert on the femur

the menisci improves congruency between femoral and tibial condyles during movement

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45
Q

describe how the extensor mechanisms provide stabilty to the knee joint *

A

quadriceps act through the patella to the tibial tuberosity

patella has articulation with supracondylar region of the femer - not involved in the knee joint

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46
Q

describe the bursae that provide stability to the knee joint *

A

they are a sac found between muscle tendons and ones

reduce friction

some our out-pockets of synovial membrans of joints

if get inflammed they are dehabilitating in long term/short term ie in prepatellar bursitis

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47
Q

describe the bones of the knee joints *

A

femer comes in at an angle

the condyles form lateral femorotibial articulations and medial femorotibial articultaions

the femoral condyle is a long curved surface to allow flexion adn extension

the distal femer articultes to the proximal tibia

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48
Q

describe the cruciate ligaments of the femer

*

A

in the intercondylar region of the knee

the anterior cruciate ligament attaches to the anteriro of the intercondylar eminence of the tbia and crosses back to attach to the intercondylar fossa of femer,

posterior cruciate ligament attachs posteriorly to tuibia then goes anteriorly to to attach to the intercondylar fossa of femer

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49
Q

describe the collateral ligaments of the femer *

A

there is a lateral and medial

they prevent any abduction./adduction

lateral so string if you apply enough pressure the head of the fibula will break before the ligament will

lateral is attached to lateral femoral epicondyle and depresson in upper surface of the fibula head - separated from teh fibrous membrane by a bursa

the medial is attached to fibrous membrane, anchored superiorly to the medial and femoral epicondyle inferior to the adductor tubercle then attach to medial margin of the tibia

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50
Q

describe the cartilage of the tibial plateau *

A

the hyalin cartilage is on top of the bone, on top of this are the menisci

meniscus is attached to collateral lig - so if ligament stretches it will pull on the meniscus and possible damage it

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51
Q

illustrate the tendol of politus muscle on the superior view of the tibia

A
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52
Q

describe the proximal tibioibular joint *

A

is plane type synovial

has capsular ligaments that limit the movement

53
Q

describe the distal tibiofibular joint *

A

fibrous joint

fibres on outside, adn ligaments hold the joint together

not at very tip of tibula

54
Q

when is there movement of the tibiofibular oint *

A

during dorsi/plantarflexion of the foot

55
Q

describe the collateral ligaments of the ankl joint *

A

medially - tibiotalar ligament - broad - also called delytpid ligament

lateral - all related to the fibular malleoulus: posterior talofibular and anterior talofibular (attach to the talus bone) and calcaneofibular ligament attaching to calcaneos bone

56
Q

describe a sprained ankle *

A

one of the collateral ligaments breaks in the foot - usually lateral by over inversion

57
Q

describe the location of the talus joint *

A

the weight baring ankle boe is the talus

it is in a square socket called a mortise sitting ion top of calcaneus

the socket is formed by distal ends of tibular and fibular

the fact that fib is held tightly to tibia maintains the stability of this

58
Q

describe the joints of teh foot *

A

subtalar joint is the joint consists of the talo-calcaneal joint, talo-navicular joint, calcaneo-buboid joint

the talo-calcaneonavicular joint is between the navicular bone, cboid, calcaneus and talus

also have tarsometatarsal joint

the talo-calcaneonavicular jpoint is the transverse tarsal joint or the mid-tarsal joint

movement here contributs to inversion adn eversion with movment of the subtalar joint

plantarflexion and dorsiflexion occur at the ankle joinyt

the joints btween the tarsels are synovial joints

59
Q

what are the arches of the foot *

A

medial longitudinal

laterak longitudinal

transverse metataral arch

60
Q

describe teh arches of the foot *

A

longitudinal is formed between the posterior end of the calcaneus and the heads of the metatarsals

the medial longitudinal is higher than the lateral

transverse arch is formed from the tarsal bones - highest in coronal plane at the head of the talus

if have flat feet it reduces the efficiency of locomotion

61
Q

what stabalise the arches *

A

the plantar aponeurosis that comes from the calconeus and fans out

ligaments ]including the spring ligament - calcaneonavicular ligament that holds the arches together, the plantar calcaneocuboid (short plantar ligament) adn long plantar ligaments

long tendons and intrinsic muscles also help eg FHL, calcaneal tendon, tibialis posterior, tibialuis anterior, peroneal longus, intrinsic plantar muscles, fibularis longus

62
Q

what is the path of teh arteries *

A

external iliac - femoral artery at midinguinal point - profunda femoris artery and circumflex vessles

femoral arteyr continues as the superficial femoral artery and then popliteal artery which gives off genicular branches

the popliteal artyery divides to give tibial artery adn common perineal artery

anterior tibial pierces the interosseous membrane and posterior continues down the back of the leg

anterior tibial artery supplies anterior compartment, posterior tibial artery supplis the posterior compartment and peroneal artery supplis lateral compartment

at ankle the posterior tibial artery passes behind the medial malleolus supplies the sole of the feet via medial and lateral plantar arteries

anterior tibial continues across ankle adn bcomes dorsalis pedis artery supplying dorsum of foot and digits

63
Q

describe the venous drainage of the region *

A

dorsal venous arch gives off long saphenous and short saphenous and perforating veins to the deep system

long saphenous travels 2cm above adn 2cm medial to the medial maleous up leg, behind the knee in the medial of thigh, then travels anterior and pierces through the saphenous opening and enters the femoral vein

in the leg the long saphenous anastomoses with the short, both also have perforating veins with the deepo veins of the calf

the short travels posterior to the lateral malleolus at ankle - pierce the popliteal fascia and enter the popliteal vein

64
Q

describe the deep veins of the region *

A

they follow the arteries and have venae comittates

dorsal digital veins

posterior tibial veins

venae comitantes of arteries in deep calf

popliteal vein

femoral

external iliac

sapheno-femoral junction

venae comitants of the profunda femoris artery

perferatng veisn where blood passes from superficial to deep system

65
Q

what is the motor segmental supply *

A

hip flexors - l2 3

hip extensors ;4 5

knee extensors l3 4

knee flexors l5 s1

ankle dorsiflexors l4 5

ankle plantar flexors s1 2

66
Q

what is the segmental sensory supply *

A

dermatomal distribution

l5 to great toe s

s1 to lateral side of foot and sole

67
Q

what is teh motor peripheral supply *

A

femoral nerve - knee xtensors

sciating nerve - hamstring - knee flexors

tibial nerve - posterior compartment and foot intrinsics

common perineal - anterior and lateral compartmnets

68
Q

describ ethe path of the sciatic nerve *

A

pass from pelvis to buttock via greater sciatic notch

n buttock lis in inferior and medial quadrant

pass along anterior aspect of the thigh

divides into tibial nerve and common perineal nerve

supplies hamstring adn all muscles below knee

69
Q

describe the tibial nerve 8

A

posterior compartment of the leg

pass behind medial malleolus - divides into medial plantar nerve and lateral plantar nerve

supply intrinsics of foot except EDB

70
Q

describe the common perineal nerve &

A

winds around neck of fibula

deep peroneal supplies anterior compartment

superficial supplies lateral

71
Q

describe the sural nerve *

A

formed from a branch of tibial nd common peroneal nerves

cutaneous branch

used in nerve regeneration surgery

runs distally close to the short saphenous vein towards the lateral foot

72
Q

describe the sensory peripheral supply *

A

sensory nbranches of the femoral l2 3 4 supply the front of the thigh

saphenous nerve a branch of femoral nerve supplis a strap of skin along the inner border of the leg and ankle - this accompanies the long saphenous veinn

sural nerve a bracnch of tibial nerve in popliteal fossa, supply lateral aspect of leg and foot = accompanies the short saphenous vein

superficial peroneal - most of the dorsum of the foot

deep peroneal - a patch of skin on the dorsum of the foot at the base of the great and second toes

tibial nerve

medial and lateral plantar nerve

73
Q

summarise the ankle joint *

A

hinge synovial joint

between the tibia (medial malleolus) fibula (lateral malleolus) and talus (talar dome)

mainly allows dorsiflexion and plantarflexion

the tibia and fibia form a bracket shaoped socket for the talus

  • roof is the inferior surface of distal end of tibia
  • medial is medial malleosus
  • lateral end is lateral malleosus

articular surfaces are covered by hyaline cartilage

the joint is more stable when it is dorsiflexed because the wider part of the hyaline cartilage is in the joint, compared to when plantar flexed and the narrower part of the talus is in the joint

the articular cavity is surrounded by a synovial membrane - attaches around membranes of the articular surfaces and by a fibrous membrane that attaches around the synovial membranes and is attached to the adjacent bones

74
Q

escribe the lymph drainage *

A

lymph flows with the deep and superficial veins

75
Q

describe the path of the flexor hallucis longus *

A

attach to distal 1/2 of posterior surface of fibula and lower part of the interosseous membrane, crural fascia and posterior intermuscular septum

tendon passes posterior to medial malleolus

runs medially in foot to attach to plantar surface of the distal phalanx of hallux

flex hallux, weak plantar flexion of foot, weak inversion adn adduction of foot

peroneal a, posterior tibial a

tibial nerve l5 s1 2

76
Q

describe the path and function of the tibialis posterior *

A

attach to the posterior surface of the interosseous membrane and adjacent regions of tibia and fibia

tendon passes posterior to the medial malleolus

under the plantar calcaneal lig

splits to attach to the navicular tuberosity and adjacent region of the medial cuneiform and bases of the 2-4th etatarsals, cuboid and sustentaculum tali of calcineus

INVERSION OF FOOT, stabalises ankle, adduction of foot, prevents hyperpronation in gait, weak plantarflexion of ankle

blood - peroneal and posterior tibial a

tibial n - l5 s1

77
Q

describe the path of peroneus longus *

A

attach to head of fobula adn the upper 1/2 -2/3 of lateral fibular shaft surface

pass behind the lateral malleolus nad run laterally in foot

the tendon turns medially to attach at the plantar-posterolateral aspect of the medial cuneiform nad lateral side of the 1st metatarsal base

78
Q

describe the path of peroneus brevis *

A

attaches to the inferior 2/3 of the lateral fibula surface

pass behind the lateral malleolus and runs laterally in the foot

it attaches to the lateral styloid procewss 5th metatarsal base

79
Q

what is the flexor retinaculae at the ankle *

A

strap like layer of conective tissue that spans the bony depression formed by the medial malleolus, medial and posterior surfaces of tallus and medial surface of calcaneous and the inferior surface of the sustentaculum tali

it attaches above the medial malleolus and below and behind to the inferio-medial margin of the calcaneus

80
Q

what is the extensor retinaculae of the ankle *

A

2 extensor retinaculae strap the extensor tendens of the extensor muscles to the ankle region and prevent tendon bowling during expression of the foot and toes

  1. superior extensor retinaculum - is a thickening of deep fascia in the distal leg, just superior to the ankle joint and attached to the anterior borders of the fibula and tibia
  2. inferiro retinaculum - y shaped, attached by its base to the lateral sideof the upper surface of the calcaneus and crosses medially over the foot to attach by one of its arms to the medial malleolus; the otehr arm wraps medially around the foot and attaches to the medial side of the polantar aponeurosis
81
Q

describe the flexor hallucis brevis tendon *

A

distal attachment os to the latreal and medial sides of the proximal phalanx of hullux via 2 tendons - each of which contain a sesamoid bone

this allows the the long tendon of the flexor hallucis longus to run in the groove between the sesamoid bones - protecting iot during walking and running

82
Q

observe on the femer the shaft, linea aspera, medial and lateral femoral condyles, mdial and latreal supracondylar lins, intecondylar fossa, femora; trochlea, medial and lateral epicondyles , adductor tubercle *

A

femoral trochlea is on patlla surface

intercondylar fosa is posterior

adductor tubercle is above the medial epicondyle

83
Q

identofy on th tibia

medial and lateral condyle

medial and lateal tibial plateaus

intercondylar eminence

medial and lateral intercondylar tibercles

anterior and posterior intercondylar areas (where the cruciate ligamnts and menisci are attached)

tibial tuberosity,

shaft

mdial mallolus

distal articular surface for the tallus

*

A
84
Q

identify on a fibula

head

neck

body

kateral malleolus

articular facet on lateral mallelus

malleolar fossa

A

head - superior end, oval/round articular facet dn styloid process

facet on malleolus - triangular facet for talus on medial side of malleolus

fossa - located behind the triangular articular fact for talus - found on its L for the L fibula and on R for the R fibula

85
Q

find on the patella *

anterior surface

posterior surface

pointd apex - inferior

broad base - superior

A

anterior surface - convex

posterior - inclined medial and lateral articular surfaces - lateral surface longer so if put patella down it will sit on lateral side so that indicates what side of the body it is from

86
Q

how many tarsus bones are there

A

7 `

87
Q

identify the bones and tehir features in the proximal row of the tarsus

A

talus - trochlear (dome of talus on superior surface), body (sits on calcaneum), nck of talus, head

calcaneus (heel bone) - calaneal tuberosity, sustentaculum tali (medial side)

88
Q

identify the bones and their features of the intermediate row of the tarsal bones *

A

navicular (little ship) - navicular tuberosity inferiorly

89
Q

identify the bones of the distal row of the tarsus *

A

medial, intermediate and lateral cuneiform, cuboid (mnost lateral)

90
Q

describe the metatarsals *

A

there is a single row of 5 metatarsals

1 is the big toe etc

have a body/shaft, base (at proximal end), head at distal end

91
Q

describe the phalanges *

A

there are 3 - prox, middle and distal, in each digit xcept the great toe which has 2

have body base and head

92
Q

examine the bony landmarks above the knee

A

medial and lateral femoral condyls - palpate anteriorly in a flexed knee

medial and lateral femoral epiconyles - palpate on the sides of the condyles superiorly

patella

adductor tubercle - above medial femoral epicondyl

medial and lateral tibial condyls

medial and lateral joint lines - palpate in a flexed knee between the condyles of the femer and tibia

head of the fibula - palpate on the lateral border of the leg at the level of the tibial tuberosity

neck of the fibula - palpate just below head

93
Q

examine the bony landmarks in th kleg adn ankle

A

body of tubia

body of fibia = only felt distally

medial malleolus

lateral malleolus

talar done - palpate anteriorly when the ankle is fully plantar flexed

94
Q

examine the feartures of the foot

A

calcaneus

navicular

base of the 5th metataral

head of the 1st metatarsal

the metatarso-phalangeal joint of the great toe

medial arch of the foot

lateral and transverse arches of foot

95
Q

examine the sopft tissue parts in the thigh *

A

quad muscle

quad tendon

patella tendon

popliteal fossa

hamstring muscle

bicep femoris muscle - lateral boundary of the popliteal fossa

semitendinous - medial boundary of the popliteal fossa is innermost

smeimembranous - medial boundary of the popliteal fossa tndon is outermost

96
Q

examine the tibialis anterior *

A

nerve - deep fibular l4 5

subject asked to turn foot in and upward - inversion

examiner grasps forefoot to opose movement

tendon becomes prominant and is palpated below and anterior to the medial malleolus

97
Q

examine the extensor hallucis longus admn extensor digitorum longus *

A

nerve - depp fibular l4 5

subject asked to dorsiflex

examiner place palm of hand across toes - inc great toe to oppose the movement

the tendons of EHL EDL and tibialis anterior can be seen and palpated

98
Q

examine ibularis longus and brevis *

A

nerve - superficial fibular l5 s1 s2

subject asked to evert foot - turn out and platar flex

while examiner grasps forefoot to oppose movement

the tendons become prominent and palpated below the lateral malleolus

99
Q

examine the gastrocnemous, soleus muscles and teh calcaneal tendon *

A

nerve - tibial

subjct is asked to stand on tos

muscle bellies and calcaneal tendon can be seen and palpatd on the calf and on the posterior side of the ankle

100
Q

take the popiteal artery pulse *

A

subject lies prone with knee flexed

palpate in inferior part of the fossa in relation to the tibia

101
Q

palapate the dorsalis pedis artery pulse *

A

just lateral to the extensor hallucis longus tendon

102
Q

palpate the posterior tibial artery pulse *

A

palpate just behind the middle malleolus

103
Q

surface mark the long saphenous vein *

A

runs upars 2cm in front of medial malleolus along the mdial side of the leg, a hands width along the medial sie of the patella ad along the medial side of the thigh to the saphenous opening in the inguinal region

104
Q

what are the phases of the gait cycle

A
  1. heel strike - initial contract - glut max, tibialis anterior and posterior capsule
  2. loading response - foot flat = quad
  3. midstance - triceps surae
  4. terminal stance - heel off triceps surae
  5. pressing - toe off - ectus femois, deep plantar-flexors, flexors of the toes, intrinsic foot muscles
  6. initial swing - contralateral abductors of the hip ileopsas and rectus femoris
  7. mid swing - contralateral abductors of the hip ileopsas and rectus femoris
  8. terminal swing - hamstrings, quadriceps femoris, tibialis anterior

stance phase is 1-4

swing phase is 5-8

105
Q

which joints are flexed at each of the subphases of the joint cycle *

A
  1. hip knee
  2. hip ankle
  3. ankle
  4. kne ankle
  5. knee ankle
  6. knee ankle
  7. knee ankle
  8. hip
106
Q

which joints are extended at each of the subphases of the gait cycle *

A
  1. ankle hip
  2. ankle hip
  3. -
  4. knee
  5. knee
  6. kjnee hip
  7. hip
107
Q

during which phae of the gait cycle do the ight gluteus medius and mnimus muscles remain contracted *

A

2 3 4

that is when the L leg is in the air - they contract so that you dont fall over

108
Q

during which part of the gait cycle are both fet on the ground *

A

1 4

109
Q

during which part of teh gait cycle do the calf muscles contract

A

1

2

3

4

5

8

110
Q

during which part of the gait cycle does the r ilum move in front of the l ileum

A

6

111
Q

function iof the acl

A

stops the femer foving posterior relative to the tibia

112
Q

function of the pcl

A

stops the femer moving anterior in relation to tibia

113
Q

what type of joint is the interosseous membrane

A

fibrous

114
Q

describe the intertarsal joints *

A

they are the subtalar, talocalcaneonavicular, calcaneocuboid joints

the talocalcaneonavicular and calcaneocuboid joints together form the transverse tarsal joint

intertarsal joints between the cuneiforms and cuneiforms and the navicular allow limited movement

joint between cuboid and navicular is normally fibrous

115
Q

describe the subtalar joint *

A

it is between the large posterior calcaneal facet on the inferior surface of the talus and the corresponding posterior talar facet on the superior surface of the calcaneus

the articular cavity is enclosed by synovial membrane which is covered by fibrous membrane

it allows gliding and rotation - these are involved in inversion and eversion of the foot

lateral, medial and interosseous talocalcaneal ligaments stabalise the joint

the interosseous talocalcaneal ligament is in the tarsal sinus

116
Q

describe the talocalcaneonavicular joint *

A

the head of the talus articulates with the clacaneous and the calacaneonavicular ligamnet below and the navicular in front

allows gliding and rotation movement - when combined with similar movements from the subtalar joint it allows inversion and eversion

also involved in pronation adn supination

117
Q

describe the calcanecuboid joint *

A

synovial

between the facet on the anterior surface of the clacaneous and the corresponding facet on the posterior surface of teh cuboid

allows sliding and rotating movements involved with inversion and eversion

also contributes to pronation adn supination

118
Q

describe the tarsometatarsal joints *

A

plane joints and allow limited sliding movement

WHEN COMBINED WITH THE TARSOMETATARSAL JOINT ARE INVOLVED IN PRONATION AND SUPINATION OF THE FOOT

119
Q

describe the metatarsophalangeal joints

A

ellipsoid synovial

allow extension., flexion, limited adduction and abduction rotation and circumduction

120
Q

describe the medial ligament of the ankle joint *

A

deltoid ligament

large, stroong, triangular,

apex attached above the medial malleolus

base is attacehd from tuberosity of navicular bone to infront of the medial tubercle of teh talus

the tibionavicular part attaches in front of the navicualr tuberosity nd the margin of the spring ligament - connects the navicular bone to the sustentaculum tali of the calcaneus behind

tibiocalcaneal part - attaches to sustentaculum tali of calcaneus bone

posterior tibiotalr part attaches to medial side and medial tubercle of the talus

the nateriortibiotalar part is deep to the tibionavicualr and tibiocalcaneal parts of the medial ligament and attaches to the medial surface of the talus

121
Q

describe teh 3 parts of the lateral ligament of the ankle *

A

anterior talofibular lig - short, attaches the anterior margin of lateral malleolus to the adacent region of the talus

posterior - runs horizontally backward and medially from the malleolar fossa on the medial side of the lateral malleolus to the posterior process of teh talus

calcaneofibular - is attached above to the malleolar fossa on the posteriomedial side of the lateral malleolus and passes posteroingferiorly to attach below to a tubercle on the lateral surface of the calcaneus

122
Q

attachment of peroneus tertius *

A

distal part of medial surface of fibula

dorsomedial surface of base of metatarsal

123
Q

explain the locking mechanism of the knee that occurs at full extension*

A

the knee joint is locked into position - reducing the amount of muscle work needed to maintain the position

the femoral surfaces that articulate with the tibia change shape - they move to the broad flat areas on the inferior aspect of the femoral condyles, as opposed to the curved and rounded surface on the posterior condyles

the joint surfaces become larger and more stable in extension

there is also medial rotation of the femer on the tibia during extension - this tightens all of the ligaments

also the body’s centre of gravity is positioned along a vertical line that passes anterior to the knee joint

124
Q

describe the anatomy of the knee joint *

A

synovial

articulation between the femer and tibia is weight bearing

aticulation between patella and femer which allows pull of quadriceps femoris muscle to be directed anteriorly over the knee

the fibrocartilaginous menisci accomodate changes in shape of the articular surfaces

articular surcaes are covered by hyaline cartilage - the surfaces are the superior aspect of the tibial condyle and the femoral condyles

the artiuclar surfaces and the menisci are enclosed in a single articular cavity

the synovial membrane attaches ot the margins of the articular surface and to the superior and inferior margins of the mensici

the cruciate ligaments are outside the articular cavity but enclosed in the fibrous membrane

the synovial membrane is separated from the patella by the infrapatella fat pad - on each side of the margin the membrane forms an alar fold

the synovial mebrane covering the lower part of the infrapatella fat pad is raised into the infrapatella synovial fold which attaches to the intercondylar fossa from the femur

125
Q

describe the pouches formed by the synovial membrane *

A

teh smallest is the subpopliteal recess - extends posterolaterally from articular cavity and lies betweel lateral meniscus and popliteal tendon

teh suprapatella bursa is a continuation of the articular cavity superiorly between distal end of shaft of femer and the quadriceps femoris muscle and tendon, the apex of the bursa is attached to the small articulus genus muscle which pulls the bursa away from the joint during extension of the knee

other bursa include the subcutaneous prepatella bursa, deep and subcut infrapatella bursae

126
Q

describe the fibrous membrane of the knee joint *

A

partly formed and reinforcesd by extensions of the tendons of surrounding muscle

on medial side it blends with tibial collateral lig, ans is attached to internal surface of meniscus

laterally - separated by a space from the fibular collateral ligament

anteriorly - attached to the margins of the patella where it is reinforced by tendinous expansions from vastus lateralis and vastus medialis muscles

it encloses the articular cavity and the intercondylar region

is reinforced anterolaterally by the liotibial tract and posteriorly by the oblique popliteal ligament

127
Q

test for the stability of the posterior cruciate ligament *

A

posterior drawer test - a positive posterior drawer test is when the prox head of tibia can be pushed posteriorly on the femer

the pts knee is placed in a supine position and knee is flexed to 90degrees with the foot in the neutral position

teh examiner sits gently on the pts foot placing both thumbs on the tbial tuberosity and pushing the tibia back

if tibial plateau moves the posterior cruciate ligament is torn

128
Q

test for the anterior cruciate liagment *

A

lachman’s - pt lies on bed, examiner places 1 hand around distal femur and other around prox tibia, elevates knee producing 20 degrees of flexion, pts heel rest on the couch - the examiner’s thumb must be on the tibial tuberosity, the hand on the tibia applies a brisk anteriorly directed force - if movement of tibia doesnt come to sudden stop - tear in ACL

ant4erior drawer test - same as posterior, index fingers are used to check taht the hamstrings are relaxed, while other fingers encircle the upper end of the tibia and pull it - if moves frowrd ACL is torn- other structues ie medial mesniscus must be damaged for this sign

pivot shift test - pts foot wedged between examiner’s body nda elbow, examiner places 1 hand flat under tibia, pushing it forward into knee extension, other hand is placed against pts thigh pushing it the other way. lwoer limb is taken into slight abduction by examiner’s elbow. examiner maintains anterior tibial translation and the valgus and initiates flexion of knee - at 20degrees the pivot shift will occur as the lateral tibial plateau reduces

129
Q

which structures of the knee joint can be damaged in trauma *

A

soft tissue injuries are common

tear of ACL and PCL, meniscal tears and trauma to collateral ligaments

may ingvolve the neuromuscular bundle

anatomy of the limbs (14 decks)

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