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LE Joints Flashcards

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1
Q

Articulating parts of hip

A

Femur (femoral l.) and acetabulum

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2
Q

4 parts of the acetabulum

A
  1. acetabular notch
  2. acetabular fossa
  3. lunate surface of the acetabulum: articular area
  4. acetabular rim (acetabular labrum attached)
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3
Q

What type of joint in the hip?

A

ball and socket- largest ROM secondary to shoulder

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4
Q

Acetabulum joint

A
  • irradiate (“shiny”) cartilage with 15 degree anteverted and 45 degree caudal tilt
  • fully fuses between 15-25 yo
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5
Q

7 Ligaments involved in acetabulofemoral joint

A
  1. transverse acetabular l.
  2. acetabular labrum: fibrocartilaginous rim to margin of acetabulum
  3. Articular capsule of the acetabulofemoral joint: fibrous capsule and internal synovial membrane
    - - 4. Iliofemoral l
    - - 5. pubofemoral l
    - - 6. Ischiofemoral l
  4. L. of the Head of the Femur
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6
Q

Ligaments of joint capsule of hip bone and function

A
  1. Iliofemoral (anterior and posterior): prevent hyperextension
  2. Pubofemoral l. (anterior and inferior)
    - anterior are strongest
  3. Ischiofemoral l. (posterior, weakest)
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7
Q

Iliofemoral l. attachments and function

A
  • Attachments: AIIS and acetabular rim (proximally) and intertrochanteric line (distally)
  • strongest ligament of body
  • prevent hyperextension of hip while standing by screwing femoral head into acetabulum
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8
Q

What is the strongest ligament of the body?

A

iliofemoral l.

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9
Q

Pubofemoral ligament attachments

A

obturator crest to IT line (merges with fibrous layer of joint capsule)

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10
Q

Pubofemoral ligament function

A

prevents overabduction and hyperextension

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11
Q

Iliofemoral ligament function

A
  • prevent hyperextension of hip while standing by screwing femoral head into acetabulum
  • reinforced by rectus femoris and iliopsoas
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12
Q

Ischiofemoral l origin and insertion

A

ischial part of acetabular ring to femoral neck, medial to base of greater trochanter

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13
Q

Vasculature of the hip joint (3)

A
  1. Main: retinacular arteries from circumflex femoral a.
  2. medial and lateral circumflex femoral arteries:
    - medial: underneath capsule posterior
    - lateral: pierces Ischiofemoral L.
  3. Artery to head of femur: (only 0-4 yo) (branch of Obturator A)
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14
Q

What are the 5 ligaments/cartilage of the bony pelvis?

A
  1. Obturator membrane
  2. Inguinal L.
  3. Pubic symphysis: 4) superior and 5) inferior pubic l.
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15
Q

What are the 2 ligaments of the sacroiliac joint?

A
  1. Sacrospinous L

2. Sacrotuberous L

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16
Q

What are the 11 ligaments of the knee?

A
  1. Articular capsule of the knee
    * Extracaosular l
  2. Patellar L.
  3. Fibular (Lateral) Collateral L.
  4. Tibial (Medial) Collateral L.
  5. Oblique Popliteal L.
  6. Arcuate Popliteal L.
    * Intraarticular l.
  7. Anterior Cruciate L
  8. Posterior Cruciate L.
  9. Coronary L. of the Knee
  10. Transverse L. of the Knee
  11. Posterior Meniscofemoral L
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17
Q

What are the 5 extracapsular ligaments of the knee?

A
  1. Patellar L.
  2. Fibular (Lateral) Collateral L.
  3. Tibial (Medial) Collateral L.
  4. Oblique Popliteal L.
  5. Arcuate Popliteal L.
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18
Q

What are the 5 intracapsular ligaments of the knee?

A
  1. Anterior Cruciate L
  2. Posterior Cruciate L.
  3. Coronary L. of the Knee
  4. Transverse L. of the Knee
  5. Posterior Meniscofemoral L
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19
Q

What are the 4 ligaments of the tibiofibular joint?

A
  1. Superior tibiofibular L.
  2. Posterior inferior tibiofibular L.
    * Tibiofibular syndesmosis
  3. Interosseous membrane
  4. Anterior inferior Tibiofibular L.
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20
Q

What are the 3 joints involving the talus bone?

A
  1. Talocrural joint
  2. Talocalcaneal (subtalar) joint
  3. Transverse tarsal joint: talocalcaneonavicular joint
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21
Q

What are the 2 ligaments of the talocrural joint and each of their subligaments?

A
  1. Lateral L of the Ankle
    - Anterior Talofibular L
    - Posterior Talofibular L
    - Calcaneofibular L
  2. Medial L. of the Ankle
    - Anterior Tibiotalar L.
    - Posterior Tibiotalar L.
    - Tibionavicular L.
    - Tibiocalcaneal L.
    - Plantar calcaneonavicular l.
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22
Q

What are the 5 ligaments within the Medial L. of the Ankle “deltoid L”

A
  • Anterior Tibiotalar L.
  • Posterior Tibiotalar L.
  • Tibionavicular L.
  • Tibiocalcaneal L.
  • Plantar calcaneonavicular l.
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23
Q

What are the 3 ligaments within the Lateral L. of the Ankle

A
  • Anterior Talofibular L
  • Posterior Talofibular L
  • Calcaneofibular L
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24
Q

What are the two joints within the transverse tarsal joint?

A
  1. Talocalcaneonavicular joint

2. Calcaneocuboid joint

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25
What is the ligament of the Talocalcaneonavicular joint
Plantar calcaneonavicular L.
26
What are the ligaments of the Calcaneocuboid joint
1. Plantar calcaneocuboid (spring) L. | 2. Long plantar L
27
What are the movements permitted at the acetabulofemoral joint?
1. Flex/Extend 2. Abd/ADd 3. Medial/Lat Rotation 4. Circumduction
28
What are the 4 nerves supplying the hip?
Articular rami from intramuscular rami 1. Femoral N: Anterior (hip flexors) 2. Obturator N: Inf/Post (lateral rotators) 3. N. to Quadratus Femoris: inferior (lateral rotators) 4. Superior gluteal N.: superior (abductors)
29
What do the sacrospinous and sacrotuberous ligaments produce?
ligamentous borders produce greater and lesser sciatic foramen
30
Calcar Femorale
- dense, vertically oriented bone in posteromedial aspect of proximal femur - fractures unstable vs stable
31
Ligament of Head of the Femur: O/I, function
- Acetabular notch/transverse acetabular L to fovea - Synovial fold: conducts artery to head of femur (from Obturator A) - Minimal contribution to stability
32
Labrum O/I and Function
- Fibrocartilaginous rim to margin of acetabulum | - increase acetabular articular area by 10%
33
Transverse acetabular L
Cont of labrum inferiorly over acetabular notch | -increase acetabular articular area by 10%
34
Hilton's Law in regard to innervation of hip
nerve supplying muscles extending directly across and acting at hip, also contribute to innervation of that hip
35
What muscles flex the hip?
1. Iliopsoas 2. Sartorius 3. Tensor fascia lata 4. Rectus femoris 5. Pectineus 6. Adductor longus 7. Adductor brevis 8. Adductor Magnus - anterior
36
What is the strongest hip flexor?
Iliopsoas m.
37
What muscle flexes and extends hip?
Adductor magnus
38
What is the primary extensor from sitting to standing?
Gluteus maximus
39
What 6 muscles adduct the hip?
1. pectineus 2. adductor longus 3. adductor brevis 4. adductor Magnus 5. obturator exturnus 6. gracilis
40
What 6 muscles laterally rotate hip?
1. obturator externes 2. obturator internus 3. Piriformis 4. Gemelli, superior and inferior 5. Quadratus femoris 6. Gluteus maximus
41
What 5 muscles extend the hip?
1. gluteus maximus 2. semitendinosus 3. semimembranosis 4. biceps femoris, long head 5. adductor Magnus, posterior
42
What 3 muscles abduct hip?
1. gluteus medius 2. gluteus minimus 3. tensor fascia lata
43
What 3 muscles medially rotate hip?
1. gluteus medius 2. gluteus minimus 3. tensor fascia lata
44
Fadir Special test for hip
-Pt starts: hip flexed to 90, adducted and IR + if groin pain -indication: labral pathology
45
Faber (Patricks) Hip Specialty Test
- Pt starts: flex, ABd, ER - + pain with limited ROM - Indication: intraairticular or iliopsoas (hip pain) or SI pain (if posterior pain)
46
Hip Dislocation
- Simple vs complex (with acetabular/femur fx) - Posterior dislocation 90% of time - Hip position at time of injury affects dislocation direction (if flexed like when driving a car then more susceptible to dislocation b/c capsular laxity)
47
What is the resting leg position in a posterior hip dislocation?
slightly flexed, adducted, IR
48
What are the 3 compartments of the knee joint?.
1. medial femorotibial 2. lateral femorotibial 3. patellofemoral
49
In what position is the knee most stable?
extension
50
What is the function of the lateral collateral l.?
resist varus strain
51
What is the O/I of the lateral collateral l.?
lateral epicondyle to fibular head | -inserts along with biceps femoris m.
52
What is the function and O/I of anterolateral l?
- lateral femoral epicondyle to tibia posteriorly | - stability with knee rotation
53
What is the function and O/I of anterolateral l?
- lateral femoral epicondyle to tibia posteriorly | - stability with knee rotation
54
What does a segond fracture indicate?
-ACL rupture
55
What is the function of MCL l.?
resist valgus stress
56
What is the function of the meniscus'?
- shock absorption | - 2ndary knee stabilizer (lateral x2>medial)
57
what are the ligaments attaching to the meniscus?
1. Inter meniscal l. - connect each other 2. Coronary L. - connect to capsule 3. Meniscofemoral l
58
What is the O/I for the ACL?
lateral intercondylar ridge to anterior tibia (b/t intercondylar eminence)
59
What are the 2 parts of the ACL?
1. anteromedial (tightest in flexion) | 2. posterolateral (tightest in extension)
60
O/I for PCL
post tibial sulcus to medial femoral condyle
61
What are the 2 parts of PCL?
1. anterolateral: tight in flexion | 2. posteromedial: tight in extension
62
What does the middle genicular a supply?
cruciate, synovium, posterior horn of meniscus
63
What 4 nerves innervate the knee?
1. Femoral N., anterior 2. Common fibular N. 3. Tibial N. 4. Obturator/Saphenous N.
64
What are the motions of the knee? What muscles supply these?
Extension: 1. quadriceps femoris & 2. tensor fascia lata (weak) Flexion: 1. Hamstrings & 2. Gracilis, sartorius, gastrocnemius, popliteus
65
What are the 3 sprain classifications?
Grade 1: stretching & small tears Grade 2: larger tear Grade 3: complete rupture
66
How would one test/diagnose LCL pathology?
Varus stress test: brace medial knee, push distal leg midline -tenderness laterally
67
How would one test/diagnose MCL pathology?
Valgus stress: 30 knee flexion and push ankle away from midline +: medial tenderness, instability at 0 degrees
68
What are common causes of an MCL injury?
Valgus stress in slight flexion (blow to lateral knee) - commonly associated with ACL injury - intimately associated with medial meniscus
69
What is O'Donoghue unhappy triad
ACL, MCL, and medial meniscus are inter-related so injury to one commonly affects all
70
What is the most accurate test for a PCL injury diagnosis?
posterior drawer test
71
What are the mechanisms of PCL injury?
1. direct blow to anterior tibia 2. dashboard injury 3. hyperextension injury 4. fall onto flexed knee with foot plantarflexed
72
What are 3 ACL exams?
1. lachmans test 2. anterior drawer test 3. pivot shift
73
Foot arch function
1. absorbs shock during weightbearing | 2. makes foot adaptable to surface and weight change
74
What bones form the medial longitudinal arch?
``` calcaneus talus- talar head is keystone* navicular 3 cuneiforms medial 3 metatarsals ```
75
What tendons support and bones form the lateral longitudinal arch?
- flatter than medial and rests on ground during standing - calcaneus, cuboid, 2 lateral metatarsals - fibularis longus t. and flexor digitorum longus
76
What is the transverse arch and what bones make it up?
- area b/t medial and lateral longitudinal arch | - cuboid, 3 cuneiforms, metatarsal base
77
What tendons maintain curvature of transverse arch?
fibularis longus and tibialis posterior
78
What tendons help support the medial longitudinal arch?
tibialis anterior | tibialis posterior
79
What is passive support of the foot and what 4 ligaments make it up?
- forming and maintaining foot arches 1. plantar aponeurosis 2. long plantar ligament 3. plantar calcaneocuboid (short plantar) L. 4. plantar calcaneonavicular (spring) L.
80
What is dynamic support of the foot and what 5 muscle groups/ligaments compose it?
- maintaining arches 1. tibialis anterior m. 2. tibialis posterior m. 3. flexor hallucis longus m. 4. fibularis longus m. 5. intrinsic plantar muscles
81
Pes transversoplanus
loss of transverse arch
82
pes planus
loss of longitudinal arch, "fallen arches" - usually medial - plantar ligaments and aponeurosis become abnormally stretched - Plantar spina L. no longer support talus head so it displaces inferomedially and becomes prominent
83
What type of joint is the ankle (talocrural) joint?
Hinge synovial
84
What is the movement of the talocrural joint?
dorsiflexion and plantar flexion
85
function of the medial L of the ankle?
stabilize during eversion
86
Pott's fracture
- occurs when ankle is forcibly everted which pulls on extremely long medial L, which tears off medial malleolus - talus then moves laterally, sheering off lateral malleolus or breaking fibula - Can cause trimalleolar fx if distal end of tibia is also sheered off of talus
87
High ankle sprain involves which ligaments?
2 of the lateral L., Tibiofibular syndesmosis 1. posterior tibiofibular l. 2. Anterior tibiofibular l.
88
Movement of transverse tarsal joint and what 2 joints make up this?
Work together to permit slight rotation and thus add to inversion/eversion of talocalcaneal joint -talonavicular and calcaneocuboid joints
89
What do you transect when amputating the foot?
across transverse tarsal joint
90
Subtalar (talocalcanean) joint: location, motion, components
- Where talus rests on calcaneus - inversion and eversion - fibrous capsule supported by interosseous talocalcaneal ligament
91
Ankle sprain
ligament fiber tears, almost always inversion | -most frequently injured joint in body
92
How would the affect leg present with a posterior hip dislocation?
IR, adducted, and flexed knee
93
6 Specialty tests of the hip
1. Fadir 2. Patricks Faber 3. Log roll 4. Thomas test 5. Ober's test 6. Stinchfield
94
Patricks Faber test
- flex, abduct, ER | - Positive = pain
95
What is a clinical suspicion for positive Patricks faber test with hip pain?
intraarticular or iliospoas
96
What is a clinical suspicion for positive Patricks faber test with posterior pain?
sacroiliac pain
97
FADIR specialty test
- hip flex to 90, adduct, IR - positive = groin pain - DD: labral pathology/FAI
98
Log Roll Specialty hip test
- supine, IR/ER rotate leg - Positive = pain - DD: possible hip fx
99
Ober's Specialty Hip Test
- lat recumbent with affected side up - extend hip/flex knee and allow to drop - + if affected leg not passing neutral adduction
100
Stinchfield specialty hip test
- supine and resist hip flexion - + = pain - DD: intraarticular pathology, particularly osteoarthritis
101
Affected leg presentation in a hip fracture
shortened and ER

MSK 2 (6 decks)

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