Lecture 12: Joints Of Lower Extermities I

Question 1

The nerves innervating the periarticular tissues - somewhat misleading called ___________ nerves - are composed of both postganglionic autonomic (sympathetic) and sensory axons, the latter of which end peripherally as encapsulated or free sensory receptors

Answer 1

Articular

Question 2

Nerves to any one particular joint always arise from where?

Answer 2

More than one level in the spinal cord

Question 3

The synovium contains a large number of what?

Answer 3

Thinly myelinated and unmyelinated nerve fibers

Question 4

What are the 2 types of synovial fibers?

Answer 4

1) Postganglionic sympathetic adrenergic fibers -> located around blood vessels and are responsible for the control of articular blood flow 2) Unmyelinated C fibers -> responsible for pain transmission

Question 5

When do unmyelinated C fibers fire?

Answer 5

Typically only when there is trauma -> they are nociceptive

Question 6

__________________ associated with inflammation can induce signaling in the nociceptive fibers of the synovium causing pain in the normal ROM

Answer 6

Prostaglandin E2

Question 7

What joint type is the hip joint?

Answer 7

Diarthrotic ball and socket type of synovial joint

Question 8

The rim of the acetabulum is incomplete inferiorly. What is this bridged by?

Answer 8

Transverse acetabular ligament

Question 9

The acetabulum has a centrally located no articular area called the acetabular fossa. What occupies this space?

Answer 9

A fatpad covered by a synovial membrane -> the malleable nature permits positional changes of the femoral head during hip joint movements

Question 10

In the hip joint, what deepens the socket for the femoral head?

Answer 10

Acetabulum depth increased. By fibrocartilaginous acetabular labrum

Question 11

How can an acetabular labrum tear be induced?

Answer 11

By twisting on a weight bearing hip

Question 12

When an acetabular labrum tear occurs, the pain may become diffuse and difficult to pinpoint and it is not possible to see swelling, although the inflamed joint may become larger in volume because of an effusion due to trauma. If the pt were to feel a pinching sensation when flexing the hip by bringing the knee up the the chest, what part of the hip joint is affected?

Answer 12

The front of the hip joint

Question 13

In the hip joint articular capsules, some deep fibers can pass circularly around the neck of the femur forming a collar around the neck the helps hold the femoral head in the acetabulum. What is this zone called where the fibers pass circularly around the neck??

Answer 13

The orbicular zone

Question 14

What hold down the retinacular arteries in the hip joint?

Answer 14

Some deep longitudinal fibers that form a retinacula superiorly along the neck

Question 15

What are thickened parts of the fibrous (articular) hip joint capsule called?

Answer 15

Intrinsic ligaments

Question 16

What does the iliofemoral ligament help prevent?

Answer 16

Overextension

Question 17

What intrinsic ligament of the hip is a strong y-shaped band that covers the anterior aspect of the hip?

Answer 17

Iliofemoral ligament

Question 18

What intrinsic ligament of the hip strengthens the joint capsule posteriorly?

Answer 18

Ischiofemoral ligament

Question 19

What does the Ischiofemoral ligament help prevent?

Answer 19

Overextension

Question 20

What ligament in the hi is a weak intracapsular ligament that has little importance in strengthening the hip joint?

Answer 20

Round femoral head ligament

Question 21

The round femoral head ligament contains an obturator vessel. What might the function of that vessel be?

Answer 21

To assist in spreading synovial fluid

Question 22

During what hip movements is the round femoral head ligament stretched?

Answer 22

When flexed thigh is addicted or laterally rotated

Question 23

What is another name for the round femoral head ligament?

Answer 23

Ligamentum teres

Question 24

What ligament of the hip can carry up to 30% of the blood supply to the femur and if torn can cause the bone to become necrotic due to loss of blood supply to the femur?

Answer 24

Round femoral head ligament - Does this through the obturator vessel

Question 25

What type of hip dislocation would be caused by a blow to the leg from behind while in a squatting position?

Answer 25

Anterior - Anything that pops the head of the femur forward out of the acetabulum

Question 26

What type of hip dislocation is caused by falling from height?

Answer 26

Anterior

Question 27

What type of hip dislocation can cause damage to the sciatic nerve?

Answer 27

Posterior - may result in paralysis of hamstrings and muscles distal to the knee - Sensory change may occur in skin over the posterolateral aspects of leg and most of foot

Question 28

How do the female and male femoral angles compare?

Answer 28

The female femoral angle is a little more angled, making it less efficient because this requires the load arm to be longer. Females therefore put more stress on the small gluteal muscles and there is increased stress on the medial aspect of the knee because there is more load down onto the knee

Question 29

Why do female athletes tend to get ACL tears more?

Answer 29

Because the female femoral angle is more angled, causing an increased load arm and therefore increased load on the knee and more stress to it

Question 30

What patient population do you see the highest proportion of gluteal tears in?

Answer 30

Elderly female patients because they have to contract harder than males due to the reduction in efficiency of the female pelvis

Question 31

What muscles of the gluteal region are responsible for medial rotation?

Answer 31

- Tensor fascia lata - Gluteus minimus - Gluteus medius

Question 32

What muscles of the gluteal region are responsible for lateral rotation?

Answer 32

Quadratus femoris gluteus maximus Piriformis Triceps coxae Obturator internus and externus

Question 33

Which of the small lateral rotators in the gluteal region is the least effective abductor when the thigh is flexed?

Answer 33

Quadratus femoris

Question 34

What is the function of the articularis genu?

Answer 34

Pulls suprapatellar bursa superiorly during knee extension

Question 35

The articularis genu prevents the suprapatellar bursa from getting bunched up during what movement?

Answer 35

Extension

Question 36

The articularis genu is actually fibers that extend off what muscle and insert into the suprapatellar bursa?

Answer 36

Vastus intermedius

Question 37

Any muscle that is inserted at the ________________ can still be used in abduction even when you go into flexion. So, when you go into flexion they are still positioned high enough that they are able to aid in abduction.

Answer 37

Trochanteric fossa

Question 38

Gluteal muscles that insert at the trochanteric fossa are function to ______________ when the leg is extended and function to ________________ when the lef is flexed.

Answer 38

Laterally rotate; abduct - When the leg is flexed, the quadratus femoris shifts inferiorly so it doesnt abduct well when you flex and can only really laterally rotate because it isnt positioned high enough

Question 39

What type of joint is the knee joint?

Answer 39

Diarthrotic, primarily hinge type of synovial joint (flexion and extension) - Permits some gliding and rotation about vertical axis

Question 40

Is the fibula involved in the knee joint?

Answer 40

No

Question 41

Because of articular surfaces, knee joint stability depends on what 2 things?

Answer 41

1) Strength of surrounding muscles 2) Ligaments. That bind femur to tibia

Question 42

What are the 5 extracapsular or external knee joint ligaments?

Answer 42

1) Patellar ligament 2) Fibular collateral ligament 3) Tibial collateral ligament (intrinsic) 4) Oblique popliteal ligament (intrinsic) 5) Arcuate popliteal ligament

Question 43

What ligament found in the knee is an anterior knee joint ligament and is a continuation of the quadriceps/patellar tendon?

Answer 43

Patellar ligament

Question 44

What found in the knee joint is an aponeurotic expansion of vastus medialis and lateralis and functions to support the articular capsule laterally and medially

Answer 44

Patellar retinacula

Question 45

What ligament found in the knee joint is a strong cordlike ligament that extends inferiorly from lateral femoral epicondyle to the fibular head?

Answer 45

Lateral collateral ligament (fibular collateral ligament)

Question 46

The popliteus tendon passes deep to fibular collateral ligament (lateral collateral ligament), separating it from what?

Answer 46

The lateral meniscus

Question 47

In the knee joint, what is the biceps femoris tendon split by?

Answer 47

The fibular collateral ligament (lateral collateral ligament)

Question 48

What ligament in the knee joint is a flat band that extends from the medial femoral epicondyle to the medial tibial condyle?

Answer 48

Tibial collateral ligament (medial collateral ligament)

Question 49

What do tibial and fibular collateral ligaments found in the knee joint prevent?

Answer 49

Disruption of the sides of the knee joint

Question 50

When are the tibial and fibular collateral ligaments found in the knee joint taut and when do they have slack?

Answer 50

Taut when les is extended (prevent rotation) Slack during leg flexion (permit some rotation)

Question 51

The oblique popliteal ligament represents an expansion of what tendon?

Answer 51

Semimembranosus tendon

Question 52

What is the function of the oblique popliteal ligament?

Answer 52

Reinforces the knee resisting hyperextention of the knee and strengthens the capsule posteriorly

Question 53

What ligament in the knee joint is a y-shaped band that represents the edge of capsules that arches over the popliteus muscle?

Answer 53

Arcuate popliteal ligament - Also strengthens capsule posteriorly

Question 54

What type of ligaments found in the knee joint are considered internal ligaments (within capsule, yet separate from joint cavity)?

Answer 54

Cruciate ligaments

Question 55

What type of ligaments in the knee join join the femur and tibia?

Answer 55

Cruciate ligaments

Question 56

How are cruciate ligaments in the knee joint named?

Answer 56

According to their attachment to the tibia (anterior and posterior)

Question 57

When is the anterior cruciate ligament (ACL) of the knee taut and what does it prevent?

Answer 57

Taut when leg is extended; prevents posterior displacement of the femur and anterior displacement of the tibia

Question 58

When is the posterior cruciate liagament (PCL) of the knee taut and what does it prevent?

Answer 58

Taut when leg is flexed and prevents anterior displacement of the femur and posterior displacement of the tibia

Question 59

What is the function of the anteromedial (AMB) bundle of the ACL?

Answer 59

Resists anterior tibial translation especially during flexion

Question 60

What is the function of the posterolateral (PLB) bundle of the ACL?

Answer 60

Resists anterior tibial translation and tibial rotation in extension

Question 61

The curve of the femoral condyles is dictated by the placement of what?

Answer 61

The anterior and posterior cruciate ligaments

Question 62

What is function of the ACL?

Answer 62

Prevents the femur from sliding posteriorly on the tibia and hyperextension of the knee and limits medial rotation of the femur when the foot is on the ground and leg is flexed

Question 63

What is the function of the PCL?

Answer 63

Prevents the femur from sliding anteriorly on the tibia, particularly when the knee is flexed

Question 64

What are the C-shaped plates of fibrocartilage on the medial and lateral articular surfaces of the tibia called and what is their function?

Answer 64

Menisci; function is to deepen the articular surface and absorb shock

Question 65

How do the external and internal margins of the menisci found in the knee joint differ?

Answer 65

- External margins: thick, attached to joint capsule - Internal margins: thin, not attached to joint capsule

Question 66

How are the anterior edges of the menisci in the knee joint joined together and what does this allow?

Answer 66

Joined by transverse ligament of knee -\> allows menisci to move together during movements of femur on tibia

Question 67

What does the anterior horn and posterior horn of the medial meniscus of the knee joint attach to?

Answer 67

Anterior horn may attach anteriorly to ACL and posterior horn may attach anterior to PCL

Question 68

What is the role of the meniscofemoral ligament found in the knee joint?

Answer 68

It joins the lateral meniscus to the PCL

Question 69

What tendon passes between the lateral meniscus and the LCL of the knee joint?

Answer 69

Popliteus tendon

Question 70

What meniscus of the knee joint is nearly circular, the anterior and posterior ends are close together and its smaller and more mobile that the medial meniscus?

Answer 70

Lateral meniscus

Question 71

What are the 3 ligaments that make up the "unhappy triad"?

Answer 71

ACL Tibial collateral ligament Lateral meniscus

Question 72

What nerve innervates the superior portion of the hip joint?

Answer 72

The superior gluteal nerve

Question 73

Which nerve innervates the posterior aspect of the hip joint?

Answer 73

The nerve to quadratus femoris

Question 74

What nerve innervates the inferior aspect of the hip joint?

Answer 74

Obturator nerve

Question 75

What nerve innervates the anterior aspect of the hip joint?

Answer 75

Femoral nerve

Question 76

Label A-E

Answer 76

Question 77

Label F-I

Answer 77

Question 78

Label A-E

Answer 78

Question 79

Label F-J

Answer 79

Question 80

Label all

Answer 80

Question 81

Label all

Answer 81