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COM: MSK (Midterm) COPY > Lecture 12: Joints Of Lower Extermities I > Flashcards

Lecture 12: Joints Of Lower Extermities I Flashcards

1
Q

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

A

Articular

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2
Q

Nerves to any one particular joint always arise from where?

A

More than one level in the spinal cord

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3
Q

The synovium contains a large number of what?

A

Thinly myelinated and unmyelinated nerve fibers

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4
Q

What are the 2 types of synovial fibers?

A

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

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5
Q

When do unmyelinated C fibers fire?

A

Typically only when there is trauma -> they are nociceptive

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6
Q

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

A

Prostaglandin E2

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7
Q

What joint type is the hip joint?

A

Diarthrotic ball and socket type of synovial joint

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8
Q

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

A

Transverse acetabular ligament

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9
Q

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

A

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

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10
Q

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

A

Acetabulum depth increased. By fibrocartilaginous acetabular labrum

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11
Q

How can an acetabular labrum tear be induced?

A

By twisting on a weight bearing hip

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12
Q

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?

A

The front of the hip joint

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13
Q

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??

A

The orbicular zone

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14
Q

What hold down the retinacular arteries in the hip joint?

A

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

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15
Q

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

A

Intrinsic ligaments

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16
Q

What does the iliofemoral ligament help prevent?

A

Overextension

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17
Q

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

A

Iliofemoral ligament

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18
Q

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

A

Ischiofemoral ligament

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19
Q

What does the Ischiofemoral ligament help prevent?

A

Overextension

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20
Q

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

A

Round femoral head ligament

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21
Q

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

A

To assist in spreading synovial fluid

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22
Q

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

A

When flexed thigh is addicted or laterally rotated

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23
Q

What is another name for the round femoral head ligament?

A

Ligamentum teres

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24
Q

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?

A

Round femoral head ligament - Does this through the obturator vessel

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25
Q

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

A

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

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26
Q

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

A

Anterior

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27
Q

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

A

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

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28
Q

How do the female and male femoral angles compare?

A

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

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29
Q

Why do female athletes tend to get ACL tears more?

A

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

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30
Q

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

A

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

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31
Q

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

A
  • Tensor fascia lata - Gluteus minimus - Gluteus medius
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32
Q

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

A

Quadratus femoris gluteus maximus Piriformis Triceps coxae Obturator internus and externus

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33
Q

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

A

Quadratus femoris

34
Q

What is the function of the articularis genu?

A

Pulls suprapatellar bursa superiorly during knee extension

35
Q

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

A

Extension

36
Q

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

A

Vastus intermedius

37
Q

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.

A

Trochanteric fossa

38
Q

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

A

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

39
Q

What type of joint is the knee joint?

A

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

40
Q

Is the fibula involved in the knee joint?

A

No

41
Q

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

A

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

42
Q

What are the 5 extracapsular or external knee joint ligaments?

A

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

43
Q

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

A

Patellar ligament

44
Q

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

A

Patellar retinacula

45
Q

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

A

Lateral collateral ligament (fibular collateral ligament)

46
Q

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

A

The lateral meniscus

47
Q

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

A

The fibular collateral ligament (lateral collateral ligament)

48
Q

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

A

Tibial collateral ligament (medial collateral ligament)

49
Q

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

A

Disruption of the sides of the knee joint

50
Q

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

A

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

51
Q

The oblique popliteal ligament represents an expansion of what tendon?

A

Semimembranosus tendon

52
Q

What is the function of the oblique popliteal ligament?

A

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

53
Q

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

A

Arcuate popliteal ligament - Also strengthens capsule posteriorly

54
Q

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

A

Cruciate ligaments

55
Q

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

A

Cruciate ligaments

56
Q

How are cruciate ligaments in the knee joint named?

A

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

57
Q

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

A

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

58
Q

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

A

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

59
Q

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

A

Resists anterior tibial translation especially during flexion

60
Q

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

A

Resists anterior tibial translation and tibial rotation in extension

61
Q

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

A

The anterior and posterior cruciate ligaments

62
Q

What is function of the ACL?

A

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

63
Q

What is the function of the PCL?

A

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

64
Q

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

A

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

65
Q

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

A
  • External margins: thick, attached to joint capsule - Internal margins: thin, not attached to joint capsule
66
Q

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

A

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

67
Q

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

A

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

68
Q

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

A

It joins the lateral meniscus to the PCL

69
Q

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

A

Popliteus tendon

70
Q

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?

A

Lateral meniscus

71
Q

What are the 3 ligaments that make up the “unhappy triad”?

A

ACL Tibial collateral ligament Lateral meniscus

72
Q

What nerve innervates the superior portion of the hip joint?

A

The superior gluteal nerve

73
Q

Which nerve innervates the posterior aspect of the hip joint?

A

The nerve to quadratus femoris

74
Q

What nerve innervates the inferior aspect of the hip joint?

A

Obturator nerve

75
Q

What nerve innervates the anterior aspect of the hip joint?

A

Femoral nerve

76
Q

Label A-E

A
77
Q

Label F-I

A
78
Q

Label A-E

A
79
Q

Label F-J

A
80
Q

Label all

A
81
Q

Label all

A

COM: MSK (Midterm) COPY (23 decks)

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