Lecture 13 Flashcards
(136 cards)
1
Q
What type of joint is the hip joint?
A
ball and socket synovial (3 DOF)
2
Q
What are the movements of the hip joint?
A
flexion/extension
abduction/adduction
medial/lateral rotation
Circumduction
3
Q
What is another name for hip joint?
A
iliofemoral joint
4
Q
What are the articular surfaces of the hip joint?
A
head of femur w/ acetabulum (lunate surface)
5
Q
What are the axes in the hip joint?
A
horizontal (flexion, extension), vertical (rotation), antero-posterior (abduction, adduction)
6
Q
T/F: The femoral head forms about 2/3 of a sphere of diameter 4-5 cm. The head is supported by the neck of femur, the axis of which runs superiorly, medially and anteriorly
A
True
7
Q
The head of the femur in the adult forms an angle of ~125 (Angle of __) with the femoral shaft to place the knee under the weight-bearing line of the head of the femur
A
Inclination
8
Q
There is an impression on the head of the femur for the attachment of the round ligament of the head, called the __
A
fovea
9
Q
The head of the femur in the adult forms an acute angle of 10-30 with the femoral plane (angle of __).
A
anteversion
10
Q
Femoral anteversion can be determined by?
A
measuring the angle formed between the long axis of the femoral neck and a line parallel to the dorsal aspect of the femoral condyles
11
Q
An increase in angle of anteversion is called __ and is one factor that is considered to cause in-toeing, or pigeon toes, as well as genu valgum
A
anteversion
12
Q
A decrease in the angle of anteversion is called __, which may lead to out-toeing (external rotation) during standing and walking as well as genu varum during standing.
A
retroversion
13
Q
The angle of anteversion normally ___ with growth and development of the child, causing orthopedists to be conservative in treatment of children who walk with in-toeing
A
decreases
14
Q
A
anteversion
15
Q
A
retroversion
16
Q
A
angle of anterversion
17
Q
HIp joint: Only the __ surface of the acetabulum is lined by a horseshoe-shaped articular cartilage, which is interrupted inferiorly by the deep acetabular notch
The central part of the cavity (__ fossa) is deeper and is non-articular.
The acetabulum is directed __, __, __
A
lunate
acetabular
laterally, inferiorly, and anteriorly.
18
Q
Hip joint: The __ __ permits movement of the ligamentum teres and importantly serves as a reservoir for synovial fluid when the hip is heavily loaded
A
acetabular fossa
19
Q
Hip joint: When joint forces are decreased, __ __ once again returns to the joint space to provide lubrication and nutrition to the articular cartilages.
A
synovial fluid
20
Q
The acetabular __ is a fibrocartilaginous ring inserted into the acetabular rim. It deepens the acetabulum and fills out the various gaps of the acetabular rim.
__ __ ligament (TAL) is attached to either side of the acetabular notch and to the labrum
A
labrum
Transverse acetabular
21
Q
The __ __ (LT) of the head of the femur (ligamentum capitis femoris) is a flattened fibrous band, which arises from the acetabular notch and runs at the floor of the acetabular fossa before its insertion into the fovea femoris capitis.
It is embedded in __-__ tissue within the acetabular fossa and is lined by the synovial membrane . This ligament is extremely strong (breaking force equivalent to 45 Kg. weight) and its primary function is to carry the __ supply to the head of the femur
A
ligamentum teres
fibro-adipose
vascular
22
Q
Hip joint: The capsule is like a cylindrical sleeve running from the hip bone to the upper end of the femur. Medially it is inserted into the __ __ and laterally into a line which runs along the __ line and at the junction of the lateral and middle thirds of the __ neck
A
acetabular rim
intertrochanteric
femoral
23
Q
Capsular ligament: Y-shaped ligament that has two thick borders known as superior and inferior bands. It covers the hip joint anteriorly and superiorly
A
iliofemoral ligament
24
Q
Capsular ligament: What ligament is anterior and inferior to the hip, limiting lateral rotation & abduction?
A
pubofemoral ligament
25
Capsular ligament: What ligament is posterior and inferior, limiting medial rotation?
ischiofemoral ligament
26
What do the capsular ligaments do?
thicken the joint capsule
27
__ fibres linking two discs resemble those making up the tube-like fibrous layer of the hip joint capsule.
Parallel
28
When one disc (the femur) rotates relative to the other (the acetabulum), the fibers become increasingly __ and draw the two discs __
oblique
together
29
The __ of the hip joint winds (increases the obliquity of) the fibers of the fibrous layer, pulling the head and neck of the femur tightly into the acetabulum, increasing the stability of the joint
extension
30
Which movement of the hip joint loosens the joint capsule?
flexion (most injury occurs in this position)
31
In standing, a horizontal axis running in a side-to-side direction is used for __ and __
flexion and extension
32
The __ _ _ represents a line connecting the centers of the two femoral heads, with movement occurring about this axis when, for example, the pelvis rocks forward and backward in standing, or when both knees are pulled up to the chest from a supine lying position.
common hip axis
33
Active hip flexion with the knee flexed can be reached to __ degrees. With the knee extended, flexion is limited to _-_ degrees by the hamstrings.
120
70-90
34
Passive hip flexion with knee flexed exceeds 145 degrees , but with knee extended would be less, due to __ __
hamstring stretching
35
__ of the hip is limited to 10-20 degrees by the iliofemoral ligament. (further motion is usually perceived when one attempts this movement, however, it is extension of the lumbar vertebrae which gives a misleading impression).
Hyperextension
36
Hyperextension of the hip joint is less when knee joint is flexed due to?
Fact that the hamstrings lose some of their efficiency as extensors of the hip because their contraction has largely been utilized in flexing the knee
37
The axis for abduction and adduction in the standing position is in a __-_-__ direction
front-to-back
38
Either the limb may move in relation to the __ (lifting the limb laterally), or the pelvis may move in relation to the __ (inclining the trunk to the side of the stance leg). In either case, either abduction or adduction of the hip is the correct term to use to describe these movements.
pelvis; limb
39
Hip __ is abut 45 degrees and is usually accompanied by elevation of the pelvis.
Hip __ is frequently described as contact between the two thighs, or 0 degrees. However, with the legs crossed about 30-40 degrees of adduction is possible.
abduction
adduction
40
Hip __ is easier to observe when the knee is flexed to 90 dgerees and the motion of the tibia from the neutral position is measured
rotation
41
The axis for medial and lateral rotation in standing is vertical, and identical to the?
mechanical axis of the femur
42
Flexor muscles lie __ to the frontal plane, which passes through the center of the joint
anterior
43
There are many flexor muscles of the hip joint and the most important of which are the?
Psoas major
Iliacus
Sartorius
Rectus femoris
Tensor fascia latae
Pectineus
Adductor longus
Gracilis
Anterior fibers of glutei medius and minimus
44
Which muslces produce flexion, abduction, and medial rotation of hip?
anterior fibers of glutei medius & minimus
tensor fascia latae
45
Which muscles produce flexion, adduction, and lateral rotation hip?
psoas major
iliacus
pectineus
adductor longus
46
__ muscles lie behind the frontal plane that passes through the center of the joint
Extensor
47
Extensor muscles that insert into the femur are?
Gluteus maximus
Posterior fibers of gluteus medius
Posterior fibers of gluteus minimus
48
Extensor muscles that insert into knee are?
Biceps femoris
Semitendinosus
Semimembranosus
Adductor magnus
49
__ muscles generally lie lateral to the sagittal plane which traverses the center of the joint
Abductor
50
What are the abductor muscles of the hip?
Anterior fibers of gluteus medius
Gluteus minimus
Tensor fascia lata
Gluteus maximus (upper fibers)
Piriformis
+ sartorius, obturators, gemelli
51
__ muscles lie generally medial to the sagittal plane, which traverses the center of the joint
Adductor
52
What are the adductor muscles of the hip?
Adductor magnus
Gracilis
Semimembranosus
Semitendinosus
Biceps femoris
Gluteus maximus
Quadratus femoris
Pectineus
Obturator externus
Adductor longus
Adductor brevis
53
What the lateral rotators of the hip joint?
Piriformis
Obturator internus
Obturator externus
Quadratus femoris
Gluteus maximus
Gluteus medius (Posterior fibers)
Gemelli
54
What are the medial rotators of the hip joint?
Tensor fascia lata
Gluteus minimus (Anterior fibers)
Gluteus medius (Anterior fibers)
55
What type of joint is the knee joint?
synovial modified hinge joint
56
Complex joint, consisting of three bones, 2 DOF, and three articulating surfaces
knee joint
57
What are the 3 articulating surfaces of the knee joint?
- Medial tibio-femoral
- Lateral tibio-femoral
- Patello-femoral
58
T/F: All articulating surfaces of the knee joint are enclosed by common (same) joint capsule
True
59
What are functions of the knee joint?
- Withstanding large forces
- Providing great stability
- Enabling a large ROM
60
What provides mobility of the knee joint? Stability?
Mobility is primarily provided by the knee bony structure
Soft tissues, including ligaments, muscles (most important), and cartilage, provide stability
61
What type of joint is the tibiofemoral (lateral & medial - knee joint) and what movements does it provide?
modified hinge
- flexion
- extension
- internal rotation
- external rotation
62
What type of joint is the patellofemoral (knee joint) and what movement does it provide?
planar
- slide/glide
63
Knee joint: The articular surfaces of the femur represent a segment of a pulley, which recalls the twin undercarriage of an aeroplane. The two __ __ convex in both planes, form the two lips of the pulley, and they are extended anteriorly by the pulley-shaped __ surface
femoral condyles
patellar
64
Knee joint: The __ surfaces are reciprocally curved and comprise two curved and concaved parallel gutters which are separated by a blunt eminence running antero-posteriorly. This eminence lodges the two __ tubercles, and if we prolong this eminence, it coincides with the vertical ridge on the deep surface of the patella
tibial
intercondylar
65
Knee joint: To allow __ rotation, the tibial surface must be so modified as to shorten the intercondylar eminence. This is achieved by planning the two ends of the eminence and leaving its middle part to act as a pivot, which, by lodging in the __ notch, allows the tibia to rotate around it (axis R).
axial
intercondylar
66
The knee joint capsule comprises complex passive and active connections among the?
menisci, ligaments, retinacula, bones, muscles, and the capsule itself
67
The knee joint capsule forms a sleeve around the joint, attaching just above the __ condyles and below the __ condyles.
femoral; tibial
68
__ and __ reinforce and become integral parts of the capsule
Retinacula; ligaments
69
The proximal tendon of the __ muscle pierces the capsule to attach to the lateral femoral condyle
popliteus
70
The semimembranosus muscle forms part of the __ __ ligament and gives off fibres to the MCL and its large bony attachment. It reinforces the joint capsule posteriorly
oblique popliteal
71
The __ __ ligament also strengthens the joint capsule postero-laterally. It arises from the posterior aspect of the fibular head, passes supero-medially over the tendon of the popliteus, and spreads over the posterior surface of the knee joint
arcuate popliteal
72
__ ligaments (medial & lateral) strengthen the articular capsule on its medial and lateral aspects. They are, therefore, responsible for the transverse stability of the knee during extension
Collateral
73
The __ collateral ligament runs from the medial epicondyle of the femur to the upper end of the tibia just posterior to the pes anserine tendon. So it runs inferiorly and anteriorly
medial (tibial)
74
The ___ collateral ligament runs from the lateral epicondyle of the femur to the head of the fibula
lateral
75
The collateral ligaments are __ during extension and __ during flexion
stretched; slackened (relaxed)
76
Which ligament attaches to the medial meniscus?
tibial collateral ligament
77
In the anterior view of the knee joint, the __ ligaments are seen in the center of the joint, being largely contained within the intercondylar notch and fossa
cruciate
78
The __ __ __, the weaker of the two cruciate ligaments, is attached to the anterior intercondylar area of the tibia. It runs superiorly, posteriorly and laterally and is attached to the internal aspect of the lateral condyle of the femur
anterior cruciate ligament (ACL)
79
Which collateral ligament is more likely to be injured?
tibial collateral ligament
80
The __ __ __ is attached to the posterior intercondylar area of the tibia. The ligament runs obliquely medially, anteriorly, and superiorly to be inserted into the edge of the lateral surface of the medial femoral condyle
posterior cruciate ligament (PCL)
81
Cruciate ligaments stabilize the knee in the __-__ direction and allow the joint to work as a hinge while keeping the articular surfaces in contact
antero-posterior
82
Cruciate ligaments are intracapsular but extra __
synovial
83
The interposition of the menisci (semi-lunar fibrocartilages) corrected the lack of __ in the articular surfaces
congruency
84
extrinsic intracapsular ligament of the knee?
cruciate ligaments
85
These rings (mensici) are incomplete in the region of the intercondylar tubercles of the tibia so that they are crescent-shaped with an __ and a __ horn.
The horns of the lateral meniscus come closer to each other so that the meniscus is almost a complete circle. Whereas the medial meniscus is?
anterior; posterior
C-shaped
86
anterior cruciate ligament, posterior cruciate ligament, medial mensicus are more prone to?
damage
87
Menisci have important attachments from a functional point of view. Each horn is anchored to the __ condyle in the anterior and posterior intercondylar areas respectively
tibial
88
What are the important ligament attachments of the menisci?
- The two anterior horns are linked by the transverse ligament of the knee
- The medial collateral ligament of the knee is attached to the medial meniscus.
- The lateral collateral ligament of the knee is separate from its corresponding meniscus by the tendon of popliteus, which sends a fibrous expansion to the posterior border of the lateral meniscus
89
What movements can the knee joint complete?
flexion/extension
axial rotation
90
__ ranges from 120-150 degrees depending on the size of the muscle mass in the calf and posterior thigh as they make contact
__ of the knee is minimal, and usually will not exceed 15 degrees
Flexion
Hyperextension
91
Which plane does axial rotation of the knee occur in?
transverse plane when knee is flexed
92
With the knee flexed to 90 degrees the ligaments are slackened, allowing for a considerable amount of __ to occur
rotation
93
Rotation of the knee joint is limited by?
limited by capsular and ligamentous structures, including the collateral, cruciate, and oblique popliteal ligaments as well as the retinacula and the Iliotibial tract
94
There is also a type of automatic axial rotation called __-__ __ because it is inevitably and involuntarily linked to movements of flexion and extension.
It occurs especially at the end of extension or the start of flexion.
When the knee is __ the foot is laterally (EXTernally) rotated; hence the mnemonic EXTension and EXTernal rotation. When the knee is __ the leg is medially rotated. When the knee is fully extended with the foot on the ground, the knee passively “locks” because of lateral rotation of the tibia on the femoral condyles
Screw-Home Mechanism
extended
flexed
95
The quadriceps femoris is the extensor muscle of the knee. It is composed of four heads known as?
Vastus intermedius
Vastus lateralis
Vastus medialis
Rectus femoris
96
The __ increases the efficiency of the quadriceps muscle up to 33%
patella
97
The flexor muscles of the knee are the hamstrings and some other muscles which consist of?
Biceps femoris
semitendinosus
Semimembranosus
Gracilis
Sartorius
Gastrocnemius
98
Rotators of the knee
99
Pelvis support and protection to the pelvic organs
pelvic girdle
100
T/F: Pelvic girdle transmits forces from the head, arms, and trunk to the lower extremities
True
101
What are the 7 joints of the pelvis region?
Lumbosacral
Sacroiliac
Sacrococcygeal
Symphysis pubis
Hip
102
Hip joints are the most structurally stable, yet most __ joints in the body
mobile
103
Which joint transmits large forces between the trunk and the ground?
hip joint
104
Which joint sustains more than three times the body weight with each step?
hip joint
105
The __ joint can be a sight of low back pain, often following childbirth due to injuries of ligaments, hyper- and hypo-mobility, or inflammatory conditions
sacroiliac (SI)
106
What type of joint is the sacroiliac joint?
synovial planar (gliding)
107
What are the articular surfaces of the sacroiliac joint?
ilium part of the hip bone and sacrum
108
SI joint: The __ surface is covered in hyaline cartilage and the __ surface is covered in fibrocartilage
sacral
iliac
109
On the posterior side of the sacrum, the __ ligaments fill the space between the sacrum and the inner side of the iliac tuberosity
interosseous
110
Several layers of the posterior __ ligaments cover the interosseous ligaments and the posterior aspect of the sacrum
On the anterior aspect lie the anterior __ ligaments
sacroiliac
111
The __ and __ ligaments are connecting to the spinous process and ischial tuberosity, providing them with excellent leverage to hold the distal aspect of the sacrum in place against the anterior weight-bearing forces
sacrotuberous; sacrospinous
112
Because the fibers of the interosseous and posterior sacro-iliac ligaments run obliquely upward and outward from the sacrum, the axial weight pushing down on the sacrum pulls the ilia inward (medially) so that they compress the sacrum between them, locking the irregular but congruent surfaces of the sacro-iliac joints together. The iliolumbar ligaments are accessory ligaments to this mechanism. This is called a __-__ __
self-locking mechanism
113
What type of joint is the sacrococcygeal joint?
may be classified as a synovial planar (gliding) joint or as a symphysis (secondary cartilaginous) synarthrosis joint, depending on the subject’s age
114
What type of joint is the intercoccygeal joints?
synarthrosis
115
Motion increases between which joints during pregnancy, and ossification of the joints occurs with aging?
- sacrococcygeal
- intercoccygeal
116
Pubic symphysis: The articulating surfaces of the pubic bones are separated by a fibrocartilaginous interpubic disc, hence its classification as a cartilaginous symphysis (secondary cartilaginous) __ __ __ joint
amphiarthrosis cartilaginous symphysis
117
Even small motions occurring at the __ joints must be accompanied by motion at the symphysis pubis, as the symphysis pubis completes the closure of the ring of the pelvic articulations
SI (sacroiliac)
118
Extensor digitorum brevis
Ori: Dorsal surface of calcaneus
Ins: Lateral side of the tendon of extensor digitorum longus for toes # 2 - 4
Function: extension of toes 2-4 @ MTP & DIP, PIP joints
Innervation: deep fibular (peroneal) nerve
119
Extensor hallucis brevis
Ori: Dorsal surface of calcaneus
Ins: Proximal phalanx of big toe
Function: extension of big toe @ MTP joints
Innervation: deep fibular (peroneal) nerve
120
How many layers of muscle are in the sole of the foot?
4
121
What muscles are in the 1st layer?
1) Abductor hullucis
2) Flexor digitorum brevis
3) Abductor digiti minimi
122
Which layer of the sole of the foot is most superficial?
one
123
Which layer of the sole of the foot is deepest?
fourth
124
What is in the second layer of the sole of the foot?
The second layer of the muscles in the sole includes two muscles and two tendons:
1) Flexor hallucis longus tendon
2) Flexor digitorum longus tendon
3) Quadratus plantae ( Flexor accessorius) Lumbricals
4) Lumbricals (4 muscles)
125
What muscles are in the third layer of the sole of the foot?
1) Flexor hallucis brevis
2) Adductor hallucis
3) Flexor digiti minimi brevis pedis
126
What muscles are in the fourth layer of the sole of the foot?
Two groups of muscle:
1) Plantar interossei (3 muscles)
2) Dorsal interossei ( 4 muscles)
127
Abductor hallucis
Ori:
- Medial process of tuberosity of the Calcaneus
- Plantar fascia
Ins: Base of the proximal phalanx of the big toe
Function: abduction of big toe @ MTP joint
Innervation: medial plantar nerve
128
Flexor digitorum brevis
Ori:
- Medial process of tuberosity of the calcaneus
- Plantar fascia
Ins: The sides of the middle phalanx of toe #2-5
Function: flexion of toes #2-5 @ MTP, PIP Joints
Innervation: medial plantar nerve
129
Abductor digiti minimi
Ori:
- Lateral process of the tuberosity of the Calcaneus
- Plantar fascia
Ins: Base of the proximal phalanx of 5th toe
Function: abduction of toe #5 @ MTP joint
Innervation: lateral plantar nerve
130
Quadratus plantae (flexor accessorius)
Ori: Calcaneus
Ins: Tendon of the flexor digitorum longus
Function: assists flexor digitorum longus to flex toes #2-5 @ MTP & IP joints
Innervation: lateral plantar nerve
131
Lumbricals
Ori: tendon of the flexor digitorum longus
Ins: Dorsal digital expansion of toes #2-5
Function:
- Flexion of toes #2-5 @ MTP joints
- Extension of toes #2-5 @ PIP & DIP joints
Innervation:
- Lumbrical #1: medial plantar nerve
- Lumbrical #2-4: lateral plantar nerve
132
Flexor hallucis brevis
Ori:
- Cuboid
- 3rd (lateral) cuneiform
Ins: Medial and lateral sides of proximal phalanx of great toe (the tendon contains sesamoid bones)
Function: flexion of big toe @ MTP joint
Innervation: medial plantar nerve
133
Flexor digiti minimi brevis pedis
Ori:
- Base of 5th metatarsal
- Tendon of fibularis longus
Ins: Proximal phalanx of 5th toe
Function: flexion of 5th toe @ MTP joint
Innervation: lateral plantar nerve
134
Adductor hallucis
Ori:
Oblique head:
- The base of metatarsals # 2 – 4
- Tendon of fibularis longus
Transverse head :
- Plantar metatarsophalangeal ligaments
Ins: Base of the proximal phalanx of great toe
Function: adduction of big toe @ MTP joint
Innervation: lateral plantar nerve
135
Dorsal interossei
Ori: Adjacent sides of metatarsal bones.
Ins: Bases of the proximal phalanges (and dorsal digital expansion).
- 1st is inserted into the medial side of the 2nd toe
- other 3 are inserted into the lateral sides of the 2nd, 3rd, and 4th toes
Function:
- Abduction of toes #2-4 @ MTP joint
- Flexion of toes #2-4 @ MTP joint
- Extension of toes #2-4 @ DIP, PIP joint
Innervation: lateral plantar nerve
136
Plantar interossei
Ori: Metatarsal bones #3 - 5
Ins: Bases of proximal phalanges (and dorsal digital expansion).
- 1st is inserted into the medial side of the 3rd toe
- other 2 are inserted into the medial sides of the 4th & 5th toes
Function:
- Adduction of toes #3-5 @ MTP joints
- Flexion of toes #3-5 @ MTP joints
- Extension of toes #3-5 @ DIP, PIP joints
Innervation: lateral plantar nerves
