lower extremity Flashcards
(136 cards)
1
Q
Muscles of the thigh originate on the pelvis and insert on the femur, acting only on the hip joint
A
Gluteals, small external rotators, adductors
2
Q
Muscles that originate on the femur and cross the knee
A
Vastus medius, intermedius, and lateralis
3
Q
Muscles that cross both hip and knee joints
A
Rectus femoris, biceps femoris, medial hamstrings
4
Q
Causes of limps
A
length, deformity, muscle weakness
5
Q
Abnormally decreased angle of inclination
A
Coxa vara
6
Q
Abnormally increased angle of inclination
A
Coxa valga
7
Q
Where patellar tendon attaches
A
TIbial tuberosity
8
Q
Weight bearing bone in the leg
A
Tibia
9
Q
True or false: You can ambulate with a broken fibula
A
True
10
Q
Bone that bears body weight transmitted from the tibia
A
Talus
11
Q
Largest, strongest bone in the foot, transmits most of the body weight from the talus to the ground
A
Calcaneus
12
Q
Tarsal bone between talus head posteriorly and three cuneiforms anteriorly
A
Navicular “little ship”
13
Q
Lateral tarsal that articulate between calcaneus and metatarsals
A
Cuboid
14
Q
Where are sesamoid bones in the foot?
A
Two on distal, plantar side of first metatarsal
15
Q
Flat foot , name and cause
A
Pes planus
Rarely symptomatic
Posterior tibial tendon dysfunction or Charcot disease in diabetes
16
Q
High arch, name and cause
A
Pes cavus
More symptomatic than flat feet
Congenital
17
Q
Most clinically significant arch of the foot
A
Longitudinal
18
Q
Factors going into arch support
A
Shape of tarsals, plantar ligaments, plantar fascia, muscle pull
19
Q
Weak point of hip in trauma
A
Pubic symphysis
20
Q
Sacroiliac joint has ____ ligaments posteriorly and ____ ligaments anteriorly.
A
Strong posteriorly, weak anteriorly
Open book injury
21
Q
Strongest, most important hip joint ligament
A
Iliofemoral (Y ligament)
Resists hyperextension and lateral rotation of the hip.
22
Q
Iliofemoral ligament attachment
A
AIIS and intertrochanteric line of femur below
23
Q
Spiral shaped ligament that limits medial rotation. Name and where it attaches
A
Ischiofemoral ligament.
Attaches to ischium and greater trochanter.
24
Q
Triangular ligament that limits medial rotation. Name and where it attaches
A
Pubofemoral ligament
Attaches pubis to femur (intertrochanteric line)
25
True or false: Ligament of femoral head helps to stabilize the femur.
False
26
True or false: Artery to the head of the femur enters through the ligament of the femoral head.
True
27
What is the position of stability of the hip?
Extension
28
True or false: Fibula is part of the knee joint.
False
29
Stabilize varus and valgus in knee
Collateral ligaments
30
Stabilize anterior/posteriorly in knee
Cruciate ligaments (named for where they attach on the tibia)
31
Tendons above the patella and below the patella
Above: Quadriceps tendon
Below: Patellar tendon
32
Where does the iliotibial band insert?
Gerdy's tubercle
33
Caused by running downhill or hyperpronation of foot. Causes pain in lateral knee.
Iliotibial band syndrome
34
Overpull of the patellar tendon on the tibial tubercle. Usually around puberty in running sports.
Osgood Schlatter disease
35
What is the normal Q angle in men and women?
13 in men
| 18 in women
36
Knee flexion ____ (contracts, relaxes) ACL and _______ (increases, decreases) knee stability.
Relaxes, decreases
37
Prevents posterior displacement of femur on the tibia and joint hyperextension
ACL
38
Prevents knee hyperflexion, femur's main stabilizer with walking downhill or down stairs
PCL
39
When is the knee most stable?
In extension with taut cruciate ligaments
40
Function of menisci
Deepen articular surface of the tibia to allow better connection with femur, which improves weight transfer and stability
41
Where to medial meniscus attach?
Medial collateral ligament
| More susceptible to injury
42
Bursa that communicates with synovial cavity of the knee joint and may infect knee joint of housemaid. Also may be injured with distal femur fracture.
Suprapatellar bursa
43
Synovial effusion that accumulates in popliteal fossa. May interefere with knee movement in adults, asymptomatic in children.
Baker's cyst
44
What can a baker's cyst mimic with rupture?
DVT
45
When in the ankle joint most stable?
Dorsiflexion
46
Medial ligament of foot attaches to where?
Deltoid ligament. attaches medial malleolus to talus, calcaneus, and navicular
47
Lateral collateral ligament of ankle attaches where?
Lateral malleolus to talus and calcaneous. Not as strong as deltoid ligament
Has 3 parts: A/P talofibular and calcaneofibular
48
Creates mortise for the ankle
Distal tibiofibular joint
49
Common tendon of gastrocnemius and soleus
Achilles tendon
50
Rupture feels like being kicked in the calf and weak plantar flexion
Achilles tendon rupture
51
Rupture causes posterior lateral malleolus pain/tenderness
Peroneal tendon
52
Rupture causes tenderness along anterior ankle
Extensor rupture
53
Metatarsals connect with proximal phalanges
MTP joint
54
Proximal and middle phalanges connect
PIP joint
55
MIddle and distal phalanges connect
DIP
56
Disrupts subtalar joint and can be disabling with subsequent instability. jumping off a ladder can cause this
Calcaneal fracture
57
What ligament can cause medial foot tenderness?
Posterior tibialis
58
What ligament can be sprained with excessive eversion injury?
Deltoid ligament
59
What two things can muscles do?
Shorten or elongate (concentric v. eccentric contraction)
| Both create tension
60
When a muscle crosses a joint, ____ (contraction/relaxation) moves or stabilizes a joint.
Contraction
61
Dense fibrous tissue that ensheaths the lateral thigh
Fascia lata
62
What does fascia lata connect?
Tendons of gluteus maximus and tensor fascia lata to form IT tract, inserts on Gerdy's tubercle of tibia.
63
What does the fascia lata pass over on its way from ASIS to Gerdy's tubercle?
Greater trochanter
64
What may result in snapping hip syndrome?
Friction as IT band moves AP during repetitive motion (stair climbing, running)
65
Primary hip flexor. Main postural muscle.
Iliopsoas.
66
Where does iliopsoas muscle attach?
Femur's lesser trochanter
67
Muscles that work in hip flexsion
Iliopsoas, rectus femoris, sartorius, TFL
| I really shouldn't though
68
Muscles that work in hip extension
Gluteus maximus, medius, and minimus. More postural than ROM (short, fat muscles). Hamstrings.
69
What causes a limp? (abductor lurch)
weak gluteus medius and minimus
70
Span both hip and knee joints. Extend the thigh at hte hip and flex hte leg at the knee.
Hamstring muscles
71
Muscles that abduct the hip
Gluteus medius and minimus.
72
Additional movement of the hip produced by these muscles
sartorius, TFL, piriformis
73
What is a positive Trendelenberg gait?
Pelvis descends on unsupported side when standing on one leg
74
Treatment for trendelenberg gait
Cane on opposite side of disease. Lessens forces across hip joint by 2/3 by decreasing abductor force
75
Muscles that adduct the hip
Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus
76
What is the nerve supply of hip adductors?
Everything is supplied by obturator nerve EXCEPT picky pectineus (femoral nerve)
77
Muscles that externally rotate the hip
Gluteus maximus, deep rotator muscle group (piriformis, obturator internus and externus, superior and inferior gamellus, quadratus femoris)
78
Muscles that internally rotate the hip
Gluteus medius and minimus
79
Muscles that flex the knee
Posterior thigh compartment
| Hamstrings: Biceps femoris, semitendinosis, semimembranosis, popliteus
80
Muscles that extend the knee
Anterior thigh compartment
Quadriceps (major knee stabilizers)
Vastus lateralis, medialis, intermedius.
81
Prevents lateral patellar dislocation
Vastus medialis
82
Kicking muscle that crosses both hip and knee
Rectus femoris
83
Pes anserine bursitis
Bursitis of medial knee. Separates sartorius, gracilis, and semitendinosis muscles from tibia and medial collateral ligaments.
84
"Foot of the goose"
Pes anserine bursitis
85
Muscles that dorsiflex the ankle
Anterior leg compartment
| Tibialis anterior, extensor digitorum longus, extensor hallucis longus
86
Weak tibialis anterior may cause what?
foot drop
87
Muscles that evert the ankle
Lateral leg compartment
| FIbularis longus and fibularis brevis
88
Muscles that invert the ankle
Deep posterior compartment.
| Tibialis posterior, flexor hallucis longus, flexor digitorum longus
89
Muscles that plantar flex the ankle
Posterior compartment
Gastrocnemius
Soleus
Plantaris
90
What are the most superficial structures in the popliteal fossa and therefore at high risk of injury?
Popliteal artery and tibial nerve
91
Continuation of femoral artery that divides into anterior and posterior tibial arteries at inferior end of fossa
Popliteal artery
92
Popliteal artery --> anterior tibial artery --> ____?
Dorsalis pedis to dorsum of foot
93
Popliteal artery --> posterior tibial artery --> -___?
Medial malleolus
94
Foot dorsiflexors
Anterior tibialis and anterior compartment
95
Muscles in anterior leg compartment
Tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius
96
Muscles in lateral leg compartment
FIbularis longus, fibularis brevis, common peroneal nerve
97
Muscles in superficial posterior leg compartment
Gastrocnemius, soleus, and plantaris muscles
98
Muscles in deep posterior leg compartment
Flexor digitorum longus, flexor hallicus longus, popliteus, tibialis posterior. Tibial artery, nerve, and vein are here as well.
99
Normal tissue pressure
0-8 mmHg
100
When does tissue become ischemic due to bleeding?
Pressure rises over capillary perfusion pressure
101
What do we use to measure compartment pressure?
Hand held manometer (Stryker)
102
What pressure requires decompression by fasciotomy?
Delta pressure less than 30 mmHg
103
What are some criteria to make diagnosis of compartment syndrome clinically?
Pain out of proportion, pain despite treatment, pain with passive stretch
104
Muscles that plantar flex the toes
Extrinsic muscles from deep posterior leg compartment (flexor hallucis longus, flexor digitorum longus)
Intrinsic muscles from plantar foot compartment (flexor hallucis brevis, flexor digitorum brevis)
105
Muscles that dorsiflex the toes
Extrinsic muscles from anterior compartment (extensor hallucis longus, extensor digitorum longus)
Intrinsic muslces from dorsal foot compartment (extensor hallucis brevis, extensor digitorum brevis)
106
Covers structures posterior to medial malleolus (Forms tarsal tunnel)
Retinacula flexor
107
Tarsal tunnel syndrome is compression of what nerve?
Tibial nerve
108
Restrain extensor tendons at the ankle
Retinacula extensor
109
Restrain peroneal tendons lateral to the ankle
Retinacula peroneal
110
Structures passing posterior to the medial malleolus
```
Tom, Dick, and Harry
TIbialis posterior
flexor Digitorum longus
posterior tibial Artery and tibial Nerve
flexor Hallucis longus
```
111
"midline" that other toes move relative to
Second toe
112
How many layers of plantar foot muscles are there?
4
113
Spinal level of lumbosacral plexus
L4, L5, S1-S3
114
Lumbosacral plexus to the lower limb
Gluteal, femoral, obturator, sciatic
115
Sciatic nerve is made of what?
Tibial and common peroneal, which separate in distal part of thigh
116
Supplies more skin than any other nerve
Posterior femoral cutaneous
117
Gluteal nerve leaves the pelvis through what?
Greater sciatic foramen
118
Femoral nerve passes deep to the middle of the __________ into the femoral triangle. Supplies ______ and ______ thigh muscles.
inguinal ligament
| anterior, medial
119
Supplies quadriceps L2-L4
Femoral nerve
120
Enters thigh behind inguinal ligament
femoral nerve
121
What are the boundaries of the femoral triangle?
Superior: inguinal ligament
Medial: Adductor longus
Lateral: sartorius
122
What is contained in the femoral triangle?
Femoral nerve, artery, and vein. As well as lymph nodes and vessels
123
Continuation of fascia from abdominal cavity around femoral vessels
Femoral sheath
124
Damage to femoral nerve blocks what reflex?
Patellar
125
L2,L3,L4. Emerges from medial psoas muscle
Obturator nerve
126
Obturator nerve ---> anterior division--> ___?
thigh adductors and hip joint
127
Obturator nerve --> posterior division --> ____?
adductors and knee joint
128
Nerve supply of gluteal compartment
Gluteal nerves
129
Nerve supply: Thigh, anterior compartment
Femoral nerve
130
Nerve supply: Thigh, medial compartment
Obturator
131
Nerve supply: Thigh, posterior compartment
Tibial nerve
132
Nerve supply: Leg, anterior compartment
Deep peroneal nerve
133
Nerve supply: Leg, lateral compartment
Superficial peroneal nerve
134
Nerve supply: Leg, posterior compartment
Tibial nerve
135
Nerve supply: Foot, dorsal compartment
Deep peroneal nerve
136
Nerve supply: Foot, plantar copartment
plantar nerve
