lower limb Flashcards
(262 cards)
1
Q
Achilles tendinopathy causes
A
overuse and poor biomechanics
2
Q
achilles tendinopathy physical exam
A
pain with palpation, pain at rest more likely, swelling around tendon, RIMT to plantar flexion
3
Q
achilles tendinosis
A
degeneration
4
Q
achilles tendinitis
A
inflammation
5
Q
biomechanics that can cause achilles tendinopathy
A
pes clavus and pes Planus
6
Q
achilles tendon rupture physical exam
A
decrease in active plantar flexion, inflammation/bruising, Thompson test
7
Q
common achilles tendon rupture history
A
someone kicked me, Middle Ages male athlete, pivoting and running, burst jumping
8
Q
where does achilles tendon rupture occur
A
2 inches above the heel
9
Q
thompson test
A
squeeze gastro/soleus and plantar flexion will occur, if achilles tendon is torn no flexion will occur
10
Q
syndesmosis ligament sprains (high ankle) history
A
“turned ankle” (lateral rotation) and excessive dorsiflexion
11
Q
syndesmosis ligament sprains physical exam
A
swelling/edema, decrease ROM, point tenderness
12
Q
lateral ligament sprain history
A
“turned ankle”, common
13
Q
lateral ligament sprain- ligaments
A
anterior talofibular
calcaneofibular
posterior talofibular
14
Q
anterior talofibular ligament (LLS) causes injury
A
plantar flexed and inverted
15
Q
calcaneofibular (LLS) causes
A
in neutral then excessively inverted
16
Q
posterior talofibular (LLS) physical exam
A
swelling/edema, decreases ROM, point tenderness, high and low arch
17
Q
0 degree dorsiflexion
A
planti grade
18
Q
medial ligament sprain history
A
“turned ankle”, eversion
rare- tibionavicular, anterior tibiotalar, tibiocaneal
19
Q
medial ligament sprain physical exam
A
swelling/edma, decreased ROM, point tenderness, low arch
20
Q
plantar fasciosis history
A
overuse, poor biomechanics, due to small tears and stretching of planter fascia
21
Q
plantar fasciosis risk factors
A
flat and high arch, obesity, sudden weight gain, and gastro/soleus and hamstring tightness
22
Q
plantar fasciosis physical exam
A
pain with palpation, morning pain, high/low arch, hypo mobility of 1st metatarsal
23
Q
out of gastro/soleus, hamstring, or BMI which one is the number 1 risk factor
A
gastro/soleus
24
Q
arterial supply starting at femoral artery
A
femoral artery –> popliteal artery –> A. tibial artery or P.tibial artery —-> A. - dorsal pedal or P. M/L plantar artery
25
femoral artery is also known as
peroneal artery
26
arcuate artery of foot is also known as
Doral arch
27
3 bones that make up the hip
ilium, ischium, and pubic
28
subluxing
comes out of socket and returns back
29
dislocation
does not go back into socket
30
ilium pubic bone and the ischium make up the
innominate
31
socket and femoral head is lined with
hyaline and fibro cartilage
32
the surface of the acetabulum is covered in
hyaline cartilage
33
the periphery of the acetabulum is covered by
rim of fibrocartilage
34
acetabulum labrum is covered in
covered in fibrocartilidge,
35
labrum provides what
proprioception, stability, and cushioning
36
labral tears can result from
injury or dislocation of hip joint, "wear and tear" from repetitive movement (twisting or pivoting), and degeneration (osteoarthritis)
37
labral tears occur where
1 and 2 on the right side
10 and 11 on the left side
38
with labral tears there may be
locking, clicking or catching sensation in joint, pain in hip or groin, stiffness or limited range of motion
39
coxa femoral joint has how many degrees of freedom
3 degrees- ball and socket joint
40
articular capsule is taut when it is placed in what position
extension and internal rotation
41
a strong and dense, forms a cylindrical sleeve that encloses the hip joint and most of the neck of femur
fibrous capsule
42
coxa joints 3 degrees of freedom are
flexion/extention, abduction/adduction, internal/external rotation
43
where is the articular capsule attached
proximally to the edge of acetabulum and transverse acetabular ligament, distally to neck of femur
44
the capsule is reinforced by
intra articular ligaments and taut in full
45
increase capsular laxity could result in increase stress to ____ and ____
labrum and articular surface
46
pubofemoral ligament
limits extension and limits abduction
47
iliofemoral ligament
limits extension, limits medial rotation, and helps maintain an erect posture
48
ischiofemoral ligament
limits extension and limits internal rotation
49
ligaments teres
limits adduction, flexion, and external rotation
50
what does the ligaments teres artery do
supplies blood flow to the head of the femur in childhood
51
movement at the hip joints
flexion, extension, adduction, abduction, medial rotation, and lateral rotation
52
main flexor of the hip
iliopsoas
53
main extensor at the hip
gluteus maximus
54
When walking what muscle is being recruited the most
hamstrings
55
when running, jumping, sprinting what muscle is being recruited the most
glute max
56
main adductor muscle in hip
adductor Magnus
57
main abductor of the hip
glue medius
58
main medial rotator of the hip
glute minimus
59
main lateral rotation of the hip
glute max
60
pelvis region includes
ilium, ischium, and pubic bone
61
obturator foramen
obturator nerve, artery, and vein go through (the lower hole by the ischium of the pelvis)
62
the coxafemoral joint has how many degrees of freedom
3 degrees ( frontal, transverse, sagittal)
63
coxafemoral joint is what kind of joint
ball and socket
64
is the coxafemoral joint stabile?
yes, not a lot of subluxation or dislocations
65
hip socket is
acetabulum
66
covers 25% of humeral head
glenoid fossa
67
which is higher in subluxation/ dislocations coxafemoral joint or glenohumeral joint
glenohumeral due to overlapping of the socket
68
covered in hyaline cartilage, surrounds socket and femoral head, periphery is covered by fibrocartilage
acetabulum
69
acetabular labrum
fibrocartilage, horseshoe-shaped, covered in hyaline cartilage,
70
fibrocartilage of the acetabular labrum has what functions
provides stability, cushion, and proprioception
71
osteoarthritis of the hip
initial labral tear leads to frictions between femoral head and acetabulum that leads to wearing down of hyalin cartilage at femoral head
72
labral tears result from (3)
injury to or dislocation of hip, "wear and tear" , degeneration
73
a patient complains about groin pain with clicking and subjective pain associated with it as well as locking and limited ROM of hip joint then it could be a
labral tear
74
what part typically tears at the coxafemoral joint and why
anterior superior labrum because of pivoting and twisting
75
articular capsule of the hip joint
fibrous capsule that is strong and dense, forms a cylindrical sleeve that encloses the hip joint and most of the neck of femur
76
the articular capsule of the hip joint is reinforced by
intra articular ligaments and taut in hip extension an internal rotation
77
what can cause stress to labrum and articular surface
increase capsular laxity
78
Capsule from margins of acetabulum to neck of femur do what
Holds synovial membrane in place
79
intra articular ligaments are the (4)
pubofemoral
iliofemoral
ischiofemoral
ligamentus teres
80
what does the pubofemoral ligament do
limits extension and abduction
81
what does the iliofemoral ligament do
limits extension
limits medial rotation
helps have erect posture
82
intertrochanteric line
head of femur with a long attachment of tendon
83
what does the ischiofemoral ligament do
limits extension and limits medial/internal rotation
84
the ischiofemoral wraps around where
front of femur
85
what does the ligaments teres do
limits adduction
limits flexion
limits external rotation
provides hip stabilization
86
ligaments teres location
acetabulum socket to head of femur
87
what artery supplies blood to the head of femur ONLY in childhood
ligamentus teres artery
88
ligaments teres medial and lateral circumflex arteries supply what
neck and head of femur in adulthood
89
a strain is
muscle over lengthen
90
a sprain is
tears of the muscle ( tendon over lengthen)
91
fascia lata
aka deep fascia covering muscle groups (whole thigh), tough connective tissue
92
iliotibial band/tract
thickening/hardening part of the fascia lata, iliac tubercle to gervis tubercle
93
iliotibial band syndrome
excessive friction on lateral epicondyle that creates pain on the lateral knee
94
anterior muscles include
psoas major
pectineus
adductor longus/brevis
quadriceps
sartorius
95
psoas major
one of the main hip flexors, to stretch bring hip into extension
96
pectineus
spirorami of pectineal line of femur, hip flexor and adductor
97
linea aspera
bony portion going down posterior side of femur
98
adductor longus/brevis
innervated by the obturator nerve
99
quadriceps
extend knee and flexes hip
100
sartorius
flexes hip, abducts hip, externaly rotates hip ( figure 4 position/ criss cross legs)
101
adductor muscles
adductor brevis and longus
adductor magnus
gracilis
102
adductor muscles are ___ to the hip joint
anterior
103
adductor hiatus
hole in adductor Magnus where the femoral artery and vein goes through
104
femoral artery goes from
anterior part of thigh, adductor hiatus, posterior part of thigh, popliteal fossa then turns into popliteal artery and vein
105
gracilis
attaches to Pes anserine
106
how many muscles attach to pet anserine and which ones
gracilis, semitendinous and sartorius
107
abductor muscles
tensile fascia lata
glute max
iliotibial band
glute med
glute min
108
glute medius
main abductor, external rotation, main stabilizer of the coxafemoral joint
109
glute minimus
attaches to greater trochanter, abducts and internal rotation of hip
110
glute minimus and medius are part of what nerve
superior gluteal nerve
111
glute max borders
superior- greater trochanter and PSIS
inferior- coccyx to ischial tuberosity
112
hamstrings
one of the main flexors of knee
113
deep posterior muscles
obturator externus
gemellus superior/inferior
obturator internus
quadratus femoris
114
most inferior deep posterior muscle
quadratis femoris
115
hip replacement with a posterior approach could cause what
drop foot because moving piriformis could hurt the common peroneal nerve
116
bursas behave like
contractile lesions (stretching or contraction causes pain)
117
trochanteric bursa are where
gluteus minimus
sub gluteus max
sub gluteus medius
118
trochanteric bursitis causes
repeated movement like climbing stairs, sleeping on same side, overrecruiting glutes, falling on hip by greater trochanter
119
what muscle is most affected by bursitis
sub gluteus maximus
120
ischial bursitis
between hamstring origin and ischial tuberosity
121
ischial bursitis causes
overuse
trauma
running/jumping
prolonged sitting
122
how to tell ischial bursitis
tenderness of ischial tuberosity, pain when weightbearing, and pain with contraction of hip extensors
123
iliopectineal bursitis causes
same as ischial bursitis
124
how to tell iliopectineal bursitis
tenderness to femoral triangle
pain when power walking and running
pain with resistive hip flexion and adductions
125
greater sciatic foramen- superior to piriformis
superior gluteal vessels and superior gluteal nerve
126
greater sciatic foramen- inferior to piriformis
pudendal nerve, sciatic nerve, posterior femoral cutaneous, nerve to obturator internus and quadrates femoris
127
sacral plexus comes out from
inferior to piriformis
128
pudenal nerve flow
inferior to piriformis, wraps around, and goes backin to the lesser sciatic Foramen
129
lesser sciatic foramen
internal pudendal vessels
pudenal vessels
obturator internus
nerve to obturator internus
130
pudendal nerve affects
sensation of external genitalis and anus, some muscles of pelvis
131
obturator internus flow
from obtruator membrane, lesser sciatic Foramen, to greater trochanter
132
trendelenberg sign
weakness and absence of hip abductor mechanism, hip drop on contralateral side
133
what muscle makes sure pelvis is level
glute medius
134
floor of femoral triangle
lateral: iliopsoas
medial: pectinous
135
borders of femoral triangle
superior: inguinal ligament
lateral: sartorius
medial: adductor longus
136
femoral hernia
loop of intestine forces out through femoral triangle due to weakness or tear in abdominal wall: risk of strangulation
137
inferior vena cava splits into
common iliac vein left and right, then becomes external iliac vein then the femoral vein
138
aponeurosis from anterior iliac spine forms what
canal
139
inguinal hernia
abdominal contents (intestines) want to go into the deep ring to the inguinal canal (indirect hernia) and eventually the scrotum
140
direct hernia
abdominal contents go directly to superficial ring and eventually could go into scrotum
141
femoral hernia
abdominal contents go into femoral triangle- can compress femoral nerve - extreme pain in groin
142
sports hernia
tear of covering of inguinal canal
143
supplies most of the blood to head and neck of femur, can be torn in femoral neck fracture or hip dislocations
medial circumflex
144
comes out of the internal iliac artery
superior and inferior gluteal arteries and obturator artery
145
legg- calve-perches disease
injury to ligamentus teres artery - femoral head does not get nutrition- necoris/fracture- total hip replacement
146
blood supply of hip starting at the aorta
aorta - common iliac artery- internal and external iliac artery - internal splits into 2- external iliac artery goes under inguinal ligament and canal and femoral triangle - splits into superfical and Deep femoral artery - superficial becomes popliteal artery
147
venous system starting at inferior vena cava
left and right common iliac vein
external and internal iliac vein
internal- branches of S/I iliac vein, pudendal, obtruator vein
external - femoral vein
superficial and deep femoral veins
deep- blood to posterior vein
superficial- becomes popliteal vein
148
superficial veins are in the
hypodermis
149
great saphenous vein
runs medially in lower leg and empties into femoral vein
150
small saphenous vein
lower leg posterior side and empties into popliteal vein through popliteal fossa to femoral vein
151
2 deep inguinal lymph nodes
vertical in orientation, lateral to great saphenous vein, main collectors of the lymph nodes
152
superficial lymph nodes dumps into.....then....
superficial lymph nodes- deep nodes- external iliac nodes- vessels -venous angle to bring back some to venous system
153
popliteal lymph nodes
drains lymph into deep inguinal lymph nodes- external lymph nodes- venous angle (towards subclavian vein)- into venous system
154
signs/symptoms of hip osteoarthritis
joint pain, morning stiffness lasting less than 60 minutes, loss of function, mian with nothing, antalgic gait, bony enlargement at affected joints, limited ROM
155
hip osteoarthritis causes
hyalin cartilage is worn down from excessive friction and labral tears
156
crackling/graveling sound
crepitus
157
painful gait
antalgic gait
158
where are the 2 articulation of the knee joint
between patella and femur
between femoral and tibial condyles
159
where is the meniscus
between tibia and femoral condyles
160
sesamoid bone in quadriceps tendon
patella
161
patella function
biomechanics advantage for pull of quads by increasing distance of quads from axis of knee
162
what attaches to the apex of patella
patellar tendon
163
normal sulcus angle
128 degrees
164
if femoral condyles make an angle of 145 degrees, patella has a higher chance of what
dislocation
165
where does the patella normally dislocate and why
laterally because there are not condyles to keep it in place
166
patellar movement
knee flexion- patella inferiorly glides
knee extension- patella superiorly glides
167
articular capsule of knee
strong fibrous capsule, especially where it forms instrinsic and extrinsic ligaments which are continuous with the fibrous capsule
168
what does the articular capsule of the knee not include
ACL and PCL
169
synovial capsule of knee
-lines the inner aspect of the fibrous capsule
-more extensive than nay other joint
170
what happens when the knee is inflamed
synovial fluid increases and aspirate fluid to relieve pressure, remove blood that has entered the joint
171
why would you aspirate the knee
if the joint is swollen the capsule can push on nerves and causes pain
172
knee ligaments
-patellar ligament
-fibular collateral ligament
-tibial collateral ligament
-oblique popliteal ligament
-arcuate popliteal ligament
173
extracapsular ligaments
-patellar ligament/tendon
-lateral collateral ligament
-medial collateral ligament
- oblique popliteal ligament
-arcuate popliteal ligament
174
patellar ligament
strong band continuation from quad tendon, runs from patella to tibial tuberosity, helps generate force
175
osgood schlatter disease
patellar ligament is overly recruited in childhood and it pulls on insertion of the ligament bone is added to try to adapt= more pain
176
lateral collateral ligament
head of fibula to lateral epicondyle, prevents excessive varus movement
177
varus
distal end of joint pointing in (bowlegged <>)
178
valgus
distal end of joint point out (knocked knees ><)
179
how is LCL injured example
football player squatting and being tackled so someone hitting medial knee and pushing outward
180
medial collateral ligament
strong flat band, continuous with tendon of adductor Magnus, deep fibers are attached to medial meniscus and fibrous capsule of knee joint
181
lateral collateral ligament
disruption of lateral side of knee joint, common peroneal nerve wraps around head of fibula, resists varus stress
182
LCL does what
stabilizes lateral knee and limits external rotation of knee
183
what happens if LCL tears
head of fibula can tear off, common peroneal nerve can also be stretched which can cause drop foot,
184
how to determine if LCL is in tact
varus test- put lower extremity in 30 degrees and create varus stress in knee
185
MCL does what
prevents disruption of medial side of knee joint , resists against valgus stresses, external tibia rotation and resist translation of tibia anterior on femur
186
what is the unhappy triad
ACL,MCL, and meniscus
187
what happens if the MCL is torn
meniscus and ACL may also be damaged due to the MCL being attached to medial meniscus
188
oblique popliteal ligament
lateral condyle and epicondyle of femur to posterior medial tibial condyle
- reinforces posteriormedial knee
189
arcuate popliteal ligament
head of fibula to lateral epicondyle and the oblique popliteal ligament
- strengths capsule posterior lateral
190
intracapsular (intrinsic) knee ligaments
ACL
PCL
medial meniscus
lateral meniscus
coronary ligaments
transverse ligaments
191
Cruciate ligaments of knee joint
essental to the anteroposterior stability of the knee joint- especially when flexed
- prevents excessive anterior or posterior movement of knee
192
cruciate ligaments join what
tibia and femur
193
ACL
weaker ligament, slack when knee is flexed and taut when fully extended
194
ACL function
prevent excessive anterior movement of tibia on the femur, provides valgus stability
prevents excess IR/ER of tibia
195
ACL injury causes
-MCL tear
- excessive anterior movement of tibia on femur
- hyperextension of knee
- excess IR/ER of tibia
196
ACL injury test
anterior drawer test
197
gastrocnemius muscle affect on ACL
gastro has more protective effect on PCL bc of orgin and insertion guards tibia from moving posteriorly
198
PCL
-stronger ligament
-rarely torn
-tightens during flexion of the knee
199
PCL function
-prevents hyper flexion of knee (stabilizes femur when going downhill
- prevents anterior displacement of the femur on tibia
200
PCL injury causes
-knee flexed and superior tibia is struck
- tibia is driven posterioir on femur
- knee joint is severely hyperflexed
201
PCL injury test
posterior drawer test
202
coronary ligaments
capsular fibers that attach the menisci to the tibial condyles
203
transverse ligament of the knee
joins the anterior edges of the 2 menisci, goes through the menisci horns
204
menisci function
stability, cushion, proprioception and acts as a shocket absorber
205
peripheral margins of menisci are ____ and interior portions are _____
vascularize, avascular
206
medial meniscus
bigger, C-shaped, firmly attached to deep surface of MCL, more likely to tear
207
lateral meniscus
smaller, horseshoe shaped, very moveable/adaptable, popliteus muscle seperates it from LCL, harder to treat becuase it moves more
208
outer (anterior) of menisci is
1/3, vascular, injury here can be reattached
209
inner of menisci
2/3, avascular, low chance of repair
210
common mode of injury for menisci
pivoting and twisting when leg is flexed
211
what can happen if medial mensci detaches from fibrous capsule
knee can be in a "locked" flexed position
212
menisci injury test
thessalys test
213
what can be used for a ACL/PCL graft
part of hamstring to patellar ligament
214
bursae around the knee that are connected
supra patellar (quads)
popliteus bursa
gastrocnemius bursa
215
most important bursa of knee
suprapatellar bursa
216
suprapatellar bursa
articulates menu attaches to bursa and when contracted bursa moves up, when relaxed bursa moves down
decreases friction between quads and femur
217
popliteus bursa
decreases friction between popliteus and lateral femoral condyle
218
Pes anserine bursa
between SGT (sartorius, gracilis, and semitendinosis)
219
housemaids knee
inflamed subcutaneous pre patellar bursa
220
subcutaneous prepatellar bursa
between skin and anterior surface of patella, allows movement of skin over patella when flex/ext of knee
221
subcutaneous infrapatellar bursitis
between skin and patellar ligament, allows skin to glide over tibial tuberosity and withstand pressure when kneeling with trunk upright
222
clergymans knee
infrapatellar inflammation and occurs in roofer/floor tilers
223
knee extension is due to what muscle
quads (femoral nerve L2-L4)
224
knee flexion is due to what muscles
bicep femoris, semitendin and semi membran (sciatic nerve- tibial nerve)
225
lateral rotation of femur is what muscles
popliteal muscles (popliteus)
226
open kinematic chain activity
body prefers to move tibia, distallimb is not fixed against stable surface
227
when knee is locked what happens (open chain)
tibia is externally rotates
228
when the knee is unlocked what happens (open chain)
popliteus is recruited by internally rotating tibia or externally rotating femur
229
closed kinematic chain
distal part of limb is fixed against a stable surface, body moves the femur
230
how does the knee unlock in a closed chain
popliteus muscle externally rotates the femur
231
chondromalacia patella
softening of cartilage ,rubs agaisnt the femur instead of gliding
232
what causes cohndromalacia patella
bone mislaignment or muscle imbalance
233
creates popliteal fossa
bicep femoris going to tibial head
semimemb and semitend going to proximal tibia
heads of gastro on medial and lateral sides
234
contents of popliteal fossa
small saphenous vein
popliteal arteries and veins
tibial and common fibular nerves
posterior cutaneous nerves of thigh
popliteal lymph nodes and lymphatic vessels
235
arterial supply to knee
femoral artery- popliteal artery- genicular artery- genicular anastomosis
236
geni means
knee
237
angulation of knee -normal
185 - slightly valgus
238
angulation of knee - genus varus bowleg
<175, patella moves laterally when leg is extended
239
angluation of knee- genus valgus
>185, more tensile stress on medial side, more compressive stress on lateral side
240
tensile stress
when you pull apart attached surfaces
241
osteoarthritis of knee would lead to varus or valgus?
varus- medial compression and lateral tensile
242
components of the ankle/foot complex
28 bones, 25 joints
rear, mid, and forefoot
243
body weight when walking, running and jumping
walking- 1.2.x
running- 2x
jumping- 5x
244
rear foot consists of
distal tibiofibular joint
talocrural joint
subtalar joint
245
Distal tibiofibular joint:
between tibia and fibula
dosriflexion and plantar flexion
246
talocrural joint
between tibia dn fibula with talus
dorsiflexion and plantar flexion
247
subtalar joint
between talus and calcaneus
inversion and eversion
248
mid foot is also known as
choparts joint
249
main midfoot joints
talocaneonavicular and calceocuboid
250
what do the main midfoot joints do
supination (planter flex, invert, and adducts) and pronation (dorsiflex, eversion, and abduction)
251
forefoot contains
tarsometatarsal joint
inter metatarsal
metatarsophalangeal
interphalangeal
252
ankle ligaments
anterior inferior tibiofibular ligament
anterior talofibular
calcaneofibular
posterior inferioridistalfibular liga
poserior talofib
calcaneus navicular ligament
253
Anterior inferior (distal) tibiofibular ligament
Tears with high ankle strains
254
Anterior talofibular
Most common ligament to tear/sprain at ankle/foot
255
Posterior inferior (distal) tibiofibular ligament
-Part of ligaments surrounding tibia and fibular distally
-Can tear with high ankle strain
256
Calcaneus navicular ligament (aka spring ligament)
-Calcaneus to navicular bone
-Important for stability of medial arch
257
4 deltoid ligaments
anterior tibiotalar
tibiocalcaneal
posterior tibiotalar
tibionavicular
258
long plantar ligament
calcaneus to cuboid bone
259
fibular retinaculum
holds brevis and longus in place
260
spring ligament
Important for stability of medial arch
261
Long plantar ligament
-Calcaneus to cuboid to 2nd-4th metatarsal heads (with extensions
-Stabilizes arch laterally w/ short one
262
short plantar ligament
-Calcaneus to cuboid
-Stabilizes arch laterally w/ long one
