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Anatomy (Karen) > Lower Limb > Flashcards

Flashcards in Lower Limb Deck (150):
1

Weight-bearing epiphyses are formed as a result of

weight bearing pressure

2

Traction epiphyses are formed as a result of

attachments of ligaments and muscles that exert force

3

The head of the femur is a ______ epiphysis

weight-bearing (fuses early 20s)

4

The greater trochanter is a ______ epiphysis

traction

5

The head of the femur is oriented

upwards, medially, and slightly anteriorly (ante-verted)

6

T/F The anterior part of the head of the femur is within the socket

False, it lies anteriorly outside the socket, protected by the psoas bursa

7

T/F The psoas bursa communicates with the acetabular joint

False, but it may

8

The head of the femur articulates with

the roof of the acetabulum (thickest cartilage here)

9

What are the intra-articular structures of the hip joint?

fat pad, labrum, ligamentum teres

10

What is ligamentum teres?

Directs branch of obturator artery to femoral head in development until puberty

11

What is the role of the vertical bundle of trabeculae?

Weight-bearing in stance

12

What is the role of the arcuate bundle of trabeculae?

Resisting bending forces on the neck of the femur

13

What is the significance of the 2 trabeculae system in the neck of the femur?

At the inferior aspect of the arcuate bundle where the 2 intersect becomes a site of weakness in ageing and osteoporosis due to loss of trabeculae

14

At the hip joint, the line of gravity passes _________ the centre of the joint

behind

15

At the knee joint, the line of gravity passes _________ the centre of the joint

in front of

16

At the ankle joint, the line of gravity passes _________ the centre of the joint

in front of

17

What is the 'close packed position'?

Position of greatest stability; articular surfaces meet as best they can with the capsules and ligaments taught - hip extension, abduction, and medial rotation (open packed is sitting cross-legged, least stability)

18

Which ligaments of the hip joint blend with the capsule?

Pubofemoral and ischiofemoral

19

Iliofemoral ligament attaches

ASIS to intertrochanteric line

20

What is the function of the iliofemoral ligament?

Tightens in extension to resist further extension; causes medial rotation in extension

21

Retinacular fibres

extension of capsule around neck of femur; transmits retinacular blood vessels to epiphysis (growth) and head of femur (following closure)

22

Disruption of retinacular blood vessels in development causes

Perthe's disease - avascular necrosis of the femoral head

23

What is a screw-home mechanism?

The joint gets tighter as it goes into extension - eg in hip, medial rotation occurs with extension to lock the joint

24

_______ rotation occurs in stance, _______ rotation occurs in swing

medial; lateral

25

Main movements of the hip are in the ________ plane

sagittal

26

What is the function of gluteus maximus?

hip extension in extreme force/acceleration; stabilizes pelvis when rising from seated position

27

The principal role of the cuff muscles in the hip joint is to

pull the head of the femur into the socket; they can laterally rotate the hip as well

28

Range of flexion at the hip

120 deg

29

Range of extension at the hip

10-20 deg

30

Medial rotation of the hip is associated with

stance

31

Lateral rotation of the hip is associated with

swing

32

Gluteus medius and minimus _______ the thigh

abduct

33

Illiopsoas ________ the thigh

flexes

34

What is the critical role of gluteus medius and minimus?

Keeping the pelvis level in walking by pulling it down to prevent fall to the unsupported side

35

Injury to the gluteus medius and minimus results in

Trendellenberg gait where the pelvis is unstable and drops to the unsupported side

36

The hip joint is innervated by

articular branches of the femoral and obturator nerves

37

Referred pain from the hip via the obturator nerve presents

medial thigh above the knee

38

Referred pain from the lumbar spine and sacro-iliac joints presents

Hip joint

39

Hip flexion myotome

L2 L3

40

Hip extension myotome

L4 L5

41

Knee extension myotome

L3 L4

42

Knee flexion myotome

L5 S1

43

Dorsiflexion myotome

L4 L5

44

Plantar flexion myotome

S1 S2

45

Inversion myotome

L4

46

Eversion myotome

L5 S1

47

Hallicus flexion myotome

S1 S2

48

Hallicus extension myotome

L5 S1

49

Blood supply to the hip joint comes from

retinacular fibres from the medial and lateral femoral circumflex arteries (profunda femoris; femoral a.)

50

Which vessels are susceptible in a #NOF?

retinacular and circumflex vessels

51

Posterior dislocation of the femur endangers

Sciatic nerve

52

What is the normal neck-shaft angle of the femur?

135 deg (smaller in women)

53

Coxa valga

neck-to-shaft angle less than 125

54

Coxa vara

neck-to-shaft angle greater than 125

55

Why does a #NOF present with external rotation and shortening of the limb?

Spasm of gluteal muscles, especially external rotators

56

Pain of osteoarthritis in the hip joint commonly refers via

articular branches of the obturator nerve tf presenting on medial knee

57

How is congenital hip dislocation tested?

Abdudction of the flexed hip joint

58

How is congenital hip dislocation treated?

Hips braced in abducted position so that adductor magnus will pull along the line of the femur and the head of the femur back into the socket

59

What are the two types of hip dislocation?

Traumatic and congenital

60

Rotation of the knee only occurs during

flexion

61

The knee is in closed-pacjed position when in __________

extension

62

Bursae in the knee joint sit

between the patella and the overlying ligament; between the femur and the quadriceps tendon; deep to popliteus and semimembranosus; between ligaments and bone

63

The knee gets its support primarily from

cruciates, collaterals, menisci, and muscles

64

The knee joint is most vulnerable in

flexion and rotation

65

Medial condyles of tibia and femur are

longer and thinner than the lateral

66

The femur rotates ______ on the tibia in moving from flexion to extension

medially

67

What is the screw-home mechanism at the knee?

passive, occurs around the tightening ACL in the last 15-20deg of extension - the femur rotates medially on the tibia

68

________ is responsible for initiating flexion at the knee

Popliteus

69

Locking of the knee in extension is ________ whereas flexion of the knee is ________

passive; active

70

Menisci are made of

fibrocartilage

71

T/F Menisci are covered in synovial membrane

False; this would wear out and cause swelling

72

Menisci are lubricated by

synovial fluid

73

The synovial membrane covers

interior of the joint capsule and cruciates (anterior of PCL and ACL)

74

The cruciate ligaments are _____capsular but ______synovial

intracapsular but extra-synovial (outside the membrane)

75

Why is an ACL tear likely to be accompanied by bleeding?

because the cruciates are covered in synovial membrane which is very vascular

76

What is Osgood-Schlatter disease?

apophysitis of tibial tubercle - inflammation of the patellar ligament at the tibial tuberosity

77

The knee joint capsule is reinforced anteriorly by

patellar tendon and retinacular fibres (lateral and medial)

78

The knee joint capsule is reinforced laterally by

popliteus, biceps femoris, IT band

79

The knee joint capsule is reinforced medially by

pes anserinus tendons

80

The knee joint capsule is reinforced posteriorly by

oblique popliteal ligament from semimembranosus

81

What are the components of pes anserinus?

Say Grace Before Tea: Sartorius, Gracilis, Bursa, semiTendinosus

82

Which bursa communicate with the knee joint?

suprapatellar and those deep to popliteus and semimembranosus

83

What is a Baker's cyst?

Thickening of the lining of the bursa at the back of the knee, becomes irritated in flexion

84

The anterior cruciate ligament travels __________ from the ___________ to the __________

Posterolaterally, anterior tibia to lateral condyle

85

The posterior cruciate ligament travels __________ from the _________ to the __________

anteromedially, posterior tibia to medial condyle

86

What is the function of the ACL?

Stops anterior displacement of the tibia on the femur/posterior displacement of the femur on the tibia

87

What is the function of the PCL?

Stops anterior displacement of the femur on the tibia/posterior displacement of the tibia on the femur in flexion eg going down stairs

88

The ACL is ________ in flexion and ________ in extension

twisted; untwisted & tight (pulls femur medially to lock it)

89

ACL is commonly injured when

rotation occurs in the opposite direction (laterally) on the weight bearing leg - ie moving laterally in extension instead of medially

90

ACL repair grafts are commonly taken from

mid-portion of patellar tendon or a hamstring tendon from the pes anserinus (sartorius)

91

PCL is prone to injury in

falls on flexed knee; bumper bar impact on femur

92

The MCL attaches to

medial femoral epidondyle to medial tibia close to pes; deep part blends w/capsule and inserts into medial meniscus

93

What is the function of the MCL?

Resists valgus (abduction) forces and lateral rotation of the tibia; limit anterior displacement of tibia 2nd to ACL

94

The LCL attaches to

Lateral epidcondyle to head of fibula; separated from meniscus but popliteus tendon

95

What is the function of the LCL?

Resists varus (adduction) forces, medial movement of tibia

96

What is the 'unhappy triad'?

Tearing of the ACL, MCL, and medial meniscus usually due to lateral rotation of the femur on the planted tibia

97

What is the function of the menisci?

Absorb and distribute weight; increase area of contact by 1/3

98

Menisci move with the femur during ________ but the tibia during ________ and _______

rotation; flexion and extension

99

Menisci are endangered in

changing direction with the knee flexed

100

Locked knee occurs when

a flap of torn cartilage gets in the way of the articular surfaces and prevents unlocking

101

The meniscus receives blood supply to the

(because it is fibrocartilage it can have a blood supply) periphery but not the medial zone which is avascular (white)

102

What structures are responsible for stability at the patellofemoral joint?

raised lateral lip of femoral condyle (passive); medial patellar retinaculum/capsule (passive); strong vastus medialis (active)

103

What is the role of vastus medialis in stabilizing the patella?

Pulls patella in position during the last 15-20 degrees of extension

104

The Q angle is between

quadriceps tendon and patellar tendon

105

What is chondromalacia patellae?

inflammation of the underside of the patella and softening of the cartilage

106

Why is fibular fracture common with tibial fracture?

the 2 bones form a ring (ring hypothesis)

107

The tibial tuberosity is a _________ epiphysis

Traction

108

The ___________ eminence sits between the tibial plateaus and serves as attachment for

intercondylar eminence; cruciate and meniscal hook ligaments

109

Fractures in the distal 3rd of the tibia heal more slowly due to

less blood supply than proximal

110

The soleal line runs

obliquely along the posterior tibia (lateral to medial)

111

The superior tibiofibular joint is a ______________ joint and allows _________ movement

plane synovial; some gliding movement

112

The superior tibiofibular joint is supported by

LCL, ant and post tibiofibular ligaments, biceps femoris tendon

113

The inferior tibiofibular joint is a ___________ joint and

fibrous (syndesmosis)

114

The inferior tibiofibular joint functions to

prevent separation of tib and fib in weight bearing

115

The inferior tibiofibular joint is reinforced by

ant and post tibiofibular ligaments, continuous fibres of IOM

116

What is the malleolar mortise?

formed by lateral malleolus, hinge of ankle joint that connects tib and fib to the talus

117

What is a March Fracture?

Stress fracture of the 2nd metatarsal due to it's wedged position between the 1st and 3rd metatarsal bones

118

What are accessory bones?

Secondary centres of ossification that don't fuse with the parent bone

119

Talocrural joint

Between talus and mortice between tib and fib malleoli

120

The taolcrural joint is reinforced by which ligament?

Inferior transverse ligament

121

The talocrural joint is a ____________ joint and permits ____________ and __________ only

synovial hinge; flexion and extension

122

What is the significance of the longer lateral malleolus?

Creates an oblique axis of rotation such that dorsiflexion is associated with eversion and plantar flexion is associated with some inversion - it's not a straight hinge

123

Subtalar joint

talocalcaneal joint

124

Midtarsal joints

talocalcaneonavicular and calcaneocuboid

125

The ankle is more stable in ___________ due to

dorsiflexion; the talus is wider anteriorly and fits better into the mortice in dorsiflexion; hence the ankle is less stable in plantar flexion where the narrower posterior talus sits in the mortice

126

Deltoid ligament

MCL of ankle joint

127

Spring ligament

plantar calcaneonavicular ligament

128

Deltoid ligament/MCL has ___ parts

4

129

LCL at the ankle has ___ parts

3

130

_____% of ankle sprains are ________ injuries

85-90%; inversion

131

The ankle is most vulnerable to injury in

inversion and plantarflexion

132

Inversion injuries to the ankle stress

LCLs and fibularis muscles

133

Pott's fractures are

associated with ankle inversion sprains - fracture of the medial malleolus and fibular shaft

134

Inversion injuries of the ankle commonly fracture

lateral malleolus of fibula

135

Inversion and eversion occur about the ________ joints

subtalar/talocalcaneal and taleocalcaneonavicular (TCN)

136

What is the function of the spring ligament?

Supports the head of the talus inferiorly into the TCN joint

137

What is the significance of the sinus tarsi?

carries the interosseus talocalcaneal ligament which binds the talus and calcaneus together, and the vascular sling which supplies the otherwise avascular talus

138

Where is the sinus tarsi?

between the talus and calcaneus, between the talocalcaneal articular surfaces

139

Fracture of the talus occurs at the _______ and endangers __________

neck; vascular sling - can get avascular necrosis of talus

140

Heel strike in running is in which plane?

eversion

141

Weight transfer to the forefoot in running puts the foot into

inversion (greater ROM)

142

The calcaneocuboid joint is a ___________ joint and allows ____________

plane synovial joint; rotary gliding movement for pronation and supination

143

What occurs in pronation of the foot?

eversion at subtalar and TCN, lateral rotation at calcaneocuboid

144

What occurs in supination of the foot?

inversion at subtalar and TCN, medial rotation at calcaneocuboid

145

What joints form the midtarsal joint?

TCN and calcaneocuboid

146

T/F The calcaneocuboid joint is involved in inversion and eversion with the TCN

False; it provides some rotation but is functionally independent of the TCN

147

Pronation and supination of the foot occur about the ___________ joint

calcaneocuboid (with subtalar and TCN involvement)

148

Pronation and supination of the foot refers to relative movement between

hindfoot (stable) and forefoot around it - up and down movement of the arch

149

What are the arches of the foot?

2 longitudinal: medial (higher) and lateral, 1 transverse hemi-arch

150

Arches of the foot are supported by which ligaments?

Long and short plantar ligaments, plantar aponeurosis