Lower Limb

Question 1

What Comprises the pelvis?

Answer 1

The two hip bones of the pelvic girdle and the sacrum

Question 2

Which of these bones contribute to the formation of the –

• obturator foramen?
• greater sciatic notch?

Answer 2

obturator foramen? ischium and pubis

greater sciatic notch? ilium and ischium

Question 3

Define nutation & when it occurs:

Answer 3

Body weight forces the base of the sacrum anteriorly & inferiorly, which forces the apex posteriorly and superiorly. This causes an anterior tilt of the sacrum relative to the ilium. Eg. Trunk or hip flexion

Question 4

Define counternutation & when it occurs:

Answer 4

Opposite of nutation. Body weight forces the base of the sacrum posteriorly & superiorly, which forces the apex anteriorly and inferiorly. This causes an anterior tilt of the ilium relative to the sacrum
Eg. Hip or trunk extension

Question 5

Which capsular hip ligaments increase tension during flexion of the hip?

Answer 5

None

Question 6

Which capsular hip ligaments increase tension during extension of the hip?

Answer 6

Iliofemoral, Ischiofemoral and Pubofemoral

Question 7

Which capsular hip ligaments increase tension during Abduction of the hip?

Answer 7

Pubofemoral

Question 8

Which capsular hip ligaments increase tension during adduction of the hip?

Answer 8

Iliofemoral (superior part) and Ischiofemoral (in hip flexion)

Question 9

Which capsular hip ligaments increase tension during medial rotation of the hip?

Answer 9

Iliofemoral (superior part) and Ischiofemoral (primary restraint)

Question 10

Which capsular hip ligaments increase tension during lateral rotation of the hip?

Answer 10

Iliofemoral

Question 11

In what position are all the ligaments of the hip taut?

Answer 11

Extension

Question 12

Which of the 3 ligaments provide greatest restraint to anterior translation of the femoral head in hip extension?

Answer 12

Iliofemoral ligament

Question 13

If you had an intra-articular hip pathology (i.e. increase synovial fluid inside the capsule), what hip position would you adopt?

Answer 13

Hip Flexion as the ligaments are most lax

Question 14

Which 2 movements move the head of the femur deeper into the acetabulum?

Answer 14

Hip flexion and abduction

Question 15

Which end of range movement could impinge the anterior femur on the anterior acetabulum?

Answer 15

Internal rotation in end range flexion

Question 16

What is the function of the muscles in the lateral pelvis group during gait?

Answer 16

The gluteus medius provides stability to the non-weight bearing leg to prevent contralateral hip drop.

Question 17

Describe and identify the fascia lata and the iliotibial tract (band).

Answer 17

ITB is the thickening of the tensor fascia latae muscle. The TFL runs from the ASIS and iliac crest to the ITB which attaches to the lateral tibia at gerdy’s tubercle.

Question 18

Which muscles attach closely to the pubic symphysis?

from superiorly: from inferiorly:

Answer 18

from superiorly: rectus abdominis from inferiorly: adductor group and gracilis

Question 19

Which muscles are hip flexors?

Answer 19

psoas major
iliacus
rectus femoris

Question 20

Which muscles are hip extensors?

Answer 20

gluteus maximus
hamstrings
adductor magnus

Question 21

Which muscles are hip abductors?

Answer 21

gluteus maximus (superior fibres)
gluteus minimus
tensor fascia latae

Question 22

Which muscles are hip adductors?

Answer 22

pectineus
adductor brevis adductor longus
adductor magnus
gracilis

Question 23

Which muscles are hip external rotators?

Answer 23

piriformis
obturator internus*
superior gemellus
inferior gemellus
quadratus femoris
obturator externus*
gluteus maximus*

Question 24

THERE ARE NO MUSCLES AT THE HIP WITH A PRIMARY ACTION OF HIP MEDIAL ROTATION. List some that may contribute.

Answer 24

gluteus medius (F/E) (anterior fibres)
gluteus minimus (F/E) (anterior fibres)
semitendinosus (E)
semimembranosus (E)
piriformis* (F)

Question 25

List the ligaments of the Sacro-Iliac joint (SIJ)

Answer 25

``` dorsal sacroiliac ligament interosseous sacroiliac ligaments ventral sacroiliac ligaments sacrospinous ligament sacrotuberous ligament ```

Question 26

List the ligaments of the Pubic Symphysis

Answer 26

superior pubic ligament | arcuate (inferior) pubic ligament

Question 27

Observe the difference in anterior-posterior length of the articular surfaces of the lateral and medial femoral condyles. What affect does this have on tibiofemoral joint movement?

Answer 27

The medial condyle is longer, which means that they move together until end range extension where the femur internally rotates and locks. This is known as the screw home mechanism

Question 28

Observe the shape (anterior versus posterior portions) of the femoral condyles. How does the shape affect stability in knee extension (standing) versus knee flexion?

Answer 28

In extension (standing) the knee is in close packed position which allows greater stability but less mobility (limited rotation). Whilst in flexion the knee is in open packed position which allows more mobility (rotation) but less stability (reduced articular surface contact area).

Question 29

Compare the relative sizes of the tibial condyles with those of the femoral condyles. What does the difference in size mean for the relative movement of articular surfaces during flexion – extension?

Answer 29

The femoral condyles are larger than the tibial condyles, this means that for flexion at the knee to occur the femur must glide anteriorly on the tibia to avoid rolling off of the tibia.

Question 30

What are the functions of the menisci?

Answer 30

To increase surface area, reduce articular friction, absorb joint forces, improve tibiofemoral joint congruency and protect the hyaline cartilage.

Question 31

Which meniscus is less mobile and what is the possible consequence of this?

Answer 31

Medial, predisposed to shearing force injury tears

Question 32

Which meniscus provides relatively less coverage of its tibial plateau and what is a possible consequence of this?

Answer 32

Medial, more likely to develop osteoarthritis

Question 33

Which is the most common direction of deviation / subluxation / dislocation of the patella? Why?

Answer 33

Lateral. The bony features create a barrier to medial movement of the patellar. Ligamentous stability is stronger on the lateral side. The line of action of the quadriceps all include a lateral pull, except for the vastus medialis and obliquus which have a much smaller PSCA and pull than the laterally pulling muscles.

Question 34

What are the passive restraints to lateral dislocation? | Passive =

Answer 34

* Lateral femoral condyle * Medial patellofemoral ligament * Natural alignment of the knee (lateral pull) Q angle

Question 35

How would removal of the patella affect knee extensor strength?

Answer 35

The patella increases the moment arm of the quadriceps at the knee. By reducing the moment arm, torque is also reduced, thus the strength of the knee extensors would be reduced.

Question 36

What action does sartorius produce?

Answer 36

Hip F + ER + Abd + Kn F

Question 37

What action does rectus femoris produce?

Answer 37

Hip F + Kn E

Question 38

What action does vastus lateralis produce?

Answer 38

Kn E

Question 39

What action does vastus medialis longus produce?

Answer 39

Kn E

Question 40

What action does vastus medialis obliquus produce?

Answer 40

Kn E

Question 41

What action does vastus intermedius produce?

Answer 41

Kn E

Question 42

What action does gracilis produce?

Answer 42

Add Hip + Knee F

Question 43

What action does biceps femoris produce?

Answer 43

Both heads Knee F + LR and the long head also Hip E

Question 44

What action does semitendinosus produce?

Answer 44

Hip E + Knee F & MR

Question 45

What action does semimembranosus produce?

Answer 45

Hip E + Knee F & MR

Question 46

What action does semimembranosus produce?

Answer 46

Hip E + Knee F & MR

Question 47

What action does gluteus maximus produce?

Answer 47

Hip E, LR & ABD | Resists knee varus

Question 48

What action does tensor fasciae latae produce?

Answer 48

Hip F, IR & ABD | resists knee varus

Question 49

What action does gastrocnemius produce?

Answer 49

PF and Knee F

Question 50

What action does plantaris produce?

Answer 50

Weak PF and weak knee F

Question 51

What action does popliteus produce?

Answer 51

Performs LR of femur on tibia; resists LR of tibia on femur

Question 52

Which structures resist anterior translation of the tibia on the femur?

Answer 52

ACL, menisci, hamstrings

Question 53

Which structures resist posterior translation of the tibia on femur?

Answer 53

PCL, quadriceps, menisci

Question 54

Which structures resist tibiofemoral hyperextension?

Answer 54

oblique popliteal ligament, ACL, PCL

Question 55

Which structures resist tibiofemoral valgus?

Answer 55

tibial collateral ligament, ACL, PCL, semitendinosus, gracilis, sartorius, semimembranosis

Question 56

Which structures resist tibiofemoral varus?

Answer 56

fibular collateral ligament, ACL, PCL, popliteus, menisci, ITB

Question 57

Which structures resist internal rotation of tibia on femur?

Answer 57

ACL, ALL

Question 58

Which structures resist external rotation of tibia on femur?

Answer 58

PCL

Question 59

Identify the boundaries and contents of the popliteal fossa:

Answer 59

Superomedial: semimembranosus and semitendinosus Superolateral: biceps femoris Inferomedial: medial head of gastrocnemius Inferolateral: lateral head of gastrocnemius (+plantaris) Contents: popliteal artery, popliteal vein, tibial nerve, common fibular nerve

Question 60

Define - Genu varus: Genu valgus:

Answer 60

Genu varus: distal segment is medial from the knee (knock-kneed) Genu valgus: distal segment is lateral from the knee (bow-legged)

Question 61

How do we measure the mechanical alignment of the lower limb?

Answer 61

Hip knee angle (HKA). Intersection of mechanical axis of femur and mechanical axis of tibia. On average is slightly less than 180 degrees = 1-2 degrees varus

Question 62

How does HKA affect loading of the tibiofemoral joint?

Answer 62

Load bearing more medial compartment than lateral

Question 63

What is the normal alignment of the femur and tibia in the coronal plane using the anatomical axes? What is the consequence of this alignment?

Answer 63

Natural anatomical valgus. More prone to valgus injuries

Question 64

What is the “pes anserinus”?

Answer 64

Goose’s foot - insertion of the conjoined medial knee tendons into the anteromedial proximal tibia

Question 65

Define the components of the functional units within the foot: • hindfoot: • midfoot: • forefoot:

Answer 65

hindfoot: calcaneus and talus • midfoot: medial cuneiform, intermediate cuneiform, lateral cuneiform, navicular and cuboid • forefoot: metatarsals, proximal, middle & distal phalanges and seismoid

Question 66

Which metatarsal is shortest? Which metatarsal is longest? Which metatarsal has the thickest diaphysis? What does this suggest?

Answer 66

Which metatarsal is shortest? 1st Which metatarsal is longest? 2nd Which metatarsal has the thickest diaphysis? 1st What does this suggest? More load bearing

Question 67

Compare the relative length of the metatarsals & phalanges of the foot with the metacarpals & phalanges of the hand.

Answer 67

Phalanges in the hand are longer to assist with dexterous function. Metatarsals are longer to assist with an increase in surface area of feet for bipedal gait.

Question 68

Compare the mobility and function of the 1st ray & hallux with that of the thumb.

Answer 68

1st ray and hallux is designed for weight bearing function. Thumb is designed for function tasks such as gripping and dexterity rather than weight bearing

Question 69

Identify the plantar fascia / aponeurosis. Proximal attachment: Distal attachment:

Answer 69

Proximal attachment: medial tuberosity of the calcaneus | Distal attachment: capsules of all MTP joints

Question 70

What action(s) does the tibialis anterior perform?

Answer 70

DF + Inversion

Question 71

What action(s) does the extensor digitorum longus perform?

Answer 71

2nd - 5th toe E

Question 72

What action(s) does the extensor hallucis perform?

Answer 72

Hallux E

Question 73

What action(s) does the fibularis tertius perform?

Answer 73

DF + eversion

Question 74

What action(s) does the soleus perform?

Answer 74

Ankle PF

Question 75

What action(s) does the tibialis posterior perform?

Answer 75

Inversion + PF

Question 76

What action(s) does the flexor digitorum longus perform?

Answer 76

2nd - 5th toe F

Question 77

What action(s) does the flexor hallucis perform?

Answer 77

Hallux F

Question 78

What action(s) does the fibularis longus perform?

Answer 78

Eversion

Question 79

What action(s) does the fibularis brevis perform?

Answer 79

Eversion

Question 80

What action(s) does the extensor digitorum brevis perform?

Answer 80

2nd - 4th toe E

Question 81

What action(s) does the extensor hallucis brevis perform?

Answer 81

Hallux E

Question 82

What action(s) does the abductor hallucis perform?

Answer 82

Hallux abduction + F

Question 83

What action(s) does the flexor digitorum brevis perform?

Answer 83

2nd - 5th PIP F

Question 84

What action(s) does the abductor digiti minimi perform?

Answer 84

5th digit abduction

Question 85

What action(s) does the quadratus plantae perform?

Answer 85

Assists FDL

Question 86

What action(s) does the lumbricles perform?

Answer 86

MTP F + IP E

Question 87

What action(s) does the flexor hallucis brevis perform?

Answer 87

Hallux F

Question 88

What action(s) does the flexor digiti minimi perform?

Answer 88

5th MTP F

Question 89

What action(s) does the dorsal interossei perform?

Answer 89

abduct toes 2-4

Question 90

What action(s) does the plantar interossei perform?

Answer 90

adduct toes 3-5

Question 91

What does the anterior talofibular ligament (ATFL) resist?

Answer 91

Inv in PF

Question 92

What does the posterior talofibular ligament (PTFL) resist?

Answer 92

DF

Question 93

What does the anterior tibiotalar ligament resist?

Answer 93

PF

Question 94

What does the posterior tibiotalar ligament resist?

Answer 94

DF

Question 95

What does the calcaneofibular ligament (CFL) resist?

Answer 95

adduction

Question 96

What does the tibionavicular ligament resist?

Answer 96

abduction

Question 97

What does the tibiocalcaneal ligament resist?

Answer 97

abduction

Question 98

Which ligament is most commonly injured in an ankle sprain? Explain how & why

Answer 98

ATFL, a forced supination in plantarflexion movement. It usually occur during a rapid shift of body center of mass over the landing or weight-bearing foot. The ankle rolls outward, whilst the foot turns inward causing the lateral ligament to stretch and tear.

Question 99

What does the interosseous ligament within the sinus tarsi do?

Answer 99

controls the talus during inversion and eversion

Question 100

What does the plantar calcaneonavicular (spring) ligament resist?

Answer 100

stabilises medial longitudinal arch + head of the talus

Question 101

What does the deltoid ligament resist?

Answer 101

PF, ER + Pronation

Question 102

What does the anterior inferior tibiofibular ligament (AITFL) resist?

Answer 102

anterior displacement + medial shifting of the talus | posterior displacement + lateral rotation of the tibia + fibula

Question 103

What does the posterior inferior tibiofibular ligament (PITFL) resist?

Answer 103

posterior displacement of the talus