Midterm Flashcards
1
Q
Describe the how BW is transferred from the vertebral column to the forefoot/ spring ligament?
A
Transferred from vertebral column through sacroiliac ligaments to pelvic girdle to the hip joints on femurs
Femoral condyles articulat w/ tibia (femortibial joints) to the talus (talocrural joint) then to the calcaneus & forefoot/spring ligament
2
Q
The muscles within the superficial region of the gluteal have what main attachment & common actions?
A
- Ala of illium
- Mainly extend, about & medially rotate the thigh
3
Q
The muscles within the deep region of the gluteal have what common attachment & common actions?
A
- Intertrochanteric crest of femur
- Laterally rotate thigh & stabilize hip joint
4
Q
What does the femoral nerve supply?
A
- Anterior thigh muscles, skin of thigh, & branch to anteromedial skin of knee, leg & foot
5
Q
Where does the obturator nerve run & what does it supply?
A
- Runs medial to psoas major, along lateral wall of pelvis to exit through obturator foramen to supply muscles of medial thigh
6
Q
True or False: The sciatic nerve innervated muscles in the gluteal region
A
False: Even though it appears here it does not innervate any muscles
7
Q
What does the lateral intermusclar septum separate?
A
Anterior & posterior compartments
8
Q
What are the boundaries of the femoral triangle?
A
Inguinal Ligament
Sartorius muscle
Adductor Longus muscle
9
Q
What are the contents of the femoral triangle?
A
- Femoral Nerve
- Femoral Artery
- Femoral Vein
- Empty Space
- Deep inguinal lymph nodes
10
Q
What does the the saphenous nerve pass through?
A
- Vastoabductor Canal
11
Q
At what point does the femoral artery become popliteal?
A
At the adductor hiatus
12
Q
What is the purpose of the femoral canal?
A
Allows femoral vein to increase in size when there is an increased venous return
13
Q
When does the external iliac artery have a name change and to what?
A
- At femoral triangle to the femoral artery
14
Q
What two arteries do the popliteal artery turn into & when?
A
-Anterior & posterior tibial artery at the inferior border of popliteus
15
Q
How does the anterior tibial artery get to the anterior compartment?
A
Pokes through the interosseous membrane
16
Q
What does the anterior tibial artery turn into and when?
A
Dorsal pedis artery at distal to the inferior extensor retinaculum
17
Q
What does the posterior tibial artery turn into & when?
A
Medial & lateral plantar arteries, distal to the flexor retinaculum
18
Q
What compartments do the fibular artery supply?
A
Posterior & indirectly the lateral
19
Q
How does the fibular artery supply the lateral compartment?
A
Through perforating branches
20
Q
Does the talus have any muscular attachments?
A
NO
21
Q
If a patient comes into the clinic complaining of pain in their foot and they tell you they fell onto their heel what are you suspecting?
A
Calcaneous Fx
22
Q
The deltoid ligament fans out from medial malleolus and attaches?
A
Distally to talus, calcaneous (talar shelf) & navicular bone
23
Q
What two joints make up the transverse tarsal joints?
A
Talonavicular & calcaneocuboid
24
Q
Where doe most amputation of the foot occur?
A
Transvers tarsal (“surgeon’s tarsal joint)
25
What kinda of support do muscles & ligament give the arches respectively?
Muscles --> active
Ligament --> passive
26
What bones does the medial arch contain?
Navicular, cuneiforme & metatarsal 1-3
27
What bones the lateral longitudinal arch contain?
cuboid & metatarsal 4 + 5
28
What bones make the transverse arch?
Cuboid, cuneiforms & bases of all metatarsals
29
What ligaments, responsible for maintaining the arches, receive the most amount of stress?
Plantar ligaments
30
When the plantar ligaments & aponeurosis have been severely stretched out that the spring ligament can no longer support the talar head & then medial arch falls, this is know as?
Pes Planus (Flat foot)
31
What is the most important action of the intrinsic foot muscles?
Help maintain the arches of the foot
32
What intrinsic foot muscles are innervated by the medial plantar nerve?
1st lumbrical
Abductor hallucis brevis
Flexor hallucis brevis
Flexor digitorum brevis
33
How does quadratus plantae assist in flexion of 4 digits?
It inserts into the tendon of flexor digitorum longus
34
Collectively what is the action of the lumbricals?
Flex proximal phalanges
(Aid) Extend in middle & distal phalanges
35
The plantar arterial arch represents an anastomosis b/w what arteries?
Lateral Plantar artery & dorsal pedis (via deep plantar artery)
36
Where does the deep plantar artery emerge from & what is its significance?
Emerges on plantar surface b/w base of 1st & 2nd metatarsal
Creates the anatomosis b/w lateral plantar artery & dorsals pedis
37
What branches from the dorsals pedis artery?
Arcuate
38
What does the superficial fibular nerve innervate?
Cutaneous sensation to majority of dorsal aspect of foot
Muscles of lateral compartment
39
Where does the deep fibular nerve provide cutaneous innervation?
Skin inbetween 1st & 2nd digits
40
Where does the tibial nerve course and where does it divide & into what?
Couses posterior compartment, divides into medial & lateral plantar nerves posterior to medial malleolus
41
What cutaneous supply does the medial plantar nerve supply?
Medial 3 & 1/2 digits on plantar surface of foot
42
What cutaneous supply does the lateral plantar nerve supply>
Lateral 1 & 1/2 digits on plantar surface of foot
43
What cutaneous innervation of the saphenous & sural nerves provide respectively?
Saph--> medial foot surface
Sural --> lateral foot surface
44
What innervates the proximal plantar surface?
calcaneal branches off tibial nerve
45
What are the superficial boundaries of the popliteal fossa?
- Biceps femoris (superolaterally)
- Semimembranosus & semitendinosus muscles (superomedially)
- Medial head of gastric (inferomedially)
- Lateral head of gastroc (inferolaterally)
- Skin & deep fascia (roof)
46
What are the deep borders of the popliteal fossa?
- Supracondylar lines of femur (superior)
- Soleal line of tibia (inferior)
- Posterior capsule & fascia (floor)
47
What are the contents of the popliteal fossa?
1. Termination of small saphenous V
2. Popliteal artery & vein
3. Tibial & common fibular nerves
4. Posterior cutaneous nerve of thigh
5. Lymph nodes & vessels
6. Fat
48
Where does the IT band attach on the tibia?
Gerdy tubercle
49
What divides the posterior compartment into superficial & deep?
Transverse inter-muscular septs
50
What does the flexor retinaculum do for the posterior compartment?
Holds tendon, tibial nerve & posterior tibial artery in place
51
What is the flexor retinaculum a continuation of?
transverse intermuscular septum
52
What is the purpose of the genicular anastomosis?
Full knee flexion may kink popliteal artery, so important to maintain arterial flow
53
What does the sciatic nerve divide into & where?
Tibial & common fibular nerve at superior margin of popliteal fossa
54
What nerves do the branches, medial & lateral sural cutaneous nerves, come off respectively & what do these branches come together to form?
Medial comes off tibial
Lateral comes off common fibular
Form to make sural nerve
55
What are the muscles of the anterior compartment of the leg and what are their innervation?
Tib anterior, extensor digitorum, extensor hallucis longus & fib tertius
Deep fibular
56
What are the muscles of the lateral compartment of the leg and what is their innervation?
Fib long & brev
Superficial fibular nerve
57
If a patient comes in with foot drop what nerve may be injured?
Common fibular nerve
58
True or False: The gastroc muscles can plantar flex the ankle but only when the knee is extended
True
59
True or False: The soleus can PF the ankle from any position
True (b/c does not cross knee joint)
60
What type of muscle fibers is the gastroc muscle predominantly?
Fast twitch (powerful, spurt contraction)
61
What type of muscle fiber is the soleus?
Slow twtich
62
What nerve innervated the posterior compartment of the leg?
tibial
63
When is some rotation allowed at the knee joint?
When the tibia is fixed
64
When is the knee most stable and why?
In extension b/c articulating surface are most congruent, collateral & cruciate ligaments are taut
65
How does the patella provide greater mechanical advantage?
Moves tendon more anteriorly than the tibial tuberosity & farther from joint axis
66
What way does the patella commonly sublux?
Laterally
67
Clinically, why is it important that the supra patellar bursa is continuous with the joint space?
Infection in bursa can extend to & involve knee joint space
68
What do the pre patellar & superficial infra patellar bursae allow?
skin to move freely around knee as it bends
69
What separates the deep inframpatellar bursa from the joint space?
infra patellar fat pad
70
What structures are continuous with the capsule of the knee?
Tendons of quadriceps femoris, patella, patellar ligament
71
True or false: the cruciate are not within synovial cavity
True
72
Why are the cruciate not within the synovial cavity?
Synovium tents around them by small attachment anteriorly to intercondylar notch of femur (infrapaterllar synovial fold)
73
What important role do the medial & lateral patellar retinacula play?
keep vertical ridge on deep surface of the patella in condylar groove
74
Respectively what are the medial & lateral patellar retinacula extensions from?
Aponeurosis of vastus medialis & lateralis
75
what is the oblique popliteal ligament an expansion of and what is its footprint?
Expansion of semimembranous
Spans intracondylar fossa, arises posterior to medial tibial condyle & passes superolaterally toward lateral femoral condyle blending w/ joint capsule
76
Where does the arcuate popliteal ligament arise from, passes, & spreads over?
Arises from posterior aspect of fibular head
Passes superomedially over tendon of popliteus muscle
Spreads over posterior surface of knee joint
77
What is the footprint of the MCL?
Extends from medial epicondyle of femur to medial condyle & superior part of medial surface of tibia
78
What is the function of the MCL?
Stability while standing
Limit lateral rotation of tibia when knee flexed
79
When can the MCL limit lateral rotation of tibia?
When knee is flexed
80
True or False: Fibers of MCL are firmly adherent to medial meniscus
True
81
Which is damaged more often MCL or LCL?
MCL (weaker)
82
What is the foot print of LCL?
Extends from lateral epicondyle to lateral surface of fibular head
83
When can the LCL resist varus stress?
On extended knee & flexed up to 30°
84
When does the LCL resist medial rotation of the tibia?
when knee is flexed
85
What tendon does the LCL split?
Bicep femoris
86
In knee flexion what is limiting medial & lateral rotation of leg?
Medial rotation (10°) is limited by winding of cruciates
Lateral rotation (60°) is limited by MCL
87
What is the function of the ACL?
1. Limit femoral condyles from rolling in flexion
2. Prevents posterior displacement of femur on tibia & hyperextension of knee joint
88
What is the function of the PCL?
1. Limits anterior rolling of femoral condyles in extension
2. Prevents anterior displacement of femur on tibia
89
What is the main stabilizer when bearing weight on a flexed knee? (ACL or PCL)
PCL
90
What does the poster meniscofemoral ligament join?
Lateral meniscus to PCL & medial femoral condyle
91
What ligament joins the 2 meniscus?
Transvers meniscal ligament
92
Which meniscus is more mobile & why?
Lateral b/c contraction of popliteus muscle
93
Which tear of meniscus are more likely to heal?
Peripheral tears
94
Why is it hard to heal central tears of Meniscus?
Poor blood supple
95
What are the names of the bands that make up deltoid ligaments?
Anterior tibiotalar
Posterior tibiotalar
Tibionavicular
Tibiocalcaneal
96
Order the lateral 3 bands of the ankle from weakest to strongest?
ATFL
CFL
PTFL
97
Embryologically what occurs to result in a pronated position?
Lower limb from trunk and rotated medially
98
What two nerves make lumbar plexus?
Femoral and obturator
99
What nerve makes sacral plexus?
Sciatic
100
What specifically helps to support the integrity of the medial longitudinal arch?
Plantar Fascia
Spring Lig
Tib Post
Tib ant
FHL, FDL, FHB, FDB
101
What specifically helps to support the integrity of the lateral longitudinal arch?
Plantar fascia
Long plantar lig
Short plantar lig
Fib longus muscle
FDB
102
What specifically helps to support the integrity of the transverse arch?
Fib Long m
Tib posterior m
ADH (transverse head)
103
What muscles are in layer one of the plantar aspect of foot?
Abductor hallucis
Abductor digiti mini
Flexor digitorum brevis
104
What muscles and tendons are in layer 2 of plantar aspect of foot?
Quadratus plantae
Lumbricals
Flex digitorum longus tendon
Flex hallucis longus tendon
105
What is in the 3rd layer of the plantar aspect of the foot?
Flexor Hallucis brevis (both heads)
Adductor hallucis (both heads)
Flexor digiti minimi
sesamoid bones
106
What is in layer 4 of the plantar aspect of the foot?
3 plantar
4 dorsal
107
True or False: The patella does not have an articulation with the tibia
True
108
What are the extra capsular ligaments of the knee that provide anterior stabilization?
Quad tendon & patellar lig
Medial & lateral retinaculum
Extension of fascia from quad muscle
109
What are the extra capsular ligaments of the knee that provide posterior stabilization?
Oblique popliteal ligament
Arcuate popliteal ligament
110
What is the extra capsular ligament of the knee that provides medial stabilization?
MCL
111
What is the extra capsular ligament of the knee that provides lateral stabilization?
LCL
112
What are intracapsular ligaments of the knee?
Cruciates
Posterior meniscofemoral ligament
113
What makes up the TT joint?
calceocuboid & talonavicular
114
What makes up the TCN joint?
Talonavicular & subtalar
115
What kind of joint is proximal tibiofibular joint?
Plane synovial
Superior/infer gliding
116
What ligaments support the tibiofibular joint?
Anterior and posterior ligaments of the fibulae head
Interosseous membrane
117
What kind of joint is the distal tibiofibular joint?
Syndesmosis
118
What are the supporting ligament for the distal tibiofibular joint?
Crural tibiofibular interosseous ligament
Anterior and posterior ligament
119
What type of joint is the talocrural joint?
Hinge synovial
120
What are the two bands of the bifurcate ligament?
Calcaneonavicular
Calcaneocuboid
121
What is the technical name for the spring ligament?
Calcaneonavicular
122
What is the technical name for the long plantar ligament?
Calcaneo-cuboid-metatarsals
123
What is the technical name for short plantar?
Calcaneo-cuboid
124
What kind of joint is the TCN joint?
Compund (ball and socket)
125
What makes up the Talar acetabulum?
Navicular
Anterior and middle facets
Spring ligament
Deltoid ligament
Bifurcate ligament
126
What part of the bifurcate ligament is within the talar acetabulum?
Calcaneonavicular
127
What kind of joint is TT?
Ball and socket (talonavicular)
Part planar (calcaneocuboid)
128
What type of joints are the TMT joints?
Plane type
129
What type of joints are the MTP?
Condyloid
130
What type of joints are the IP?
Hinge
131
What is the only bone in the foot to articulate with the leg bones?
Talus
132
How many facets are on the subtalar joint and what are their names?
3
Posterior
Middle
Anterior
133
What type of joints are the femorotibial articulation?
Synovial modified hinge joints
134
What motions are allowed at the femorotibial articulations?
Flexion, extension (gliding, rolling)
Some rotation when knee is flexed
135
How many facets does the patella have?
7
136
True or false: the patella does not articulate with the tibia
true
137
What is the supra patellar bursae?
Superior extension of the joint cavity
138
What separates the medial and lateral femoral condyles?
Intercondylar fossa
139
Which epicondyle of the femur is larger?
Medial
140
What is a common MOI for housemaid's knee?
Kneeling often without protecting knee pads
141
What are both menisci firmly adherent to? And where do their external margins attach?
Intercondylar region
External margins attach to joint capsule of knee
142
Which meniscus is less mobile and why?
Medial b/c adherent to MCL
143
What are the shapes of the medial and lateral meniscus resepectively?
Medial --> C
Lateral --> o
144
What are coronary ligaments?
Portions of the joint capsule extending b/w margins of the meniscus & most periphery of tibial condyles
145
What are the medially supporting muscles of the knee joint?
Pes Anserine
Sartorius, Gracillis, Semitendinous
146
What muscles supports the knee joint laterally?
IT band & bicep femoris
147
What muscles support the knee joint posteriorly?
Lateral head of gastroc
148
What muscles support the knee joint anteriorly?
Rectus femoris
Fibers of vastus medals & laterals
149
what two joints does the Calcaneofibular ligament cross?
Talcocrural & Subtalar
150
What are the primary ligamentous support of the subtalar joint?
Tibiocalcaneal part of ML
Calcaneofibular part of LL
Interosseous ligament
Cervical ligament
151
which calcaneal tubercle makes contact with ground in standing?
Medial
152
What is the angle of inclination?
Obtuse angle b/w axis of head/neck of femur & shaft
153
What is the average angle on inclination?
126
Decreases w/ age
154
What is the torsion angle?
Difference b.w axes of femoral neck & femoral condyles when viewed along longitudinal axis
155
True or false the femur articulates with fibula?
False
156
True or False: The medial side of the foot is not in contact with the ground
True
157
What does the ATFL course?
Extend from lateral malleolus to neck of talus
158
What does the PTFL course?
Runs horizontally & medially from malleolus to lateral tubercle of talus
159
What does the CFL course?
Tip of malleolus to lateral surface of calcaneus
160
What 2 arches does fib longus support?
Lateral & transverse
161
How does pes planus occur?
Overstretching plantar ligaments & aponeurosis
Spring ligament can not fully support talar head so medial longitudinal arch falls with talar head displacing inferomedially
162
What is the position of the forefoot pes planus occurs?
Laterally deviated
163
True or False: The EHB is actually part of the EDB
True
164
What is the plantar aponeurosis continuous with?
crural fascia (deep fascia of the leg)
165
Which three digits are the plantar interossei muscles going to adduct?
lateral 3
166
What side of the digits will the plantar interossei muscles be found?
Medial
167
What are the borders of the anterior compartment?
- Lateral surface of tibia
- Interosseous membrane
- Medial surface of fibular
- Anterior intermuscular septa
168
When does the transverse intemuscluar septa become the flexor retimaculum?
Spans medial malleolus to calcaneus
169
What are the borders of the lateral compartment?
- Anterior & posterior intermuscular septa
- Superior fibular retinaculum
