Midterm Exam Flashcards
1
Q
Patella
A
-Triangle Shaped Sesamoid
-Bone in tendon of the quad (Specifically Rec Fem)
2
Q
Sesamoid
A
A bone embedded in a tendon (usually shaped like a sesame seed)
3
Q
Patella (Anterior View)
A
-Base (the flat superior edge)
-Apex (the more pointed inferior edge)
4
Q
Patella (Posterior View)
A
-Vertical Ridge
-Medial Articular Facet
-Lateral Articular Facet
*Facets articulate with the patellar surface of the femur and the medial and lateral condyles of the femur
5
Q
What are the three articulations of the knee?
A
- Lateral condyle of the tibia articulates with the lateral femoral condyle
- Medial condyle of the tibia articulates with the medial femoral condyle
- Patella articulates with the femur
6
Q
Available Movements of the Knee
A
-Flexion
-Extension
-Internal Rotation (Limited)
-External Rotation (Limited)
*Rotation occurs ONLY when Knee is flexed
7
Q
Patellofemoral Joint
A
-Medial and Lateral facets of the patella articulate with the patellar surface of the femur
-Synovial
-Plane
-Patella moves down (inferiorly) during flexion and up (superiorly and laterally) during extension
*The lateral femoral condyle projects farther (anteriorly) than the medial femoral condyle
*This more anterior prominence of the lateral femoral condyle prevents the patella from tracking too far laterally
8
Q
Tibiofemoral Joint
A
-Medial and Lateral Condyles of the tibia articulate with the medial and lateral femoral condyles
-Synovial
-Modified Hinge (because it allows for some rotation)
-Biaxial
9
Q
The __________ femoral condyle projects farther (anteriorly) than the __________ femoral condyle
A
Lateral, Medial
10
Q
This more anterior prominence of the lateral femoral condyle prevents the _____________ from tracking too far ___________.
A
Patella, Laterally
11
Q
Valgus
A
Lateral deviation of the distal bone(s) of a joint
-When knee is fixed and the tibia (specifically the distal end) has deviated laterally (relative to knee)
-a.k.a. Knock-Knee
12
Q
Varus
A
(return) Medial deviation of the distal bone of a joint
-When the knee is fixed and the tibia (specifically the distal end) has deviated medially (relative to the knee)
-a.k.a. bow-leg
13
Q
Lateral Collateral Ligament (LCL) (fibular collateral ligament)
A
-Attached: lateral epicondyle of the femur - fibular
head
-checks/restricts VARUS deviation
-“pencil-like” (easier to palpate)
14
Q
Medial Collateral Ligament (MCL) (tibial collateral ligament)
A
-Attaches: medial epicondyle of femur - medial condyle of the tibia
-checks/restricts VALGUS deviation
-it is a flat thickening of the joint capsule
-the deep fibres of the ligament are attached to the medial meniscus
15
Q
Anterior Cruciate Ligament (ACL)
A
-Attaches: medial epicondyle of the femur - medial condyle of the tibia
-checks/restricts valgus deviation
-it is a flat thickening of the joint capsule
-the deep fibres of the ligament are attached to the medial meniscus
16
Q
Posterior Cruciate Ligament
A
-Attaches: posterior intercondylar area of the tibia - anterior and lateral side of the medial femoral condyle
-slack when the knee is extended and taut when the knee is in full flexion
-checks posterior translation of the tibia on the femur (or anterior translation of the femur on the tibia) and knee flexion
17
Q
Cruciate ligaments are named for __________________.
A
Where they attach on the tibia. (i.e. the anterior cruciate ligament attaches anteriorly on the tibia)
18
Q
Medial and Lateral Coronary Ligaments (Attachments)
A
-Attach the medial and lateral menisci to their respective tibial plateaus
19
Q
Menisci of the knee
A
-C-shaped plated of fibrocartilage attached to the articular surfaces of the tibia
-Centre is thinner than the outer edges
-Slightly mobile and and aid in the spreading of synovial fluid during knee movement
-Function: shock absorbers
-Function: deepen the articulation (provide more stable articulation between the tibia and the femur
-ends of the C-shape are called horns
-medial meniscus is attached to the medial collateral ligament
20
Q
What is the terrible triad?
A
Anterior Cruciate Ligament (ACL)
Medial Collateral Ligament (MCL)
Medial Meniscus
21
Q
2 menisci are connected anteriorly by the _____________.
A
Transverse Ligament of the Knee
22
Q
Menisci of the knee (Function)
A
-Function: shock absorbers
-Function: deepen the articulation (provide more stable articulation between the tibia and the femur
23
Q
Menisci of the knee (Attachments)
A
-C-shaped plated of fibrocartilage attached to the articular surfaces of the tibia
-Medial meniscus is attached to the medial collateral ligament
24
Q
Posterior Cruciate Ligament (Checks/Restricts)
A
-Checks posterior translation of the tibia on the femur (or anterior translation of the femur on the tibia) and knee flexion
25
Posterior Cruciate Ligament (Attachments)
-Attaches: posterior intercondylar area of the tibia - anterior and lateral side of the medial femoral condyle
26
Anterior Cruciate Ligament (ACL) (Attachments)
-Attaches: medial epicondyle of the femur - medial condyle of the tibia
-The deep fibres of the ligament are attached to the medial meniscus
27
Anterior Cruciate Ligament (ACL) (Checks/Restricts)
-Checks/restricts valgus deviation
28
Medial Collateral Ligament (MCL) (Attachments)
-Attaches: medial epicondyle of femur - medial condyle of the tibia
-the deep fibres of the ligament are attached to the medial meniscus
29
Medial Collateral Ligament (MCL) (Checks/Restricts)
-Checks/restricts VALGUS deviation
30
Lateral Collateral Ligament (LCL) (Attachments)
-Attached: lateral epicondyle of the femur - fibular
head
31
Lateral Collateral Ligament (LCL) (Checks/Restricts)
-Checks/restricts VARUS deviation
32
Patellofemoral Joint (joint type)
-Synovial
-Plane
33
Patellofemoral Joint (Articulation)
-Medial and Lateral facets of the patella articulate with the patellar surface of the femur
34
Patellofemoral Joint (Movements)
-Patella moves down (inferiorly) during flexion and up (superiorly and laterally) during extension
*The lateral femoral condyle projects farther (anteriorly) than the medial femoral condyle
*This more anterior prominence of the lateral femoral condyle prevents the patella from tracking too far laterally
35
Tibiofemoral Joint (joint type)
-Synovial
-Modified Hinge (because it allows for some rotation)
-Biaxial
36
Tibiofemoral Joint (Articulation)
-Medial and Lateral Condyles of the tibia articulate with the medial and lateral femoral condyles
37
Pelvis Functions
-Protect the internal organs
-Transmit forces from upper body onto the lower limb
-Absorb forces from lower limb
38
Female Pelvis is _______________ and ________________ than the male pelvis.
Shorter, Wider
39
Coccyx
Tailbone (remnant of tail human embryos have until the beginning of 8th week)
40
Sacrum
-Wedge-shaped bone between 2 hip bones
41
Hip
-2 hip bones
-Each hip bone has 3 regions (separated in newborn (connected with cartilage) fused in early adulthood (15-20yrs))
1. Ilium
2. Ishium
3. Pubis
42
What are the 3 regions of hip bone?
1. Ilium
2. Ishium
3. Pubis
43
Ilium
(pl. Ilia) (yellow)
-Large, superior part (2/3rds of the bone)
44
Ischium
(pl. Ischia) (blue)
-Posterior, Inferior
45
Pubis
-Piriformis
-Sciatic Nerve
-Posterior Femoral Cutaneous Nerve
46
Lateral View of Pelvis Structures
-Posterior superior iliac spine (PSIS)
-Posterior inferior iliac spine (PIIS)
-Greater sciatic notch (converted into greater sciatic foramen by sacrospinous ligament)
-Body of ilium
-Ischial spine
-Lesser Sciatic notch
-Body of ischium
-Ischial tuberosity “sitting bone”
-Ramus of ischium
-Obturator foramen
-Inferior pubic ramus
-Pubic tubercles
-Superior pubic ramus (ischopubic ramus)
-Acetabulum
-Anterior inferior iliac spine (AIIS)
-Anterior superior iliac spine (ASIS)
-Iliac crest (runs from the ASIS to PSIS)
Iliac tubercle (tuberculum) (~5cm posterior to ASIS)
47
Obturator Foramen
-Junction of ischium-pubis forms the obturator foramen
-Partly covered by connective tissue membrane
-Opening allows nerves and blood vessels to pass through (obturator vessels and nerve)
48
Greater sciatic notch (converted into __________________ by __________________ ligament).
Greater Sciatic Foramen, Sacrospinous
49
Medial View Pelvis Structures
-Iliac crest
-Anterior superior iliac spine (ASIS)
-Iliac fossa
-Anterior inferior iliac spine (AIIS)
-Iliopubic eminence
-Superior pubic ramus
-Pectineal Line (Pectin Pubis)
-Pubic tubercle
-Inferior pubic ramus
-Obturator foramen
-Ramus of Ischium
-Ischial Spine
-Greater sciatic notch
-Posterior inferior iliac spine (PIIS)
-Auricular (ear) surface of the ilium (for articulation with sacrum)
-Posterior superior iliac spine (PSIS)
50
Acetabulum
-The junction of the Ilium-ischium-pubis forms the acetabulum
-Place where thigh bone (head of femur) articulates with pelvis
51
Anterior View Pelvis Structures
-Iliac crest
-Anterior superior iliac spine (ASIS)
-Anterior inferior iliac spine (AIIS)
-Iliopubic eminence
-Superior pubic ramus
-Obturator foramen
-Pubic tubercle
-Inferior pubic ramus
-Ischial tuberosity
-Pubic symphysis (a.k.a. symphysis pubis)
-Lesser sciatic notch
-Pectineal Line
-Ischial Spine
-Greater sciatic notch
Sacrum
52
Each ilium articulates with the ____________.
Sacrum
53
Ischiopubic rami
Combined form of ramus of the ischium and the inferior pubic ramus
54
Inguinal Ligament
The boundary between the lower limb and the abdomen
-ASIS and pubic tubercle are attachments of inguinal ligament
-Inguinal region is the depression between the abdomen and thigh (referred to as groin)
55
Hip (Coxafemoral Joint)
-Head of femur articulates with the acetabulum
-Synovial
-Multiaxial
-Ball and Socket
-Head of femur projects medially, superiorly, & anteriorly
-Acetabulum projects laterally inferiorly, & anteriorly
56
Available Motions at Hip Joint
-Flexion
-Extension
-Medial Rotation
-Lateral Rotation
-Abduction
-Adduction
57
Articular Surface of the Acetabulum
-Horseshoe Shaped
58
Articular Cartilage
-Covers head of the femur and the horseshoe shaped part of the acetabulum
*Articular cartilage is part of a synovial joint
59
Ligament of the Head of Femur
-a.k.a ligamentum teres, round ligament, foveal ligament
-Connects head of femur to the acetabulum
60
Acetabular Labrum
-Fibrocartilagenous lip that attached to the bony rim of acetabulum
-Functions to deepen acetabulum (make ‘socket’ a deeper socket)
61
Acetabular Fossa
-Centre of acetabulum
-Fossa is occupied by fat pad covered with synovium
62
Acetabular Notch
-Notch between the 2 ends of the horseshoe
-Passage for blood vessels
63
Transverse Ligament of Acetabulum
-Connects (closes) the acetabular notch
64
Ligaments of the Hip
-All the capsular ligaments of the hip are coiled or twisted as they pass from the pelvis to the femur (in a neutral position)
-Extension/hyperextension tightens them further making extension part of the close-packed position and a position of stability in an upright posture
-Conversely, full hip flexion with abduction is an unstable position
65
Iliofemoral Ligament (Y ligament)
Attaches: AIIS, acetabular rim - intertrochanteric line of femur
Checks: extension, abduction, lateral rotation
66
Pubofemoral Ligament
Attaches: superior pubic ramus - iliofemoral ligament
Checks: abduction
67
Ischiofemoral Ligament
Attaches: ischial part of acetabular rim - femoral neck and medial greater trochanter
Checks: hyperextension
68
Trochanteric Bursa
-Between the gluteus maximus muscle and the (postero-lateral) greater trochanter
69
Ischiogluteal Bursa
-Overlying the ischial tuberosity
-Weavers bottom (layman’s term for ischiogluteal bursitis) - people weaving would have to extend one leg forward then the other - the repetitive position changes put excessive pressures on the ischial tuberosity and therefore the bursa
70
Weavers bottom
(layman’s term for ischiogluteal bursitis)
-People weaving would have to extend one leg forward then the other - the repetitive position changes put excessive pressures on the ischial tuberosity and therefore the bursa
71
Iliopectineal Bursa
Between the iliopsoas muscle and the iliopubic eminence
72
Pubic Symphysis (a.k.a. Symphyis Pubis)
-Joint between the 2 pubic bones
-Cartilaginous Joint (there is cartilage between 2 ends)
-Fibrocartilagenous disc between 2 bones which acts as a shock absorber
-Limited movement
-Ligaments: superior pubic ligament, inferior pubic ligament
73
Sacroiliac Joint
-Joints between ilia and sacrum (sacrum is suspended between the ilia)
-Synovial Joints (very strong joint - capsule is strong, ligaments are strong, etc.)
*Does not fit under specific joint category
-Surfaces are irregular in shape and contour (elevations and depressions) which result in. a partial interlocking of the bones
-Limited movement (trade mobility for stability)
-Ligaments: anterior and posterior sacroiliac ligaments
74
Pelvis is held together by _________________.
Ligaments
75
Ligaments (and the pubic symphysis) progressively _____________ during pregnancy to allow passage of the fetus through the birth canal.
Relax
76
Iliolumbar Ligament
-TVP’s L4 & L5 to the posterior iliac crest
-Key stabilizer of L5
-Limits/checks/restricts lateral flexion
77
Sacrotuberous Ligament
-Posterior surface of the sacrum/coccyx to the ischial tuberosity
-Stabilizes the SI joint and provides a surface attachment for gluteus maximus
78
Sacrospinous Ligament
-Lateral sacrum/coccyx to the ischial spine
-Converts the greater sciatic notch into the greater sciatic foramen
79
What is the only intrinsic muscle on dorsum foot?
Extensor Digitorum Brevis
80
Potential cause of tarsal tunnel syndrome
Rheumatoid Arthritis
81
What is the most anterior tendon behind medial malleolus?
Tibialis Posterior
82
To stretch soleus you need to ___________ ankle and _________ knee.
Dorsiflex, Flex
83
What is the 2nd tendon you will palpate across anterior ankle medial to lateral?
Extensor Hallusis Longus
84
Tendon sheath surround tendon to prevent friction between tendon and ________________.
Retinacula
85
What 2 muscles form a stirrup for the foot by sharing a common distal attachment at base of 1st MT?
Peroneus Longus, Tibialis Anterior
86
Boundary between lower limb and abdomen?
Inguinal Ligament
87
Subcutaneous Prepatellar Bursa
-a.k.a. housemaid's knee
-Between the skin and the anterior part of the patella
88
Suprapatellar Bursa
-Between tendon of the quadriceps muscle and the femur
-Connected to the joint capsule
-Bursa is held in place (and retracted during knee extension) by the articularis genus muscle
89
Subcutaneous Infrapatellar bursa
-a.k.a. clergyman's knee or carpet layer's knee
-Between the skin and the proximal tibia (in the area of the tibial tuberosity)
90
Deep Infrapatellar Bursa
-Between the patellar ligament and the anterior tibia (superior to the tibial tuberosity)
91
Pes Anserine Bursa
-Between the tendons of the pes anserinus muscles and the medial tibia
-Pes anserinus muscles: sartorius, gracilis, semitendinosus
-Looks like goose foot
92
Pes Anserine Muscles
sartorius, gracilis, semitendinosus
93
Medial Semimembranosus Bursa
-a.k.a. Bakers Cyst
-Between the tendons of the medial semimembranosus muscles and the medial gastrocnemius
94
Bursa Deep to the Iliotibial Band
-a.k.a. runners knee (layman's term), IT band friction syndrome (medical term)
-Between the iliotibial band and the lateral femoral epicondyle
95
Quadriceps
-4 quadriceps
-Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius
-Prime mover for extension of the knee
-All share a common distal attachment at the tibial tuberosity, via the patellar ligament
96
How many Quadriceps are there?
4
97
What are the 4 Quadriceps?
-Rectus Femoris
-Vastus Lateralis
-Vastus Medialis
-Vastus Intermedius
98
What is a prime mover for extension of the knee?
Quadriceps
99
Rectus Femoris (Attachment)
-Superior/Proximal Attachment: AIIS and superior to acetabular rim (straight head and reflected head)
-Inferior/Distal Attachment: Tibial Tuberosity (via patellar ligament)
100
Rectus Femoris (Actions)
-Hip flexion
-Knee Extension
101
What is the only quadricep muscle to cross the hip joint?
Rectus Femoris
102
_____________ is the only quadricep muscle to cross the ________________.
Rectus Femoris, Hip Joint
103
Vastus Lateralis (Attachment)
-Superior/Proximal Attachment: Lateral lip of the linea aspera
-Inferior/Distal Attachment: Tibial Tuberosity (via the patellar ligament)
104
Vastus Lateralis (Action)
Knee joint extension
105
Vastus Medialis (Attachment)
-Superior/Proximal Attachment: medial lip of linea aspera
-Inferior/Distal Attachment: Tibial Tuberosity (via the patellar ligament)
106
Vastus Medialis (Action)
Knee joint extension
107
Vastus Medialis Obliquus (VMO) (Attachment)
Superior/Proximal Attachment: medial distal femur, vastus medialis, adductor magnus
Inferior/Distal Attachment: medial patella
108
Vastus Medialis Obliquus (VMO) (Action)
-Knee joint extension
-Pulls patella medially (to prevent excessive lateral tracking)
109
Vastus Intermedius (Attachment)
-Superior/Proximal Attachment: proximal 2/3rds of the femur
-Inferior/Distal Attachment: Tibial Tuberosity (via the patellar ligament)
110
Vastus Intermedius (Action)
Knee joint extension
111
Vastus Intermedius is ______________ to ________________.
Deep, Rectus Femoris
112
Articularis Genu (Attachment)
-Superior/Proximal Attachment: anterior distal femur
-Inferior/Distal Attachment: Proximal articular Capsule of the knee joint
113
Articularis Genu (Action)
Pulls the capsule proximally during knee extension to prevent pinching of the capsule
114
What is the longest muscle in the body?
Sartorius
115
Sartorius (Attachment)
Superior/Proximal Attachment: ASIS
Inferior/Distal Attachment: proximal anteromedial tibia (one of the pes anserinus tendons)
116
Sartorius (Actions)
-hip flexion, abduction, and lateral rotation
-Knee flexion, and medial rotation (when knee is already flexed)
117
Pectineus (Attachment)
-Superior/Proximal Attachment: anterior pubic bone (pectineal line)
-Inferior/Distal Attachment: just inferior to the lesser trochanter
118
Pectineus (Action)
-Hip Adduction
-Hip Flexion (weak)
119
Adductor Brevis (Attachment)
Superior/Proximal Attachment: anterior pubic bone
Inferior/Distal Attachment: proximal linea aspera
120
Adductor Brevis (Action)
-Hip Adduction
-Hip Flexion (weak)
121
Adductor Longus (Attachment)
Superior/Proximal Attachment: anterior pubic bone
Inferior/Distal Attachment: linea aspera (middle 1/3rd)
122
Adductor Longus (Action)
-Hip Adduction
-Hip Flexion (weak)
123
Gracilis (Attachment)
Superior/Proximal Attachment: anterior pubic bone
Inferior/Distal Attachment: proximal anteromedial tibia (one of the pes anserinus tendons)
124
Gracilis (Action)
-Hip Adduction
-Knee Flexion
-Knee Medial Rotation
125
What Muscle is most Medial out of all the Adductors?
Gracilis
126
What is the Only Hip Adductor that Crosses the Knee?
Gracilis
127
What are the 3 Pes Anserinus Muscles?
1. Sartorious
2. Gracilis
3. Semitendinosis
128
Adductor Magnus - Anterior Fibres (Attachment)
-Superior/Proximal Attachment: anterior pubic bone
-Inferior/Distal Attachment: linea aspera
129
Adductor Magnus - Anterior Fibres (Action)
-Hip Adduction
-Hip Flexion
130
Adductor Magnus - Posterior Fibres (Attachment)
-Superior/Proximal Attachment: ischial tuberosity
-Inferior/Distal Attachment: adductor tubercle
*Note: In the inferior attachment of adductor magnus (about hand with above the adductor tubercle), is an opening called the adductor hiatus which allows for blood vessels to pass through
131
In the inferior attachment of adductor magnus (about hand with above the adductor tubercle), is an opening called the ___________________ which allows for __________________________________.
adductor hiatus, blood vessels to pass through
132
Adductor Magnus - Posterior Fibres (Action)
-Hip Adduction
-Hip Extension
133
Biceps Femoris - Long Head (Attachment)
-Superior/Proximal Attachment: ischial tuberosity
-Inferior/Distal Attachment: fibular head
134
Biceps Femoris - Long Head (Action)
-Hip Extension (and lateral rotation)
-Knee Flexion
-Knee Lateral Rotation
135
All of the Hamstrings are Prime Movers for _________________ and Synergists to Glute Max for _________________.
Knee Flexion, Extension
136
Biceps Femoris - Short Head (Attachment)
-Superior/Proximal Attachment: linea aspera (mid shaft)
-Inferior/Distal Attachment: fibular head
137
Biceps Femoris - Short Head (Action)
-Knee Flexion
-Knee Lateral Rotation
138
Semitendinosus (Attachment)
-Superior/Proximal Attachment: ischial tuberosity
-Inferior/Distal Attachment: proximal anteromedial tibia (one off the pes anserinus tendons)
139
Semitendinosus (Action)
-Hip Extension (and medial rotation)
-Knee Flexion
-Knee Medial Rotation
140
Semimembranosus (Attachment)
-Superior/Proximal Attachment: ischial tuberosity
-Inferior/Distal Attachment: posterior aspect of the medial condyle of the tibia
141
Semimembranosus (Action)
-Hip Extension (and medial rotation)
-Knee flexion
-Knee medial rotation
142
What Muscles are Knee Flexors?
Hamstrings, Gastrocnemius, Popliteus, Sartorious
142
What Muscles are Knee Extensors?
Quadriceps
143
What Muscles are External Rotators of the knee?
Biceps Femoris
144
What Muscles are Internal Rotators of the knee?
Semimembranosus, Semitendinosus, Gracilis
145
What are the Dorsiflexors of the Ankle (Talocrural Joint)?
Tibialis Anterior, EDL, EHL, Peroneus Tertius
146
What are the Plantarflexors of the Ankle (Talocrural Joint)?
Triceps Surae, Plantaris, Peroneus Longus/Brevis, Tibialis Posterior, FHL FDL
147
What are the Inverters of the Ankle (Subtalar Joint)?
Tibialis Anterior, Tibialis Posterior
148
What are the Everters of the Ankle (Subtalar Joint)?
Peroneus Longus/Brevis/Tertius, EDL
149
What are the Flexors of the Metatarsophalangeal Joints?
FHL, FHB, FDL, FDB, Lumbricales
150
What are the Extensors of the Metatarsophalangeal Joints?
EDL, EDB, EHL, EHB
151
What are the Abductors of the Metatarsophalangeal Joints?
Dorsal Interossei
152
What are the Adductors of the Metatarsophalangeal Joints?
Plantar Interossei
153
What are the PIP Flexors of the Interphalangeal Joints?
FDL, FDB
154
What are the DIP Flexors of the Interphalangeal Joints?
FDL
155
What are the PIP Extensors of the Interphalangeal Joints?
EDL, EDB, Lumbricales
156
What are the DIP Extensors of the Interphalangeal Joints?
EDL, Lumbricales
157
What are the 1st toe IP Flexors of the Interphalangeal Joints?
FHL, FHB
157
What are the 1st toe IP Extensors of the Interphalangeal Joints?
EHB, Lumbricales
158
What are the Flexors of the Hip?
Prime Mover: Iliopsoas (Psoas Major, Iliacus)
Synergists: Rectus Femoris, TFL, Pectineus, Adductor Longus, Adductor Brevis, Adductor Magnus (Anterior Fibres), Sartorius
159
What are the Extensors of the Hip?
Prime Mover: Maximus
Synergists: Hamstrings, (Except Biceps Femoris Short Head), Adductor Magnus (Posterior Fibres)
160
What are the Abductors of the Hip?
Prime Mover: Medius
Synergists: Gluteus Minimus Sartorius
161
What are the Adductors of the Hip?
Prime Mover:Magnus
Synergists: Adductor Longus, Adductor Brevis, Gracilis
162
What are the External Rotators of the Hip?
Prime Mover: Maximus
Synergists: Gemellus Superior, Gemellus Inferior, Obturator Internus, Obturator Externus, Quadratus Femoris, Gluteus Medius (Posterior Fibres), Sartorius
163
What are the Internal Rotators of the Hip?
Prime Mover: TFL
Synergists: Gluteus Medius (Anterior Fibres), Gluteus Minimus (Anterior Fibres), Piriformis (With Hip Flexed)
164
What is the Femoral Triangle?
Depression in the superomedial thigh (inferior to the inguinal ligament) observable during hip flexion
165
What are the Boundaries of the Femoral Triangle?
Superiorly: Inguinal Ligament
Medially: Adductor Longus
Laterally: Sartorius
Floor (Medial to Lateral): Pectineus, Iliopsoas
Roof: Fascia Lata
Contents: Femoral A., Femoral V., Femoral N.
166
Relevant Bones of the Upper Limb
-Sternum
-Clavicle
-Scapula
-Humerus
-Ulna
-Radius
-Carpals
-Metacarpals
-Phalanges
167
Shoulder
-Scapula, Clavicle
-a.k.a. Pectoral girdle, Thoracic girdle
-Junction between the arm and the trunk
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Arm
-Humorous
169
Forearm
-Ulna, Radius
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Wrist
-Carpals
171
Hand
-Metacarpals
172
Fingers
-Phalanges
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Axial Skeleton
Scull, Vertebral Column, Sternum, Ribs
174
Appendicular Skeleton
Shoulders, Upper Limbs, Hips, Lower Limbs
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Clavicle
-First bone in body to ossify
-Shaped like S (lateral concave anteriorly, medial convex anteriorly)
-Lateral 1/3rd is flattened (most common location for fracture)
-Connects upper limb to axial skeleton
-Acromial end: end that connects to the scapula
-Sternal end: End that connects to the manubrium (top of breast bone)
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Acromial end of the Clavicle
End that connects to the scapula
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Sternal end of the Scapula
-Relatively flat, triangular bone
-Sits flat against rib cage from (approx.) 2nd-7th ribs (when standing in anatomical position with proper posture)
-Connects the clavicle to the humerus
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Scapula Landmarks
-Acromion (tip of the shoulder)
-Coracoid process (ravens beak)
-Glenoid Fossa (a.k.a. Glenoid cavity) (where head of humerus articulates with scapula)
-Supraglenoid tubricle
-Infraglenoid tubricle
-Lateral border (a.k.a. axillary border)
-Inferior angle (easily palpated, good place to start for many palpations)
-Subscapular fossa
-Medial border (a.k.a. vertebral border)
-Superior angle
-Suprascapular notch
-Spine (of scapula)
-Supraspinous fossa
-Infraspinous fossa
-Root of spine (medial end of spine)
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Scapulothoratic Joint
a.k.a. S-T Joint
*Not a true joint - is a functional joint
180
What is the only joint that is NOT a true joint?
Scapulothoratic Joint
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Scapulothoratic Joint (Movements)
-Elevation: Gliding motion with the scapula moving superiorly
-Depression: Gliding motion with the scapula moving inferiorly
-Retraction/Adduction: Gliding motion with the scapula moving toward the spine
-Protraction/Abduction: Gliding motion with the scapula moving away from the spine
Rotation: Glenoid fossa is the point of reference
Upward/Lateral Rotation: Glenoid fossa moves superiorly (inferior angle moves laterally) (ant-post axis, frontal plane)
Downward/Medial Rotation: Glenoid fossa moves inferiorly (inferior angle moves medially)
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Sternoclavicular Joint
a.k.a. S-C Joint
Sternal end articulates with the manubrium
-Saddle
-Synovial
There is an articular disc
-Disk prevents medial displacement of the clavicle and helps dissipate forces
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Sternoclavicular Joint (Movements)
-Superior/Inferior Glide
-Anterior/Posterior Glide
-Rotation (M-L axis)
-Scapular Depression: Sternal end of the clavicle moves superiorly
-Scapular Elevation: Sternal end of the clavicle moves inferiorly
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What type of joint is Sternoclavicular Joint?
-Saddle
-Synovial
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The ___________________ Joint is the only true articulation between the upper limb and the axial skeleton.
Sternoclavicular Joint
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The Sternoclavicular Joint has an articular disk that helps __________________.
Absorb Shock
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What are the ligaments of the Sternoclavicular Joint?
-Anterior Sternoclavicular Ligament
-Posterior Sternoclavicular Ligament
-Interclavicular Ligament
(These reinforce the capsule)
-Costoclavicular Ligament
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Acromioclavicular Joint
a.k.a. A-C Joint
Acromial end of the clavicle articulates with the acromion of the scapula
-Plane
-Synovial
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What type of joint is the Acromioclavicular Joint?
-Plane
-Synovial
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Acromioclavicular Joint (Movements)
-Anterior/Posterior Glide
-Some mild rotation
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What are the ligaments of the Acromioclavicular Joint?
-Acromioclavicular Ligament
-Coracoacromial Ligament
-Coracoclavicular Ligament
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Coracoacromial Ligament
Coracoid Process <-> Acromion
Coracromial arch is formed by the coracoid process, the coracoacromial ligament and the acromion (clinically relevant!)
192
Acromioclavicular Ligament
Clavical <-> Acromion
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Coracoclavicular Ligament
Coracoid Process <-> Clavicle
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Costoclavicular Ligament
Inferior Clavicle <-> 1st Rib
195
Humerus (Anterior View) Landmarks
-Head
-Anatomical Neck
-Greater Tubercle
-Lesser Tubercle
-Surgical Neck (common fracture site)
-Bicipital Groove (a.k.a. intertubercular groove, intertubercular sulcus)
-Deltoid tuberosity
-Lateral Supracondylar Ridge
-Lateral Condyle
-Radial fossa
-Lateral epicondyle
-Capitulum
-Coronoid Fossa
-Trochlea
-Medial epicondyle
-Medial Condyle
-Medial Supracondylar Ridge
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Humerus (Posterior View) Landmarks
-Radial groove (a.k.a. spiral groove)
-Olecranon Fossa
-Groove for the Ulnar Nerve
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Glenohumeral (GH) Joint
The Glenoid Fossa of the scapula articulates with the head of the humerus
198
What type of joint is the Glenohumeral (GH) Joint?
-Ball and Socket
-Synovial
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Glenohumeral (GH) Joint (Movements)
-Abduction/Adduction
-Flexion/Extension
-Internal/External Rotation
-Horizontal Abduction/Horizontal Adduction
-Circumduction
-Scaption
200
Glenoid Labrum (GH Joint)
Fibrocartilagenous ring that attaches to the glenoid fossa it deepens the joint (the joint is like a golf ball tee which is unstable) (glenoid fossa articulates with about 1/3rd of the humeral head)
201
Joint Capsule (GH Joint)
-Thin and loose
-Weakest inferiorly at the axillary recess
-Weak spot in the capsule anteriorly called the Foramen of Weitbrecht
202
What are the ligaments of the GH Joint?
-Coracohumeral Ligament
-Glenohumeral (capsular) ligaments
203
-Coracohumeral Ligament
-Glenohumeral (capsular) ligaments
Coracoid process <-> Greater Tubricle
204
What are the bursas of the GH Joint?
-Subacromial Bursa
-Subdeltoid Bursa
*Subdeltoid and Subacromial bursa are often used interchangeably
205
Subacromial Bursa
Between the acromion and the joint capsule
206
Subdeltoid Bursa
Between the deltoid muscle and the joint capsule often connected with the subacromial bursa
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Scaption (Movement)
-Scapula sits at an angle of approx. 45deg relative to the frontal and sagittal planes
-Movement of the arm in this plane is termed scaption
-There is less tension on the capsule and greater elevation is possible than with pure frontal or sagittal plane elevation
-Neither internal nor external rotation of the humerus is needed to prevent impingement
-Many functional activities occur in this plane
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Scapulohumeral Rythm
-Abduction of the arm involves movement at the glenohumeral (GH) joint, the scapulothoracic (ST) articulation, the acromioclavicular (AC) Joint, and the sternoclavicular (SC) joint.
-During normal abduction range , there is a specific relationship in the amount of movement at the GH joint, compared to the ST articulation.
-0-15 deg: no movement of the scapula
-15-120 deg: 2:1 ratio (GH:ST)
-120-180 deg: 1:1 ratio (GH:ST)
-Another way to look at it is that between 15 and 120 deg of abduction, for every 3 deg of movement, 2 deg comes from the GH and 1 deg comes from ST.
209
Biomechanics of Abduction
-During abduction of the humerus, the humerus must undergo external rotation (this usually happens around 90deg of abduction)
-This helps the greater tubercle clear the coracoaromial arch (preventing impingement)
-Note: how many structures are in a relatively small space
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Spine
Spine is comprised of several individual bones called vertebrae and divided into 5 different segments
211
How many segments of the spine are there?
5 segments
212
What are the 5 segments of the spine?
-Cervical Spine has 7 Vertebrae
-Thoracic Spine has 12 Vertebrae
-Lumbar Spine has 5 Vertebrae
-Sacrum is Considered 1 Bone (made of 5 fused vertebrae)
-Coccyx is considered 1 Bone (made of (usually) 4 fused vertebrae)
213
How many Vertebrae are in the Cervical Spine?
7
214
How many Vertebrae are in the Thoracic Spine?
12
215
How many Vertebrae are in the Lumbar Spine?
5
216
How many Vertebrae are in the Sacrum?
1 Bone (5 fused vertebrae)
217
How many Vertebrae are in the Coccyx?
1 Bone (made of (usually) 4 fused vertebrae)
218
Posterior prominences of the spine are called?
Spinous Processes
219
Lateral prominences of the spine are called?
Transverse Processes
220
Spine (Available Movements)
-Flexion
-Extension
-Rotation (left,right)
Lateral flexion or side bending (left, right)
221
The __________________ fascia is extensive fascia in the low back that covers from the ________________ to the ________________.
Thoracolumbar, 12th Rib, Iliac Crest
222
What muscles connect upper limb to the spine?
-Upper/middle/lower trapezius
-Latissimus dorsi
-Rhomboids
-Levator Scapula
223
Upper Trapezius (Attachments)
-Superior Attachment: Middle 1/3rd of the superior nuchal line, external occipital protuberance (inion) to the C7 SP via the nuchal ligament
-Inferior Attachment: Lateral clavicle, acromion, superior lip of the spine of the scapula
224
Upper Trapezius (Action)(Head/Neck Fixed)
-Action: S-T elevation
-Action: S-T upward rotation
225
Upper Trapezius (Action)(Scapula Fixed)
-Action: head/neck extension (bilaterally contracting)
-Action: head/neck ipsilateral lateral flexion
-Action: head/neck contralateral rotation
226
Middle Trapezius (Attachment)
Medial Attachment: C7-T5 SPs
Inferior Attachment: Superior lip of the spine of the scapula
227
Middle Trapezius (Action)
Action: S-T Retraction
228
Lower Trapezius (Attachment)
Medial Attachment: T6-T12 SPs
Inferior Attachment: Root of the spine of the scapula
229
Lower Trapezius (Action)
-Action: S-T Depression (when acting with pectoralis minor
-Action: S-T upward rotation
230
Latissimus Dorsi (Attachment)
-Medial Attachment: SP T6-Iliac crest, lumbar and sacral vertebrae via the thoracolumbar fascia, ribs 9-12, inferior angle of the scapula (this is an inconsistent attachment)
-Lateral Attachment: Floor of the bicipital groove
231
Latissimus Dorsi (Action)
-Action: G-H Internal rotation
-Action: G-H extension
-Action: G-H adduction
232
Rhomboids (Attachment)
-Medial Attachment: SP C7-T5
-Lateral Attachment: Root of the spine of the scapula to the inferior angle of the scapula
233
Rhomboids (Action)
-Action: S-T Retraction
-Action: S-T Downward Rotation
-Action: S-T Elevation
-Action: Help Serratus Anterior Hold the Scapula against the ribs
*Used when forcibly lowering raised upper limbs
234
Levator Scapula $ (Attachment)
-Superior Attachment: TVP's of C1-C4
-Inferior Attachment: Superior angle to the root of the spine of the scapula
*Twists from one attachment to the other (this can make it easier to palpate)
235
Levator Scapula $ (Action) (Head/Neck Fixed)
-Action: S-T elevation
-Action: S-T downward rotation
236
Levator Scapula $ (Action) (Scapula Fixed)
-Action: Head/Neck Extension (when bilaterally contraction)
-Action: Head/Neck ipsilateral lateral flexion
-Action: Head/Neck ipsilateral rotation
237
Muscles of the Pectoral Region
-Pectoralis Major
-Pectoralis Minor
-Subclavius
-Serratus Anterior
238
Pectoralis Major
2 Divisions: Upper fibers (clavicular head) and lower fibres (sternocostal head)
239
Pectoralis Major (Attachment)
-Medial Attachment (upper fibres: Medial 1/2 of the anterior clavicle
-Medial attachment (lower fibres): sternum, anterior costal cartilages of ribs 2-6
-Lateral Attachment (both heads): Lateral lip of the bicipital groove
240
Pectoralis Major (Action)
-Action: G-H Medial Rotation
-Action: G-H adduction
-Action: G-H flexion (from deep extension)
-Action: G-H extension (from deep flexion)
-Action: G-H horizontal adduction
241
Pectoralis Minor (Attachment)
Superior Attachment: Coracoid Process
Inferior Attachment: Ribs 3-5
242
Pectoralis Minor (Action)
-Action: S-T protraction
-Action: S-T depression (when acting with lower trapezius)
-Action: S-T downward rotation
-Action: If the scapula is fixed, pectoralis minor help to elevate the ribs with forced inhalation
243
Tipping Scapula
Inferior angle of the scapula moves posteriorly off of the rib cage (this is likely due to a short pectoralis minor)
244
Force Couple
MM working in equal but opposite directions resulting in one turning motion
245
Serratus Anterior (Attachment)
-Medial Attachment: Anterior surface of the medial border of the scapula
-Lateral Attachment: Lateral Surfaces of the upper 8 ribs
*Keeps the medial border of the scapula flat against the ribs - if this muscle is weak, a winging scapula can present (the medial border of the scapula moves off the ribcage)
246
Serratus Anterior (Action)
Action: S-T Protraction
Action: S-T Upward Rotation (low fibres only)
247
Winging Scapula
The medial border of the scapula moves posteriorly off of the ribcage ( this is likely due to a weak serratus anterior)
248
Tight Pectoralis Minor
Tipping Scapula
249
Weak Serratus Anterior
Winging Scapula
