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year 2 > MS- tib/fib joint (prox and distal), ankle and foot > Flashcards

MS- tib/fib joint (prox and distal), ankle and foot Flashcards

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1
Q 
superior tib/ fib joint
 type of joint
 movements
 degrees of freedom => direction of movements
 articular surfaces (arthrokinematics)
 nerve supply
A
  1. arthrodial/ plane synovial joint
  2. movements: gliding (sliding)
  3. 2 degrees of freedom => caudal/cephalad and dorsal/ventral
  4. concave fib moving on convex tib => same motion
  5. nerve supply: common peroneal nerve
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2
Q

superior tib/fib joint
resting position
closed pack position
capsular pattern

A

resting position: 25 knee flex & 10 PF
closed pack position: none known
capsular pattern: none known

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3
Q

superior tib/fib joint
function/purpose
does this help increase ROM?

A
  1. serve the ankle, considered closed chain unit

2. joints don’t increase ROM but if limited they will decrease ROM

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4
Q

ligaments of superior tib/fib joints (3)
+ 1 muscle
+ primary stabilizer

A
  1. anterior and (2) posterior superior tibiofibular ligaments
    both reinforce the capsule
    both ligamentsrun oblique superiormedial from fib head -> lateral femoal condyle
    (anterior is made up of 2-3 bands)
  2. interossous membrane
  3. popliteus muscle reinforces posterior capsule
  4. primary stabilizer are ligaments of inferior tib/fib jt
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5
Q 
LAB: sup tib/fib jt
 anterior glide
pt position
stabilize
mobilize (w/ what)
indication
A
  1. pt prone, knee flexed 25, ankle on pillow at 10PF
  2. stabilize- tib
  3. mobilize- head of fib with heel of hand
  4. increase splaying in DF
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6
Q 
LAB: sup tib/fib jt
 posterior glide
pt position
stabilize
mobilize (w/ what)
indication
A
  1. pt. supine, knee flexed, foot on bed
  2. stabilize foot by sitting on it
  3. mobilize- head of fib with heel of hand
  4. increase PF
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7
Q 
inferior tib/fib jt
 type of joint
 movements
 degrees of freedom => direction of movements
 articular surfaces (arthrokinematics)
 nerve supply
A
  1. syndesmosis = fibrocartilaginous, about 1mm hyaline cartilage covers inf joint
  2. 2 degrees of freedom => 4 possible movements
    dorsal/ ventral glide
    caudal/ cephalad glide
    medial/ lateral splay (during DF)
    lat rotation around fibula
  3. articular surfaces- convex fibb moving on concave tib => opposite motions
  4. nerve supply- deep peroneal and tibial nerve
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8
Q

inferior tib/fib joint
resting position
closed pack position
capsular pattern

A

resting position- 10PF midway btwn eversion/inversion
closed pack position - none b/c syndesmosis joint
capsular pattern- none b/c syndesmosis joint

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9
Q

inferior tib/fib joint what happens to fib during PF? (3)

A

adducts
IR
glides anteriorly

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10
Q

inferior tib/fib joint what happens to fib during DF? (3)

A

abduct
ER
glide posterior

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11
Q

ligaments of inf tf joint (5)

and their purposes

A
  1. crural tibiofibular interosseous ligament
    strong/thick oblique fibers which serve as axis of motion for fib
    gives stability at inf jt, movement at sup jt.
  2. ant (3) posterior tibiofibular ligaments (so strong bone will break before these tear)
    ant- limits post glide
    post- limits ant glide
    b/c these are a little oblique
  3. inferior transverse ligament
  4. interosseous membrane
    holds shafts of bones together
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12
Q

clinical relevance of tib/fib joints
falling
joint health

A
  1. falling on mortice (side of foot) will fracture fib or tear ankle collateral lig before injure tf ligs
  2. prox tf is dependent on distal tf for motion so they both must have adequate mobility because hyaline cartilage nourishment is dependent on movements
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13
Q 
LAB: inf tib/fib jt
 ant glide
pt position
stabilize
mobilize (w/ what)
indication
A

pt: prone (or side-ly) with leg on wedge and foot in 10PF
stabilize: med tibia
mobilize: heel of hand mobilize posterior lateral malleolus
indication: PF

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14
Q 
LAB: inf tib/fib jt
 posterior glide
pt position
stabilize
mobilize (w/ what)
indication
A

pt: supine (or side-ly) with leg over edge of table
stabilize: med tibia
mobilize: heel of hand mobilize anterior lateral malleolus
indication: DF

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15
Q 
LAB: inf tib/fib jt
 cranial glide
pt position
stabilize
mobilize (w/ what)
indication
    how to turn this into treament
A

pt: side-ly (or supine) with medial leg on plinth
stabilize: foot or distal leg against table
mobilize: heel of hand mobilize inferior lateral malleolus
indication: DF
with exersion => treatment

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16
Q 
LAB: inf tib/fib jt
 caudal glide
pt position
stabilize
mobilize (w/ what)
indication
    how to turn this into treament
A

pt: side-ly (or supine) with medial leg on plinth
stabilize: foot or distal leg against table
mobilize: heel of hand mobilize inferior lateral malleolus
indication: PF
with inversion => treatment

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17
Q

subtalar joint fibular movement
pronation
supination

A
  1. pronation => slides proximal and ant

2. supination => distal and posterior

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18
Q 
transmalleolar axis 
 stresses
 type of axis
 bones that comprise the axis 
 angle of inclination, what it is and why
A

transmalleolar axis

  1. subject to varus stress and compressive loading
  2. oblique axis
  3. joint axis goes btwn med/lateral mall thru talus
  4. angle of inclination is 15 deg ER (toe out) because fibular head extends further distally (and is smaller)
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19
Q

ankle and foot injury
%
things it can affect (2)

A
  1. 80% of pop has problem

2. can affect: gait and stresses on other joints => further pathology

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20
Q

stability demands on ankle/foot complex (4)

A
  1. provide stable base for the body
  2. adapt to variety of postures and positions
  3. avoid excess muscular activity/ energy expenditure
  4. act as rigid lever for effective push off during gait
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21
Q

mobility demands on ankle/foot complex (3)

A
  1. dampen rotations imposed by prox joints (tib/fib)
  2. be flexible to absorb shock of bw as foot hits floor
  3. allow foot to conform to changing terrains
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22
Q

4 types of force acting on ankle/foot

A
  1. compression: during heel plant-> mid stance
  2. shearing: during transitions in gait
  3. rotation: of tib/fib
  4. tension: from ligaments/ tendons and muscles
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23
Q

planes of ankle movement
x
y
z (two names for movements)

A
  1. x = DF/PF around saggital plane
  2. y= ad/aB around transverse plane
  3. z= inversion/eversion (or talar tilt) around frontal plane
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24
Q

pronation of ankle in non-WB

3 cardinal plane movements

A

pronation and supination are considered movement around axis that lies in an angle to the cardinal planes

movements that comprise pronation:
DF
eversion
abduction

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25
supination of ankle in non-WB | 3 cardinal plane movements
pronation and supination are considered movement around axis that lies in an angle to the cardinal planes movements that comprise supination: PF inversion adduction
26
pronation of ankle in closed chain (WB) | 4 movements
calcaneal eversion talus aDduction PF IR of tibia
27
supination of ankle in close chain (WB) | 4 movements
calcaneal inversion talus aBducted DF ER of tibia
28
ankle varus and valgus
calcaneal valgus - increase in medial angle | calcaneal varus - decrease in medial angle
29
3 sections of the foot and joints involved hindfoot midfoot forefoot
``` hindfoot: talocrural joint (talus & calcaneus) subtalar joint midfoot: navic, cuboid, & 3 cuneiform bones 3. forefoot- MT & phalanges ```
30
``` ankle joint a.k.a. (2) 3 bones that make it up articular surfaces of talus (3) arthrokinematics ```
ankle = talocrural joint made of up medial and lateral malleoli + trochlea of talus talus has 3 convex surfaces that move on the concave med/lateral malleoli (mortise)
31
cartilage of talar trochlear is...
continuous with medial and lateral facets of the malleoli
32
articular surfaces of talus (relative sizes) (2)
1. anterior > posterior 2-4mm 2. lateral facet > medial facet (despite that lateral malleoli < medial)
33
``` talocrural joint type of joint movements degrees of freedom => direction of movements articular surfaces (arthrokinematics) ```
1. synovial hinge joint 2. 1 DOF => DF/PF 3. convex talus (3 surfaces) moving on concave mortise
34
talocrural joint resting position closed pack capsular pattern
resting position: 10 PF/ midway btwn sup/pro closed pack: max DF capsular pattern: limited PF (>DF)
35
talocrural joint capsule
``` very thin and weak ant & post so... lig of (1) distal tf jt, (2) talocrural and (3) subtalar jts support capsule ```
36
medial ligaments of talocrural joint (4) purpose of ligaments
``` 1. superficial deltoid (= medial collateral lig) made of up: posterior tibiotalar med mall => med talar & talar tuberosity anterior tibionavicular med mall => navicular tuberosity tibialcalcaneal ligament med mall => sustentaculum tali ``` 4. deep deltoid = anterior tibiotalar resist valgus force and help limit motions when at end range of DF/PF
37
lateral ligaments (lateral collaterals) 3 segments what they each check individually what they check as a whole (2)
``` 1. anterior talofibular** most often sprained checks PF and inversion 2. posterior talofibuar checks DF 3. calcaneofibular ligament checks inversion ``` together these check varus forces and end range PF/DF
38
DF... what happens at the tibfib joints as a result of talocrural joint mortise fib (3) talus
``` b/c talus is wider anterior: mortise spreads fib glides cranially aBducts glides posterior/ ER talus glides posterior ```
39
PF... what happens at the tibfib joints as a result of talocrural joint talus fib (2)
talus glides anterior fib glides caudally anterior/ IR
40
``` LAB: talocrural joint distraction *assessment or treatment* pt position stabilize mobilize (w/ what) indication ```
pt supine with ankle 10PF stabilize- lower leg to table with belt or assistance mobilize: cup hand over dorsum of foot at talus and shift weight backwards to distract indication: DF
41
LAB: talocrural joint anterior/ post glide assessment pt position stabilize mobilize (w/ what)
pt supine with knee flexed, heel on table stabilize foot around calcaneus mobilize tibia
42
``` LAB: talocrural joint anterior/ post glide treatment and assesment pt position stabilize mobilize (w/ what) indication ```
pt supine with ankle 10 PF over edge of table (or flex knee and fixate foot on table) stabilize: cup and distract calaneus mobilize: anterior talus --> posterior with web of hand indication: increase DF
43
``` LAB: talocrural joint anterior/ glide treatment and assesment pt position stabilize mobilize (w/ what) indication ```
pt prone with ankle 10 PF over edge of table stabilize: cup and distract calaneus mobilize: posterior talus --> anterior with web of hand indication: increase PF
44
``` subtalar joint (talocalcaneal) type of joint degrees of freedom => movements secondary movements around oblique axis ``` articular surfaces (arthrokinematics) and capsules
1. synovial joint/ plane 2. only 1 DOF because of all the opposite articulations => pronation/ supination secondary motions that occur around oblique axis inversion/eversion, aB/ad and maybe some DF/PF (all these movements should have equal ROM) 3 separate articulations: anterior and middle surfaces are the convex inferior body and neck of talus moving on concave calcaneus these share joint capsule with talonavicular joint posterior surface of talus is concave with own joint capsule
45
subtalar joint resting position close packed position capsular pattern
``` resting position: midway btwn pro/sup and 1- PF closed pack: supination capsular pattern: inversion (varus) limited > eversion supination > pronation ```
46
angle of inversion of subtalar joint from above from side
``` above = 23 degrees side = 41 degrees ```
47
ligaments of subtalar joint (4) and what motions they check
1. interosseous talocalcaneal ligament - runs the length of tarsal canal; checks pronation and maintains stability ``` all others check supination 2. lateral talocalcaneal ligament 3. posterior talocalcaneal ligament 4. ligamentum cervicis*- strongest lat sinus tarsi -> neck of talus **only on the talus** ```
48
passive normal movements of hindfoot (review) talocrural joint subtalar joint and end feels of both
talocrural - PF/DF subtalar- pronation/ supination (** even though capsular pattern in inversion) and some inversion/eversion and aB/adduction normal end feel is tissue stretch
49
accessory movements of hindfoot (joint play- what we do in lab) ``` talocrural joint (2) subtalar joint (2) what bone are we moving? ```
talocrural joint- long axis extension (traction) A/P glide subtalar joint- talar rock: A/P and M/L with distraction **moving talus** talar tilt: valgus and varus tilt - also called inversion/eversion **moving calcalenus**
50
``` subtalar joint in gait heel strike foot flat mid stance push off ```
heel strike - supination (2-3deg) foot flat- pronation (3-4 deg) mid stance-neutral push off- supination
51
midfoot joints | 6
1. talocalcaneo-navicular 2. cuneonavicular 3. cuboidonavicular 4. intercuneiform 5. cuneicuboid 6. calcaneocuboid
52
talocalcaneal-navicular type of joint movements degrees of freedom => direction of movements
talo-navicular+ subtalar- functionally and anatomically work together ball and socket synovial joint => multi-axial, 3 DOF concave navicular on convex talus
53
talocalcaneal-navicular joint resting position close pack position capsular pattern
``` resting position- midway btwn extremes close pack position- supination capsular pattern: DF PF Add MR ```
54
TCN jt ligaments (3)
1. dorsal talonavicular 2. bifurcated - reinforces capsule laterally 3. plantar calcaneonavicular (spring* ligament)
55
calcaneocuboid joint type of joint degrees of freedom => movements secondary movements around oblique axis articular surfaces (2 on each bone) & (arthrokinematics) closed pack position
saddle synovial joint w/ its own capsule 2DOF => gliding and conjoint rotation 1: supination/ pronation 2: because of horizontal/ oblique axis of the transverse tarsal: longitudinal axis is so horizontal => inversion/eversion oblique axis => PF w/ aD (DF w/ aB) articular surfaces: calcaneus concave dorsal-> plantar on oblique axis*** => concave movement on convex cuboid convex M ->L on longitudinal axis cuboid *convex dorsal -> plantar concave M -> L closed pack = supination
56
calcaneocuboid joint interaction with hindfoot/ subtaler joint capsules and WB arthrokinematics
even though calcaneocubiod jt has it has its own capsule, it is linked in WB to subtalar joint. calcaneus and talus move on a fixed cuboid => concave calcaneus moving on convex cuboid
57
midfoot plantar ligaments (3) | and purpose
purpose is to support tarsal joints and bony arches 1. plantar calcaneonavicular = spring ligament sustentaculum tali => inf navic (short oblique ligament lat -> med) 2. short plantar ligament = plantar calcaneocuboid supports lateral longitudinal arch 3. long plantar ligament supports lateral longitudinal arch (and transverse tarsal joints calcan => 3rd/4th MT))
58
review of medial and dorsal ligaments that support the hindfoot (4)
1. deltoid ligament (medial) 2. bifurcate (calcaneus -> cuboid and calcaneus -> navicular) dorsal 3. dorsal talonavicular 4. dorsal calcaneocuboid
59
articular motions of transverse tarsal joints what motion locks and unlocks jts? what happens in early gait what happens in late stance
1. transverse tarsal jts are unlocked when foot is everted 2. early gait the IR of tibia moves foot into eversion => unlocked => able to supinate and allow forefoot to maintain contact with ground 3. end of stance ER of tibia moves foot into inversion => locked ** so its rigid for push off*
60
cuboidnavicular jt portion of foot type of joint movement
midfoot fibrous joint movement = slight gliding and rotation
61
accessory movements of midfoot (2)
a/p glide | rotation
62
``` all midfoot joints, except cuboidnavicular are... what type of joint movements allowed resting position closed pack position capsular pattern ``` midfoot joints
``` plane synovial slight gliding and rotation resting postion= 10PF, midway btwn sup and pro (slight sup) closed pack = supination capsular pattern = limit sup > pronation ``` ``` midfoot joints: cuneonavicular cuboidonavicular cuneocuboid intercuneiform TMTs ```
63
``` TMT joints (a.k.a.) type of joint & DOF primary movement resting position closed pack capsular pattern articular surfaces ```
a.k.a. Lisfranc's joint- common place for amputation all: plane synovial joints with 1 DOF primary movement is PF/DF resting position: midway btwn pro/sup closed pack: full supination capsular pattern: none tarsals are convex/ MTs concave
64
joint capsules of TMT (3)
1. 1st TMT has own capsule 2. 2nd and 3rd TMT share capsule 3. 4th and 5th TMT share a capsule
65
types of movement at | 1st & 2nd TMT vs. at 4th & 5th
1st TMT most amount of motion 1/2 - DF + inversion/aDduction 4/5- DF + eversion/aBduction
66
TMT ligaments (3)
each joint is reinforced by: 1. interosseous 2. dorsal and (3) plantar tarsometatarsal ligaments
67
accessory movements of TMT joints (2)
A/P glide | rotation
68
forefoot: interMT joints classification of joints DOF / movements
synarthrosis | 1DOF => dorsal and plantar glide
69
MTphalangeal joints classification of joints DOF/ movements articular surfaces resting position closed pack capsular pattern
condyloid synovial joint 2 DOF => flex/extend ab/aDduction MT convex, phalanges concave ``` resting postion- midway btwn flex/ext closed pack - full extension capsular pattern: 1st toe- limited ext > flex 2-5th toes- limites flex > ext ```
70
accessory movements of MTP joint (4)
1. long axis extension (traction) 2. A/P glide 3. lateral glide 4. rotation same at interphalangeal
71
ligaments of forefoot (2)
1. plantar ligaments | 2. collateral ligaments
72
interphalangeal joints classification of joints DOF/ movements articular surfaces resting position closed pack capsular pattern
synovial joint - 1 DOF flex/extend proximal phalanx is convex, distal is concave resting position- slight flexion closed pack position- full extension capsular pattern- limited flex > ext
73
ligaments of interphalangeal joints (2)
medial and lateral collateral ligaments
74
accessory movements of interphalangeal jts (4)
1. long axis extension (traction) 2. A/P glide 3. lateral glide 4. rotation same as MTP

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