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Semester 2 > MSK Session 12 > Flashcards

MSK Session 12 Flashcards

1
Q

What is the function of the ankle joint in upright posture?

A

Bear all body weight as it transfers to foot

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2
Q

What is the clinical importance of the ankle joint?

A

Arterial pulses of limb can be examined here

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3
Q

Where do venous and lymph drainages undergo particular changes so that their low pressure systems can return fluid to the body?

A

Ankles

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4
Q

How do arteries, motor nerves and tendons enter the foot?

A

Turning forwards

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5
Q

How do veins, sensory nerves and lymphatics exit the foot?

A

Turning upwards

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6
Q

What prevents bow-stringing of the long tendons of leg muscles at the ankle?

A

Crural fascia

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7
Q

How does the foot support body weight?

A

Establishes broad base for bearing body weight
Robust
Absorbs shock

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8
Q

What two opposing functions does the foot have?

A

Supporting body weight and organ of locomotion

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9
Q

What features of the foot allow it to be an organ of locomotion?

A

Loose to permit movement but stable when moving
Permits movement on flat, sloping and uneven surfaces
Lightweight
Able to lift body weight during initiation of movement

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10
Q

What forms the ankle joint proper?

A

Articulation of tibia and fibula w/talus

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11
Q

How many articular surfaces are there in the ankle joint proper?

A

6

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12
Q

What are the articular surfaces of the ankle joint proper lined with?

A

Hyaline cartilage

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13
Q

What are key landmarks in distal superficial venous drainage of the lower limb?

A

Malleoli

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14
Q

Where do the tibia and fibula articulate with each other?

A

Most of their lengths

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15
Q

What is the proximal articulation of the tibia and fibula?

A

Tibio-fibular articulation

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16
Q

What type of joint is the proximal articulation of the tibia and fibula?

A

Plane type synovial

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17
Q

What is the intermediate articulation of the tibia and fibula?

A

Interosseous membrane

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18
Q

What is the distal articulation of the tibia and fibula?

A

Tibio-fibular syndesmosis

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19
Q

What type of joint is the distal articualtion of the tibia and fibula?

A

Fibrous

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20
Q

Which two ligaments tie the ends of the tibia and fibula together in the tibio-fibular syndesmosis?

A

Anterior and posterior tibio-fibular ligaments

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21
Q

Which ligament deepens the articulatory surfaces of the tibio-fibular syndesmosis?

A

Posterior tibio/fibular

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22
Q

What type of joint is the ankle joint proper?

A

Mortise and tenon
Ginglymus
Rolling hinge synovial

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23
Q

Why is the ankle joint described as a mortise and tenon joint?

A

Leg bones form recess (mortise)

Superiorly rounded talus fills recess (tenon)

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24
Q

What allows changes between extremes of plantarflexion and dorsiflexion at the ankle joint?

A

Superiorly rounded talus allows rolling in a plane

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25
Q

Which are the joint stabilising surfaces of the ankle joint?

A

Malleolus
Posterior distal tibio-fibular ligament
Transverse tibio-fibular ligament

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26
Q

Which are the weight bearing surfaces of the ankle joint?

A

Tibia
Talus
(Fibula takes ~17% so contributes to stability)

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27
Q

Which bones of the foot form the medial longitudinal arch?

A 
Calcaneus
Talus
Navicular
3 cuneiforms
1-3 metatarsals
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28
Q

Which bones of the foot form the lateral longitudinal arch?

A

Calcaneus
Cuboid
4th + 5th metatarsals

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29
Q

Which bones of the foot form the transverse arch?

A

Tarsals and metatarsals

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30
Q

What strengthens the transverse arch of the foot?

A

Long tendon of leg muscles

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31
Q

Why must the segmented structure of the foot be arranged in an arch?

A

Can only weight bare if in an arch

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32
Q

How many arches are present in the foot at birth?

A

3

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33
Q

Why may the foot appear flat in children

A

Subcutaneous fat pad masks arches present

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34
Q

In which two direction are the arches of the foot arranged?

A

2 antero-posteriorly

1 transverse medio-lateral

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35
Q

What type of attachments does the talus have?

A

Purely ligamentous

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36
Q

Where is the long axis of the talus directed?

A

Forwards and medially

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37
Q

What is the significance of the direction of the long axis of the talus?

A

Tibia and fibular can roll over and direct weight in its deviated path

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38
Q

How is the dorsal aspect of the talus identified?

A

Superiorly convex medial and lateral edges

Central portion concave

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39
Q

How does the posterior articular surface (body) of the talus compare to the anterior articular surface (head)?

A

Narrower

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40
Q

What are the three parts of the talus bone?

A

Head, neck and body

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41
Q

What does the plantar surface of the talus form?

A

Talo-calcaneal (sub-talar) joints

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42
Q

What is visible on the inferior view of the talus?

A

Sulcus tali

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43
Q

What type of joint is the subtalar joint?

A

Uniaxial hinge

44
Q

What allows side to side motion of the foot?

A

3 parts of subtalar joint

45
Q

How is the talus orientated in relation to the calcaneus?

A

Slightly obliquely on anterior surface

46
Q

What separates the two articulations of the talus and calcaneus?

A

Tarsal canal (sinus tarsi)

47
Q

What is the anterior talocalcaneal articulation?

A

Convex talus on concave calcaneus

48
Q

What is the posterior talocalcaneal articulation?

A

Concave talus accommodates convex calcaneus

49
Q

What allows us to walk on sloping/uneven ground by allowing the use of the sides of the feet?

A

Subtalar joint facilitating version and inversion

50
Q

How far can the foot usually be everted?

A

15 degrees

51
Q

How far can the foot usually be inverted?

A

30 degrees

52
Q

Which surfaces articulate in dorsiflexion?

A

Anterior option of talar trochlea occupies and completely fills mortise

53
Q

What is joint stability like in dorsiflexion?

A

Maximum

54
Q

Adjustments at what contribute to stability of ankle joint in extreme dorsiflexion when the malleoli spread?

A

Tibio-fibular syndesmosis

55
Q

What innervates dorsiflexion?

A

Fibular division of sciatic nerve (L4-5 same as for great toe)

56
Q

Which muscles cause dorsiflexion?

A

Tibialis anterior

Assistance from extensor digitorum longus and extensor hallucis longus

57
Q

What articulates in plantar flexion?

A

Posterior portion of talar trochlea occupies mortise

58
Q

What allows some rotation for AB/AD-duction?

A

Posterior talar trochlea not filling mortise

59
Q

Why is dorsiflexion less stable than plantar flexion?

A

Smaller articulation

60
Q

What is the innervation of plantar flexion?

A

Tibial division of sciatic (S1-2)

61
Q

Which muscles cause plantar flexion?

A

Gastrocnemius
Soleus
Assistance from tibialis posterior, FHL and FDL

62
Q

Which ligament is the strongest of the ankle joint?

A

Medial

63
Q

Where is the deltoid ligament positioned?

A

Originates from apex of medial malleolus and fans downwards in triangular shape to tarsal bones

64
Q

Where do the anterior fibres of the medial ligament stretch down to?

A

Tibio-navicular

65
Q

Where do the middle fibres of the medial ligament of the ankle joint stretch down to?

A

Calcaneo-tibial

66
Q

Describe the posterior fibres of the deltoid ligament.

A

Talo-tibial which pass backwards and laterally

67
Q

What is the deep ligament of the ankle joint?

A

Fibres attached to medial malleolus and medial talus

68
Q

Which fibres of the deltoid ligament is the deep ligament of the ankle joint related to?

A

Tibio-navicular

69
Q

What do the anterior and posterior fibres of the lateral ligament of the ankle join?

A

Lateral malleolus and talus

70
Q

What do the intermediate fibres of the lateral ligament of the ankle join?

A

Lateral malleolus and calcaneus

71
Q

Why does trauma to the ankle usually result in injury to both medial and lateral aspects of the joint?

A

Joint forms arming of bones and ligaments

72
Q

What causes a Pott’s fracture?

A

Excessive eversion of the foot w/abduction and external rotation

73
Q

What is a Pott’s fracture?

A

Bimalleolar ankle fractures

74
Q

Describe the mechanism of injury in Pott’s fracture.

A

Pull on medial ligament often causes avulsion of medial malleolus
Talus moves laterally
Lateral malleolus sheared off

75
Q

What injury to the fibula is commonly caused in Pott’s fracture?

A

superior to tibio-fibular syndesmosis

76
Q

What happens if the tibia is carried anteriorly in Pott’s fracture?

A

Posterior margin of distal tibia is sheared off by talus

77
Q

What type of bones are the tarsals?

A

Short

78
Q

What are the characteristics of the tarsals that classify them as short bones?

A

Irregular
Cuboidal
6 articular surfaces

79
Q

What is the anterior talofibular ligament?

A

Flat, weak band that extends anteromedially from lateral malleolus to neck of talus

80
Q

What is the posterior talofibular ligament?

A

Thick, strong band horizontal medially and posteriorly that passes from malleolar fossa to lateral tubercle of talus

81
Q

Which ligament is a round cord that joins the lateral malleolus to lateral calcaneus?

A

Calcaneofibular

82
Q

What is the nerve supply to the ankle joint?

A

Derived from tibial nerve and deep fibular

83
Q

What is the blood supply of the ankle joint?

A

Arteries derived from malleolar branches of the fibular, anterior and posterior tibial arteries

84
Q

What limits dorsiflexion by the muscles in the anterior leg compartment?

A

Passive resistance of triceps surae to stretching

Tension in medial and lateral ligaments

85
Q

How is the gait cycle split into two phases?

A

40% swing

60% stance

86
Q

What are the three stages of the stance phase in the gait cycle?

A

Heel strike
Support
Toe-off

87
Q

What are the functions of gluteus maximus, quadriceps femoris and the muscles in the anterior compartment of the leg during heel-strike?

A

Gluteus maximus: decelerates lower limb
Quadriceps femoris: keeps leg extended at knee and hip
Anterior compartment: maintain ankle dorsiflexion

88
Q

What is the function of quadriceps femoris in the support stage of the stance phase?

A

Keeps leg extended to accept body weight

89
Q

What do the foot inverters and everters do in the support stage in the stance phase of the gait cycle?

A

Stabilise foot?

90
Q

What is the function of gluteus medius and tensor fascia lata in the support stage of the stance phase in the gait cycle?

A

Steady pelvis

91
Q

Which muscles are involved in the toe-off stage of the stance phase?

A

Hamstrings extend hip
Quadriceps femoris maintain extended knee
Posterior leg plantarflexes ankle

92
Q

Which muscles are involved in the swing phase of the gait cycle?

A

Iliopsoas
Rectus femoris
Quadriceps femoris
Anterior compartment of leg

93
Q

What is the function of iliopsoas and refute femoris in the swing phase of the gait cycle?

A

Keep hip flexed and resist gravity

94
Q

What is the function of quadriceps femoris in the swing phase of the gait cycle?

A

Extend knee to position foot for landing

95
Q

What role do the muscles in the anterior compartment of the leg play in the swing phase of the gait cycle?

A

Maintain ankle dorsiflexion

96
Q

What are the 5 stages of the gait cycle?

A 
Heel strike
Support
Toe-off
Leg lift
Swing
97
Q

What causes Trendelenberg gait?

A

Lesion of superior gluteal nerve

98
Q

Why does the pelvis drop on the side of the raised leg in a Trendelenberg gait?

A

Abductor muscles on opposite side of pelvis are paralysed

99
Q

Describe the movements of the trunk in Trendelenberg gait.

A

Lurches to opposite side of pelvic drop then whips back but overcompensates

100
Q

What is an antalgic gait?

A

When the patient spends less time on painful limb

101
Q

How is an antalgic gait identified?

A

Examine cadence

102
Q

What causes foot drop?

A

Lesion of common/deep fibular nerve

103
Q

What is observed in foot drop?

A

Foot dragged on floor

104
Q

How do patients with foot drop compensate for their lost plantarflexion?

A

High stepparent gait
Eversion flick
Waddling gait
Swing-out gait

105
Q

Why do guardsmen fall forwards when they faint?

A

Centre of gravity passes just anterior to ankle joint

106
Q

What are the components of the deltoid ligament?

A

Tibionavicular
Tibiocalcaneal
Anterior and posterior tibiotalar

107
Q

Which three tarsals are attached to the medial ligament of the ankle?

A

Talus
Calcaneus
Deltoid

Semester 2 (45 decks)

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