Test 3 Info Flashcards
(330 cards)
1
Q
what type of nerves are pelvic splanchnic nerves?
A
parasympathetic
2
Q
what types of nerves are lumbar splanchnic nerves?
A
sympathetics
3
Q
what type of and name of the muscle that makes up the wall of the bladder?
A
smooth muscle; detrusor muscle
4
Q
peritoneum
A
fascial covering in the gut
5
Q
is the urinary bladder mostly superior or inferior to the peritoneum?
A
inferior to (along with the kidneys)
6
Q
apex of bladder
A
anterior aspect near pubic symphysis
7
Q
fundus of bladder
A
base of bladder, formed by its posterior wall; opposite the apex
8
Q
body of bladder
A
major portion of bladder between apex and fundus
9
Q
neck of bladder
A
where fundus and inferolateral surfaces of bladder meet (close to exit point, near prostate in males)
10
Q
trigone of bladder
A
area of bladder defined by smooth internal surface, formed by 2 ureters and internal urethral orifice
* sensitive to expansion/ stretch (highly innervated with sensory fibers– lets you know bladder is filling)
11
Q
what prevents urine from retrograding when it is leaving the bladder?
A
flap valves at the point where ureters enter bladder, shut when bladder muscle contracts
12
Q
referred visceral pain: heart
A
C8-T4 on left
13
Q
referred visceral pain: lungs
A
T2-T5
14
Q
referred visceral pain: esophagus
A
T4-T5
15
Q
referred visceral pain: liver
A
T6-T9 on right
16
Q
referred visceral pain: ovaries and Fallopian tubes
A
T11-L1
17
Q
referred visceral pain: kidneys
A
T10-T11
18
Q
referred visceral pain: ureters
A
T11-L2
19
Q
referred visceral pain: colon
A
T8-L2
20
Q
referred visceral pain: bladder
A
T11-L3
21
Q
referred visceral pain: rectum, ovaries, prostate
A
S2-S5
22
Q
4 parts of urethra in male
A
preprostatic
prostatic
membranous
spongy
23
Q
preprostatic urethra characteristics
A
contains internal urethral sphincter
24
Q
membranous urethra characteristics
A
passes through external urethral sphincter
25
spongy urethra characteristics
goes through the penis
26
internal urethral sphincter characteristics and function
involuntary sphincter of smooth muscle
| prevents retrograde movement of SEMEN into bladder during ejaculation
27
what kind of neural control is the internal urethral sphincter under?
ANS control
28
what is the internal urethral orifice?
leads to urethra
29
what is the purpose of the ejaculatory duct and where is it found?
where sperm enters the semen, found in the prostatic urethra
30
what is the purpose of the prostate?
secretes fluid that provides nutrition for sperm
31
external urethral sphincter characteristics and function
consists of skeletal muscle -- under VOLUNTARY control
makes up part of the UG diaphragm
provides a means of stopping the escape of urine from the body
32
function of urogenital diaphragm
supports contents of deep pelvis along with pelvic diaphragm
33
what is one reason why females are more prone to UTIs?
length of female urethra is shorter (bacteria has a shorter distance to go)
34
what is the micturition reflex?
visceral afferent fibers stimulated by bladder stretch (~350-400mls) causes the bladder to contract reflexively while the internal sphincter relaxes and urine flows into urethra
35
what is required in order to suppress the micturition reflex?
training and intact neural pathway from supra spinal centers (e.g., external urethral sphincter would remain contracted -- voluntary control via pudendal n)
36
testes
male sex organs that lie within scrotum
| produce sperm and testosterone
37
epididymis
portion of male genital tract where sperm maturation is partially accomplished (sperm stored here)
receives sperm from testes and continues as ductus deferens
38
ductus deferens
thick walled tubular structure running from each testis into ejaculatory duct
carry sperm from epididymis towards penis
39
seminal vesicles
produce semen (fluid that activates and protects sperm after it has left penis)
40
prostate
gland in male that surrounds portion of urethra
| secretes alkaline liquid that neutralizes acid in urethra and stimulates motility of sperm
41
bulbourethral glands
two small, rounded, pea sized bodies posterolateral to membranous urethra
discharge component of seminal fluid into urethra
42
ejaculatory duct
begins at seminal vesicles, passes through prostate, and empties into urethra
during ejaculation, semen passes through EJ ducts
43
function of internal urethral sphincter in female
literature suggests no function or it does not exist, bc function is specific to male
44
what does parasympathetic innervation do in terms of B B SF?
generally vasodilatory (--> erection)
stimulate (motor) bladder contraction
inhibit internal urethral sphincter (so it relaxes and you can urinate)
modulates activity of lower colon (peristalsis)
45
what does sympathetic innervation do in terms of B B SF?
contraction of smooth muscle in internal urethral sphincter and internal anal sphincters (preventing urination and defecation)
cause smooth muscle contraction associated with reproductive tract and accessory glands
help move secretions from epididymis and associated glands into urethra to form semen during ejaculation
46
spastic bladder occurs with what type of injury?
SCI above S2-4 segments
47
what aspects of bladder control are intact with a spastic bladder?
micturition reflex is intact
| bladder contracts and reflexively empties in response to certain level of filling pressure
48
what aspects of bladder control are lost with a spastic bladder?
lose sensation of bladder dissension and urge to urinate (supraspinal contral)
49
how does an SCI pt with a spastic bladder relieve themselves?
bladder training can be used -- trigger stimulus to establish planned voiding (makes bladder reflexively contract)
- tapping
- pulling pubic hair
also. ..
- pay attention to how much you drink
- try to plan ahead of time
50
flaccid bladder occurs with what type of injury?
SCI involving S2-4 levels or the sacral ventral/dorsal roots of S2-4
51
what aspects of bladder control are intact with a flaccid bladder?
not really anything
52
what aspects of bladder control are lost with a flaccid bladder?
no reflex action of detrusor muscle -- micturition reflex destroyed
no supraspinal control (pathway between brain and SC interrupted)
- unable to establish reflex voiding
53
how does an SCI pt with a flaccid bladder relieve themselves?
usually intermittent catheterization is used
may use Val Salva maneuver along with manual compression (Crede Maneuver) of lower abdomen
*more apt to leakage
54
external anal sphincter
under voluntary control
skeletal muscle
supplied by S4 ventral ramus
55
internal anal sphincter
involuntary smooth muscle
supplied by sympathetic fibers (maintain tone)
supplied by parasympathetic fibers (inhibit tone)
56
spastic bowel occurs with what type of injury?
SCI above S2-4 region
57
what aspects of bowel control are intact with spastic bowel?
anal sphincters are intact
58
what aspects of bowel control are lost with spastic bowel?
no supraspinal control (pathway between brain and SC interrupted)
59
how does an SCI pt with a spastic bowel relieve themselves?
responds well to rectal/ anal stimulation and timed voiding
| prognosis excellent for good bowel control -- hydration, fluid monitoring with high fiber diet are essential
60
flaccid bowel occurs with what type of injury?
SCI at S2-4 region
61
what aspects of bowel control are intact with flaccid bowel?
not much of anything
62
what aspects of bowel control are lost with flaccid bowel?
anal sphincters are not intact
no supraspinal control (pathway between brain and SC interrupted)
arrival of stool in rectum results in incontinence
63
how does an SCI pt with a flaccid bowel relieve themselves?
bowel control possible with routine daily bowel evacuation (removes stool before it enters rectum-- manual evacuation with straining via increased abdominal pressure)
hydration and fluid monitoring along with high fiber diet is key to success
64
what could happen if stool is impacted?
ANS is activated --> autonomic dysreflexia
65
what is an upper motor neuron (UMN)?
UMN is a neuron whose cell body originates in the cerebral cortex or brainstem and terminates within the brainstem or spinal cord
66
what is a lower motor neuron (LMN)?
cell body of a LMN lies within the ventral horn of the spinal cord or the brainstem motor nuclei of the cranial nerves which have motor modalities (in CNS). axon of a LMN exits the CNS and forms the somatic motor part of the peripheral nervous system (PNS).
67
example of LMN lesion
ventral rami lesion
68
example of LMN lesion
ventral rami lesion
69
is erectile function greater for male with a UMN or LMN lesion?
UMN lesion
70
reflexogenic erection
sensory stimulation of genitals or perineum
also can occur due to (day)dreams
requires intact reflex arc (S2-S4)
71
what is still intact in a female in terms of sexual function if there is an UMN lesion?
reflex arc still intact --- vaginal lubrication, engorgement of labia and clitoral erection are still intact
aka motor process works but can't feel the sensation through the genital region
72
another name for deep fascia of lower limb
fascia lata
73
fascia lata characteristics
non-elastic
especially strong -- encircles limb like a stocking
prevents bulging of muscles during contraction, making it more efficient
74
fasciotomy
since fascia is not elastic, nerves start dying off if fascia is too tight
often done when person has compartment syndrome
75
what is a Trendelenburg sign and what does it indicate?
pelvic drop during gait -- pelvis drops on uninvolved side when uninvolved side is lifted
indicates gluteus medius weakness
76
weakness in R gluteus medius - what would Trendelenburg sign show?
when walking and left foot is in the air, left hip would drop
77
piriformis muscle is a landmark for what?
superior gluteal n.a.v. exit above it
inferior gluteal n.a.v. exit below it
sciatic n TYPICALLY exits below it
78
what positioning can compress sciatic nerve and why?
passive hip IR
because piriformis is hip ER so it is stretched via IR -- when muscle is elongated, it can compress on the sciatic n which typically exits below it
79
what is piriformis syndrome?
irritation of sciatic n caused by "compression" or irritation of n within buttock area by piriformis m
80
etiology of piriformis syndrome (5)
hypertrophy, inflammation or spasm (rare) of piriformis m
direct trauma resulting in hematoma and scarring
more common in females (6:1)
pseudoanuerysm of inferior gluteal a
anatomical abnormalities (like potentially split piriformis)
81
s/s of piriformis syndrome
pain in posterior buttock that may or may not radiate into posterior thigh
increased by contraction of piriformis muscle, prolonged sitting, or direct pressure applied to muscle
pain with active ER of hip
pain with passive IR of hip
82
differential diagnosis for piriformis syndrome
```
lumbar radiculopathy (nerve involvement)
lumbar spine referred pain (joint involvement)
```
83
where can lumbar spine refer pain?
lower back, buttock, posterior thigh
84
where does nerve to obturator internus and superior gemellus exit?
exits below piriformis
85
where are the gemelli muscles?
form a "gemellus sandwich" with the obturator internus
| superior gemellus - obturator internus - inferior gemellus
86
what are the 6 deep lateral rotators of the thigh?
```
piriformis
obturator internus
superior gemelli
inferior gemelli
quadratus femoris
obturator externus
```
87
what is a common fracture site of femur
intertrochanteric line
88
the intertrochanteric line is ___
anterior
89
the intertrochanteric crest is __
posterior
90
what is the angle of inclination and what is the normal measure of the angle?
angle between long axis of neck/head and long axis of shaft
| normal = ~126
91
coxa vara
angle of inclination is diminished
| <126 deg
92
coxa valga
angle of inclination is increased
| (>126 deg) -- valGa is Greater
93
angle of anteversion is...
aka angle of femoral torsion
| plane of femoral neck and head lies ANTERIOR to plane of femoral condyle
94
normal degree of angle of anteversion
~15 deg
| ~31 in infancy and decreases with WB
95
what is the most frequent cause of childhood in-toeing?
excessive femoral anteversion
96
excessive femoral anteversion characteristics
affected LE is IR
more common in females
most noticeable between ages 4-6
gait looks clumsy
in-toeing will often appear worse with running and when fatigued
will become worse over time with W-sitting
97
excessive femoral anteversion - braces, twister cables, special shoes, etc.
make no difference in outcome
| compliance is problem
98
acetabular labrum
fibrocartilaginous ring, which deepens the cup and increases stability
99
transverse acetabular ligament
goes across acetabular notch to help create full "circle" around head of femur
100
what is the fovea and what is attached here?
```
pit in head of femur
ligamentum teres (or ligament of the head of the femur) attaches here
```
101
what does the ligament of the head of the femur help with?
blood supply to region - contains a small artery to head of femur
102
what are the ligaments that support the hip?
iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament
103
iliofemoral ligament attachments
from AIIS to intertrochanteric line
104
iliofemoral ligament characteristics
strongest ligament
| located anteriorly
105
iliofemoral ligament becomes taut with what action of the hip?
hyperextension of the hip
106
pubofemoral ligament attachments
from superior ramus of pubis to intertrochanteric line
107
pubofemoral ligament characteristics
runs anterior and inferior
108
pubofemoral ligament becomes taut with what action of the hip?
hyperextension and abduction of hip joint
109
ischiofemoral ligament attachments
ischium to femoral neck
110
ischiofemoral ligament characteristics
arises posteriorly and spirals superolaterally
| - only ligament on posterior aspect of hip
111
ischiofemoral ligament becomes taut with what action of the hip?
hyperextension of hip
112
what ligaments restrict hip extension?
iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament
113
blood supply to femoral head and neck
- ligamentum teres acetabular branch of the obturator aa
| - medial circumflex femoral artery
114
examples of intracapsular fractures of femur
subcapital neck fracture
| transcervical neck fracture
115
examples of extracapsular fractures of femur
subtrochanteric fracture
fracture of greater trochanter
fracture of lesser trochanter
116
when would you use a pin vs ORIF?
both used for hip fractures
| pin only is typically used for clean neck fracture, where ORIFs are used for big fractures that need more support
117
importance of hip ligamentous structures for our patients
paraplegic patients can "stand" or hang on iliofemoral ligaments for stability because they are so strong
118
what are bursae?
membranous sacs lined with synovial membrane, found between tendons and bony protuberances in areas subject to friction (like hip)
role: decrease friction
119
ischial bursa
separates gluteus maximus from ischial tuberosity
120
iliopsoas bursa
separates joint from muscle
121
trochanteric bursa
separates gluteus maximus from greater trochanter
122
gluteofemoral bursa
separates iliotibial band from superior portion of vests laterals
123
how do bursae become irritated and how is this irritation treated?
resting or leaning on something hard for a long time (i.e. falling asleep on concrete)
rest, relaxation, and injections can help
124
how to differentiate between semitendinosus and semimembranosus
semitendinosus tendon feels more tendinous and is more superficial ("Tom on Mary")
semiMembranosus is more Medial
125
superior border of popliteal fossa
hamstrings
medially: semimembranosus and semitendinosus
laterally: biceps femoris
126
inferior border of popliteal fossa
2 heads of gastroncnemius (medial and lateral heads) and plantaris (laterally)
127
posterior border of popliteal fossa
skin and fascia
128
anterior border of popliteal fossa
popliteal surface of femur, oblique popliteal ligament, popliteal fascia over popliteus
129
where does the sciatic nerve split and what are the names of its branches?
just proximal to or right around popliteal fossa
| splits into common fibular (peroneal) branch and tibial branch
130
what is sural n?
superior cutaneous nerve of lower leg that is formed by the medial and lateral sural nn coming together (which are branches off the common fibular/ peroneal branch and tibial branch of sciatic nerve)
131
what is the commonplace name of the plantaris tendon?
"fool's nerve" or "freshman's nerve"
132
contents of popliteal fossa
popliteal arteries and veins (deeper)
lesser saphenous vein (superficial)
tibial and common perineal nerves (med/lat sural nn, sural n)
posterior femoral cutaneous n
popliteal lymph nodes and lymphatic vessels
133
when the femoral artery passes through the ___, it changes its name to the popliteal artery
adductor hiatus
134
what does the femoral artery supply?
anterior and anteromedial surface of thigh
135
what does the profunda femoral artery supply?
posterior, lateral, and anterior aspect of thigh
136
what does the medial femoral circumflex artery supply?
primary blood supplier to head and neck of femur via posterior reticular arteries
137
what does the lateral femoral circumflex artery supply?
primarily supplies lateral hip muscles
ascends to gluteal region
transverses around femur
descends to knee
138
when does the external iliac artery change its name to the femoral artery?
after crossing the inguinal ligament
139
where does the profunda femoral artery arise from and what does it give rise to?
from femoral artery near inguinal ligament
| gives rise to perforating branches thru adductor magnus muscles (4)
140
what does the medial femoral circumflex artery arise from and what does it give rise to?
usually from profunda femoral artery, but can arise from femoral artery
terminates by dividing into ascending/ transverse branches
** enters gluteal region below quadratus femoris and gives rise to posterior reticular aa **
** travels posteriorly between iliopsoas and pectineus**
141
what does the lateral femoral circumflex artery arise from?
usually from profundal femoral artery, but can arise from femoral artery
142
what are retinacular arteries?
arise from *medial* (and lateral) femoral circumflex arteries and are main supply to hip joint
143
what arteries does cruciate anastomosis include?
1. transverse and ascending branch of lateral femoral circumflex a
2. medial femoral circumflex a
3. inferior gluteal a
4. first perforating artery from profunda femoral a
144
the cruciate anastomosis of hip - which artery anastomoses with ascending branch of medial circumflex femoral a?
ascending branch of lateral femoral circumflex a
145
the cruciate anastomosis of hip - inferior gluteal a anastomoses with which artery?
ascending branch of medial femoral circumflex a
146
if the neck of the femur is fractured, what happens with the blood supply to the head of the femur?
all of the arteries of the cruciate anastomosis may be compromised, and the acetabular branch of the artery to the head of the femur (in ligamentum teres) is the only branch that is still intact
147
what is often the result of a femur neck fracture?
pt needs ORIF or hip replacement, depending on how much blood supply is compromised or if the bone is shattered
148
what is avascular necrosis?
condition that results from poor blood supply to an area of bone, causing bone death
149
what can cause avascular necrosis?
```
trauma and damage to blood vessels that supply oxygen to bone
systemic steroids
sickle cell anemia
alcohol abuse
radiation therapy
```
150
poor blood supply may lead to _________________________________, causing ...
may lead to ischemia and necrosis of bone tissue, causing weakening of bone with eventual collapse
151
what is Legg-Calves Perthes disease?
child avascular necrosis with unknown origin
152
is Legg-Calves Perthes disease more common in boys or girls, and at what age is it most prevalent?
boys
| 4-7
153
how is Legg-Calves Perthes disease treated?
historically, with casting or bracing
now, evidence suggests that those who are casted or braced have no difference in outcomes to those who did not receive treatment
now, it is more important to treat specifically for pt's condition -- research done on joint-preserving surgery which is relatively successful
154
what is slipped capital femoral epiphysis (SCFE)?
epiphysis of femoral head make slip away from femoral neck due to weakened epiphyseal plate
155
causes of slipped capital femoral epiphysis (SCFE)
acute trauma (large force through hip like a fall)
repetitive micro trauma with shear stress
gradual slippage with associated hip pain that *may refer to the knee*
156
what s/s is often associated with a slipped capital femoral epiphysis (SCFE)
antalgic gait
| hip pain that also may refer to the knee
157
slipped capital femoral epiphysis (SCFE) usually occurs in...
children between 10 and 16
overweight and short, or thin and tall adolescents
boys > girls
African Americans > caucasian
158
difference between stable and unstable slipped capital femoral epiphysis (SCFE)
if unstable, likely unable to weight bear and is often an emergent situation
159
common treatment for slipped capital femoral epiphysis (SCFE)
"in situ fixation"
bone held in place with single central screw, which keeps femur from slipping and closes growth plate
sometimes do prophylactic bilateral surgical intervention
160
great saphenous vein blood flow
ascends anterior to medial malleolus
passes posterior to medial condyle of femur
passes through saphenous opening/ fossa ovalis
empties into femoral vein
161
what is the popliteal artery a continuation of, and where does it end?
continuation of femoral artery
| ends at superior border of popliteus muscle
162
what are the branches of the popliteal artery?
```
superomedial genicular
superolateral genicular
middle genicular
inferomedail genicular
inferolateral genicular
```
163
what do the genicular arteries supply?
articular capsule and ligaments of knee
164
what does the genicular anastomosis include?
all genicular arteries (x5)
descending genicular branch of femoral a (anteriorly)
descending branch of lateral femoral circumflex a
recurrent branch of anterior tibial a
165
the popliteal artery divides into....
anterior and posterior tibial arteries
166
when doing hip abductions in sidelying, if hip is placed into flexion, what primary muscle(s) is being used?
tensor fascia lata (TFL)
167
when doing hip abductions in sidelying, if hip is placed into extension/ neutral, what primary muscle(s) is being used?
gluteus medius and gluteus minimus
168
what is the femoral triangle?
triangular depress inferior to inguinal ligament
169
borders of femoral triangle
superior: inguinal ligament
medial: adductor longus m
lateral: sartorius m
floor: iliopsoas and pectineus mm
roof: (deep to superficial) fascia lata, cribriform fascia, subcutaneous tissue, skin
170
name of the opening of the femoral triangle
saphenous opening (or fossa ovalis)
171
what covers/ fills in saphenous opening?
cribriform fascia
172
what is the falciform margin?
the most lateral portion of the saphenous opening, very clear rounded border, very tough
173
drainage pattern of great saphenous vein
dorsal venous arch
anterior to medial malleolus
posterior to medial knee
up along medial thigh to saphenous opening
174
femoral triangle contents (from lateral to medial)
NAVEL
| femoral nerve, artery, vein, empty space, and lymph
175
contents of femoral sheath (from lateral to medial)
femoral artery, vein, and canal
| femoral n is NOT INCLUDED
176
purpose of femoral sheath
allows for femoral artery and vein to glide deep to inguinal ligament with hip motion (prevents compression during hip flexion)
177
what is femoral canal and what does it contain?
most medial compartment of sheath
contains loos CT, fat, and lymph vessels
purpose: allows room for blood vessels to expand
178
femoral ring is the proximal opening to the ____
femoral canal
179
clinical correlation of the femoral canal
femoral hernia
intestine protrudes through femoral ring
most common postpartum or in people with digestive problems (lots of bearing down)
180
clinical correlation of femoral triangle
palpating femoral a
| trigger point dry needling -- DO NOT want to go near femoral triangle
181
what is the patellar tendon reflex and what does it check?
tap patellar ligament, which pulls on quadricep tendon and on the muscles that attach to it
integrity check of L2-L4
182
quadriceps tendon vs patellar ligament
quadriceps tendon is PROXIMAL and connects muscle to bone (superior aspect of patella)
patellar ligament is DISTAL and connects bone to bone (apex of patella to tibial tuberosity)
183
medial and lateral patella retinaculi
tendinous expansions of vastus medialis and lateralis which attach to margins of the patella -- meshes to help become the patellar ligament
184
if the patella dislocates laterally, the __ retinaculum could rupture
medial
185
if the patellar retinaculum ruptures, what could happen to the patella?
it could be prone to sublux more often
186
deep tendon reflex of patellar region tests integrity of...
L2, L3, L4*
187
deep tendon reflex of achilles tests integrity of...
S1*
188
deep tendon reflex of hamstrings tests integrity of...
L5*
189
what is the adductor canal and where is it found?
middle 1/3 of medial thigh
| contains femoral a and v, saphenous n (sensory), and usually the n to vastus medialis
190
boundaries of adductor canal
lateral: vastus medialis
medially: adductor magnus and adductor longus
superficial: sartorius
191
adductor hiatus location and what goes through it
opening in aponeurotic distal attachment of adductor angus
distal end of adduct canal
femoral a and v, and saphenous n go through it to the popliteal fossa
n to vastus medialis exits and innervates VM before entering popliteal fossa
192
where is adductor brevis relative to adductor longus?
adductor brevis is deep to adductor longus
193
about what % of body weight does the tibia accept?
~90%
194
what does the tibia articulate with?
femoral condyles proximally
talus distally
fibula
195
tibia plateau
superior surface of tibia, within it you can find medial and lateral tibial condyles and intercondylar groove
196
what attaches to Gerdy's tubercle and where is it found?
insertion of IT band
| on anterior aspect of lateral condyle of tibia
197
what attaches to tibial tuberosity and where it is found?
distal attachment for patella tendon (ligament)
| on anterior surface of tibia
198
distal articulating surface of tibia is...
plafond
199
normal tibial torsion at distal end:
externally rotated (toe-out when standing), usually 20-40 deg
200
where is soleal line?
on posterior aspect of tibia
201
where is the "third malleolus"?
posterior margin of articular surface of distal tibia
202
function of fibula
```
function for attachment of muscle
provides lateral stability of ankle joint (talocrural joint), assists in stabilizing talus
```
203
head of fibula articulates with...
proximal/ lateral portion of tibia
204
apex of fibula
pointed end of head
205
body of fibula is __ shape... borders are ....
triangular with 3 borders
anterior
interosseous
posterior
206
where does the lateral malleolus end relative to medial malleolus
lateral malleolus is directed more posteriorly and ends 1cm more distal than medial malleolus
207
common characteristics of trimalleolar fracture (what occurs with injury, how it is treated)
dislocation with ligamentous injury
disruption and separation to tibial-fib syndesmosis
treatment: ORIF
can happen with extreme inversion injuries
208
proximal tibiofibular joint is __ shape and a __ joint
plane shaped
| synovial joint
209
proximal tibiofibular joint is between the ___ and ___
slightly convex facet on head of fibula
| slightly concave facet on lateral condyle of tibia
210
proximal tibiofibular joint: surrounded by joint capsule?
yes
211
proximal tibiofibular joint is supported by...
anterior and posterior ligaments to head of fibula
212
movements of proximal tibiofibular joint
small amounts of...
- superior and inferior sliding of fibular and fibular rotation - during DF/PF of ankle joint (respectively)
ER of fibula during DF
- IR of fibula during PF
213
distal tibiofibular joint is made up of __ joint between ....
syndesmosis (fibrous joint) between concave facet of tibia and convex facet of fibula
214
distal tibiofibular joint surrounded by joint capsule?
no
215
in distal tibiofibular joint, tibia and fibula are separated by...
fibroadipose tissue
216
distal tibiofibular joint is supported by...
**interosseous ligament (extension of interosseous membrane)
anterior tib-fib ligament
posterior tip-fib ligament
medial collateral (deltoid) ligament
217
ankle joint function is completely dependent on..
tib-fib mortise
218
purpose of ligaments at distal tibiofibular joint
restrict motion at distal tip-fib joints and assist in maintaining stable ankle mortise
219
mortise joint
comprised of distal tib-fib articulation
| articulates with talus
220
two most common fractures in body
1. radial head fracture
| 2. distal tib-fib fracture
221
distal tib-fib fracture usually results from...
```
sprained ankle
avulsion fracture (fragment of bone tears away from main mass of bone) or from shear force on talus along surface of tibia and fibula
```
222
talus articulates with...
fibula
calcaneus
navicular
223
body of talus has __ articular surfaces:
3: large lateral facet, smaller medial facet, trochlear facet superiorly
224
body of talus characteristics
** wider anteriorly than posteriorly, wedge shape
225
trochlear surface of talus characteristics
large convexity, central groove at angle
226
talus muscular attachments
** NONE
227
talus rests medially on...
sustentaculum tali ** (part of calcaneus)
228
sustentaculum tali
on medial surface of calcaneus, juts out like a shelf for talus to rest on
229
talocrural joint is a __ shape and a __ joint, with __ DOF
```
hinge shaped synovial joint
1 DOF (PF/ DF)
```
230
talocrural joint is articulation between...
convex talus and concave distal tibia
| convex talus and concave distal fibula
231
closed pack position of talocrural joint
full DF
| closed pack position --> all tissues are elongated and can't move as much
232
open pack position of talocrural joint
PF -- can still move ankle well aka is MORE UNSTABLE
| one reason why walking on toes or in heels is unstable
233
why does eversion have the end feel it does? (what is this end feel)
hard because of contact between lateral malleolus and calcaneus
234
what happens to the bones of the talocrural joint during DF?
**DF moves the wider anterior part of the trochlea (of talus) posteriorly, which spreads the tibia and fibula slightly apart
this is why DF is closed pack position
235
if the distal tib-fib joint is fused (i.e. with trimalleolar fracture), what movements are affected?
DF is compromised -- tibia and fibula cannot spread
236
axis of rotation of talocrural joint
oblique line running med/lateral through fibular (lateral) malleolus, body of talus, and just distal to tibial malleolus
about 15 deg off coronal plane -- "toe out" position
about 8 deg off horizontal
237
medial ligamentous support of ankle
```
medial collateral ligament (deltoid ligament)
runs from medial malleolus to...
- talus
- calcaneus
- navicular
```
238
deltoid ligament is comprised of...
1. anterior and posterior tibiotalar ligaments
2. tibiocalcaneal ligament
3. tibionavicular ligament
239
lateral ligamentous support of ankle
lateral collateral ligaments:
- anterior talofibular (ATFL)
- calcaneofibular (CFL)
- posterior talofibular (PTFL)
240
anterior talofibular ligament (ATFL) goes from...
lateral malleolus of distal fibula to neck of talus
241
calcaneofibular ligament (CFL) goes from...
from tip of lateral malleolus to lateral calcaneus
242
posterior talofibular ligament (PTFL) goes from...
from malleolar fossa to lateral tubercle of talus
| runs horizontal
243
calcaneus articulates with...
talus superiorly and cuboid anteriorly
244
characteristics of calcaneus
largest and strongest bone in foot
transmit most of weight of foot to ground
sustentaculum tali (medially)
peroneal (fibular) trochlea (laterally)
245
what would happen if there was a fracture of sustentaculum tali?
articulation between talus and calcaneus would be compromised
246
what ligament(s) are tested in anterior drawer test for ankle?
ATFL (anterior talofibular ligament) and CFL (calcaneofibular ligament)
247
performance of anterior drawer test for ankle
posterior to anterior translatory force
ankle remains in neutral position (no DF/ PF)
if positive, see puckering/ gapping in skin
248
if there was a fracture at the base of the 5th metatarsal, what motions would be limited?
DF and eversion (because peroneus tertius attaches there)
249
superior extensor retinaculum function
binds down muscles in anterior compartment, prevents them from bowstringing during DF
250
superior extensor retinaculum attachments
connects fibula to tibia, proximal to malleoli
251
inferior extensor retinaculum function
forms strong loop around tendons of peroneus tertius and EDL
252
inferior extensor retinaculum attachments
Y-shaped, attaches laterally to anterosuperior surface of calcaneus
253
compartment syndrome
- crural fascia around leg compresses structures in compartment (usually after trauma to leg that results in inflammation or hemorrhage)
- fasciotomy to reduce pressure
254
deep peroneal nerve entrapment: how it occurs and what is the result
occurs due to excessive use of muscles supplied by deep peroneal n
muscles swell in anterior compartment, and there is dorsal pain in 1st web space
255
shin splints, aka
anterior tibialis tendinopathy
256
anterior tibialis tenidonpathy
overuse injury that could lead to stress fracture
swelling and pain in distal 2/3 of tibia, resulting from repetitive micro trauma of tibia anterior and small tears of periosteum of tibia
257
peroneus longus position relative to brevis
share fascial compartment, longus is more superficial
258
common peroneal n location
near neck of fibula
259
common peroneal n injuries
- when fibular head fractures
- prolonged bedrest with LE externally rotated (puts pressure on nerve)
- "bar stool palsy" legs crossed for prolonged period of time
260
common peroneal n injury results in...
paralysis of muscle of anterior and lateral compartments
| foot drop
261
region of common peroneal n where lesion would affect lateral sural n
closer to popliteal fossa = lost
| near fibular head = intact
262
lateral sural n innervates...
lateral aspect of proximal 1/2 of shank
263
superficial peroneal n innervates...
lateral aspect of distal 1/2 of shank and dorsal aspect of foot (not 1st web space)
264
sural n innervates....
lateral aspect of dorsum of foot
265
deep peroneal n innervates...
1st web space on dorsal aspect of foot
266
saphenous n innervates...
anterior and medial aspect of shank
267
which is the largest compartment of the leg?
posterior compartment
268
what divides superficial and deep groups of calf muscles?
transverse intermuscular septum
269
what provides blood supply to posterior compartment of leg?
posterior tibial artery and vein
270
muscles in superficial group of posterior compartment of leg
1. gastrocnemius
2. soleus
3. plantaris
271
muscles in deep group of posterior compartment of leg
1. popliteus
2. flexor digitorum longus
3. flexor hallicis longus
4. tibialis posterior
272
where is the small saphenous vein found? What region does it drain, and what does it drain into?
goes down center of bifurcation of gastrocnemius muscle
drains superficial foot
drains into popliteal vein
273
gastrocnemius and soleus combined is called...
triceps surae
274
which posterior leg compartment muscle is absent is 10-15% of the population? What is it commonly used for?
plantaris -- commonly used for grafting during reconstructive surgery
275
plantaris and popliteus relative locations to each other
popliteus is more medial
276
clinical importance of popliteus
attaches to lateral meniscus --- if lateral meniscus is torn and is surgically repaired, active or resisted knee flexion is deferred for a few weeks
277
where does the flexor hallucis longus tendon run and why is its location important?
tendon runs between 2 sesamoid bones in tendons of flexor hallucis brevis
sesamoid bones protect FHL tendon from pressure at first metatarsal
278
anterior tibial artery terminates as....
dorsalis pedis a
279
where to find pedal pulse
just distal to medial/ lateral malleoli, between 1st and 2nd metatarsals
280
deep fascia of plantar foot is called ___ and thick central part is ___
plantar fascia, central part is plantar aponeurosis
281
roles of plantar fascia
holds foot together
protects plantar surface from injury
supports longitudinal arches of foot
282
plantar aponeurosis attachments
from calcaneus
| to 5 divided bands that become continuous with tendon sheath of each toe
283
function of intrinsic muscles of foot
instead of producing motion, primarily focus on isometrically working to maintain foot arches
284
layer 1 of intrinsic foot muscles
1. abductor hallucis
2. flexor digitorum brevis
3. abductor digiti minimi
285
layer 2 of intrinsic foot muscles
4. quadratus plantae
| 5. lumbricals (x4)
286
layer 3 of intrinsic foot muscles
6. flexor hallucis brevis (2 heads -- medial and lateral)
7. adductor hallucis (2 heads -- oblique and transverse)
8. flexor digiti minimi brevis
287
layer 4 of intrinsic foot muscles
9. plantar interossei (x3)
| 10. dorsal interossei (x4)
288
how many plantar interossei are there?
3
289
how many dorsal interossei are there?
4
290
characteristics of medial plantar n compared to lateral plantar n
medial plantar n larger and more anterior
291
border between medial and lateral plantar nn is...
along 4th metatarsal
292
which cutaneous n travels through the adductor canal?
saphenous n
293
bones in hindfoot
talus and calcaneus
294
bones in mid foot
navicular, cuboid, cuneiforms (medial, lateral and intermediate)
295
bones in forefoot
metatarsals, phalanges
296
subtalar joint is articulation between...
three separate inferior articulating surfaces on talus with 3 separate articulating surfaces on superior aspect of calcaneus
297
functions of subtalar joint
- translates motion of tibia to foot and vice versa
- dampens rotational forces while maintaining contact with ground
- allows for smooth walking over uneven surfaces, pivoting
298
ligaments supporting subtalar joint
- talocalcaneal ligaments
- medial collateral ligaments
- lateral collateral ligaments
299
the subtalar joint has __planar movement around a __ axis
triplanar movement
| single oblique joint axis
300
subtalar axis is __ degrees up from horizontal plane and __ degrees in from sagittal plane
42 degrees up from horizontal
| 25 degrees in from sagittal plane
301
composite motions of subtalar joint
supination and pronation
302
supination is a combination of...
inversion
adduction
PF
303
pronation is a combination of...
eversion
abduction
DF
304
lateral subtalar joints
- lateral talocalcaneal ligament
- dorsal talonavicular ligament
- interosseous talocalcaneal ligament (at sinus tarsi canal)
305
cuboid bone articulates with....
calcaneus posteriorly
lateral two metatarsals anteriorly
navicular and lateral cuneiform medially
306
cuboid bone key characteristics
cuboid tuberosity on plantar surface
| groove for peroneus longus tendon
307
navicular articulates with...
talus
cuboid
3 cuneiform bones
308
navicular key characteristics
```
flattened, boat shape
navicular tuberosity (attachment of tibialis posterior m)
```
309
in ankle pronation, medial malleolus is ____ relative to lateral malleolus
higher
310
medial cuneiform articulates with....
1st MT bone
311
intermediate cuneiform articulates with...
2nd MT bone
312
lateral cuneiform articulates with...
3rd MT bone and cuboid bone
313
cuneiform ___ motion lends to....
```
planar motion (small amount)
lends some flexibility to foot
```
314
high ankle sprain
separation between distal tibia-fibula joint
315
transverse tarsal joint is between....
calcaneus and talus proximally, and cuboid and navicular distally (divides hind foot and Midfoot)
316
what type of joint is transverse tarsal joint?
compound synovial joint
317
transverse tarsal joint major ligamentous support
plantar calcaneonavicular ligament (spring ligament)
long plantar ligament
short plantar ligament (plantar calcaneocuboid ligament)
318
long plantar ligament extends from...
calcaneus to 2-4 MT
319
function of plantar calcaneonavicular ligament (spring ligament)
helps maintain middle arch
320
purpose of arches of foot
adds to weight bearing capabilities and resiliency of foot
provides for shock absorption
arches become slightly flattened during WB, resume curve during NWB
321
integrity of arches maintained by...
shape of interlocking bones
strength of plantar ligaments
strength of plantar aponeurosis
322
lateral longitudinal arch is comprised of...
calcaneus, cuboid, and lateral 2 metatarsals
323
medial longitudinal arch
calcaneus, talus, navicular, 3 cuneiforms, and medial 3 metatarsals
324
if you fracture your talus, which arch(es) would be affected?
medial longitudinal arch
325
if you fracture your calcaneus, which arch(es) would be affected?
lateral and medial longitudinal arches
326
transverse arch is comprised of...
cuboid, cuneiforms, and bases of metatarsals (runs lateral to medial)
327
tarsometatarsal joint is a ___ joint
plane joint (gliding only), synovial
328
inter metatarsal joint is a ___ joint
plane joint (gliding motion only), synovial
329
metatarsophalangeal joints (MTP) are ___ joints with __ DOF
ovoid synovial joints with 2 DOF (flex/ext, abd/add)
330
interphalangeal joints are ___ joints
synovial hinge joints
