Functional Anatomy Ii

Front 1

Functions of the spine
6

Back 1

Protects spinal chord
provides proximal stability for distal mobility (stable trunk so you can move limbs)
allows movement in all directions
supports a lot of weight/lifting (e.g. head)
provides sites for muscle/ligament attachment
acts as a shock absorber

Front 2

How many bones in the spine?
what regions?

Back 2

33
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal

(about 5% of people have 8 cervical or 6 lumbar

Front 3

All ribs attach to...
how many of each kind are there

Back 3

the thoracic vertebrae
7 true ribs attaching to sternum
5 "false" - 3 vertebrochondral (costal cartilage) and 2 vertebral (floating)

Front 4

A lordotic curve can be found in which regions?

Back 4

cervical and lumbar (overemphasized)

Front 5

What type of excessive curve tends to occur in the thoracic region

Back 5

Kyphotic

Front 6

Which region of the spine is most mobile?
which articulation

Back 6

cervical
between atlas and axis provides most rotation, atlantoaxial

Front 7

What restricts movement in the thoracic region?

Back 7

Connection to ribs (which move as rings/units), orientations of facets, and long spinous processes

Front 8

The lumbar region has a large range of motion in...

Back 8

flexion and extension

Front 9

Intervertebral joint is a motion segment with __ joints working together

Back 9

2
anterior has interbody joint (intervertebral disc)
posterior has apophyseal/zygoappophyseal (intervertebral joint)

Front 10

these structures allow motion, restrict excess motion, and are most resistant to compression

what other properties do they have?

Back 10

Vertebral disks

aneural (no neural inervation)
avascular
viscoelastic

Front 11

What is the central part of a disk?
outer?

Back 11

nucleus pulposus (squishy...)
annulus fibrosus (collagen fibers with different perpendicular rotations)

Front 12

When is a disk most susceptible to injury?

Back 12

when rotating quickly from one direction to the other (change in tension forces of annulus fibrosus)
Combination of shear force, compression, and flexion

Front 13

In what plane is the lumbar region most limited? Why?

Back 13

Transverse, orientation of facets

Front 14

Functions of cervical region of spine

Back 14

supports skull, shock absorber for brain, protects brainstem and spinal chord
facilitates transfer of weight, provides attachment for muscles and ligaments
orient head to receive sensory information from the environment through sight and hearing

Front 15

Passive and active stability of spine provided by

Back 15

ligaments, boney congruence, intervertebral discs, joint capsules

muscles and tendons such as multifidus, simispinalis capitus, longis capitus, longis colli (some designed for stability more than prime moving)

Front 16

Anterior longitudinal ligament limits
o/i

Back 16

extension (hyperextension)
and forward sliding of vertebrae

sacrum; anterior vertebral body and disc to above anterior body and disc; atlas

Front 17

Posterior longitudinal ligament limits?

o/i

what else does?

Back 17

flexion and lateral flexion

posterior verteral body and disc to posterior body and disc of next vertebra

Front 18

Iliocostalis Cervicis
Origin/insertion
Action

Back 18

o: angles of 3rd-6th ribs
i: transverse processes of C4-C6

a: bilaterally extends cervical vertebrae, uni - laterally flexes vertebrae and rotates to same side

Front 19

Iliocostalis thoracis
Origin/insertion
Action

Back 19

Origin: Lower 6 ribs (angles of ribs 7-12, medial to insertion of lumborum)
insertion: ribs 1-6, transverse process of C7
Action: extends vertebral column
one - laterally flexes, rotation to same side

Front 20

Iliocostalis Lumborum
Origin/insertion
Action

Back 20

Origin: medial and lateral sacral crests, spinous processes of L1-L5, T11, T12, iliac crest
insertion: lower 6th or 7th ribs (angle of ribs 6 or 7-12)
Action: extension of lower vertebral column
alone- lateral flexion and rotation to same side

Front 21

Sternocleidomastoid
Origin
Insertion
Action

Back 21

Origin: sternum and clavicle
Insertion mastoid process
Action: Flexes neck, hyperextends head
alone- laterally flexes neck, rotates to opposite side

Front 22

Longus Capitis
Origin:
Insertion:
Action:

Back 22

Origin:transverse processes of cervical vertebrae C3-C6
Insertion: occipital bone
Action: flexes head,
ipsilateral rotation

Front 23

Longus cervicis and longus colli
Origin:
Insertion:
Action:

Back 23

Origin: transverse processes and bodies of lower cervical and upper thoracic vertebrae
Insertion: transverse processes and bodies of upper cervical vertebrae
Action: cervical flexion,
ipsilateral rotation, lateral flexion

Front 24

Scalenes (anterior, middle, posterior)
Origin:
Insertion:
Action:

Back 24

Origin: transverse processes of cervical vertebrae
Insertion: ribs 1 and 2
Action: cervical flexion
contralateral rotation, lateral flexion

Front 25

supraspinous ligament limits
o/i

Back 25

flexion and resists forward shear force on spine

spinous process to spinous process of next vertebra

Front 26

Ligamentum flavum limits
o/a

Back 26

limits flexion, assists extension, maintains constant tension on disc,
laminae to laminae

Front 27

Interspinous ligament limits

origin
insertion

Back 27

flexion, shear forces acting on vertebrae

spinous process to transverse process

Front 28

Splenius capitus
Origin:
Insertion:
Action:

Back 28

Origin: Ligamentum nuchae; spinous process of C7, T1-T3
Insertion: Mastoid process, occipital bone
Action: head extension, lateral flextion, ipsilateral rotation

Front 29

Splenius cervicis
Origin:
Insertion:
Action:

Back 29

Origin: spinous process of T3-T6
Insertion: Transverse process of C1-C3
Action: neck extension, lateral flexion, ipsilateral rotation

Front 30

Semispinalis capitus
Origin:
Insertion:
Action:

Back 30

Origin: C4-C6 facets; transverse process of C7
Insertion: base of occipital flexion
Action: cervical extension, lateral flexion, contralateral rotation

Front 31

Semispinalis cervicis
Origin:
Insertion:
Action:

Back 31

Origin: Transverse process of T1-T6
Insertion: Spinous process of C1-C5
Action: cervical extension, lateral felxion, contralateral rotation

Front 32

Semispinalis ThoracisOrigin:
Insertion:
Action:

Back 32

Origin: Transverse processes of T6-T10,
Insertion: spinous processes of T1-T4, C6, C7
Action: extension, lateral flexion, contralateral rotation

Front 33

Longissiumus capitis
Origin:
Insertion:
Action:

Back 33

Origin: Transverse process of T1-T5, C4-C7
Insertion: mastoid process
Action: head extension, head lateral flexion, ipsilateral rotation

Front 34

Longisimus cervices
Origin:
Insertion:
Action:

Back 34

Origin: Transverse process of T1-T5,
Insertion: transverse process of C4-C6
Action: extension, lateral flexion, ipsilateral rotation

Front 35

Longisimus thoracis
Origin:
Insertion:
Action:

Back 35

Origin: Posterior transverse process of L1-:L5; thoracolumbar fascia
Insertion: transverse process of T1-T12
Action: extension, lateral flexion, ipsilateral rotation
(fibers angle out)

Front 36

Erector Spinae Group basic muscles and actions

Back 36

lateral layer - iliocostalis (lumborus, thoracis, cervices)
Middle layer - longissimus (capitus, cervicis, thoracis)
Medial layer - spinalis (thoracis, cervicis)

extension, lateral flexion, rotation (ipsilateral for all except semispinalis)

Front 37

Spinalis cervicis
Origin:
Insertion:
Action:

Back 37

Origin: spinous process of c7
Insertion: spinous process of axis
Action: extension, lateral flexion

Front 38

Spinalis thoracis
Origin:
Insertion:
Action:

Back 38

Origin: Spinous processes of L1-L2, T11-T12
Insertion: spinous processes of T1-T8, ligamentum nuchae
Action: extension, lateral flexion, ipsilateral rotation

Front 39

Deep Posterior Group

Back 39

Intertransversarii
interspinales
rotatores
multifidus

rotation is contralateral when at all

Front 40

Deep Posterior Group: Intertransversarii

Origin:
Insertion:
Action:

Back 40

Origin: transverse process
Insertion: transverse process
Action: extension, lateral flexion (not rotation)

Front 41

Deep Posterior Group
Interspinales:
Origin:
Insertion:
Action:

Back 41

Origin: spinous process
Insertion:spinous process
Action: extension, hyperextension, lateral flexion (according to book)

Front 42

Rotatores
Origin:
Insertion:
Action:

Back 42

Origin:Transverse process
Insertion: laminae of next vertebrae
Action: extension, contralateral rotation (lateral flexion according to book)

crosses 1-2 intervertebral junctions

Front 43

Deep posterior group: multifidus
Origin:
Insertion:
Action:

Back 43

Origin: Sacrum; iliac spine; transverse processes L5-C4
Insertion: Spinous process of next vertebral side
Action: extension, lateral flexion, contralateral rotation

Crosses 2-4 intervertebral junctions

Front 44

Trunk Rotators - External Oblique

Back 44

From 5th-12th ribs to linea alba, pubic tubercle, anterior iliac crest

Contralateral rotation, lateral flexion to same side, flexion

Front 45

Trunk Rotators - Internal Oblique

Back 45

From Lumbar fascia, iliac crest
To last 3 or 4 ribs and ab aponeurosis to linea alba

Ipsilateral Rotation, ipsilateral lateral flexion, flexion

Front 46

Trunk Flexors - Rectus Abdominus

Back 46

From pubic crest and symphysis to costal cartilage of 5th-7th ribs and xiphoid process

Front 47

Trunk Flexors are

Back 47

Rectus abdominus
External and internal obliques
Illiacus
Psoas Major and Minor

Front 48

Trunk Flexors - Iliacus

Back 48

– FROM: Inner surface
of ilium and sacrum
– TO: lesser trochanter of
femur

Trunk flexion, thigh flexion

Front 49

Trunk Flexors - Psoas (major and minor):

Back 49

– FROM: bodies and transverse processes of lower
thoracic and lumbar vertebrae, and inner surface of
ilium and sacrum
– TO: lesser trochanter of
femur

flexion, thigh flexion

Front 50

Trunk lateral flexors - Quadratus Lumborum

Back 50

From: iliac crest, transverse processes of lumbar vertebrae
To: transverse processes of lumbar vertabrae and 12th rib

Lateral flexion of trunk, or pelvic lateral tilt

Front 51

Functional significance of muscles of respiration

Back 51

physiological demand of activity is always going to win. i.e. breathing!
Performance and/or rehabilitation can be greatly enhanced by training respiratory muscles

Front 52

Respiratory muscles - thoracic diaphragm

Back 52

• From: xiphoid process
and posterior side of
lower six ribs,
interdigitating with
transverse abdominis
• To: lumbarcostal
arches (anterior
vertebral bodies)

ON inhale, central tendon pulls down, creating a pressure gradient, relaxes for exhalation

Front 53

List muscles of respiration

Back 53

Thoracic Diaphragm (inhalation)
External intercostal muscles (inhalation)
Internal intercostal muscles (forced exhalation)
Assist: Scalene (inhalation)
Assist: Sternocledomastoid (inhalation)
Assist: Pectoralis minor (in)
Assist(?): abdominals (forced exhalation)

Front 54

Which muscles are involved in accessory muscle breathing?
What does this breathing pattern impact?

Back 54

Trapezius
Sternocleidomastoid
Scalenes
(also Pectoralis minor)
It decreases a person's ability to move his/her head because those muscles are being used for breathing, not movement.

Front 55

Highest loads on the spine are experienced during:

Back 55

(starting with highest load)
lifting with trunk flexed
lifting with trunk extended
standing while carrying load standing with trunk flexed (stooped posture)
Seated with trunk flexed (stooped)

Front 56

Disk degeneration

Back 56

happens with age
loss of height and loosening of ligaments
disc protrusion
disc degeneration and osteophyte formation (calcium buildup)
See what book says

Front 57

Most common mechanism of disc injury
what happens

Back 57

flexion + compression + rotation
Disturb annular fibers, middle bulges (usually posterior and lateral)
levels are bulge, herniation, expulsion

Front 58

Spondylolysis

Back 58

Repetitive quickly loaded hyperextension creates fatigue fracture of pars articularis (posterior neural arch - lamina)

Front 59

Spondylolithesis

Back 59

Repetitive quickly loaded hyperextension causes fatigue fracture of BOTH pars articulais (posterior neural arch), displaced vertebral body to anterior side (not held in place in back)

Front 60

Scoliosis
80-90% is

Back 60

right thoracic rotation (R rib hump)
impacts movement patterns and breathing function - diaphragm and organs, left abdominal wall less active than right

Front 61

Sex differences in the sacroiliac joint

Back 61

males have thicker/stronger sacroiliac ligaments
Center of mass more posterior in females, less stable joint (not creating strength through pressure)
More mobility and higher injury rates in females

Front 62

Pelvic movements in sagittal plane
frontal
transverse

Back 62

Anterior and posterior tilt
R/L lateral tilt
R/L rotation

Front 63

What are pelvic movements for the swing phase of the right leg

Back 63

right lateral tilt and left rotation

Front 64

Iliofemoral ligament
From...To...
Limits

Back 64

Anterior inferior iliac spine TO intertrochanteric line of femur

Supports anterior hip; resists movements of extension, internal rotation, external rotation

Front 65

Ischiofemoral ligament
From...to
function - limits...

Back 65

Posterior acetabulm TO iliofemoral ligament

Resists adduction and internal rotation

Front 66

Pubofemoral ligament
from...to
limits

Back 66

Pubic part of acetabulum; superior rami TO intertrochanteric line

Resists abduction and external rotation

Front 67

Sacrotuberous ligament
from...to
limits

Back 67

Posterior ischium TO sacral tubercles, inferior margin of sacrum & upper coccyx

Prevents the lower part of the sacrum from tilting upward and backward under the weight of the rest of the vertebral column

Front 68

What resists flexion of the thigh at the hip?

Back 68

No ligaments do!
Muscles do, depending on how much stretch their under, as well as fascia and bones touching

Front 69

Angle of inclination of the femoral neck greater than 125 degrees in the frontal plane is called...
creates...

Back 69

Coxa valga
Less effective abductors (smaller moment arm)
Longer limb

Front 70

Angle of inclination of the femoral neck less than 125 degrees in the frontal plane is called...
creates...

Back 70

Coxa vara
More effective abductors (greater moment arm)
Shorter limb

Front 71

Internal femoral torsion is called

Back 71

anteversion
normal is 12-14 deg, ante is less(?)

large angle of anteversion common in toddlers, decreases with growth, 2x as likely to persist in females (especially W sitters)

Front 72

external femoral torsion is called

Back 72

retroversion
greater than normal of 12-14 degrees

Front 73

Q angle is the angle between
Normal =
increased by...

Back 73

Quadriceps femoris muscles and patellar tendon
Normal for males - 14degrees, Females- 17 degrees
"knock-knees" = genu valgum
Femoral anteversion
External tibial torsion
laterally positioned tibial tuberosity

associated with knee injury

Front 74

"downstream" effects of excessive coxa vara and anteversion

Back 74

increased Q-angle, patelar problems, mor pronation, increased lumbar curvature, hyperextension

Front 75

"downstream" effects of excessive coxa valga and retroversion

Back 75

Reduced Q-angle, more supination at the subtalar joint

Front 76

Strengths of biarticular (2-joint) muscles

Back 76

aid in transferring energy/power from proximal to distal segment (in jump, rectus femoris flexes hip and extends knee)

Extension at proximal joint helps maintain favorable contraction velocity at distal joint (length-tension)

Optimizes storage/return of elastic energy (gastrocnemius is essentially in isometric contraction during some running/jumping movements)

Front 77

Weaknesses of biarticular muscles

Back 77

active insufficiency - 2-joint muscle can not shorten enough to permit full ROM at both joints at the same time (too slack)

Passive insufficienty - the muscle cannot lengthen enough to permit full ROM at both joints at the same time (hamstrings)

Body avoids those positions to prevent injury

Front 78

Largest contributors to hip flexion are
others

Back 78

Iliacus, psoas major/minor, and rectus femoris

pectinius, sartorius, TFL

Front 79

Hip flexors - iliacus

Back 79

Inner surface of ilium, sacrum TO lesser trochanter

Flexion and assists in lateral rotation

Front 80

Hip flexors - Psoas

Back 80

Transverse processes, body of L1-L5, T12 TO lesser trochanter

Flexion and assists with lateral rotation

Front 81

Hip Flexors - Rectus Femoris

Back 81

Anterior inferior iliac spine TO patella, tibial tuberosity

Flexion and assists abduction

Front 82

Hip extensors - Semitendinosus

Back 82

Ischial tuberosity TO medial tibia (pes anserine)

Extension and assists medial rotation

Front 83

Which of the hamstrings cross the hip joint?

Back 83

All but the short head of biceps femoris which goes to linea aspera

Front 84

Hip Extensors - Semimembranosus

Back 84

Ischial tuberocity TO medial condyle of tibia

Extension and assists medial rotation

Front 85

Hip extensors - Biceps femoris

Back 85

Ischial tuberosity TO lateral condyle of tibia;head of fibula

Extension and assists lateral rotation

Front 86

Role of hamstrings during stance and swing phases of gait

Back 86

stance - resist gravity's attempt to flex hip, propel body forward by extending thigh

swing- decelerate hip and knee extension

Front 87

Role of gluteus maximus during gait

Back 87

Contralateral swing - resist anterior pelvic rotation (caused by rectus femoris)

Front 88

Gluteus Maximus

Back 88

Posterior ilium, sacrum, coccyx TO gluteal tuberosity, iliotibial band

Hip extensor, lateral rotation

Front 89

Gluteus Medius

Back 89

Anterior, lateral ilium, TO lateral surface of greater trochanter

Abduction and medial rotation

Front 90

Gluteus minimus

Back 90

Outer, lower illium TO front of greater trochanter

abduction and medial rotation

Front 91

Trendelenburg gait

Back 91

disfunctional abductors (glute med/min), intense lateral tilt - use cane on strong side to partially unweight it

Front 92

Hip adductors during gait

Back 92

frontal plane control - resist pelvic tilt to swing side
work as a pair with contralateral abductors
during swing phase, function also as hip flexors
Primary role in stabilizing during stance phase

Front 93

Gracilis

Back 93

Inferior rami of pubis TO medial tibia (pes anserine)

Adduction and assits medial rotation

Front 94

Pectineus

Back 94

Pectinial line on pubis TO bellow lesser trochanter

flexion and adduction

Front 95

Adductor Brevis

Back 95

inferior rami of pubis TO upper half of posterior femur

Adduction

Front 96

Adductor Longus

Back 96

Inferior rami of pubis TO middle third of posterior femur

Adduction, assist medial rotation

Front 97

Adductor Magnus

Back 97

Anterior pubis, ischial tuberosity TO linea aspera on posterior femur, adductor tubercle

Adduction, assist in extension and medial rotation

Front 98

External rotators of the hip
Prime movers
assistants
6 deep hip rotators

Back 98

Prime Movers
• Gluteus maximus
• Sartorius
• 6 deep hip rotators
• Assists
– Biceps femoris
– Psoas
– Iliacus
6 Deep hip rotators
• Piriformis
• Superior gemellus
• Inferior gemellus
• Obturator externus
• Obturator internus
• Quadratus femoris

Front 99

What happens in piriformis "syndrome"?
How can the piriformis be stretched?

Back 99

The sciatic nerve is compressed
Flexion, adduction, and external rotation

Front 100

Iliolumbar ligament

Back 100

transverse process of L5 to iliac crest

limits lumbar motion in flexion, rotation

Front 101

Anterior sacroiliac ligament

Back 101

Thin; pelvic surface of sacrum TO pelvic surface of ilium

Maintains relationship between sacrum and ilium

Front 102

IT band "syndrome"

Back 102

IT band is blamed, but not at fault. Could be overcompensating from pelvic instability
Presents on contralateral side

Rolling could actually be stimulating trigger points on vastus lateralus

Front 103

What might the diagnosis be for anterior hip pain?

Back 103

Difficult to make because it could be lots of things...
labral tear
sports hernia
femoral acetabular impingement (doesn't glide... growth spurs)
Osteoarthritis
Pubic symphysis pain
inguinal hernia

Front 104

Possible mechanism for femoral head or neck fracture

Back 104

Shear force from fall on greater trochanter or sometimes before a fall when people turn

huge problem in elderly (osteoporotic)

Front 105

3 joints in knee region

Back 105

tibiofemoral joint
patellofemoral joint
superior tibiofibular joint

Front 106

Movements at the tibiofemoral joint

Back 106

condyloid - 2 df + some linear motion (slide, present in all joints)
flexion/extension
external/internal rotation

Front 107

Which condyles in the knee joint are convex and which concave?
What does this provide

Back 107

Both condyles of femur are convex
Medial plateau of tibia is oval and concave
Lateral plateau is circular and convex, creating more mobility

Front 108

Functions of the menisci:

Back 108

• Increase the contact surface
• Shock absorption
• Protect bone and cartilage by reducing
friction
• Enhance lubrication of the joint
• Limit motion between tibia – femur

Front 109

Which meniscus is more commonly torn?

Back 109

The medial, c-shaped, less-mobile meniscus

lateral, o-shaped meniscus is more mobile

Front 110

Meniscal movements and causes of translation

Back 110

- posterior with flexion (popliteus, semimembranosus and PCL via posterior meniscofemoral ligament attach on
posterior aspect)
- anterior with extension (quadriceps femoris via patella and ACL attach on
anterior aspect)
- anterior to ipsilateral side with rotation

Front 111

Fibular/lateral collateral ligament

Back 111

Lateral epicondyle of femur TO head of fibula

Resists varus forces, taut in extension

Front 112

Medial/tibial collateral ligament

Back 112

Medial epicondyle of femur to medial condyle of tibia and medial meniscus

Resists valgus forces; taut in extension; resists internal, external rotation

Front 113

What position would you want to put the
knee in assess collateral ligament integrity?

Back 113

Slight flexion, so stability isn't due to bony congruence (screw-home)

Front 114

Varus force

Back 114

Laterally driven, distal segment forced medially, injures lateral collateral ligament

"var is the ball?"

Front 115

Valgus Force

Back 115

Medially driven (from outside)
Distal segment forced laterally
Injures medial collateral ligament

Front 116

Posterior cruciate ligament

Back 116

posterior spine of tibia TO inner condyle of femur

Resists posterior tibial movement; resists flexion and rotation

Front 117

Anterior cruciate ligament

Back 117

Anterior intercondylar area of tibia TO medial surface of lateral condyle
Back of femur to front of tibia

Prevents anterior tibial displacement; resists extension, internal rotation, and flexion

Front 118

Screw home mechanism

Back 118

locking action; external tibial rotation in the last 20 degrees of extension

Caused by differences in sized of condyles
perhaps from ACL being taut just prior to extension forcing the rotation?

Front 119

Patellofemoral Compressive
Force in extension and flexion

Back 119

Extension: larger contact area and less
patellofemoral compressive force
Flexion: smaller contact area and more
patellofemoral compressive force

Front 120

Forces in the knee in flexion and extension

Back 120

Flexion:
- Posterior shear forces increase
(stresses PCL)
- Patellofemoral compressive forces
increase
Extension:
- Anterior shear forces increase
(stresses ACL)
- Patellofemoral compressive forces
decrease

Front 121

What kind of patellar tracking occurs with a Q angle less than 10 degrees?
More than 17?

External tibial torsion?
Internal tibial torsion?

Back 121

Medial tracking (genu varum)
Lateral tracking (genu valgum)

Q-angle above or below normal values is associated with increased incidence of patellofemoral pain syndrome

External tibial torsion? lateral tracking
Internal tibial torsion? medial

Front 122

What is the type and role of the superior tibiofibular joint

Back 122

plane/gliding joint

relieves the tibia - takes on 10-20% of BW when weight-bearing

Motion at ankle is impacted if it's not moving (talocrural joint)
Biceps femoris attaches there, on fibula

Front 123

About how many bursae are in the knee joint region?

Back 123

around 20 fat pads, they provide a protective, gliding surface

Front 124

Knee flexors
prime movers and assistors

Back 124

PM: Biceps femoris, semimenbranosus, semitendinosus

Asst: gastrocnemius, gracilis, popliteus, sartorius

(gracilis and sartorius to pes anserinus)

Front 125

Knee extensors

Back 125

PM: rectus femoris, vastus intermedius, vastus lateralis, vastus medialis

Front 126

Hamstrings are more effective at ___ the knee if hip is flexed

Rectus femoris - more effective knee ____ if hip is extended

Back 126

Flexing

Extensor

Front 127

Internal rotators at the knee

Back 127

Popliteus (medial to lateral lip of femoral condyle, unlocks the knee))
Semitendinosus
Sartorius
Gracilis

Front 128

External rotators at the knee

Back 128

Biceps femoris (on lateral side of midline)

Front 129

Knee joint stability influenced by

Back 129

Passive restraint of ligaments
Joint geometry - plateaus,size of condyles
Muscle activity
Compressive forces (pushing bones together, patella into femur, body weight)

Front 130

Genu Recurvatum

Back 130

hyperextension of knee, stretched joint capsule and ligaments
Some stand that way because of quad weakness (passive rather than active support)

Scary video!

Front 131

The "unhappy triad"

Back 131

ACL tears, MCL, Medial Meniscus
In addition to ACL injury:
Menisci (50%)
Articular cartilage (30%)
Collateral ligaments (30%)

Front 132

Mechanisms of ACL injury

Back 132

Usually non-contact
- excessive anterior tibial
displacement
- internal tibial rotation
- valgus force
e.g. right foot fixed while body
rotates to the right
e.g. landing off-balance
Plant and change directions

Front 133

Is ACL reconstruction always necessary? How's it done?

Back 133

Some are fine without ACL if they have good mechanics and strong quads

Autographs from part of
Patellar ligament
Semitendinosus tendon (most common)
Quadriceps tendon

high success rates

Front 134

ACL injuries: gender differences

Back 134

• Women: 4-6x more likely to sustain ACL injury
Theories:
• Anatomic
– wider pelvis, increased valgus knee (incr. Q angle)
– Increased foot pronation
– narrower femoral intercondylar notch (‘rubs’ on ACL?)

• Hormonal effects on laxity of ligaments
– Inconclusive measurements of laxity
– Some reports of increased rupture rates during ovulatory
phase

most support for:
• Biomechanical/Neuromuscular control
differences
– Landing stiffer, less knee flexion (more taut), flatter foot
– Greater knee abduction angle at landing
– 2.5 times greater knee abduction moment
– 20% higher ground reaction force (whereas contact
time was 16% shorter) hence, increased motion,
force, and moments occurred more quickly.
– Muscular timing/patterns/strength (quads vs. hams)

• High-risk movement patterns in ‘jumping and
cutting’ sports (VB, BB, Soccer)
– One-leg landings
– Out-of-control baseline landings
– Straight-leg landings
– Upright torso during cutting

Front 135

PCL injury
Name and causes

Back 135

• “Dashboard injury”
• Falling on bent knee - PCL taut in flexion
• Forced knee hyperextension

Front 136

Meiniscal tears

Back 136

Cutting- bucket handle tear
Forced flexion - peripheral tear

Can be traumatic or degenerative
Inconsistent pain
In athletic population
Location of injury matters - lateral part has good blood supply, while inner sections usually need surgical repair

Front 137

Patellofemoral pain

Back 137

Multifactorial:
structural
muscular
alignment
-rotation
-Q angle

Not the knee's fault

Front 138

Lateral and medial retinaculum are

Back 138

connective tissue systems that contribute to patellar control and tracking

Front 139

The pes anserinus is the common insertion of

Back 139

sartorius, gracilis, and semitendinosus

Front 140

"Breast stroker's knee"

Back 140

Bursitis
Maybe from sartorius being overactive
Re-educate the gluteus maximus to do its part and let the sartorius take a break