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119 Cards in this Set
- Front
- Back
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What injury does anterior compression forces cause to hip? |
fractures of pubic rami |
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what injury do lateral compressive forces and falls from roofs landing on feet cause at the hip? |
fractures of acetabulum |
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what is a complication of a femoral neck fracture? |
disruption of the blood supply of the obturator artery to the head of the femur causing aseptic necrosis |
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what ligaments blend with the joint capsule of the hip? |
iliofemoral, ischiofemoral and pubofemoral |
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What movement does iliofemoral ligament resist? |
aka "Y" ligament resists extension |
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what movement does the ischiofemoral ligament resist? |
Extension and IR |
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what movement does pubofemoral ligament resist? |
abduction |
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what is the position of the femoral neck relative to the axis of the femur? |
femoral neck is rotated 15 deg anterior = anteversion |
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what can excessive anteversion cause? retroversion? |
increased IR leading to toe-in gait pattern retroversion will cause ER of limb and toe-out gait pattern |
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what are actions of the iliopsoas in open and closed chain? |
open: flexes hip closed: tilts pelvis anteriorly and increases lumbar lordosis |
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What are the major hip extensors? |
glut max and HS |
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What are the major abductors? |
glut med and min -stabilize pelvis in unilateral stance to prevent opposite side of pelvis from dropping -in open chain: work with TFL and piriformis to abduct femur |
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What are the prime hip adductors? |
adductor longus, brevis and magnus -contract during swing phase -can assist in extension and rotation of the femur |
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what are the prime muscles for hip ER and IR? |
IR: glut med and min (anterior fibers) ER: obturator externus and quadratus femoris rotators fine tune femoral position during gait and open chain activities |
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What is the largest nerve in the body? |
sciatic nerve |
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What is the path of the sciatic nerve? |
main branch of sacral plexus-->passes under piriformis (sometimes splits on either side over mm)-->enters thigh via sciatic notch near the ischial tuberosity-->branches into tibial and common peroneal nn about halfway or more down the thigh |
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Does sciatic nerve supply proximal structures? |
supplies NO muscles in gluteal region |
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What two places can cause sciatic nerve compression? |
piriformis syndrome occasionally the HS can be involved in sciatic nn compression and irritation |
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what attaches to the epicondyles of the femur? |
tibial and fibular collateral ligaments |
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what type of joint is the tibiofemoral joint? |
modified hinge that allows some rotation between distal femur and proximal tibia |
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what structures does the joint capsule of the knee enclose? |
surrounds femoral condyles and tibial plateaus and reinforced by blending with medial and lateral collateral ligaments |
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What are the functions of the collateral ligaments of the knee? |
primary restraints to valgus and varus stresses especially between full ext and 30 deg of flexion |
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What are the functions of the cruciate ligaments of the knee |
ACL & PCL stabilize the knee in the anterior-posterior and rotational planes of movement and taut throughout knee AROM |
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What shape and composition are the menisci? What are the functions of the menisci? |
2 semi-lunar fibrocartilage discs that deepen tibial fossa and incr knee stability -shock absorbers by spreading the load over articular cartilage -lateral menisci is smaller, more circular and moves > than medial menisci |
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how does the patella improve knee function? |
provides mechanical advantage to quadriceps by acting as pulley |
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what are the ligamentous and tendon attachments at the knee? |
-QUADRICEPS TENDON attaches to patella superiorly and continues distally as patella ligament to the tibial tuberosity -VASTUS MEDIALIS tendon forms medial retinaculum -VSTUS LATERALS forms lateral retinaculum -ITB attachment on lateral border of patella |
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Describe the knee locking mechanism. |
knee locks with medial rotation of femur in closed chain -lateral rotation of tibia in open chain -to unlock the femur is rotated laterally and the tibia is rotated medially = action of popliteus |
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How much of the force do the menisci transmit across the knee? |
50% in full ext and 85% at 90 deg flexion i.e. more in flexion than ext |
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how do the menisci move during flexion/ext? |
-menisci move with tibia during flexion ext. -i.e. move anteriorly during ext and posteriorly during flexion (same as tibia concave on convex) |
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what is the blood supply of the mensici |
inner 2/3 is avascular outer 1/3 is partly vascular |
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When are the LCL and MCL taut? |
LCL is tauter in tibial internal rotation MCL is tauter in tibial external rotation |
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Which collateral ligament is more likely to be injured? |
MCL: has an attachment to medial meniscus which is also more likely to be injured than lateral meniscus |
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When is rupture of the MCL likely to occur? |
lateral blow to knee and often associated with tearing of the medial meniscus and ACL |
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what knee ligament is the strongest? |
PCL |
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How do ACL and PCL run? |
ACL runs from anterior-medial tibia to posterior-lateral femur PCL runs from posterior-lateral tibia to anterior-medial femur |
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what does PCL prevent? |
posterior displacement of the tibia and hyperflexion/hyperextension of the knee joint. |
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when is PCL commonly damaged? |
when superior part of tibia is struck with the knee flexed such as in MVA- knee struck by dashboard |
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What is the most commonly injured knee ligament? |
ACL |
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what movements does ACL prevent? |
taut in extension prevents anterior translation of the tibia and hyperextension of the knee |
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When is ACL likely to be injured? |
tibia driven anteriorly femur driven posteriorly on tibia or knee hyperextended with tibial IR |
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What muscle is important in prevent lateral knee dislocation? |
Vastus medialis oblique (VMO) resists lateral displacement of the patella out of trochlear groove during CLOSED chain activites |
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when can patella injuries occur? |
poor activation or strength of the VMO or tightness of the ITB or lateral retinaculum can lead to patellofemoral syndrome |
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what are the prime knee extensors? |
quadriceps: rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius |
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when does the most stress to the ACL occur? |
0-75 deg: quads pulls tibia anteriorly against ACL -most stress on ACL from quads occurs from 45-0 deg (OKC) |
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what muscle assists the ACL in restraining anterior displacement of the tibia? |
Hamstrings |
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What are the functions of the hamstring in OPEN chain activities? |
primary flexors of the knee biceps femoris externally rotates tibia semimembranosus internally rotates tibia and retracts the medial meniscus |
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what are the functions of the HS in CLOSED chain? |
control hip flexion and knee extension |
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where does the suprapatellar bursa lie? |
between the femur and the quadriceps tendon |
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where does the popliteus bursa lie |
between the popliteus tendon and the lateral tibial condyle |
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where does the anserine bursa lie? |
between tendons of sartorius, gracilis, semitendinosus tendons and the proximal part of the medial surface of the tibia |
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where does the gastrocnemius bursa lie? |
deep to the attachment of the tendon of the medial gastrocnemius |
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does anything lie between tibia and fibula? |
yes, interosseous membrane |
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describe the distal end of the tibia? |
smaller than proximal end -has facets for talus and fibula -projects medially and inferiorly as the medial malleolus |
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Where do tibial fractures occur most frequently? |
in the middle of the shaft, at its narrowest part |
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when can a spiral tibial fracture happen? |
from severe torsion such as during a skiing accident |
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What is a complication that may occur with tibial fractures? |
has poor blood supply even stable, undisplaced fractures can take up to 6 months to heal |
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What forms the lateral malleolus and where is it in relation to the medial malleolus? |
distal end of fibula forms lateral malleolus lateral malleolus lies more inferior and posterior than medial |
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What bones does the talus articulate with? |
tibia, fibula, calcaneous, navicular (talus lies medial) |
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what shape is the superior articular surface of the talus? |
saddle shaped: bears the weight of the body |
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what is the largest bone in the foot? |
calcaneus & the first to ossify |
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what does the calcaneus articulate with? |
articulates with the talus superiorly and the cuboid anteriorly |
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where does the navicular lie? |
between the head of the talus and the 3 cuneiforms |
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what does the cuboid articulate with? |
lies laterally articulates with navicular, calcaneous, lateral cuneiform, 4th and 5th metatarsals |
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what do the cuneiform bones articulate with? |
-all articulate with navicular proximally -medial cuneiform articulates with 1st metatarsal -Intermediate cuneiform articulates with 2nd metatarsal -lateral cuneiform articulates with cuboid and 3rd metatarsal |
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what is the function of the sesamoid bones on the plantar surface of the first metatarsal? |
give FHL muscle a mechanical advantage |
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what injury can occur with violent inversion of the foot? |
avulsion of the tuberosity of the fifth metatarsal into which the peroneus brevis tendon inserts |
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what are the 4 functional regions of the foot? |
1. ankle 2. rearfoot 3. midfoot 4. forefoot |
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what type of joint is the distal tibiofibular joint? |
syndesmosis joint |
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what is the distal tibiofibular joint stablized by? |
-inferior transverse ligaments -interosseous ligament -anterior and posterior tibiofibular ligaments |
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what movement occurs at the distal tibiofibular joint? |
fibula rotates laterally with DF (opposite of what's shown in this picture) |
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what are the bones of the talocrural joint? |
tibia fibula talus |
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what type of joint is the talocrural and shape of articular surfaces |
uniaxial modified hinge concave surfaces on distal talus, medial malleolus, and lateral malleolus |
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what are the ligament support structures of the talocrural joint? |
medially: deltoid ligament laterally: calcaneofibular ligament anterior talofibular ligament posterior talofibular ligament |
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what ankle sprain is most common? |
inversion sprain to lateral ligaments |
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what bones form the subtalar joint? |
talus and calcaneus |
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what type of joint is the subtalar joint? |
synovival joint with oblique axis allowing triplanar movement |
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what are the ligaments of the subtalar joint? |
ML PL I: medial and lateral collateral ligaments posterior and lateral talocalcaneal ligament interosseous talocalcaneal ligament |
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what are the movements of the subtalar joint? |
open chain pronation: dorsiflexion, eversion, and ABDuction of calcaneous open chain supination: inversion, plantarflexion and ADDuction of the calcaneous |
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what joints make up the midfoot joint? |
talonavicular, calcaneocuboid, naviculocuboid, naviculocuneiform, intercuneiform |
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what shape is the talonavicular joint? |
ball and socket (navicular is concave, talus is convex) |
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what shape is the calcaneocuboid joint? |
saddle joint |
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what ligaments support the talonavicular and calcaneocuboid joints? |
DDCC: deltoid, dorsal talonavicular, calcaneonavicular, and calcaniocuboid ligaments |
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what type of joint is the intercuneiform, naviculocuboid, and naviculocuneiform joint? |
plane synovial |
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what movements occur at midfoot/transverse tarsal/midtarsal joint? |
inversion and adduction eversion and abduction -tied in with subtalar pronation and supination -assists in pron/sup by elevating longitudinal arch in supination and lowering arch in pronation |
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what is transverse tarsal/midtarsal joint function in closed chain? |
compensation for subtalar pronation -subtalar pronation lifts lateral portion of forefoot off ground -midtarsal compensates by allowing forefoot to move into relative supinated position to allow forefoot to remain in contact with the ground -during subtalar supination, midtarsal joint restricted in ability to compensate for subtalar movement and midtarsal carried into supination as well which assist in push-off phase of gait when foot is required to be rigid lever but can result in injury on uneven ground |
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what are the joints of the forefoot? |
tarsometatarsal intermetatarsal metatarsophalangeal interphalangeal
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what type of joints are the TMT? |
plane synovial
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what type of joint is the IMT? |
plane synovial
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what type of joint is the MTP joint? |
condyloid |
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what type of joint is the IP joints of foot? |
uniaxial synovial hinge |
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what movement occurs at the MTP joint? |
flexion, ext, abd and adduction |
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what movement occurs at the foot IP joints? |
flexion and extension |
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what movement occurs at the TMT joint in Open chain? |
assist midtarsal in compensating for terrain and maintaining contact with surface -DF force across TMT-->extension of 5 MTs with inversion of 1st 2 rays and eversion of last 2 rays (flattening contour of plantar surface) -PF force flexes the TMT everting the first 2 rays and inverting last two rays (cupping plantar surface) |
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Describe how talus glides during DF/PF |
during DF, talus slides posterior (convex talus moving on concave tibia) -add joint stability and decr joint mobility During PF, talus slides anterior and disengages from tibia/fibula -increase joint mobility and decr joint stability |
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What is the motion that occurs at subtalar joint during weightbearing/closed chain activities? |
Pronation= calcaneal eversion with PF and adduction of talus on calcaneus and medial rotation of tibia and fibula (i.e. the leg)
Supination= calcaneal inversion with DF and abduction of talus on calcaneus + lateral rotation of tibia and fibula
https://www.youtube.com/watch?v=0R4zRSE_-40 |
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what does the pronated subtalar joint allow during gait cycle? what does the supinated subtalar joint allow during the gait cycle? |
pronated subtalar joint allows foot to conform to irregular surfaces supinated subtalar joint provides rigid lever that allows propulsion |
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What joint does the supination and pronation twist occur? |
tarsometatarsal (TMT)
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what movement does the TMT joint produce in closed chain? |
supination twist: supination of TMT in closed chain = 1st & 2nd ray (metatarsal + medial and middle cuneiform) DF and 5th and 4th mets PF rotating foot into inversion
Pronation Twist: Pronation of TMT in open chain = 1st and 2nd ray PF and 4th and 5th mets DF rotating foot into eversion (*this allows the forefoot to stay in contact with the ground during gait when hindfoot and midtarsal joint are locked in supination) |
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What are the posterior superificial muscles of the lower leg? |
gastronemius and soleus |
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What joints does the gastronemius cross and what motions does it cause in open chain? |
crosses knee and ankle -causes knee flexion in open chain |
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what joints does the soleus cross and what motion does it cause? |
crosses ankle and with gastroc causes ankle PF |
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what are the deep posterior muscles of the lower leg? |
posterior tibialis, flexor digitorum longus and flexor hallucis longus (Tom, dick, and harry)
-also the above order is the order of the tendons from anterior to posterior behind the medial malleolus (e.g. post. tib = most anterior/closest to medial malleolus) |
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What is the function of the posterior tibialis muscle in open chain? |
ankle INversion and PF |
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what is the function of the posterior tibialis in closed chain? |
main function is to control anterior movement of TIBIA on ankle during midstance (along with FDL and FHL helping)
-i.e. eccentric control of the DF produced by anterior tibialis |
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What are the lateral muscles of the lower leg? |
peroneus longus and brevis |
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what are the function of the peroneus longus and brevis in open chain? |
concentrically contract to produce eversion of foot and ankle -longus also produces pronation at subtalar joint |
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what are the function of the peroneus longus and brevis in closed chain? |
peroneus longus supports the transverse and longitudinal arches and stabilizes 1st metatarsal during push-off (attaches to lateral side of the plantar surface of the navicular and base of 1st metatarsal) -peroneus brevis stabilizes the mid tarsal joint (attachment on base of 5th met) |
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what muscle contributes to arch stability in the foot? |
peroneus longus, posterior tibialis, and foot intrinsics |
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what muscles make up the anterior compartment of the lower leg? |
anterior tibialis, EHL , EDL |
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what do the EHL and EDL do in open chain? |
extend the toes and dorsiflex ankle |
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what do the anterior compartment muscles do in closed chain activities? |
anterior tibialis, EHL, EDL -contract eccentrically to control PF as foot goes from heel strike to foot flat in gait |
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what are the intrinsic muscles of the foot? |
Plantar surface: Flexor digitorum brevis (FDB) flexor hallucis brevis (FHB) abductor hallucis adductor hallucis lumbricals
Dorsal surface: Extensor hallucis brevis |
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what is the function of the foot intrinsic muscles? |
stabilize the mid tarsal joint and forefoot |
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what are the 3 arches of the foot? |
medial longitudinal lateral longitudinal transverse arch |
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what bones do the longitudinal arches extend from? |
from calcaneus to metatarsal heads |
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What is the dynamic and static support of the medial longitudinal arch? |
dynamic support: peroneus longus, posterior tibialis, foot intrinsics, FHL
Static support: plantar calcaneonavicular ligament (spring ligament) |
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what structure supports the lateral longitudinal arch? |
long plantar ligament |
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what bones form the transverse arch? |
formed by the cuboid and cuneiforms -supported by metatarsal heads and a musculoligamentous complex which prevents the metatarsals from spreading out |
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where can you palpate the dorsal pedal pulse? |
dorsal pedis artery is on the dorsum of the foot -palpated as crosses over navicular and cuneiform bones just lateral to EHL -must palpate to rule out intermittent claudication |
