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644 Cards in this Set
- Front
- Back
what's the hip bone formed by?
|
fusion of ilium, ischium, and pubis of pelvis
|
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what does the hip bone articulate w/?
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sacrum @ sacroiliac joint to form pelvic girdle
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what part of hip bone does ilium make up?
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lateral part
|
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what does the ilium, pubis, and ischium join to form?
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acetabulum
|
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what are the parts of the ilium?
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body
ala/wing anterior-superior iliac spine anterior-inferior iliac spine posterior iliac spine greater sciatic notch iliac fossa gluteal lines |
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what does the pubis form?
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anterior part of acetabulum
anteromedial part of hip bone |
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what does the ischium form?
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posteroinferior part of acetabulum
lower posterior part of hip bone |
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what are the parts of the pubis?
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body
superior ramus inferior ramus part of obturator foramen |
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what are the parts of the ischium?
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body
ramus ischial spine ischial tuberosity lesser sciatic notch |
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what's the ischiopubic ramus formed by?
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ischium joining inferior pubic ramus
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what is the acetabulum?
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incomplete cup-shaped cavity on lateral side of hip bone where femur fits
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what are the parts of the acetabulum?
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acetabular notch
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what's it formed by?
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ilium- superiorly
ischium-posteroinferiorly pubis-anteromedially |
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what's the femur's claim to fame?
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longest and strongest bone in body!
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what are the main parts of the femur?
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head
neck greater trochanter lesser trochanter linea aspera pectineal line adductor tubercle |
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how is head of femur positioned in acetabulum?
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directed medially, upward, and slightly forward to fit
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what is a special part of femur head?
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fovea capitis femoris- depression in articular surface
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how do you dislocate the femoral head?
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you get old! (osteoperosis)
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how do you fix a dislocated femoral head?
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hip replacement
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how does a dislocated femoral head present?
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shortened lower limb w/ medial rotation
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what happens if you fracture the neck of the femur? why?
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ischemic necrosis of the neck and head b/c of an interruption of blood supply from the medial femoral circumflex artery
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how does a fractured femur neck present in clinic?
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pull of distal fragment upward by quadriceps femoris, adductors and hamstring muscles so that the affected lower limb is shortened w/ lateral rotation
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what is a pertrochanteric fracture?
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-femoral fracture thru trochanters
-form of extracapsular hip fracture |
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who is pertrochanteric fracture more common in?
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elderly women than men b/c osteoperosis contribs to this
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what does the neck of the femur do?
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connects the head to the body
forms an angle of about 125 degrees w/ the shaft fractures commonly! |
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what is the neck separated from the shaft by?
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intertrochanteric line
|
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where is the greater trochanter?
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projects upward from the junction of the neck with the shaft
|
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where is the lesser trochanter?
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lies in angle b/w neck and shaft
projects at the inferior end of the intertrochanteric crest |
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what's the linea aspera?
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rough line or ridge on the body of the femur
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where's the pectineal line?
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runs from lesser trochanter to medial lip of linea aspera
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what's the adductor tubercle?
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small prominence at uppermost part of medial femoral condyle
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what's the result of a dislocated knee or fractured distal femur?
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may injure the popliteal artery b/c of the artery's deep position next to femur and knee joint capsule
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how do you get a transverse patellar fracture?
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from a blow to the knee or from sudden contraction of the quadriceps muscle
|
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what's the result of the transverse patellar fracture?
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-proximal fragment of patella is pulled superiorly w/ quadriceps tendon
-distal fragment stays w/ patellar ligament |
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what's a bumper fracture?
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fracture of the lateral tibial condyle that's caused by an automobile bumper
|
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what's the result of a bumper fracture?
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common peroneal nerve injury
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what's the patella's claim to fame?
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largest sesamoid bone
|
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what are the patella's funcs?
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-prevents wear and attrition (wearing down) on the quadriceps tendon as it passes across the trochlear groove
-increases angle of pull of quadriceps femoris, magnifying its power |
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what tendon encloses the patella?
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w/i the quadriceps femoris tendon
|
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what are the tibia's funcs?
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-weight-bearing medial bone of leg
-has tibial tuberosity that patellar ligament uses as an insertion -articulates w/ femur condyles by using its medial and lateral condyles |
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what are the tibia's parts?
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tibial tuberosity
medial condyles lateral condyles medial malleolus malleolar groove |
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what's the fibula's func?
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not weight bearing
provides attachment for muscles -lateral malleolus articulates w/ trochlea of talus |
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what are the parts of the fibula?
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head
lateral malleolus sulcus |
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what is Pott's fracture (Dupuytren's fracture)?
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fracture of the lower end of the fibula
|
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what fractures often accompany Pott's fracture (Dupuytren's fracture)?
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medial malleolus frature
deltoid ligament rupture |
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what causes Pott's fracture (Dupuytren's fracture)?
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forced eversion of foot
|
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what's Pillion's fracture?
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T-shaped fracture of the distal femur w/ displacement of the condyles
|
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what causes Pillion's fracture?
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blow to the flexed knee of a person riding pillion on a motorcycle (riding on the seat behind the main seat)
|
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what's the result of a fracture of the fibular neck?
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injury to the common peroneal nerve
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what's the result of the fracture of the fibular neck?
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common peroneal n injury:
paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexors and evertors of the foot), causing foot drop! |
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how many bones in tarsus?
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7 tarsal bones
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list the bones of the tarsus:
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talus
calcaneus navicular bone cuboid bone 3 cuneiform bones |
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what is the func of the talus?
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-transmits the weight of the body from the tibia to the foot
-its head serves as the keystone of the medial longitudinal arch of the foot |
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what's the talus' claim to fame?
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only tarsal bone w/o muscle attachments
|
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what are the parts of the talus?
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neck
sulcus tali body head |
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what's calcaneus' claim to fame?
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largest and strongest bone of foot
|
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where is the calcaneus?
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lies below the talus
|
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what are the parts of calcaneus?
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sustentaculum tali
groove |
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what's the calcaneus' func?
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forms the heel of the foot
provides an att for Achilles tendon |
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what's the sustentaculum tali?
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medial projection from the calcaneus
supports the head of the talus has groove |
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what's the navicular bone?
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boat-shaped tarsal bone b/w the head of the talus and the 3 cuneiform bones
|
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what's special about the cuboid bone?
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-most lateraly placed tarsal bone
-serves as keystone of lateral longitudinal arch of foot |
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what are the cuneiform bones?
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3 wedge shaped bones that form part of medial longitudinal and proximal transverse arches
|
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what is the metatarsus made up of?
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5 metatarsals
|
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what's the march fracture (stress fracture)?
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fatigue fracture of one of the metatarsals
|
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how can you get the march fracture?
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prolonged walking
|
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what population has common metatarsal fractures?
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female ballet dancers when they lose their balance and put their full body weight on the metatarsals
|
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how many phalanges?
|
14 bones: 2 in 1st digit
3 in ea other digit |
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what type of joint is the hip (coxal) joint?
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multiaxial ball-and-socket synovial joint
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what is the hip joint a joint b/w?
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acetabulum of hip bone and head of femur
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what mvmnts does hip joint allow?
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abduction
adduction flexion extension circumduction rotation |
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what stabilizes hip joint?
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acetabular labrum
fibrous capsule capsular ligaments |
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what deepens the hip joint cavity?
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fibrocartilaginous acetabular labrum
|
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what completes the hip joint cavity?
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transverse acetabular ligament, which converts acetabular notch into foramen for passage of nutrient vessels and nerves
|
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what supplies the blood to the hip joint?
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medial femoral circumflex arteries
lateral femoral circumflex arteris superior gluteal inferior gluteal obturator arteries |
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what artery does the posterior branch of the obturator artery give rise to?
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artery of ligamentum teres capitis femoris
|
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what's the acetabular labrum?
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complete fibrocartilage rim that deepens articular socket for the head of the femur and then stabilizes the hip joint
|
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what does the fibrous capsule of the hip joint enclose?
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part of the head of the femur
most of the neck of the femur |
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what reinforces the fibrous capsule of the hip joint?
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ant- iliofemoral ligament
post- ischiofemoral ligament inf- pubofemoral ligament |
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what's coxa valga?
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alteration of the angle made by the axis of the femoral neck to the axis of the femoral shaft
angle exceeds 135 degrees femoral neck straightens out |
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what's coxa vara?
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alteration of angle made by axis of femoral neck to the axis of the femoral shaft
angle is less than 135 degrees femoral neck becomes more horizontal |
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what's the iliofemoral ligament?
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largest and most important ligament that reinforces the fibrous capsule anteriorly
in form of an inverted Y |
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what's the purpose of the iliofemoral ligament?
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resists hyperextension and lateral rotation at the hip joint during standing
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what's the purpose of the ischiofemoral ligament?
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reinforces the fibrous capsule posteriorly
limits extension and medial rotation of the thigh |
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what's the purpose of the pubofemoral ligament?
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reinforces the fibrous capsule inferiorly
limits extension and abduction |
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what's the round ligament of the head of femur?
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ligamentum teres capitis femoris
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what's the purpose of ligamentum teres capitis femoris?
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provides pathway for the artery of the ligamentum capitis femoris (foveolar artery) from the obturator artery
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what's the importance of the foveolar artery?
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supplies significant amt of blood to femoral head during childhood
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what's the func of the transverse acetabular ligament?
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bridges acetabular notch
converts acetabular notch into a foramen that allows entrance of nutrient vessels into joint |
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what's the largest and most complicated joint?
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knee joint!
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what type of joint is knee joint?
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condylar type of synovial joint
saddle joint |
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what is condylar type of synovial joint of knee b/w?
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2 condyles of femur and tibia
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what's saddle joint of knee b/w?
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femur and patella
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what encompasses the knee joint?
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fibrous capsule
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describe fibrous capsule?
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thin, weak and incomplete
surrounds lateral and post aspects of knee joint |
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what mvmnts does knee joint permit?
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flexion
extension some gliding rotation in flexed position full extension w/ medial rotation |
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what stabilizes the knee joint laterally?
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laterally- biceps and gastrocnemius
iliotibial tract fibular collateral ligaments |
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what stabilizes the knee joint medially?
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sartorius
gracilis gastrocnemius semitendinosus semimembranosus tibial collateral ligament |
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what does knee joint get blood from?
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genicular branches of popliteal artery
descending branch of lateral femoral circumflex artery articular branch of descending genicular artery anterior tibial recurrent artery |
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what's the knee innervated by?
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sciatic n
femoral n obturator n |
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what supports knee?
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several ligaments
menisci |
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what does hemarthrosis (blood in joint) cause?
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rapid swelling of injured knee joint
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what does inflammatory joint effusion cause?
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slow swelling of knee joint
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what are the ligaments of the knee?
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anterior cruciate ligament
posterior cruciate ligament |
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where is the anterior cruciate ligament?
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inside knee joint capsule
outside synovial cavity of joint |
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how does the ACL compare to the PCL?
|
ACL IS LONGER
|
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what's the purpose of the ACL?
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prevents forward sliding of the tibia on the femur (or posterior displacement of the femur on the tibia)
prevents knee joint hyperextension |
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when is ACL taut and when is it lax?
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taut- knee extension
lax- knee flexion |
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how does ACL get torn?
|
when knee is hyperextended
|
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where is the posterior cruciate ligament?
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outside synovial cavity
inside fibrous joint capsule |
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what condyles do ACL and PCL att to?
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ACL- lateral femoral condyle
PCL- medial femoral condyle |
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how does PCL compare in size to ACL?
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PCL is shorter, straighter and stronger than ACL
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what's the func of PCL?
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prevents backward sliding of tibia on femur (or anterior displacement of femur on tibia)
limits hyperflexion of knee |
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when is PCL taut? lax?
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taut- knee flexion
lax- knee extension |
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what's the anterior drawer sign?
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forward sliding of tibia on femur b/c of ACL rupture
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what's the posterior drawer sign?
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backward sliding of tibia on femur caused by PCL rupture
|
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which meniscus of knee is more frequently torn in injuries? why?
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medial meniscus b/c of its strong att to tibial collateral ligament
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where is the medial meniscus?
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outside synovial cavity
w/i joint capsule |
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what's the shape of meniscus?
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C-shaped: semicircle
|
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what's the func of medial meniscus?
|
acts as cushion or shock absorber
lubricates articular surfaces by distributing synovial fluid in windshield wiper fashion |
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when does "unhappy triad" of knee joint happen?
|
when football player's cleated shoe is planted firmly in turf and knee is struck from lateral side
|
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how does an "unhappy triad" present?
|
markedly swollen knee, (esp in suprapatellar region)
results in tenderness on application of pressure along tibial collateral ligament |
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what is damaged in "unhappy triad"?
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-rupture of tibial collateral ligament
-tearing of anterior cruciate ligament b/c of forward displacement of tibia -injury to medial meniscus b/c of att to tibial collateral ligament att |
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where is the lateral meniscus?
|
outside synovial cavity
within joint capsule |
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what's the shape of lateral meniscus?
|
nearly circular
|
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what's the func of lateral meniscus?
|
acts as a cushion
facilitates lubrication forms more stable base for articulation of femoral condyle |
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what happens if medial (tibial) collateral ligament is damaged? why?
|
results in injury to medial meniscus b/c the 2 are firmly attached to ea other
|
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what's the func of the medial (tibial) collateral ligament?
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-prevents medial displacement of 2 long bones and thus abduction of the leg @ the knee
-becomes taut on extension and limits extension and abduction of leg |
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what's the func of the medial (tibial) collateral ligament?
|
prevents medial displacement of the 2 long bones and thus abduction of the leg at the knee becomes taut on extension and thus limits extension and abduction of the leg
|
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what is knock knee (genu valgum)?
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deformity in which the tibia is bent or twisted laterally
|
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what can cause knock knee?
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from collapse of the lateral compartment of the knee and rupture of the medial collateral ligament
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what is bowleg (genu varum)?
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deformity in which the tibia is bent medially
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what can cause bowleg?
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collapse of the medial compartment of the knee and rupture of the lateral collateral ligament
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what's the func of the lateral (fibular) collateral ligament?
|
becomes taut on extension and limits extension and adduction of the leg
|
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which ligament is a continuation of the quadriceps femoris tendon?
|
patellar ligament
|
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what's the patellar ligament's claim to fame?
|
part of it can be used to fix the anterior cruciate ligament
|
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what's the patellar tendon reflex?
|
a tap on the patellar tendon elicits extension of the knee joint
|
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where are both the afferent and efferent limbs of the reflex arc for the patellar tendon reflex?
|
femoral nerve (L2-L4)
|
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what can be used for tendon autografts to the long flexors of the fingers?
|
plantaris muscle tendon
|
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what are the intracapsular ligaments of the knee?
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ACL, PCL, medial meniscus, lateral meniscus, transverse ligament
|
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what are the extracapsular ligaments of the knee?
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medial (tibial) collateral ligament, lateral (fibular) collateral ligament, patellar ligament (tendon), arcuate popliteal ligament, oblique popliteal ligament, popliteus tendon
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what's the func of oblique popliteal ligament?
|
resists hyperextension of the leg and lateral rotation during the final phase of extension
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what tendon is the oblique popliteal ligament an oblique expansion of?
|
semimembranosus tendon
|
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what's the major bursa communicating w/ the knee joint cavity?
|
suprapatellar bursa
|
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what other bursa also may communicate w/ the knee joint cavity?
|
semimembranosus bursa
|
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list the bursae of the knee:
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suprapatellar bursa, prepatellar bursa, infrapatellar bursa, anserine bursa/ pes anserinus
|
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what's the infrapatellar bursa consist of?
|
subcutaneous infrapatellar bursa, deep infrapatellar bursa
|
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what's prepatellar bursitis (housemaid's knee)?
|
inflammation and swelling of the prepatellar bursa
|
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what's a popliteal (Baker's) cyst?
|
swelling behind the knee
|
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what can cause popliteal cyst?
|
knee arthritis, meniscus injury, herniation or tear of the joint capsule
|
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what is impaired by a popliteal cyst?
|
flexion and extension of the knee joint
|
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what makes the popliteal cyst pain worse?
|
worse when knee fully extended, like during prolonged standing or walking
|
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how do you treat a popliteal cyst?
|
draining and decompressing the cyst
|
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list the tibiofibular joints:
|
proximal tibiofibular joint, distal tibiofibular joint
|
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what type of joint is the proximal tibiofibular joint?
|
plane-type synovial joint b/w the head of the fibula and tibia
|
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what type of mvmnt does the proximal tibiofibular joint allow?
|
little gliding mvmnt
|
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what type of joint is the distal tibiofibular joint?
|
fibrous joint b/w the tibia and fibula
|
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what type of joint is the ankle (talocrural) joint?
|
hinge-type (ginglymus) synovial joint b/w the tibia and fibula superiorly and the trochlea of the talus inferiorly
|
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what mvmnts does the ankle (talocrural) joint allow?
|
dorsiflexion and plantar flexion
|
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what's the articular capsule?
|
thin, fibrous capsule that lies anteriorly and posteriorly, allowing mvmnt in the ankle
|
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what reinforces the articular capsule?
|
medially- medial (deltoid) ligament laterally- lateral (collateral) ligament
|
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why does articular capsule need to be reinforced?
|
prevents anterior/posterior slipping of the tibia and fibula on the talus
|
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what are the 4 parts of the medial (deltoid) ligament?
|
tibionavicular, tibiocalcaneal, anterior tibiotalar, posterior tibiotalar ligaments
|
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what's the func of the medial (deltoid) ligament?
|
prevents overeversion of the foot and helps maintain the medial longitudinal arch
|
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what are the 3 parts of the lateral ligament?
|
anterior talofibular, posterior talofibular, calcaneofibular ligaments
|
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what's the func of the lateral ligaments?
|
resists inversion of the foot
|
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which ligament may be torn during an ankle sprain (inversion injury)?
|
lateral ligament
|
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what are the 4 intertarsal joints?
|
talocalcaneal (subtalar) joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal (midtarsal) joint
|
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what type of joint is the talocalcaneal (subtalar) joint?
|
plane synovial joint b/w the talus and calcaneus bones
|
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what funcs does the talocalcaneal joint allow?
|
inversion and eversion of the foot
|
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what type of joint is the talocalcaneonavicular joint?
|
ball and socket joint b/w talus (ball) and calcaneus and navcular bones (socket)
|
|
what supports the talocalcaneonavicular joint?
|
spring (plantar calcaneonavicular) ligament
|
|
what type of joint is the calcaneocuboid joint?
|
resembles saddle joint b/w calcaneus and cuboid bones
|
|
what supports the calcaneocuboid joint?
|
short plantar (plantar calcaneocuboid) and long plantar ligaments and the tendon of the peroneus longus muscle
|
|
what's the transverse tarsal (midtarsal) joint?
|
collective term for the talonavicular part of the talocalcaneonavicular joint and the calcaneocuboid joint … the two joints are separated anatomically, but act together functionally
|
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what's the func of the transverse tarsal (midtarsal) joint?
|
inversion and eversion of the foot
|
|
what type of joint is the tarsometatarsal joint?
|
plane synovial joints that strengthen the transverse arch
|
|
what unites the tarsometatarsal joints?
|
articular capsules
|
|
what reinforces the tarsometatarsal joints?
|
plantar, dorsal, and interosseous ligaments
|
|
what type of joint is the metatarsophalangeal joint?
|
ellipsoid (condyloid) synovial joint
|
|
what unites the metatarsophalangeal joint?
|
articular capsules
|
|
what reinforces the metatarsophalangeal joint?
|
plantar and collateral ligaments
|
|
what's a bunion?
|
localized swelling @ the medial side of the 1st metatarsophalangeal joint (or of the first metatarsal head)
|
|
what causes a bunion?
|
inflammatory bursa.. And it's unusually associated w/ hallux valgus
|
|
what's a bunionectomy?
|
excision of an abnormal prominence on the medial part of the 1st metatarsal head
|
|
what's a hallux valgus?
|
lateral deviation of the big toe
|
|
what symptom is hallux valgus frequently accompanied w/?
|
swelling (bunion) on the medial aspect of the 1st metatarsophalangeal joint
|
|
what's a hallux varus?
|
medial deviation of the big toe
|
|
what type of joint is the interphalangeal joint?
|
hinge-type (ginglymus) synovial joints
|
|
what joins the interphalangeal joint?
|
articular capsules
|
|
what reinforces the interphalangeal joint?
|
plantar and collateral ligaments
|
|
what plexus does the lateral femoral cutaneous n come from?
|
lumbar plexus
|
|
what nerve levels does lateral femoral cutaneous n come from?
|
L2, L3
|
|
what does the lateral femoral cutaneous n innervate?
|
skin on the anterior and lateral aspects of the thigh as far as the knee
|
|
what do the clunial (buttock) nerves innervate?
|
skin of the gluteal region
|
|
what are the branches of the clunial nerves?
|
superior- lateral branches of the dorsal rami of the upper 3 lumbar nerves
middle- lateral branches of the dorsal rami of the upper 3 sacral n inferior- gluteal branches of the posterior femoral cutaneous nerve |
|
what plexus does the posterior femoral cutaneous nerve come from?
|
sacral plexus
|
|
what nerve levels does the posterior femoral cutaneous nerve come from?
|
S1, S2, S3
|
|
what nerves go thru the greater sciatic foramen?
|
sciatic nerve and posterior femoral cutaneous nerve, superior/inferior gluteal nn, pudendal n, n to obturator internus, n to quadratus femoris
|
|
what does the posterior femoral cutaneous nerve innervate?
|
skin of buttock, thigh and calf
|
|
where does the saphenous n come from?
|
from femoral n in the femoral triangle
|
|
what vessels does saphenous n accompany thru the femoral triangle?
|
femoral vessels
|
|
what vessels does the saphenous n descend down leg w/?
|
great saphenous vein
|
|
what does the saphenous n innervate?
|
skin on medial part of the leg and foot
|
|
how can the saphenous n be injured?
|
its proximal part can be injured during surgery to repair varicose veins
|
|
where does the lateral sural cutaneous n come from?
|
common peroneal n in the popliteal fossa
|
|
does the lateral sural cutaneous n communicate w/ the medial sural cutaneous n?
|
it may
|
|
what does the lateral sural cutaneous n innervate?
|
skin on posterolateral part of leg
|
|
where does the medial sural cutaneous n come from?
|
tibial n in the popliteal fossa
|
|
what happens if the medial sural cutaneous n and lateral sural cutaneous n join?
|
they form the sural nerve
|
|
what does the medial sural cutaneous n innervate?
|
innerv skin on the back of the leg and the lateral part of the ankle, heel and foot
|
|
what does the sural n innervate?
|
skin on back of the leg and the lateral part of the ankle, heel and foot
|
|
what does the superficial peroneal n innervate?
|
skin on the lateral side of the lower leg and the dorsum of the foot
|
|
what nn does the superficial peroneal n divide into?
|
medial dorsal cutaneous n and intermediate dorsal cutaneous n
|
|
what does the medial dorsal cutaneous n innerv?
|
medial sides of foot and ankle, medial side of great toe and adjacent sides of the 2nd and 3rd toes
|
|
what does the intermediate dorsal cutaneous n innerv?
|
skin of the lateral sides of the foot and ankle and adjacent sides of the 3rd, 4th, and little toes
|
|
what does the deep peroneal n innerv?
|
anterior muscles of leg and foot and skin of the contiguous sides of the first and second toes
|
|
where does the great saphenous vein begin?
|
at the medial end of the dorsal venous arch of the foot
|
|
what vein does the great saphenous v join?
|
passes thru the saphenous opening (fossa ovalis) to join femoral vein
|
|
what veins does the great saphenous vein receive?
|
external pudendal, superficial epigastric, superficial circumflex ilia, lateral femoral cutaneous and accessory saphenous veins
|
|
what is a good vessel to use in coronary artery bypass surgery?
|
great saphenous vein
|
|
what's a good vessel to use for venipuncture?
|
great saphenous vein
|
|
what n is vulnerable to injury when the great saphenous vein is harvested for bypass?
|
saphenous n
|
|
how do you prepare the great saphenous v for the bypass?
|
reverse the vein so the valves don't obstruct blood flow in the graft
|
|
what happens to the great saphenous v in the leg?
|
vein and its tributaries become dilated and varicosed
|
|
where are varicose veins common?
|
posteromedial parts of lower limb
|
|
where does the small (short) saphenous vein begin?
|
at the lateral end of the dorsal venous arch
|
|
where n does the small saphenous v accompany?
|
sural n
|
|
where does small saphenous v go w/ sural n and where does it end?
|
goes thru the popliteal fossa where it ends in the popliteal v
|
|
what's a thrombophlebitis?
|
venous inflammation w/ thrombus formation that happens in the superficial veins in the lower limb
|
|
what can thrombophlebitis lead to?
|
pulmonary embolism
|
|
where do most pulmonary emboli originate?
|
in deep veins
|
|
what can reduce the risk of embolism?
|
anticoagulant treatment
|
|
where do varicose veins develop?
|
develop in superficial veins of the lower limb
|
|
why do varicose veins develop?
|
reduced elasticity and incompetent valves in the veins or thrombophlebitis of the deep veins
|
|
what are superfical lymph vessels formed by?
|
vessels from the gluteal region, abdominal wall and external genitalia
|
|
what groups are the superficial lymph vessels divided into?
|
medial group and lateral group
|
|
what does the medial group of superficial lymph vessels follow?
|
great saphenous vein to the end in the inguinal nodes
|
|
what does the lateral group of superficial lymph vessels follow?
|
small saphenous vein to end in popliteal nodes… their efferent follow femoral vessels to end in inguinal nodes
|
|
what are the deep lymph vessels made of?
|
anterior tibial, posterior tibial, peroneal vessels
|
|
what do the deep lymph vessels enter?
|
popliteal lymph nodes
|
|
what path do the lymph vessels from the popliteal nodes take?
|
accompany femoral vessels to the inguinal nodes, which enter external iliac nodes and ultimately drain into the lumbar (aortic) nodes and vessels
|
|
where are the superficial inguinal grp of lymph nodes?
|
subcutaneously near the saphenofemoral junction
|
|
what do the superficial inguinal grp of lymph nodes drain?
|
superficial thigh region
|
|
what nodes does the superficial inguinal grp of lymph nodes drain into?
|
external iliac nodes
|
|
where does the superficial inguinal grp of lymph nodes receive lymph from?
|
receives lymph from the anterolateral abdominal wall below the umbilicus, gluteal region, lower parts of the vagina and anus, and external genitalia except the glans
|
|
where's the deep inguinal grp of lymph nodes?
|
lies deep to the fascia lata on the medial side of the femoral vein
|
|
where does the deep inguinal grp of lymph nodes receive lymph from?
|
deep lymph vessels (efferents of popliteal nodes) that accompany femoral vessels and from glans penis or glans clitoris, and drains into external iliac nodes through the femoral canal
|
|
what ligaments turns the lesser sciatic notch into the lesser sciatic foramen?
|
sacrotuberous ligament and sacrospinous ligament
|
|
what ligament converts the greater sciatic notch into the greater sciatic foramen?
|
sacrospinous ligament
|
|
what muscles have pathway thru greater sciatic foramen?
|
piriformis muscle
|
|
what vessels have pathway thru greater sciatic foramen?
|
superior/ inferior gluteal vessels, internal pudendal vessels
|
|
what muscles have pathway thru lesser sciatic foramen?
|
obturator internus TENDON
|
|
what nn have pathway thru lesser sciatic foramen?
|
n to obturator internus, pudendal n
|
|
what vessels have pathway thru lesser sciatic foramen?
|
internal pudendal vessels
|
|
what passes thru both the greater sciatic foramen and the lesser sciatic foramen?
|
pudendal n, n to obturator internus, internal pudendal vessels
|
|
what's the iliotibial tract?
|
thick lateral part of the fascia lata
|
|
what's the func of the iliotibial tract?
|
forms fibrous capsule of knee joint, maintains posture and locomotion, provides insertion for gluteus maximus and tensor fasciae latae muscles
|
|
what's fascia lata?
|
membranous, deep fascia covering muscles of the thigh
|
|
what does fascia lata form?
|
lateral and medial intermuscular septa by its inward extension to the femur
|
|
what's gluteal gait (gluteus medius limp)?
|
waddling gait : pelvis falls (droops) towards unaffected side when the opposite leg is raised @ each step
|
|
what causes gluteal gait (gluteus medius limp)?
|
paralysis of the gluteus medius muscle, which normally functions to stabilize the pelvis when the opposite foot is off the ground
|
|
what is a common site for the intramuscular injection of medications?
|
gluteal region: superior lateral quadrant to avoid injury to the underlying sciatic nerve and others
|
|
what are the muscles of the gluteal region?
|
gluteus maximus, gluteus medius, gluteus minimus, tensor fascia latae, piriformis, obturator internus, superior gemellus, inferior gemellus, quadratus femoris
|
|
what are the posterior muscles of the thigh?
|
semitendinous, semimembranosus, biceps femoris
|
|
what n innerv gluteus maximus?
|
inferior gluteal
|
|
what n innerv gluteus medius?
|
superior gluteal
|
|
what n innerv gluteus minimus?
|
superior gluteal
|
|
what n innerv tensor fasciae latae?
|
superior gluteal
|
|
what n innerv piriformis?
|
sacral (S1-S2)
|
|
what n innerv obturator internus?
|
n to obturator internus
|
|
what n innerv superior gemellus?
|
n to obturator internus
|
|
what n innerv inferior gemellus?
|
n to quadratus femoris
|
|
what n innerv quadratus femoris?
|
n to quadratus femoris
|
|
what's the action of gluteus maximus?
|
extends and rotates thigh laterally
|
|
what's the action of gluteus minimus?
|
abducts and rotates thigh medially
|
|
what's the action of gluteus medius?
|
abducts and rotates thigh medially; stabilizes pelvis
|
|
what's the action of tensor fasciae latae?
|
flexes, abducts, and rotates thigh medially
|
|
what's the action of piriformis?
|
rotates thigh laterally
|
|
what's the action of obturator internus?
|
abducts and rotates thigh laterally
|
|
what's the action of superior gemellus?
|
rotates thigh laterally
|
|
what's the action of inferior gemellus?
|
rotates thigh laterally
|
|
what's the action of quadratus femoris?
|
rotates thigh laterally
|
|
what n innerv semitendinosus?
|
tibial part of sciatic n
|
|
what n innerv semimembranosus?
|
tibial part of sciatic n
|
|
what n innerv biceps femoris?
|
tibial (long head) and common peroneal (short head) : parts of sciatic n
|
|
what's the action of semitendinosus?
|
extends thigh; flexes and rotates leg medially
|
|
what's the action of semimembranosus?
|
extends thigh; flexes and rotates leg medially
|
|
what's the action of biceps femoris?
|
extends thigh; flexes and rotates leg medially
|
|
what are the n of the gluteal region?
|
superior gluteal n, inferior gluteal n, posterior femoral cutaneous n, sciatic n
|
|
what are the aa of the gluteal region?
|
superior gluteal a, inferior gluteal a
|
|
what's piriformis syndrome?
|
condition in which piriformis muscle irritates and places pressure on the sciatic n
|
|
what's the result of piriformis syndrome?
|
pain in buttocks and referring pain along course of sciatic n: sciatica
|
|
what causes sciatica?
|
herniation of a lower lumbar intervertebral disk compromising nerve roots
|
|
how can you treat piriformis syndrome?
|
progressive piriformis stretching.. If this fails, corticosteroid can be injected into the piriformis muscle… still pain? Surgical exploration is your last resort
|
|
where do you see a positive trendelenburg's sign?
|
fracture of femoral neck, dislocated hip joint (head of femur), weakness and paralysis of the gluteus medius and minimus muscle
|
|
what's the result of trendelenburg's sign?
|
can't abduct hip… if right gluteus medius and minimus muscles are paralyzed, the unsupported left side (sound side) of pelvis falls (sags) instead of rising.. Which is weird b/c normally pelvis should rise
|
|
who normally gets a hamstring injury/strain (pulled/torn hamstrings)?
|
ppl who are running, jumping and quick start sports
|
|
what happens during a hamstring injury?
|
origin of hamstrings from the ischial tuberosity may be avulsed, resulting in blood vessel rupture
|
|
what causes hamstring injury?
|
avulsion of ischial tuberosity may result from forcible flexion of hip w/ knee extended
|
|
so when hamstrings are torn, does it hurt?
|
VERY PAINFUL
|
|
what is an anterior dislocation subluxation of the hip joint?
|
tearing of joint capsule anteriorly w/ mvmnt of femoral head out from acetabulum
|
|
where is the femoral head in relation to the pubic bone or acetabulum during an anterior dislocation subluxation of the hip joint?
|
lies anteroinferior to the pubic bone or acetabulum
|
|
what's a posterior dislocation of the hip joint?
|
posterior tearing of the joint capsule
|
|
what's the result of a posterior dislocation of the hip joint?
|
resting fractured femoral head on posterior surface of ischium, probaby ruptures both posterior acetabular labrum and ligamentum capitis femoris, injury of the sciatic nerve
|
|
what happens to the affected limb during posterior dislocation of the hip joint?
|
affected limb is shortened, adducted and medially rotated
|
|
what is medial or intrapelvic dislocation of the hip joint?
|
tearing of joint capsule medially
|
|
what's the result of medial or intrapelvic dislocation of the hip joint?
|
dislocated femoral head lies medial to pubic bone, possible acetabular fracture and bladder rupture
|
|
what's the femoral triangle bounded by?
|
superiorly- inguinal ligament laterally- sartorius muscle medially- adductor longus muscle
|
|
what's the floor of the femoral triangle bounded by?
|
iliopsoas, pectineus, adductor longus muscles
|
|
what's the roof of the femoral triangle bounded by?
|
fascia lata and cribiform fascia
|
|
what strucs are in the femoral triangle?
|
femoral Nerve Artery Vein Lymphatics (lateral to medial)
|
|
what's the abdominal opening of the femoral canal?
|
femoral ring
|
|
what's the femoral ring bounded by?
|
anteriorly- inguinal ligament laterally- femoral vein medially- lacunar ligament posteriorly- pectineal ligament
|
|
where's the femoral canal?
|
medial to femoral vein in the femoral sheath
|
|
what contents are in the femoral canal?
|
fat, areolar conn tissue, lymph nodes and vessels
|
|
what's the func of the femoral canal?
|
transmits lymphatics from the lower limb and perineum to the peritoneal cavity
|
|
what's the clinical significance of the femoral canal?
|
potential weak area site of femoral herniation, which happens more frequently in women b/c of the greater width of the superior pubic ramus of the female pelvis
|
|
who is a femoral hernia more common in?
|
women
|
|
where is the femoral hernia located?
|
passes thru femoral ring and canal, lies lateral and inferior to pubic tubercle and deep and inferior to inguinal ligament
|
|
what is the femoral hernia's sac formed by?
|
parietal peritoneum
|
|
what's a complication of the femoral hernia that can happen?
|
strangulation of a femoral hernia may happen b/c of sharp, stiff boundaries of femoral ring, and strangulation interferes w/ the blood supply to the herniated intestine --> tissue death
|
|
what's the femoral sheath formed by?
|
prolongation of the transversalis and iliac fascia in the thigh
|
|
what does the femoral sheath contain?
|
femoral artery and vein, femoral branch of the genitofemoral nerve, and the femoral canal (femoral n lies outside the femoral sheath, lateral to the femoral a
|
|
how does the femoral sheath rech the level of the proximal end of the saphenous opening?
|
with its distal end
|
|
where does the adductor canal begin and end?
|
begins- apex of femoral triangle ends- adductor hiatus (hiatus tendineus)
|
|
where is the adductor canal ?
|
b/w the adductor magnus and longus muscles and the vastus medialis muscle and is covered by the sartorius muscle and fascia
|
|
what does the adductor canal contain?
|
femoral vessels, saphenous nerve, n to vastus medialis, and descending genicular artery
|
|
what is the adductor hiatus (hiatus tendineus)?
|
aperture in the tendon of insertion of the adductor magnus
|
|
what's the significance of the adductor hiatus?
|
allows passage of the femoral vessels into the popliteal fossa
|
|
what's the saphenous opening?
|
oval gap in the fascia lata below the inguinal ligament that's covered by the cribiform fascia
|
|
what are other names of the saphenous opening?
|
saphenous hiatus or fossa ovalis
|
|
what's the cribiform fascia?
|
part of the superficial fascia of the thigh
|
|
what's the significance of the saphenous opening?
|
pathway for greater saphenous vein
|
|
what are the anterior muscles of the thigh?
|
iliacus, sartorius, rectus femoris, vastus medialis, vastus lateralis, vastus intermedius
|
|
what n supplies the anterior thigh muscles?
|
femoral n
|
|
what n supplies the sartorius muscle?
|
femoral n
|
|
what n supplies the rectus femoris muscle?
|
femoral n
|
|
what n supplies the vastus medialis?
|
femoral n
|
|
what n supplies the vastus lateralis?
|
femoral n
|
|
what n supplies the vastus intermedius?
|
femoral n
|
|
what's a groin injury/pulled groin?
|
strain, stretching or tearing of the origin of the flexor and adductor of the thigh
|
|
how does a groin injury often occur?
|
in sports that require quick starts, like the 100-meter dash and football
|
|
what's the clinical significance of the gracilis?
|
relatively weak member of the adductor grp of muscles and thus surgeons often transplant this muscle or part of it, with nerve and blood vessels, to replace a damaged muscle in the hand
|
|
what are the proximal muscle attachments of the gracilis?
|
inguinal region or groin
|
|
what are muscle strains of the adductor longus?
|
may happen in horseback riders and make pain b/c the riders adduct their thighs to keep from falling from animals
|
|
what's the action of the iliacus muscle?
|
flexes thigh (w/ psoas major)
|
|
what's the action of the sartorius muscle?
|
flexes and rotates thigh laterally, flexes and rotates leg medially
|
|
what's the action of the rectus femoris muscle?
|
flexes thigh; extends leg
|
|
what's the action of the vastus medialis?
|
extends leg
|
|
what's the action of the vastus lateralis?
|
extends leg
|
|
what's the action of the vastus intermedius?
|
extends leg
|
|
what n supplies the adductor longus?
|
obturator
|
|
what n supplies the adductor brevis?
|
obturator
|
|
what n supplies the adductor magnus?
|
obturator and sciatic (tibial part)
|
|
what n supplies the pectineus?
|
obturator and femoral n
|
|
what n supplies the gracilis?
|
obturator n
|
|
what n supplies the obturator externus?
|
obturator n
|
|
what's the action of the adductor longus muscle?
|
adducts and flexes thigh
|
|
what's the action of the adductor brevis muscle?
|
adducts and flexes thigh
|
|
what's the action of the adductor magnus muscle?
|
adducts, flexes and extends thigh
|
|
what's the action of the pectineus muscle?
|
adducts and flexes thigh
|
|
what's the action of the gracilis muscle?
|
adducts and flexes thigh; flexes and rotates leg medially
|
|
what's the action of the obturator externus muscle?
|
rotates thigh laterally
|
|
what's the popliteal fossa bounded by superomedially and superolaterally?
|
superomedially- semitendinosus and semimembranosus muscles superolaterally- biceps muscle
|
|
what's the popliteal fossa bounded by inferolaterally and inferomedially?
|
inferolaterally- lateral head of the gastrocnemius and plantaris muscles
inferomedially - medial head of the gastrocnemius muscle |
|
what's the floor of the popliteal fossa made of?
|
femur, oblique popliteal ligament, popliteus muscle
|
|
what does the popliteal fossa contain?
|
popliteal vessels, common peroneal and tibial nerves and the small saphenous vein
|
|
what's the pes anserinus?
|
combined tendinous expansions of the sartorius, gracilis, and semitendinosus muscles at the medial border of the tuberosity of the tibia
|
|
what's the clinical significance of the pes anserinus?
|
may be used to surgically repair the anterior cruciate ligament of the knee joint
|
|
what are the anterior and lateral muscles of the leg?
|
tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus (fibularis) tertius, peroneus (fibularis) longus, and peroneus (fibularis) brevis
|
|
what's the lateral part of the anterior and lateral muscles of the leg?
|
peroneus (fibularis) longus and peroneus (fibularis) brevis
|
|
what does deep peroneal n supply?
|
anterior and lateral leg muscles:
tibialis anterior extensor hallucis longus extensor digitorum longus peroneus (fibularis) tertius |
|
|
|
|
.
|
.
|
|
.
|
.
|
|
what does the superficial peroneal (fibular) n supply?
|
anterior and lateral leg muscles:
peroneus (fibularis) longus peroneus (fibularis) brevis |
|
|
|
|
what's the action of the tibialis anterior?
|
dorsiflexes and inverts foot
|
|
what's the action of the extensor hallucis longus muscle?
|
extends big toe, dorsiflexes and invertes foot
|
|
what's the action of the extensor digitorum longus muscle?
|
extends toes, dorsiflexes and everts foot
|
|
what's the action of the peroneus (fibularis) tertius muscle?
|
dorsiflexes and everts foot
|
|
what's the action of the peroneus (fibularis) brevis muscle?
|
everts and plantar flexes foot
|
|
what are the posterior muscles of the leg?
|
gastrocnemius, soleus, plantaris, popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
|
|
what muscles make up the superficial grp of the posterior muscles of the leg?
|
gastrocnemius, soleus, and plantaris
|
|
what muscles make up the deep grp of the posterior muscles of the leg?
|
popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
|
|
what n supplies the gastrocnemius muscle?
|
tibial
|
|
what n supplies the soleus muscle?
|
tibial
|
|
what n supplies the plantaris muscle?
|
tibial
|
|
what n supplies the popliteus muscle?
|
tibial
|
|
what n supplies the flexor hallucis longus muscle?
|
tibial
|
|
what n supplies the flexor digitorum longus muscle?
|
tibial
|
|
what n supplies the tibialis posterior muscle?
|
tibial
|
|
what's the action of the gastrocnemius?
|
flexes knee; plantar flexes foot
|
|
what's the action of the soleus muscle?
|
plantar flexes foot
|
|
what's the action of the plantaris muscle?
|
flexes leg; plantar flexes foot
|
|
what's the action of the popliteus muscle?
|
flexes by unlocking knee and rotates leg medially
|
|
what's the action of the flexor hallucis longus muscle?
|
plantar flexes foot; flexes distal phalanx of big toe
|
|
what's the action of the flexor digitorum longus muscle?
|
flexes lateral 4 toes; plantar flexes foot
|
|
what's the action of the tibialis posterior muscle?
|
plantar flexes and inverts foot
|
|
what’s anterior tibial compartment syndrome?
|
ischemic necrosis of the muscles of the anterior compartment of the leg
|
|
why does anterior tibial compartment syndrome occur?
|
b/c of compression of arteries (anterior tibial a and its branches) by swollen muscles, following excessive exertion
|
|
what are the symptoms of anterior tibial compartment syndrome?
|
extreme tenderness and pain on the anterolateral part of the leg
|
|
what is a shin splint?
|
painful condition of the anterior compartment of the leg along the thin bone (tibia)
|
|
what's shin splint caused by?
|
swollen muscles in the anterior compartment, especially the tibialis anterior muscle, after athletic overexertion
|
|
what might shin splints be a mild form of?
|
anterior compartment syndrome
|
|
what's a muscle cramp (charley horse)?
|
sudden, involuntary, painful contraction of muscles of the lower limb
|
|
what causes a muscle cramp/charley horse?
|
muscle fatigue, overexertion, dehydration, depletion or imbalance of salt and minerals (electrolytes) like calcium, sodium, potassium, and magnesium
|
|
what's claudication?
|
type of calf pain
|
|
what can cause claudication?
|
poor blood supply to leg muscles caused by smoking and atherosclerosis
|
|
what are the most commonly affected muscles in muscle cramp/charley horse?
|
calf muscle (gastrocnemius), hamstrings and quadriceps
|
|
what can relieve the muscle cramp/charley horse?
|
goes away w/I a few minutes, or can be treated by a gentle stretch and massage of the cramped muscle, pain relievers and muscle relaxers
|
|
what's intermittent claudicatin?
|
condition of limping caused by ischemia of the muscles in lower limbs, chiefly the calf muscles
|
|
who is intermittent claudication seen in?
|
occlusive peripheral arterial diseases, especialy the popliteal artery and its branches
|
|
what's the main symptom of intermittent claudicaton?
|
leg pain that happens during walking and intensifies until walking is impossible
|
|
what relieves intermittent claudication?
|
rest
|
|
what are the nerves of the leg?
|
tibial n, common peroneal (fibular) n, deep peroneal (fibular) n, superficial peroneal (fibular) n, sural and medial and lateral sural n
|
|
what are the blood vessels of the leg?
|
popliteal a, posterior tibial a, peroneal (fibular) a, genicular anastomosis
|
|
when does the knee jerk happen?
|
when the patellar ligament is tapped
|
|
what's the result of a knee jerk?
|
sudden contraction of the quadraceps femoris
|
|
what does the knee jerk reflex test?
|
L2-L4 femoral nerve by activating muscle spindle in the quadraceps
|
|
what's the reflex arc of the knee jerk?
|
afferent impulse travel in the femoral n to the spinal cord, efferent impulses are transmited to the quadriceps via motor fibers in the femoral n
|
|
what's the superior extensor retinaculum?
|
broad band of deep fascia extending b/w the tibia and the fibula, above the ankle
|
|
what's the inferior extensor retinaculum?
|
Y-shaped band of deep fascia that froms loop for tendons of extensor digitorum longus and peroneus tertius and then divides into an upper band and a lower band
|
|
what's the flexor retinaculum?
|
deep fascia band that passes b/w medial malleolus and medial surface of calcaneus
|
|
what does the flexor retinaculum form?
|
tarsal tunnel w/ tarsal bones for tibial n, posterior tibial vessels and flexor tendons
|
|
what does the flexor retinaculum hold?
|
3 tendons, blood vessels and a nerve in place deep to it
|
|
what mnemonic does this help for: Tom Drives A Very Nervous Horse:
|
flexor retinaculum: Tibialis posterior, flexor Digitorum longus, posterior tibial Artery and Vein, tibial Nerve, and flexor Hallucis longus
|
|
what's tarsal tunnel syndrome?
|
complex symptom resulting from compression of the tibial n or its medial and lateral plantar branches in the tarsal tunnel
|
|
what are the symptoms of tarsal tunnel syndrome?
|
pain, numbness, tingling sensations on the ankle, heel and sole of the foot
|
|
what can cause tarsal tunnel syndrome?
|
repetitive stress with activities, flat feet, or excess weight
|
|
what's the tendo calcaneus (Achilles tendon)?
|
tendon of insertion of the triceps surae (gastrocnemius and soleus) into the tuberosity of the calcaneus
|
|
what does an avulsion/rupture of Achilles tendon cause?
|
disables triceps surae (gastrocnemius and soleus) muscles
|
|
what's the symptom of avulsion/rupture of the Achilles tendon?
|
patient can't plantar flex the foot
|
|
what does forced eversion of the foot cause?
|
avulses the medial malleolus or ruptures the deltoid ligament
|
|
what does forced inversion cause?
|
avulses the lateral malleolus or tears the lateral collateral (anterior and posterior talofibular and calcaneofibular) ligament
|
|
what causes ankle sprain (inversion injury)?
|
results from rupture of calcaneofibular and talofibular ligaments and a fracture of the lateral malleolus caused by forced inversion of the foot
|
|
what's plantar aponeurosis?
|
thick fascia investing plantar muscles
|
|
what is plantar aponeurosis' path?
|
radiates from the calcaneal tuberosity toward the toes
|
|
what does plantar aponeurosis provide attachment for?
|
provides att to the short flexor muscles of the toes
|
|
what are the muscles of the foot on the dorsum?
|
extensor digitorum brevis, extensor hallucis brevis
|
|
what are the muscles on the 1st layer of the sole of the foot?
|
abductor hallucis, flexor digitorum brevis, abductor digiti minimi
|
|
what are the muscles on the 2nd layer of the sole of the foot?
|
quadratus plantae, lumbricals
|
|
what are the muscles on the 3rd layer of the sole of the foot?
|
flexor hallucis brevis, adductor hallucis, oblique head, transverse head, flexor digiti minimi brevis
|
|
what are the muscles on the 4th layer of the sole of the foot?
|
plantar interossei (3), dorsal interossei (4)
|
|
what nn innervate the muscles of the foot?
|
deep peroneal, medial plantar, lateral plantar
|
|
what n innervates the extensor digitorum brevis?
|
deep peroneal
|
|
what n innervates the extensor hallucis brevis muscle?
|
deep peroneal
|
|
what n innervates the abductor hallucis muscle?
|
medial plantar
|
|
what n innervates the flexor digitorum brevis muscle?
|
medial plantar
|
|
what n innervates the abductor digiti minimi muscle?
|
lateral plantar
|
|
what n innervates the quadratus plantae muscle?
|
lateral plantar
|
|
what n innervates the lumbricals muscle?
|
1st- medial plantar, lateral 3- lateral plantar
|
|
what n innervates the flexor hallucis brevis muscle?
|
medial plantar
|
|
what n innervates the adductor hallucis oblique head muscle?
|
lateral plantar
|
|
what n innervates the adductor hallucis transverse head muscle?
|
lateral plantar
|
|
what n innervates the flexor digiti minimi brevis muscle?
|
lateral plantar
|
|
what n innervates the plantar interossei muscle?
|
lateral plantar
|
|
what n innervates the dorsal interossei muscle?
|
lateral plantar
|
|
what muscle extends toes?
|
extensor digitorum brevis
|
|
what muscle extends the big toe?
|
extensor hallucis brevis
|
|
what muscle abducts the big toe?
|
abductor hallucis
|
|
what muscle flexes middle phalanges of lateral four toes?
|
flexor digitorum brevis
|
|
what muscle abducts little toe?
|
abductor digiti minimi
|
|
what muscle aids in flexing toes?
|
quadratus plantaej
|
|
what muscle flexes metatarsophalangeal joints and extends interphalangeal joints?
|
lumbricals (4)
|
|
what muscle flexes the big toe?
|
flexor hallucis brevis
|
|
what muscle adducts the big toe?
|
adductor hallucis
|
|
what muscle flexes the little toe?
|
flexor digiti minimi brevis
|
|
what muscle adducts toes, flexes proximal and extends distal phalanges
|
plantar interossei (3)
|
|
what muscle abducts toes, flexes proximal and extends distal phalanges?
|
dorsal interossei (4)
|
|
what are the arches of the foot?
|
medial longitudinal, lateral longitudinal, proximal transverse, distal transverse
|
|
what is the purpose of the arches of the foot?
|
supports the body in the erect position and acts as a spring in locomotion
|
|
what arch is formed and maintained by the interlocking talus, calcaneus, navicular, cuneiform and 3 medial metatarsal bones?
|
medial longitudinal arch
|
|
what's the keystone of the medial longitudinal arch?
|
head of talus
|
|
where is the head of the talus?
|
at the summit b/w the sustentaculum tali and the navicular bone
|
|
what supports the medial longitudinal arch?
|
spring ligament and flexor hallucis longus tendon
|
|
what is flat foot also called?
|
pes planus or talipes planus
|
|
what is flat foot?
|
condition of disappearance or collapse of the medial longitudinal arch w/ eversion an dabduction of the forefoot
|
|
what does flat foot cause?
|
greater wear on the inner border of the soles and heels of shoes than on the outer border
|
|
what is the result of flat foot?
|
pain from stretching the plantar muscles and straining the spring ligament and the long and short plantar ligaments
|
|
what's pes cavus?
|
exaggerated height of the medial longitudinal arch of the foot
|
|
what arch is formed and maintained by the calcaneus, cuboid bone and lateral 2 metatarsal bones?
|
lateral longitudinal arch
|
|
what's the keystone of the lateral longitudinal arch?
|
cuboid bone
|
|
what suppports the lateral longitudinal arch?
|
peroneus longus tendon and long and short plantar ligaments
|
|
what's the func of the lateral longitudinal arch?
|
supports the body in the erect position and acts as a spring in locomotion
|
|
what arch is formed and maintained by the navicular bone, 3 cuneiform bones, cuboid bone, and the bases of the 5 metatarsal bones of the foot?
|
transverse arch: proximal (metatarsal)
|
|
what supports the transverse arch: proximal (metatarsal)?
|
peroneus longus tendon
|
|
what arch is formed by the heads of the 5 metatarsal bones?
|
transverse arch: distal
|
|
what is the transverse arch: distal maintained by?
|
transverse head of the adductor hallucis
|
|
what does the long plantar (plantar calcaneocuboid) ligament form?
|
canal for tendon of the peroneus longus
|
|
what is the func of the long plantar (plantar calcaneocuboid) ligament ?
|
supports the lateral side of the longitudinal arch of the foot
|
|
what is the func of the short plantar (plantar calcaneocuboid) ligament?
|
supports lateral longitudinal arch
|
|
what's the func of the spring (plantar calcaneonavicular) ligament?
|
supports talus head and the medial longitudinal arch
|
|
why is it called the spring ligament?
|
b/c it has lots of elastic fibers to give elasticity to the arch and spring to the foot
|
|
what supports the spring (plantar calcaneonavicular) ligament?
|
tibialis posterior tendon
|
|
what's another name for clubfoot?
|
talipes equinovarus
|
|
what's clubfoot?
|
congenital foot deformity: foot is plantarflexed, inverted and adducted
|
|
what are all of the forms of clubfoot?
|
1) foot is plantarflexed, inverted and adducted 2) foot is plantarflexed (equinus) or dorsiflexed (calcaneus) and heel is turned laterally (valgus) or medally (varus) 3) heel is elevated and turned laterally (equinovalgus) or medially (equinovarus) 4) anterior part of foot (forefoot) is elevated and the heel is turned laterally (calcaneovalgus) or medially (calcaneovarus)
|
|
what are the ligaments of the ankle joint?
|
medial (deltoid) ligament, lateral ligament
|
|
what plexus does the obturator nerve come from?
|
lumbar plexus
|
|
what n levels does the obturator n come from?
|
L2, L3, L4
|
|
how does the obturator n enter the thigh?
|
obturator foramen
|
|
what does the anterior branch of the obturator n innerv?
|
adductor longus, adductor brevis, gracilis, and pectineus muscles
|
|
what's the result of a damaged obturator n?
|
weakness of adduction and lateral swinging of limb during walking b/c of unopposed abductors
|
|
what plexus does the femoral n come from?
|
lumbar plexus
|
|
what are the branches of the femoral n?
|
muscular branches, articular branches, cutaneous branches (including anterior femoral cutaneous n and saphenous n)
|
|
what's the result of a damaged femoral n?
|
impaired hip flexion and impaired leg extension resulting from quadriceps femoris paralysis
|
|
what plexus does the superior gluteal n come from?
|
sacral
|
|
what n levels does the superior gluteal n come from?
|
L4, L5, S1
|
|
what does the superior gluteal n innerv?
|
gluteus medius, gluteus minimus, tensor fascia latae, hip joint
|
|
what's the result of an injured superior gluteal n?
|
motor loss, resulting in a weakened abduction of the thigh by the gluteus medius, a disabling gluteus medius limb and gluteal gait.
|
|
what plexus does the inferior gluteal n come from?
|
sacral
|
|
what n levels does the inferior gluteal n come from?
|
L5, S1, S2
|
|
what does the inferior gluteal n innerv?
|
gluteus maximus
|
|
what plexus does the posterior femoral cutaneous nerve come from?
|
sacral
|
|
what n levels does the posterior femoral cutaneous n come from?
|
S1, S2, S3
|
|
what does the posterior femoral cutaneous nerve innervate?
|
skin of buttock, thigh and calf and scrotum or labium majus
|
|
what plexus does the sciatic n come from?
|
sacral
|
|
what are the n levels of the sciatic n?
|
L4, L5, S1, S2, S3
|
|
what's the largest n in the body?
|
sciatic n
|
|
what nn does the sciatic n divide into?
|
divides at popliteal fossa into the tibial n and common peroneal n
|
|
what does the sciatic n innerv?
|
hamstring muscles w/ tibial , except for short head of biceps femoris, which innerv the common peroneal division
|
|
what's the result of a damaged sciatic n?
|
impaired extension at the hip and impared flexion at the knee, loss of dorsiflexion and plantar flexion at the ankle, inversion and eversion of the foot, and peculiar gait b/c of increased flexion at the hip to lift the drooped foot off the ground
|
|
what are the n levels of the common peroneal (fibular) nerve?
|
L4, L5, S1, S2
|
|
where is the common peroneal (fibular) n vulnerable to injury?
|
as it winds around the neck of the fibula
|
|
what n does the common peroneal n divide into?
|
deep peroneal and superficial peroneal.. Also gives rise to the lateral sural cutaneous n
|
|
what does the lateral sural cutaneous n innervate?
|
skin on lateral part of back of leg and recurrent articular branch to the knee joint
|
|
what's phantom limb pain?
|
intermittent or continuous pain perceived as originating in an absent (amputated) limb
|
|
how can you get a damaged common peroneal (fibular) n?
|
result of fracture of head or neck of the fibula b/c it passes behind the head of the fibula and then winds laterally around the neck of the fibula
|
|
what's the result of a damaged common peroneal (fibular) n?
|
foot drop (loss of dorsiflexion), loss of sesation on the dorsum of the foot and lateral aspect of the leg and causes paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexor and evertor muscles of the foot)
|
|
is the superficial peroneal (fibular) n more or less vulnerable to injury than the common peroneal (fibular) n? why?
|
superficial is less b/c on the lateral side of the neck of the fibula
|
|
what does the superficial peroneal n innervate?
|
peroneus longus, peroneus brevis, skin on the lateral side of the lower leg and dorsum of the foot
|
|
what happens if the superficial peroneal (fibular) n is damaged?
|
no foot drop, but causes loss of eversion of foot
|
|
what happens if the deep peroneal (fibular) n is damaged?
|
foot drop (loss of dorsiflexion) and high stepping gait
|
|
is the deep peroneal (fibular) n more or less vulnerable to injury than the common peroneal (fibular) n? why?
|
deep less b/c on the lateral side of the neck of the fibula
|
|
what does the deep peroneal n descend on?
|
interosseus membrane
|
|
what does the deep peroneal n innerv?
|
anterior muscles of leg and foot and skin of the contiguous sides of the first and second toes and extensor hallucis brevis and extensor digitorum brevis
|
|
what does the medial branch of the deep peroneal n accompany?
|
dorsalis pedis a
|
|
what are the branches of the deep peroneal n and what do they innerv?
|
lateral- extensor hallucis brevis, extensor digitorum brevis medial- skin on adj sides of the 1st and 2nd toes
|
|
what n levels are the tibial n?
|
L4, L5, S1, S2, S3
|
|
what fossa does the tibial n go thru?
|
popliteal
|
|
what branches does the tibial n give rise to?
|
3 articular branches, muscular branches, medial sural cutaneous n, medial calcaneal branch to the skin of the heel and sole, articular branches to the ankle joint, medial and lateral plantar nerves
|
|
what arteries does the tibial n accompany?
|
3 articular branches accompany medial superior genicular, middle genicular, and medial inferior genicular arteries to the knee joint
|
|
how does the tibial n end and where?
|
ends beneathe the flexor retinaculum by dividing into medial and lateral plantar nn
|
|
what's the result of a damaged tibial n?
|
loss of plantar flexion of foot and impaired inversion from tibialis posterior paralysis, causes difficulty in getting heel off ground and shuffling gait, clawing of toes and secondary loss on the sole of the foot, affecting posture and locomotion
|
|
what does the medial plantar n innerv?
|
abductor hallucis, flexor digitorum brevis common digital branches --> proper digital branches that innerv flexor hallucis brevis and 1st lumbrical and skin of medial 3 and 1/2 toes
|
|
what's the smaller of the terminal branches of the tibial n?
|
lateral plantar
|
|
what does the lateral plantar n innerv?
|
quadratus plantae, abductor digiti minimi superficial branch: innerv flexor digiti minimi deep branch: innerv plantar and dorsal interossei, lateral 3 lumbricals and adductor hallucis
|
|
where does the superior gluteal a coe from?
|
internal iliac a
|
|
what does the superior gluteal a supply?
|
superficial: gluteus maximus deep: gluteus medius and minimus, tensor fascia latae
|
|
what a does the inferior gluteal a come from?
|
internal iliac a
|
|
how does the inferior gluteal a enter the buttock?
|
greater sciatic foramen
|
|
how does the superior gluteal a enter the buttock?
|
greater sciatic foramen
|
|
what n does the inferior gluteal a run w/?
|
posterior femoral cutaneous n
|
|
what does the inferior gluteal a supply?
|
gluteus maximus
lateral rotators of hips hamstrings (upper part) hip joint |
|
what does the superior gluteal a anastomose w/?
|
lateral and medial circumflex a
inferior gluteal aa |
|
what does the inferior gluteal a anastomose w/?
|
cruciate anastomosis: anastomoses w/ superior gluteal, internal pudendal and obturator a
|
|
what does the obturator a come from?
|
internal iliac a in the pelvis
|
|
what hole does it pass thru?
|
obturator foramen
|
|
what are the branches of the obturator?
|
anterior --> muscular branches
posterior --> acetabular branch |
|
how does the obturator a enter the hip joint?
|
via the acetabular branch that goes thru the acetabular notch, ramifies in the acetabular fossa and sends an artery to the head of the femur
|
|
what's the significance of the artery to the head of the femur?
|
important source of blood to the femoral head in kids
may/may not persist in adults may be insufficient to sustain viability of femoral head --> ischemic necrosis |
|
what's the corona mortis?
|
vascular anastomoses b/w the obturator and external iliac systems
|
|
give specific ex. of corona mortis:
|
vascular anastomosis b/w pubic branches of the obturator a and of external iliac (inferior epigastric) a is called corona mortis b/c these vessels in retropubic area are hard to be distinguished and can be injured in groin or pubic surgery
|
|
what happens if corona mortis is injured?
|
massive, uncontrolled bleeding
|
|
how can surgeons prevent a bleeding corona mortis?
|
since venous conn is more probable than an arterial one, if dealing w/ inguinal and femoral hernias, surgeons should avoid venous bleeding and need to be aware of these anastomoses and their close proximity to the femoral ring
|
|
what's the clinical significance of an aberrant obturator a?
|
it may arise from the external iliac or inferior epigastric a and is vulnerable during surgical repair of a femoral hernia
|
|
where does the femoral a come from?
|
external iliac a
|
|
how can you find femoral a?
|
palpable pulsation that can be felt inferior to midpoint of the inguinal ligament
|
|
why is the femoral a vulnerable to injury?
|
it's relatively superficial in the femoral triangle
|
|
what are the branches of the femoral a?
|
superficial epigastric a
superficial circumflex iliac a superficial external pudendal a deep external pudendal a profunda femoris (deep femoral) a medial femoral circumflex a lateral femoral circumflex a descending genicular a |
|
what a emerges from saphenous ring?
|
superficial external pudendal a
|
|
what a runs toward umbilicus?
|
superficial epigastric a
|
|
which a runs laterally almost parallel w/ inguinal ligament?
|
superficial circumflex iliac a
|
|
which a runs medially over the spermatic cord / round ligament of the uterus and sends inguinal branches and anterior scrotal (or labial) branches?
|
superficial external pudendal a
|
|
what a is distributed to the skin of the perineum, scrotum or labium majus?
|
deep external pudendal a
|
|
what a gives rise to the medial and lateral femoral circumflex and muscular branches?
|
profunda femoris (deep femoral) a
|
|
what does the profunda femoria (deep femoral) a supply?
|
in adductor canal, four perforating arteries that supply adductor magnus and hamstring muscles
1st perforating a sends an ascending branch, which joins the cruciate anastomosis of the buttock |
|
what does the medial femoral circumflex a arise from?
|
femoral artery
profunda femoris a |
|
what branches does the medial femoral circumflex a give rise to?
|
muscular branches and acetabular branch to the hip joint.. divides into ascending brach, which anastomoses w/ superior and inferior gluteal a branches and a transverse branch which joins cruciate anastomosis
|
|
what's the clinical sig of the medial femoral circumflex a?
|
its branches run thru the neck to reach the head and it supplies most of the blood to the neck and head of the femur except for a small proximal part that gets blood from a branch of the obturator a
|
|
what's the cruciate anastomosis of the buttock formed by?
|
ascending branch of the 1st perforating a, inferior gluteal a, and transverse branches of the medial and lateral femoral circumflex aa
|
|
what can the cruciate anastomosis bypass?
|
obstruction of the external iliac or femoral a
|
|
what does the lateral femoral circumflex a arise from?
|
femoral or profunda femoris a
|
|
what branches does the lateral femoral circumflex a divide into?
|
ascending branch
transverse branch descending branch |
|
what does the ascending branch of the lateral femoral circumflex a do?
|
forms vascular circle w/ branches of the medial femoral circumflex a around the femoral neck and also anastomoses w/ the superior gluteal a
|
|
what does the transverse branch of the lateral femoral circumflex a do?
|
joins cruciate anastomosis
|
|
what does the descending branch of the lateral femoral circumflex a do?
|
anastomoses w/ the superior lateral genicular branch of the popliteal a
|
|
what a does the descending genicular a arise from?
|
femoral a in the adductor canal before passing thru the aductor hiatus
|
|
what does the descending genicular artery divide ino?
|
articular branch- enters anastomosis around knee
saphenous branch- supplies superficial tissue and skin on medial side of knee |
|
what's the position of the femoral a?
|
easily exposed and cannulated at the base of the femoral triangle just inferior to the midpoint of the inguinal ligament
|
|
what's the clinical significance of the femoral a?
|
it's location makes it vulnerable to injury by laceration and gunshot wounds
|
|
what's the result of a ligated femoral a?
|
cruciate anastomosis supplies blood to the thigh and leg
|
|
what a does the popliteal a come from?
|
femoral a at the adductor hiatus and runs through the popliteal fossa
|
|
where can you feel the popliteal a?
|
popliteal fossa
|
|
how can the popliteal a be injured?
|
femur fracture
dislocation of knee joint |
|
how does the popliteal a terminate?
|
divides into anterior/posterior tibial aa
|
|
what are the aa that the popliteal a gives rise to?
|
5 genicular aa:
superior lateral genicular a superior medial genicular a inferior lateral genicular a inferior medial genicular a middle genicular a |
|
what's the result of a popliteal aneurysm?
|
edema and pain in the popliteal fossa
|
|
how can a popliteal aneurysm arise?
|
if femoral a must be ligated, blood can bypass occlusion thru genicular anastomoses and reach popliteal a distal to ligation
|
|
what a does the posterior tibial a come from?
|
popliteal a
|
|
what accompanies posterior tibial a?
|
2 venae comitantes and tibial n on post surface of the tibialis posterior muscle
|
|
what aa does the posterior tibial a give rise to?
|
peroneal (fibular) a
posterior lateral malleolar branch posterior medial malleolar, perforating, and muscular branches terminates: medial and lateral plantar aa |
|
what does the peroneal (fibular) a give rise to?
|
lateral muscles in the posterior compartment
|
|
what does the medial plantar a supply?
|
superficial: big toe
deep branch: 3 superficial digital branches |
|
what's the diff b/w medial and plantar a in size?
|
medial = smaller
|
|
what does the lateral plantar a run w/?
|
lateral plantar n
|
|
what does the lateral plantar a form?
|
plantar arch by joining deep plantar branch of dorsalis pedis a
|
|
what does the plantar arch give rise to?
|
4 plantar metatarsal aa
|
|
what does the anterior tibial a come from?
|
popliteal a
|
|
how does the anterior tibial a enter the anterior compartment?
|
by passing thru gap b/w tibia and fibula at upper end of interosseus membrane
|
|
what does anterior tibial a descend w/?
|
deep peroneal vessels
|
|
what a does the anterior tibial a give rise to?
|
anterior tibial recurrent a
anterior medial malleolar aa anterior lateral malleolar aa |
|
what gives rise to the dorsalis pedia a?
|
anterior tibial a
|
|
what aa does the dorsalis pedia a give rise to?
|
medial tarsal, lateral tarsal, arcuate and 1st dorsal metatarsal aa
|
|
what does the arcuate a give rise to?
|
2nd, 3rd, 4th dorsal metatarsal aa
|
|
how does the dorsalis pedia a terminate?
|
as the deep plantar a
|
|
what forms the plantar arch?
|
joining of deep plantar a and lateral plantar a
|
|
where can you feel the pulse in the dorsalis pedis a?
|
pulsation on the navicular and cuneiform bones lateral to the tendon of flexor hallucis longus
|
|
what are the deep veins of the leg?
|
venae comitantes to the anterior and posterior tibial aa
|
|
what v does the popliteal v receive?
|
small saphenous vein and vv corresponding to popliteal a branches
|
|
what does the popliteal v accompany?
|
popliteal a
|
|
what does the femoral v accompany?
|
femoral a as continuation of popliteal v
|
|
what v does the femoral v receive?
|
great saphenous v and tributaries from branches of femoral a
|
|
where's the femoral v?
|
lies immediately medial to femoral a, which can be identified by pulsation
|
|
what happens when the femoral v is cannulated?
|
permits administration of fluids or catheters, which are passed superiorly thru external and common iliac vv into the inferior vena cava and then right atrium of the heart
|
|
what are the mvmnts of the hip joint?
|
flexion
extension adduction abduction medial rotation lateral rotation |
|
what are the mvmnts of the knee joint?
|
flexion
extension medial rotation lateral rotation |
|
what are the mvmnts of the ankle joint?
|
dorsiflexion
plantar flexion |
|
what are the mvmnts of the intertarsal joint (talocalcaneal, transverse tarsal joint) ?
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inversion
eversion |
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what are the mvmnts of the metatarsophalangeal joint (ellipsoid joint)?
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flexion
extension |
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what are the mvmnts of the interphalangeal joint (hinge joint)?
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flexion
extension |
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what innerv muscles of the anterior compartment of the thigh?
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femoral n
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what innerv muscles of the medial compartment of the thigh?
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obturator n
exceptions: adductor magnus- obturator and tibial nn pectineus- femoral and obturator nn |
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what innerv muscles of the posterior compartment of the thigh?
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tibial part of sciatic n
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what innerv muscles of the lateral compartment of the thigh?
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inferior gluteal n
superior gluteal n n to piriformis n to obturator internus n to quadratus femoris |
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what innev the muscles of the anterior compartment of the leg?
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deep peroneal n
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what innerv the muscles of the lateral compartment of the leg?
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superficial peroneal n
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what innerv muscles of the posterior compartment of the leg?
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tibial n
exceptions: short head of biceps femoris: common peroneal part of sciatic n adductor magnus- tibial part of sciatic n and obturator n |
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what muscles are involved in dorsiflexion?
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anterior tibialis
extensor digitorum longus extensor hallucis longus peroneus tertius |
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what muscles are involved in plantar flexion?
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triceps surae
plantaris posterior tibialis peroneus longus peroneus brevis flexor digitorum longus flexor hallucis longus |
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what muscles are involved in inversion of the foot?
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tibialis posterior
tibialis anterior triceps surae extensor hallucis longus |
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what muscles are involved in eversion of the foot?
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peroneus longus
peroneus brevis peroneus tertius extensor digitorum longus |