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WEEK 26:
Introduction to lower limb joints:
| Question | Answer |
|---|---|
| bearing surfaces of lower limb joints have what | articular cartilage covering and each has arterial anastomosis around |
| hip joint | ball and socket synovial joint |
| articulations between hip joint | acetabulum of femur to the acetabular foramen of the pelvis |
| function of the gluteal region | extend, abduct, and rotate hip |
| gluteus maximus action | extension and lateral rotation |
| deep gluteal muscles (4) | piriformis, obturator internus, gemelli, quad femoris |
| deep gluteal muscle action | lateral rotation and extension of thigh, abduct flexed thigh |
| gluteus medius and gluteus minimus action | abduction and medial rotation |
| posterior compartments of the thigh | hamstrings |
| hamstring action | extension of hip (and flexion of knee) |
| hamstrings attach | proximally to ischial tuberosity |
| hamstring innervation by | sciatic nerve (tibial division) |
| biceps femoris heads | has 2 heads but only long head acts on hip |
| long head biceps femoris action | extends thigh when knee is flexed (eg when starting to walk)m |
| hamstring muscles | long head of biceps femoris, semitendinosus, and semimembranosus |
| anterior thigh muscles action | flexors of hip (and extensors of knee) |
| anterior thigh muscles cross | hip joint |
| hamstrings cross | hip joint |
| anterior thigh muscle innervation | femoral nerve |
| iliopsoas made of | iliacus and psoas major |
| iliopsoas | chief flexor and hip joint |
| pectineus function | adduction and flexes thigh |
| sartorius function | abduction and flexes and lateral rotation of thigh and flex the knee |
| rectus femoris | one of the quadriceps |
| anterior thigh muscles include | pectineus, sartorius, rectus femoris, iliopsoas |
| medial compartment of thigh function | adductor hip |
| medial compartment of thigh crosses | hip joint |
| medial compartment of thigh innervated by | obturator nerve |
| muscles of the medial compartment of thigh | adductor brevis, adductor longus, adductor magnus and gracilis |
| function of iliofemoral ligament | prevents hyperextension and lateral rotation |
| iliofemoral ligament location | anterior and superior |
| pubofemoral ligament function | prevents excessive abduction |
| iliofemoral ligament location | inferior and anterior |
| ischiofemoral ligament function | limits medial rotation and extension |
| iliofemoral ligament location | posterior |
| hip joint ligaments (3) | iliofemoral, pubofemoral, and ischiofemoral ligament |
| additional function of all the hip joint ligaments | keep femoral head in acetabulum |
| acquired dislocation | uncommon as is strong and stable but can occur in automobile accident |
| explain what happens in a car crash to bones | while riding in car hip is flexed, adducted and medially rotated so head of femur is driven posteriorly out of acetabulum and sciatic nerve can be injured |
| congestion dislocation (CDH) | femoral head not properly in acetabulum and affected limb is shorter with positive trendelenburg sign |
| trendelenburg sign (positive) | hip drop sign to one side while walking, instability to abduct |
| tearing of retinacular arteries in pelvis can result in | avascular necrosis of femoral head |
| dislocation/ fracture of hip can affect | superior gluteal arteries as well as from medial and lateral circumflex femoral arteries with first perforating artery |
| shenton line | imaginary curved line drawn along border of superior pubic ramus (superior border of obturator foramen) and along the inferomedial border of the neck of femur |
| appearance of shentons line | continuous and smooth |
| normal gluteal muscle function | gluteus medius and minimus contract to keep pelvis level when contralateral foot is off the floor |
| action of gluteal muscles when nerve damaged | gluteus medius and minimus do not contract to keep pelvis level when contralateral foot off floor leading to tipping of pelvis on the unsupported/ opposite side |
| knee joint | hinge synovial joint |
| knee joint action | flexion and extension and limited rottion |
| in full extension and with foot on the ground, the knee is | locked due to some medial rotation which forms a strong column for weight bearing |
| posterior compartment of thigh | hamstrings |
| hamstrings action | extensors of hip and flexors of knee |
| hamstrings cross over | knee joint |
| hamstring innervation | sciatic nerve (tibial division) |
| anterior thigh muscles action | flexors of hip and extensors of knee |
| anterior thigh muscles cross | knee joint |
| innervation of anterior thigh muscles | femoral nerve |
| tibial (medial) collateral ligament | firmly attached to medial meniscus |
| fibular (lateral) collateral ligament | separate from lateral meniscus by popliteus |
| anterior cruciate ligament (ACL) | limits posterior rolling of femur on tibia and hyperextension (weaker of the cruciates) |
| posterior cruciate ligament | limits anterior rolling of femur on tibia and hyperflexion |
| difference between ACL and PCL | PCL stronger and limits ANTERIOR rolling of femur on tibia and hyperFLEXION but ACL limits POSTERIOR rolling of femur on tibia and hyperEXTENSION |
| cruciates are within | joint capsule |
| curciates are outside | articular cavity |
| to test collateral ligaments (4)- (straight leg push left and right) | Take leg in the hands with knee straight. Gently adduct the knee – to test fibular collateral Gently abduct the knee – to test tibial collateral There should be very little movement |
| drawers test | tests cruciate ligament (flex knee 90* sit on foot and pull leg forward from tibia (ACL) and push leg back (PCL) - should be little movement |
| menisci | important in shock absorption where medial meniscus is less mobile than lateral meniscus |
| difference between medial and lateral meniscus | medial meniscus is less mobile than lateral meniscus |
| shape of lateral meniscus | O shaped |
| shape of medial meniscus | C shaped |
| when is the knee locked | in full extension and foot on ground the knee is locked due to some medial rotation of femur on tibia (meaning many muscles can relax in this position) |
| how do you unlock the knee | popliteus contract to laterally rotate the femur on the tibia by 5 degrees |
| housemaids knee | prepatellar bursitis |
| clergymans knee | infrapatellar bursitis |
| bakers cysts | when cysts form in popliteal region |
| where do bursae form | around knee |
| cause of bakers cysts | usually complication of chronic knee joint effusion, interfering with knee movement |
| ankle joint | hinge type synovial joint |
| where does the talus fit | into a mortise formed from the tibia and fibula |
| when is the ankle joint more stronger and stable | during dorsiflexion |
| when is the ankle joint relatively unstable | during plantarflexion |
| why is the ankle joint relatively unstable during plantarflexion | trochlea of talus is narrow posteriorly and lies loosely in the mortis created by the tibia and fibula |
| posterior compartment of the leg composes of | calf muscles - plantarflexors |
| 2 groups of posterior compartment leg muscles | superficial and deep |
| superficial group of muscles in posterior compartment of leg | plantarflex ankle (and some flex toes) |
| triceps surae function | plantarflexion force |
| triceps surae made of | soleus and 2 heads and gastrocnemius |
| lateral compartment of leg | evertors - ever the foot at subtalar joint |
| what is special about fibularis tertius | aids in eversion but is in anterior compartment whereas usual muscles that evert the foot are in the lateral compartment and this muscle also helps dorsiflex ankle |
| muscles which are in the lateral compartment of the leg and evert the foot | fibularis longus and fibularis brevis |
| all muscles which evert the foot | fibularis longus and fibularis brevis (in lateral compartment of leg) and fibularis tertius (in anterior compartment of leg) |
| anterior compartment of leg has | dorsiflexors of ankle and extensors of toes |
| tibialis anterior | also inverts foot with tibialis posterior |
| anastomosis of the ankle, leg are derived from | medial and lateral malleolus branches |
| how many parts of medial ligaments in the ankle joint | 4 |
| how many parts of the lateral ligaments in the ankle joint | 3 |
| anterior talofibular ligament during inversion injury | most likely to be damaged in ankle sprain (partially or fully torn) |
| what else can be damaged in inversion injury apart from anterior talofibular ligament | calcaneofibular ligament may also be torn |
| Pott's fracture | caused when foot forcibly everted where strong medial ligaments can fracture medial malleolus and talus moves in lateral direction fracturing lateral malleolus or fibula |
| transverse tarsal joint | compound joint - so is 2 separate joints which are aligned in the transverse direction (talonavicular and calcaneocuboid) |
| where is the usual site for surgical amputation of the foot | transverse tarsal joint |
| hilton law | nerve supplying the muscles that cross and act on joint also innervate that joint |
Created by:
kablooey
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