Anatomy Exam 1 Lower Leg

Auricular Surface

1

Ligamentum Teres

A dislocation of the femur, can cause a tear in this ligament, resulting in avascular necrosis of the femur

Internal rotation of the hip: External rotation of the hip

Differentiate internal and external rotation of the hip

Open chain: Actively moving while non-weight bearing Close chain: Actively moving while weight bearing (distal extremity is stable and proximal is moving) Ex. Squats, push-us

Differentiate open chain motion vs close chain motion

Lumbar plexus: Sacral Plexus:

Differentiate the lumbar and sacral plexus

No

Does any muscle have internal rotation of the hip as their primary function?

No, it attaches all around the patella

Does the articular capsule of the knee, cover the patella?

No and no

Does the fibula articulate with the femur? Is it weight bearing?

No

Does the head of the fibula articulate with the femur?

Joint space

Space between two bony structures in a joint

Fifth

The base of this metatarsal of the foot has a tuberosity lateraly that covers the cuboid and provides attachment for the pernoneus brevis.

anterior border of tibia

shin

Ischial Spine

1 Projects medially and separates the greater/lesser sciatic notches

superior ramus of pubis

1 This passes superiorly and lateraly to the acetablulum and is fused to the ilium and ischium

Ala

1 Wing of the Sacrum

Median Crest

2

Pubic Body

2

Sacral Promonotory

2

Ischial Tuberosity

2 The sitting bones. Covered by the gluteus maximus. Palpated in the gluteal fold

Medial Crest

3

Superior Articular Process

3

Inferior Pubic Ramus

3 This passes posteriorly, inferiorly, lateraly to join the ramus and form 1/2 of the pubic arch

Superior Ischial Ramus

3. This extends medially from the body and joins the inferior ramus of the pubis to form the ischiopubic ramus and complete the obturator foramen

Anterior Foramina

4

Lateral Crest

4

Obturator Foramen

4 This is the opening formed by the bodies and rami of the pubis and ischium. Males: Round Females: Oval

Apex

5

Posterior Sacral Foramina

5

Sacral Hiatus

6

Cornua of Sacrum and Coccyx

7

Deltoid ligament

A large and strong ligament which attaches proximally to the medial malleolus. Its fibers fan out to attach distally to the talus, calcaneus and navicular. It stabilizes the ankle during eversion

Shenton's line

A line from the lesser trochanter of the femur to the pubic symphasis. C-shaped

The ankle mortise widens unchecked

A syndesmotic sprain of the tibiofibular joint occurs when what happens?

Medial collateral ligament; lateral collateral ligament

A valgus directed force at the knee joint will affect the ________________ and a varas directed force will affect the _____________.

Contact surface area increases and migrates superiorly on the surface of the patella

As you go into knee flexion, how does the contact surface area change with the patella?

Spongy bone: withstands axial forces Cortical bone:

Compare and contrast the function of spongy bone vs cortical bone

Puberty (15-23)

Complete fusion of the three hip bones (Ilium, Ischium, and Pubis) happens between what ages?

Adductor canal: Entry to the tunnel anteriorly. Contains Femoral artery and vein, Saphenous nerve, and vastus medialis nerve Adductor hiatus: exit of the tunnel posteriorly Contains: Femoral artery which turns into popliteal artery, Femoral vein which turns into popliteal vein

Contrast the adductor canal and adductor hiatus

acetabular fossa

Depression where the head of the femur attaches to the acetabulum by the ligamentum teres

Degenerative changes

Due to the support of the body weight against gravity, the lower extremities are more prone to this.

Inferiorly; superiorly

During knee flexion, the patella glides ______________. During knee extension, the patella glides ________.

Collateral ligaments

Every hinge joint (knee, elbow) has these type of ligaments on each side.

Purely sensory. Supplies sensation to skin from knee to ankle.

Explain the function of the saphenous nerve

Medial rotation of the femur on the tibia The popliteus contracts, rotating the femur laterally so flexion can occur.

How does the knee lock? Unlock?

Uniaxial hinge joint Flexion/extension

How many degrees of freedom does the knee joint have? What type of joint?

Weight bearing activity

If someone has undergone an injury during a closed chain activity, their symptoms will likely be exacerbated during what?

All the structures of the adductor canal

If someone was undergoing an amputation and had a tourniquet around their distal thigh compressing medial structures on the distal thigh, what structures should you be concerned about?

Medial meniscus of the knee

If you have a medial collateral ligament injury, you may also injury this structure.

The lateral facet (it is larger)

If you lay a patella on its posterior side, what will it rest on?

ACL and PCL

In a closed chain motion, while the foot is planted, torsional force of the knee can injure what two ligaments?

Anterior cruciate ligament Posterior cruciate ligament

In an open-chain, the knee hyper extension can injure this ligament. If you are riding in a car as a passenger and your friend slams the breaks while your knee is flexed. The dashboard of the car hits the tibial tuberosity, pushing the tibia backwards. What ligament of the knee could be injured?

Femur; Tibia

In closed chain exercises of the knee joint, this bone moves. In open chain exercises of the knee joint, this bone moves.

Reduction in joint space

In degenerative conditions of the joints, the articular cartilage is reduced, causing erosion of the cartilage, resulting in what?

Most amount of contact

In full flexion of the knee joint, the patella has the ________ amount of contact with the femur.

Compartment Syndrome

Increased intra-compartmental pressure. When muscles undergo hypertrophy. Will compress on the arteries, veins, and nerve in the compartment. Loss of vascularity, blood supply, bluish discoloration.

Peroneal Trochlea

Lateral projection of the Calcaneus that separates the tendons of the Peroneus Longus and Brevis

The hamstring part of the adductor magnus attaches at the adductor tubercle of the medial epicondyle

Like the other adductors, the adductor part of the adductor magnus inserts at the medial lip of the linea aspira. However, it also attaches where?

Sustentculum Tali

Medial projection of the Calcaneus that supports the talus and provides the groove for the flexor hallucis longus

Cuboid

Most lateral in distal row of tarsals. Has anterior facets for the 4th and 5th metatarsals and has an inferior groove for the peroneus longus

Cause motion; Check motion

Muscles and tendons _____________ motion whereas ligaments ____________ motion

Iliac Crest

Name this specific part of the ilium. Found by placing your hand on your hip.

Lesser sciatic notch

Name this specific part of the pelvic bone.

Posterior superior iliac spine

Name this specific part of the pelvic bone.

Body of the ischium

Number 4 The superior thick portion that is fused with the ilium and the pubis at the acetabulum

O - Greater trochanter and lateral lip of lin aspera I - Common tendon to tibial tuberosity A: Knee ext N Femoral nerve

OIAN of Vastus lateralis

O - AIIS I - tendon to tibial tuberosity A - knee ext and hip flex N - Femoral nerve

OIAN of rectus femoris

Pes anserine bursae

Overuse of the sartorius, gracilis, and semitendonosus can injury this bursae through overuse

Pubis

Part of the hip bone anterior to the other two

Ischium

Part of the hip bone posterior to the other two

Ilium

Part of the inominate bone superior to the other two

Soleal Line

Rough ridge on the post. surface of the tibia that functions as the superior attachment of the soleus

neck

Rough, narrow area between body and head of the talus.

Lateral Epicondyle

Smaller and less prominent than its medial counterpart, this gives attachment to the fibular ligament of the knee joint.

Anterior translation of tibia/posterior translation of the tibia Posterior translation of the tibia/anterior translation of the femur

The ACL checks this motion. The PCL checks this motion

Anterior Cruciate ligament; Posterior cruciate ligament

The ________ ligament originates at the lateral femoral condyle. The _________ ligament originates at the medial femoral condyle

Angle of declination ~15 degrees

The angle of the femur in the transverse plan

mortise

The ankle joint is formed by three bones; the tibia and fibula of the leg, and the talus of the foot: The tibia and fibula are bound together by strong tibiofibular ligaments. Together, they form a bracket shaped socket, covered in hyaline cartilage. This socket is known as a what?

base

The broad superior portion of the patella that forms the attachment area for the quadriceps tendon

Iliac Fossa

The broad, slightly concave inner surface of the ilium.

Coronary ligaments of the knee

The capsular fibers of the knee joint attach to the margins of the menisci to the tibial condyles through these ligaments

Intercondylar eminence of the tibia

The cruciate ligaments of the knee insert here.

Eversion of the foot

The deltoid ligaments check this motion

Tarsals Metatarsals Phalanges

The foot contains these three types of bones

Synovial membrane

The hip joint has this, which secretes synovial fluid, which is important for lubrication and nutrition.

Anteversion of the hip Retroversion of the hip

The hips are always in a slight degree of _________________ meaning that the toe is postured in. Whereas ________________ will cause toe out posturing

Extracapsular ligaments of the hip joints

The iliofemoral, pubofemoral, and ischiofemoral are what?

Ala

The interior portion of the ilium between the iliac crest and the iliac fossa

Tibial Tuberosity

The large oblong elevation on the proximal anterior aspect of the tibia. This is where the patellar tendon attaches to bone.

The fibers of the medial meniscus attach to the medial collateral ligament. The fibers of the lateral collateral ligament do not attach to the meniscus

The lateral collateral ligament has gap underneath it, whereas the medial collateral ligament does not. Why?

Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament

The lateral ligaments of the tibiofibular joint include these three ligaments

Tibial nerve

The posterior compartment of the lower leg is supplied by this nerve. (gastrocnemius, Soleus, Plantaris)

Piriformis (Piriformis syndrome)

The sciatic nerve exits the greater sciatic notch under what muscle? If this muscle is tight, it can pinch the sciatic nerve and cause sciatica pain

Tibial and common peroneal nerves

The sciatic nerve is actually these two nerves contained in one sheath that splits in the popliteal fossa

Inguinal ligament

The superior border of the femoral triangle

Superior: IT Band Inferioir: Gluteal tuberosity

The superior fibers blend into what? The inferior fibers attach to what?

Talus

The superior surface of this bone articulates with the Tibia and Fibula to form the Talocrural Joint

Fractures of the neck of the talus

The talus is susceptible to avascular necrosis due to fractures of this part.

The lateral collateral ligament and the lateral meniscus of the knee

The tendon of the popliteal muscle travels between these two structures.

Semitendinosus Semimembranosus Adductor magnus Long head of the biceps

The tibial nerve supplies these muscles of the hamstrings?

Gastrocnemius bursae

The two bursae right underneath the two heads of the gastrocnemius

Pelvic girdle

The weight of the upper extremity is transferred from the vertebral column to what?

Meniscus

These are c-shaped structures that sit on top of the tibial plateaus. They absorb shock forces that go through the knee joint. They also increase the concavity of the tibial condyles (like the labrum of the acetabulum)

Genicular anastomosis around the knee

These are the arteries that come out of the popliteal artery superiorly and inferiorly and in the middle of the knee. They wrap around the knee joint.

Interosseus memrbane Anterior tibiofibular ligament Posterior tibiofibular ligament

These are the three static stabilizers of the posterior tibiofibular ligaments

Anterior tibiofibular ligament Posterior tibiofibular ligament

These are the two static stabilizers of the anterior tibiofibular joints

cuneiforms (medial, intermediate, lateral)

These bones articulate with the navicular post

Metatarsals

These bones, numbered from the medial portion of the food, bear the most weight during late stance.

Obturator nerve Femoral nerve Tibial nerve Common fibular nerves (peroneal nerves)

These four nerves are responsible for innervation of the knee

Sacrotuberous ligament Sacrospinus ligament

These ligaments are where the sciatic nerve passes through the greater and lesser sciatic notch

Patella and Fibula

These two bones of the ankle have little weight bearing responsibility

Joint capsule of the hip joint The inferior side

Thin round connective tissue layer that surrounds the entire hip joint. This is air-tight and reinforced by ligaments on the outside. Where is the joint capsule of the hip joint thinnest?

Navicular

This bone articulates with the talus and the 3 cuneiforms

Coccyx

This bone, which is a remnant of the tail 3-5 vertebra has no body weight support but attaches the gleut max and coccygeus ms.

Medial Epicondyle

This bony protrustion bears an elevation called the adductor tubercle which serves as the attachment of the adductor magnus

Popliteal bursae

This bursae is between the popliteus tendon and underlying bone

Medial Malleolus

This extends distal to the shaft of the tibia to make part of the talocrural joint

lateral facet of patella

This faces posteriorly and is the largest part of the articular surface of the patella

Medial facet of patella

This faces posteriorly and is the smaller articulation of the patella

Odd Medial Facet

This facet, is medial to the medial facet and does not articulate with the femur until flexion exceeds 90 degrees. On deep flexion, the patella rotates and this articulates with the medial femoral condyle

Greater Sciatic Notch

This feature, inferior to the sacroiliac joint, is where the sciatic nerve passes through

Pubic Symphasis

This fibrocartilaginous joint is the joint between the two pubic bodies.

Iliosoas bursae

This fluid-filled sac is between the iliosoas muscle and the pubofemoral and iliofemoral ligaments

Trochanteric bursae

This gel-filled pillow is between the greater trochanter and the it band

Ischial bursae

This gel-filled pillow overlies the ischial tuberosity and is covered by the edge of the gluteus maximus

Gluteal bursae

This gel-filled pillow reduces friction above and behind the greater trochanter and underneath the gluteus maximus and medius. This protect the gluteal muscles from friction with the greater trochanter

Abductors of the hip (mainly the gluteus medius)

This group of muscles is responsible for balancing equilibrium as we walk

Ischiofemoral ligament

This hip ligament checks extension of the hip, internal rotation

Ligament of the head of the femur (ligamentum teres, capitate ligament)

This intracapsular ligament attaches to the head of the femur in the fovea capitis. It's function is to carry the artery that supplies the hip joint.

Articular capsule of the talocrural joint

This is a fibrous capsule that is thin anteriorly and posterior. It is supported by by the strong collateral ligaments on each side.

Housemaids Knee

This is a repetitive use injury due to kneeling on the floor.

Head of Talus

This is a spherical part of the talus directed anteriorly and medially, and it has an articulating surface for articulation with the navicular bone.

Ward's triangle

This is a triangle at the neck of the femur where the trabeculae do not cross, causing a point of weakness

Adductor canal and adductor hiatus

This is a tunnel fromed by the adductor magnus muscle. It is deep to the sartorius. It's contents are the femoral artery and vein, saphenous nerve, and nerve to vastus medialis

Acetabular Notch

This is bridged by the transverse acetabular ligament which carries blood supply to the through the obturator branch into the head of the femur

developmental dysplasia of the hip

This is caused by the failure of the ilium, ischium, and pubis to form during adolescance

Semitendinosus

This is commonly used as a graft for tendon reconstruction due to it have a long tendon that attaches to the pes anserine

Nutrient Foramen

This is immediately below the popliteal line. These are always directed away from the growing ends of bone.

Talus

This is one of the few bones in the body without any muscular attachments.

Lateral Condyle

This is one of the two projections of the distal femur.

Medial Condyle

This is one of the two projections on the lower extremity of the femur. This is bigger than its counterpart due to more weight bearing caused by the centre of mass being medial to the knee.

Patellafemoral articulation

This is the articulation between the patella and femur

Patella

This is the largest Sesamoid bone in the body. It is formed in the tendon of the quadriceps and gives the quads mechanical advantage.

Fracture of the neck of the femur

This is the most common reason that people over age 75 go to the ED

apex of patella

This is the most inferior part of the patella and gives attachment to the patellar ligament

Lateral collateral complex (anterior talofibular ligament)

This is the most injured ligament of the human body due to rolling of the ankle

Adductor Tubercle

This is the superior part to the medial femoral condyle and serves as the attachment for the adductor magnus

Pubofemoral ligament

This ligament checks abduction of the hip and external rotation of the hip, and extension

Transverse ligament of the knee joint

This ligament connects the medial and lateral meniscus and allows them to move as a single unit.

Posterior meniscofemoral ligament

This ligament helps in giving the meniscus of the knee the stability of the knee.

transverse acetabular ligament

This ligament, under the acetabular notch, bridges the gap between the acetabular notch and the horseshoe shaped acetabulum

Sacrospinous ligamanet

This makes attaches at the ischial spine and the sacrum. It makes the greater sciatic notch a full circle

Popliteus

This muscle comes from the lateral eipcondyle of the femur and inserts into the tibia above the soleal line by passing posteriolaterally.

Plantaris

This muscle, which comes from the lateral femoral condyle, travels down to the calcaneus. It's long tendon supplies grafts for surgery.

Soleus

This muscle, which plantar flexes the foot, originates underneath the soleal line of the tibia and inserts at the achilles tendon. It is deep to the gastrocnemius.

Obturator internus tendon

This muscle/tendon separates the superior and inferior gemellus

Medial Tibial Plateau

This protrudes anteriorly 1cm beyond the medial femoral condyle

Angle of inclination ~125 degrees

This refers to the angle between the neck and the shaft of the femur.

Thigh

This region contains the distal femur, patella, and the anterior surface of the knee

The hip

This region containts the iliac crest to the mid-thigh. It connects the axial skeleton to the lower limb

Lower leg

This region is between the inferior knee and superior ankle. It contains the following articulations: 1. Superior tibiofibular 2. Inferior Tibiofibular 3. Talocrural

Linea Aspira

This rough ridge of bone serves as the attachment site for the adductor brevis and magnus

Trendelenburg test

This test is where you put both hands on the hip and ask the leg to go up. If the hip drops, the abductors (gluteus medius) are weak

Sacrum

This wedge shaped bone at the base of the spine provides strength and stability to the pelvis.

Inominate bone

This whole bone is called what?

Calcaneus

This, largest and strongest bone of the foot, forms the support for the weight of the body and attachment point for the achilles tendon

1. Pelvic girdle 2. Hip joints 3. Femurs 4. Tibia 5. Talocrural joint 6. Foot/Talus

Weight is transferred to the lower extremities in what order?

Tensor fascia latae Gluteus maximus Gluteus medius Gluteus minimus Nerve: Superior and inferior gluteal nerve

What are the abductors of the hip? What nerve supplies them?

Superiorly: Semimem/Biceps fem Inferiorly: Two heads of gastroc Floor: Popliteus and popliteal surface of femur

What are the borders of the femoral triangle? Floor?

Femoral vein Femoral artery Femoral nerve

What are the contents of the femoral triangle from medial to lateral?

Gluteus maximus Hamstrings Gluteus medius Adductor magnus Piriformis

What are the extensors of the hip?

Piriformis Obturator internus Gemellus suprior Gemellus inferior Quadratus femoris

What are the external rotators of the hip? What nerve supplies them?

Lateral: Long head of Biceps femoris Short head of biceps femoris Medial: Semitendinosus Semimembranosus

What are the four hamstring muscles? What are the lateral two and the medial two?

Biceps femoris (long and short head) Semimemranosus Semitendinosus O: Ischial tuberosity

What are the hamstrings? Where do they all originate?

Sartorius Rectus femoris (secondary action) Iliopsoas Nerve supply: Femoral nerve (Iliopsoas: lumbar spinal nerves)

What are the hip flexors? What is the nerve supply?

Tibialis anterior Extensor Digitorum Longus Peroneus tertius Extensor hallucis longus Function: Dorsiflexors Nerve: Deep peroneal nerve

What are the muscles of the anterior compartment of the ankle? What are the functions and nerve?

Flexor hallucis longus Flexor digitorum longus Tibialis posterior Popliteus Nerve: Tibial

What are the muscles of the deep posterior compartment of the ankle?

Peroneus longus Peroneus brevis Nerve:

What are the muscles of the lateral compartment of the ankle? What are their function? What nerve?

Gastrocnemius Soleus Plantaris Nerve: Tibial

What are the muscles of the posterior superficial compartment of the ankle?

Popliteal artery Popliteal vein Sciatic nerve

What are the structures of the popliteal fossa

SGT (sergeant) Sartorius Gracilis Semitendinosus

What are the three muscles that make the pes anserine?

Uniaxial: one plane of motion Biaxial: (fingers) Two planes of motion Triaxial: (Hip joint) Three planes of motion

What are the three types of synovial joints and an example of each?

superior tibiofibular

What articulation is highlighted here?

The trunk

What checks flexion of the hip joint?

Reinforce the joint on the popliteal side. They check extension of the knee joint.

What do the oblique and arcuate popliteal ligaments do?

Screwhome mechanism of the knee joint The medial condyle of the tibia is larger than the lateral condyle so when you go into full extension, the knee rotates externally due to the medial tibial condyle moving farther than the lateral condylee. The knee locks where the tibia rotates externally

What happens at the knee joint when you go into full extension in open chain

Coxa Valga: Hips come closer Coxa Vara: hips go away from each other

What happens if the angle of inclination increases in the femur? What about if it reduces?

Externus: Externally rotates the hip Internus:

What is the action of the obturator externus and internus?

Adductors of the hip (closing your legs): Pectineus Adductor brevis Adductor longus Adductor magnus Gracilis Nerve: Obturator nerve Pectineus is supplied by the femoral nerve

What is the function of the muscles of the medial compartment of the thigh? What are they? What nerve?

Base of the patella

What is the insertion of all of the quadriceps muscles?

Tibial branch

What is the medial branch of the sciatic nerve?

Rectus femoris

What is the only two joint muscle in the quadricep group?

Knee extension

What is the primary function of the quadriceps?

Inferior Tibiofibular

What joint is highlighted here?

Ascending branches of the medial and lateral circumflex femoral arteries

What supplies blood to the hip joint?

Superior: Inguinal ligament Lateral: Sartorius Medial: Adductor longus Floor: Iliopsoas and pectineus Roof: Skin and fascia

What three structures form the femoral triangle? What about the floor and roof?

During dorsiflexion (

When is the inferior tibiofibular ligament injured? (high ankle sprain)

Semimembranosus

Which is larger, the semitendinosus or the semimembranosus?

Saphenous nerve

Which nerve enters the adductor canal but pierces the subsartorial membrane to come out?

Medial

Which tibial condyle is larger?

Asymmetry between the condyles of the tibia and femur.

Why do you have conjunct motion (knee locking)?

The ankle mortise must widen to accomodate the widening of the talus anteriorly thus resulting in a tighter joint during dorsiflexion of the foot.

Why is dorsiflexion of the talocrural joint more stable than plantar flexion?

The attachment of the patellar tendon at the apex of the patella, is non-contractile.

Why is the patellar tendon considered a static stabilizer?

Intercondylar Fossa

depression between the condyles

Lateral Malleolus

distal end of fibula

Tibiofemoral Articulation

femur with tibia (condyloid joint)

Lateral Tibial Plateau

flat plateau on the proximal, lateral end of the tibia; articulates with the lateral femoral condyle

posterior inferior iliac spine (PIIS)

located just below the PSIS

Interosseus membrane

membranous ligamental structure between the shafts of the Tibia and Fibula

Anterior Inferior Iliac Spine

origin of rectus femoris

Anterior Superior Iliac Spine

origin of sartorius muscle

Auricular Surface

region on the ilium for articulation with the sacrum

Trochlea

site of articulation with the tibia

Patellar Surface

smooth area where patella rests to form knee cap

Gastrocnemius Soleus Plantaris

superficial muscles of the posterior compartment of the leg which all form the Achilles tendon. When they contract, they pull the foot into plantar flexion.