Anatomy Exam 2 - bones, muscles, etc.

What muscles do initial and midswing?

*** contralateral abductors of the hip hamstrings ilipsoas and rectus femoris

What muscles do terminal stance (heel off)?

*triceps surae*

Key adaptations in human bipedality:

-S-shaped vertebral column -full extension at the hip -bicondylar angle -near full extension at the knee -ankle stability with limited mobility -permanently pronated foot at ankle -hallux (great toe) permanently adducted to lateral digits -arches in the foot

The os coxae is made up of:

-ilium -ischium -pubis

What's bad about habitual bipedalism?

-low back pain -headaches/migraines -osteoarthritis -trauma -hip/knee/ankle/foot pain -complications of pregnancy -hernias -varicose veins -herniated discs -spondyloisthesis -we are slow; carnivores catch us easily -upper limbs freed to lift heavy objects can result in herniated discs, radiculopathy, muscle sprain -challenging birthing process bc big heads -vascular problems in lower limbs

What is the plantar aponeurosis?

-modified deep fascia -thick fibrous sheet across the plantar surface -arises from the calcaneus -distally separates into 5 bands going to 4 digits and the great toe -at the distal end of the metatarsals, bands of palmar aponeurosis are interconnected by the superficial transverse metatarsal ligaments -very similar to palmar aponeurosis but strong as there is greater stress on the foot surface than the palm -shorter than length of bones in foot to maintain arch

Lower limb adaptations for bipedality

-orientation of pelvic girdle and shape of ilia -hip joint at extension -bicondylar angle of femur (angle of inclination) -knee in extension, locking mechanism -fixed relationship between tibia and fibula -limited motion at ankle -foot permanently pronated with adducted halux -arches of foot -ligaments and joint morphology

What is the path of lymphatics for the lower limb?

-popliteal lymph nodes -superficial or deep inguinal lymph nodes -external iliac lymph nodes -venous blood

Adaptions for human bipedality: appendicular skeleton/upper limb

-upper limb no longer used in locomotion or bipedal stance -scapulae on dorsal thorax -wide range of motion at shoulder -limited bony articulation with axial skeleton at sternoclavicular joint

Why are veins of the lower limb clinically significant?

-varicose veins -deep vein thrombosis -edema

lateral intercondylar tubercle

1

What 5 things are seen w hallux valgus?

1. enlargement at the base of the great toe that is chracteried by the lateral deviation of the great toe 2. the great toe overlaps the 2nd toe 3. there is a decrease in the medial longitudinal arch 4. 1st metatarsal shifts medially 5. sesamoids shift laterally *bursitis can develop

Intrinsic muscles of 1st layer:

1. flexor digitorum brevis 2. abductor hallucis 3. abductor digiti minimi

What are the stages during the stance phase?

1. heel strike/ initial contact 2. loading response 3. midstance 4. heel off/terminal stance 5. toe off/preswing

articular surface of lateral malleolus

10

lateral malleolus

11

fibula

12

The femoral neck comes from the shaft superomedially at an angle of ___ on average. This allows for improved range of motion of the lower extremity

125 degrees

medial surface of fibula

13

interosseous border of fibula

14

lateral surface of fibula

15

neck of fibula

16

head of fibula

17

apex

18

lateral condyle

19

medial intercondylar tubercle

2

medial condyle

3

How many layers of muscles are in the foot?

4

tibial tuberosity

4

anterior border of tibia

5

Signs and symptoms of compartment syndrome

5 P's Pain Pallor (pale skin tone) Parethesia (numbness in entire leg or foot) Pulselessness (weak pulse) Paralysis (muscle weakness)

interosseous border of tibia

6

What are the stages during the swing phase?

6. initial swing 7. midswing 8. terminal swing

How many tarsal bones are there?

7

medial surface of tibia

7

How many stages are there of the gait cycle?

8

medial malleolus

8

inferior articular surface of tibia

9

Deep vein thrombosis

A blood clot in a deep vein, most often an extremity

The unhappy triad is a traumatic injury to the knee, specifically the ____, ____, and ____

ACL MCL medial meniscus

Rectus femoris origin

AIIS (anterior inferior iliac spine)

Sartorius origin

ASIS

Tensor fasciae latae origin

ASIS

Edema

Abnormal accumulation of fluid in interstitial spaces of tissues

What is the "socket" in the ball and socket joint?

Acetabulum of hip

Adductor hallucis action

Adduction of great toe at MTP joint

____ are muscles that work together to do a primary action

Agonists ex. hip flexors (iliopsoas)

____ are muscles that do the opposite action of the primary action

Antagonists ex. hip extender (gluteus maximus)

____ are fluid filled sacs located around joints to ease friction forces from joint use

Bursae

___is a painful condition that affects the small fluid filled pads (that act as a cushion among bones, tendons, and muscles)

Bursitis

____ syndrome results from pressure build up within the tissue compartments and since fascia does readily expand, this causes compression of neurovasculature and muscles

Compartment may be acute or chronic

____ contractions are when you contract your muscle and it shortens

Concentric ex. what your biceps do when you are pulling your chin above the bar during a pull up

Muscular Compartment of Retro inguinal space

Contains iliopsoas and femoral nerve

Tibialis anterior innervation

Deep fibular nerve (L4, L5)

Extensor digitorum brevis innervation

Deep fibular nerve (S1, S2)

Extensor hallucis brevis innervation

Deep fibular nerve (S1, S2)

_____ refers to when the toes are only in contact with the ground (ex. dog)

Digitigrade

____ contractions are when you contract your muscle, but it undergoes a controlled and gradual relaxation while continually exerting a diminishing force

Eccentric ex. what your biceps do when you are slowly lowering yourself down from having your chin above the bar during a pull up

Fibularis longus function

Eversion and plantarflexion of foot; supports arches of foot

Vastus lateralis action

Extends the leg at the knee joint

Vastus medialis action

Extends the leg at the knee joint

Extensor hallucis longus function

Extension of great toe and dorsiflexion of foot

Extensor hallucis brevis function

Extension of metatarsophalangeal joint of great toe

What motions are involved in circumduction?

FLABEXAD flexion abduction extension adduction

Vastus intermedius innervation

Femoral nerve (L2, L3, L4)

Vastus lateralis innervation

Femoral nerve (L2, L3, L4)

Vastus medialis innervation

Femoral nerve (L2, L3, L4)

Flexor digiti minimi brevis function

Flexes little toe at metatarsophalangeal joint

Lumbricals action

Flexion of metacarpophalangeal joints and extension of interphalangeal joints

What is the "ball" in the ball and socket joint?

Head of femur

What myotomes test flexion at the hip?

L2 L3 L4 iliopsoas

What myotomes test adduction at the hip?

L2 L3 L4 adductors

What myotomes test extension at the knee?

L2 L3 L4 quadriceps

Flexion of hip. Myotomes?

L2, L3

Adduction (hip). What myotomes?

L2, L3, L4

Leg dermatomes: medial knee

L3

Extension knee. Myotomes?

L3, L4

Quadriceps (knee jerk). Myotomes?

L3/L4

Leg dermatomes: great toe

L4 L5

What myotomes test flexion at the knee?

L4 L5 S1 S2 hamstrings

Dorsiflexion ankle. Myotomes?

L4, L5

Inversion of foot. What myotomes?

L4, L5

Medial internal rotation has to do with what myotomes?

L4, L5

What myotomes test abductions at the hips?

L4, L5, S1—gluteus medius and minimus

Leg dermatomes: middle digits

L5

Leg dermatomes: lateral knee

L5 S1

Abduction (hip). What myotomes?

L5, S1

Eversion of foot. What myotomes?

L5, S1

Extension of hip. Myotomes?

L5, S1

Extension of toes. Myotomes?

L5, S1

Flexion knee. Myotomes?

L5, S1

Lateral external rotation has to do with what myotomes?

L5, S1

Vastus intermedius blood supply

Lateral circumflex femoral a

Adductor hallucis insertion

Lateral side of base of proximal phalanx of great toe

Extensor digitorum brevis insertion

Lateral sides of the tendons of extensor digitorum for digits 2-4

Fibularis brevis origin

Lower 2/3 of lateral surface of fibula

Disruption of the epiphyseal plate at the tibial tuberosity may cause inflammation of the tuberosity and chronic reoccurring pain during adolescence. This is know as ___ __ disease

Osgood-Schlatter

____ ____ is also referred to as "over-use" injury - it is micro tears and degeneration of collagen fibers within the plantar aponeurosis -common cause of heel pain

Plantar fasciitis

____ refers to the entire length of foot being in contact with the ground

Plantigrade

Leg dermatomes: little toe

S1

Plantarflexion ankle. Myotomes?

S1 S2

The Achilles reflex testing is testing what nerve roots?

S1 S2

What myotomes test extension at the hips?

S1 gluteus maximus

Calcaneal (achilles; ankle jerk)

S1/S2

Leg dermatomes: heel

S2

Flexion of toes. What myotomes?

S2 S3

Achilles tendon rupture

Trauma: typically sports related, commonly associated with popping or snapping sound at time of injury -severe pain and swelling near the heel -inability to plantarflex -peak age range is 30-40

What are the 4 bursa in the gluteal region? TOIG

Trochanteric bursa Obturator internus bursa Ischial bursa Gluteofemoral bursa

Gluteus minimus action

abduct and medially rotate thigh abducts the thigh stabilizes the hip anterior portion provides internal rotation of the thigh posterior protein provides external rotation of the thigh

Gluteus medius action

abduct and medially rotate thigh abducts the thigh, stabilizes the hip anterior portion provides internal rotation of the thigh posterior portion provides external rotation of the thigh

The lateral plantar nerve enters the sole deep to the ___ muscles, runs anterolaterally, and divides into:

abductor hallucis superficial, deep branch

The medial plantar nerve supplies:

abductor hallucis flexor digitorum brevis flexor hallucis brevis 1st lumbrical

The anatomy of standing at ease: lateral sway of the pelvic grilled is corrected by hip ____ and ____

abductors and iliotibial tract

Abductor hallucis function

abducts and flexes great toe at metatarsophalangeal joint

Abductor digiti minimi action

abducts little toe at the metatarsophalageal joint

Varicose veins

abnormally swollen veins, usually occurring in the superficial veins of the legs

Varicose veins

abnormally swollen, twisted veins with defective valves; most often seen in the legs

How many valves does the great saphenous vein have?

about 12

What is the mechanical goal of the preswing?

accelerate mass

What is the mechanical goal of the terminal stance?

accelerate mass stabilize pelvis

What is the mechanical goal of the initial swing?

accelerate thigh; vary cadence clear foot

What is the mechanical goal of the loading response?

accept weight stabilize pelvis

The socket of the acetabulum is primarily covered by the ____ which has a fibrocartilaginous structure

acetabular labrum *there's a small fat pad in the acetabular fossa, covered by synovium, it accommodates variations in femoral head and acetabulum congruity

Adductor Magnus action

adductor part: adducts thigh and medially rotates thigh hamstring part: adducts thigh

Adductor Magnus insertion

adductor part: gluteal tuberosity, linea aspera, and medial supracondylar ridge hamstring part: adductor tubercle of femur

Adductor Magnus origin

adductor part: ischopubic ramus hamstring part: ischial tuberosity

Iliacus function

adducts and flexes thigh assists with medial rotation of thigh

Pectineus action

adducts and flexes thigh assists w medial rotation

Adductor brevis action

adducts and medially rotates thigh

Gracilis action

adducts thigh medially rotates

Adductor longus action

adducts thigh medially rotates

Tibial tuberosity typically develops by inferior bone growth from the superior epiphyseal center at about 10 years of age, but a separate center for the tibial tuberosity may appear around ___ ___

age 12

The superficial and deep branches of the lateral plantar nerve supply:

all intrinsic muscles of the sole NOT supplied by the medial plantar n

Many vessels form an ____ network around the joint

anastomotic descending branch of the lateral circumflex femoral artery circumflex fibular artery

What is the angle of inclination?

angle of neck of the femur to the shaft -decreases with age -smaller in women

What is the Q angle?

angle of shaft with vertical axis -larger in females

The anterior tibial artery passes into the anterior compartment through an aperture at the proximal end of the interosseous membrane and supplies structures in the ____ compartment

anterior

The pubofemoral ligament strengthens the ____ and ___ portions of the _____

anterior inferior articular capsule

The ACL attaches to a spine on the ___ part of the tibia and ascends posteriorly to a spine at the beach of the ____ wall of the intercondylar fossa of the femur

anterior lateral

The pubofemoral ligament is in what orientation to the hip?

anterior and inferior to hip joint

Vastus intermedius origin

anterior and lateral surfaces of shaft of femur

The popliteal artery divides at the apex of the popliteal fossa into the ____ and ___ ___ arteries

anterior and posterior tibial

The deep branch of the common fibular nerve supplies what?

anterior compartment muscles *and instrinsic muscles (extensors digitorum and hallucis brevis)

What test is done to test ACL function?

anterior drawer test (push posterior to anterior)

What is the origin of the pubofemoral ligament?

anterior medial iliopubic eminence superior pubic ramus obturator membrane

Psoas major innervation

anterior rami of lumbar nerves (L1, L2, L3)

Piriformis origin

anterior surface of sacrum sacrotuberous joint

What ligament is the most likely to be injured? What about the least likely?

anterior talofibular (most) calcaneofibular posterior talofibular (least)

What are the three primary sources of blood supply to the ankle?

anterior tibial artery posterior tibial artery peroneal (fibular) artery *form an anastomoses

Deep veins: perforating veins penetrate the deep fascia forming an ____ vein in the anterior leg

anterior tibial vein

The great saphenous vein is located ____ to ___ malleoulus

anterior to medial

Quadratus plantae function

assists flexor digitorum longus tendon in flexing toes 2-5

The medial meniscus is attached/not attached to the joint capsule and MCL

attached

The MCL is the medial collateral ligament and it ___ to the medial meniscus and blends with the fibrous capsule

attaches

Flexor digiti minimi brevis origin

base of 5th metatarsal

What is the insertion of the pubofemoral ligament?

base of lesser trochanter on the fibrous membrane

Flexor digiti minimi brevis insertion

base of proximal phalanx of 5th digit

Extensor hallucis brevis insertion

base of proximal phalanx of great toe

What is the insertion of the ischiofemoral ligament?

base of the greater trochanter, deep to the iliofemoral ligament

Flexor digitorum longus insertion

bases of distal phalanges of lateral 4 digits

Flexor hallucis longus insertion

bases of distal phalanges of lateral 4 digits

The small saphenous vein is located on the lateral side of the foot and ascends where?

behind lateral malleolus

The ___ is the degree of obliquity of the femoral shaft between proximal and distal ends (at hip or knee, respectively)

bicondylar angles -positions knees close to midline of body - this keeps center of gravity closer to the stance leg during walking for standing, this keeps knees directly below weight of trunk which improves energy efficiency

Adductor brevis origin

body and inferior ramus of pubis

Gracilis origin

body and inferior ramus of pubis

Adductor longus origin

body of pubis inferior to pubic crest

Piriformis innervation

branches from S1 to S2

The acetabular notch along the inferior border allows the passage of ____ to provide a small bloody supply to the femoral head and is bridged by the ____ ligament

branches of the obturator nerve transverse acetabular ligament

The superficial layer of the posterior leg compartment has a common distal attachment. What is it?

calcaneal tendon

Quadratus plantae origin

calcaneus

Lateral longitudinal arch component bones are as follows:

calcaneus, cuboid, and lateral 2 metatarsals

Medial longitudinal arch component bones are:

calcaneus, talus, navicular, 3 cuneiform and medial 3 metatarsals

The anatomy of standing at ease: tendency to fall forward must be counterbalanced by ___ ____

calf muscles

What causes Trendelenburg gait?

caused by dysfunction of lesser gluteal muscles (Glut med and min)

What is the mechanical goal of the midswing?

clear foot

What innervates the anterior lateral compartment (leg)?

common fibular

The superficial fibular (perineal) nerve is a terminal branch of the ____ ___ nerve.

common fibular nerve *nerve of the lateral compartment of the leg *arises between fibularis longus and neck of fibula *descends in lateral leg compartment *pierces deep fascia to become subcutaneous *supplies fibularis longus and brevis *supplies skin on distal third of anterior surface of leg and dorsum of foot

Quadratus plantae insertion

common tendon of flexor digitorum longus

Plantar fasciitis complications and treatment

complications: long term will affect gait treatment: antiinflammatory meds, physical therapy, splints

When walking normally, we pull our center of gravity forward using ____ contraction

concentric

Femoral triangle apex

continuous w adductor canal

What makes up the apex of the femoral triangle?

continuous with adductor canal

The ____ ligaments are located between the condyles of the femur and connect the femur to the tibia

cruciate

What are the 4 tarsal bones in the distal group?

cuboid, 3 cuneiforms,

Hip blood supply:

deep femoral artery branches into medial and lateral circumflex femoral arteries

Extensor digitorum longus innervation

deep fibular nerve (L5, S1)

Extensor hallucis longus innervation

deep fibular nerve (L5, S1)

Fibularis tertius innervation

deep fibular nerve (L5, S1)

The medial plantar artery ultimately ends by doing the digital branch of the ___ ____ ___ which supplies the medial side of the ___

deep plantar arch great toe

What muscles do preswing (toe off)?

deep plantar flexors, and flexors of toes; intrinsic foot muscles rectus femoris

Corners of the hoods attach mainly to the _______

deep transverse metatarsal ligament

In Pott's fracture, stress is put on the ____ ligament, but the ligament is so strong it usually breaks off the inferior portion of the medial malleolus before it tears!

deltoid

Each expansion hood is triangular with the apex attached to the ___ phalanx, the central region attached to the ____ or ____ phalanx, and each corner of the base wrapped around the sides of the metatarsophalangeal joints

distal middle, proximal

The roof of the mortise:

distal inferior end of the tibia

Fibularis tertius origin

distal part of medial surface of fibula

What are the functions of plantar arches?

distribute weight over foot for shock absorption serve as a platform for propulsion (part of gait cycle)

The tendons of the extensor digitorum longus, extensor digitorum brevis, and extensor hallucis longus pass into the ___ aspect of the digits

dorsal

Extensor hallucis longus insertion

dorsal surface of base of distal phalanx of great toe

The anterior tibial artery also gives off lateral and medial malleolar branches and becomes ____ ____ artery midway between the malleoli

dorsalis pedis

The lateral plantar artery which joins the deep plantar artery, or terminal branch of ___ ___ artery) to form the ___ ___ ____

dorsalis pedis deep plantar arch

The superior portion of the talus is wider anteriorly, so when the ankle is ______ the joint is more stable due to a tighter fit between the bones

dorsiflexed

Combo moves: pronation

dorsiflexion eversion abduction

Fibularis tertius function

dorsiflexion and eversion of foot

Tibialis anterior action

dorsiflexion of foot at ankle joint inversion of foot dynamic support of medial arch of foot

Fibularis tertius insertion

dorsomedial surface of base of metatarsal V

Once the limb passes the center of gravity, we contract ____ to continue the smooth movement prevent a lurching during the transfer of weight to the other limb

eccentrically

Fibularis brevis function

eversion of foot

Semimembranosus action

extend thigh, flex leg

Extensor digitorum brevis function

extend toes 2-4

Vastus intermedius action

extends the leg at the knee joint

Gluteus maximus action

extends thigh assists in lateral rotation steadies thigh an assists in rising from sitting position

Semitendinosus action

extends thigh and flexes leg

The aforementioned motions together tighten the ligaments of the knee, holding the knee in _____, so the leg can support the body with minimal energy expenditure

extension

Extensor digitorum longus function

extension of lateral four toes and dorsiflexion of foot

DABs insertion

extensor hoods and bases of proximal phalanges of toes II - IV

PADs insertion

extensor hoods and bases of proximal phalanges of toes III - V

Quadriceps are ____

extensors

What makes up the roof of the popliteal fossa?

fascia lata and crural fascia

The popliteal artery is a continuation of the ___ artery

femoral

vascular compartment of retro inguinal space contains?

femoral a and v lymphatics

The joint complex rests on the ____ and ___ condyles

femoral and tibial

Vastus medialis blood supply

femoral artery and deep femoral artery and superior medial genicular branch of popliteal artery

A ____ ____ is an invagination of abdominal viscera through the femoral ring into the femoral canal. More common in females due to wider pelvis. Presents initially as a mass in the femoral triangle, inferior and lateral to the pubic tubercle. Can result in necrosis of herniated intestines.

femoral hernia

What innervates the anterior compartment (thigh)?

femoral n

Running lateral to medial in the retro-inguinal space, NAVL

femoral nerve femoral artery femoral vein lymphatics

Iliacus innervation

femoral nerve (L2, L3)

Sartorius innervation

femoral nerve (L2, L3)

Pectineus innervation

femoral nerve (L2, L3) may receive a branch from obturator n

Rectus femoris innervation

femoral nerve (L2, L3, L4)

The great saphenous vein ultimately drains into the _____ vein in the ___ ____

femoral vein femoral triangle

The hip joint is comprised of the ___ and ____ in a ball and socket formation

femur hip bone

The knee joint is the articular between what three bones?

femur, tibia, patella

After the synovial membrane, there is a ___ membrane surrounding the synovial membrane

fibrous

Flexor hallucis longus action

flexes great toe at all joints weakly plantar flexes ankle supports medial longitudinal arch of foot

Flexor digitorum longus action

flexes lateral 4 digits; plantar flexes ankle; supports longitudinal arches of foot

Flexor digitorum brevis action

flexes lateral four toes at proximal interphalangeal joints

Biceps femoris action

flexes leg and extends thigh

flexor hallucis brevis action

flexes the metatarsophalangeal joint of the great toe

Psoas major action

flexes the thigh at the hip joint

Rectus femoris action

flexes the thigh at the hip joint and extends the leg at the knee joint

Sartorius action

flexes, abducts, and laterally rotates thigh at hip joint flexes leg at knee joint (medially rotates leg when knee is fixed)

What are the two primary movements of the knee joint?

flexion extension

Intrinsic muscles layer 3:

flexor hallucis brevis adductor hallucis flexor digiti minimi brevis

The medial plantar nerve arises deep to the ____ and enters the sole by passing deep to the ___

flexor retinaculum abductor hallucis

Hamstrings are ____

flexors

The medial side of the mortise:

formed by the medial malleolus of the tibia

The longer lateral side of the mortise:

formed by the of the fibula

The ____ is the attachment for the ligament of the femoral head

fovea (the pit)

What are the contents of the tarsal tunnel?

from anterior to posterior tibialis posterior tendon flexor digitorum longus tendon posterior tibial a. posterior tibial v. tibial n. flexor hallucis longus tendon tom, dick, and a very nervous harry

The patella has a broad base superiorly and apex inferiorly. It acts as a ____ for the quadriceps muscles to reduce work in extending the knee and thereby reducing wear on the knee joint

fulcrum

What happens in stoppage gait?

full damage to tibialis anterior or deep fibular nerve patient loses ability to dorsiflex, so their toes drag unless they lift the affected side higher and fling their toes forward

The anatomy of standing at ease: hip and knee in ____ ____ with taut ligaments

full extension

The femoral sheath is what?

funnel shaped tube of fascia (transversals and iliopsoas fascia)

What is the major vascular source for the knee?

genicular branches of the popliteal artery

What happens to the angle of inclination as we age?

gets smaller

Gluteus minimus origin

gluteal surface between anterior and inferior gluteal lines

Gluteus medius origin

gluteal surface between anterior and posterior gluteal lines

What muscles do heel strike?

gluteus maxmus tibialis anterior

The dorsal vein of the great toe unites with the dorsal venous arch to form the ____

great saphenous vein

Gemellus inferior insertion

greater trochanter

Gemellus superior insertion

greater trochanter

Obturator internus insertion

greater trochanter

Vastus lateralis origin

greater trochanter and lateral lip of linear asper of femur

Gluteus medius insertion

greater trochanter of femur

Gluteus minimus insertion

greater trochanter of femur

Piriformis insertion

greater trochanter of femur

A ____ ___ is also called a bunion

hallux valgus

What muscles do terminal swing?

hamstrings quad femoris tibialis anterior

Biceps femoris insertion

head of fibula *tendon is split by fibular collateral ligament of knee

The medial longitudinal arch is ___ than the lateral longitudinal arch and is more flexible and most important part of the longitudinal arch

higher

What type of joint is the ankle joint?

hinge

What type of joint is the knee joint?

hinge

The Trendelenburg/Lurch gait presents as ______

hip drop during mid stance stage

The acetabulum

hip socket (head of femur fits here)

The femoral head is covered by ____ cartilage

hyaline cartilage

Iliacus origin

iliac crest iliac fossa ala of sacrum anterior sacro-iliac ligaments

The pubofemoral ligament blends with the deep surface of the ____ ligament as it moves laterally

iliofemoral

The ____ ligament is a Y-shaped ligament covering the joint ____

iliofemoral anteriorly

What ligaments of the pelvic girdle prevent hyperextension?

iliofemoral ligament anterior cruciate ligament

Femoral triangle floor

iliopsoas, pectineus, adductor longus

What makes up the floor of the femoral triangle?

iliopsoas, pectineus, adductor longus

Tensor fasciae latae insertion

iliotibial tract

Gluteus maximus. Insertion?

iliotibial tract and gluteal tuberosity of femur

Gluteus maximus. Origin

ilium sacrum sacrotuberous ligament

The acetabulum is a cup-shaped socket formed by what 3 bones of the hip?

ilium ischia, pubis bone

What is the origin of the iliofemoral joint?

ilium between AIIS and acetabular margin

What is the function of menisci?

improve congruency between the femoral and tibial condyles during joint movement

Trendelenburg seen in who?

in patients with myopathies like muscular dystrophy

Superficial lymphatic vessels accompany the great saphenous vein on medial side of foot and leg and drain into ____ group of _____ lymph nodes

inferior (aka vertical) group of superficial inguinal lymph nodes

Flexor hallucis longus origin

inferior 2/3 of posterior surface of tibia inferior to solar line; by a broad tendon to fibula

Plantaris origin

inferior end of lateral supracondylar line of femur; oblique popliteal ligament

Gemellus superior blood supply

inferior gluteal artery

Obturator internus blood supply

inferior gluteal artery

Quadratus femoris blood supply

inferior gluteal artery

Gluteus maximus innervation

inferior gluteal nerve

The ____ bursa has a superficial and deep component (to the patellar ligament)

infra patellar

The greater sciatic foramen found inferior to the piriformis muscle is called the ____. What are its contents?

infrapiriform foramen sciatic n inferior gluteal n a v pudendal n internal pudendal a v posterior femoral cutaneous n n to obturator internus nerve to quadratus femoris

Lymph from superficial tissue of the gluteal region passes initially to the superficial ____ nodes

inguinal

The femoral vein passes deep to the ____ ligament to become the ____ vein

inguinal external iliac

Femoral triangle base

inguinal ligament

What makes up the base of the femoral triangle?

inguinal ligament

The retro-inguinal space is deep to what ligament?

inguinal ligament ASIS to pubic tubercle

What are the other names for hip bone?

innominate os coxae

Lumbricals insertion

insert to medial aspect of digital extensor hoods

Tibialis posterior origin

interosseous membrane; posterior surface of tibia inferior to soleal line; posterior surface of fibula

In extracapsular fractures, there are 3 subcategories:

intertrochanteric - between greater and lesser trochanters subtrochanteric - lesser than or equal to 5cm below the lesser trochanter

Quadratus femoris insertion

intertrochanteric crest of femur

What is the insertion of the iliofemoral joint?

intertrochanteric line

Vastus medialis origin

intertrochanteric line and medial lip of linea aspera of femur

Hip fracture: trauma can result in fracture of proximal femur. There are two groups of fractures:

intracapsular extra capsular

Gemellus superior origin

ischial spine

Gemellus inferior origin

ischial tuberosity

Quadratus femoris origin

ischial tuberosity

Semimembranosus origin

ischial tuberosity

Semitendinosus origin

ischial tuberosity

What makes up the floor of the popliteal fossa?

joint capsule and bones popliteus

The unhappy triad occurs when a ____ force impacts the knee while the foot is fixed to the ground - this creates a strong values and rotary force that tears all three structures

lateral

A femoral neck fracture can disrupt the primary blood flow to the femur. What is this?

lateral and medial circumflex arteries

Abductor digiti minimi origin

lateral and medial processes of calcaneal tuberosity and band of connective tissue connecting calcaneus with base of metatarsal V

flexor hallucis brevis insertion

lateral and medial sides of base of proximal phalanx of the great toe

Rectus femoris blood supply

lateral circumflex femoral artery

Vastus lateralis blood supply

lateral circumflex femoral artery

Gluteus maximus blood supply

lateral circumflex femoral artery, superior gluteal artery

Tensor fasciae latae blood supply

lateral circumflex femoral artery; superior gluteal artery

The superficial branch of the common fibular nerve supplies what?

lateral compartment muscles

Gastrocnemius origin

lateral head: lateral aspect of lateral condyle of femur medial head: popliteal surface of femur; superior to medial condyle

How many compartments does the femoral sheath have?

lateral intermediate medial

Abductor digiti minimi insertion

lateral side of base of proximal phalanx of little toe

Popliteus origin

lateral surface of lateral condyle of femur and lateral meniscus

Tibialis anterior origin

lateral surface of tibia and adjacent interrosseous membrane

Fibularis brevis insertion

lateral tubercle at base of metatarsal V

Gemellus inferior action

laterally rotate extended thigh abduct flexed thigh steady femoral head in acetabulum

Gemellus superior action

laterally rotate extended thigh abduct flexed thigh steady femoral head in acetabulum

Obturator internus action

laterally rotate extended thigh abduct flexed thigh steady femoral head in acetabulum

Piriformis action

laterally rotate extended thigh abduct flexed thigh steady femoral head in acetabulum

Obturator externus action

laterally rotates thigh

Quadratus femoris action

laterally rotates thigh steadies femoral head in acetabulum

Psoas major insertion

lesser trochanter of femur

Biceps femoris origin

long head: ischial tuberosity short head: linea aspera

Biceps femoris innervation

long head: tibial division of sciatic nerve (L5, S1) short head: common fibular division of sciatic nerve (L5, S1)

The lateral longitudinal arch sits flat on the ground when standing and its major support is ___

long plantar ligament -arises from calcaneus, inserted to inferior surface of cuboid and. bases of metatarsals - major support for lateral longitudinal arch

What causes the increased risk for Achilles tendon rupture?

long term steroid use or fluoroquinolone antibiotics (eg. ciprofloxacin or levofloxacin)

What is the mechanical goal of the heel strike?

lower forefoot to ground

What myotomes test dorsiflexion?

mainly L4 L5 tibialis anterior

What myotomes test plantar flexion?

mainly S1 gastrocnemius, soles

The fibularis Longus tendon supports ___

mainly the transverse arch

Obturator externus origin

margins of obturator foramen and obturator membrane

PADs origin

media sides of metatarsals of toes III - V

Tibialis anterior insertion

medial and inferior surfaces of medial cuneiform and adjacent surfaces on base of metatarsal

Semitendinosus insertion

medial aspect of upper tibial shaft (pes anserinus)

Femoral triangle medial border

medial border of adductor longus

Femoral triangle lateral border

medial border of sartorius

Pectineus blood supply

medial circumflex femoral a

Iliacus blood supply

medial circumflex femoral artery

Psoas major blood supply

medial circumflex femoral artery

The ____ ____ is a medial compartment that allows for expansion of the femoral vein. The base of the canal is the femoral ring. Clinical consideration: femoral hernia

medial compartment

Semimembranosus insertion

medial condyle of tibia

What is the origin of the ischiofemoral ligament?

medial ischium

The ___ arch is the arch that can flatten in dorsiflexion

medial longitudinal

The deltoid (medial collateral) ligament attaches to the ___ ___ to the tarsal bones

medial malleolus

What makes up the medial border of the femoral triangle?

medial margin of adductor longus

What makes up the lateral border of the femoral triangle?

medial margin of sartorius

Flexor digitorum longus origin

medial part of posterior surface of tibia inferior to soleal line; by a broad tendon to fibula

The posterior tibial artery enters the plantar foot from the posteromedial aspect and divides into:

medial plantar artery lateral plantar artery

The tibial nerve enters the foot through the tarsal tunnel and has 2 branches:

medial plantar n lateral plantar n

Abductor hallucis origin

medial process of calcaneal tuberosity

Flexor digitorum brevis origin

medial process of calcaneal tuberosity and plantar aponeurosis

Abductor hallucis insertion

medial side of base of proximal phalanx of great toe

The popliteus causes the tibia to rotate ____, causing it to line up with the internally rotated femur and releases the ligaments, allowing the knee to flex

medially

The proximal tibial articular surface contains two C shaped fibrocartilaginous rings called ____

menisci

Extensor hallucis longus origin

middle 1/2 of medial surface of fibula and adjacent surface of interosseous membrane

Adductor longus insertion

middle third of linea aspera of femur

When we strand, the postural axis is the ____ axis through the sacrum

middle transverse axis

The anatomy of standing at ease

minimal energy expenditure from muscles erector spinae slightly active (especially in cervical and lumbar regions) feet slightly apart and at an angle (heels pointed medially) limited muscle activity necessary to maintain stance long term

The articulation between the three bones of the ankle joint make a box like ____

mortise

What tarsal bone is in the intermediate group?

navicular

What are possible causes of foot drop?

nerve injury muscle or nerve disorders: forms of muscular dystrophy, polio, Charcot-Marie-Tooth disease) brain and spinal cord disorders: amytrophic lateral sclerosis or ALS, multiple sclerosis, stroke, etc)

Gemellus superior innervation

nerve to obturator internus

Obturator internus innervation

nerve to obturator internus

Gemellus inferior blood supply

nerve to quadratus femoris

Quadratus femoris innervation

nerve to quadratus femoris

Is balancing against gravity over a base of support a passive process?

no

Would the branch of the obturator artery save the femoral head since it supplies that area?

no - does supply area but is too small to supply enough blood

The lateral meniscus is attached/not attached to the capsule and has increased mobility

not attached

When we walk, our pelvis rotates around the ____ axis of the leg we are standing on during the swing phase

oblique

Adductor hallucis origin

oblique head: bases of metatarsals 2-4 transverse head: plantar ligaments of metatarsophalangeal joints

The posterior capsule is bordered laterally and inferiorly by the _____ ligament, an extension of the semi membranosus tendon

oblique popliteal ligament

The ligament of the femoral head originates from the transverse acetabular ligament and carries a small branch of the _____ ____ to the femoral head, not only providing mechanical support but nutritional support as well

obturator artery

The lesser sciatic foramen has what contents?

obturator internus muscle tendon pudendal n and internal pudendal a and v

What innervates the medial compartment (thigh)?

obturator n

Adductor brevis innervation

obturator n (L2-4)

Obturator externus innervation

obturator n (L2-4)

What are the contents of the obturator canal?

obturator n, a, v

Adductor Magnus innervation

obturator nerve (L2-4)

Adductor longus innervation

obturator nerve (L2-4)

Gracilis innervation

obturator nerve (L2-4)

Lumbricals origin

originate from separated tendons of flexor digitorum longus

The pubofemoral ligament tenses during extension and abduction, preventing _____ of the hip joint

over-abduction

The iliofemoral ligament tenses during hip extension, preventing ____ of the joint

overextension

What happens in slap gait?

partial damage/weakness to tibialis anterior or deep fibular nerve patient doesn't heel strike on injured side, because instead of the heel contacting the ground first, the forefoot makes the initial contact

What is the retro inguinal space?

passageway from abdominopelvic cavity to the lower limb for contents of femoral triangle

Center of gravity during bipedal stance:

passes through anterior aspect of both cervical and lumbar lordosis (through body of L3) immediately in front of S2 vertebra runs just posterior to a line between both hip joints midline between knees (bicondylar angle brings knees closer to midline, line of gravity) just in front of ankle (talocrural joint) falls in median plane at point just anterior to both heels (approximately posterior third of feet)

The anterior capsule is supported by the ___ ____ and tendinous expansions of the ____

patellar margins vastus medialis and lateralis

Pectineus origin

pectineal line (superior rami of pubis)

Adductor brevis insertion

pectineal line and proximal part of linea aspera of femur

Pectineus insertion

pectineal line of femur just inferior to lesser trochanter

Obturator internus origin

pelvic surface of the obturator membrane

What are common causes of compartment syndrome?

physical trauma such as fracture, crash injury, a severely bruised muscle, anabolic steroid use, constricting bandages, restoration of blood flow after circulation has been compromised

Tibialis posterior action

plantar flexes ankle inverts foot

Gastrocnemius action

plantar flexes ankle when knee is extended; raises heel during walking; flexes leg at knee joint

What are the primary motions of the ankle joint?

plantar flexion dorsiflexion

Instrinsic muscles of 4th layer:

plantar interossei (3) dorsal interossei (4)

Flexor hallucis brevis origin

plantar surface of cuboid and lateral cuneiform; tendon of tibialis posterior

Soleus action

plantarflexes ankle independent of position of knee; steadies leg on foot

Combo moves: supination

plantarflexion inversion (usually what causes injury) adduction

Lymph vessels from lateral side of foot and leg accompany small saphenous vein and drain first into ___ lymph nodes in the ____ and then via efferent channels, into the ___ lymph nodes

popliteal lymph nodes popliteal fossa superficial inguinal lymph nodes

The anterior tibial vein, posterior tibial vein, and fibular vein from the leg flow into the ____ ____ posterior to the knee which becomes the ____ vein in the thigh

popliteal vein femoral vein

The small saphenous vein ultimately empties into the ____ vein in the ____

popliteal vein popliteal fossa

What is the mechanical goal of the terminal swing?

position foot extend knee to place foot (control side); prepare for contact

The ischiofemoral ligament covers and reinforces the ____ section of the articular capsule

posterior

The line of gravity falls ___ to the hip joint

posterior

Soleus origin

posterior aspect of head and superior quarter of posterior surface of fibula; solar line and middle third of medial border of tibia; tendinous arch extending between the bony attachments

The PCL attaches to the ____ and ascends anteriorly to attach to the ___ wall of the intercondylar fossa of the femur

posterior aspect of the intercondylar area of the tibia medial wall

What test is done to test the function of the PCL?

posterior drawer test (push anterior to posterior)

Gastrocnemius insertion

posterior surface of calcaneus via calcaneal tendon

Plantaris insertion

posterior surface of calcaneus via calcaneal tendon

Soleus insertion

posterior surface of calcaneus via calcaneal tendon

Popliteus insertion

posterior surface of tibia superior to soleal line

Blood supply to the foot is by branches of the ____ ____ and ___ ___ arteries

posterior tibial dorsalis pedis

Deep veins: Medial and lateral plantar aspect of the foot form the ____ and ____ veins posterior to the medial and lateral malleoli

posterior tibial and fibular veins

What is the primary blood supply of the posterior leg compartment?

posterior tibial artery and fibular artery

The deltoid ligament is made up of 4 smaller ligaments:

posterior tibiotalar tibiocalcaneal tibionavicular anterior tibiotalar

What is the general function of the cruciate ligament?

prevent anterior or posterior displacement of the tibia relative to the femur

The suprepatellar bursa is attached superiorly to the articularis genu muscle which pulls the bursa superiorly in knee extension to ____ ____ of the bursa between the patella and femur

prevent impingement

What is the function of the ACL?

prevents anterior displacement of the tibia relative to the femur

What is the function of the PCL?

prevents posterior displacement of the tibia relative to the femur

What are the 3 deep arteries of the thigh?

profunda femoris medial circumflex femoral a lateral circumflex femoral artery

Sartorius blood supply

profunda femoris and saphenous branch of descending genicular arterty

Pott's fracture is a supination/pronation injury

pronation

Balance and muscle coordination during standing, walking, running, etc. are unconsciously influenced by aspects of _____

proprioception

The intrinsic ligaments of the knee do what?

provide anterior and posterior support to the fibrous capsule of the knee joint

Each extensor expands over the ___ phalanges to form dorsal digital expansions known as 'extensor hoods'

proximal

Extensor digitorum longus origin

proximal 1/2 of medial surface of fibula and related surface of lateral tibial condyle

What muscles make up the thigh flexors?

psoas major iliac pectineus

Rectus femoris insertion

quad femoris tendon

Vastus lateralis insertion

quad femoris tendon and lateral margin of patella

Vastus medialis insertion

quad femoris tendon and medial border of patella

Vastus intermedius insertion

quad femoris tendon, lateral margin of patella, lateral condyle of tibia

Intrinsic muscles of second layer:

quadrates plantae lumbricals

What muscles do loading response (flat foot)?

quadriceps femurs

The patellar ligament is essentially a continuation of the ___ ___ inserting on the tibial tuberosity

quadriceps tendon

Plantar flexion does what to the ligaments?

relaxes them

Hip blood supply: four ____ branch off of the circumflex arteries and run where?

retinacular arteries beneath the synovial membrane *anterior, posterior, superior, and inferior

During the last 15 degrees of extension, the femur ____ ____

rotates internally

Plantar fasciitis is common in ___

runners, overweight individuals, pregnant women, shoes with inadequate support, and abnormal arches

The ___ ____ is a gap in the fascia lata inferior to the medial part of the inguinal ligament and roughly 4cm inferolateral to the pubic tubercle

saphenous opening

The common fibular (perineal) nerve is a branch of the ___ nerve and divides between fibularis longus and the neck of the fibula into superficial and deep branches

sciatic

Tibial fractures are more serious in young children (under 16) due to the potential impact on growth prior to fusion of the ____ ossification center with the shaft

secondary. this affects the epiphyseal growth plate

What are the margins of the popliteal fossa?

semitendinosus semimembranosus biceps femoris gastocnemius plantaris

The LCL is the lateral collateral ligament and it is ___ from the lateral meniscus by the popliteus and from the fibrous capsule by a bursa

separated

The patella is the largest ___ bone in the body

sesamoid (lives in a tendon)

Psoas major origin

sides of T12-L5 vertebrae and discs between them; transverse processes of all lumbar vertebrae

DABs origin

sides of adjacent metatarsals

Flexor digitorum brevis inseriton

sides of palmar surface of middle phalanges of lateral four toes

There are two forms of foot drop. When dorsiflexion has been decreased, it is called ___ gait

slap

Dorsal vein of the little toe units with dorsal venous arch to form ____

small saphenous vein

There are two collateral ligaments whose function is:

stabilization of the knee

What is the mechanical goal of the mid stance?

stabilize pelvis

Tensor fasciae latae action

stabilizes knee in extension; abduct and medially rotate thigh tenses the fascia lata; abductor and internal rotation of the thigh also aids in stabilization of the hip and knee joints

There are two phases of the Gait cycle:

stance phase (60% of cycle during normal walking) swing phase (40% of cycle during normal walking)

In the form of foot drop where dorsiflexion is lost, this is called ____ gait

steppage

Why do we have lower limbs?

structural support - the lower limbs should support the body with minimal expenditure of energy locomotion - the lower limbs allow the body to move through space

In intracapsular fractures, there are 3 subcategories:

subcapital - just below the femoral head midcervical - mid neck of the femur basicervical - base of the neck of the femur

What movements are effected by contraction of calf (posterior leg) muscles?

subtalar inversion metatarsophalangeal and phalangeal plantarflexion knee flexion plantar flexion (ankle)

Fibularis brevis innervation

superficial fibular n (L5, S1, S2)

Fibularis longus innervation

superficial fibular n (L5, S1, S2)

What is the innervation of the posterior leg compartment?

superficial layer: tibial n (S1, S2) deep layer: tibial n (L4-S3)

Gluteus medius blood supply

superior and inferior gluteal arteries

Piriformis blood supply

superior and inferior gluteal arteries

What innervates the gluteal muscles?

superior and inferior gluteal n

The "triceps coax" is made up of what 3 muscles?

superior gemellus, obturator internus, inferior gemellus

What nerve is affected in trendelenburg?

superior gluteal (myotome L4-S1)

Gluteus minimus blood supply

superior gluteal artery

What nerves are found in the gluteal region?

superior gluteal n inferior gluteal n posterior femoral cutaneous n nerve to quad femoris nerve to obturator internus sciatic n *lumbosacral plexus (don't need to know how to draw)

Gluteus medius innervation

superior gluteal nerve

Gluteus minimus innervation

superior gluteal nerve

Tensor fasciae latae innervation

superior gluteal nerve

Gracilis insertion

superior part of medial surface of tibia (pes anserinus)

Sartorius insertion

superior part of medial surface of tibia (pes anserinus)

Extensor digitorum brevis origin

superolateral surface of calcaneus

Extensor hallucis brevis origin

superolateral surface of the calcaneus

What supplies the lateral compartment of the leg?

supplies by perforating branches from anterior tibial and fibular arteries

What do the ligaments that surround the fibrous membrane do?

support the head of the femur when the hip is in extension

The ___ bursa is located between the distal femur and quadriceps tendons

supra patellar

The greater sciatic foramen found superior to the piriformis muscle is called the ____. What are its contents?

suprapiriform foramen superior gluteal n a v

The articular capsule has many layers... like an anion. The ___ membrane is the deepest layer and covers the articular surfaces of the joint and the space in between

synovial

Why is a hip fracture especially bad for elderly patients?

take so long to heal due to lack of blood supply to area worst case scenario: avascular necrosis of the femoral head

What are the two tarsal bones in the proximal group?

talus and calcaneous

What are the three groups of bones in the foot?

tarsal bones metatarsals phalanges

The ___ ___ is the passageway from leg to plantar foot

tarsal tunnel

Iliacus insertion

tendon of poas major lesser trochanter femur distal to it

The ankle (talocrural) joint is formed between what bones?

the distal tibia, distal fibula, and superior portion of the talus

What is special about the phalanges of the toes?

the great toe has only 2 phalanges (proximal and distal) while the other 4 toes has 3 phalanges (proximal, middle, distal)

The plantar calcaneocuboid ligament (short plantar ligament) is deep to the long plantar ligament and provides support for ___

the lateral longitudinal arch and calcaneocuboid joint (1)

Clinical correlate: bend the knee. What happens here?

the legs return the blood to the heart by using the leg muscles to pump blood if the knee is locked, the lower leg muscles may not pump enough blood back to the heart extended periods of knee extension can cause syncope (fainting)

The plantar calcaneonavicular or spring ligament is a thick wide band deep to the long plantar ligament and provides support for ____

the medial longitudinal arch (2)

What does one cycle of gait consist of?

the time and stages between the heel strike of one limb until the following heel strike of the that same limb (1 step w each foot)

Ataxic, wide based gait:

they could have taxis that is impairing their cerebellum or something else altering their sense of proprioception like being intoxicated this gait is when the person points their toes laterally and spreads their legs wider to try to stabilize however they often tend to shift one direction and the next because they constantly feel like they are falling and overcorrect

How many ligaments surround the fibrous membrane?

three

When the knee extends, the flat surface of the femoral condyles articulates with the ____, resting the widest portion of the distal femur on the tibia

tibia

Semimembranosus innervation

tibial division of sciatic nerve (L5, S1)

Semitendinosus innervation

tibial division of sciatic nerve (L5, S1)

What innervates the posterior compartment (thigh/leg)?

tibial n

What are the contents of the popliteal fossa?

tibial n common fibular n popliteal a and v

Tibialis posterior innervation

tibial n (L4, L5)

Popliteus innervation

tibial n (L4, L5, S1)

Plantaris innervation

tibial n (S1 S2)

Flexor digitorum longus innervation

tibial n (S2 S3)

Flexor hallucis longus innervation

tibial n (S2, S3)

Gastrocnemius innervation

tibial n S1,S2

Soleus innervation

tibial nerve (S1 S2)

The supporting tendons of the medial longitudinal arch:

tibialis posterior tendon tibialis anterior tendon fibulas longus tendon

In a lateral view of the pelvic girdle, we can see that the sacrum is ____ as in a quadruped

tilted

3 arches of foot:

transverse arch medial longitudinal arch lateral longitudinal arch

What three issues were discussed that could cause gait to be wrong?

trendelenburg gait/sign (myopathic gait) foot drop (slap gait, stoppage gait) ataxic gait

What muscles do mid stance?

triceps surae

Obturator externus insertion

trochanteric fossa of femur

Tibialis posterior insertion

tuberosity of navicular, cuneiform, cuboid, and sustentaculum tali of calcaneus; bases of 2nd, 3rd, and 4th metatarsals

How many apertures are between the tibia and fibula?

two aperture for tibial vessles aperture for perforating branch of fibular artery

Fibularis longus insertion

undersurface of lateral sides of distal end of medial cuneiform and base of metatarsal I

Plantar fasciitis symptoms:

unilateral presentation gradual development pain in first step after waking up or sitting for extended periods stabbing pain in heel

Fibularis longus origin

upper lateral surface of fibula, head of fibula, and occasionally the lateral tibial condyle

What is good about habitual bipedalism?

upper limbs freed up for making and using tools efficient for long term standing (standing uses only about 7% more oxygen consumption than lying supine) can walk or run for long distances (efficiency allows for endurance)

Is Trendelenburg gait uni or bilateral?

usually uni but can be bi

What compartment does the femoral sheath line?

vascular

What muscles attach to the base of the patella?

vastus medialus vastus intermedius vastus lateralis quadriceps

In a lateral view of the pelvic girdle, the coccyx curves ____

ventrally

Extensor digitorum longus insertion

via dorsal digital expansion into bases of distal and middle phalanges of lateral 4 toes

Plantaris action

weakly assists gastrocnemius in plantar flexing ankle

Popliteus action

weakly flexes knee and unlocks it by rotating femur 5 degrees on fixed tibia; medially rotates tibia of unplanted limb